An audit of the technical quality of primary orthograde root canal treatment performed by undergraduate dental students

Aim To investigate the technical quality of primary orthograde root canal treatment performed by undergraduate dental students. Methodology A retrospective radiographic analysis of the technical standard of root canal treatment performed over 1 year of the undergraduate course was undertaken. All primary root canal treatments performed by late 4th and final year students between 1 April 2006 and 31 March 2007 were evaluated. All students had completed an introductory laboratory course using stainless steel hand instruments and Gates Glidden drills and a subsequent course using Nickel titanium instruments. Additionally, some students completed a voluntary one‐term special study module (Endodontics) for 12 sessions. All radiographs of completed root canal treatments were assessed as to the technical quality of the root filling. Two calibrated observers assessed the radiographs under standard conditions using a lightbox and SDI radiograph viewer. The root fillings in each canal were assessed by length, satisfactory being within 0–2 mm of the radiographic apex, quality of obturation (absence of voids) classified as satisfactory, and taper, with the radiographic appearance of a uniform taper classed as satisfactory. The type of clinic, either a general restorative or endodontic was also recorded. Results A total of 266 root canals were evaluated in 149 teeth. The final radiograph was unsuitable in four teeth and one tooth was extracted shortly after canal preparation. The remaining sample size was 253 canals in 144 teeth (61 anterior, 37 premolar, 46 molar). No endodontic instruments were fractured during the study. Overall, 163 individual root canals (64.4%) and 87 teeth (60.4%) were classed as satisfactory. Fifty‐five canals and 21 teeth (one lower anterior, five premolars, 15 molars) were treated on the endodontic clinic, 46 canals (83.6%) and 15 teeth (71.4%) of these were satisfactory. A total of 198 canals in 123 teeth (60 anterior, 32 premolar, 31 molar) were treated on the restorative clinic with 117 canals (59.1.6%) and 72 teeth (58.5%) being satisfactory. Conclusions Overall, 60.4% of teeth met the criteria of root filling within 2 mm of the radiographic apex, no voids and uniform taper. A higher percentage of compliance was noted on the endodontic special study module.     

Rotary Versus Reciprocation Root Canal Preparation: Initial Clinical Quality Assessment in a Novice Clinician Cohort

Introduction

Reports comparing clinical outcomes using nickel-titanium (NiTi) reciprocating instruments with other instrumentation modalities are scarce. This study examined initial shaping outcomes after an instrumentation change of root canal instrumentation technique in a doctor of dental surgery educational program. Student characteristics, faculty/student ratio, facility, and overall endodontic treatment guidelines remained unchanged.

Quality of root canal treatment performed by undergraduate dental students at the University of Khartoum, Sudan

The aim of the present study was to evaluate the quality of root canal treatment performed by undergraduate dental students at the University of Khartoum. Assessment was by examination of periapical radiographs of completed endodontically treated teeth, performed by undergraduate dental students. A total of 166 postoperative periapical radiographs compromising 265 roots were included. The quality of endodontic treatment was examined in relation to the length of the root filling in relation to the radiographic apex, the density of the obturation according to presence of voids and the taper of root canal fillings. Adequate length of the root filling was found in 34.7% of the maxillary teeth and in 10.9% of mandibular teeth in this study. Adequate density was found in 38.87% of maxillary and 16.98% of mandibular teeth and appropriate taper was found in 40% of maxillary and 16.6% of mandibular teeth. Overall 24.2% in all evaluated teeth were found to have a root filling of an acceptable quality. This result may be because of insufficient preclinical endodontic training of the students' operators or because of the introduction of students to endodontic clinical practice late in their program.     

Reasons for taking radiographs in general dental practice

This survey investigated the reasons why general dental practitioners take radiographs. 179 (54%) dentists responded and provided information for 2359 patients who were radiographed during a specified week. Of those patients aged less than 15 yr, 62% were radiographed primarily for orthodontic purposes and 22% for caries. In older age groups, caries was the predominant reason for taking radiographs but endodontic assessment assumed increasing importance with age and accounted for 37% of radiographs in patients aged more than 45 yr. Only 8% of patients were radiographed for periodontal reasons. These findings are discussed with respect to the changing pattern of disease and treatment provided in general dental practice.     

Philosophies and practices regarding the management of the endodontic smear layer: results from two surveys

The purpose of this investigation was to ascertain the prevailing attitudes within the endodontic community regarding smear layer removal. The first survey asked the philosophies and techniques currently being taught to predoctoral dental students and postdoctoral endodontic residents in the United States, whereas the second surveyed some of the members of the American Association of Endodontists currently practicing in the United States. Findings from these surveys revealed that more than three-fourths of the dental students and nearly two-thirds of the endodontic residents are not being taught routine smear layer removal. Slightly more than one-half of endodontists responded they practice smear layer removal. These surveys indicate that there is no clear consensus in the endodontic community, either academically or clinically, as to whether the smear layer should be removed or be allowed to remain before obturation of the root canal space.     

Educational necessities to compensate for faculty shortage

The purpose of this investigation was to evaluate whether senior dental students (4DS) could serve as effective instructors in a two-semester preclinical laboratory course and whether such teaching experience could enhance their interest in academics as a future career. Based on academic performance, five senior students were recruited to serve as instructors in a two-semester morphology/occlusion laboratory course in which ninety-five first-year dental students were enrolled. The first-year students were randomly assigned so that each student was instructed by a faculty member in one semester and a 4DS in the other semester. Outcomes included course evaluation forms completed by the first-year dental students at the end of each semester; a comparison of students' performances in each course determined by faculty instructors and 4DSs; and the 4DSs' self-report of their teaching experiences. Results showed no significant difference between the performance of 4DS and faculty instructors in all criteria evaluated (p>.05). Furthermore, there was no significant difference between the performance of students instructed by faculty members and those instructed by 4DS in either semester (p>.05). Despite the fact that such experience seemed to have minimal influence on students' decision to consider academics as a future career, 4DSs do seem to provide effective instruction and thereby can serve to compensate for faculty shortages.     

Use of panoramic radiographs in general dental practice in England

The rapid growth in the use of panoramic radiographs provoked this survey of the reasons why general dental practitioners in Avon take such views. Of the 193 dentists who responded, 42 (22%) took one or more panoramic radiographs during a specified week. A total of 195 patients, 8% of those x-rayed, had a panoramic radiograph taken either alone or in combination with other views. Panoramic radiographs were stated to have been taken primarily for the diagnosis of caries (48%) and surgical (24%), periodontal (20%), orthodontic (20%) and endodontic/apical assessment. These findings are discussed with respect to published guidelines on the use of panoramic radiographs and the teaching of radiology in dental schools.     

Retention of teeth versus extraction and implant placement: treatment preferences of dental faculty and dental students

The purpose of this study was to determine the treatment preferences amongst dental faculty and dental students for either retention of teeth by endodontic and restorative treatment or extraction and implant placement. A survey of 134 general dentistry faculty and 253 senior (fourth-year) dental students was conducted in a university college of dentistry. Participants completed a survey consisting of questions for which one of two choices could be selected. For questions describing specific clinical situations, dental faculty and dental students more frequently selected endodontic and restorative treatment over extraction and implant placement. However, dental students selected implants more frequently than dental faculty, and more recent graduates on the dental faculty selected implants more frequently than less recent graduates on the dental faculty. In addition, there was an increase in the selection of implants, for all participant groups, as the prosthetic and endodontic complexities of the clinical situations increased. Participants were more likely to select endodontics rather than implants for medically compromised patients, and an implant was overwhelmingly selected over a fixed bridge for the replacement of a single tooth unit. In conclusion, the findings of this study indicate that retention of teeth is preferred, but there may be an increased preference toward implants in the future.     

A survey of root canal treatment of molar teeth by general dental practitioners in private practice in Saudi Arabia

The purpose of this study was to evaluate the practice and depth of knowledge of root canal treatment by general dental practitioners working in private dental centers in different cities within the Kingdom of Saudi Arabia. A questionnaire was distributed to 400 general dental practitioners. Completed questionnaires were analyzed in term of simple summary statistics. A total of 252 (63%) practitioners responded. The majority of the respondents were Syrians (59%) and Egyptians (32%). Ninety-one per cent of the respondents indicated that they performed root canal treatment. Amongst those who carried out root canal treatment, only seven practitioners (3%) used rubber dam for isolation. More than half of the respondents (55%) used saline to irrigate canals during treatment. Forty-six per cent of practitioners used formocresol as an inter appointment medicament. The standardized and step-back preparation techniques were the method of choice for the majority of the respondents (91%). Ninety-seven per cent of the practitioners used stainless steel hand instruments to prepare root canals and the majority (92%) used gutta-percha for obturation. Seventy-four per cent of the respondent used cold lateral condensation. The average number of radiographs routinely taken for root canal treatment was four. Ninety-three per cent indicated that they usually completed a root canal treatment of molar teeth in three or more visits. Eighty-eight per cent of the practitioners preferred waiting for 1 or 2 weeks to restore the teeth permanently. Results of this study confirm that many general dental practitioners are not following quality guidelines for endodontic treatment.     

Providing care in an infectious disease clinic. Why students volunteer*

This qualitative study explores the motivations of dental students who volunteered as care providers for patients identified as carriers of infectious diseases. The study involved 12 students, seven 4th year and five 3rd year students who worked 1–2.5 days per week in an infectious disease clinic in a dental school in the northeastern United States. 4 faculty members who also volunteered their time in the clinic supervised the students. Personal interviews were conducted with each student to determine their reasons for volunteering and to explore the perceived significance of their experiences in the clinic. Internal validity was established through group interviews wherein responses during the personal interviews were discussed with the students. All 12 students were interested in Oral Medicine and all 4th year students had completed a course on HIV-AIDS for their selective requirement. Students expressed willingness to care for patients who are medically compromised in anticipation of an increase of this type of patients in their future practice. Previous exposure to a family member or friend or patients (non-dental) who were terminally ill or to patients with HIV was another common reason. All 12 students preferred to work in the infectious disease clinic more than in other school clinics. They felt that there was more faculty-student interaction and a more stimulating learning atmosphere that the faculty created. The students felt that the patients treated in the clinic were more appreciative. Students also claim they experienced more team spirit among their fellow students and staff and that the clinic atmosphere was more relaxed and less competitive. Students got the most satisfaction from helping patients who were perceived to have had problems in accessing care prior to their visit to the clinic. Results of the study show that the students volunteered to treat patients who are known to have infectious diseases such as HIV/AIDS because they find personal and academic satisfaction from working in a clinic which provides care to individuals with specific medical needs.     

Dental anxiety among Israeli dental students: a 4-year longitudinal study

The aims of the present study were (a) to evaluate students' estimation of their parents' dental anxiety; (b) to measure students' dental anxiety and to study their ranking of the most fear provoking stimuli in the dental situation during their pre-clinical and clinical years; (c) to investigate gender differences among students with regard to dental anxiety. 30 3rd-year students (15 male and 15 female) who completed a 4-section questionnaire which requested sociodemographic information, evaluation of parents' dental anxiety, dental anxiety scale (DAS) and dental fear scale (DFS), completed the DAS and DFS in their 5th and 6th years. Both male and female students estimated their mothers' dental anxiety as significantly higher than their fathers'. Female students ranked their parents higher than males. DAS scores were significantly higher among female students than among males in the 3rd year. However, DAS scores were reduced from the 3rd to the 6th year among the total class and significantly among females, while males' levels of anxiety remained within close range throughout the years. The dental anxiety scores of all students who experienced a dental procedure in the past were higher than the scores of the students who did not. The most fearful stimulus was 'feeling the needle'. Our findings may suggest that the change in the reported dental anxiety of the students during the years of dental studies in the present study may be explained by the increased professional education and clinical experience that the students acquire throughout their studies in the dental school. Being exposed to basic trivial dental procedures (such as local anaesthetic injection) may help students either to be habituated or to use rational coping strategies when dealing with personal dental experience.     

A comparison between xeroradiographs and conventional radiographs as an aid in root canal therapy for maxillary molars

The purpose of this study was to compare the quality of images obtained with dental xeroradiography to that obtained with conventional dental radiography during performance of root canal therapy on maxillary molars. For each step requiring radiographic information during endodontic treatment of 12 maxillary molars, a conventional radiograph and a xeroradiograph were made. This produced four pairs of images for each tooth treated as follows: (1) preoperative, (2) initial files for length determination, (3) master cones fitted, and (4) completed obturation of the root canal systems. The same x-ray machine was used as the source of radiation for all exposures with a setting of 70 kVp and 15 mA and with near identical projection for each pair of images achieved through use of a modified film holder and a custom positioning occlusal index made for each patient. Exposure time for the radiographs was 60 impulses (1 impulse = 1/60 second) and for the xeroradiographs it was 42 impulses. Images of structures and items important in endodontic diagnosis and treatment were rated as unacceptable (0), poor (1), adequate (2), or optimal (3) by four independent evaluators. Analysis of data showed the following: images of bone trabeculae, periodontal ligament spaces, root morphology, root apices, and fine bony abnormalities were judged to be significantly better in the radiographs than in the xeroradiographs (p less than 0.01) whereas there were no significant differences in image quality of pulp chamber morphology, root canal morphology, metallic measuring instruments, or endodontic filling materials.     

Oral hygiene and gingival health in Danish dental students and faculty

This survey attempted to determine the status of oral cleanliness and gingival health in 150 dental students and 101 faculty members in a dental school. Without advance notice, plaque deposits were scored, using the Plaque Index System, and gingival health was determined using the criteria of the Gingival Index System. The 1st-year students had the poorest hygiene and gingival health. An improvement (P less than 0.01) was noted in the 2nd-year students who were still not in clinical training but had completed a course in preventive dentistry including oral hygiene techniques. Further improvement (P less than 0.05) was found in students participating in the clinical courses (3rd and 4th years). However, some deterioration of both hygiene and gingival status occurred in the senior 5th year. Among the faculty, the best oral hygiene and gingival state were found in members of departments in which clinical work centered around patient motivation toward prevention and tooth conservation. The scores for plaque and gingivitis were worse in the departments of oral surgery, dental materials, orthodontics and the basic science departments. Almost all departments and every class showed a few individuals with very poor oral hygiene. It is suggested that regular patient contact influences the personal attitude toward oral hygiene, and that professional activity and emphasis on different aspects of the curriculum may be reflected in the attitude of health professionals toward oral health.     

Endodontic-related paresthesia: a case report and literature review

Introduction

Endodontic-related paresthesia is a potential complication despite the development of endodontic materials and techniques. We describe a case of periapical lesion-induced paresthesia that was successfully treated endodontically. The literature review of endodontic-related paresthesia is also presented.

Methods

The patient sought treatment from a general practitioner for lower lip paresthesia as the only symptom. Paresthesia was present on the left side of the lower lip extending from the mandibular midline to the second premolar both extraorally and intraorally in the area of mental nerve stem. Apical lesion of an endodontically treated second premolar with short obturation was observed radiographically. Retreatment was unsuccessful at reaching the apex; instead, swelling, pain, and extension of numbness on the region resulted, and the patient was referred to an endodontist.

Results

The root canal chemomechanical debridement was completed, and calcium hydroxide was placed for the follow-up. Two months later the symptoms had significantly improved, the radiograph indicated partial healing, and the tooth was obturated. The healing progressed so that the symptoms completely resolved within a year after the treatment.

Conclusions

Periapical pathosis might cause paresthesia with a good potential for healing after appropriate endodontic treatment. Complications might be prevented by careful preoperative examination, good quality radiographs, and good instrumentation, irrigation, and obturation techniques. However, according to the literature paresthesia might still occur. In case of treatment-related paresthesia in which apical extrusion of endodontic materials is observed, the need for surgical debridement (especially in cases of extrusion of obturation materials) should be considered within 48 hours.     

Endodontic standards in general dental practice--a survey in Birmingham,Part I

A postal questionnaire was used to evaluate endodontic treatment performed in the general dental services in Birmingham, assessing whether practice type--private or National Health Service (UK), or year of graduation, influences compliance with established guidelines. For the aspects of treatment investigated, many dentists were not following guidelines. More private practitioners adhered to the guidelines. Practitioner age was not related to compliance with guidelines, although there were differences in the procedures and materials employed among the different age groups. Within the survey's limits, it was concluded that endodontic performance varies from established guidelines.     

Consequences of experience and specialist training on the fabrication of implant-supported prostheses: A survey

Statement of problem

Fabricating fixed restorations on implants requires that dentists stay up-to-date with the scientific publications.

Patterns of oral care in dental school and general dental practice

This study compared patterns of oral care provided by predoctoral dental students for patients seeking treatment at the University of Washington (UW) with patterns reported for general dental offices by the Washington Dental Service (WDS). Dental care included about 5 million services provided to 880,317 patients by 2,803 WDS general dentists and about 45,600 dental services provided to 9,488 patients by 155 UW dental students during 1999. There was high fidelity between databases and randomly surveyed patient records for treatment provided in both UW (95 percent) and WDS (97 percent) populations. While patient age patterns were generally similar, UW students completed more procedures for young children and for adults older than seventy-four years but completed fewer procedures for age groups of from thirteen to eighteen and from forty-five to fifty-four than general dental offices. The relative mix of all services completed by UW and WDS providers was similar (ANOVA, P=0.82). Within categories of service, the percentage of total services completed by students compared to those submitted by community dentists to WDS was about the same for examinations, radiographs, fluoride and sealants, amalgams, composites, single crowns, and endodontics. The percentage of total procedures completed showed a greater emphasis by UW students on inlays/onlays, dentures, extractions, and periodontal maintenance, and lesser experience with implants, orthodontics, sedation, and emergency procedures than general dental offices. We conclude that the relative distribution of clinical services provided by UW dental students is comparable to those procedures reported to WDS by dental offices in the adjacent community.     

Comparison between a hand stainless-steel K file and a rotary NiTi 0.04 taper

Straightening of curved canals is one of the most common procedural errors in endodontic instrumentation. It can lead to ledging, perforation, and stripping of the canal. The problem is commonly encountered when root canal preparation is performed in curved molars. The purpose of this study was to compare the results of root canal preparation by undergraduate dental students using traditional stainless-steel 0.02 taper K files to results obtained using rotary nickel-titanium 0.04 taper files. One hundred ninety six extracted teeth comprising maxillary and mandibular first molars were used. Preoperative and postoperative radiographs of each tooth were taken. Graduate endodontic residents evaluated the radiographs according to the evaluation criteria used by the endodontic department. The presence of errors--such as stripping, perforation, ledging, transportation, zipping, and instrument breakage--was recorded by examining the radiographs.     

Recognition of malocclusion: an education outcomes assessment.

The purpose of this study was to assess the outcome of predoctoral orthodontic dental education in an American dental school. A test was used that measured the clinical abilities of dental students in the diagnosis of malocclusion in children, as well as their didactic abilities in answering select questions from recent national board examinations in orthodontics. The records of 7 children with different types of malocclusion were selected from the practice of a board-certified orthodontist. These cases were presented to dental students who were asked to make diagnoses and recommendations for treatment. The results of the didactic and clinical tests were used to assess the outcome of the predoctoral dental curriculum in imparting orthodontic knowledge to future general dentists. Didactic knowledge increased over the 4 years of dental education. First year students answered 30% of the questions correctly, whereas fourth year students answered 59% correctly. The relationship between clinical diagnostic skills and dental education, however, was not as strong. The fourth year students answered 70% of questions concerning the 7 cases correctly. These results indicate that fourth year dental students demonstrated only slight improvement compared with first year students, who answered 65% of the questions correctly. Thus, this study indicated that orthodontic diagnostic skills, as measured by the clinical test used, did not improve substantially during 4 years of undergraduate dental education.