bluuebunny/crossref_metadata_2025 huggingface dataset:
Student productivity in a comprehensive care program without numeric requirements
Authors: Holmes DC , Trombly RM , Garcia LT , Kluender RL , Keith CR
Published: June 2020

As the dental students of the Class of 2000 entered the Comprehensive Care Clinic at the University of Colorado School of Dentistry in the spring of their second year (spring of 1998), a different, competency‐based set of clinical expectations was communicated to them. These students were presented a list of “Recommended Core Experiences” and told that the “requirements” for completion of the Comprehensive Care Program were 1) successful performance on all departmental competency examinations, and 2) timely completion of the comprehensive dental treatment appropriate to each assigned patient. This study examined the number of procedures completed during the six semesters in the Comprehensive Care Clinic for the Class of 2000, as compared to the clinical activity for the Class of 1999 during the same stage of their career. The overall mean number of clinical procedures performed per student was 7 percent greater for the students in the Class of 2000 than for those in the Class of 1999. These results suggest that numerical requirements are not necessary to ensure dental student productivity and that, in fact, students can complete more clinical procedures in a comprehensive care clinical environment without numerical requirements.
Cross‐sectional comparison of dental students' knowledge and attitudes before geriatric training: 1984–1999
Authors: Wood GJ , Mulligan R
Published: June 2020

The existence of negative attitudes toward aging and a lack of factual information has been voiced in the dental and other health professions. With increasing numbers of elderly in society, intergenerational social contact is more likely to occur and has the potential to reduce negative attitudes and increase knowledge about aging. The purposes of this study were to determine if the level of intergenerational social contact of dental students in one dental school had changed over the last fifteen years and whether any such changes were related to shifts in students' baseline knowledge about aging and attitudes toward elderly patients. Dental students (n=269) representing three different cohorts were surveyed about intergenerational contact, knowledge about aging, and attitudes toward elderly patients prior to receiving any geriatric training. Overall, findings revealed little evidence of increasing intergenerational social contact, an actual decrease in knowledge, an increased negative bias in knowledge, and unchanged attitudes toward elderly patients over the past fifteen years. Recent students were more likely to have had grandparents living in the family home, to have slightly less correct factual knowledge, and to be more negatively biased in their incorrect factual knowledge than earlier students. There were no differences in attitudes toward elderly patients among cohorts. We concluded that additional research is needed to confirm or refute our trends on a national scope. Should these trends be confirmed, dental educators would be alerted to the continuing necessity of countering the students' potential negative biases as well as a lack of basic knowledge about aging.
Student adjustment problems in two dental schools in Thailand
Authors: Benjakul P , Cheunarrom C
Published: June 2020

Adjustment problems and academic achievement among dental students at two universities, one located in Thailand's capital city (Mahidol University) and the other in southern Thailand (Prince of Songkla University), were studied. All first‐ to sixth‐year students at each university completed the Mooney Problem Checklist Thai version, by Supapan, which covers eleven areas of adjustment problems. The most severe adjustment problems at both schools were related to adjustment to college work. Problems relating to health and physical development, social and recreational activities, and moral and religious adjustment of MU dental students were significantly higher than those of PSU dental students. The checklist showed that, in both universities, the most important adjustment problem was the need for advice from staff concerning clinical experience. Stepwise regression indicated that four variables–adjustment to college work, sex, secondary education system and university (MU or PSU)–were associated with the academic achievement of dental students.
A comparison of patient satisfaction among current and former dental school patients
Authors: Butters JM , Willis DO
Published: June 2020

Patient satisfaction is becoming an increasingly important indicator of quality dental care. However, most patient satisfaction surveys target only the current patients of the dental practice or institution, which may give an inflated estimate of satisfaction with care, since dissatisfied patients are likely to have left the practice or institution. The purpose of this study was to compare the satisfaction of three categories of dental school patients with several aspects of care received at the school. Data were collected using a telephone survey of 291 patients, systematically selected from the dental school's computer listings of all current, recall, and former patients. The survey instrument sought information about why respondents came to the school for dental treatment, why respondents who were no longer in treatment had dropped out of care, and respondents' opinions on eleven aspects of quality of care provided at the dental school. Dental students who had completed a training session served as interviewers. Results indicate that, overall, patient satisfaction with the care received was high, with none of the means for any category of patient falling into the dissatisfied range. Respondents who had dropped out of care were less satisfied than active or recall patients in five areas: quality of care, length and number of appointments, treatment explanation, and fees. Results have implications for dental school administrators and educators in their efforts to provide high quality patient care and to retain an adequate patient pool to ensure optimal clinical experiences for students.
The Microbiology of Primary Dental Caries in Humans
Authors: Tanzer Jason M. , Livingston Jill , Thompson Angela M.
Published: June 2020

A systematic literature review from 1966 to 2000 revealed 2,730 English‐language publications on the role of bacteria in human primary dental caries in vivo. The most pertinent 313 papers were analyzed in evidence tables accessible online (http://www.nidcr.nih.gov). The search targeted all bacterial types implicated previously in caries and asked two questions. First, what is the association of specific bacteria with tooth decay and can causation be attributed to any of those bacteria? Retrieved studies were categorized as randomized‐blinded‐interventional, longitudinal, case‐control, and cross‐sectional and were weighted in descending order in terms of significance. Although many studies, due to ethical requirements, had confounding variables, they still indicate strongly: 1) the central role of the mutans streptococci in initiation of caries of smooth surfaces and fissures of crowns of teeth and suggests their potent role in induction of root surface caries; and 2) that lactobacilli are implicated as important contributory bacteria in tooth decay, but their role in induction of lesions is not well supported. Second, what is the source of infection by cariogenic bacteria? Molecular/genetic studies of implicated bacteria isolated from humans, randomized‐blinded‐interventional, and longitudinal studies indicate that mutans streptococci are spread vertically among humans, mostly from mothers to their children. Implications of these conclusions are briefly discussed. The most significant problems of literature interpretation include the benefits/shortcomings of salivary and plaque monitoring of the flora, the role of sugar(s) in decay as it influences the flora, and modeling strategies to predict lesion score increments as distinct from determination of the etiological role of specific bacteria. Future directions for microbiological clinical caries research are suggested, and the use of the term “caries” to describe the disease, not its lesions, is urged.
Exposure to Metal Ions and Susceptibility to Dental Caries
Authors: Bowen William H.
Published: June 2020

Results from several epidemiologic studies have shown that there are large differences in the prevalence of dental caries from one region to another within the United States as well as in other countries. It has been postulated that the observed differences may be attributed in part at least to exposure to trace elements such as selenium, vanadium, molybdenum, strontium, and lead. Although data from epidemiologic studies usually support this hypothesis, direct evidence is sparse with the possible exception of exposure to lead. Data from several epidemiologic studies and animal‐based research support the concept that lead is a caries‐promoting element. Lead mimics calcium in several respects and may affect development of teeth and salivary glands, clearly enhancing susceptibility to dental caries. Elevated blood levels are found most commonly in persons residing in inner cities, particularly among the poor. Many states require blood lead level to be monitored in young children. Where feasible, these records should form part of health history and be available to the treating dental practitioner to ensure that extra preventive procedures may be implemented.
The Effect of Non‐Cariogenic Sweeteners on the Prevention of Dental Caries: A Review of the Evidence
Authors: Hayes Catherine
Published: June 2020

The role of sugar substitutes such as xylitol and sorbitol in the prevention of dental caries has been investigated in several clinical studies. The purpose of this report is to review the current published evidence regarding the relationship between sugar substitutes and dental caries. A literature search was conducted using MEDLINE and EMBASE and included studies published from 1966 to 2001. Studies that included human subjects and were published in English were included in this review. A total of fourteen clinical studies were reviewed that evaluated the effect of sorbitol or xylitol or the combination of both sugar substitutes on the incidence of dental caries. Most of the reports were of studies conducted with children outside of the United States. These studies demonstrated a consistent decrease in dental caries, ranging from 30 to 60 percent, among subjects using sugar substitutes as compared to subjects in a control group. These caries rate reductions were observed in subjects using xylitol or sorbitol as the sugar substitute in chewing gum or toothpaste. The highest caries reductions were observed in subjects using xylitol. These findings suggest that the replacement of sucrose with sorbitol and xylitol may significantly decrease the incidence of dental caries.
Systematic Review of Conservative Operative Caries Management Strategies
Authors: McComb Dorothy
Published: June 2020

The relationship between cavity preparation extension and restoration longevity is examined through a systemic review of the available evidence on specific conservative, operative caries‐management strategies. Evidence tables are provided for three specific techniques in the permanent dentition: 1) the proximal “tunnel” restoration, 2) the proximal “box‐only” restoration, and 3) the preventive resin restoration. In the primary dentition, the clinical trials involving the proximal box‐only restoration, most of which involved glass‐ionomer materials, are reviewed. In the permanent dentition, the evidence reveals low effectiveness for “tunnel” restorations, limited but supportive results for proximal‐only restorations, and generally favorable outcomes for the occlusal composite resin‐sealant restoration. The weak link in the latter is the overlying fissure sealant, which requires adequate ongoing maintenance. Conservative operative strategies in the primary dentition have not been uniformly successful, and deleterious material effects dominate restoration performance. This systematic review concludes that operative conservatism per se does not guarantee increased restoration longevity and that all restorations are vulnerable to caries recurrence, material failures, and technical deficiencies. The more successful conservative strategies are expected to enhance tooth longevity, provided concomitant caries control is effective.
Dental Caries in the Second Millennium
Authors: Ismail Amid I. , Hasson Hana , Sohn Woosung
Published: June 2020

This historical review of dental caries diagnosis and management is based on information obtained from reports published between 1839 and 1965 and forty textbooks on caries diagnosis and management published since the nineteenth century. The history of understanding of any disease or condition in humans has passed through two distinct eras. The first, which lasted until the twentieth century and may still be ongoing today, is the “observational” era. The second, which has developed and revolutionized our understanding of the causes and treatments of all diseases, is the “scientific” era. During the observational era, treatments of oral or dental problems were based on neither biological nor scientific principles. Rather, experimentation without validation was, and to a lesser extent during the last fifty years is still, common. In terms of disease management, dental practice is still in the gray years of the “restorative era” and in the midst of the “preventive era” where the emphasis would soon shift towards early detection of biological markers of diseases and prevention of their initiation and progression. This review has found that most contemporary questions on caries diagnosis and management have been debated since the middle of the nineteenth century. There is a need for a comprehensive research program to provide scientifically based information to assist dental practitioners in caries detection, diagnosis, and management.
Clinical Diagnosis of Dental Caries: A European Perspective
Authors: Pitts Nigel B.
Published: June 2020

The aim of this paper is to provide a broad international perspective on aspects of the RTI/UNC systematic review, to introduce relevant literature not cited, and to make recommendations for clinical practice education and research suggested by the evidence. Clinical caries diagnosis represents the foundation on which the answers to most of the consensus questions will be based. This paper highlights needs for being clear about definitions and nomenclature; understanding the importance of the concepts underlying the D1 and D3 diagnostic thresholds used widely within the RTI/UNC Review; and appreciating that the diagnostic challenge now faced by clinicians is significant and is becoming more complex as the presentation and distribution of the disease changes over time and the range of preventive and operative treatment options expands. A series of recommendations informed by the evidence are made, including a rather contentious issue for many clinicians concerning the lack of evidence supporting the continued use of a sharp explorer as a diagnostic tool for primary caries diagnosis. This practice should be discontinued as it may cause some harm to the patient and yet fails to provide a significant balancing diagnostic benefit. Finally, it is suggested that dentistry should learn from the developing evidence base in medicine on how best to disseminate the findings of reviews and promote appropriate changes in clinical practice.
Clinical Diagnosis of Dental Caries: A North American Perspective
Authors: Rosenstiel Stephen F.
Published: June 2020

This paper summarizes current trends in the clinical diagnosis of occlusal caries in response to the RTI/UNC review and reflects the dilemma felt by many dentists who understand the difficulty in accurately assessing the extent and activity of pit and fissure caries in many of their patients. They are unsure if they should be aggressive in instrumenting suspicious lesions and provide small restorations, some of which may not be indicated. Alternatively, should they wait until signs are more clear‐cut and provide larger restorations? Discussed here is the advantage of practicing dentists who obtain immediate false‐positive feedback when they instrument a tooth with no clinical caries and false‐negative feedback when a recall patient exhibits progression of an equivocal lesion. They should be encouraged to use this feedback as part of their diagnostic procedure and explain to their patients the difficulty of providing an accurate and precise diagnosis with existing tests.
Patient Satisfaction with the Comprehensive Care Model of Dental Care Delivery
Authors: Mascarenhas Ana Karina
Published: June 2020

In the summer of 1997, the College of Dentistry, The Ohio State University, changed its predoctoral clinics from the traditional model to the comprehensive care (CC) model. Although the CC model is considered the better model for delivery of care, from the patient perspective it has not been previously evaluated. The purpose of this study was to compare the two dental care delivery systems—the traditional model and the CC model—using patient satisfaction. The Dental Satisfaction Questionnaire (DSQ) developed by the Rand Corporation was used to assess patient satisfaction. The questionnaire consists of nineteen items, measuring overall satisfaction and subscales of access, pain management, and quality. The questionnaire was self‐administered to active and recall patients in the summers of 1997 and 1998 to evaluate satisfaction with care in the traditional and CC models respectively. The completed DSQ was returned by 119 respondents in 1997 and 116 respondents in 1998. There were no significant differences in age, gender, and self‐rated general and oral health of patients using the two delivery systems. No statistically significant differences were seen in the overall Dental Satisfaction Index and the subscales of access, pain management, and quality of care. Statistically significant differences were observed on only two of the nineteen individual items. We conclude that there was no difference in satisfaction levels of our patients between the two dental care delivery models.
A Revolution in Biomedical Assessment: The Development of Salivary Diagnostics
Authors: Tabak Lawrence A.
Published: June 2020

Since the early 1900s, saliva has proven to be a noninvasive medium from which to measure a wide range of hormones, pharmaceuticals, and antibodies. It has also proven to be a convenient source of host and microbial DNA. As we enter the era of genomic medicine, increasing use of salivary diagnostics will help catalyze a shift from disease diagnosis to health surveillance. However, with the advances in this technology comes the additional obligation to ensure the privacy and rights of patients.
Long‐Term Management of the Fearful Adult Patient Using Behavior Modification and Other Modalities
Authors: Berggren Ulf , Odont.
Published: June 2020

This paper reviews reports on the treatment of fearful adult dental patients with special emphasis on behavioral and cognitive methods and long‐term followup. A number of such treatment methods are available that can be used by dentists for the alleviation of fear and anxiety in their patients. At an “intuitive” level, many dentists probably use these methods frequently as a comprehensive part of everyday praxis. Considering the high number of fearful individuals visiting dentists regularly, a better knowledge of such methods would improve dental care for the majority of these patients. It would also help prevent aggravation of fears among individuals at risk. However, despite the success of treatment methods performed by specially trained dentists, it seems reasonable that there should be limits to what can be expected of a dentist in terms of psychological, diagnostic, and therapeutic competence. Dental phobia may constitute a complex psychological and odontological problem with far‐reaching consequences for a relatively large proportion of fearful individuals. It therefore seems likely that optimal care of such patients can best be achieved by cross‐disciplinary efforts involving both dentists and psychologists.
Guiding and Managing the Child Dental Patient: A Fresh Look at Old Pedagogy
Authors: Feigal Robert J.
Published: June 2020

Society's approach to children during the past half‐century has changed dramatically, and a transformation of medical and hospital pediatric care has followed. Dentistry has been slower to incorporate sound, child‐friendly approaches to care. Nonetheless, much has changed in dental practice pertaining to children. The regular involvement of parents in the surgical/ therapeutic suite is one such change. Expanded communication to ensure informed consent for treatment as well as consent for type of management approach to children is the standard of care. Since sedation policies are becoming more complex, enhancing the skills of all dentists and staff members in the best methods of nonpharmacological child management will be essential in the next decades. Biobehavioral methods will gain prominence, along with better communication skills of the dental team. These changes will occur only if more time and resources are positioned to teach dental students, dentists, and staff the necessary skills. Emphasis must be placed on early, timely intervention; parental involvement; effective communication; cultural competence; and the “medical/dental home” concept as methods to reduce negative dental attitudes and behaviors of children.
Pain and the Neuromatrix in the Brain
Authors: Melzack Ronald
Published: June 2020

The neuromatrix theory of pain proposes that pain is a multidimensional experience produced by characteristic “neurosignature” patterns of nerve impulses generated by a widely distributed neural network—the “body‐self neuromatrix”—in the brain. These neurosignature patterns may be triggered by sensory inputs, but they may also be generated independently of them. Acute pains evoked by brief noxious inputs have been meticulously investigated by neuroscientists, and their sensory transmission mechanisms are generally well understood. In contrast, chronic pain syndromes, which are often characterized by severe pain associated with little or no discernible injury or pathology, remain a mystery. Furthermore, chronic psychological or physical stress is often associated with chronic pain, but the relationship is poorly understood. The neuromatrix theory of pain provides a new conceptual framework to examine these problems. It proposes that the output patterns of the body‐self neuromatrix activate perceptual, homeostatic, and behavioral programs after injury, pathology, or chronic stress. Pain, then, is produced by the output of a widely distributed neural network in the brain rather than directly by sensory input evoked by injury, inflammation, or other pathology. The neuromatrix, which is genetically determined and modified by sensory experience, is the primary mechanism that generates the neural pattern that produces pain. Its output pattern is determined by multiple influences, of which the somatic sensory input is only a part, that converge on the neuromatrix.
The Role of Dentists in Dentistry
Authors: Chambers David W.
Published: June 2020

The extent to which dentists influence the outcomes of dental care, compared to the effects of dental technology or patient variation, has not been well studied. A review of the literature on the personality and value structures of dentists and dental students reveals general trends involving preferences of concrete, utilitarian, unambiguous, and conventional situations that are classified and judged in terms of their potential for dentists' power and control and for relationships of helping others but avoiding mutual dependency. These findings are summarized in a hypothesis that dentists seek situations where they can exercise control and establish paternalistic relationships with others. The evidence about career satisfaction of dentists is difficult to interpret. Between 20 percent and 50 percent of dentists report that they would not choose to enter the profession again if given a chance. Yet the number leaving the profession voluntarily is less than the number of career changers in the general population by a factor of about 1 to 15. Career satisfaction of practitioners can be partially predicted from an understanding of dentists' personality and values. Factors such as uncooperative patients, incompetent staff, and government and insurance intrusions are major dissatisfiers; they threaten dentists' core need for control. Factors such as quality of work, which is under the control of dentists, are major satisfiers. The personalities and values of dentists and the expression of these in professional norms may function to limit our understanding of dentistry. Based on this analysis, eight predictions are offered about the profession.
Tobacco Use and Oral Cancer: A Global Perspective
Authors: Johnson Newell
Published: June 2020

For both genders, cancer of the mouth and pharynx ranks sixth overall in the world; it is also the third most common site among males in developing countries. In industrialized countries, men are affected two to three times as often as women, largely due to higher use of alcohol and tobacco. Ethnicity strongly influences prevalence due to social and cultural practices, as well as socioeconomic differences. In population terms, survival rates around the world show little improvement. In terms of etiology, the effects of tobacco use, heavy alcohol consumption, and poor diet together explain over 90 percent of cases of head and neck cancer. All forms of tobacco represent risk factors for oral cancer, but on present evidence, snuff habits as they exist in Scandinavia and probably in the United States carry lower risks of serious health hazards, including oral cancer. Alcohol synergizes with tobacco as a risk factor for all upper aerodigestive tract SCC: this is super‐multiplicative for the mouth, additive for the larynx, and between additive and multiplicative for the esophagus. The increase in oral cancer in the Western world has been related to rising alcohol use.
Tobacco Prevention and Control in Dental Practice: The Future
Authors: Mecklenburg Robert E.
Published: June 2020

Tobacco use adversely affects oral health and dental care. Globally, the health consequences of tobacco use are worsening, particularly those caused by cigarette smoking. Concerned government and nongovernmental organizations are attempting to contain the transnational tobacco companies' promotion of tobacco use and its disregard for the serious health consequences. Dependence prevents most tobacco users from easily breaking free from their high‐risk behavior. Evidence‐based clinical treatment methods that substantially increase quit rates are available in the Public Health Service clinical practice guideline, Treating Tobacco Use and Dependence. Guideline recommendations are as useful to dental clinicians as to other health care disciplines. Dental educators have a strategic role in ensuring that clinicians are well informed and are skilled in and committed to providing tobacco prevention and cessation services to their patients. Dental organizations must identify and overcome perceived and real clinician and practice barriers to adopting essential cessation services. The dental profession is in an excellent position to play a major role in several emerging issues, such as helping the public and policymakers understand the chronic nature of tobacco dependence and supporting cessation services for all people, particularly pregnant women and youths. Such messages should be presented in terms that resonate with the public because tobacco industry activities and products continue to undermine well‐being, the health economy, and individual self‐directed behavior of choice.
Variation, Certainty, Evidence, and Change in Dental Education: Employing Evidence‐Based Dentistry in Dental Education
Authors: Marinho Valéria Coelho Catão , Richards Derek , Niederman Richard
Published: June 2020

Variation in health care, and more particularly in dental care, was recently chronicled in a Reader's Digest investigative report. The conclusions of this report are consistent with sound scientific studies conducted in various areas of health care, including dental care, which demonstrate substantial variation in the care provided to patients. This variation in care parallels the certainty with which clinicians and faculty members often articulate strongly held, but very different opinions. Using a case‐based dental scenario, we present systematic evidence‐based methods for accessing dental health care information, evaluating this information for validity and importance, and using this information to make informed curricular and clinical decisions. We also discuss barriers inhibiting these systematic approaches to evidence‐based clinical decision making and methods for effectively promoting behavior change in health care professionals.
The Human Genome, Implications for Oral Health and Diseases, and Dental Education
Authors: Slavkin Harold C.
Published: June 2020

We are living in an extraordinary time in human history punctuated by the convergence of major scientific and technological progress in the physical, chemical, and biological ways of knowing. Equally extraordinary are the sparkling intellectual developments at the interface between fields of study. One major example of an emerging influence on the future of oral health education is at the interface between the human genome, information technology, and biotechnology with miniaturizations (nanotechnology), suggesting new oral health professional competencies for a new century. A great deal has recently been learned from human and non‐human genomics. Genome databases are being “mined” to prompt hypothesis‐driven “post‐genomic” or functional genomic science in microbial models such as Candida albicans related to oral candidiasis and in human genomics related to biological processes found in craniofacial, oral, and dental diseases and disorders. This growing body of knowledge is already providing the gene content of many oral microbial and human genomes and the knowledge of genetic variants or polymorphisms related to disease, disease progression, and disease response to therapeutics (pharmacogenomics). The knowledge base from human and non‐human genomics, functional genomics, biotechnology, and associated information technologies is serving to revolutionize oral health promotion, risk assessment using biomarkers and disease prevention, diagnostics, treatments, and the full range of therapeutics for craniofacial, oral, and dental diseases and disorders. Education, training, and research opportunities are already transforming the curriculum and pedagogy for undergraduate science majors, predoctoral health professional programs, residency and specialty programs, and graduate programs within the health professions. In the words of Bob Dylan, “the times they are a‐changing.”
Trends in Allied Dental Education: An Analysis of the Past and a Look to the Future
Authors: Haden N. Karl , Morr Kathleen E. , Valachovic Richard W.
Published: June 2020

Allied dental healthcare providers have been an integral part of the dental team since the turn of the 19th century. Like dental education, allied dental education's history includes a transition from apprenticeships and proprietary school settings to dental schools and community and technical colleges. There are currently 258 dental assisting programs, 255 dental hygiene programs, and 28 dental laboratory technology programs according to the American Dental Association's Commission on Dental Accreditation. First‐year enrollment increased 9.5 percent in dental hygiene education from 1994/95 to 1998/99, while enrollment in dental assisting programs declined 7 percent and declined 31 percent in dental laboratory technology programs during the same period. Program capacity exceeds enrollment in all three areas of allied dental education. Challenges facing allied dental education include addressing the dental practicing community's perception of a shortage of dental assistants and dental hygienists and increasing pressure for career tracks that do not require education in ADA Commission on Dental Accreditation accredited programs. The allied dental workforce may also be called upon for innovative approaches to improve access to oral health care and reduce oral health care disparities. In addition, allied dental education programs may face challenges in recruiting faculty with the desired academic credentials. ADEA is currently pursuing initiatives in these and other areas to address the current and emerging needs of allied dental education.
The Face of a Child: Children's Oral Health and Dental Education
Authors: Mouradian Wendy E.
Published: June 2020

Dental care is the most common unmet health care need of children. Those at increased risk for problems with oral health and access to care are from poor or minority families, lack health insurance, or have special health care needs. These factors place more than 52 percent of children at risk for untreated oral disease. Measures of access and parental report indicate unmet oral health needs, but do not provide guidance as to the nature of children's oral health needs. Children's oral health needs can be predicted from their developmental changes and position in the life span, their dependency and environmental context, and current demographic changes. Specific gaps in education include training of general dentists to care for infants and young children and those with special health care needs, as well as training of pediatric providers and other professionals caring for children in oral health promotion and disease prevention. Educational focus on the technical aspects of dentistry leaves little time for important interdisciplinary health and/or social issues. It will not be possible to address these training gaps without further integration of dentistry with medicine and other health professions. Children's oral health care is the shared moral responsibility of dental and other professionals working with children, parents, and society. Academic dental centers hold in trust the training of oral health professionals for society and have a special responsibility to train future professionals to meet children's needs. Leadership in this area is urgently needed.
Use of Fissure Sealant Retention as an Outcome Measure in a Dental School Setting
Authors: Mascarenhas Ana Karina , Moursi Amr M.
Published: June 2020

The purpose of this study was to describe and assess the use of fissure sealant retention as a quality measure of the delivery system for pediatric dentistry. The Pediatric Dentistry Section at the Ohio State University College of Dentistry adopted Sealant retention as a measure of quality. Sealant retention in first and second molars was evaluated at each six‐month recall appointment. Sealants were categorized as satisfactory or unsatisfactory. Two hundred five sealants were evaluated between March 1998 and March 1999. The mean age of the patients at the time of sealant evaluation was 14.0±2.9. Mean sealant retention period was 29.8±23.2 months, with a range of 0.9 to 148 months. Median sealant retention period was 23.2 months. Overall, 75.6 percent of the sealed teeth were classified as satisfactory. Use of this data in making improvements is discussed. Our results indicate that the use of sealant retention is a suitable measure for quality of care in pediatric dentistry.
Relationships of Admissions Data and Measurements of Psychological Constructs with Psychomotor Performance of Dental Technology Students
Authors: Evans James G. , Dirks Sarah J.
Published: June 2020

The psychomotor skills required in dental laboratory technology and dentistry are similar. Dental educators have recognized the problems in selecting from among dental school applicants those with potential psychomotor skills. The purpose of this study was to examine the relationships of admissions data and measurements of psychological constructs of dental technology students with their psychomotor performance in first‐semester dental laboratory courses. The dependent variables selected for the study were grades from three laboratory courses. Significant positive correlations (p<.05) were noted between all laboratory grades and previous college hours, previous college GPA, interview scores, field dependence‐independence scores, block counting, trust, straightforwardness, and dutifulness. These data indicate that individual differentiation in learning ability, visual or spatial perception, and personality do affect psychomotor learning and should be taken into consideration in the design and execution of teaching and training curricula.
Recent Insights into Brainstem Mechanisms Underlying Craniofacial Pain
Authors: Sessle Barry J.
Published: June 2020

This article briefly highlights some of the recent advances in knowledge of the neural processes underlying pain in the face and mouth. It particularly focuses on those mechanisms operating in the brainstem that are involved in the transmission and modulation of nociceptive signals and that reveal a remarkable degree of plasticity following injury or inflammation of craniofacial tissues. Insights into these processes hold promise of the development of new or improved therapeutic procedures for the relief of pain.
Treatment Planning Processes in Dental Schools
Authors: Hook Charles R. , Comer Robert W. , Trombly Robert M. , Guinn John W. , Shrout Michael K.
Published: June 2020

Treatment planning is a critical aspect of clinical education in the dental school curriculum. It is surprising, therefore, that so little attention has been given to this subject in the dental literature. The importance of treatment planning is reinforced in the standards and the tests that clearly present methods and necessity for treatment planning. However, there is minimal evidence about how these treatment planning courses have been evaluated, how they were incorporated into the curriculum, or how they have been integrated into treatment planning in the academic clinical setting. The purpose of this study was to survey and profile current treatment planning processes in U.S. dental schools. A questionnaire consisting of twenty‐nine items relating to treatment plan preparation, process, and outcomes was mailed to fifty‐four U.S. dental schools. The primary topics included patient assignments, treatment planning, plan sequencing, plan presentation, informed consent, and plan modifications. Forty‐seven of the fifty‐four U.S. dental schools (87 percent) completed and returned the surveys. Profiling the treatment planning process in dental schools reveals many similarities. Typically, the schools screen patients prior to assignment to students and expect the student diagnostician to complete the planning process as well as comprehensive care. The patient's welfare is the primary determinant of the content of the plan in 92 percent of U.S. dental schools. Secondly, though current accreditation standards are concentrated on competencies, the treatment plans are influenced by quantitative requirements. Third, the plan is usually completed during the second patient visit after screening. Fourth, the approaches vary among the schools when a multidisciplinary or complex treatment plan is appropriate. Some depend on a panel of experts, whereas others do not have interactive planning with specialists. A significant number of schools decentralize treatment planning and delegate part of the plan to disciplines or group practice leaders. Fifth, the treatment plans and treatment risks are presented in accordance with the intent of the accreditation guidelines; however, fewer than half the schools explain the risk of procedures to patients at the time of plan presentation. Finally, plans change frequently, but the modifications are generally considered to be minor.
Preclinical Restorative Training
Authors: Ferguson Michael B. , Sobel Morton , Niederman Richard
Published: June 2020

In conjunction with its problem‐based learning curriculum, Harvard School of Dental Medicine (HSDM) developed a shortened preclinical restorative training curriculum. This study compared our curriculum with those in other dental schools and examined student reaction to it. Twenty‐nine U.S. dental schools responded to a survey regarding the length of their preclinical course in Operative Dentistry. Nationally, preclinical courses ranged from 179 hours to 280 hours (mean ± SEM = 193 ± 9 hours; n = 29). In marked contrast, the new seventy‐five‐hour preclinical curriculum at Harvard was the lowest of any school, and significantly lower than the U.S. average (p<0.01). In Harvard's previous curriculum, students spent 232 curriculum hours. Reactions of Harvard students to this compact preclinical curriculum were surveyed using a three‐topic, three‐category survey instrument. Results indicated that, prior to beginning clinical patient care, approximately 80 percent of students felt that the course was too short and 20 percent just right. Conversely, and retrospectively, after completing their dental school training, only 35 percent felt it was too short, and 65 percent felt it was just right. Retrospectively, in terms of clinical preparedness, 55 percent felt adequately prepared and 35 percent felt well prepared to treat their patients. No significant change was noted between Part II National Board scores following the change to the reduced curricula time. The average National Board Part II scores prior to initiating the new curriculum was 86.3, and afterwards, it was 86.2. Further, for the North East Regional Board, HSDM students in the past four years demonstrated a 98 percent overall success rate with 100 percent primary pass in the operative dentistry part of the examination. These results suggest that an abbreviated preclinical training is not only possible, but may make time available for training opportunities in other areas, such as aesthetic dental procedures and new biomaterials.
Making a Comprehensive Diagnosis in a Comprehensive Care Curriculum
Authors: Douglass Gordon D.
Published: June 2020

Comprehensive care models in dental education encourage students to deliver patient‐centered care. But to deliver effective comprehensive care, a clinician must first make a comprehensive diagnosis. Students of general dentistry are taught to make one or more diagnoses as defined by the dental specialties, and to direct patient care accordingly. Without a comprehensive diagnosis, patients may receive fragmented, poorly prioritized care that is inappropriate to their overall oral health. This paper presents a simple diagnostic classification that can be used to make a comprehensive diagnosis with which to guide the student of general dentistry in planning comprehensive care.
Serving Underserved and Hard‐Core Smokers in a Dental School Setting
Authors: Seidman Daniel F. , Albert David , Singer Steven R. , Barrows Randolph C. , Tepper Lynn M. , Ovalles Martin , Albin Jayme
Published: June 2020

The dental profession has recognized tobacco cessation as an important part of comprehensive dental care, yet implementation of the Public Health Service clinical practice guideline on “Treating Tobacco Use and Dependence” remains a challenge. This is especially the case for patients presenting in dental clinics for whom smoking represents a large financial burden. Many of these smoking‐addicted patients also present with multiple risk factors: dental, medical, and psychiatric. Innovative approaches are necessary to reduce barriers to providing smoking cessation services to underserved and high‐risk smokers. A tobacco cessation clinic in a dental school setting provides an opportunity for dental students to learn about the management of difficult‐to‐treat cases and to bring their enhanced intervention skills back into the primary care dental setting. This paper describes a multidisciplinary approach to tobacco cessation in a dental school clinic within an academic medical center.
Leadership Strategies for Department Chairs and Program Directors: A Case Study Approach
Authors: Comer Robert W. , Haden N. Karl , Taylor Robert L. , Thomas D. Denee
Published: June 2020

As a part of the 2000‐01 American Dental Education Association (ADEA) Leadership Institute, the Leadership Institute Fellows conducted a faculty development workshop for department chairpersons and program directors during the 2001 ADEA Annual Session. A central premise of the workshop was that successful chairpersons and program directors are both effective leaders and effective managers and that leadership and management involve complementary activities. The workshop was case‐based. The ADEA Leadership Institute Fellows developed the cases and led roundtable discussions of each case. A group facilitator led large group debriefings to apply management and leadership theory to each case. The purpose of this paper is to review leadership challenges and management concepts as they were applied in a case‐based faculty development workshop. The program was structured to address leadership challenges relating to managing people, mission management, conflict recognition, and conflict management. The cases were developed to relate management theories to situations in academic administration. The situations were designed to encourage debate from numerous perspectives. Each case presented general dilemmas that could be addressed from the vantage point of the dean, chair, or individual faculty member. Reinforcing discussion followed and included identification of central issues, key management concepts, and action alternatives. Because of the breadth of possible discussion, group case analyses at the workshop and in the appended case reviews explore only one perspective. This overview article introduces concepts of leadership and management that provide the foundation for analysis of three case studies that follow. These cases address common leadership and management issues in academic dentistry through three typical cases: the frustrated faculty member (case 1), the misdirected faculty member (case 2), and the faculty member stuck in the middle (case 3).
Web‐Based Orthodontic Instruction and Assessment
Authors: Komolpis Ruangrat , Johnson Richard A.
Published: June 2020

Orthodontic records—study models, panoramic and cephalometric radiographs, and the patient's facial and intraoral photographs—are used to collect data to establish a diagnosis and to develop problem‐solution lists. These records, however, can be damaged or lost when dispensed to students and need to be stored and maintained every year. An orthodontic diagnosis web site, therefore, has been set up using digital records to provide students with an accessible source of complete, good‐quality study materials. The web site is also used for clinical examination in orthodontic courses. The effectiveness of the web‐based digital records in providing relevant information to students in comparison to the traditional records was evaluated by a randomized controlled trial involving ninety‐nine second‐year dental students. One group (fifty students) studied two cases from the web site; the other group (forty‐nine students) studied the same two cases from traditional orthodontic records. Effectiveness was assessed by comparing test scores and the time spent on the tests by t‐statistics. There were no significant differences between means for the two study groups in test performance or time. Attitudes of students toward the web site, assessed from post‐test questionnaires, were positive. It was concluded that web‐based digital orthodontic records were as effective in teaching clinical orthodontic diagnosis as were conventional records.