Benefits of virtual externships with a pediatric dentistry program for potential residents

PURPOSE

To determine if a virtual externship (VE) is beneficial to potential applicants regarding their perceived knowledge of a pediatric dentistry residency program. Secondarily, this study identified general program characteristics that influence resident ranking decisions.

METHODS

All applicants who applied to a pediatric dentistry residency program in the Southeast were invited to participate in a VE. Those who participated in the externship (n = 65) were asked to voluntarily complete Pre- and Post-VE surveys. Participants were asked 22 questions about their level of knowledge of both tangible and intangible aspects of the program such as stipend, patient volume, faculty-resident interaction, and resident comradery. Participants were also asked to rank 9 general characteristics that influence ranking decisions such as geography, cost to attend, and reputation of the program and were asked to rate their satisfaction with the VE. Post-VE data were compared to pre-VE data to determine level of knowledge gained via Wilcoxin matched pairs signed rank test (significance set at p < 0.05).

RESULTS

When comparing Pre- and Post-VE ratings of level of knowledge about each category, all 22 categories assessed showed statistically significant mean differences indicating perceived knowledge gain with the most knowledge gained for "resident satisfaction in the program." Of the nine program characteristics, clinical experience was the most important factor to participants. Participants (100%) were satisfied with the VE experience and indicated the VE gave them the opportunity to get to know the program.

CONCLUSIONS

A virtual externship is a satisfactory option for increasing applicant knowledge of the tangible and intangible aspects of a residency program.

Dental students and recent dental graduates' perceptions of preparedness in treating pediatric patients

PURPOSE/OBJECTIVES

To survey potential applicants applying to advanced education in pediatric dental programs and evaluate their preparedness upon graduating from an accredited dental school.

METHODS

Attendees of a virtual externship of a University program were recruited to participate in a web-based survey. The survey collected demographic data, current levels of confidence with various pediatric clinical procedures, predicted confidence with those procedures, and number of procedures completed. Chi-Square and analysis of variance statistics were performed on resulting data to determine statistical significance.

RESULTS

Fifty-three participants completed the survey in its entirety (n = 53). Most respondents reported adequate didactic training, mean score of 3.6 (range 0-5) and a moderate to high impact of coronavirus disease 2019 on their overall training with a mean score of 4.9 (range 0-10). Current dental students reported that they are "not confident at all" (<2.0) for 15/24 (63%) of the procedures. Graduates reported "somewhat confident" (<3.0) for 13/24 (54%) of the categories. Both students and graduates report the lowest levels of confidence for managing dental trauma, invasive treatment of young patients (<4 years of age), and patients with special healthcare needs. Dental students self-reported the expectation to feel more confident throughout their matriculation; however, their clinical experience was still reported to be limited. Students did not report reaching the level of "confident" for 75% of the procedures.

CONCLUSION

Dental students and recent dental graduates alike perceive themselves to be under prepared for practice and do not feel confident in performing pediatric dental procedures. This study can provide dental schools, program directors, recent graduates, and dental students with an understanding of areas where they are under prepared and could offer areas where curricula and clinical experiences could be updated or modified.

Alcohol use among US dental students: Results of a nationwide survey

PURPOSE/OBJECTIVES

Substance use may be a consequence of dental student stress. Studies have examined the alcohol use among medical students, but there are fewer studies among dental students. The purpose of this study was to examine alcohol use in a large geographically diverse sample of US Dental Students.

METHODS

An anonymous web-based survey instrument was modeled after well-known surveys of college student substance use. Survey data collection used best practices for web-based surveys when possible.

RESULTS

2019 responses were collected with the cooperation of fifteen US dental schools (potential sample size: 6029; RR: 7.6%, n = 463). 2021 responses were collected using the American Student Dental Association email list (potential sample size: 18,722; RR: 2.2%, n = 424). Respondents came from all regions of the US. Thirty-day alcohol usage and binge drinking rates were somewhat higher among dental students than college-age students from other surveys. Women's 30-day prevalence of alcohol use was slightly higher than men, but binge drinking prevalence was greater among men. Prevalence of binge drinking was higher among white students, as was mean drinks per drinking occasion. Students who self-reported below average academic performance were more likely to report drinking to get away from problems and had a higher prevalence of some alcohol-related problems (ARPs).

CONCLUSIONS

Despite the limitations of this study, the results are consistent with that of other studies. This study has provided some valuable insight into the prevalence of alcohol usage and ARPs among US dental students. Of special concern are the reasons for drinking as mechanisms for relieving tension and stress, which may continue into dental practice.

A Randomized Controlled Pilot Study Examining Effects of Animal Assisted Therapy in Children Undergoing Sealant Placement

Purpose: The purpose of this study was to examine the effects of a companion canine on physiologic responses, discomfort level, and behavior in children undergoing sealant placement using a dental isolation system (Isodry^®). Methods: Forty-seven healthy six- to 10-year-olds who needed sealants were randomly assigned to a control group (N =23) or experimental group (N =24) that utilized an emotional support canine in the child's lap. Preoperative baseline anxiety was obtained. Pulse, pulse oximetry, and behavior (measured by Frankl and Houpt scales) were recorded at various time points (beginning, at first sealant placement, switching the isolation system to the other side, second side sealant placement, and end) throughout the procedure. Participants reported a comfort level utilizing the FACES scale. Participants in the intervention group were asked, "Did you like having the dog in your lap?" The dentist rated the difficulty of and time required for the procedure. Results: Baseline anxiety was similar; no significant differences in physiologic measurements or FACES ratings were found between groups. The intervention group had significantly lower Houpt ratings for all three variables when the isolation system was repositioned (P=0.002, P=0.03, and P=0.05) and had higher Frankl scores at isolation repositioning and when completing sealants on the second side (P=0.02 and P=0.03, respectively). Both groups had similar ratings from the dentist. Conclusions: Animal-assisted therapy (AAT) should be studied more rigorously to substantiate its effectiveness in enhancing cooperative behavior in children for dental procedures. High levels of satisfaction were observed among pediatric users of AAT.

Parents' Preferences and Perceptions of Their Children's Consumption of Sugar and Non-nutritive Sugar Substitutes

Purpose: The purpose of this study was to investigate opinions and preferences of parents from various sociodemographics regarding sugar and both natural and artificial non-nutritive sugar substitutes (NNS). Methods: Oral interview surveys were conducted in dental practice settings. Parents were asked about demographics, their consumption of and feelings about sugar and NNS for themselves and their children, and their concerns regarding NNS. Parents were asked about natural and artificial labels and were asked to select snacks/beverages they would purchase for their children. Results: Parents (N equals 100) preferred sugar-sweetened drinks for their children (76 percent), and 78 percent expressed concern about the potential health effects of NNS, especially cancer. Parents felt sugar was safer than NNS and were more positive about natural NNS than artificial ones. More highly educated parents (P = 0.02) were more likely to avoid NNS for their children, and parents of the lowest income level were likely to express ambivalence regarding naturally labeled NNS. Conclusions: Parents are concerned about giving their children NNS and cite cancer as the primary reason. Parents from higher sociodemographic backgrounds are more likely to limit their children's consumption of NNS and have negative feelings about them. Most parents, especially those of higher sociodemographics, are more accepting of natural NNS.

Trends in First-Year Dental Students' Information Technology Knowledge and Use: Results from a U.S. Dental School in 2009, 2012, and 2017

Dental students must be skilled in the use and application of information technology (IT), but there are few studies of IT use and knowledge among U.S. dental students. The aim of this study was to retrospectively analyze survey data regarding IT use and knowledge collected from first-year dental students at one U.S. dental school in 2009, 2012, and 2017. Data were collected from an anonymous survey of these students as part of a D1 course called Informatics and Evaluation of Dental Literature. All students participated in the survey each year, for a response rate of 100%. Annual numbers of participants were 80 (2009), 90 (2012), and 97 (2017), for a total 267 respondents. The students reported that they frequently accessed Internet resources multiple times per day and that frequency of use had increased over time, principally from access via smartphones. These students reported feeling comfortable with higher education IT applications such as learning management systems and computerized testing. However, despite their frequent IT use, the students reported low levels of knowledge about IT security, and the three years of survey data showed that IT security knowledge had declined over time. These findings have implications for dental educators, including the need for methods for training students to protect their personal data and that of their patients.

A comprehensive clinical competency-based assessment in periodontics

Traditional periodontics clinical examinations in dental education frequently assess a narrow set of clinical skills and do not adequately assess the ability of students to independently manage a periodontal patient. As an alternative, the authors developed a comprehensive periodontics competency case experience (CCCE) for senior dental students and surveyed students regarding their experience with the CCCE. Students challenging the CCCE must treat a patient with moderate periodontitis and must independently decide when a state of periodontal and oral health has been achieved. Students are also required to conduct an oral presentation to periodontology faculty. Dental students who completed the CCCE had a favourable impression of the experience, compared with the traditional clinical examinations taken in the junior year. The majority of students rated all the components of the CCCE as 'somewhat' or 'very helpful'. About 72.4% of students felt that being able to work independently on the examination was very helpful for learning about the clinical management of patients with periodontal disease, followed by 'simulation of care in private practice' (65.5%), and oral photography experience (55.2%). The greatest difficulty reported by students was finding an acceptable patient. About 62.1% of students rated 'finding the right patient' as very difficult. Students reported having to screen a mean of 5.9 patients (SD: 4.5) to find a qualified patient. The results of the survey will be useful in improving the examination as an assessment tool in periodontal therapy.

Effect of dental restorative materials on total antioxidant capacity and calcium concentration of unstimulated saliva

Background

To evaluate the effect of dental amalgam and composite restorations on total antioxidant capacity (TAC) and calcium (Ca) ion concentration of unstimulated saliva.

Material and Methods

Forty-eight children aged 6-10 years selected and divided into three groups of sixteen (8 males, 8 females). In group A and B, samples consisted of two class II dental composite or amalgam restorations, while in group C samples were caries-free (control group). Unstimulated saliva from all samples was collected and TAC was measured by spectrophotometry using an adaptation of 2, 2’-azino-di-(3-ethylbenzthiazoline-6-sulphonate) (ABTS) assay. The Ca ion level was estimated by an auto- analyzer. Data were analyzed with one- and two-way ANOVA test, at a p<.05 level of significance.

Results

Composite samples showed significantly higher TAC and lower Ca ion levels compared to amalgam and caries-free samples (p<.05). The TAC values showed only significant difference between groups (p<.05), while the Ca ion results showed significant differences within and between groups (p<.05).

Conclusions

Dental composite restorations increased TAC and decreased Ca ion levels more than amalgam restorations in saliva. Gender is an effective factor in changes induced in oral cavity as females showed more emphatic reaction to dental filling materials than males.

Statement of Clinical Relevance

Patients who have dental restorations, especially dental composites, should pay more attention to their dental hygiene, because dental restorations can increase oxidative stress and decrease Ca ion level in saliva, which might jeopardize remineralization process of tooth structures after demineralization.

Key words:Amalgam, caries, composite, saliva, total antioxidant capacity.

A poster and a mobile healthcare application as information tools for dental trauma management

BACKGROUND/AIMS

Prompt management of dental trauma in children affects outcomes, and multiple educational resources are available. The aim of this study was to compare subjects' accuracy in answering a survey about dental trauma management utilizing a poster and a mobile healthcare application and to determine user preference for mode of delivery of information.

MATERIALS AND METHODS

A survey was administered to parents of patients in two pediatric dental practices. Questions collected demographic information, frequency of internet use, and responses to questions regarding dental trauma management for two separate scenarios. Participants used both a poster and a mobile application, but were randomly assigned as to which tool was utilized first.

RESULTS

Eighty-nine surveys were usable. The majority of respondents were aged 36-45 years (50.6%), had education beyond high school (64%), and had private insurance (52.8%). Less-educated individuals were more likely to report searching the Internet (74%) compared to individuals with a graduate degree (57%) (P = 0.017). The majority of subjects answered trauma management questions correctly with both tools. However, for an avulsed permanent tooth, individuals receiving the mobile application were more likely to select: 'put the tooth back in place' (71.1%) compared to those utilizing the poster, who chose 'put the tooth in milk' (56.8%) (P = 0.004). Less-educated individuals were willing to pay more for the application (P = 0.015) and were more likely to report being interested in receiving dental information through mobile technology in the future (P = 0.006).

CONCLUSIONS

Both a poster and a mobile healthcare application are effective in delivering dental trauma information.

Clinical Evaluation and Parental Satisfaction with Pediatric Zirconia Anterior Crowns

PURPOSE

The purpose of this study was to evaluate the clinical success of and parental satisfaction with anterior pediatric zirconia crowns.

METHODS

A retrospective analysis of maxillary anterior pediatric zirconia crowns was performed. Crowns were evaluated for retention, gingival health, color match, contour, marginal integrity, and opposing tooth wear. Parental satisfaction regarding the esthetics of the crowns and parental perception of the impact of treatment on the child's appearance and oral health were evaluated by questionnaire.

RESULTS

Fifty-seven crowns were evaluated in 18 children. Eight teeth were lost to exfoliation, three were extracted due to pathology, and two crowns debonded, leaving 44 available for examination. The average crown age at time of examination was 20.8 months. Sixteen crowns (36 percent) displayed gingival inflammation and color mismatch. No recurrent caries or opposing tooth wear was noted. Parents reported high satisfaction with the color, size, and shape of the crowns. The majority of parents reported that crowns improved the appearance and oral health of their child (78 percent and 83 percent, respectively). Eight-nine percent of parents reported that they would highly recommend these crowns.

CONCLUSIONS

Zirconia crowns are clinically acceptable restorations in the primary maxillary anterior dentition. Parental satisfaction with zirconia crowns is high.

Comparing comprehensive care and departmental clinical education models: students' perceptions at the University of Tennessee College of Dentistry

In summer 2012, the University of Tennessee Health Science Center College of Dentistry transitioned from a departmental clinical education model to a comprehensive care/group leader model. The aim of this study was to investigate the perspectives of the fourth-year class of dental students who, because the transition took place during their training, had experienced treating patients under both educational models. To achieve this objective, a questionnaire was designed to assess the students' opinions on the efficiency of their effort, availability of specialty faculty, stress, collaboration with classmates, and availability of exposure to different practice styles and techniques under the two systems. The students were also given an opportunity to provide open-ended feedback on the shortcomings and advantages of the systems. The Class of 2013 had 81 students, 55 of whom participated in the survey for a response rate of 67.9%. The majority (86%) of the respondents preferred the comprehensive care model and reported feeling that, in it, they were able to accomplish more comprehensive dentistry with greater consistency of supervision from faculty in a more patient-centered environment than in the departmental model. However, 56 percent considered having the same group leader for two years a disadvantage and recommended rotation of at least one group leader every six months. The results of this survey can help this college and other dental schools that are seeking to optimize their educational model to best serve students' educational experience and the dental needs of their patient population.

Seeking to Understand the Reader of Interest-Your Patient-Health Literacy and Adherence Concerns for the Dentist and the Dental/Medical Team

The overall health of the United States' (U.S.) population has been surveyed and reported for several decades in a quest by healthcare professionals to understand the etiology for healthcare disparities and seek to lessen its effects on individuals and, ultimately, eliminate them. Many of these surveys and reports have illuminated disparities, of access to healthcare by focusing on measures to address health literacy deficiencies. A plethora of information concerning patients' health literacy skills and printed information has been made available for dentists and their staff. The printed information is in the format of published patient- centered educational guidelines and readable dental and medical limited reach media (LRM), such as information sheets and prescription drug leaflets. LRM has great potential to enhance access to healthcare information for the reader of interest--your patient--at a readable and comprehensible level. Printed materials are an effective means to enhance health promotion and education for the lay populace. Tailored LRM protocol and the Patient Introduction Form (PIF) are excellent educational instruments for dentists and the dental/medical team (The Team). These instruments are valuable assets for The Team to assist its patients in monitoring and maintaining dental and medical adherence protocols in their daily lives.

The incidence and pattern of maxillofacial injuries in helmeted versus non-helmeted motorcycle accident patients

PURPOSE

The aim of this study was to investigate the difference in incidence and pattern of bony and soft tissue injuries sustained by helmeted versus non-helmeted motorcycle accident patients.

MATERIALS AND METHODS

The medical records of motorcycle accident patients over a 10-year period were reviewed. Basic demographic data including age, gender, and Injury Severity Score (ISS) were collected. The patients were separated into 2 groups based on helmet use. For each group, the incidence of specific maxillofacial injuries (based on the International Classification of Diseases, Ninth Revision) was tallied. Statistical analysis was performed with the Fisher exact test.

RESULTS

A total of 717 patients were included in the study: 598 patients (mean age, 41.6 years; male gender, 90.8%; ISS, 18.2) were in the helmeted group and 119 patients (mean age, 40.8 years; male gender, 90.8%; ISS, 19.5) were in the non-helmeted group. Among the helmeted riders, 26.1% (n=156) sustained a maxillofacial injury, and among the non-helmeted riders, 45.4% (n=54) sustained a maxillofacial injury (P=.0001). The non-helmeted riders also had a significantly higher incidence of malar and maxillary fractures (P=.040), orbital fractures (P=.044), and soft tissue contusions and abrasions (P=.031).

CONCLUSIONS

The results of this study suggest that not only do helmets protect against facial injuries in totality, they appear to be more effective at preventing midfacial fractures when compared with mandible fractures.

The influence of endodontic broken stainless steel instruments on the urinary levels of iron

Previous studies on the endodontic broken stainless steel instruments have mainly focused on retrieval of specimens. However, the systemic consequences of the retained separated instruments need an investigation. The current study aimed to evaluate the correlation between broken stainless steel instruments inside the root canal space and the urinary level of iron (Fe) in patients. Sixty near-aged and same-gender patients were selected. Thirty patients in the control group had no endodontic treatment in their history, while the other 30 patients in the endodontic group had broken stainless steel instrument. The urine samples were collected in iron-free containers. All specimens were refrigerated for 1 day and then subjected to Fe level measurement by electrothermal atomic absorption spectrometry. Data were analyzed by Kolmogorov-Smirnov and t tests at P < 0.05. The correlation coefficients of age and sex were also evaluated in relation with Fe levels in the urine. The level of Fe did not show any significant increase in the experimental group (P > 0.05). There was a positive correlation between age and Fe levels of endodontic and control groups. However, the joint effects of age and sex on Fe levels were different for the two groups. The presence of broken stainless steel instruments inside the root canal space did not elevate the level of Fe in the urine of patients. However, this value was positively correlated with the patient age.

Correlation between endodontic broken instrument and nickel level in urine

This study aims to evaluate the correlation between the presences of separated endodontic instrument inside the dental canal and the nickel (Ni) level in the urine samples of subjected patients. Same-gendered and near-aged participants were selected and were instructed to collect their urine in sterile nickel-free plastic containers. The procedures were carried out in the office, and samples were stored in low-temperature cooler for 1 day and then they were transferred to the laboratory for electrothermal atomic absorption spectrometry. The level of Ni was measured and the correlation coefficient was calculated. Data were analyzed using t tests, Pearson's correlation coefficients, and linear regression analysis, at a level of significance P < 0.05. The statistical analysis has showed significant difference in Ni level between endodontic and control groups (P < 0.05). There was no correlation between Ni level in urine and the age or time period of broken instrument inside the canal; however, Ni level of urine and the age of participants in experimental group has demonstrated a positive correlation. The amount of Ni element can be increased in the urine of patients who have experienced broken endodontic instrument inside the dental canal. However, there is no positive correlation between the remaining pieces of instruments inside the canal and the elevation of nickel amount in urine during the tested time period. This issue suggested that the aging of remaining broken instrument inside the canal does not show any remarkable concern regarding the Ni elevation in the urine excreted by an individual.

The role of occlusal loading in the pathogenesis of non-carious cervical lesions

PURPOSE

To evaluate the putative role of occlusal loading in the pathogenesis of non-carious cervical lesions (NCCLs) in subjects who exhibited mixed excursive guidance [i.e., immediate canine guidance on one side and group function (GF) on the other].

METHODS

20 subjects with Angle Class 1 occlusion and having from 1 to 5 NCCLs on separate teeth were selected. Only subjects who displayed mixed excursive guidance were recruited so that they could serve as their own controls. Non-carious cervical lesions were recorded on casts mounted in semi-adjustable articulators.

RESULTS

On the GF sides, 22.5% of all teeth that contacted in working excursions exhibited NCCLs; only 2.1% of the teeth on the canine guided sides exhibited NCCLs, which were found exclusively in canines. Although a case for the multifactorial etiology of NCCLs remains strong, our data, albeit limited, seems to support the dominant role of occlusion in lesion formation.

"I can't understand your information sheet, doc!" Readability of limited-reach media materials for the lay population

Patients are provided limited-reach media materials, such as information sheets and pamphlets, as reinforcement of information when the oral healthcare professional is no longer face-to-face. Patients are more likely to use the printed information if text complexity and reader's ability match, or if their need to know the content provokes an urge to read. A number of researchers have developed readability tests. This study used the Fry Readability Graph to plot the results of three independent raters' averages of the number of sentences and the words (syllables) of continuous (prose) and non-continuous (matrix-style) pre-selected passages from several reputable sources. These limited-reach materials are frequently used in academic institutions' community engagement efforts. Several of the limited-reach materials we studied were ranked above the fifth-grade reading level, so consideration must be given to future distribution of these documents in communities where the average reading proficiency is lower. Several limitations, such as the quality of illustrations and measuring the reading level of individuals, were not investigated and must be considered as the authors continue to distribute literature in certain urban and suburban locales. This study is the genesis of an academic institution's community engagement efforts to provide information to clinicians and improve its outreach distribution of limited-reach media for patients who have varying levels of general and health literacy backgrounds.

An innovative behavioral science curriculum at the University of Tennessee College of Dentistry

Communication skills have long been associated with practice success in dentistry. The Commission on Dental Accreditation's standards state that "Graduates must be competent in the application of the fundamental principles of behavioral sciences" and that "Graduates must be competent in managing a diverse patient population and have...interpersonal and communications skills." A recent survey of U.S. dentists found an underutilization of communication skills by general dentists. The University of Tennessee College of Dentistry strives for continuous improvement and has implemented an innovative behavioral science curriculum to improve students' communication skills, consistent with the College's "patient-centered, comprehensive care" philosophy. We describe the design and implementation of our "Patient-Centered Dentistry" course, in which third-year dental students practice communication skills with simulated patients in the Kaplan Clinical Skills Center on the UTHSC campus. The clinical simulations involve the following scenarios: The Initial Interview with a Patient, Presenting a Treatment Plan, Treating Patients with Fear and Anxiety, Interviewing Considerations for Difficult Patients, Delivering Distressing News to Patients, and Coping with a Drug-Seeking Patient. Student simulations were videotaped and assessed by course instructors as well as clinical faculty, and students received immediate feedback by instructors and clinical faculty after their simulations. Students were provided with the opportunity to view their simulation performance and to reflect on their performance in order to recognize their communication strengths as well as areas for improvement. The use of simulation experiences is becoming a widespread and expected practice in health care education. The Patient-Centered Dentistry course provides students with the opportunity to experience the kinds of real-life situations that they would experience in dental practice, without risks to patients. It provides students with the opportunity to assess their communication skills, make mistakes and improve.

Faculty development to improve teaching at a health sciences center: a needs assessment

There has been increasing interest at health science centers in improving the education of health professionals by offering faculty development activities. In 2007-08, as part of an effort to expand education-related faculty development offerings on campus, the University of Tennessee Health Science Center surveyed faculty members in an effort to identify faculty development activities that would be of interest. Factor analysis of survey data indicated that faculty interests in the areas of teaching and learning can be grouped into six dimensions: development of educational goals and objectives, the use of innovative teaching techniques, clinical teaching, improving traditional teaching skills, addressing teaching challenges, and facilitating participation. There were significant differences in the level of interest in education-related faculty development activities by academic rank and by the college of appointment. Full professors expressed somewhat less interest in faculty development activities than faculty members of lower ranks. Faculty members in the Colleges of Medicine and Dentistry expressed somewhat greater interest in faculty development to improve traditional teaching skills. The policy implications of the survey results are discussed, including the need for faculty development activities that target the needs of specific faculty groups.

Tennessee smiles: the UT grassroots oral health outreach initiative

Access to and awareness of oral healthcare in the United States have been highlighted in the mass media and discussed among diverse populations. The current surge to provide access to oral healthcare for citizens springs from this quagmire of oral healthcare issues which affects global to local (grassroots) communities. Publications by the World Health Organization's (WHO) Health for All and the United States' Healthy People have set into motion an agenda by which institutions, healthcare professionals and governments can develop action plans to foster and nurture grassroots organizations to address these issues. An initiative has been undertaken by members of the faculty, student doctors and staff of the University of Tennessee Health Science Center, College of Dentistry (UTHSC CoD) and its partners. This cadre of volunteers has implemented grassroots efforts for the citizens of western Tennessee to date as the flagship of Tennessee Smiles: UT Grassroots Oral Health Outreach Initiative (Tennessee Smiles). By participation in health fairs, school programs and other cultural events, these volunteers have made a difference in the lives of thousands of Tennessee citizens who need exposure to information regarding their oral health care needs. The authors discuss the basis for the Tennessee Smiles organization, their successes and challenges. Future plans and the need for support of the organization are emphasized.

Computer-assisted learning and simulation lab with 40 DentSim units

There are an increasing number of studies about the computer-assisted dental patient simulator DentSim (DenX, Israel), by which dental students can acquire cognitive motor skills in a multimedia environment. However, only a very few studies have been published dealing with efficient ways to use and to manage a computer-assisted dental simulation lab with 40 DentSim units. The current approach and optimization steps of the College of Dentistry at the University of Tennessee Health Science Center were evaluated based on theoretical and practical tests and by questionnaires (partial 5-point Likert scale). Half of the D1 (first-year) students (2004/05) already had experience with computer-assisted learning at their undergraduate college and most of the students even expected to be taught via computer-assisted learning systems (83.5%) at the dental school. 87.3% of the students working with DentSim found the experience to be very interesting or interesting. Before the students carried out the preparation exercises, they were trained in the skills they needed to work with the sophisticated technology, eg, system-specific operation skills (66.6% attained maximal reachable points) and information searching skills (79.5% attained maximal reachable points). The indirect knowledge retention rate / incidental learning rate of the preparation exercises in the sense of computer-assisted problem-oriented learning regarding anatomy, preparation procedures, and cavity design was promising. The wide- ranging number of prepared teeth needed to acquire the necessary skills shows the varied individual learning curves of the students. The acceptance of, and response to, additional elective training time in the computer-assisted simulation lab were very high. Integrating the DentSim technology into the existing curriculum is a way to improve dental education, but it is also a challenge for both teachers and the students. It requires a shift in both curriculum and instructional goals that have to be reevaluated and optimized continuously.

Evidence-based dentistry resources for dental practitioners

The American Dental Association has taken an active role in support of an evidence-based approach to the practice of dentistry. This concept integrates clinically relevant scientific evidence into a clinician's decision-making process, along with the patient's oral and medical history, the dentist's own expertise and the patient's treatment needs and preferences. The purpose of this article is to assist dentists in locating and retrieving quality research reports and research evidence which can be integrated into the clinical decision making process. The research methodologies which constitute the foundation of evidence-based dentistry are described. The advantages and disadvantages associated with literature that summarizes research, such as the literature review, the systematic review and meta-analysis are described. Evidence-based resources for dentists are described, such as journals specializing in an evidence-based approach, online resources such as PubMed and the Cochrane Collaboration.

The relationship between gender and postgraduate aspirations among first- and fourth-year students at public dental schools: a longitudinal analysis

The purpose of this study was to examine gender differences and other predictors of postgraduate plans among U.S. dental students. A national sample of dental students was surveyed in their first and fourth years of dental school. Female first-year students were less likely than male students to express interest in specialization in endodontics and oral surgery. Fourth-year students who had a dental school mentor, a high GPA, and encouragement from significant others were more likely to apply for postgraduate training. Gender and first-year interest in dental specialization did not affect the likelihood of applying for postgraduate training in the fourth year. Female fourth-year students were more likely to predict that they would be an associate in a practice five years following graduation. The results suggest that mentoring and faculty encouragement are important influences on dental students' plans for postgraduate education.

Using the DISC system to motivate dental patients

BACKGROUND

Dentists report that motivating patients to accept treatment plans and adopt behaviors that will improve their oral health is a significant challenge in their practices. According to the DISC system, which was developed by William Moulton Marston, people can be classified as having a "dominant" (D), "influencing" (I), "steady" (S) or "cautious" (C) behavioral style. Dentists and dental team members who recognize patients' DISC styles and tailor their communication accordingly may have greater success in motivating patients.

CONCLUSIONS

Practitioners cannot classify all patients easily into one of the four DISC styles, and patients may have multiple reasons for rejecting treatment plans and resisting behavioral changes. However, the DISC system provides a set of useful principles for motivating many patients. Practice Implications. The benefits of using the DISC system may include an increase in the rate of treatment plan acceptance and an improvement in patients' behavior necessary for optimal oral health.

A comparison of 3 routes of flumazenil administration to reverse benzodiazepine-induced desaturation in an animal model

PURPOSE

The purpose of this study was to examine intralingual (IL) and submucosal (SM) delivery offlumazenil as viable alternatives to immediate intravenous (IV) administration for reversing benzodiazepine sedation in an animal model.

METHODS

A dog animal model was chosen based upon comparable body weight to children (12-17 kg) and the ease of oral access in this species. Research design was a nonrandomized matched pair study. This type of "before-and-after study" allowed the dogs to receive 3 different routes of flumazenil administration (IV, IL, and SM) following an initial dose of midazolam (0.5 mg/kg IV). Blood samples were obtained (at 0, 2, 4, 8, 15, and 30 minutes) for high performance liquid chromatography (HPLC) analysis of flumazenil and midazolam, and oxygen saturation values were recorded.

RESULTS

Both IL and SM delivery of flumazenil were determined to be viable alternatives to immediate IV administration for reversing benzodiazepine-induced oxygen saturation (SaO2) desaturation. For flumazenil to be able to reverse the SaO2 desaturation, the plasma levels must be greater than 5 ng/ml, which was exceeded by IL and SM drug delivery.

CONCLUSION

In a benzodiazepine-induced desaturation, the submucosal and intralingual routes are viable alternatives to intravenous administration of flumazenil in an animal model.

Profiling gingival crevicular fluid from smoking and non-smoking chronic periodontitis patients

BACKGROUND

Smoking is a major risk factor for the development and progression of chronic periodontitis (CP). Gingival crevicular fluid (GCF) derived from these patients contains many proteins that could serve as important diagnostic indicators. A protein chip technology called Surface Enhanced Laser Desorption/Ionization-Time of Flight-Mass Spectrometry (SELDI-TOF-MS) has recently been developed to facilitate protein profiling of complex biological mixtures. The hypothesis to be tested was SELDI-TOF-MS could distinguish between GCF of CP patients by smoking status and pocket depth.

METHODS

GCF samples collected before treatment from sixteen CP patients (eight smokers and eight non-smokers) at both shallow and deep sites were evaluated by SELDI-TOF-MS. Spectral fingerprints were constructed for both cohorts and analyzed by a two-way ANOVA according to smoking status and pocket depth. Significance threshold was set at p < 0.05. Mean molecular weight (MW) peaks and intensities were also analyzed.

RESULTS

The spectral fingerprints were significantly different between the two cohorts when analyzed by ANOVA according to smoking status (p < 0.0001) but not pocket depth (p = 0.9876). Also, the mean intensity of many individual MW peaks were determined to be significantly different between the two cohorts. Several peaks ranging in MW from 11-14 kDa were only detected in the GCF obtained from smokers.

CONCLUSIONS

This study has demonstrated that profiling of GCF by SELDI-TOF-MS can distinguish between CP smokers and non-smokers. Moreover, over-expressed proteins in GCF from smokers may serve as biomarkers for this high risk patient population.

Comparison of the Hydrabrush powered toothbrush with two commercially-available powered toothbrushes

INTRODUCTION

An examiner-blinded, randomized, parallel, three-cell, controlled clinical trial was conducted to compare the efficacy of a new powered toothbrush (Hydrabrush) to that of two presently marketed power brushes (Oral-B and Sonicare) in reducing stain, supragingival plaque, gingivitis and the signs of periodontitis while monitoring safety.

METHODS

One hundred ten subjects were randomly assigned to three groups (35--Oral-B group, 36--Sonicare group, and 39--Hydrabrush group). Subjects were instructed to use the assigned powered toothbrush according to the manufacturer's instructions for 2-minutes duration twice per day. Clinical examinations conducted at baseline and at weeks 4, 8, and 12 included the following parameters: (1) oral tissues; (2) staining; (3) plaque index; (4) gingivitis; (5) probing depth; (6) clinical attachment loss; and 7) bleeding on probing.

RESULTS

The results showed that the body intensity and extent of stain and the gingival intensity and extent of stain at 8 and 12 weeks, respectively, were significantly less in the Hydrabrush group compared with the Sonicare group. The modified gingival index (MGI) in all groups significantly decreased over the 12 weeks. However, the groups did not differ from each other statistically. At 4, 8 and 12 weeks, the Hydrabrush group had statistically significantly less plaque than the Sonicare group. At 4 weeks, the Hydrabrush group had statistically significantly lower mean probing depth than both the Oral-B and Sonicare groups. At 8 and 12 weeks, the Hydrabrush group had statistically significantly lower mean probing depths than the Sonicare group. With regard to mean percentage of sites with probing depth > or =4 mm, the Hydrabrush group had statistically significantly fewer sites > or =4 mm at 4, 8 and 12 weeks. Differences among the groups in clinical attachment loss at 4, 8 and 12 weeks were representative of small imbalances at baseline. No differences were seen among the treatment groups with regard to gingival recession and bleeding on probing.

CONCLUSIONS

With the exception of clinical attachment loss, all subject groups were balanced for all measured clinical parameters at baseline. Tooth stain became significantly less in the Hydrabrush group compared with the Sonicare group at 8 and 12 weeks. At all examinations, the Hydrabrush group had statistically significantly less plaque than the Sonicare group. At 4 weeks, the Hydrabrush group had statistically significantly lower mean probing depth than both the Oral-B and Sonicare groups, and at 8 and 12 weeks, the Hydrabrush group had statistically significantly lower mean probing depth than the Sonicare group. With regard to mean percentage of sites with probing depth > or =4 mm, the Hydrabrush group had statistically significantly fewer sites > or =4 mm when compared to the other two tested brushes at all examinations. No differences were seen among the treatment groups with regard to gingival recession and bleeding on probing and none of the tested brushes caused any adverse reactions.

Augmented transforming growth factor-beta1 in gingival crevicular fluid of smokers with chronic periodontitis

BACKGROUND

Patients who smoke are at increased risk for chronic periodontitis (CP). Also, CP patients who smoke exhibit significantly less reduction of probing depths and gains in clinical attachment compared to non-smokers following periodontal therapy. Several studies suggest that the effects of smoking on the host response may be paramount in regulating the basal systemic inflammatory status and therapeutic outcomes in this cohort. Growth factors, specifically transforming growth factor beta1 (TGF-beta1), are critical in regulating the wound healing response by controlling cell division, differentiation, and motility. The hypothesis to be tested was that gingival crevicular fluid (GCF) TGF-beta1 production was altered in smokers compared to non-smokers with CP.

METHODS

GCF was collected from smokers and non-smokers with CP, both at baseline and 1 to 2 weeks after initial therapy. GCF volume was determined using an electronic device and TGF-beta1 concentration was measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS

Smokers exhibited a higher mean concentration of GCF TGF-beta1 at baseline compared to non-smokers (P = 0.03). After initial therapy, smokers exhibited significantly less reduction in mean GCF volume compared to non-smokers (P = 0.04).

CONCLUSIONS

Augmented constitutive production of GCF TGF-beta1 in smokers may explain the clinical appearance of fibrotic gingival tissue exhibited by this patient cohort. A diminished reduction in GCF volume in smokers following root instrumentation suggests a chronic inflammatory status in conjunction with an ineffective host response. These findings support the concept that smokers with CP display an altered local inflammatory response after initial therapy, perhaps symptomatic of colonization by residual periodontal pathogens.

Enhancing relationships among dental team members: the application of research on marital interaction

BACKGROUND

Despite some important differences, relationships among dental team members bear striking similarities to marital relationships. Empirical research on marital interaction can be useful in enhancing relationships among dental team members.

CONCLUSIONS

As with marriage, it is unrealistic to expect that conflict and differences of opinion will never occur among dental team members. However, a set of principles derived from extensive, empirical, behavioral science research on marital interaction can provide dental teams with strategies for strengthening working relationships and managing conflict.

PRACTICE IMPLICATIONS

Benefits of using these principles may include a reduction in employee turnover, improvements in efficiency and productivity, and the creation of an environment that helps attract and retain patients.

In vitro evaluation of color change in maxillofacial elastomer through the use of an ultraviolet light absorber and a hindered amine light stabilizer

STATEMENT OF PROBLEM

External prostheses composed of silicone elastomers exhibit an unwanted color change over time.

PURPOSE

This study evaluated color stability when an ultraviolet light absorber and hindered amine light stabilizer were mixed in the maxillofacial elastomer containing either organic or inorganic pigments.

MATERIAL AND METHODS

The materials used were an RTV silicone elastomer, 1 natural inorganic dry-earth pigment (burnt sienna) and 2 synthesized organic pigments (hansa yellow and alizarin red), ultraviolet light absorber (UVA) and hindered amine light stabilizer (HALS). Specimens (n=160) were fabricated in a custom mold and randomly assigned and exposed to weathering sites in Miami and Phoenix for approximately 3 months. Eight test groups (2 of each 4 material types with or without additives) of 10 specimens each were assigned to each site. L*, a*, b* readings were obtained before and after weathering from a spectrocolorimeter. Nonpigmented elastomers served as the control. Three-factor ANOVA was conducted to examine interaction effects between weathering sites, specimen type, and the presence of additive (alpha=.05). Overall color change (Delta E) and change in color coordinates (Delta L*, Delta a*, Delta b*) of specimen groups with and without additive were analyzed with independent sample t tests.

RESULTS

In specimen groups with the additives (UVA and HALS), color change decreased significantly (P<.05) in burnt sienna and hansa yellow in Phoenix and in the control and hansa yellow in Miami. Additives did not affect color change in the alizarin red group.

CONCLUSION

UVA and HALS were shown to be effective in retarding color change in some circumstances.

Comparison of the Use of a Toothpick Holder to Dental Floss in Improvement of Gingival Health in Humans

BACKGROUND

Although advances have been made in modulation of host inflammatory response in periodontal therapy, it is important to control the bacterial challenge to the host immune system through conventional therapy and improvement of personal oral hygiene. Although toothbrushing is generally performed, interdental cleaning is not as common. This study compared the use of dental floss to a toothpick holder in the improvement of gingival health.

METHODS

Participants were examined and those with clinical gingivitis or slight chronic periodontitis were included in the study. O'Leary plaque, interproximal plaque index (IPI), and Eastman interdental bleeding index scores (EIBI) were recorded at baseline and following appointments. Forty-two females and 13 males ranging from 18 to 50 years in age were randomly divided into either a dental flossing group or toothpick holder using group. Each was given instructions in the use of the oral hygiene device and examined 2, 6, and 12 weeks following baseline. At 12 weeks, 27 floss users and 20 toothpick-holder users completed the study.

RESULTS

Plaque scores were reduced in both groups as the study progressed. Mean O'Leary plaque scores decreased significantly for both methods from baseline to week 12 (P < 0.05). The EIBI and IPI scores decreased in mean scores over time for each method (P < 0.05). A correlation was found between the O'Leary plaque index and the IPI scores (P < 0.05).

CONCLUSION

The results of this study found that the use of dental floss or toothpick holder resulted in no significantly different effect in the improvement of gingival health.

In vitro deformation of acetyl resin and metal alloy removable partial denture direct retainers

STATEMENT OF THE PROBLEM

Acetyl resin removable partial denture (RPD) direct retainers may provide an esthetic alternative to conventional metal direct retainers. The effect of repeated stress on acetyl resin direct retainers is unknown.

PURPOSE

This study compared deformation of acetyl resin and metal alloy RPD direct retainers after repeated dislodgments over a test die.

MATERIAL AND METHODS

Ten acetyl resin (Thermoflex) and 10 metal alloy (Ticonium Premium 100) RPD direct retainers, fabricated to manufacturers' specifications, were dislodged over a stainless steel die by means of a laboratory test apparatus for a simulated 3-year period (5000 cycles). Occlusal and facial digital images made before and after cycling were measured (mm) for direct retainer deformation by using computer-imaging software (Scion Image 1.62). Student t tests (alpha=.05) were performed for statistical comparisons.

RESULTS

A significant difference in deformation between acetyl resin and metal alloy direct retainers occurred in the occlusal view (P=.045), but not in the facial view (P=.832). Average deformation varied but was greatest in the occlusal view: 0.09 +/- 0.8 mm for acetyl resin direct retainers compared with 0.01 +/- 0.9 mm for metal alloy direct retainers. Average facial view deformations revealed no significant differences: 0.039 +/- 0.6 mm for metal alloy and 0.033 +/- 0.7 mm for acetyl resin direct retainers.

CONCLUSION

Within the limitations of this in vitro study, significantly greater deformation resulted with acetyl resin compared with metal alloy direct retainers after 3 years of simulated use.

Effect of surface roughness of cavity preparations on the microleakage of Class V resin composite restorations

This study determined whether surface roughness of the internal walls of a Class V resin composite preparation, using a carbide bur, a medium-grit diamond bur and a fine-grit diamond bur, affected the degree of microleakage of the restoration. The facial and lingual surfaces of 45 non-carious extracted human molars provided 90 samples for evaluation. The specimen surfaces were assigned randomly in equal numbers to one of three groups (n = 30). Conservative Class V composite preparations were made using one of three different burs: a 330-carbide bur, a 330 fine-grit diamond bur or a 330 medium-grit diamond bur (Brasseler USA). After acid etching, PQ1 (Ultradent Products Inc) primer/bonding resin and Vitalescence (Ultradent Products Inc) were applied and cured following the manufacturers' instructions. After minor finishing, the apices of all root surfaces were sealed with Vitrebond (3M), and the unprepared external surfaces were sealed with nail polish to within 1 mm of the restoration margins. The specimens were stored in distilled water at room temperature for 24 hours, then subjected to 1,200 thermocycles at 5 degrees C and 55 degrees C with a 30-second dwell time. After cycling, the teeth were immersed in a 5% solution of methylene blue dye for 12 hours. The molars were invested in clear acrylic casting resin, labeled, then sectioned once vertically approximately midway through the facial and lingual surfaces using a diamond coated saw blade. Microleakage was evaluated using a 10x microscope for the enamel and cementum surfaces and blindly scored by two independent examiners. In all cases, regardless of the examiner, at both the enamel and the dentin margins, the analysis revealed no statistically significant differences in microleakage across bur types. Further results show that dentin margins leaked significantly more than enamel margins for all bur types.

Gender differences in first-year dental students' motivation to attend dental school

Women's role in the field of dentistry has historically been limited to the dental auxiliary fields, rather than that of D.D.S. or D.M.D. Today, women are nearly 38 percent of U.S. dental school students and 14 percent of active practitioners. The slow(er) influx of women into dentistry has been little studied by dental educators. During the 2000-01 academic year, we conducted a survey of first-year dental students at a sample of publicly funded U.S. dental schools. The purpose of the survey was to assess gender differences in motives for pursuing a dental career. The data show that male dental students rate self-employment and business-related motives as more important, while female dental students rate people-oriented motives more highly. Factor analysis revealed four distinct clusters of motives for pursuing a dental career: a financial motive, a business-oriented motive, a people-oriented or caring motive, and a flexibility motive. Women scored significantly higher than men on the caring factor, whereas the reverse was true on the business factor. Male and female students rated financial and flexibility motives equally. The implications of the results for attracting students to the profession of dentistry are discussed.