bluuebunny/crossref_metadata_2025 huggingface dataset:
Tobacco use cessation curricula in the U.S. dental schools and dental hygiene programs
Authors: Fried JL , Rubinstein‐DeVore L
Published: June 2020

Tobacco‐related health problems are the most preventable forms of illness in the United States. By assuming proactive tobacco use cessation counseling roles, dentists and dental hygienists can help reduce the number of people who currently use tobacco. The literature reports that many oral health professionals feel unprepared to assume such roles. To help combat the problem of tobacco‐related illness and to help prepare dentists and dental hygienists to assume tobacco use cessation counseling roles, dental schools and dental hygiene programs need to develop appropriate didactic and clinical tobacco use cessation curriculum content. To date, there are limited national data addressing the extent of tobacco use cessation education in dental schools and dental hygiene programs. Studies of medical schools have revealed a need for increased curriculum content on tobacco use prevention and cessation. Further, tobacco use cessation training programs for medical students, practicing dentists, and dental hygienists have resulted in increased student and provider confidence when tobacco use cessation counseling roles were assumed. This study surveyed all dental schools and dental hygiene programs in the U.S. to determine if tobacco‐related curriculum content exists, and if so, to what extent. Variables addressed included allocated hours, subject content, scope, department responsible, workplace smoking policy, importance, and future curricular directions. Questionnaires were mailed to all dental hygiene program directors and dental school academic deans. Study findings suggest that dental and dental hygiene students receive limited tobacco use cessation education, and respondent schools have no immediate plans for curriculum change in this area.(ABSTRACT TRUNCATED AT 250 WORDS)
Do dentists have sufficient information about their patients to control infection?
Authors: Hazelkorn HM
Published: June 2020

This study examined dentists' knowledge of infection control, what dentists say they do to control infection, and what procedures they actually take to prevent the transmission of disease. A professional actor, obviously in need of dental care and playing the part of a patient, was sent to three groups of randomly selected dentists in general practice. The dentists were uninformed subjects who were debriefed about the research immediately after their part in the experiment was completed. The study found that dentists apparently know what they should do to protect themselves from contamination. However, very few dentists discussed HIV or AIDS while taking a pretreatment history of a new patient even if that patient was perceived to belong to a high‐risk group. The behavior of the dentists indicates a neglect of this important aspect of a thorough history, providing more evidence that emphasis on infection and infection control is necessary in the dental school curriculum and beyond. Unless dentists learn to fully understand what infections their patients may have, they take the chance of transmitting diseases to other patients as well as to themselves, their staff, and their families.
Discrimination training and formative evaluation for remediation in basic waxing skills
Authors: Knight GW , Guenzel PJ
Published: June 2020

In a quasi‐experimental design the “experimental” group (n = 6) received discrimination training and self‐evaluation exercises on four waxing projects and four handpiece projects over 13 hours. An equivalent “conventional” group (n = 7) received verbal feedback with models on seven waxing projects over 13 hours. Both groups took a posttest using plastic molars with two‐surface preparations to be restored in wax. In blind evaluations of final products, the experimental group outperformed the conventional group. Results demonstrate the efficiency and effectiveness of structured discrimination and self‐evaluation training in improving motor skills.
Trends in quality assurance in the dental profession
Authors: Marcus M
Published: June 2020

I have dealt with three questions concerning trends in quality assurance. In summary, we must ask ourselves whether the profession can develop methods for dealing effectively with dentists whose performance is found to be continually unsatisfactory. This may be achieved by making available effective tools for others to use in developing quality assurance systems. These tools will involve criteria and standards for services, appropriateness of treatment, measuring outcomes of care, and methods for assessing dental practices. This may involve working closely with consumer representatives to assist in gaining the consumer's point of view and incorporating it into the technology of quality assurance. Berwick, in a recent article in the New England Journal of Medicine, called for the application of a “Theory of Continuous Improvement” rather than the “Theory of Bad Apples.” His view is that we should examine the process itself and try to improve it rather than look for outliers or bad apples. His point of view is consistent with the concept of quality assurance I have been talking about. Quality assurance systems should assure quality by proper assessment, identifying strengths and weaknesses in the provision of care. The strengths should be reinforced and the weaknesses should be rectified. This necessitates positive communication between those who perform quality assurance and those who are being evaluated. It also assumes that the technology is appropriate, recommendations are reasonable and that, when changes are made, quality will improve. In order to make the theory of continuous improvement work, it should be consistent with financial incentives and professional values.(ABSTRACT TRUNCATED AT 250 WORDS)
Catching information technology by the tail for problem‐based learning
Authors: Vickers JD
Published: June 2020

While computer‐based resources are appealing, there is currently little evidence that they are superior to less expensive, traditional educational technologies and thus their introduction will be slow until we learn how to benefit from them. The lesson learned from the orientation of problem‐based learning is that communications aspects of the new technologies may be much more important and should be, at least currently, the focus of attention. Thus, rather than concerning ourselves with the tiger, since communications do not require particularly sophisticated equipment, the important approaches now appear to be to give students experience with the means to access and exchange information; with those skills they should be reasonably prepared to survive in the Information Age and take advantage of what technology has to offer in the future.
Issues in the dental care management of patients with bloodborne infectious diseases: an opinion survey of dental school seniors
Authors: Solomon ES , Gray CF , Gerbert B
Published: June 2020

This study revealed some significant findings concerning the views of dental school seniors. Through a series of questions, we determined the opinions that seniors had about treating patients with bloodborne infections and the way they regarded their professional responsibility to provide care to these patients. We were able to identify that the majority of seniors had knowingly treated patients with one of these diseases, and believed that they had a professional obligation to do so. The study showed that these future professionals were aware of the risks related to disease transmission and they had real concerns about those risks; nevertheless, they were prepared to accept their professional obligation to provide care to these individuals. More than half of the survey population was fearful of treating patients with these diseases, and over half indicated that they would not treat these patients given the choice. This fear was compounded by their presumption that other patients would not want to be treated by a dentist who provides care to HBV/HIV patients, and by the presumption of increased cost of infection control. More than three fourths of these dental seniors agreed that treatment of infected patients would place them at higher risk. Nevertheless, in the face of this perceived danger, 62 percent indicated that they were willing to treat these patients, 79 percent said that they were capable of treating them, and 76 percent acknowledged the responsibility of the profession to treat. Another finding of note involves the treatment of infected patients and the effect that treatment experience had on the seniors' attitudes.(ABSTRACT TRUNCATED AT 250 WORDS)
Psychology and decision making: modelling health behavior with multiattribute utility theory
Authors: Carter WB
Published: June 2020

The success of much of dental practice is linked to patient behavior. Understanding the issues that influence patients' decisions when they choose to not follow preventive or therapeutic dental recommendations is instrumental to improving adherence, and ultimately, to improving dental health outcomes. Multiattribute Utility Theory (MAU) provides a methodology for systematically exploring these issues. It is based on a well‐established body of knowledge in the psychological literature, and currently represents a state‐of‐the‐art model for predicting behavior and delineating potentially modifiable behavioral determinants. Two examples are presented to illustrate how MAU can be used in clinical settings. In the first example, MAU is used to identify key reasons why nearly 70 percent high‐risk patients did not obtain flu shots, a behavioral problem comparable to many confronted in dentistry. MAU correctly predicted the vaccination behavior of 82 percent of patients, and an intervention based on MAU findings nearly doubled vaccination rates. The second example used MAU to identify physician behaviors that influenced patients' satisfaction with an ambulatory care visit. MAU findings from this study identified specific behaviors in a provider's style that if modified may improve patient satisfaction. These MAU applications also emphasize the importance of soliciting the patient's perspective in clinical interactions since some of the most important determinants of patient behavior are not represented in traditional clinical decision models.
Decision making in radiographic imaging
Authors: Hollender L
Published: June 2020

In 1987, the U.S. Department of Health and Human Services issued guidelines for prescription of dental radiographic examinations, and although these recommendations have been reprinted in several widely circulated publications, it seems that the adoption of these guidelines is far from common, even among U.S. dental schools. The recommended criteria are founded on the existing knowledge of prevalence and progression of the most common dental diseases and on the fact that occult diseases within the jaws are uncommon. There are, however, other factors that may influence the decision on the time and extent of a radiographic examination, which may lead to deviations from the suggested guidelines. These factors include: education, peer influence, patient's preference, legal considerations, the dentist's field of interest or specialty, the training of the staff, and practice routine. The diagnostic interpretation of radiographs is far from a completely objective process, even if it is a question as simple as the presence and/or extent of a carious lesion. Numerous studies have shown a large variation among observers, both with regard to the occurrence and extent of carious lesions, in bite‐wing radiographs. Caries diagnosis is only one example of many situations where significant observer variation is found. The more complex the diagnostic task, the more variation can be expected. The effect of observer variation on treatment decisions regarding carious lesions is used as an example of the problems encountered daily in the dental practice.
Is dental education in step with current geriatric health promotion initiatives?
Authors: Dolan TA
Published: June 2020

As dramatic changes in U.S. society continue to stress our health care system, we must consider new strategies to meet the oral health needs of older individuals. Several recent national initiatives, including the Healthy People 2000 health objectives and the Surgeon General's Workshop on Health Promotion and Aging, provide measurable health objectives and suggestions for educational activities in the area of geriatric oral health promotion. Using these and other recent documents like “Practitioners for 2005, An Agenda for Action for U.S. Health Professional Schools,” we can evaluate current educational programs in geriatric dentistry, as well plan programs and health promotional activities that meet the future needs of dental professionals and the patients they serve.
Response to the dental scientist model
Authors: Baum BJ
Published: June 2020

In general, considerable strength and much realism exist in the model as presented by Dr. McHugh. Progress in biological science is central to any scheme anticipating change in medicine, including dental and oral medicine. In my view, there are two weaknesses in his presentation: 1) a perhaps semantic difference with me over whether dentists should be trained as scientists or as individuals who can use science (fact and process); and 2) a substantive difference as to how to reinforce didactic, basic biomedical science in clinical training.
A problem‐based course in dental implantology
Authors: Bell FA , Hendricson WD
Published: June 2020

A problem‐based predoctoral implantology course was implemented for ten senior dental students at the University of Texas Health Science Center at San Antonio. Students met in small tutorial groups three times a week to analyze patient cases developed for the course. As students explored the patient's problems, they identified areas where their knowledge was deficient, as well as special interests, and prioritized these areas, known as learning issues, into a learning agenda for subsequent study. During unprogrammed free time between tutorials, students researched the learning issues, and came to the next tutorial prepared to discuss what they had learned and in so doing, helped their peers learn the material. The faculty tutor used non‐directive questioning to facilitate group problem‐solving and promote interaction but did not lecture or give answers. The cases were developed in the “progressive disclosure paperback” format, reflecting the evolving nature of the patient's implant therapy. In conjunction with the PBL tutorials, students performed implant surgery and prosthodontics on a minimum of three patients and provided maintenance therapy on three to four other implant patients. Course evaluation consisted of three elements: (1) weekly peer evaluation by the students using a six item checklist, (2) tutor evaluation, using the same checklist, and (3) an oral examination. The tutor met individually with each student midway through the course and at the conclusion to summarize the peer evaluations and discuss the student's performance, including contributions to group process. Student reaction to this PBL experience was enthusiastically supportive, and student performance exceeded faculty expectations.
Accommodating dental students with disabilities
Authors: Keyes GG
Published: June 2020

The passage of The American with Disabilities Act (ADA) has broadened the legal protection afforded students with disabilities. Since it is most likely that dental schools, or their parent universities, have been in compliance with the Rehabilitation Act of 1973, they should experience minor additional requirements, in the academic arena, from the ADA. Dental schools increasingly will be asked to consider the special needs of disabled students, and may encounter conflicts between students' accommodation needs and clinical requirements and academic standards. This paper reviews federal law that protects the disabled from discrimination. More specifically, federal court decisions that have interpreted federal law were examined to see how the respective interests of disabled professional students and school administrators were treated.
PENN PASS: a program for graduates of foreign dental schools
Authors: Berthold P , Lopez N
Published: June 2020

An increasing number of graduates of foreign dental schools who enroll in advanced standing programs to qualify for licensure calls for dental schools to be prepared to handle not only the curricular demands but also the growing cultural diversity among its student population. The “reeducation” of this student group not only meets the need of foreign dentists for an American degree but may also provide health professionals to service various ethnic populations whose language and culture they are able to understand and identify with. A survey of students and graduates of a two‐year Program for Advanced Standing Students (PASS) for graduates of foreign dental schools representing 34 countries aimed to arrive at an understanding of this student group through characterization of the foreign dentists and identification of their attitudes and feelings toward various aspects of the program, the school and faculty and their experience of stress. This report includes description of the distinctive features of the program which cater to specific needs and concerns of this non‐traditional group of dental students. PASS students are accepted on the basis of their grades in dental school in home country, scores in the National Dental Board Examination Part I, Test of English as Foreign Language (TOEFL), and ratings in personal interviews. They complete an intensive summer program consisting of didactic and laboratory courses which prepares them for integration with four‐year students for the last two years of didactic and clinical curriculum. Cultural diversity seminars, a special English class, PASS class meetings and seminars are unique additions to their program and aim to assist them adjust to the educational, social and cultural systems in an American school. Results of the survey show a majority of the PASS students feel that they are part of the school and that there is someone in the school whom they can approach for problems. An understanding of their ethnic and educational background is seen as a significant factor in their second basic dental education. Implications for education of foreign dental graduates amidst increasing diversification of the student body are discussed.
The cost of higher education and its implication for dental education
Authors: Hunt LM , Dugoni AA , Enarson HL , Formicola AJ , Mingle
Published: June 2020

In summary, the committee remains convinced that dental education and the dental profession continue to be valuable public resources, greatly respected in the eyes of the public and worthy of the educational investment by students, institutions, federal, and state governments and, ultimately, the public. Among the 54 dental schools, there are 54 different financial situations. It is difficult to generalize about them, but it is not difficult to see, from the information presented, that all are not optimizing their finances and their educational programs. It is the committee's perception that many of the private dental schools and some of the public dental schools are teetering on the verge of extinction. Unless substantial actions are taken, the irretrievable loss of some of these schools is likely to occur. While this committee cannot prescribe actions for all of the schools, it is evident that systematic and sustained effort is needed to prevent these losses. The solution to this complex problem cannot be solely that of dental education. It has to become the concern of all the related constituencies of the profession. Economic factors will continue to increase the cost of education.
Natural history of periodontitis and a review of technologies to prevent and treat it
Authors: Antczak‐Bouckoms A
Published: June 2020

The development of recommendations for what is acceptable clinical practice for patients with adult periodontitis is challenging. First, how much and what type of evidence is needed? This depends very much on the clinical problem, the nature of the evidence that is available, and the potential ill effects that may ensue if the effects of the treatment that is recommended are not what they are hoped to be. All treatments are applied with the implicit assumption that they do more good than harm. Treatments that are expensive, invasive, irreversible, or potentially risky, require more evidence than treatments that are not invasive, have reversible effects, and are without risk. Recall the hierarchy of types of evidence used in the AHCPR pain guidelines ranging from a meta‐analysis of RCTs to uncontrolled observations in patients or expert opinion. A randomized controlled trial, or a meta‐analysis of RCTs carries more weight than a much larger series of cases because of the great potential for bias when observations are made under uncontrolled conditions. One hundred poorly controlled studies do not provide evidence for optimal clinical decisions. Second, who bears the burden of proof? Certainly, any newly proposed therapy must be proven safe and effective by its proponents. But, what about treatments that have been the standard of practice, can they be grandfathered in, or must evidence be gathered for them? Given changes in understanding of mechanisms of disease pathogenesis, classification, rates of activity, and measurement of outcomes, it may be time to call all clinical dogma regarding treatment of adult periodontitis into question. Reliable evidence is not available for many of the treatments for adult periodontitis. Most of the evidence that is available was collected using methods and an underlying conceptual scheme regarding diagnosis and progression of disease that is very different from current beliefs. One could argue that even for the treatments that have been evaluated in RCTs, disease activity rates were so low by current assessment, that there was no disease to prevent or treat.
Program assessment practices in dental hygiene education
Authors: McCann AL , Schneiderman ED
Published: June 2020

A survey asked U.S. dental hygiene program directors to describe their assessment programs and satisfaction with these programs. A 65 percent response rate (138/212) resulted. The directors were less than satisfied with their assessment practices and how they use their assessment data. The majority use alumni (78 percent) and employer (61 percent) surveys and curriculum evaluations by students (57 percent). Fewer use patient satisfaction surveys (40 percent) and exit interviews (33 percent). Only 35 percent of the programs formally validate any instruments. They share the results with faculty (92 percent) but not students (42 percent) and alumni (25 percent). They use the data for curriculum revision (84 percent) but not for adding assessment measures (26 percent), remediation of students (25 percent), or gaining resources for the program (22 percent). Dental hygiene education needs a more comprehensive assessment model that is clearly linked to improvement.
Implementing and evaluating a patient instructor program
Authors: Broder HL , Feldman CA , Saporito RA , Stilwell N
Published: June 2020

A Patient Instructor (PI) program designed to improve students' data‐gathering and interpersonal skills is evaluated. Each student in two consecutive classes of third‐year students (class of 1996, n = 60; class of 1997, n = 72) interviewed four patient instructors (PIs) during a three‐hour rotation. Each PI portrayed one of six scenarios. PIs assessed students using content checklists and an abbreviated Arizona Clinical Interview Rating Scale (ACIR). After the interview, each PI gave student constructive feedback regarding interpersonal behavior and ability to identify salient content items from the patient's history. Significant improvement was observed on content checklists (p < 0.01) between the first and second rounds. Significant improvement was also noted on the ACIR (p < 0.01) between rounds one, two and three. The results indicate that data‐gathering and interpersonal skills can be enhanced by using patient instructors. Student evaluation of the program was positive.
Promoting the recruitment and retention of minority faculty
Authors: Logan NS
Published: June 2020

The need for proactive recruitment programs, I believe, will be even more essential as faculty‐ALL faculty‐become more difficult to identify, as private practice and other professional options continue to be more available and attractive and as student debt levels continue to rise. Active retention programs for new faculty will also be critical activities for departments and colleges of dentistry. Several factors threaten the longevity of junior faculty: As dentistry schools are required to become more financially self‐reliant with less support from the parent university (and/or the state), faculty will be asked to “produce” more (and the trend toward clinic track appointments is not likely to mitigate this problem). The standards and rigor of the promotion process at many universities are continually increasing. The increased teaching loads required by our seemingly inexorably increasing curricula are not supported by a commensurate increase in the number of faculty. Lastly, the need for a more diverse faculty intensifies these pressures on many new appointees. Therefore, in my view, we can no longer afford to rely on our largely informal recruitment and retention networks of the past. We must develop programs to support and monitor the transition of new faculty into our university culture.
Geriatric patient simulations for dental hygiene
Authors: Johnson LA , Cunningham MA , Finkelstein MW , Hand JS
Published: June 2020

The rapidly increasing number of this country's elderly requires that dental hygiene students practice the clinical problem‐solving skills of information gathering, assessment, and treatment applied to geriatric patients. Computer‐based simulations are purported to provide this experience, but little research has been completed with simulations in the education of dental hygienists. This paper summarizes the process used to design, develop, and evaluate a series of eighteen computer‐based geriatric simulated patients. It contains a brief description of the simulations and a description of the design, validation, authoring, and formative evaluation phases. The paper also describes the summative evaluation, provides implementation suggestions, and summarizes future directions. The summative evaluation, conducted at four institutions, suggests that computer‐based simulations are an effective instructional method as measured by pre/post‐tests. The results suggest that simulations can provide a standardized set of geriatric patient experiences. These simulations may prove especially valuable at institutions that are unable to provide clinical geriatric experiences or lack the expertise to conduct a didactic course in geriatrics.
Caries prevention
Authors: Stookey GK
Published: June 2020

It is apparent that the use of fluoride in multiple measures has a significant impact upon the prevention of dental caries. These measures involve public health benefits of water fluoridation, professional fluoride treatments in the dental office, and the home use of effective fluoridated dentifrices, with the use of fluoride rinses and gels as adjuncts when needed. In many clinical situations, professional judgment is required to identify the most appropriate treatment measures to address the needs of individual patients.
Value in dental aptitude testing for minority applicants
Authors: Kramer GA
Published: June 2020

Dental Admission Test (DAT) content is designed to be relevant to the scientific material encountered in the dental school curriculum. Before use, all items are examined to ensure that they are equally familiar to all groups participating in the testing program. Moreover, performance on the DAT has been found to be the best nationally available predictor of success in dental school programs. While differential test performance has been observed for the various groups participating in the testing program, the validity of the test is comparable across these groups. Clearly, evidence supports the use of the Dental Admission Test in dental school admissions for all applicants.
Exposures to blood and body fluids among dental school‐based dental health care workers
Authors: Kennedy JE , Hasler JF
Published: June 2020

A survey of United States dental schools was conducted to determine the annual incidence of reported percutaneous and mucosal exposures to blood and other body fluids among dental school‐based dental health care workers (DHCW). A response rate of 51.9 percent provided information on 10,433 DHCW and 1.6 million student clinic and 169,836 school‐based faculty practice patient visits. This response represents approximately half of all DHCW and student clinic visits in U.S. dental schools in AY 1996/1997. A total of 652 exposures were reported, of which 629 occurred in student clinics. Dental schools averaged twenty‐three reported exposures per year, and the overall annual reported exposure rate in student clinics was 4.0/10,000 patient visits and 1.3/10,000 in faculty practice. Dental students accounted for 62.5 percent of all reported exposures, a rate of 106.3/1000 students per year. The exposure rate for dental students was significantly greater that any other category of DHCW. Expressed in terms of person years, an exposure rate of 0.17 was comparable to that reported for dental schools but considerably less than found in other dental care settings. A second survey directed to individual DHCW drew responses from only 8.3 percent of the 10,433 DHCW. Among these respondents, 31 percent of those acknowledging an exposure reported it. A judgment that the injury was not serious, the time necessary to report an exposure, and a belief that the patient was healthy were the primary reasons for not reporting. The results of this study provide dental schools with benchmarks for comparing their reported exposure experience and assessing programs intended to prevent and manage exposures.
Employing oral examinations (viva voce) in assessing dental students' clinical reasoning skills
Authors: Ryding HA , Murphy HJ
Published: June 2020

The development and evaluation of a comprehensive oral examination system are described. These examinations are designed to measure, in an authentic manner, graduating students' understanding and use of the clinical reasoning and professional communications skills employed in the diagnosis, treatment, and management of realistic clinical situations. The examination cases were developed from actual clinic cases, enhanced to fit the requirements of the examination. Faculty members were provided with training sessions designed to promote consistency of administration and scoring. A mock oral examination was held to acquaint students with the process and to help reduce their anxiety. The results suggest that the oral examination is a reasonably valid and reliable approach to assessing clinical reasoning skills and that graduating students demonstrated competency in the areas tested.
Socioeconomic Status and Selected Behavioral Determinants as Risk Factors for Dental Caries
Authors: Reisine Susan T. , Psoter Walter
Published: June 2020

The purpose of this review is to summarize a systematic review evaluating the evidence regarding the association between the incidence and prevalence of dental caries and: 1) socioeconomic status; 2) toothbrushing; and 3) the use of the baby bottle. Literature was drawn from two databases, Medline and EmBase. Because of limited resources, we did not conduct hand‐searching or search unpublished studies. Three thousand one hundred thirty‐eight abstracts were identified, 358 reviewed, and 272 papers included in the systematic review. There is fairly strong evidence for an inverse relationship between SES and the prevalence of caries among children less than twelve years of age. The evidence for this relationship is weaker for older children and for adults because of the relatively small number of studies and methodological limitations. There is weak evidence that toothbrushing prevents dental caries, but it is uncertain whether the effects of toothbrushing are due to use of a fluoride dentifrice or from mechanical removal of plaque. Finally, the evidence for the relationship between prolonged use of the baby bottle and dental caries is weak. More studies directly aimed at analyzing the relationship between SES and dental caries are needed to identify factors associated with SES that contribute to dental caries risk. Toothbrushing should continue to be recommended as a measure to prevent dental caries, particularly using a fluoride dentifrice. Recommendations regarding bottle use should continue until clear evidence about the relationship between prolonged bottle use and dental caries can be obtained.
Inherited Risks for Susceptibility to Dental Caries
Authors: Shuler Charles F.
Published: June 2020

Dental caries incidence is affected by host factors that may be related to the structure of dental enamel, immunologic response to cariogenic bacteria, or the composition of saliva. Genetic variation of the host factors may contribute to increased risks for dental caries. This systematic review examined the literature to address the question, “Is the risk for dental decay related to patterns of genetic inheritance?” Numerous reports have described a potential genetic contribution to the risk for dental caries. Studies on twins have provided strong evidence for the role of inheritance. Establishing a basis for a genetic contribution to dental caries will provide a foundation for future studies utilizing the human genome sequence to improve understanding of the disease process. Inherited disorders of tooth development with altered enamel structure increase the incidence of dental caries. Specific genetic linkage has not been determined for all of the syndromes of altered tooth development. Consequently, genetic screens of large populations for genes or mutations associated with increased caries susceptibility have not been done. Altered immune response to the cariogenic bacteria may also increase the incidence of caries. Association between specific patterns of HLA genetic inheritance and dental caries risk is weak and does not provide a predictable basis for predicting future decay rates. The evidence supporting an inherited susceptibility to dental caries is limited. Genetic linkage approaches on well‐characterized populations with clearly defined dental caries incidence will be required to further analyze the relationship between inheritance and dental caries.
Salivary Enhancement: Current Status and Future Therapies
Authors: Atkinson Jane C. , Baum Bruce J.
Published: June 2020

Saliva provides the principal protective milieu for teeth by modulating oral microbial ecosystems and reversing the initial phases of caries development. Patients with inadequate salivary function are at increased risk for dental decay. Therefore, it is likely that therapies that increase overall fluid output of these individuals will reverse early carious lesions. The most common causes of salivary dysfunction are medication usage, Sjögren's syndrome, and damage of salivary parenchyma during therapeutic irradiation. For patients with remaining functional acinar tissue, treatment with the parasypathomimetic secretogogues pilocarpine and Cevimeline may provide relief. However, these medications do not benefit all patients. The possibilities of using gene therapy and tissue engineering to develop treatments for those with severe salivary dysfunction are discussed.
The Use of Combinations of Caries Preventive Procedures
Authors: Whelton Helen , O'Mullane Denis
Published: June 2020

There are now a number of different approaches to preventing dental caries available to the clinician. Caries preventive methods are frequently used in combination. This paper reviews the potential effectiveness of combinations of preventive methods. Three groups of studies are reviewed; combinations of fluoride procedures; fluoride and fissure sealants; chlorhexadine and other agents. The review indicates that there is considerable benefit to be derived from using more than one fluoride procedure. Further research is required in the effectiveness of combining chlorhexadine with other agents. The most promising combination programme currently appears to be the use of fluoride with fissure sealing. The relevance of combination therapy for adults needs to be investigated.
Systematic Reviews of Selected Dental Caries Diagnostic and Management Methods
Authors: Bader James D. , Shugars Daniel A. , Bonito Arthur J.
Published: June 2020

A systematic review of the English‐language literature was conducted to address three related questions concerning the diagnosis and management of dental caries: a) the performance (sensitivity, specificity) of currently available diagnostic methods for carious lesions, b) the efficacy of approaches to the management of noncavitated or initial carious lesions, and c) the efficacy of preventive methods among individuals who have experienced or are expected to experience elevated incidence of carious lesions. From 1,328 caries diagnostic and 1,435 caries management reports originally identified, thirty‐nine diagnostic studies and twenty‐seven management studies were included in the final evidence tables. Point estimates or reasonable range estimates for the diagnostic validity of methods for the diagnosis of carious lesions could not be established from the literature reviewed. There are insufficient numbers of reports of diagnostic performance involving primary teeth, anterior teeth, and root surfaces. For posterior occlusal and proximal surfaces, quality issues and the variation among studies precludes establishing such estimates. The apparent differences in sensitivity among methods are generally smaller than the variation reported within methods. The literature on the management of noncavitated carious lesions consisted of five studies describing seven experimental interventions. Because these interventions varied extensively in terms of management methods tested as well as other study characteristics, no conclusions about the efficacy of these methods were possible. The literature on the management of individuals at elevated risk of carious lesions consisted of twenty‐two studies describing twenty‐nine experimental interventions. The strength of the evidence for the efficacy of fluoride varnish for prevention of dental caries in high‐risk subjects was fair, and the evidence for all other methods was incomplete. Because the evidence for efficacy for some methods, including chlorhexidine, sucrose‐free gum, and combined chlorhexidine‐fluoride methods, is suggestive but not conclusive, these interventions represent fruitful areas for further research.
Preliminary Evidence for a General Competency Hypothesis
Authors: Chambers David W.
Published: June 2020

Although predoctoral dental education is generally taught and evaluated by disciplines, there is no evidence bearing on whether the competencies necessary to begin independent practice are learned and practiced as a general set of skills, understanding, and values or as groups of discipline‐specific skills, understanding, and values, which together constitute graduation competency. There is some support in the literature for each view. In this preliminary investigation, 64,000 faculty ratings of student clinical competency were analyzed in a Year x Quarter x Discipline x Model design. The dependent variable was predictive validity of graduation quarter competency ratings using R‐values from four prediction models. Results of a multiple repeated measures ANOVA show that models based on technical skills other than the one being predicted, clinical judgment and patient management, and the combination of these two models all predict graduation competency in each of four disciplines better than do ratings in the disciplines being predicted. As the time gap between predictive and predicted competence decreases, predictions become more accurate, but an asymptote is reached by the middle of the final clinical year. By using general models to evaluate students rather than discipline‐specific ones, students needing intervention and remediation and those who could benefit from enrichment experiences can be identified as accurately at the beginning of their clinical careers as they can near the graduation deadline. This study provides preliminary support for a general competency hypothesis and suggests that research is necessary to better understand how students and dentists learn and practice rather than how they are taught.
Angiogenesis in Oral Cancer
Authors: Hasina Rifat , Lingen Mark W.
Published: June 2020

Head and neck squamous cell carcinoma (HNSCC) is an aggressive malignancy that develops after years of chronic exposure to alcohol and tobacco products. Exposure to these agents results in alterations of genes that are important in the regulation of various cellular functions. This loss of regulation allows the tumor cells to survive and grow in an unchecked manner by allowing the cells to perform functions that contribute to the growth of the tumor. Some of these important changes include the acquisition of immortality and the ability to invade tissue and/or metastasize to other sights, as well as acquiring the ability to induce angiogenesis. Angiogenesis, the growth of new blood vessels from pre‐existing ones, is a complex phenomenon that is absolutely required for the continued growth and survival of solid neoplasms. Without new blood vessels to provide nutrients and remove waste, tumors would be unable to grow larger than 2‐3 mm in diameter. Therefore, one could envision its potential role in both the treatment and prevention of malignancies such as HNSCC. The concept of chemoprevention is extremely important in HNSCC since patients often develop multiple independent lesions throughout the mucosa of the upper aerodigestive tract. Therefore, the comprehensive treatment of this disease must address not only the initial primary neoplasm, but also prevent the progression of the premalignant lesions lurking throughout the rest of the mucosal surfaces. This review will outline the basic changes that occur in tumor cells that result in the switch to angiogenic phenotype. In addition, it will discuss the present status of using antiangiogenic agents in the treatment of cancer. Finally, this paper will present a rationale for the use of multiple antiangiogenic agents as a means of developing new chemotherapeutic and chemopreventive protocols that may result in reduced patient toxicity while maintaining similar clinical efficacies.
Expanding the Boundaries: Enhancing Dentistry's Contribution to Overall Health and Well‐Being of Children
Authors: Slavkin Harold C.
Published: June 2020

The Surgeon General's Report, Oral Health in America, is the first comprehensive assessment of oral, dental, and craniofacial health in the history of our nation. The intent of this report is to alert all Americans to the full meaning of oral health and its importance to general health and well‐being across the life span. Moreover, the report has been released at a time of enormous changes in human history as well as opportunities. The convergence of public health policies, “quality of life” expectations, global informatics, a new century of biotechnology, the advent of nanotechnology, the completion of the human genome project, changes in the management of health care, and the acknowledgment of enormous health disparities heralds a call to action. These changes affect children and their caregivers and the elderly. They also affect the social, economic, and health issues associated with special patients, including those with developmental disabilities. This paper highlights dentistry's future and how oral health is broadening the impact on patient and community health and dental practice, with a focus on children's oral health. The paper provides recommendations and suggests a call to action.
Tobacco Use and Oral Leukoplakia
Authors: Bánóczy Jolán , Gintner Zeno , Dombi Csaba
Published: June 2020

The increase in cancer mortality throughout the world justifies the study of its causes and development. Hungary has the highest mortality rate from oropharyngeal cancer out of forty‐six countries. Tobacco use is implicated in the development of oral cancer, and oral leukoplakia as well. The aim of the study was to give an overview of the connection between tobacco use and oral leukoplakia, considering the epidemiologic patterns of tobacco habits, the prevalence of smoking in oral leukoplakia, and the effect of smoking on clinically healthy oral mucosa with special respect to central Europe and Hungary. In the data, strong evidence has been found for the role of smoking in the development of both oral cancer and oral leukoplakia. Epidemiologic patterns of cigarette smoking show a steep increase in central European countries. Cross‐sectional studies show a higher prevalence rate of leukoplakia among smokers, with a dose‐response relationship between tobacco use and oral leukoplakia, and intervention studies show a regression of the lesion after stopping the smoking habit.
Tobacco Cessation Through Dental Office Settings
Authors: Gordon Judith S. , Severson Herbert H.
Published: June 2020

There is increasing interest in broadly inclusive public health interventions that involve low‐cost, self‐help materials and minimal support from professionals. Dental health care workers (DHCWs) are a largely untapped resource for providing advice and brief counseling to tobacco‐using patients, and there are good reasons to believe that they can be effective in this role. The results of our randomized clinical trials have shown that a brief dental office‐based intervention can be effective in helping smokeless tobacco users to quit and smokers to reduce their use and become more ready to quit. A third clinical trial tested the effectiveness of two methods of disseminating the smokeless tobacco intervention to DHCWs throughout the western United States. Workshops were more effective than self‐study in effecting behavior change, although our analyses indicate that self‐study was more cost‐efficient. These studies have demonstrated the viability of using dentists and dental hygienists to provide brief cessation advice and supportive materials in the context of regular oral health visits to encourage their patients to quit. The results of these studies also support the timeliness of further dissemination and diffusion of this program to practitioners, dental schools, and dental hygiene programs.
The Question of Cost: Reimbursement and Remuneration
Authors: Damiano Peter C.
Published: June 2020

Dentists and the dental team have been encouraged to become an important part of the effort to curb tobacco use. Many health insurance policies, however, do not cover tobacco cessation programs, especially by dentists. The generosity of insurance for tobacco cessation has been found to influence the use of these programs. The dental profession can help by: 1) training more dental students, dental hygienists, and dental practitioners to provide tobacco cessation counseling; 2) increasing the number of practices routinely monitoring tobacco use and providing tobacco cessation programs; 3) increasing the utilization of the available procedure codes for tobacco cessation, whether it is a covered service or not; and 4) stimulating demand for more tobacco cessation coverage by employees.