Showing papers in "Journal of Dental Education in 2001"
TL;DR: 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 neurom atrix"-in the brain.
Abstract: 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.
673 citations
TL;DR: 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, and Implications of these conclusions are briefly discussed.
Abstract: 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.
543 citations
TL;DR: 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.
Abstract: 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.
358 citations
TL;DR: It was concluded that the relationship between sugar consumption and caries is much weaker in the modern age of fluoride exposure than it used to be and controlling the consumption of sugar remains a justifiable part of caries prevention, however, if not always the most important aspect.
Abstract: This systematic review addresses the question: In the modern age of extensive fluoride exposure, do individuals with a high level of sugar intake experience greater caries severity relative to those with a lower level of intake? The MEDLINE and EMBASE databases were searched for English-language papers published between 1980 and 2000 using a search expression developed in conjunction with an experienced librarian. There were 809 papers located in the initial search. A review of titles and abstracts to identify clearly irrelevant papers reduced this number to 134. Two readers each read one half of these papers, and application of predetermined inclusion/exclusion criteria reduced this number of papers to sixty-nine. Criteria were established for scoring the quality of each of these papers on evidence tables. The maximum score for each paper was 100; the sixty-nine papers rated scored between 12 and 79. Final judgment of results was limited to those thirty-six papers that scored 55 or higher on the evidence tables and that reported studies carried out in countries where there is moderate-to-extensive fluoride exposure. Results showed that only two papers found a strong relationship between sugar consumption and caries development, sixteen found a moderate relationship, and eighteen found weak-to-no relationship. It was concluded that the relationship between sugar consumption and caries is much weaker in the modern age of fluoride exposure than it used to be. Controlling the consumption of sugar remains a justifiable part of caries prevention, however, if not always the most important aspect.
348 citations
TL;DR: There is fairly strong evidence for an inverse relationship between SES and the prevalence of caries among children less than twelve years of age and for adults, but the evidence for the relationship between prolonged use of the baby bottle and dental caries is weak.
Abstract: 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) tooth-brushing; 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 tooth-brushing prevents dental caries, but it is uncertain whether the effects of tooth-brushing 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. Tooth-brushing 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.
315 citations
TL;DR: A systematic review of the English-language literature was conducted to address three related questions concerning the diagnosis and management of dental caries: the performance (sensitivity, specificity) of currently available diagnostic methods for carious lesions, the efficacy of approaches to the management of noncavitated or initial carious lesions, and the effectiveness of preventive methods among individuals who have experienced or are expected to experience elevated incidence of caries.
Abstract: 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.
287 citations
TL;DR: The risks of oral cancer and periodontal disease decline as time from cessation increases, and some oral mucosal lesions may resolve with cessation of smokeless tobacco use.
Abstract: Tobacco use is a risk factor for oral cancer, oral mucosal lesions, periodontal disease and impaired healing after periodontal treatment, gingival recession, and coronal and root caries. Available evidence suggests that the risks of oral diseases increase with greater use of tobacco and that quitting smoking can result in decreased risk. The magnitude of the effect of tobacco on the occurrence of oral diseases is high, with users having many times the risk of non-users. There is a clear benefit to quitting tobacco use. The risks of oral cancer and periodontal disease decline as time from cessation increases, and some oral mucosal lesions may resolve with cessation of smokeless tobacco use. Smoking accounts for half of periodontal disease and three-fourths of oral cancers in the United States. Because tobacco accounts for such a high proportion of these diseases, comprehensive tobacco control policies are required to make progress in reducing the burden of tobacco-related oral diseases. Effective treatments to prevent tobacco use and increase cessation are available and need greater implementation. Dental practices may provide a uniquely effective setting for tobacco prevention and cessation.
252 citations
TL;DR: This systematic review evaluated critically the evidence supporting the role and effects of saliva in caries pathogenesis and found that intrinsic host factors play a key role in modulating the initiation and progression of caries.
Abstract: The etiology and pathogenesis of dental caries are known to be multifactorial, but the interplay between intrinsic and extrinsic factors is still not fully understood. As in other host/parasite interactions, there appear to be marked variations in individual susceptibility to the disease. It therefore is likely that intrinsic host factors play a key role in modulating the initiation and progression of caries. The objective of this systematic review was to evaluate critically the evidence supporting the role and effects of saliva in caries pathogenesis. The full-length evidence report, including evidence tables, and the structured abstract presented at the NIH/NIDCR Consensus Development Conference on the Diagnosis and Management of Dental Caries Throughout Life, March 26-28. 2001, can be accessed at the web site http://www.nidcr.nih.gov. The present abridged report is a summary of the main findings from our evidence-based review.
217 citations
TL;DR: The predictive validity of the models reviewed depended strongly on the caries prevalence and characteristics of the population for which they were designed, and in many instances a single predictor gave equally good results as the use of a combination of predictors.
Abstract: The aim of this review was to systematically assess clinical evidence in the literature to determine the predictive validity of currently available multivariate caries risk-assessment strategies (including environmental, sociodemographic, behavioral, microbiological, dietary/nutritional, and/or salivary risk factors) in: 1) primary teeth; 2) coronal surfaces of permanent teeth; and 3) root surfaces of permanent teeth. We identified 1,249 articles in the search, and selected 169 for full review. Inclusion and exclusion criteria were established prior to commencement of the literature search. Papers that conformed to these criteria were included (n = 15 for primary teeth; n = 22 for permanent teeth; and n = 6 for root surfaces), and 126 papers were excluded. Included articles were grouped by study design as: longitudinal, retrospective, and cross-sectional. The predictive validity of the models reviewed depended strongly on the caries prevalence and characteristics of the population for which they were designed. In many instances, the use of a single predictor gave equally good results as the use of a combination of predictors. Previous caries experience was an important predictor for all tooth types.
189 citations
TL;DR: The impact of the current simulation laboratories on dental education is discussed and advanced technology simulation that has recently become available or is in the developmental stage is reviewed.
Abstract: Simulation is becoming very beneficial in the area of health care education. Dentistry has used various types of simulation in preclinical education for some time. This article discusses the impact of the current simulation laboratories on dental education and reviews advanced technology simulation that has recently become available or is in the developmental stage. The abilities of advanced technology simulation, its advantages and disadvantages, and its potential to affect dental education are addressed.
186 citations
TL;DR: The current understanding of dental enamel formation is reviewed, and this information is related to clinical circumstances where this understanding may be particularly relevant.
Abstract: The nature of tooth enamel is of inherent interest to dental professionals. The current-day clinical practice of dentistry involves the prevention of enamel demineralization, the promotion of enamel remineralization, the restoration of cavitated enamel where demineralization has become irreversible, the vital bleaching of dental enamel that has become discolored, and the diagnosis and treatment of developmental enamel malformations, which can be caused by environmental or genetic factors. On a daily basis, dental health providers make diagnostic and treatment decisions that are influenced by their understanding of tooth formation. A systemic condition during tooth development, such as high fever, can produce a pattern of enamel defects in the dentition. Knowing the timing of tooth development permits estimates about the timing of the disturbance. The process of enamel maturation continues following tooth eruption, so that erupted teeth can become less susceptible to decay over time. Mutations in the genes encoding enamel proteins lead to amelogenesis imperfecta, a collection of inherited diseases having enamel malformations as the predominant phenotype. Defects in the amelogenin gene cause X-linked amelogenesis imperfecta, and genes encoding other enamel proteins are candidates for autosomal forms. Here we review our current understanding of dental enamel formation, and relate this information to clinical circumstances where this understanding may be particularly relevant.
TL;DR: Findings suggest that the replacement of sucrose with sorbitol and xylitol may significantly decrease the incidence of dental caries.
Abstract: 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.
TL;DR: An encouraging finding is that periodontal disease progression slows in patients who quit smoking and that these individuals have a similar response toperiodontal therapy as nonsmokers.
Abstract: This article reviews the effects of smoked and smokeless tobacco on periodontal status, including the impact of smoking on periodontal therapy and potential mechanisms for the adverse effects of tobacco on the periodontium. Approximately half of periodontitis cases have been attributed to either current or former smoking. Both cigar and cigarette smokers have significantly greater loss of bone height than nonsmokers, and there is a trend for pipe smokers to have more bone loss than nonsmokers. Unlike smokers, who experience widespread periodontal destruction, the most prevalent effects of smokeless tobacco are localized to the site of placement, in the form of gingival recession and white mucosal lesions. Smoking has an adverse effect on all forms of periodontal therapy, and up to 90 percent of refractory periodontitis patients are smokers. The pathogenesis of smoking-related periodontal destruction has been attributed to alterations in the microflora and/or host response. Some data indicates that smoking may increase levels of certain periodontal pathogens, but there is more evidence that smoking has a negative effect on host response, such as neutrophil function and antibody production. An encouraging finding is that periodontal disease progression slows in patients who quit smoking and that these individuals have a similar response to periodontal therapy as nonsmokers. The facts presented in this paper will assist dental health professionals in treatment-planning decisions and provide them with important information to share with patients who use tobacco products.
TL;DR: The rationale for the introduction of a PBL pedagogy into dental education, the modalities of PBL being introduced, and the implications of the introduction into dental schools are discussed.
Abstract: The past decade has seen increasing demands for reform of dental education that would produce a graduate better equipped to work in the rapidly changing world of the twenty-first century. Among the most notable curriculum changes implemented in dental schools is a move toward Problem-Based Learning (PBL). PBL, in some form, has been a feature of medical education for several decades, but has only recently been introduced into dental schools. This paper discusses the rationale for the introduction of a PBL pedagogy into dental education, the modalities of PBL being introduced, and the implications of the introduction of PBL into dental schools. Matters related to implementation, faculty development, admissions, and assessment are addressed. Observations derived from a parallel-track dental PBL curriculum at the University of Southern California (USC) are presented and discussed. This program conforms to the Barrows (1998) concept of "authentic PBL" in that the program has no scheduled lectures and maintains a PBL pedagogy for all four years of the curriculum. The USC dental students working in the PBL curriculum have attained a high level of achievement on U.S. National Dental Boards (Part I) examinations, significantly superior to their peers working in a traditional lecture-based curriculum.
TL;DR: 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.
Abstract: 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.
TL;DR: In this article, the authors investigated perceived stress by dental students at the University of Jordan and found that the stressors producing the highest ratings for perceived stress were examinations and grades, fully loaded day, and lack of time for relaxation.
Abstract: This study investigated perceived stress by dental students at the University of Jordan. Two hundred sixty-six students out of 290 completed a modified DES questionnaire. The stressors producing the highest ratings for perceived stress were examinations and grades, fully loaded day, and lack of time for relaxation. For the clinical years, patients' being late or not showing for their appointments and completing clinical requirements were also substantial stressors. Significant differences were found for eleven items across all classes and five items across clinical years. The overall perception of stress by students who had medicine as their first choice for admission was higher than for students who had dentistry as their first choice. Male-female comparison revealed significant differences for five items; between classes, significant differences were accounted for by three items. Comparison with earlier studies on identical questionnaire items revealed that perception of stress by Jordanian dental students was higher than for other students for items relating to educational environment and personal or cultural aspects.
TL;DR: A 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 of dental caries as mentioned in this paper.
Abstract: 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.
TL;DR: In the data, strong evidence has been found for the role of smoking in the development of both oral cancer and oral leukoplakia, and intervention studies show a regression of the lesion after stopping the smoking habit.
Abstract: 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.
TL;DR: Needs for being clear about definitions and nomenclature and understanding the importance of the concepts underlying the D1 and D3 diagnostic thresholds used widely within the RTI/UNC Review are highlighted.
Abstract: 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.
TL;DR: Only autoclaving at 240 degrees F and 20 psi or soaking in 10 percent formalin for one week were 100 percent effective in preventing growth, and a chi-square analysis of the data indicates these two methods were significantly better than all other methods.
Abstract: Extracted human teeth are used in many preclinical courses. While there has been no report of disease transmission with extracted teeth, sterilization of teeth used in the teaching laboratory should be a concern. The purpose of this study was to determine the effectiveness of different sterilization/disinfection methods of extracted human teeth using Bacillus stearothermophilus, a bacteria resistant to heat and frequently used to test sterilizers. In this study, 110 extracted molars with no carious lesions were collected and stored in buffered saline. An endodontic occlusal access preparation was cut into the pulp chamber of each tooth. Pulp tissue in the chamber was removed with a broach. Approximately 1 x 10(5) B. stearothermophilus endospores in culture medium were injected into the pulp chamber, sealed with Cavit G, and then placed in sterile saline for twelve hours. Ten teeth were placed into each of eleven groups. Seven groups were immersed for one week in one of the following solutions: a) sterile saline (control group), b) 5.25% NaOCl, c) 2.6% NaOCl, d) 1% NaOCl, e) 10% buffered formalin, f) 2% gluteraldehyde, g) 0.28% quaternary ammonium. Four additional groups were treated by h) 10% formalin for two days, i) 10% formalin for four days, j) autoclaving at 240 degrees F and 20 psi for twenty minutes, and k) autoclaving at 240 degrees F and twenty psi for forty minutes. Each tooth was then aseptically split and placed in an individual test tube with growth medium. Samples were examined for evidence of growth (turbidity) at forty-eight hours. Only autoclaving for forty minutes at 240 degrees F and 20 psi or soaking in 10 percent formalin for one week were 100 percent effective in preventing growth. A chi-square analysis of the data indicates these two methods were significantly better than all other methods (p<0.001).
TL;DR: The observed rates of occupational exposures to blood and body fluids in this report are consistent with published reports from several other educational settings.
Abstract: Evaluation of occupational exposures can assist with practice modifications, redesign of equipment, and targeted educational efforts. The data presented in this report has been collected as part of a ten-year surveillance program of occupational exposures to blood or other potentially infectious materials in a large dental teaching institution. From 1987 to 1997, a total of 504 percutaneous/non-intact skin and mucous membrane exposures were documented. Of these, 494 (98 percent) were percutaneous, and 10 (2 percent) were mucosal, each involving a splash to the eye of the dental care worker (DCW). Among the 504 exposures, 414 (82.1 percent) occurred among dental students, 60 (11.9 percent) among staff, and 30 (6 percent) among faculty. One hundred ninety-one (37.9 percent) exposures were superficial (no bleeding), 260 (51.6 percent) were moderate (some bleeding), and 53 (10.5 percent) were deep (heavy bleeding). Regarding the circumstances of exposure, 279 (54.5 percent) of the injuries occurred post-operatively (after the use of the device), and most were related to instrument clean-up; 210 (41.0 percent) occurred intra-operatively (during the use of the device); and 23 (4.5 percent) occurred when a DCW collided with a sharp object in the dental operatory (eight cases involved more than one circumstance). The overall exposure rate for the college was 2.46+/-0.11 SD per 10,000 patient visits. The average rate for the student population was 4.02+/-0.20 SD per 100 person-years, with the highest rates being observed among junior year students. The observed rates of occupational exposures to blood and body fluids in this report are consistent with published reports from several other educational settings. Dental teaching institutions are faced with the unique challenge of protecting the student and patient populations against bloodborne infections. Educational efforts must go beyond mere teaching of universal precautions and should include the introduction of safer products and clinical procedures that can minimize the risks associated with the hands-on aspects of the students' learning process.
TL;DR: A review of evidence-based literature indicates incomplete evidence for the efficacy of most measures currently used for caries prevention, with the exception of fluoride varnishes and the use of fluoride-based interventions for patients with hyposalivation.
Abstract: A review of evidence-based literature indicates incomplete evidence for the efficacy of most measures currently used for caries prevention, with the exception of fluoride varnishes and the use of fluoride-based interventions for patients with hyposalivation. Not all fluoride agents and treatments are equal. Different fluoride compounds, different vehicles, and vastly different concentrations have been used with different frequencies and durations of application. These variables can influence the clinical outcome with respect to caries prevention and management. The efficacy of topical fluoride in caries prevention depends on a) the concentration of fluoride used, b) the frequency and duration of application, and to a certain extent, c) the specific fluoride compound used. The more concentrated the fluoride and the greater the frequency of application, the greater the caries reduction. Factors besides efficacy, such as practicality, cost, and compliance, influence the clinician's choice of preventive therapy. For noncavitated smooth surface carious lesions in a moderate caries-risk patient, the appropriate fluoride regimen would be semiannual professional topical application of a fluoride varnish containing 5 percent NaF (22,600 ppm of fluoride). In addition, the patient should use twice or thrice daily for at least one minute a fluoridated dentifrice containing NaF, MFP, or SnF2 (1,000-1,500 ppm of fluoride), and once daily for one minute a fluoride mouthrinse containing .05 percent NaF (230 ppm of fluoride). If the noncavitated carious lesion involves a pit or fissure, the application of an occlusal sealant would be the most appropriate preventive therapy. The management of the high caries-risk patient requires the use of several preventive interventions and behavioral modification, besides the use of topical fluorides. For children over six years of age and adults, both office and self-applied topical fluoride treatments are recommended. For office fluoride therapy at the initial visit, a high-concentration agent, either a 1.23 percent F APF gel (12,300 ppm of fluoride) for four minutes in a tray or a 5 percent NaF varnish (22,600 ppm of fluoride), should be applied directly to the teeth four times per year. Self-applied fluoride therapy should consist of the daily five-minute application of 1.1 percent NaF or APF gel (5,000 ppm of fluoride) in a custom-fitted tray. For those who cannot tolerate a tray delivery owing to gagging or nausea, a daily 0.05 percent NaF rinse (230 ppm of fluoride) for 1 minute is a less effective alternative. In addition, the patient should use twice or thrice daily for at least 1 minute a fluoridated dentifrice as described above for treatment of noncavitated carious lesions. In order to avoid unintentional ingestion and the risk of fluorosis in children under six years of age, fluoride rinses and gels should not be used at home. Furthermore, when using a fluoride dentifrice, such children should apply only a pea-size portion on the brush, should be instructed not to eat or swallow the paste, and should expectorate thoroughly after brushing. Toothbrushing should be done under parental supervision. To avoid etching of porcelain crowns and facings, neutral NaF is indicated in preference to APF gels for those patients who have such restorations and are applying the gel daily. The rationale for these recommendations is discussed. Important deficiencies in our knowledge that require further research on topical fluoride therapy in populations with specific needs are identified.
TL;DR: Training 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.
Abstract: 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.
TL;DR: Three major tissue engineering strategies are described that aim to re-create functional, healthy tissues and organs in order to replace diseased, dying, or dead tissues.
Abstract: Tissue engineering is a novel and exciting field that aims to re-create functional, healthy tissues and organs in order to replace diseased, dying, or dead tissues. The field has developed due to the inadequate supply of organs and tissues for patients requiring organ and tissue replacement. The following review first describes three major tissue engineering strategies. Although similar in their objectives, these strategies each maintain a unique component. Next, several examples of preclinical and clinical progress engineering oral-maxillofacial tissues are presented. Each of these examples highlights specific tissue engineering applications to different tissues of the oral-maxillofacial apparatus. Finally, practical implications are addressed as well as challenges that must be met in order for tissue engineering to reach its full potential.
TL;DR: Estimates for the number of patients or tooth surfaces needed to treat to prevent a carious event suggest that the effects of these professional treatments are low in patients who are at reduced risk for dental caries.
Abstract: This paper summarizes and rates the evidence for the effectiveness of methods available to dental professionals for their use in the primary prevention of dental caries. It reviews operator-applied therapeutic agents or materials and patient counseling. Evidence of effectiveness is extracted from published systematic reviews. A search for articles since publication of these reviews was done to provide updates, and a systematic review of the caries-inhibiting effects of fluoride varnish in primary teeth is provided. Good evidence is available for the effectiveness of fluoride gel and varnish, chlorhexidine gel, and sealant when used to prevent caries in permanent teeth of children and adolescents. The evidence for effectiveness of fluoride varnish use in primary teeth, chlorhexidine varnish, and patient counseling is judged to be insufficient. Use of fluoride, chlorhexidine and sealant according to tested protocols and for the populations in which evidence of effect is available can be recommended. However, they may need to be used selectively. Estimates for the number of patients or tooth surfaces needed to treat to prevent a carious event suggest that the effects of these professional treatments are low in patients who are at reduced risk for dental caries. The literature on use of these preventive methods in individuals other than school-aged children needs expansion.
TL;DR: This manuscript briefly reviews the history of dental implant devices and the concepts surrounding the word "biocompatibility" and contrasts the foreign body reaction with normal healing, and describes how ideas gleaned from the study of normal wound healing can be applied to improved implants.
Abstract: Hundreds of thousands of implantations are performed each year in dental clinical practice. Dental implants are a small fraction of the total number of synthetic materials implanted into the human body in all fields of medicine. Basically, these millions of implants going into humans function adequately. But longevity and complications still are significant issues and provide opportunities for the creation of improved devices. This manuscript briefly reviews the history of dental implant devices and the concepts surrounding the word "biocompatibility." It then contrasts the foreign body reaction with normal healing. Finally, the article describes how ideas gleaned from the study of normal wound healing can be applied to improved dental implants. In a concluding section, three scenarios for dental implants twenty years from now are envisioned.
TL;DR: It will be important to establish valid criteria for the diagnosis of active secondary Caries, which will be facilitated by the suggestion that secondary caries is no different from primary caries except that it occurs next to a filling.
Abstract: A systematic review of the diagnosis of dental caries was produced before the conference. It did not include the diagnosis of secondary or recurrent caries. This was a wise decision because what little literature exists on the subject potentially clouds the issue. Diagnosis is a mental resting place on the way to a treatment decision. A vital part of caries diagnosis is to decide whether a lesion is active and rapidly progressing or already arrested. This information is essential to plan logical management. However, lesion activity should be judged in the patient. Thus, research on the diagnosis of secondary caries must be carried out in vivo and this usually precludes histological validation. Even if such validation is possible, it has its own problems, particularly in distinguishing recurrent from residual caries. The diagnosis of secondary caries is very important since so many restorations are replaced because dentists think there is a new decay. It will be important to establish valid criteria for the diagnosis of active secondary caries, which will be facilitated by the suggestion that secondary caries is no different from primary caries except that it occurs next to a filling. This implies that it can be seen clinically and on a radiograph, next to a restoration.
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TL;DR: This short report supports the use of a 1996 definition of risk factor, as probably the most commonly used term related to risk, for the Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life, March 26-28, 2001.
Abstract: Risk-related terms such as risk factor, modifiable risk factor, demographic risk factor, risk indicator, determinant, and risk marker are often not well defined in the literature. This short report supports the use of a 1996 definition of risk factor, as probably the most commonly used term related to risk, for the Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life, March 26-28, 2001.
TL;DR: The premise of this paper is that the form and content of dental education do not reinforce each other, which results in suboptimal learning; dissatisfied students; difficulty generating excitement among the brightest to consider careers in dental education; erosion of dentists' self-identity as men and women of science.
Abstract: The premise of this paper is that the form and content of dental education do not reinforce each other. What results is suboptimal learning; dissatisfied students; difficulty generating excitement among the brightest to consider careers in dental education; erosion of dentists9 self-identity as men and women of science; and doubts over whether dental schools can continue as the primary providers of oral health education. A need for reform exists because dental curricula must be responsive to changes in current and projected disease demographics, to advances in science and technology, and to a changing societal culture affecting patient demand for treatment. Today9s dilemma is that dental schools need to continue to graduate competent practitioners to meet present clinical needs while also preparing students for a radically different kind of practice in the future. Possible approaches to resolve this dilemma include: a shift between what constitutes general practice and what constitutes specialty practice; and, the implementation of an asynchronous-distributed model of dental education. Such changes will likely be independently accompanied by changes in the role of universities in society in general that could make feasible many, now-unthinkable, alternative vehicles for providing dental education.
TL;DR: The results of 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.
Abstract: 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.