Rethinking the role of community-based clinical education in pediatric dentistry

The early childhood caries epidemic has prompted a look at predoctoral clinical dental education in pediatric dentistry. The purpose of this study was to examine the contribution of community-based clinical education (CBE) to procedural and patient diversity in predoctoral pediatric dental education. Using procedural and demographic data from pediatric clinical experiences of the dental class of 2007 at The Ohio State University College of Dentistry, profiles of patient diversity, clinical pediatric dental procedures, and student efficiency were developed for both CBE sites and the campus-based clinic. Ninety-two students performed 16,523 procedures on children in the fourth year in CBE sites in the community compared to 4,268 on campus in their third year. Pediatric-dedicated CBE sites accounted for almost 12,000 pediatric dental procedures. Approximately 56 percent of children treated at CBE sites were minorities. CBE sites accounted for most of the dental student restorative experience for pediatric patients for the Class of 2007, giving each student on average multiple restorative procedures. The campus-based clinic provided largely diagnostic and preventive procedures but few restorative opportunities. We conclude that community-based dental clinical education presents an opportunity to enhance pediatric predoctoral student clinical experiences in both quantity and diversity.

Peer-group assessment of pre-clinical operative skills in restorative dentistry and comparison with experienced assessors

OBJECTIVE

In order to assess the feasibility of moving away from a tutor-assessed summative assessment to a peer-group marked assessment with more formative value, a study was undertaken to investigate if any differences existed between marks given by a peer group acting as examiner when compared with experienced assessors. The null hypothesis was that no differences in grades would exist between the examiners.

METHODS

A total of 130 ivorine teeth set in dentoform models (mounted in phantom heads) were prepared by undergraduate preclinical students. The prepared teeth were randomly allocated for assessment to one of six student groups who met and graded each tooth preparation. Notes on common errors were supplied together with a list of multiple exemplar grades (of the full range of grades) and associated comments, together with a list of grade descriptors (for the five-point scale A-E) and a sectioned silicone index. The same preparations were independently assessed by two experienced restorative academic examiners using the same guidance.

RESULTS

The mean rank scores given by a Friedman test did not show any statistically significant difference (P = 0.531). Kappa scores for inter-examiner agreement varied from 0.318 to 0.530.

CONCLUSIONS

The data from the present study do not show any significant differences in grades awarded by experienced examiners to those awarded by a peer group. Peer-group assessment may be useful to encourage a greater understanding of concepts and principles underlying the development of operative skills.

Improving the quality of clinical teaching in a restorative clinic using student feedback

INTRODUCTION

A large proportion of the undergraduate curriculum is spent within Restorative Dentistry at the University of Liverpool. As well as supportive "phantom head" courses the undergraduates receive significant amounts of teaching within the clinics themselves. In 2004, to help inform the clinical tutors as to their areas of strengths and weaknesses, undergraduates were invited to complete an anonymous questionnaire on the quality of teaching they received from their clinical supervisors. This process has been repeated subsequently in 2005 and 2006.

METHOD

A 19 parameter questionnaire, employing a 5-point Likert scale and space for open comments, was circulated to every clinical undergraduate student. Questionnaires were returned anonymously and all data collected by one researcher. Descriptive statistical analysis was performed and the staff provided with individual feedback within the context of the overall departmental profile. The pooled data from each of the years was then compared to determine if any changes had occurred. Statistical analysis used Kruskal Wallis tests to determine whether these were statistically significant.

RESULTS

Although the range varied, median scores of 4 (agree) were gained for each question each year. Following statistical analysis 18 of the parameters showed a statistically significant improvement (P < 0.05) between 2004 and 2006 with only one remaining constant throughout.

CONCLUSION

It would appear that the use of a questionnaire based feedback system can result in a tangible and demonstrable improvement in the delivery of clinical teaching.

Associations among predental credentials and measures of dental school achievement

The purpose of this study was to investigate the associations among several dental school admission criteria and several measures of dental school achievement. Data were collected for 2000-07 University of Iowa dentistry graduates, including five specific preadmission credentials and five specific measures of dental school achievement for each student. Pearson product moment correlations or Mann-Whitney U statistics were computed for the association of each of the ten variables with the nine others. The strongest correlation observed was between predental science grade point average (GPA) and overall predental GPA. Dental Admission Test (DAT) Academic Average was very strongly correlated with DAT Total Science, and both of these were each moderately correlated with DAT Perceptual Ability, predental science GPA, and overall predental GPA. Among the measures of dental school achievement, the strongest association was observed between National Board Dental Examination (NBDE) scores and dental school GPA. These were also moderately correlated with final clinical grade. All of the measures of dental school achievement were slightly stronger for candidates who passed the Central Regional Dental Testing Service (CRDTS) examination than for those who failed that exam. Of the predental credentials considered, predental science GPA and overall predental GPA were the best predictors of dental school GPA. DAT Academic Average was the best predictor of NBDE scores. Although DAT Perceptual Ability was the best predictor of clinical competency at the time of graduation, these two variables were only weakly correlated. DAT Perceptual Ability scores and overall predental GPA were slightly higher for candidates who passed the CRDTS examination than for those who failed that exam.

Amalgam and composite posterior restorations: curriculum versus practice in operative dentistry at a US dental school

This study recorded the number of preclinical lecture and simulation laboratory sessions spent teaching the preparation and placement of amalgam and resin composite posterior restorations. These data were compared to the use of both materials in the operative clinic as placed by third- and fourth-year students. The number of posterior restorations inserted by the students, expressed as a function of the number of restoration surfaces, was also evaluated. The results show that the teaching of posterior restorations pre-clinically has consistently favored amalgam 2.5 to 1 during the last three years. However, clinically, resin composite is being used for posterior restorations 2.3 times more often than amalgam. The only instance that favored amalgam over composite during the last year was in the placement of four surface posterior restorations. This shift in emphasis from amalgam to composite needs to be addressed within dental educational institutions so that newly graduated dentists are prepared to place composite restorations properly.

Undergraduate requirements in restorative dentistry in the UK and Ireland

OBJECTIVES

To ascertain the requirements in restorative dentistry that undergraduate dental students have to fulfil in order to sit the finals examinations in dental schools in the UK and Ireland and to compare those requirements with the competencies stipulated by the GDC in The first five years.

METHODS

Fifteen anonymised questionnaires, of open and closed question design, were sent by post to academics in the university departments of restorative dentistry in each of the undergraduate dental schools in the UK and Ireland. The first section concerned numerical information regarding total numbers of procedures that were required to be completed in undergraduate restorative dentistry. The second section was designed to ascertain information as to how decisions are made with respect to an undergraduate's readiness to sit the finals examination in restorative dentistry (such as continual assessment and/or competency assessments).

RESULTS

A total of 15 replies were received for analysis, a 100% response rate. Several institutions emphasised that they do not have 'requirements', but provide guidelines as to what should be achieved. Six institutions did not have set numerical requirements for direct placement restorations or bridges. The number of direct placement restorations required at the other nine institutions ranged from 50 to 160. Five institutions did not have numerical requirements for dentures; four institutions did not set numerical targets for crowns, veneers, inlays/onlays or endodontics. In institutions where numerical requirements were not used, forms of competency assessments were completed. The requirements across all institutions for periodontology, integrated treatment planning and completed cases were ill-defined.

CONCLUSIONS

This study shows that there is a wide disparity amongst institutions in the UK and Ireland with regards to finals requirements in restorative dentistry. Ideally, such requirements should be similar between institutions and should be closely mapped to the GDC's required learning outcomes (The first five years) for the UK institutions.

Mechanical versus chemical retention for restoring complex restorations: what is the evidence?

This article reports the findings from a study conducted to answer this research question: can adhesive resin liners provide retention that is the same as dentinal pins or pots and slots when restoring complex amalgam restorations? The study methodology consisted of two components: a review of the literature and a survey to assess methods and materials that general practitioners use in their clinical practice for restoring complex amalgam restorations. Even though a vast majority of the general practitioners surveyed reported using dentinal pins or pots and slots, the occurrence or frequency of use was under 50 percent. It was also reported from the survey that over half the respondents are using adhesive resin liners exclusively when restoring complex restorations. New and improved materials allow general practitioners to restore complex restorations without the risks associated with the placement of pins or pots and slots. A review of the available literature indicates that adhesive resin liners may be used as an alternative or adjunct to mechanical retention. Because of the improvements of bonding strength of adhesive resin liners, dentinal pins and pots and slots should not be the only methods considered when faculty assist students in the development of treatment plans for patients who need complex amalgam restorations.

Use of an Electronic Patient Record system to evaluate restorative treatment following root canal therapy

Electronic Patient Record (EPR) systems are rapidly gaining acceptance as an important tool for managing patient information. The purpose of this project was to evaluate the use of an EPR system for assessment of quality of care in an academic dental institution. The primary outcome of interest was the timeliness and completeness of restorative care following completion of nonsurgical root canal therapy. An initial query of the EPR database was performed using the following inclusion criteria: root canal treatment performed in the postgraduate endodontics clinic between September 2002 and June 2004, patient age > or =18 years old, and posterior tooth (premolars and molars). A total of 925 patients with 1,014 endodontically treated teeth met the inclusion criteria. A random sample of 30 percent of the treated teeth (302 teeth on 281 patients) was selected for detailed review. This sample of 302 teeth was then screened to determine if any restorative treatment had been performed between September 2002 and November 2005. Forty-eight percent (n=146) of the 302 teeth did not receive any form of permanent restoration over the time period studied. Twenty-five percent (n=75) of the teeth received a buildup only, and 27 percent (n=82) received the recommended treatment, a full occlusal coverage restoration. This study documents the use of an EPR system to objectively and efficiently assess one aspect of quality of care in a dental school environment.

Dental implant education in Nigeria: a curriculum guide

AIM

Anecdotal evidence suggests that the practice of implant dentistry, "gold standard" for edentulism is presently very low in Nigeria. This article proposes a model for teaching dental implant education and also emphasises the need for inclusion of standardised dental implant education in the dental curriculum in Nigeria.

METHODS

A literature search using the MEDLINE was conducted on various models for teaching of dental implant education worldwide.

RESULTS

Implant dental education for undergraduate and postgraduate programmes has 3 components namely: didactic educational programme, laboratory hands-on experience, and clinical hands-on experience. In addition, dentists and dental educationists can gain proficiency in basic and advanced implant dentistry through implant dental education organised by recognised universities, private and international implant organisations, manufacturer-sponsored educational programmes as well as training and courses organised by dental associations.

CONCLUSIONS

Dental implant education should be given a priority and be included in both the undergraduate and postgraduate dental curriculum in Nigeria. In addition, a standardised implant dentistry programme should be formulated and developed for all dental schools in Nigeria.

The use of outreach clinics for teaching undergraduate restorative dentistry

AIM

To examine the experience of being an outreach teacher of undergraduate restorative dentistry; to describe the desirable characteristics of such teachers; and to consider the management of outreach teaching.

DESIGN

A three year pilot of an outreach course in fourth year restorative dentistry began in 2001. Students spent one day per week treating adults in NHS community dental clinics, run by Primary Care Trusts (PCTs). Action research involved monitoring meetings with students, clinic staff (dental teachers and nurses), and PCT clinical service managers. These data are supplemented by an independent evaluation involving interviews with dental school academic staff, and an account by an outreach teacher.

RESULTS

Outreach is a different and more demanding context for teaching restorative dentistry than the dental hospital, characterised by isolation, management responsibility, pressure, a steep learning curve, and stress. The desirable characteristics of outreach teachers are those which enable them to cope in this environment, together with a student-centred teaching style, and the appropriate knowledge. Management of teaching passed to the PCTs and this created an additional workload for them in relation to staffing, risk, and service-based issues. Four teaching surgeries were the maximum for a satisfactory level of patient care and student supervision. A key issue for the dental school is quality. The changes to teaching and the teaching environment introduced during and after the pilot to address problems identified are described.

CONCLUSION

In developing facilities to enable students to benefit from the advantages of outreach, dental schools should recognise that the characteristics of the outreach environment need to be taken into account during planning, that staff selection is a critical success factor, and that an ongoing proactive approach to organisational arrangements and to the support of teaching staff is necessary.

Clinical competency exercises: some student perceptions

Clinical competency assessments are an important part of dental curricula-to satisfy national requirements, maintain professionalism and ensure graduates are prepared for independent clinical practice. It has been observed within Newcastle Dental School (UK) that students tend to undertake the majority of their competency assessments at a very late stage. A questionnaire was designed to investigate student perceptions of two different competency assessment processes (formative structured clinical operative tests vs. summative grading), assess why they chose to undertake competency exercises at a particular time, investigate how well prepared they felt, and finally to evaluate potential barriers that students perceived within the competency process. Data regarding the timing of competency assessments and grades achieved were analysed. Fifty-nine per cent of students reported preferring the summative grading system. Most students felt that they undertook their competency assessments at about the right time (54%: conservation department, 66%: paediatric department) and the majority felt adequately prepared to undertake each exercise (68-98%). The greatest barrier stated to undertaking competency assessments was a lack of suitable patients both on which to practise and to undertake the exercise. No correlation was found between when students took summative assessments and the grades achieved. Therefore, we must encourage students to undertake their competency assessments once they have accrued sufficient clinical experience and reassure them that timing has little effect on the grade achieved. We should assist them to locate suitable patients wherever possible.

The impact of targeted shortened preclinical exercises on student perceptions and outcomes

The Harvard School of Dental Medicine (HSDM) introduced problem-based learning (PBL) into the dental curriculum in 1994 as a part of curriculum reform. During the reorganization, departments were consolidated, and courses were taught in an interdisciplinary fashion rather than in a discipline-based approach. The changes required a reduction in lecture and preclinical clock hours, which might have affected student performance and anxiety levels. The objectives of this study were to 1) compare the HSDM didactic and laboratory preclinical hours in Endodontics, Operative, and Prosthodontics before and after PBL implementation; 2) compare the HSDM didactic and laboratory preclinical hours in Endodontics, Operative, and Prosthodontics with other schools nationwide; 3) measure students' perceptions of their levels of stress and self-confidence at two time points during their preclinical and clinical years; 4) investigate the correlation between the number of preclinical hours and the students' stress level and self-confidence; and 5) evaluate the impact of shortened preclinical hours on the performance of HSDM students on the National Board Dental Examination Parts I and II. A survey regarding the students' level of stress, self-confidence, and preparation to treat patients during preclinical laboratory exercises was distributed to the HSDM classes of 2005 and 2006 (n=70). The HSDM preclinical curriculum hours were compared to national data as reported by the American Dental Association (ADA). Cross-tabulations were constructed, and the Fisher's exact test was conducted to examine the relationships between the variables. We found that HSDM preclinical hours in Endodontics, Operative, and Prosthodontics were significantly lower than at other schools. During the preclinical exercises, the Prosthodontics preclinical exercises were found to be the most stressful and provided the lowest self-confidence in treating patients as compared to the other preclinical subject areas. HSDM students' scores on the National Board Part I and II examinations continue to be among the highest in the nation and have not been affected by the change in curriculum. We conclude that the change in HSDM's curriculum that resulted in targeted, shorter preclinical exercises has not affected clinical and didactic outcomes, but may have affected the anxiety that students feel when entering the clinic.

A comparison of continuous clinical assessment and summative clinical assessment in restorative dentistry

A possible measure of clinical competency for undergraduates may be students' continuous clinical assessment marks. This study compared each student's continuous clinical assessment (CCA) mark with their summative clinical assessments (SCA) in Paedodontics, Crown and Bridgework, Endodontics and Basic Restorative Dentistry. This was done in order to evaluate the predictive potential of the former against the latter, more conventional measure of assessment. The criterion to determine clinical competence was 60% and any assessment achieved above this would imply clinical competency. Comparisons were made between CCA and SCA for the 39 BChD V undergraduates in the disciplines of Crown and Bridgework, Paedodontics and Endodontics, as well as for the 59 BChD IV undergraduates in the discipline of Basic Restorative Dentistry, for the 2004 academic year. Data were analysed using a two-sample t-test and were also subjected to a Spearman Rank Order Correlation test. For the BChD V students, differences between the two assessment measures were significant for Crown and Bridgework (p=0.00) and Endodontics (p=0.03), but not so for Paedodontics (p=0.22). For the BChD IV students the difference between CCA and SCA for Basic Restorative Dentistry (p=0.00) was significant. The Spearman test produced generally weak correlation values (p<0.4), while the average assessment for Crown and Bridgework for the BChD V group of <60% suggests that, on the basis of the results of this study, continuous clinical assessment cannot be used as a predictor of clinical competence in this discipline.

Two-year clinical evaluation of Cerec 3D ceramic inlays inserted by undergraduate dental students

OBJECTIVE

To evaluate the clinical results of final-year dental students' clinical performance after a practical computer-based course and training in the new Cerec 3 method.

METHOD AND MATERIALS

Cerec 3D restorations (Sirona) were made and inserted in patients by 50 dental students. The students were in their final semester in the Department of Operative Dentistry. Before treatment of the patients began, the students had undergone computer-based Cerec 3D training. The training included lessons comprising the whole Cerec procedure from planning to insertion of the restoration. Vital permanent premolars or molars requiring a 2- or 3-surface restoration were selected for the study. The evaluation started 1 week after luting. The inlays were examined in accordance with the US Public Health Service (USPHS) criteria at baseline and after 6, 12, and 24 months.

RESULTS

The 2-year survival rate of the restorations was estimated to be 93.3% according to Kaplan-Meier. No statistically significant changes were observed in color match, surface texture, and anatomic form. The decrease of pulpal hypersensitivity during the observation period was statistically significant (P <.05).

CONCLUSION

Dental students are capable of delivering demanding clinical tasks after appropriate training. The introduction of CAD/CAM restorations to the dental curriculum resulted in high short-term success rates. Further investigations are required to evaluate the long-term success of those restorations. To achieve a clinically adequate performance, it is necessary to consider the basic rules and technology associated with ceramic restorations.

Expert performance on a virtual reality simulation system

The objective of this research was to determine if the essence of expert performance could be captured on a virtual reality simulation system. Six experts in operative dentistry, six experts in periodontology, and six novice dental students performed a Class II tooth preparation task on the lower left second premolar. All subjects performed a pre-test to assess the basic skill level of each group. During the (limited) training component of the study, the three groups practiced three tooth preparations and received augmented feedback. At both a one-minute and one-day interval, subjects performed a final test in the absence of augmented feedback. All preparations were graded by the simulation system. The results showed at pre-test a significantly better performance of the experts in operative dentistry as compared to the novices. During the practice (acquisition) phase, the experts in operative dentistry outperformed both the periodontologists and novices, whereas the experts in periodontology performed more accurately than the novices. After one minute and one day following practice, similar results were obtained. Retention performance was most accurate after a one-day delay. Based on these results, the simulator appears to be a valid and reliable tool to capture expert performance. It is an effective screening device for assessing the level of expert performance.

Do tutor expertise and experience influence student performance in a problem-based curriculum?

The purpose of this study was to evaluate the association between student performance and tutor expertise and experience in the Restorative Treatment course in a problem-based learning (PBL) dental curriculum. This retrospective study evaluated a cohort of 206 third-year dental students at Harvard School of Dental Medicine who were enrolled in the Restorative Treatment course between 2000 and 2005. Tutor expertise in prosthodontics and prior tutoring experience were measured against student performance in five areas: 1) tutorial session, 2) midterm examination, 3) final examination, 4) preclinical laboratory, and 5) overall cumulative course grade. Student performance in each of the five areas measured against combinations of tutor subject matter expertise and tutoring experience level showed no statistically significant difference between the groups in the overall course grade. However, student performance in the expert group showed a significant difference in the final examination compared to the nonexpert group (p<0.05). Also, students in the group consisting of expert tutors with no experience performed better on the final examination compared to those students who had expert tutors with experience (p<0.05). The results indicate that overall student performance in the problem-based Restorative Treatment course is not affected by tutor expertise or prior tutoring experience.

An initial evaluation of virtual reality simulation in teaching pre-clinical operative dentistry in a UK setting

The use of virtual reality (VR) training in dentistry is a recent innovation and little research has been conducted to evaluate its use. For each preclinical exercise carried out the VR software currently records a final mark for the procedure, the time taken to complete the procedure and the number of 'internal' assessments carried out by the student. The aims of this study were two fold; a critical appraisal of the software by the students using a structured feedback together with an assessment of any link between the preparation time, final mark and number of evaluations. Sixteen 2nd year undergraduate dental students spent 6 hours cutting an unlimited number of Class I cavities and Class II cavities. The final mark awarded by the VR software together with the overall preparation time and number of evaluations for each cavity were recorded. For the Class I cavity the mean mark obtained was 66.8, the mean preparation time was 12.5 mins and the mean number of evaluations was 6.7. For the Class II cavity the mean mark was 26.5, the mean preparation time was 18 mins and the mean number of evaluations was 7.0. Final marks were also stratified into quartiles (0-24, 25-49, 50- 74, 75-100). For the Class II cavity the time taken to complete the cavity and the number of evaluations made were greater for those cavities that gained a mark of 50 or more. In conclusion, this initial evaluation of the DentSim VR package was a generally positive undergraduate educational experience. The class II cavity was more difficult to cut than the class I which was reflected in the mean scores. There was also a trend towards higher marks being associated with longer preparation times and more evaluations during the preparation.

Intra- and inter-examiner variability in evaluating preclinical pediatric dentistry operative procedures

Many investigators have reported attempts to develop reliable laboratory and clinic evaluation systems. However, few studies, regardless of level of success, have used an analytic procedure to identify those components of the evaluation system that, if refined further, could improve reliability. The purpose of this study was to compare intra- and inter-examiner variability in two evaluation methods: glance and grade (global), and checklist and criteria (analytical). Three faculty staff members with more than ten years of clinical and teaching experience evaluated operative procedures performed on plastic teeth representing the primary teeth by thirty dental students in pediatric dentistry preclinical laboratory sessions. The preparations were graded blindly by each of the three evaluators (A, B, and C) three times without magnification. The values were statistically analyzed using Wilcoxon signed rank test and Friedman test setting value of significance at 5 percent. The study revealed that, among the three examiners, the intra-examiner variability was nonsignificant in most situations. On the other hand, there was statistically significant variability between evaluators (i.e., inter-examiner) for almost all preparations. Neither cutting off the scores nor using either evaluation method (glance and grade or criteria and checklist) caused an improvement in variability. The problem of inter-examiner reliability and variability still existed.

Prevalence, clinical picture, and risk factors of dry socket in a Jordanian dental teaching center

AIMS

The aims of this study were to determine the prevalence, clinical picture, and risk factors of dry socket at the Dental Teaching Center of Jordan University of Science and Technology (DTC/JUST).

METHODS AND MATERIALS

Two specially designed questionnaires were completed over a four-month period. One questionnaire was completed for every patient who had one or more permanent teeth extracted in the Oral Surgery Clinic. The other questionnaire was completed for every patient who returned for a post-operative visit and was diagnosed with dry socket during the study period.

RESULTS

There were 838 dental extractions carried out in 469 patients. The overall prevalence of dry socket was 4.8%. There was no statistically significant association between the development of dry socket and age, sex, medical history, medications taken by the patient, indications for the extraction, extraction site, operator experience, or the amount of local anesthesia and administration technique used. The prevalence of dry socket following non-surgical extractions was 3.2%, while the prevalence following surgical extractions was 20.1% (P< 0.002). The prevalence of dry socket following surgical and non-surgical extractions was significantly higher in smokers (9.1%) than in non-smokers (3%) (P = 0.001), and a direct linear trend was observed between the amount of smoking and the prevalence of dry socket (P = 0.034). The prevalence of dry socket was significantly higher in the single extraction cases (7.3%) than in the multiple extraction cases (3.4%) (P = 0.018). The clinical picture and management of dry socket at DTC/JUST were similar to previous reports in the literature. The prevalence of dry socket, its clinical picture, and management at DTC/JUST are similar to those reported in the literature.

CONCLUSION

Smoking and surgical trauma are associated with an increased incidence of dry socket. Moreover, patients who had single extractions were more likely to develop dry socket than those who had multiple extractions in the same visit.

Trends in the placement of posterior composites in dental schools

The aim of this paper is to review trends in the teaching of posterior composites in the United States, Canada, Ireland, and the United Kingdom over the last fifteen years. The authors compared the results of surveys of the teaching of posterior composites performed in 1989, 1997, and 2004-05. Historical and contemporary international trends were investigated. The amount of clinical and didactic teaching of posterior composites has increased over the past fifteen years. From a time over fifteen years ago, when very few dental students placed posterior composites in dental school, approximately one-third of posterior plastic restorations placed by U.S., Irish, and UK dental students are now composite, with the corresponding finding for Canadian dental schools being approximately 50 percent. Some variations were noted between dental schools in terms of the teaching of contraindications to placement as well as lining and basing techniques. There was some inappropriate teaching of techniques, in particular, in relation to the use of transparent matrix bands and light transmitting wedges. There was also evidence of limited student exposure to newer forms of technology, notably LED curing light units. There have been clear increases in the teaching of posterior composites in the United States, Canada, the United Kingdom, and Ireland in recent years; however, the proportion of posterior composite restorations placed by dental students relative to dental amalgams does not yet match the typical situation in contemporary clinical practice. Dental schools have a responsibility to ensure that their curricula are evidence-based to best prepare their students to meet the needs and expectations of their future patients.

The introduction of a new assessment system in restorative dentistry: the undergraduate and patient experience

In 2000, the University of Bristol Dental School Division of Restorative Dentistry carried out a review of the assessment methods used within the undergraduate programme. Following this review, a number of key recommendations were made and the system of formative assessment within the division was changed. Audits were conducted immediately prior to the introduction of the new system and 2 years after it had been introduced, the results of these audits are presented. There was no change in the number of failed appointments between the initial audit and the second audit. There was a reduction in the number of patients treated by more than one student from 25% to 14% (approximating to 3% if student withdrawal from the course is taken into account). The length of time taken to complete treatment reduced between the two audits with more than half of all patients having their treatment completed within 3 months of their initial examination in the second audit. Ninety-five percent of treatment plans were completed in the second audit compared with only 62% in the first audit. In the second audit, the outstanding 5% of cases were signed off as incomplete for satisfactory reasons by the member of supervisory staff (e.g. patients who had moved away or were discharged due to poor attendance). Student comments were mostly positive, the small number of negative comments related to some students being confused by the paperwork in the new system. The overall process has been an extremely positive experience which has resulted in an assessment system with increased clarity which appears to have reduced the stress levels reported by the undergraduate students on the programme and improved the quality of patient care within restorative dentistry.

Dentistry--a show of hands, please!

Dentists have historically derived a distinctive part of their identity from the role of hand skills in practice. Dentistry is a surgical discipline, requiring a basic competency to perform what has been diagnosed and planned as being in the patients' best interests. Dental education has introduced magnification and computer-assisted technique instruction as the proportion of clock-hours devoted to laboratory practice has decreased. The threats posed by traumatic hand injury to practitioners are unknown, but may be small. By contrast, the strain of repetitive motion and injuries caused by postural problems are reported to be widespread in the profession and is generally accepted as characteristic and unavoidable. Ergonomic approaches to alleviating work strain have not been broadly embraced. As dentistry incorporates more biological alternatives and automated technology, the role of hands in practice may change.

The right hand of the David: an analogy used in operative dentistry

Educators must be able to guide students in their thinking, and analogies have emerged in the cognitive science literature as an effective tool in this domain because they allow students to relate new information to something they already understand. This gives relevance to what is being taught, allowing students to organize and conceptualize the new material for later retrieval by employing a student-centered approach to learning. This article presents an analogy used in the teaching of operative dentistry--the right hand of Michelangelo's David.

Continuing professional development: the Eastman experience

In harmony with the arrival of the new millennium, the United Kingdom's General Dental Council (GDC) introduced mandatory continuing education for dentists with a formal requirement of 250 hours every 5 years with 75 of these hours being of a verifiable nature.

An ethical lesson learned from the equestrian sculpture, "The Torch Bearers," at the University of Madrid Dental School

As dental professionals, we continue to learn ethical lessons throughout our careers and beyond. We may experience them in our day-to-day involvements with peers and patients, or they may present themselves under more unusual circumstances. In October, 1974, at the University of Madrid Dental School, the senior author had a deeply impressionable experience minutes before he helped to present a course to Spanish dentists in operative dentistry. His co-presenter was Dr. Miles R. Markley of Denver, Colorado, a National Consultant in Restorative Dentistry for the U.S. Air Force. Their ethics teacher that day was Dr. Gerardo Zabalo, Dean of the dental school. His object lesson was delivered at the base of an equestrian, aluminum, larger-than-life sculpture, "The Torch Bearers" which faced the school. The sculptor shows an old, wrinkled man, lying prostrate, with only enough strength left to raise a lighted torch upward. Reaching down to receive the torch is a robust, energized young man, who is sitting upon a sturdy stallion. The lesson which Dean Zabalo taught that day was simple but profound. The lit torch of ethics, learning and values is essentially transmitted from generation to generation, as young students learn from their elders, accept the torch from their retiring leaders, keep the torch brightly lit as they mature in their profession, and, then in turn, hand it over to those young professionals who will replace them. This process will continue, age after age. Thus the torch of learning and thinking is passed on. In the world of education, human contact and the continued sanctity of the scientific written word must be paramount. Students must be taught how to read, learn and think. Computer technology used exclusively as a mode of teaching and learning can never become a viable substitute for our traditional interactive methods which emphasize human to human interaction.

Eye safety practices in U.S. dental school restorative clinics, 2006

This study was conducted to determine how much progress U.S. dental schools have made in providing eye protection during restorative (adult operative and fixed prosthodontic) procedures since a 1979 survey. A seven-question survey was placed at a website, and fifty-five different U.S. dental schools were asked to complete the survey. Thirty-one schools responded (56 percent). Eighty-four percent of schools had safety glasses available for patients, but only 77 percent required usage during restorative procedures. Similarly, while 87 percent of schools required dental students working in restorative clinics to wear safety glasses, just 73 percent enforced the policy. Additionally, 84 percent provided blue light protection on curing lights and required students to wear eye protection while doing lab procedures. Compared to the 1979 survey, considerable progress has been made over the last twenty-seven years in protecting dental school patients and students from ocular injuries. Because one would hope to have 100 percent compliance on this issue, there is room for improvement in promoting patient eye safety and teaching good habits to dental students.

Survival analysis of complete veneer crowns vs. multisurface restorations: a dental school patient population

The purpose of this study was to compare the longevity of crowns versus large multisurface restorations in posterior teeth. The investigation used the treatment database at Virginia Commonwealth University School of Dentistry. The inclusion criteria for the final data set used for analysis were: only one restored tooth per patient, premolars with three or more restored surfaces, molars with four or more restored surfaces, molars and premolars restored with complete veneer metal crowns, or crowns veneered with metal and porcelain. The Kaplan-Meier approach was used to visualize the survival curves, and the Cox proportional hazards model was used for analysis of predictor variables. The investigation indicates crowns survive longer than large restorations and premolar restorations survive longer than molar restorations. The median survival for crowns exceeded 16.6 years, with the median survival of premolar restorations being 4.4 years and molar restorations 1.3 years. An interaction between age and treatment was discovered, with overall survival decreasing as patient age increases. The doctor supervising the treatment also affected survival with treatment supervised by specialists lasting longer than treatment supervised by nonspecialists.

Teaching the use of resin composites in Canadian dental schools: how do current educational practices compare with North American trends?

The placement of resin composites in posterior teeth is now a common procedure in dental practice. The aim of this study was to investigate current teaching of this procedure in Canadian dental schools and to compare trends in teaching with those in the United States. This study complements other investigations in which we examined teaching of the use of posterior resin composites in dental schools in the United States, Ireland and the United Kingdom. A questionnaire was distributed by email to the faculty member in each of the 10 dental schools in Canada with responsibility for teaching the operative dentistry curriculum, including the placement of posterior resin composites. The response rate was 100%. More teaching of posterior resin composites was noted since the time of a survey in the late 1990s. The amount of teaching and clinical experience in the use of posterior resin composites in Canadian dental schools seems to be higher than in dental schools in the United States. As noted in surveys of other countries, variation among Canadian teaching programs was found to persist in relation to techniques and technologies used.

Teaching the placement of posterior resin-based composite restorations in U.S. dental schools

BACKGROUND

In light of the increased use of and demand for posterior resin-based composite restorations in dental practice, the authors investigated U.S. dental schools' current teaching with regard to placement of posterior composite restorations.

METHODS

In early 2005, the authors invited 52 schools to participate in an e-mailed survey.

RESULTS

The authors received 47 completed responses, for a 90 percent response rate. Although all schools provided didactic and clinical teaching in the placement of occlusal resin-based composites in posterior teeth, the survey results showed variation in teaching the use of two- and three-surface occlusoproximal composites.

CONCLUSIONS

The survey findings demonstrate a marked change in instruction in placement of posterior resin-based composite restorations in U.S. dental schools during the last five to 10 years. However, the authors found much variation in the nature and extent of the instruction and techniques taught.

CLINICAL IMPLICATIONS

Dental schools need to ensure that their graduating students are well-prepared for independent clinical practice.

Restorative treatment on Class I and II restorations in primary molars: a survey of Brazilian dental schools

A survey was sent to 70 Brazilian dental schools evaluating techniques and restorative materials being taught for Class I and II preparation in posterior primary teeth by Pediatric Dentistry courses. After a 54% response rate, marked teaching diversity was found among Brazilian dental schools. Amalgam continues to be taught, but a tendency of preference towards more esthetic-like materials was observed.

Rater reliability: short- and long-term effects of calibration training

The purpose of this investigation was to evaluate the immediate effects of calibration on inter-rater agreement to a gold standard (GS) and to determine whether the effects can be sustained over a ten-week period. Valid criteria for a Class II amalgam preparation, a three-point rating scale, and a grade form were developed. Three tests were administered: prior to calibration training, immediately following training, and ten weeks later. Each test consisted of faculty independently evaluating ten prepared teeth. Agreement with GS scores for most of the grading criteria improved as a result of training and did not deteriorate over time. The overall percent agreement was 54.5, 66.9, and 64.6 percent across test periods. The most impressive gains in agreement occurred when the criteria evaluated had a GS score of either "standard not met" or "ideal." There was very little gain when the gold standard score was "acceptable." It is concluded that, with training, inter-rater agreement with a gold standard can improve and such improvement is reasonably resistant to deterioration after ten weeks. Nevertheless, future training ought to consider the use of a mastery approach in calibration training to ensure that a satisfactory degree of agreement with the GS is obtained.

Scope of practice comparison: a tool for curriculum decision making

The proportion of claims filed for specific dental procedures (ADA codes # 05110, 05120, 03320, 03330, 04260, 02150) between January 1, 2000 and June 30, 2004 by Texas general practitioners participating in a preferred provider network was compared to the proportion of these procedures performed by students graduating from the three Texas dental schools during the same period. Analysis of the data revealed that Texas dental students provide class two amalgam restorations in permanent teeth (02150) at approximately the same frequency as Texas general practitioners. Both groups provide periodontal osseous surgery (04260) at an extremely low frequency (<0.02% of total procedures). Bicuspid endodontic procedures (03320) were performed at a slightly higher frequency by students (0.43% of all procedures) than by general practitioners (0.36% of all procedures), and molar endodontic procedures (03330) were performed at a slightly higher frequency by general practitioners (0.65%) than by students (0.36%). Significant discrepancies between the groups were noted for the two complete denture procedures (05110, 05120). Students provided these procedures at frequencies fifteen times (05110) and twenty-five times (05120) greater than general practitioners. Dental schools should use data provided by scope of practice analyses to help determine an appropriate breadth and depth for their educational programs.

Teaching of posterior composite resin restorations in undergraduate dental schools in Ireland and the United Kingdom

PURPOSE

The aim of this study was to investigate the current teaching of posterior composite resin restorations to undergraduate dental students in Ireland and the United Kingdom (UK). The investigation was a follow-up to a survey undertaken in 1997.

MATERIALS AND METHODS

A questionnaire was distributed by e-mail to the Heads of Departments of Restorative Dentistry/Units of Operative Dentistry in each of the 15 dental schools with undergraduate dental degree programmes in Ireland and the UK. The questionnaire sought information relating to the teaching of posterior composite resin restorations in each dental school.

RESULTS

Fifteen completed questionnaires were returned (response rate = 100%). All schools (n = 15) taught the placement of composite resin restorations in occlusal cavities, 14 schools taught composite resin placement in two-surface occlusoproximal cavities and nine schools taught composite resin placement in three-surface occlusoproximal cavities. Respondents anticipated that the amount of preclinical teaching of posterior composite resin placement will increase twofold over the next 5 years, whilst the corresponding teaching of amalgam will fall to two-thirds its current level. Variation was found between dental schools in the teaching of the principles of cavity design, contraindications to placement, indications for lining and basing techniques, matrix and wedging techniques, and the use of curing lights.

CONCLUSIONS

The amount of teaching of posterior composite resin restorations in undergraduate dental schools in Ireland and the UK has increased since the time of a previous survey in 1997. Composite resin may soon equal or overtake amalgam as the material of choice when restoring posterior cavities in Irish and UK dental schools. There was, however, much variation in the nature and extent of the teaching and the techniques taught.

Clinical competence of graduates of community-based and traditional curricula

As community-based dental education programs proliferate, so do concerns about the quality of education at extramural sites. While there have been some comparisons of the effects of community-based programs on attitudes and perceptions of competency, there is virtually no information about whether such programs can train students to carry out standard dental procedures as well as if they were prepared in the dental school proper. To address this gap in our knowledge about the educational outcomes of community-based programs, the following performance measures were retrospectively compared for 457 students in traditional senior year curricula and fifty seniors in a community-based program: scores and pass/fail rates on the Northeastern Regional Boards (NERB), clinical production, passage of competencies, and on-time graduation rates. Students in the CODE (Community-Oriented Dental Education) program at the University of Medicine and Dentistry of New Jersey (UMDNJ)-New Jersey Dental School (NJDS) demonstrated significantly higher scores on the restorative section of the NERB, but this did not translate into a better overall pass rate. CODE students passed the same competencies as graduates of the traditional program, yet demonstrated appreciably higher clinical productivity and on-time graduation rates. The additional clinical experiences for the CODE students may be a factor in their higher board scores. Based on these data, it is concluded that community-based dental educational programs can be at least as effective as intramural (school-based) educational experiences in providing students with a sound clinical education.

A cohort investigation of the changes in vocational dental practitioners' views on repairing defective direct composite restorations

OBJECTIVE

To investigate changes in vocational dental practitioners (VDPs) views on repairing direct composite restorations (DCRs) during the vocational training (VT) year 2002-2003.

DESIGN

A questionnaire-based cohort study.

METHOD

Data on the repair of DCRs, including indications and details of operative techniques were collected by a questionnaire sent at the beginning of the VT year (September 2002) to all 12 Postgraduate Dental Deans in England. A follow-up questionnaire was sent to the Deans near the end of the VT year (May 2003). They were asked, on both occasions, to distribute the questionnaires among their VDPs and to return the completed questionnaires.

RESULTS

Ten deaneries participated in the study. The September 2002 and May 2003 findings (306 respondents [66%] and 313 respondents [67%] respectively) were analysed using Chi-square statistic and t-test to identify any significant differences (P<0.05). Significant changes in the attitudes of the VDPs during the VT year included a shift to viewing reduction in treatment time (30% to 48%), cost to patient (12% to 20%) and the management of the partial loss of a restoration (57% to 70%) as indications for repairs. In contrast, there was a significant change in viewing secondary caries as an indication for repair (46% to 29%). In addition, there was a significant, worrisome shift in relation to the use of bonding systems and finishing instruments, together with a reduction in the anticipated longevity of composite repairs.

CONCLUSION

Aspects of VDPs' attitudes to the repair of DCRs were found to change significantly during the VT year. Not all aspects of the changes observed were considered to be positive. Knowledge and understanding of repairs to DCRs need to be strengthened.

A Survey of Self-Perceived Educational Needs of General Dental Practitioners in the Merseyside Region

Aim

The aim of this study was to evaluate the self-perceived educational needs of a randomly selected group of general dental practitioners (GDPs) in the Merseyside region (UK).

Materials and Methods

Eighty-seven GDPs were randomly selected from 850 in the region and asked to complete a self-evaluation questionnaire regarding their self-perceived educational needs.

Results

Seventy-five (86%) responded, of which 52 (69.3%) were male and 23 (30.7%) female. There was no significant difference in self-perceived knowledge in any of the dental disciplines when gender and period of time since qualification were used as predictor variables. The majority of the GDPs felt they had a good knowledge of restorative dentistry and dental radiography. Some of the GDPs felt they had poor knowledge in implant dentistry, oral medicine, orthodontics, dental sedation techniques, oral surgery, endodontics, periodontics and dental radiography. None of the respondents felt they had poor knowledge in restorative dentistry, prosthodontics and paediatric dentistry. Seventy-four (98.7%) of the responding GDPs were motivated to attend continuing professional development (CPD) courses because of an interest in a particular dental discipline and only one reported attending out of personal learning needs. Implant dentistry was indicated by 30 (40.0%) of the respondents as their training programme of choice.

Conclusions

The respondents had high self-perceived knowledge of restorative dentistry, dental radiography, periodontics, endodontics, paediatric dentistry and prosthodontics. The respondents had low self-perceived knowledge of implant dentistry, orthodontics, oral medicine and dental sedation techniques. Of GDPs surveyed, 98.7% applied for courses they liked to attend, rather than needed to attend. Fifty-two per cent of male GDPs surveyed expressed a desire for training in implant dentistry.

Class I and Class II silver amalgam and resin composite posterior restorations: teaching approaches in Canadian faculties of dentistry

A 10-question survey was mailed to the 10 Canadian faculties of dentistry to determine current approaches to teaching undergraduates about silver amalgam and resin composite for posterior restorations in adults and children. Responses were received from all 10 pedodontic programs and from 8 of the 10 operative and restorative programs. The use of silver amalgam and posterior composite for restorations of primary and permanent teeth is covered in the curricula of all dental schools, but the relative emphasis on the 2 materials varies. In the operative and restorative programs, curriculum time devoted to silver amalgam is either greater than or equal to that devoted to posterior composite. Five of the 8 schools reported greater educational emphasis on silver amalgam for the permanent dentition; however, course directors noted that the preference among patients seen in clinics is tending toward composite restorations. Curricula appear designed to educate students about the optimal use of both materials. Requirements for performance of restorations during training generally do not specify the type of material; these requirements range from 60 restorations to 250 surfaces. Five of the 8 schools conduct clinical competency tests with both materials. The responses from the pedodontic programs were more diverse. The proportion of curriculum time devoted to each type of material in these programs ranged from less than 25% to more than 75%. Five schools reported more emphasis on silver amalgam, 3 schools reported equal emphasis, and 2 schools reported more emphasis on posterior composite. No clinical requirements were specified in any of the undergraduate pedodontic programs. Within some of the faculties, there were differences between the operative and restorative program and the pedodontic program with respect to emphasis on different materials for the posterior dentition.

Criteria referenced student self-assesment in restorative dentistry

The application of criteria referenced assessment has been previously reported, however, criteria referenced self-assessment has not yet been studied. The objective of this study was to develop and use clear and explicit criteria, linked to a level of competency and a score, as well as a checklist, for student self-assessment in Restorative Dentistry. A comparison of student self-assessment and supervisor-assessment was also undertaken to determine the validity and reliability of the criteria. Six levels of competency were adapted from the literature and a criterion was developed for each level of competency and used for student self-assessment of clinical procedures in Restorative Dentistry (BChD IV and BChD V). Each level of competency was given a score: U = Unqualified (0), NBQ = Not becoming Qualified (1), BQB = Becoming Qualified as a Beginner (2), BQL = Becoming Qualified as a Learner (3), Q = Qualified (4), E = Exceptional (5). The students used the criteria on the assessment form, to assess themselves accordingly (U, NBQ, BQB, BQL, Q, E) and this was compared to the supervisor assessment using the same criteria. The results were subjected to a Spearman Rank-Order Correlation test. The Spearman Correlation Coefficient for the BChD V group was 0.882 and 0.927 for the BChD IV group in the first semester and 0.923 for the BChD V group and 0.900 for the BChD IV group in the second semester. The results were highly significant (p< 0.05). There were no significant differences between student self-assessment and supervisor-assessment. The criteria referenced assessment system used to assess clinical competency in Restorative Dentistry is valid and reliable.

Patients treated by dental students in outreach: the first year of a pilot project

This paper describes the patients treated by 4th year undergraduate students during the first year of a pilot outreach course to teach Restorative Dentistry in community clinics in 2001-02. Data were collected from 908 summaries of patient treatment completed by the students, and from 139 patient questionnaires. Some 75% of patients were aged between 16 and 64, 58% were female, and 16% had dental phobia or anxiety. Most lived locally to the clinic and 41% made their initial contact as an emergency or drop-in. Some 37% made only a single visit (including children treated as emergencies) but 22% made six or more visits. Did not attend (DNA) was a problem and 18% of patients DNA to complete their treatment. Students undertook the full range of restorative procedures, with the emphasis on direct restorations, preventive treatment and advice, scaling, extractions and emergency treatment. Patients' main reasons for attending the clinic were lay recommendation, the need for treatment, convenience, free treatment, or the lack of access to a dentist. Some 30% said they did not have or did not know of an alternative source of dental care, and half had not seen a dentist for at least 2 years. The study demonstrates that despite difficulties related to attendance, a suitable patient base can be established offering students the opportunity to provide comprehensive care for adults in a primary care setting.

Restoration materials for primary molars—results from a European survey

OBJECTIVE

The aim of this study was to obtain an overview of the materials and restorative techniques taught for Class I and Class II restorations in primary molars of different European departments for paediatric dentistry and to compare the results to those for North America.

METHODS

The forms were sent to the chairmen of the departments of paediatric dentistry or-when included into the department for operative dentistry-to the director of 200 universities in 32 European Countries. The questions concerned the preferred materials and techniques, as well as the indications or contraindications for the use of the different tooth coloured materials.

RESULTS

Forty-three percent of the universities from western European countries (excluding Germany) responded to the survey. A 97% answer rate was obtained from German Schools. Of the other European regions, the response rate varied remarkably (24-54%). Also, opinions on materials used and methods applied were different from country to country. Only in a few regions (Eastern Europe), amalgam remains the filling material of first choice for Class I and II cavities in primary molars, whereas in others, the use has been restricted and tooth coloured materials, especially compomers or resin-modified glass ionomer cements, are being preferred.

CONCLUSIONS

Great diversity in teaching was observed not only among the European countries, but also within the countries themselves which makes it difficult to compare the results of our study to the ones obtained from the US.