Is it time to change state and regional dental licensure board exams in response to evidence from caries research?

Restorative treatment thresholds for occlusal primary caries among dentists in the dental practice-based research network

OBJECTIVES. The authors report on a study aimed at quantifying the carious lesion depths at which dentists intervene surgically for cases of varying caries penetration and caries risk. They also aimed to identify characteristics that are associated with surgical intervention.

METHODS

The investigators surveyed dentists enrolled in a dental practice-based research network who reported performing at least some restorative dentistry. In the survey, dentists were asked to indicate whether they would intervene surgically in a series of cases involving occlusal caries. Each case presentation included a photograph of an occlusal surface displaying typical characteristics of caries penetration and a written description of a patient at a specific level of risk of developing caries. Using logistic regression, the authors analyzed associations between surgical treatment with dentists' and practices' characteristics and patients' caries risk levels.

RESULTS

A total of 517 DPBRN practitioner-investigators responded to the questionnaire. Sixty-three percent of the respondents (326 of 517) indicated that in patients at low risk of developing caries, they would surgically restore teeth with lesions located in inner enamel surfaces and 90 percent would surgically restore teeth with lesions located in outer dentin surfaces. Regarding patients with a high risk of developing caries, 77 percent (398 of 517) of the respondents reported that they would surgically restore inner enamel lesions, and 94 percent (486 of 517) reported that they would restore lesions located on the outer dentin surface. Dentists who did not assess caries risk were more likely than dentists who did assess risk to intervene with dentinal lesions (P = .004). Practitioner-investigators who were in solo practice or a private practice with fewer than four dentists were significantly more likely to intervene surgically with enamel lesions than were dentists in large group practices (those with four or more dentists) (P < .001).

An Assessment of the Dental Public Health Infrastructure in the United States

OBJECTIVES

The National Institute of Dental and Craniofacial Research commissioned an assessment of the dental public health infrastructure in the United States as a first step toward ensuring its adequacy. This study examined several elements of the U.S. dental public health infrastructure in government, education, workforce, and regulatory issues, focused primarily at the state level.

METHODS

Data were drawn from a wide range of sources, including original surveys, analysis of existing databases, and compilation of publicly available information.

RESULTS

In 2002, 72.5% of states had a full-time dental director and 65% of state dental programs had total budgets of 1 million dollars or less. Among U.S. dental schools, 68% had a dental public health academic unit. Twelve and a half percent of dental schools and 64.3% of dental hygiene programs had no faculty member with a public health degree. Among schools of public health, 15% offered a graduate degree in a dental public health concentration area, and 60% had no faculty member with a dental or dental hygiene degree. There were 141 active diplomates of the American Board of Dental Public Health as of February 2001; 15% worked for state, county, or local governments. In May 2003, there were 640 U.S. members of the American Association of Public Health Dentistry with few members in most states. In 2002, 544 American Dental Association members reported their specialty as Dental Public Health, which ranged from 0 in five states to 41 in California. Just two states had a public health dentist on their dental licensing boards.

CONCLUSIONS

Findings suggest the U.S. dental public health workforce is small, most state programs have scant funding, the field has minimal presence in academia, and dental public health has little role in the regulation of dentistry and dental hygiene. Successful efforts to enhance the many aspects of the U.S. dental public health infrastructure will require substantial collaboration among many diverse partners.

Research in general dental practice

Spurred by an initiative by the National Institute of Dental and Craniofacial Research in the USA, this article presents the need for a change in clinical dental research towards practice-based research. It outlines the shortcomings of past and present-day research in dentistry, with emphasis on the lack of clinical relevance of much of the research performed. The slow transfer of sound research findings to clinical practice is also a major problem. The article reviews some problems related to restorative dentistry and how they have adversely affected general dental practice. Practice-based research places emphasis on the problems experienced by clinicians in the routine care of patients. Clinicians should be linked together in research networks. The problems they face in dental practice and the clinical experience they have will form the basis for studies by the network. Experienced clinical researchers will provide guidance and statistical support for the studies initiated by the clinicians.

Minimally invasive dentistry

BACKGROUND

During the past few decades, scientific developments in cariology, dental materials and diagnostic systems have changed dentistry's approach to diagnosis and management of dental caries. The authors summarize these developments.

OVERVIEW

Dental adhesives and restorative materials, new understanding of the caries process and remineralization, and changes in caries prevlance have catalyzed the evolution in caries management from G.V. Black's "extension for prevention" to "minimally invasive." The authors describe the scientific basis for early diagnosis; a modified classification of caries based on site and size of lesion remineralization; reduction of cariogenic bacteria; and minimally invasive cavity preparation design, techniques and material selection.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Minimally invasive dentistry is based on advances in science. Emerging technologies will facilitate evolution to primary prevention of caries, though technical, cultural and economic obstacles to full implementation in clinical practice now exist.