Diagnostic capability of questionnaires and clinical examinations to assess sleep-disordered breathing in children: A systematic review and meta-analysis

BackgroundThe reference standard for the diagnosis of pediatric sleep-disorder breathing (SDB) is a full polysomnography (PSG) (an overnight sleep study). There are many obstacles to children being able to undergo a full PSG; therefore, the authors evaluated the diagnostic value of alternative diagnostic methods (clinical history and physical examination) for pediatric SDB.Types of Studies ReviewedThe authors selected articles in which the investigators' primary objective was to evaluate the diagnostic capability of physical evaluations and questionnaires compared with the current reference standard (that is, a full PSG) to diagnose SDB in children younger than 18 years. The authors searched several electronic databases without limitations.ResultsUsing a two-step selection process, the authors identified 24 articles and used them to conduct a qualitative analysis. They conducted a meta-analysis on 11 of these articles. Among these articles, only one involved a test that had diagnostic accuracy good enough to warrant its use as a screening method for pediatric SDB, but its diagnostic accuracy was not sufficient to be considered a true diagnostic tool (that is, a replacement for full PSG) for pediatric SDB.Practical ImplicationsThe involvement of dentists in the screening process for pediatric SDB can contribute significantly to children's health. The identified questionnaire could be considered an acceptable screening test to determine which children to refer to a sleep medicine specialist.     

Early childhood caries screening tools: a comparison of four approaches

BackgroundEarly childhood caries (ECC) is prevalent and consequential. Risk assessment tools have been proposed that can be used to identify children who require intensive interventions. In this study, the authors compare four approaches for identifying children needing early and intensive intervention to prevent or minimize caries experience for their accuracy and clinical usefulness.MethodsThe authors screened 229 predominantly low-income Hispanic children younger than 3 years with ECC and 242 without ECC by using the American Academy of Pediatric Dentistry's Caries-risk Assessment Tool (CAT) and the optional screening measure of culturing Streptococcus mutans. The authors compared four approaches (CAT, CAT minus socioeconomic status, CAT minus socioeconomic status plus mutans streptococci [MS] and MS alone) for accuracy and clinical usefulness.ResultsThe results of the CAT demonstrated high sensitivity (100.0 percent) and negative predictive value (NPV) (100.0 percent) but low specificity (2.9 percent) and positive predictive value (PPV) (49.4 percent). The MS culture alone had the highest combination of accuracy and clinical usefulness (sensitivity, 86.5 percent; specificity, 93.4 percent; PPV, 92.5 percent; NPV, 87.9 percent). When we removed the socioeconomic status element, the CAT's performance improved.ConclusionsSalivary culture of MS alone in a population of young, low-income Hispanic childrenoutperformed the CAT and variations on the CAT for test accuracy (sensitivity and specificity) and clinical usefulness (predictive values).Clinical ImplicationsScreening for ECC by using salivary MS cultures and variations on the CAT are promising approaches for identifying children who need early and intensive intervention to prevent or minimize caries experience.     

Concordance between clinical practice and published evidence: Findings from The National Dental Practice-Based Research Network

BackgroundDocumenting the gap between what is occurring in clinical practice and what published research findings suggest should be happening is an important step toward improving care. The authors conducted a study to quantify the concordance between clinical practice and published evidence across preventive, diagnostic and treatment procedures among a sample of dentists in The National Dental Practice-Based Research Network (“the network”).MethodsNetwork dentists completed one questionnaire about their demographic characteristics and another about how they treat patients across 12 scenarios/clinical practice behaviors. The authors coded responses to each scenario/clinical practice behavior as consistent (“1”) or inconsistent (“0”) with published evidence, summed the coded responses and divided the sum by the number of total responses to create an overall concordance score. The overall concordance score was calculated as the mean percentage of responses that were consistent with published evidence.ResultsThe authors limited analyses to participants in the United States (N = 591). The study results show a mean concordance at the practitioner level of 62 percent (SD = 18 percent); procedure-specific concordance ranged from 8 to 100 percent. Affiliation with a large group practice, being a female practitioner and having received a dental degree before 1990 were independently associated with high concordance (≥ 75 percent).ConclusionDentists reported a medium-range concordance between practice and published evidence.Practical ImplicationsEfforts to bring research findings into routine practice are needed.     

The frequency and nature of incidental findings in cone-beam computed tomographic scans of the head and neck region: A systematic review

Background

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The authors analyzed the literature critically to determine the frequency and nature of incidental findings (IFs) in cone-beam computed tomographic (CBCT) scans of the head and neck region.Types of Studies ReviewedThe authors conducted a systematic search of several electronic databases (MEDLINE, Embase, PubMed, Scopus, Web of Science, the Cochrane Library) through July 14, 2012, as well as a limited gray-literature search (in Google Scholar). Inclusion criteria encompassed the frequency of reports of IFs in the head and neck region in CBCT imaging, regardless of the sample origin. The authors used no search limitations. They evaluated methodological quality according to 15 criteria related to study design, population characteristics and statistical analysis.ResultsInitially, the authors identified 66 articles from the electronic database searches and another one via the gray-literature search. Once they applied the final selection criteria, they found that only five articles satisfied the inclusion criteria. In articles in which investigators reported the number of IFs as the absolute number of IFs detected, the frequency ranged from 1.3 to 2.9 IFs per CBCT scan. Conversely, in articles in which authors reported the number of IFs as the number of scans containing IFs, the frequency ranged from 24.6 to 93.4 percent of CBCT scans. Methodological quality averaged 77.2 percent (range, 60-93 percent) of the maximum possible score.Conclusions and Clinical ImplicationsIFs are detected relatively frequently in CBCT imaging, and considerable variation is evident in their frequency and nature. The majority are extragnathic findings (that is, those found outside the region of the dentition and alveolus), thus emphasizing the need for complete and proper review of the entire image, regardless of field of view or region of interest.     

Preventing and treating white-spot lesions associated with orthodontic treatment: a survey of general dentists and orthodontists

BackgroundThe authors investigated the prevention and treatment of white-spot lesions (WSLs) during and after orthodontic therapy from the perspective of general dentists and orthodontists.MethodsThe authors administered a cross-sectional survey to general dentists (n = 191) and orthodontists (n = 305) in Virginia, Maryland and North Carolina.ResultsSixty-nine percent of general dentists and 76 percent of orthodontists recommended in-office fluoride treatment for patients with severe WSLs immediately after orthodontic treatment. Sixty-nine percent of general dentists reported that they had treated WSLs during the previous year, and 37 percent of orthodontists reported that they had removed braces because of patients' poor oral hygiene. Sixty percent of orthodontists referred patients with WSLs to general dentists for treatment. Eighty-five percent of orthodontists responded that they encouraged patients to use a fluoride rinse as a preventive measure. More than one-third of general dentists indicated that severe WSLs after orthodontic treatment could have a negative effect on their perception of the treating orthodontist.ConclusionsWSLs are a common complication of orthodontic treatment and their presence can result in a negative perception of the treating orthodontist by the patient's general dentist.Clinical implicationsGeneral dentists and orthodontists should work together to prevent the development of WSLs in their patients. Treatment with fluoride supplements and motivating and training patients to practice good oral hygiene will help achieve this goal. Treatment after debonding should include the topical application of low concentrations of fluoride.     

How willing are dentists to treat young children?: A survey of dentists affiliated with Medicaid managed care in New York City, 2010

BackgroundDespite recommendations for children to have a dental visit by the age of 1 year, access to dental care for young children, including children enrolled in Medicaid, remains limited. The authors conducted a survey to assess the availability of dentists to see young children enrolled in Medicaid managed care (MMC) in New York City (NYC), to determine barriers to the provision of dental care to young children and, within the context of MMC, to identify strategies to facilitate the delivery of dental care to children.MethodsThe authors mailed a survey to assess the provision of dental services to young children and perceived barriers and facilitators to 2,311 general dentists (GDs) and 140 pediatric dentists (PDs) affiliated with NYC MMC. A total of 1,127 surveys (46 percent) were received. The authors analyzed the responses according to provider type, youngest aged child seen, provider’s ability to see additional children and practice location. The authors compared responses by using the χ² test.ResultsFewer than one-half (47 percent) of GDs saw children aged 0 through 2 years. Provider type, years in practice and percentage of Medicaid-insured patients were associated significantly (P χ .005) with youngest age of child seen. Among respondents seeing children aged 0 through 2 years, PDs were significantly more likely to provide preventive therapy (P = .004) and restorative treatment (P χ .001). Additional training and access to consulting PDs were identified by GDs as potential facilitators to seeing young children.ConclusionA high proportion of NYC GDs affiliated with MMC do not see young children.Practice ImplicationsNinety-four percent of NYC MMC– affiliated dentists are GDs, but 53 percent of GD respondents did not see children aged 0 through 2 years in their practices. Improving access to dental care for young children requires changes in GDs’ practices, possibly by means of additional training and access to consulting PDs.     

Treating dental patients who use oral antithrombotic medication: a survey of dentists in the Netherlands

BackgroundFor many years, international guidelines have advised health care professionals not to adjust oral antithrombotic medication (OAM) regimens before invasive dental procedures. The authors conducted a study to examine the opinions of Dutch general dentists regarding the dental care of patients receiving treatment with these medications.MethodsThe authors invited via e-mail 1,442 general dentists in the Netherlands to answer a 20-item Internet-based questionnaire that they developed. Survey items consisted of questions about medical history taking, number of patients in the dental practice receiving OAM therapy, frequency of consulting with medical and dental colleagues and suggested dental treatment of patients during various invasive dental procedures.ResultsA total of 487 questionnaires were returned (response rate of 34 percent). The mean age of respondents was 47 years, and 77 percent were male. The majority of dentists responded that they obtain medical histories, but that they did not know how many of their patients were receiving OAM treatment. Dentists reported that they consult with medical colleagues frequently about antithrombotic medication. Ninety-one percent of respondents stated that they obtained their medical knowledge primarily in dental school. More than 50 percent of the dentists reported that they were not familiar with the international normalized ratio. The majority of dentists responded that they felt a need for clinical practice guidelines.ConclusionsAccording to the results of our survey, most dentists remain cautious when performing invasive dental procedures in patients who are treated with OAMs. Moreover, survey respondents tended to estimate that the risk of bleeding during dental procedures when OAM therapy is continued is higher than the risk of rethrombosis when use of antithrombotic medication is interrupted.Clinical ImplicationsA growing proportion of elderly patients and those with medically complex conditions are being treated in dental practices in the Netherlands. Consequently, more needs to be done to ensure that dentists are offered evidence-based guidance when treating patients who receive OAMs.     

Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: Translating clinical research to dental practice

BackgroundEffective and safe drug therapy for the management of acute postoperative pain has relied on orally administered analgesics such as ibuprofen, naproxen and acetaminophen, or N-acetyl-p-aminophenol (APAP), as well as combination formulations containing opioids such as hydrocodone with APAP. The combination of ibuprofen and APAP has been advocated in the last few years as an alternative therapy for postoperative pain management. The authors conducted a critical analysis to evaluate the scientific evidence for using the ibuprofen-APAP combination and propose clinical treatment recommendations for its use in managing acute postoperative pain in dentistry.Types of Studies ReviewedThe authors used quantitative evidence-based reviews published by the Cochrane Collaboration to determine the relative analgesic efficacy and safety of combining ibuprofen and APAP. They found additional articles by searching the Ovid MEDLINE, PubMed and http://ClinicalTrials.gov databases.ConclusionsThe results of the quantitative systematic reviews indicated that the ibuprofen-APAP combination may be a more effective analgesic, with fewer untoward effects, than are many of the currently available opioid-containing formulations. In addition, the authors found several randomized controlled trials that also indicated that the ibuprofen-APAP combination provided greater pain relief than did ibuprofen or APAP alone after third-molar extractions. The adverse effects associated with the combination were similar to those of the individual component drugs.Practical ImplicationsCombining ibuprofen with APAP provides dentists with an additional therapeutic strategy for managing acute postoperative dental pain. This combination has been reported to provide greater analgesia without significantly increasing the adverse effects that often are associated with opioid-containing analgesic combinations. When making stepwise recommendations for the management of acute postoperative dental pain, dentists should consider including ibuprofen-APAP combination therapy.     

The declining number of practicing African American dentists in Cuyahoga County, Ohio, 1970 through 2010

BackgroundThe authors tracked the declining number of practicing African American dentists and its relationship to the migratory patterns of the black community in Cuyahoga County, Ohio, from Jan. 1, 1970, through Dec. 31, 2010.MethodsThe authors conducted a longitudinal study in which they used the Geographic Information System (Environmental Systems Research Institute, Redlands, Calif.) to plot the location of each black-owned dental practice in Cuyahoga County in conjunction with the black population. They calculated the ages of the dentists by using birth dates posted on the Ohio State Dental Board's Web site and divided the dentists into five age groups.ResultsThe study results showed that dental practice distributions followed the migratory pattern of the black population from Cleveland to the surrounding suburbs. The number of black dentists in practice decreased from 1986 through 2010 in the Cleveland metropolitan area (Cuyahoga County), and 46.3 percent of the black dentists were projected to retire by 2020.ConclusionsThese results underscore the need to increase the number of black dentists in Cuyahoga County and nationwide. On the basis of the demographic data they found, the authors expect the number of black dentists to continue to decrease if no intervening circumstances occur.Practice ImplicationsThere were 48.8 percent fewer black dentists in Cuyahoga County in 2010 than there were in 1985. If this pattern continued until 2020, there could be a critical shortage of black dentists in Cuyahoga County.     

Advancing infection control in dental care settings: Factors associated with dentists' implementation of guidelines from the Centers for Disease Control and Prevention

Background and OverviewThe authors set out to identify factors associated with implementation by U.S. dentists of four practices first recommended in the Centers for Disease Control and Prevention's Guidelines for Infection Control in Dental Health-Care Settings—2003.MethodsIn 2008, the authors surveyed a stratified random sample of 6,825 U.S. dentists. The response rate was 49 percent. The authors gathered data regarding dentists' demographic and practice characteristics, attitudes toward infection control, sources of instruction regarding the guidelines and knowledge about the need to use sterile water for surgical procedures. Then they assessed the impact of those factors on the implementation of four recommendations: having an infection control coordinator, maintaining dental unit water quality, documenting percutaneous injuries and using safer medical devices, such as safer syringes and scalpels. The authors conducted bivariate analyses and proportional odds modeling.ResultsResponding dentists in 34 percent of practices had implemented none or one of the four recommendations, 40 percent had implemented two of the recommendations and 26 percent had implemented three or four of the recommendations. The likelihood of implementation was higher among dentists who acknowledged the importance of infection control, had practiced dentistry for less than 30 years, had received more continuing dental education credits in infection control, correctly identified more surgical procedures that require the use of sterile water, worked in larger practices and had at least three sources of instruction regarding the guidelines. Dentists with practices in the South Atlantic, Middle Atlantic or East South Central U.S. Census divisions were less likely to have complied.ConclusionsImplementation of the four recommendations varied among U.S. dentists. Strategies targeted at raising awareness of the importance of infection control, increasing continuing education requirements and developing multiple modes of instruction may increase implementation of current and future Centers for Disease Control and Prevention guidelines.The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, Atlanta.The authors thank Jon Ruesch, who when this study was conducted was the director, Survey Center, American Dental Association, Chicago, for his effort in the collection of the data for this research project. Mr. Ruesch is now retired.     

Risk of adrenal crisis in dental patients: Results of a systematic search of the literature

BackgroundThe authors performed a systematic search of the literature to identify the frequency of, risk of experiencing and factors associated with adrenal crises in dental patients.MethodsThe authors searched PubMed and Ovid MEDLINE (1947-June 20, 2012) and Embase (1974-2012) for English-language articles related to cases of adrenal crisis in dentistry and extracted and analyzed data from the articles. The six authors determined whether the cases identified met a consensus definition of adrenal crisis.ResultsOf 148 articles identified in the initial screening, 34 articles were included in the final review, from which six cases met the criteria of adrenal crisis. The authors categorized four cases as “suggestive of adrenal crisis” and two cases as “consistent with adrenal crisis.” Risk factors were significant adrenal insufficiency, pain, infection, having undergone an invasive procedure, having received a barbiturate general anesthetic, and poor health status and stability at the time of presentation. The authors estimated risk to be less than one in 650,000 in patients with adrenal insufficiency.ConclusionsAdrenal crisis is rare in dental patients, with only six reports of it having been published in the past 66 years. Risk is associated with unrecognized adrenal insufficiency, poor health status and stability at the time of treatment, pain, infection, having undergone an invasive procedure and having received a barbiturate general anesthetic.Clinical ImplicationsRisk of adrenal crisis is reduced through proper evaluation of the patient, identification of risk factors and following appropriate preventive measures.     

Rubber dam use during root canal treatment: Findings from The Dental Practice-Based Research Network

Background

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The Dental Practice-Based Research Network (DPBRN) provided a means to investigate whether certain procedures were performed routinely. The authors conducted a study to quantify rubber dam use during root canal treatment (RCT) among general dentists and to test the hypothesis that certain dentist or practice characteristics were associated with rubber dam use.MethodsDPBRN practitioner-investigators (P-Is) answered a questionnaire that included items about rubber dam use and other forms of isolation during RCT. DPBRN enrollment questionnaire data provided information regarding practitioner and practice characteristics.ResultsA total of 729 (74 percent) of 991 P-Is responded; 524 were general dentists who reported providing at least some RCTs and reported the percentage of RCTs for which they used a rubber dam. Of these 524 P-Is, 44 percent used a rubber dam for all RCTs, 24 percent used it for 51 to 99 percent of RCTs, 17 percent used it for 1 to 50 percent of RCTs, and 15 percent never used it during RCT. Usage varied significantly by geographic region and practice type. The use of cotton rolls and other forms of isolation also was reported.ConclusionsSimilar to other reports in the literature, not all DPBRN general dentists used a rubber dam during RCT.Clinical ImplicationsBecause the clinical reference standard is to use a rubber dam during RCT, increasing its use may be important.     

Restoration of noncarious tooth defects by dentists in The Dental Practice-Based Research Network

BackgroundThe authors conducted a study to quantify the reasons for restoring noncarious tooth defects (NCTDs) by dentists in The Dental Practice-Based Research Network (DPBRN) and to assess the tooth, patient and dentist characteristics associated with those reasons.MethodsData were collected by 178 DPBRN dentists regarding the placement of 1,301 consecutive restorations owing to NCTDs. Information gathered included the main clinical reason, other than dental caries, for restoration of previously unrestored permanent tooth surfaces; characteristics of patients who received treatment; dentists’ and dental practices’ characteristics; teeth and surfaces restored; and restorative materials used.ResultsDentists most often placed restorations to treat lesions caused by abrasion, abfraction or erosion (AAE) (46 percent) and tooth fracture (31 percent). Patients 41 years or older received restorations mainly because of AAE (P < .001). Premolars and anterior teeth were restored mostly owing to AAE; molars were restored mostly owing to tooth fracture (P < .001). Dentists used directly placed resin-based composite (RBC) largely to restore AAE lesions and fractured teeth (P < .001).ConclusionsAmong DPBRN practices, AAE and tooth fracture were the main reasons for restoring noncarious tooth surfaces. Pre-molars and anterior teeth of patients 41 years and older are most likely to receive restorations owing to AAE; molars are most likely to receive restorations owing to tooth fracture. Dentists restored both types of NCTDs most often with RBC.     

Is change in probing depth a reliable predictor of change in clinical attachment loss?

Background

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Clinicians and researchers need a measure for monitoring the periodontal condition of their patients or study participants. The authors explored the utility of change in probing depth (PD) for predicting change in clinical attachment loss (CAL).MethodsThe authors used clinical trial data from 363 participants who had received nonsurgical treatment to describe associations between PD and CAL changes. They computed the association between PD and CAL changes—correlation, sensitivity, specificity, and positive and negative predictive values—according to tooth type, tooth site and initial PD.ResultsDepending on the subset of tooth sites, sensitivity of PD change to predict CAL change ranged from 18 to 74 percent; the highest sensitivity was at initially deep sites. Specificity and negative predictive value were higher than sensitivity and positive predictive value. Correlations between person-level mean PD and CAL changes ranged from 0.60 to 0.79 and were highest at initially deep sites.ConclusionsExcept at initially deep sites, PD change did not reliably predict CAL change. Clinicians and researchers who measure only PD may fail to identify teeth that lose or gain attachment.Clinical ImplicationsClinicians should consider monitoring CAL to detect changes in periodontal status more reliably. It is unknown if these findings apply to patients treated surgically or to prediction of tooth loss.     

A usability evaluation of four commercial dental computer-based patient record systems

BackgroundThe usability of dental computer-based patient record (CPR) systems has not been studied, despite early evidence that poor usability is a problem for dental CPR system users at multiple levels.MethodsThe authors conducted formal usability tests of four dental CPR systems by using a purposive sample of four groups of five novice users. The authors measured task outcomes (correctly completed, incorrectly completed and incomplete) in each CPR system while the participants performed nine clinical documentation tasks, as well as the number of usability problems identified in each CPR system and their potential relationship to task outcomes. The authors reviewed the software application design aspects responsible for these usability problems.ResultsThe range for correctly completed tasks was 16 to 64 percent, for incorrectly completed tasks 18 to 38 percent and for incomplete tasks 9 to 47 percent. The authors identified 286 usability problems. The main types were three unsuccessful attempts, negative affect and task incorrectly completed. They also identified six problematic interface and interaction designs that led to usability problems.ConclusionThe four dental CPR systems studied have significant usability problems for novice users, resulting in a steep learning curve and potentially reduced system adoption.Clinical ImplicationsThe significant number of data entry errors raises concerns about the quality of documentation in clinical practice.     

Reimbursement rates and policies for primary molar pit-and-fissure sealants across state Medicaid programs

BackgroundLittle is known about Medicaid policies regarding reimbursement for placement of sealants on primary molars. The authors identified Medicaid programs that reimbursed dentists for placing primary molar sealants and hypothesized that these programs had higher reimbursement rates than did state programs that did not reimburse for primary molar sealants.MethodsThe authors obtained Medicaid reimbursement data from online fee schedules and determined whether each state Medicaid program reimbursed for primary molar sealants (no or yes). The outcome measure was the reimbursement rate for permanent tooth sealants (calculated in 2012 U.S. dollars). The authors compared mean reimbursement rates by using the t test (α = .05).ResultsSeventeen Medicaid programs reimbursed dentists for placing primary molar sealants (34 percent), and the mean reimbursement rate was $27.57 (range, $16.00 [Maine] to $49.68 [Alaska]). All 50 programs reimbursed dentists for placement of sealants on permanent teeth. The mean reimbursement for permanent tooth sealants was significantly higher in programs that reimbursed for primary molar sealants than in programs that did not ($28.51 and $23.67, respectively; P = .03).ConclusionsMost state Medicaid programs do not reimburse dentists for placing sealants on primary molars, but programs that do so have significantly higher reimbursement rates.Practical ImplicationsMedicaid reimbursement rates are related to dentists' participation in Medicaid and children's dental care use. Reimbursement for placement of sealants on primary molars is a proxy for Medicaid program generosity.     

An adverse event trigger tool in dentistry: A new methodology for measuring harm in the dental office

BackgroundThere is a dearth of knowledge about the type and frequency of adverse events (AEs) in dentistry. Current approaches to obtaining information rely on reviews of randomly selected records, which may not be the most efficient or effective methodology.MethodsInspired by the Institute for Healthcare Improvement's (IHI) global and outpatient trigger tools, which identifies records with characteristics (”triggers“) that are associated with AEs, the authors created the dental clinic trigger tool. The triggers included procedures for incision and drainage, failed implants and selected treatment patterns. The authors ran the trigger tool against six months of electronic health records data and compared its performance with that of a review of 50 randomly selected patient records.ResultsIn total, 315 records were triggered, 158 (50 percent) of which were positive for one or more AEs; 17 (34 percent) of the 50 randomly selected records were positive for at least one AE. The authors assigned each AE an IHI severity ranking. Most AEs caused temporary harm, but nine were considered to have caused permanent harm according to a modified IHI severity ranking.ConclusionsThe study results demonstrate the promise of a directed records review approach, as the dental clinic trigger tool was more effective in identifying AEs than was a review of randomly selected records.Practical ImplicationsAll dental practices should proactively monitor the safety of the care they provide. Use of the trigger tool will help make this process more efficient and effective.     

The effectiveness of using a patient simulator to teach light-curing skills

BackgroundThe authors evaluated the effectiveness of using a patient simulator (MARC Patient Simulator [MARC PS], BlueLight analytics, Halifax, Nova Scotia, Canada), to instruct dental students (DS) on how to deliver energy optimally to a restoration from a curing light. Five months later, the authors evaluated the retention of the instruction provided to the DS.MethodsToward the end of the DS&apos; first year of dental education, the authors evaluated the light-curing techniques of one-half of the class of first-year DS (Group 1) before and after receiving instruction by means of the patient simulator. Five months later, they retested DS in Group 1 and tested the remaining first-year DS who were then second-year DS and who had received no instruction by means of the patient simulator (Group 2). They gave DS in Group 1 and Group 2 MARC PS instruction and retested them. The authors also the tested fourth-year DS (Group 3) and dentists (Group 4) by using the MARC PS before giving any instruction by means of the MARC PS.ResultsThe results of one-way analysis of variance (ANOVA) showed that there were no significant differences in the ability of dentists and DS to light cure a simulated restoration before they received instruction by means of the patient simulator (P = .26). The results of two-way ANOVA and Fisher protected least significant difference tests showed that after receiving instruction by means of the patient simulator, DS delivered significantly more energy to a simulated restoration, and this skill was retained. There were no significant differences between DS in Group 1 and Group 2 after they had received instruction by means of the patient simulator.ConclusionsThe abilities of dentists and DS to light cure a simulated restoration were not significantly different. Hands-on teaching using a patient simulator enhanced the ability of DS to use a curing light. This skill was retained for at least five months.Practical ImplicationsThe education provided to dentists and DS is insufficient to teach them how to deliver the optimum amount of energy from a curing light. Better teaching and understanding of the importance of light curing is required.     

Minimally invasive resin infiltration of arrested white-spot lesions: A randomized clinical trial

BackgroundThe authors conducted a randomized, single-masked clinical trial involving patients who had completed orthodontic treatment to assess changes in the appearance of white-spot lesions (WSLs) that were treated with resin infiltration.MethodsThe authors divided affected teeth into control and treatment groups. In the treatment group, they restored teeth with WSLs by using resin infiltration. They evaluated changes in WSLs photographically by using a visual analog scale (VAS) (0 = no change, 100 = complete disappearance) and area measurements (in square millimeters). The authors analyzed the data by using two-way analysis of variance.ResultsThe mean VAS ratings for treated teeth demonstrated marked improvement relative to that for control teeth immediately after treatment (67.7 versus 5.2, P < .001) and eight weeks later (65.9 versus 9.2, P < .001). The results for treated teeth showed a mean reduction in WSL area of 61.8 percent immediately after treatment and 60.9 percent eight weeks later, compared with a ?3.3 percent change for control teeth immediately after treatment and a 1.0 percent reduction eight weeks later.ConclusionsResin infiltration significantly improved the clinical appearance of WSLs, with stable results seen eight weeks after treatment.Practical ImplicationsResin infiltration, a minimally invasive restorative treatment, was shown to be effective for WSLs that formed during orthodontic treatment.     

The role of dentin moisture in the degradation of resin-dentin interfaces under clinical and laboratory conditions

BackgroundThe authors conducted a study to evaluate the influence of dentin moisture on the degradation of the resin-dentin interface in primary teeth under clinical and laboratory conditions.MethodsThe authors prepared 40 Class I restorations (five teeth per group) by using a cylindrical diamond bur, leaving a flat dentin surface on the pulpal floor. They vigorously rubbed two coats of a simplified etch-and-rinse adhesive on either dry or wet demineralized dentin under clinical or laboratory conditions. After performing restorative procedures, the authors extracted teeth prepared under clinical conditions after 20 minutes (immediately) or the teeth exfoliated after six months. The authors also tested the teeth prepared under laboratory conditions immediately or after six months of being stored in water. They sectioned the teeth to obtain resin-dentin bonded specimens for microtensile testing and for silver nitrate uptake (SNU) under scanning electron microscopy. They performed a three-way analysis of variance and Tukey test (α = .05) on the SNU bond strength data.ResultsStatistically higher bond strength values (megapascals [standard deviation]) were observed when bonding was performed under laboratory conditions (clinical = 25.2 [3.6] MPa versus laboratory = 28.5 [4.4] MPa; P < .05). Degradation occurred only in the wet dentin groups under both experimental conditions (immediately = 31.3 [4.5] MPa versus after six months = 21.3 [2.1] MPa; P < .05). SNU occurred in all groups and was statistically higher after six months of clinical function or water storage (immediately = 13.9 [4.9 SD] percent versus after six months = 34.1 [4.5 SD] percent; P < .05).ConclusionsThe bonding of adhesives to dry demineralized dentin produces adhesive interfaces that are more resistant to degradation regardless of the bonding condition.Clinical ImplicationsResin-dentin bond strengths produced under laboratory conditions in primary teeth may be higher than those obtained under clinical circumstances, although both conditions (clinical and laboratory) seemed to yield similar results. Bonding to dry demineralized primary tooth dentin produced resin-dentin interfaces that were more resistant to degradation.