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.