Protocol for the clinical practice of photodynamic therapy in endodontics: assessment of guideline quality using the AGREE II instrument

BACKGROUND

The choice of parameters in Photodynamic Therapy for endodontic treatment, such as wavelength, energy, application time, and number of sessions can vary based on the characteristics of the procedure and the patient. Providing information supported by scientific evidence in an accessible way to clinicians who are unfamiliar with the literature is necessary. Thus, this study aimed to synthesize a clinical protocol for the use of photodynamic therapy in endodontics in permanent teeth.

METHODS

Protocols with high methodological quality were identified using a literature search and the Appraisal of Guidelines Research and Evaluation Instrument (AGREE II), a validated tool for assessing quality. The recommendations of these studies were synthesized and submitted to a group of experts for evaluation and adaptation, and consensus was assessed using the Delphi methodology.

RESULTS

The analysis of the literature on the application of antimicrobial photodynamic therapy in endodontics showed that clinical trials with good levels of evidence and clinical recommendations have been reported previously, with two studies identified as having a clinical recommendation level of A1A and an evidence level of A.

CONCLUSION

The written protocol was considered to be satisfactory and as having appropriate content validity during the second round of evaluation by the experts. The studies included in this research were predominantly explanatory in nature, highlighting the need for pragmatic designs to increase the degree of clinical applicability.

Biomedical Courses Should Also Be Designed for Dental Students: The Perceptions of Dental Students

INTRODUCTION

It can be challenging integrating biomedical sciences into dentistry programs. The aim was to examine students' perceptions of how joint biomedical courses with medical students and courses tailored for dental students supported their clinical studies.

MATERIALS AND METHODS

The target group was clinical phase dental students. Cross-sectional survey data were collected using a questionnaire, which consisted of questions covering biomedical and clinical study content and learning methods.

RESULTS

A total of 110 (82%) students completed the survey. Students had difficulty recognising the relevance of joint biomedical courses for clinical work, but when the link was clear, their interest in the content increased. The closer the respondents were to graduation, the less relevance they expressed the biomedical sciences had. Almost all students (95%) wanted more dental content for the early study years.

DISCUSSION

The student perspective provides valuable information for the development of biomedical courses. Students should be offered customised courses that include dental content and perspectives on clinical work, whenever suitable to the didactic content of the basic science course. Our study shows that the dental perspective needs greater integration with the biomedical content. This also supports interprofessional learning and appreciation for the other field's contribution to human health.

Utility of Photodynamic Therapy in Dentistry: Current Concepts

The significant growth in scientific and technological advancements within the field of dentistry has resulted in a wide range of novel treatment modalities for dentists to use. Photodynamic therapy (PDT) is an emerging, non-invasive treatment method, involving photosensitizers, light of a specific wavelength and the generation of singlet oxygen and reactive oxygen species (ROS) to eliminate unwanted eukaryotic cells (e.g., malignancies in the oral cavity) or pathogenic microorganisms. The aim of this review article is to summarize the history, general concepts, advantages and disadvantages of PDT and to provide examples for current indications of PDT in various subspecialties of dentistry (oral and maxillofacial surgery, oral medicine, endodontics, preventive dentistry, periodontology and implantology), in addition to presenting some images from our own experiences about the clinical success with PDT.

Radiomics and Machine Learning in Oral Healthcare

The increasing storage of information, data, and forms of knowledge has led to the development of new technologies that can help to accomplish complex tasks in different areas, such as in dentistry. In this context, the role of computational methods, such as radiomics and Artificial Intelligence (AI) applications, has been progressing remarkably for dentomaxillofacial radiology (DMFR). These tools bring new perspectives for diagnosis, classification, and prediction of oral diseases, treatment planning, and for the evaluation and prediction of outcomes, minimizing the possibilities of human errors. A comprehensive review of the state-of-the-art of using radiomics and machine learning (ML) for imaging in oral healthcare is presented in this paper. Although the number of published studies is still relatively low, the preliminary results are very promising and in a near future, an augmented dentomaxillofacial radiology (ADMFR) will combine the use of radiomics-based and AI-based analyses with the radiologist's evaluation. In addition to the opportunities and possibilities, some challenges and limitations have also been discussed for further investigations.

A strife of interests: A qualitative study on the challenges facing oral health workforce policy and planning

Oral health workforce policy has often lacked systematic connections with broader health policy, and system-based reforms that would enable more effective responses to future needs of the population. The aim of the study was to better understand challenges facing oral health workforce policy and planning and identify potential solutions. In-depth interviews of 23 senior oral health leaders and/or health policy experts from 15 countries were conducted in 2016-17. Grounded theory principles using the Straussian school of thought guided the qualitative analysis. The findings identified: (i) narrow approach towards dental education, (ii) imbalances in skills, jobs and competencies, and (iii) geographic maldistribution as major challenges. An overarching theme -"strife of interests" - shed light on the tension between the profession's interest, and the needs of the population. A key aspect was the clash for power, dominance and authority within the oral health workforce and across health professions. This study argues that appreciating the history of health professions and recognising the centrality of the strife of interests is necessary in developing policies that both address professional sensitivities and are in line with the needs of the population. Integration and closer collaboration of oral health professionals with the mainstream medical and health professions has emerged as the key issue, but the solutions will be diverse and dependent on country- or context-specific scenarios.

From high definition precision healthcare to precision public oral health: opportunities and challenges

In anticipation of a major transformation in healthcare, this review provides highlights that anticipate the near future for oral public health (and beyond). Personalized or precision healthcare reflects the expectation that advances in genomics, imaging, and other domains will extend our risk assessment, diagnostic, and prognostic capabilities, and enables more effective prevention and therapeutic options for all Americans. Meanwhile, the current healthcare system does not meet cost, access, or quality criteria for all Americans. It is now an imperative that the success of "smart," quality, and cost-effective high definition precision healthcare requires a public health perspective for several reasons: a) to enhance generalizability, b) to assess methods of implementation, and c) to focus on both risk and prevention in large and small populations, thereby providing a balance between the generation of long-term knowledge and short-term health gains. Sensitivity and resolution, reasonable cost, access to all Americans, coordinated comprehensive care, and advances in whole genome sequencing (WGS) and big data analyses, coupled to other advances in biotechnology and digital/artificial intelligence/machine learning devices, and the behavioral, social, and environmental sciences, offer remarkable opportunities to improve the health and wellness of the American people [genotype + phenotype + environment + behavior = high definition healthcare]. The opportunity is to significantly improve the well-being and life expectancy of all people across the lifespan including the least-advantaged people in our society and potentially increase access, reduce the national costs, and improve health outcomes.

How Research Training Will Shape the Future of Dental, Oral, and Craniofacial Research

This is a critical time in the history of the dental profession for it to fully embrace the responsibility to safeguard its reputation as a learned profession. In this golden era of scientific and technological advances, opportunities abound to create new diagnostics, preventions, treatments, and cures to improve oral health. Dental schools are the largest national resource entrusted with the responsibility to educate, train, and retain oral health researchers who can leverage such technologies and research opportunities that will benefit the profession at large as well as patients. This article reemphasizes the theme that research training and scholarship must be inextricably woven into the environment and culture in dental schools to ensure the future standing of the profession. An overview of the history of support provided by the National Institutes of Health and National Institute of Dental and Craniofacial Research for the training and career development of dentist-scientists is presented. In addition, new data on the outcomes of such investments are presented along with a comparison with other health professions. This overview underscores the need to expand the capacity of a well-trained cadre of oral health researchers through the reengineering of training programs. Such strategies will best prepare future graduates for team science, clinical trials, and translational research as well as other emerging opportunities. The urgent need for national organizations like the American Dental Association, American Dental Education Association, and American Association for Dental Research to create new alliances and novel initiatives to assist dental schools and universities in fulfilling their research mission is emphasized. To ignore such calls for action is to disavow a valuable legacy inherited by the dental profession. This article was written as part of the project "Advancing Dental Education in the 21^st Century."

Oral Health Research and Scholarship in 2040: Executive Summary

This executive summary for Section 6 of the "Advancing Dental Education in the 21^st Century" project provides an overview of five background articles that address the role of research and scholarship in dental education in the year 2040. Beginning with a historical account of research and discovery science in dentistry's evolution as a profession, the article then reviews the role of early thought leaders and organized dentistry in establishing research as a cornerstone of dental education and dental practice. The dental research workforce faces an uncertain future fueled by a volatile funding environment and inadequate mentoring and training of research faculty. Dental schools must forge stronger academic and scientific ties to their university and academic health centers and will be challenged to develop sustainable research and patient care collaborations with other health professions. The changing health care environment will create new opportunities for oral health care providers to expand their scope of practice and focus on prevention and screening for non-communicable chronic diseases. Dental practitioners in the future are likely to place greater emphasis on managing the overall health of their patients while promoting closer integration with other health professionals. All dental schools must develop a sustainable research mission if they hope to graduate dentists who function effectively in a collaborative health care environment. The changing scientific and health care landscape will dramatically alter dental education and dental practice. Dental schools need to reconsider their research and educational priorities and clinical practice objectives. Until dental schools and the practicing community come to grips with these challenges, a persistent attitude of complacency will likely be at the dental profession's peril.

Developing Common Competencies for Southeast Asian General Dental Practitioners

Current policy in Southeast Asian dental education focuses on high-quality dental services from new dental graduates and the free movement of dental practitioners across the region. The Southeast Asian Nations (ASEAN) Dental Councils have proposed the "Common Major Competencies for ASEAN General Dental Practitioners" to harmonize undergraduate dental education. This article discusses how the ASEAN competencies were developed and established to assist the development of general dental practitioners with comparable knowledge, skills, and attitudes across ASEAN. The competencies were developed through four processes: a questionnaire about current national oral health problems, a two-round Delphi process that sought agreement on competencies, a panel discussion by representatives from ASEAN Dental Councils, and data verification by the representatives after the meeting. Key themes of the ASEAN competencies were compared with the competencies from the U.S., Canada, Europe, Australia, and Japan. A total of 33 competency statements, consistent with other regions, were agreed upon and approved. Factors influencing the ASEAN competencies and their implementation include oral health problems in ASEAN, new knowledge and technology in dentistry, limited institutional resources, underregulated dental schools, and uneven distribution of dental practitioners. The ASEAN competencies will serve as the foundation for further developments in ASEAN dental education including policy development, curriculum revision, quality assurance, and staff development. Collaboration amongst stakeholders is essential for successful harmonization of ASEAN dental education.

Our Essential and Endangered Dentist-Scientist Workforce

Future advances in dental medicine rely on a robust and stable pipeline of dentist-scientists who are dedicated to research inspired by the patients' condition. The biomedical research community faces external and internal pressures that have been building over years. This is now threatening the current and future status of basic, translational and patient-oriented research by dentist-scientists who study dental, oral and craniofacial diseases, population sciences, and prevention. The dental academic, research and practicing communities can no longer ignore the warning signs of a system that is under considerable stress. Here, the authors report findings of the Physician-Scientist Workforce Working Group, charged by the National Institutes of Health (NIH) Director, to perform quantitative and qualitative analyses on dentist-scientists by addressing the size, composition and activities of the group, relative to other health professions. From 1999 to 2012, trends in the numbers of grant applications and awards to dentist-scientists point to an overall decline. Disturbing are the low numbers of new investigators who apply for Early Career NIH Programs. While more seasoned dentist researchers enjoy greater success, the average age of first-time funded dentists is 52.7 y for females and 54.6 y for males, with a relatively low number of applications submitted and funded. These new data led the panel to stress the need to expand the capacity of the dentist-scientist workforce to leverage technologies and research opportunities that benefit the profession at-large. Suggestions were made to invest in developing clinical research faculty, including those with foreign degrees, through new training mechanisms. The creation of new alliances between national organizations like the American Association for Dental Research, the American Dental Education Association and the American Dental Association will undoubtedly lead to bold and concerted actions that must be pursued with a sense of urgency. A more supportive culture within dental schools and universities for dentist-scientists is needed, as their success is critical to the future career choices of their mentees. Knowledge Transfer Statement: Advances in dental medicine rely on a pipeline of dentist-scientists who are dedicated to research inspired by the patients' condition. Despite the recent advancement in technology and innovation, the dental community can no longer ignore the various pressures that threaten the future of the dentist-scientist profession. Here, the authors report findings of the Physician-Scientist Workforce Working Group of NIH that were published in 2014, and draw attention to the key issues threatening the NIH-funded pool of dentist-scientists.

From Phenotype to Genotype: Enter Genomics and Transformation of Primary Health Care around the World

The progress in phenotype descriptions, measurements, and analyses has been remarkable in the last 50 years. Biomarkers (proteins, carbohydrates, lipids, hormones, various RNAs and cDNAs, microarrays) have been discovered and correlated with diseases and disorders, as well as physiological responses to disease, injury, stress, within blood, urine, and saliva. Three-dimensional digital imaging advanced how we "see" and utilize phenotypes toward diagnosis, treatment, and prognosis. In each example, scientific discovery led to inform clinical health care. In tandem, genetics evolved from Mendelian inheritance (single gene mutations) to include Complex Human Diseases (multiple gene-gene and gene-environment interactions). In addition, epigenetics blossomed with new insights about gene modifiers (e.g., histone and non-histone chromosomal protein methylation, acetylation, sulfation, phosphorylation). We are now at the beginning of a new era using human and microbial whole-genome sequencing to make significant healthcare decisions as to risk, stratification of patients, diagnosis, treatments, and outcomes. Are we as clinicians, scientists, and educators prepared to expand our scope of practice, knowledge base, integration into primary health care (medicine, pharmacy, nursing, and allied health science professions), and clinical approaches to craniofacial-oral-dental health care? The time is now.