Dental therapy in the United States: Are developments at the state level a reason for optimism or a cause for concern?

Access to dental care continues to be a challenge for millions of vulnerable Americans. In more than 50 nations worldwide, dental therapists (DTs), mid-level providers who deliver a limited scope of dental care under the supervision of a dentist, have helped increase access to needed care. Since 2003, when the Alaska Native Tribal Health System introduced DTs as part of the Federally authorized Alaska Community Health Aide Program, a total of 13 states have adopted the role. However, as of April 2020, there are fewer than 150 DTs in practice throughout the country, and educational and licensing requirements as well as scope of practice vary between each state. Such heterogeneity makes the training and recruitment of future DTs a challenge. This article summarizes the current state of the DT workforce in the United States and discusses the possible future of the profession as other states contemplate adopting the model in the face of ongoing oral health disparities.

Pain Management for Dental Medicine in 2021: Opioids, Coronavirus and Beyond

Over the past year our attention has inevitably been on the coronavirus pandemic, the health and welfare of our families, patients, and office staffs as well as the re-opening of our dental practices. In addition, the opioid crisis continues, is very likely to worsen as a result of the pandemic and continues to be a challenge to Dentistry. National public health issues and healthcare disparities continue and have created a global concern for providing evidence-based, adequate pain management in the dental setting. We have brought together a group of national thought leaders and experts in this field who will share their insights on the current state of opioid prescribing in Dentistry and describe some of the exciting work being done in advancing pain management. The learning objectives for this conference proceedings were: Describing the implications of current public health concerns for safe and effective pain management in dental medicine.Identifying risk factors and understanding the current guidelines for the use of opioid and non-opioid medications in dental medicine.Analyzing the interprofessional collaborations necessary for effective pain management in dental medicine.Recognizing the challenges and opportunities brought about by the COVID-19 pandemic for the dental profession.Applying evidence-based strategies for managing the complex pain patient in the dental setting.Appraising new and future modalities for the assessment and management of orofacial pain.

How US dental schools can better prepare their students to perform operative procedures

OBJECTIVE

The aim of this study was to characterize the curricular and supplemental resources used by dental students during their operative dentistry course, survey students' perception of each resource's "helpfulness," and assess students' perceptions of preparedness to perform operative dental procedures in clinical settings.

METHODS

American Student Dental Association delegates at all accredited dental education programs in the United States were asked to forward an email to students enrolled at their respective institutions explaining the purpose of the study and asking them to fill out our survey. The response rate was calculated using the targeted enrollment data found in American Dental Education Association Official Guide to Dental Schools.

RESULTS

A total of 715 qualified respondents completed our questionnaire for a response rate of 13.5%. 90% of students felt at least "moderately prepared" to perform operative procedures in the clinical environment. The 3 most common curricular resources provided to students were lecture slides (n = 707, 99%), live lectures (n = 664, 93%), and live faculty demonstrations (n = 547, 77%). YouTube was the most common supplemental resource utilized by students (n = 575, 80%). When asked to select which resources were the most helpful for their learning, 49% (270/547) selected live faculty demonstrations, 27% (153/575) selected YouTube videos, and 23% (155/664) selected lectures/lecture slides.

CONCLUSION

To best meet the expectations of the current generation of dental students and to prevent early-stage dental learners from being influenced by clinical misinformation online, dental schools should consider adapting and producing more online, video-based learning resources for their curricula.

Oral health care in the 21st century: It is time for the integration of dental and medical education

Major issues exist in the provision of oral health care in America, especially to underserved populations. Access to care, health disparities, an aging population with higher chronic disease burden, and rising healthcare costs continue to impact health outcomes for millions. The marginalization of oral health care, like that of behavioral health care, is a contributor. This perspective presents an idea whose time has come: putting the mouth back in the body. Several national reports stress the imperative to better integrate the practice of medicine and dentistry, including the first-ever Surgeon General's Report on Oral Health in 2000. A plan to lead a multifaceted integration of oral health into overall health is proposed. Leaders will come from new educational and practice models stressing teamwork, interprofessional education, innovative residency training programs and even dual degree options.

Massachusetts Dental Schools Respond to the Prescription Opioid Crisis: A Statewide Collaboration

The prescription opioid crisis has involved all sectors of U.S. society, affecting every community, socioeconomic group, and age group. While federal and state agencies are actively working to deal with the epidemic, medical and dental providers have been tasked to increase their awareness of the issues and consider ways to safely prescribe opioids and, at the same time, effectively treat their patients' pain. The Commonwealth of Massachusetts, under the leadership of Governor Charles D. Baker and his administration, challenged the state's four medical schools and three dental schools to improve their curricula to prepare the next generation of clinicians to deal with this crisis in an evidence-based, effective, and sympathetic way. This Perspectives article outlines the national prescription opioid crisis, details its effects in Massachusetts, and describes the interdisciplinary collaboration among the Commonwealth, the three dental schools, the Massachusetts Dental Society, and a concerned student group. The article also describes the efforts each dental school is undertaking as well as an assessment of the challenges and limitations in implementing the initiative. The authors hope that the Massachusetts model will be a useful resource for dental schools in other states.

WITHDRAWN: Health Policy Research May Ensure the Future of Oral and Maxillofacial Surgery

The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.joms.2017.03.056. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Should Dental Schools Train Dentists to Routinely Provide Limited Preventive Primary Medical Care? Two Viewpoints: Viewpoint 1: Dentists Should Be Trained to Routinely Provide Limited Preventive Primary Care and Viewpoint 2: Dentists Should Be Trained in Primary Care Medicine to Enable Comprehensive Patient Management Within Their Scope of Practice

This Point/Counterpoint acknowledges the transformation of dental practice from a predominantly technically based profession with primary emphasis on restoration of the tooth and its supporting structures to that of a more medically based specialty focusing on the oral and maxillofacial complex. While both viewpoints accept the importance of this transformation, they differ on the ultimate desired outcome and how changes should be implemented during training of dentists as oral health professionals. Viewpoint 1 argues that, in response to a shortage of both primary care providers and access to affordable oral health care, dentists need to be able and willing to provide limited preventive primary care (LPPC), and dental educators should develop and implement training models to prepare them. Among changes proposed are consideration of three types of practitioners: oral physicians with sufficient training to provide LPPC; dentists with excellent technical proficiency but minimal medical and surgical training; and mid-level providers to provide simple restorative and uncomplicated surgical care. Viewpoint 2 argues that the objective of dentists' education in primary care medicine is to help them safely and effectively provide all aspects of oral health care, including appropriate preventive medical care, that already fall within their scope of knowledge and practice. Dental educators should encourage students to use this knowledge to take full ownership of non-tooth-related pathologic conditions of the oral and maxillofacial complex not currently managed in the dental setting, but encouraging graduates to expand into non-dental LPPC outside the recognized scope of practice will only further exacerbate fragmentation of care.

The Impact of Integrating Oral Health Education into a Medical Curriculum

OBJECTIVE

The purpose of this study was to evaluate our pilot program incorporating oral health education into the medical curriculum by evaluating students' perspectives on the oral health curriculum.

SUBJECTS AND METHODS

Two hundred second-year students were asked to fill in a presession survey online regarding their familiarity with basic oral health concepts and their comfort level with performing oral examinations, and a postsession survey on paper that repeated the presession questions and added questions on the effectiveness of the session.

RESULTS

Of the 200 students, 164 (82%) participated in the surveys. The pre- and postsurvey results showed that the session helped students become more comfortable with performing oral examinations and recognizing risks for periodontal disease, with an increase from 40 (27%) to 119 (82%) and 51 (35%) to 124 (86%), respectively.

CONCLUSION

In this study, the oral health education session contributed to an increase in student awareness and understanding of oral health. Considering the reported effectiveness of the interactive session on student comfort with performing a basic clinical examination, this model shows promise for further use in other institutions.

U.S. Dental School Deans' Views on the Value of Patient-Reported Outcome Measures in Dentistry

There has historically been limited development and utilization of patient-reported outcome measures (PROMs) in clinical dentistry. However, in recent years PROMs have been recognized by other health care fields as valuable in the comprehensive assessment of patient outcomes. The aim of this study was to survey deans of U.S. dental schools to better understand their vision for the role of PROMs in the field of dentistry. A 13-question online survey was emailed to the deans of the 64 accredited U.S. dental schools at the time to gather their opinions about the value of patient-reported outcomes in dentistry. The survey consisted of questions in 12 domains such as treatment planning, perceived success/complications of surgery, identification/management of dental pain, psychological and oral function, and insurance payment/reimbursement. Of the 64 deans, 33 responses were received (51.5% response rate), but three surveys were excluded due to incomplete answers, resulting in a final response rate of 46.8%. All respondents reported there was value in utilization of PROMs for understanding a patient's satisfaction of a procedure, a patient's perceived success of dental surgery, identifying dental pain, and managing dental pain. However, there was disagreement among the respondents about utilization of PROMs for the purpose of determining insurance payment and/or reimbursement. Additional steps should be taken to develop clinically appropriate PROMs for dentistry and to determine the appropriate situations in which to use dental PROMs. This study suggests that PROMs should be incorporated into dental school curricula as they will likely play a role in future comprehensive treatment assessment.

A New Integrated Oral Health and Primary Care Education Program in the Dental Student Clinic

OBJECTIVES

The purpose of the study was to describe the implementation of a new program incorporating primary care education into a predoctoral dental curriculum in the StudentTeaching Clinic at Harvard School of Dental Medicine (HSDM) using the primary care rotations for students in a dental setting as a platform for change in our approach to patient care.

METHODS

A survey of perspectives on the need for primary care medicine in dental education was distributed to all the deans of Commission on Dental Accreditation (CODA)-accredited dental schools in the continental United States for a total of 65 eligible schools.

RESULTS

Of the 27 responses from the dental school deans, a majority of dental schools already had interprofessional collaborative practices at their schools, with collaborations with physicians and nurse practitioners being most common. Ninety-six percent of responders were supportive of integrating oral health and primary care to improve patient care and regarded primary care training for dental students as a potential method of improving patient care in dental education.

CONCLUSION

As patient care involves multidisciplinary and interprofessional environments with a wide array of health care providers, curricular directions for dental school should explore an education model that incorporates the concepts of primary care medicine.

Ultrasonographic pilot study of mental foramen size, with and without postoperative neurosensory dysfunction

OBJECTIVES

To evaluate the ability of a portable ultrasound system to visualize the mental foramen in patients with unilateral neurosensory dysfunction after third molar removal.

STUDY DESIGN

In 20 patients, an ultrasound scanner (13 MHz linear-array transducer) was used to measure the mental foramen. The anteroposterior diameter was calculated on both sides, and differences between injured and contralateral sides were tested. Intrarater and interrater reliability were calculated using Intraclass Correlation Coefficient (ICC).

RESULTS

We found a relatively high reliability on interindividual observations (ICC ≥0.89) and intraindividual observations (ICC ≥0.76). The average diameter on the injured sides was significantly smaller than the control sides. Subjective sensibility was not significantly correlated to the dimension of the mental foramen.

CONCLUSION

The results indicate a reduced size of the mental foramen, as determined by ultrasonography, in patients with permanent neurosensory dysfunction. These findings have to be verified in a larger number of patients.

Marital status and head and neck cancer outcomes

BACKGROUND

The objective of this study was to examine the effects of marital status on stage at presentation, receipt of treatment, and survival in patients with head and neck cancer (HNC).

METHODS

The Surveillance, Epidemiology, and End Results database was used to analyze 51,272 patients who were diagnosed with HNC from 2007 to 2010. The impact of marital status on cancer stage at presentation, receipt of definitive treatment, and HNC-specific mortality (HNCSM) was determined using multivariable logistic and Fine and Gray competing-risks regression models, as appropriate.

RESULTS

Marriage had a protective effect against metastatic presentation of oral and laryngeal cancers (oral cancer: adjusted odds ratio [AOR], 0.72; 95% confidence interval [CI], 0.60-0.87; P < .001; laryngeal cancer: AOR, 0.53; 95% CI, 0.42-0.67; P < .001) but not against oropharyngeal, hypopharyngeal, or nasopharyngeal cancers. Among patients with nonmetastatic disease, married patients were more likely to receive definitive treatment (overall AOR, 1.77; 95% CI, 1.60-1.95; P < .001) and had a lower risk of HNCSM (overall adjusted hazard ratio, 0.72; 95% CI, 0.68-0.77; P < .001); these associations remained significant across all HNC sites.

CONCLUSIONS

Among patients with oral and laryngeal cancers, those who are married are less likely to present with metastatic disease. In addition, married patients are more likely to receive definitive treatment and less likely to die from HNC across all HNC sites. This suggests that spousal support may have a role in the surveillance of visual and symptomatic HNC types and leads to higher rates of treatment and better survival across all HNC sites.

Impact of African-American race on presentation, treatment, and survival of head and neck cancer

OBJECTIVES

To determine the associations between African American race and stage at diagnosis, receipt of definitive therapy, and cancer-specific mortality among patients with head and neck cancer.

MATERIALS AND METHODS

The Surveillance, Epidemiology and End Results (SEER) database was used to conduct a retrospective study on 34,437 patients diagnosed with head and neck cancer from 2007 to 2010. Multivariable logistic regression analyses were applied to determine the impact of race on cancer stage at presentation (metastatic vs. non-metastatic) and receipt of definitive treatment. Fine and Gray competing-risks regression modeled the association between race and head and neck cancer-specific mortality.

RESULTS

African Americans were more likely to present with metastatic cancer compared to non-African Americans (Adjusted Odds Ratio [AOR] 1.76; CI 1.50-2.07; P<0.001). Among patients with non-metastatic disease, African Americans were less likely to receive definitive treatment (AOR 0.63; CI 0.55-0.72; P<0.001). After a median follow-up of 19months, African Americans with non-metastatic disease were found to have a higher risk of head and neck cancer specific mortality (AHR 1.19; 95% CI 1.09-1.29; P<0.001).

CONCLUSION

African Americans with head and neck cancer are more likely to present with metastatic disease, less likely to be treated definitively, and are more likely to die from head and neck cancer. The unacceptably high rates of disparity found in this study should serve as immediate targets for urgent healthcare policy intervention.

Performance of dental students versus prosthodontics residents on a 3D immersive haptic simulator

This study evaluated the performance of dental students versus prosthodontics residents on a simulated caries removal exercise using a newly designed, 3D immersive haptic simulator. The intent of this study was to provide an initial assessment of the simulator's construct validity, which in the context of this experiment was defined as its ability to detect a statistically significant performance difference between novice dental students (n=12) and experienced prosthodontics residents (n=14). Both groups received equivalent calibration training on the simulator and repeated the same caries removal exercise three times. Novice and experienced subjects' average performance differed significantly on the caries removal exercise with respect to the percentage of carious lesion removed and volume of surrounding sound tooth structure removed (p<0.05). Experienced subjects removed a greater portion of the carious lesion, but also a greater volume of the surrounding tooth structure. Efficiency, defined as percentage of carious lesion removed over drilling time, improved significantly over the course of the experiment for both novice and experienced subjects (p<0.001). Within the limitations of this study, experienced subjects removed a greater portion of carious lesion on a 3D immersive haptic simulator. These results are a first step in establishing the validity of this device.

Perceptions and practices of U.S. dental schools regarding curriculum integrated format and traditional format licensure exams

The dental licensure exam in the United States has evolved over the past ten years, and two formats-the traditional format and curriculum integrated format-are now available for students to satisfy licensure requirements. The objective of this study was to examine the differences and relative merits of the two formats. A twenty-five-question survey was distributed to the fifty-seven U.S. dental schools at the time. The survey included both quantitative and discrete variables and followed a strategic sequential order. The first set of questions sought to determine what type of board preparatory/mock exam each dental school offered, and the next set of questions asked which licensure exam each school formally offered. The final questions were qualitative in nature and aimed to determine the school representatives' opinions about the curriculum integrated format versus traditional format. Of the fifty-seven schools contacted, thirty-seven agreed to participate (response rate=64.9 percent). Fourteen schools reported that they administer the traditional format only and twelve administer the curriculum integrated format only, while eleven offer both. Thirty-two schools offered mock board exams to their graduating students, and twenty-four of those said their mock exams were identical in format to the actual qualifying clinical exams offered at their institution. The respondents reported no significant advantage to preparing for the curriculum integrated format examination as compared to the traditional format examination with regards to number of clock hours taken from regular curriculum time. In reporting on this study, this article provides an overview of the relative advantages and disadvantages of the two examination formats used for the dental licensure process in the United States.

Lingual and inferior alveolar nerve injuries after third molar removal

Trigeminal nerve injury is a rare, but serious complication of a common procedure, which results in a clinically relevant problem that deserves attention. The emergence of microsurgical repair of trigeminal injury has provided clinicians with treatment options for patients who experience persistent neurosensory deficits. The area of microsurgical repair of trigeminal nerves is now in its adolescence. While great strides have been made in the field since its conception, it is certain that a new generation of oral and maxillofacial surgeons wil bring further progress to the field. In the future, better quantitative sensory testing methods, more accurate imaging modalities, and advances in surgical technique will certainly improve the management of patients with impacted third molars. As clinicians, every day we are confronted with the management of impacted third molars. It is important to evaluate each patient individually with an appropriate clinical and radiographic exam. Every patient should be informed of the relative risks and benefits of third molar removal and a joint decision should be reached between the clinician and patient regarding ideal treatment. However, even with ideal management, complications will occur. If a patient does present with signs of a nerve injury the clinician should carefully document the neurosensory deficit and monitor the patient over time. If the patient exhibits a significant sensory deficit for more than one month a referral for evaluation to a tertiary care center capable of surgical repair of the injury is recommended. The occurrence of a "trigger" or Tinel's like sign is improtant as an indication for surgery but may not occur for a month after injury.

A 10-year survey of US deans: trends, challenges, and mentoring in prosthodontics. Part 2

PURPOSE

Part 2 of this survey reports on the 2009 survey findings distributed to the deans of US dental schools. A national, electronic survey of 58 dental school deans was distributed by e-mail to evaluate an interest in specialty training, an interest in specialty training in prosthodontics, faculty shortage issues, predoctoral curriculum in prosthodontics, ideology regarding dental specialties, and the administrative position of prosthodontics within the schools.

MATERIALS AND METHODS

The survey data were transferred to an online spreadsheet program for statistical analysis (Key Survey, Inc. http://www.keysurvey.com, Braintree, MA). The opinions of dental school deans were viewed as legitimate indicators of change within predoctoral and postdoctoral prosthodontic education. Statistical analysis was carried out using Statistica Version 9.1 (Statsoft, Tulsa, OK).

RESULTS

Of the 58 deans, 42 deans responded, for a 72.4% response rate. Twenty-three deans reported an increase in the number of students seeking specialty training after dental school. Only three deans reported a decrease in those seeking specialty training. In the 2009 survey, 45% the deans responded that there was an increased interest in prosthodontics. One or more open faculty positions in prosthodontics existed at 24 (59%) of the dental schools, and 30 (71%) offered at least one incentive or a variety of incentives to recruit faculty. The 2009 respondents to the deans' survey revealed predoctoral student exposure to prosthodontists was high, and exposure to advanced education in prosthodontics students was low. A survey of internal school programs that might have an impact on an increased interest in prosthodontics revealed the presence of a predoctoral mentoring program for prosthodontics in 36 (88%) of the institutions. The clinical curriculum included treatment of a variety of cases including complex cases as defined by a diagnostic classification system. The 2009 survey respondents reported an increase in the number of schools where prosthodontics is a separate entity or department.

CONCLUSION

Deans reported an increased interest in prosthodontics in the 2009 survey. Open faculty positions in prosthodontics existed in the majority of dental schools, and most schools offered incentives to recruit faculty. The survey of deans found a very high level of exposure of dental students to full-time prosthodontists and a very low exposure level to students enrolled in advanced education in prosthodontics. The establishment of mentoring programs in prosthodontics was reported by most deans, and the predoctoral curriculum included treating complex cases. Most deans stated that dual-specialty training in prosthodontics and periodontics would be beneficial. The 2009 survey reported an increase in the number of departments of prosthodontics in US schools.

Does Early Repair of Lingual Nerve Injuries Improve Functional Sensory Recovery?

PURPOSE

This study evaluated the relationship between timing of lingual nerve repair and functional sensory recovery.

MATERIALS AND METHODS

Using a retrospective cohort study design, the investigators enrolled a sample of subjects who had lingual nerve repair. The predictor variable was time between injury and repair, categorized as early (<90 days after injury) or late (>90 days after injury). The outcome variable was the time to functional sensory recovery (FSR), measured in days. Other variables were categorized as demographic, anatomic, and operative. Uni- and multivariate Cox proportional hazards models were used to evaluate the association between the timing of the repair and time to FSR.

RESULTS

The study sample was composed of 64 subjects who had lingual nerve repair between January 1998 and January 2005. The mean time between injury and repair was 153.2 (31-1606) days; 21.9% of subjects had early repair. The mean age was 28.4 +/- 8.0 years, 62.5% of subjects were female; 77% of the injured nerves were repaired by direct suture, and 23% had surgical exploration with decompression/neurolysis. In bivariate analyses, early repair, method of repair, and neuroma were statistically or near-statistically associated with time to FSR (P <or= .12). In a multiple Cox proportional hazards model, early repair was associated with time to FSR (P = .02). Ninety-three percent of subjects in the early repair group achieved FSR within 1 year, compared with 62.9% in the late group (P = .05).

CONCLUSIONS

Early repair of lingual nerve injuries results in FSR more frequently and earlier than late repair.

Functional Sensory Recovery After Trigeminal Nerve Repair

PURPOSE

The aim of this study was to estimate the proportion of subjects who achieved functional sensory recovery (FSR) 1 year after inferior alveolar or lingual nerve repair and to identify risk factors associated with failure to achieve FSR.

METHODS

Using a retrospective cohort study design, we developed a sample composed of subjects who underwent lingual or inferior alveolar nerve repair. Eligible subjects had at least 1 postoperative visit. For subjects having bilateral nerve repair, 1 side was selected randomly for analysis. Predictor variables were categorized as demographic, anatomic, and operative. The outcome variable was the time to FSR, measured in days. Kaplan-Meier survival methods were used to estimate the proportion of subjects with FSR at 1 year. Uni- and multivariate Cox proportional hazard models were used to identify risk factors for the failure to reach FSR at 1 year.

RESULTS

The study sample was composed of 60 subjects with a mean age of 28.7 +/- 8.3 years; 68.3% were female. The majority (86.7%) of subjects presented with a preoperative chief complaint of altered sensation and had lingual nerve damage (93.3%) that was repaired by direct suturing (75%). The mean interval between injury and repair was 145.9 +/- 200.0 days. At 1 year postoperatively, 75% of the subjects had achieved FSR (95% confidence interval [CI]: 64% to 86%).

CONCLUSIONS

The majority of subjects undergoing trigeminal (V(3)) nerve repair achieved functional sensory recovery within 1 year of surgical repair. Patients with evidence of neuroma formation were less likely to achieve FSR at 1 year in a multivariate model.

A Comparison of Patient Satisfaction and Objective Assessment of Neurosensory Function After Trigeminal Nerve Repair

PURPOSE

The purpose of this study was to compare objective and subjective assessments of neurosensory function after trigeminal nerve repair.

METHODS

This was a retrospective cohort study using a sample of patients who underwent surgical repair of trigeminal nerve injuries. The primary study variables were categorized as objective or subjective. The objective variable was the change in neurosensory examination between preoperative and 1-year postoperative visits. Neurosensory status was measured using an ordinal scale ranging from anesthetic (0) to normal (4). Subjective variables included patient satisfaction with the nerve repair and patient assessment of injury-related oral dysfunction. Demographic, anatomic, and operative variables were also collected. Appropriate univariate and bivariate statistics were computed.

RESULTS

The sample was composed of 19 patients (14 female, 17 Caucasian) who had trigeminal nerve repair (17 lingual, 2 inferior alveolar). The mean duration between injury and repair was 4.5 +/- 2.3 months; between repair and postoperative assessment was 11.9 +/- 0.9 months. The mean change in neurosensory status was 1.3 +/- 1.0 levels. The majority of patients (63.1%) rated their satisfaction with the outcome of treatment as "good" to "excellent." There was a statistically significant correlation between change in neurosensory status and patient satisfaction (rho = 0.86; P < .01).

CONCLUSION

There is evidence of a strong correlation between improvement in the neurosensory examination following trigeminal nerve repair and patient satisfaction with the surgical outcome 1-year postoperatively. Patients who experience greater neurosensory improvement also report lower frequencies of related oral dysfunction.

Massachusetts General Hospital/Harvard Medical School MD oral and maxillofacial surgery program: a 30-year review

PURPOSE

The first resident enrolled in the Massachusetts General Hospital/Harvard MD Oral and Maxillofacial Surgery (MD/OMFS) program graduated from Harvard Medical School (HMS) in 1972. The purpose of this report is to provide a summary of the first 30 years of the program and to outline plans for its future.

MATERIALS AND METHODS

This was a retrospective cohort study and the sample was composed of the residents enrolled in the MD/OMFS program between 1971 and 2000. Study variables included the dental school from which the resident graduated, successful completion of the MD/OMFS program, performance on parts I and II of the United States Medical Licensing Examination/National Board of Medical Examinations (USMLE/NBME), HMS grades, and career trajectories (full- or part-time academic or private practice). Appropriate descriptive and bivariate statistics were computed for all study variables.

RESULTS

During the study interval, 56 residents entered the MD/OMFS program and graduated from HMS. All members of the cohort, regardless of the dental school from which they graduated, performed well as evidenced by USMLE/NBME scores and medical school grades. Ninety-four percent of eligible graduates have completed the American Board of Oral and Maxillofacial Surgery examination. The pass rate was 100%. Thirty-four graduates are involved in full- or part-time academic practice. Four trainees completed medical school but did not complete the OMFS program.

CONCLUSION

The overwhelming majority of trainees completed the program, became board certified, and currently practice OMFS or a related specialty. A disproportionate number entered academic careers.

A survey of information technology management at U.S. dental schools

The purpose of this project is to assess how information technology (IT) is being implemented and managed in U.S. dental schools. Recent advances in IT have restructured many of the administrative, curricular, and clinical functions in dental schools. Purchasing hardware and software and hiring personnel to maintain IT present significant financial and administrative commitments for these schools. A nine-question survey was sent to all U.S. dental schools via email with a follow-up postal mailing. Forty-six surveys were returned (83.6 percent response rate). The analysis indicates that dental schools are managing IT in vastly different ways. For example, 71 percent of the schools report a centralized structure, and 61 percent have a line item in the budget to manage IT. On average there are 4.4 full-time equivalents hired to manage IT, with the majority of these people being trained in IT (eight schools reported dually trained IT/dental personnel). The majority of schools report using software to manage their admissions process (70 percent), curriculum analysis (72 percent), and delivery of curriculum content (72 percent), as well as to manage their student clinics (91 percent, business aspect; 87 percent, patients; 65 percent, grading on clinic floor; 76 percent, managing clinical evaluations) and faculty practices (85 percent, business aspect; 65 percent, patients). The use of multimedia (50 percent) and simulation (52 percent) in the preclinical area is mixed. The purchase of laptops (24 percent) and PCs (11 percent) is required in almost a third of all schools participating in this survey. Dental schools in the United States are managing IT in a variety of different ways, using various internally and commercially available tools. The cost to institutions can be large and is usually handled in centralized structures in the school with fixed budgets. The results of this survey can be used to assist schools in the planning and implementation of IT at their institutions.

Patient satisfaction after trigeminal nerve repair

OBJECTIVE

The purpose of this study was to measure patient satisfaction and to evaluate the factors influencing patients' perceptions of the outcome of inferior alveolar nerve or lingual nerve repair.

STUDY DESIGN

We used a retrospective cohort study design and a sample of patients who underwent repair of inferior alveolar nerve or lingual nerve injuries. The major outcome variable was the patient's overall satisfaction with treatment. The patient's satisfaction was rated as either good to excellent (group A) or fair to poor (group B).

RESULTS

The study sample was composed of 46 patients with a mean age of 28 +/- 12 years; 76% were female. Fifty-five percent of the sample reported their overall satisfaction to be good to excellent. No individual predictor factors were statistically associated with patient satisfaction. Among the outcome variables, the measures of taste, pronunciation, self-consciousness, and function were statistically significantly different (P <.05) between the 2 groups.

CONCLUSIONS

After nerve repair, more than half of the patients rated their overall satisfaction with the operative results to be good to excellent.

Panoramic radiographic risk factors for inferior alveolar nerve injury after third molar extraction

PURPOSE

The purpose of this study was to estimate the association between specific panoramic radiographic signs and inferior alveolar nerve (IAN) injury during mandibular third molar removal.

PATIENTS AND METHODS

A case-control study design was used; the sample consisted of patients who underwent removal of impacted mandibular third molars. Cases were defined as patients with confirmed IAN injury after third molar extraction, whereas controls were defined as patients without nerve injury. Five surgeons, who were blinded to injury status, independently assessed the preoperative panoramic radiographs for the presence of high-risk radiographic signs. Bivariate analyses were completed to assess the relationship between radiographic findings and IAN injury. The sensitivity, specificity, and positive and negative predictive values were computed for each radiographic sign.

RESULTS

The sample was composed of 8 cases and 17 controls. Positive radiographic signs were statistically associated with an IAN injury (P <.0001). The presence of radiographic sign(s) had positive predictive values that ranged from 1.4% to 2.7%, representing a 40% or greater increase over the baseline likelihood of injury (1%) for the individual patient. Absence of these radiographic findings had a strong negative (>99%) predictive value.

CONCLUSIONS

This study confirms previous analyses showing that panoramic findings of diversion of the inferior alveolar canal, darkening of the third molar root, and interruption of the cortical white line are statistically associated with IAN injury. Based on the estimated predictive values, the absence of positive radiographic findings was associated with a minimal risk of nerve injury, whereas, the presence of one or more of these findings was associated with an increased risk for nerve injury.

The Gies Report and Research

In the eyes of the intellectually curious William Gies, dentistry and dental education in 1926 was mechanical, empirical, commercial, reparative, and isolated from other disciplines. The solution proposed in the Gies Report included making dental schools parts of universities and collaborative equals with medical schools, increasing full-time teachers, promoting graduate study, and especially, grounding dentistry in science. Early attempts by the American Dental Association to develop and support a research agenda floundered, and scholarship was left to the universities and the government, and more recently to commercial interests. To a disappointing extent, the separation of practice from science remains today as the technologies of the scientific spirit remain unfamiliar and vaguely threatening.

The nucleotide: DNA sequencing and its clinical application

Information determining cellular structure and function is contained in chromosomal DNA. Genes, regions of DNA encoding this information, are composed of specific sequences of nucleotides. DNA sequencing methods have been developed to identify these sequences. Even subtle alteration (or mutation) of these sequences can lead to many human syndromes and diseases. This article reviews 1) the structure of the nucleotide, 2) the methods of DNA sequencing, and 3) its recent clinical application in analysis of the nevoid basal cell carcinoma syndrome.

The gene: the polymerase chain reaction and its clinical application

Chromosomal DNA transfers and stores information regarding the structure and function of the cell. Genetic information, encoded within sequences of nucleotides that compose DNA, is grouped into functional units called genes. Genetic diseases are caused by changes in the chromosomal DNA, leading to a change in the quantity or function of the protein gene product. In the past, genetic diagnosis was limited by the availability of sufficient quantity and quality of DNA and the absence of an efficient amplification procedure. The polymerase chain reaction (PCR), an inexpensive, rapid, and accurate means of amplifying DNA, is already making a major contribution to the diagnostic sciences. PCR techniques have been widely used in diverse applications, including molecular analysis of microbial pathogens, inheritable diseases and syndromes, and neoplasms. The purpose of this article is to 1) Review gene structure and function, 2) review principles of PCR technology and its applications in molecular biology, and 3) discuss an experimental clinical application of PCR to identify novel infectious agents responsible for odontogenic infections.