Attitudes and use of rubber dam by Irish general dental practitioners

AIM: To investigate the attitudes towards and use of rubber dam by Irish general dental practitioners. METHODOLOGY: A pre-piloted questionnaire was distributed amongst a group of 600 dentists randomly selected from the Irish Register of Dentists. Replies from dentists working in specialist practice or the hospital dental service were excluded. Dentists were surveyed in relation to their use of rubber dam during a variety of operative and root canal treatments, as well as their attitudes to the use of rubber dam in dental practice. RESULTS: A total of 300 replies were considered from a total of 324 that were received. Seventy-seven per cent of respondents (n=231) worked in general dental practice and 23% (n=69) worked in the Irish Health Board/Community Dental Service. Rubber dam was 'never' used by 77% of respondents (n=228) when placing amalgam restorations in posterior teeth, 52% (n=147) when placing composite restorations in posterior teeth, and 59% (n=177) when placing composite restorations in anterior teeth. Rubber dam was 'never' used by 39% of respondents (n=114) when performing root canal treatment on anterior teeth; 32% (n = 84) when performing root canal treatment on premolar teeth; and 26% (n=51) when performing root canal treatment on molar teeth. Fifty-seven per cent (n=171) considered rubber dam 'cumbersome and difficult to apply', and 41% (n=123) considered throat pack 'as good a prevention against inhalation of endodontic instruments as rubber dam'. CONCLUSIONS: Whilst rubber dam is used more frequently for root canal treatment than operative treatment, its use is limited. This presents quality issues, as well as medico-legal and safety concerns for both the profession and patients.     

Attitudes of some European dental undergraduate students to the placement of direct restorative materials in posterior teeth

Summary The aim of this article was to report on the attitudes, opinions and confidences of final year dental students in three European schools towards the restoration of posterior teeth and in particular towards the use of amalgam and resin composite. One hundred and twenty‐eight pre‐piloted questionnaires were distributed to final year dental students in Cardiff, Dublin and Malmö. The questionnaire sought information relating to various opinions and attitudes towards the use of amalgam and resin composite in posterior teeth. Information was returned anonymously. Ninety‐one completed questionnaires were returned (response rate = 71%; Cardiff: n = 40, Dublin: n = 24, Malmö: n = 27). Ninety‐three per cent of Malmö students (n = 24), 67% of Dublin students (n = 16) and 60% of Cardiff students (n = 24) reported that they feel confident when placing posterior resin composites. One hundred per cent of Malmö students (n = 27), 75% of Cardiff students (n = 30) and 33% of Dublin students (n = 8) would prefer to have a resin composite rather than amalgam, placed in one of their own posterior teeth. Eighty‐five per cent of Malmö students (n = 23), 30% of Cardiff students (n = 12) and 25% of Dublin students (n = 6) perceive amalgam as being harmful to the environment. For the restoration of a posterior tooth in a pregnant female, 44% of students (n = 40) would place a resin composite restoration, and 7% (n = 6) would place an amalgam restoration, while 32% (n = 29) would place a temporary restoration. Students at Malmö report that they place more posterior resin composites and have greater confidence at placing posterior resin composites than students at Cardiff or Dublin. There was confusion relating to the choice of restorative materials for pregnant females. Large variations in restorative strategies among graduates must be considered as dental professionals can practice in all countries within the European Union.     

Patients' attitudes to rubber dam

AIM: The aims of this study were to record patients' views of their experience of RD use in an objective manner, and to evaluate the influence of some personal and clinical factors on patients' opinion. METHODOLOGY: A questionnaire was designed which was then distributed to patients receiving dental treatment under RD by (a) final-year dental students at Birmingham Dental School, and (b) general dental practitioners. Patients completed the confidential questionnaire anonymously after treatment, outside the treatment room. After 100 correctly completed forms were collected from group (a) and 106 from group (b), data were entered into a database and subsequently analyzed using SPSS. Analyses were confined to simple cross-tabulations of the patients' responses and potential associated factors, with chi-square analysis and appropriate follow-up comparisons wherever necessary. RESULTS: In both groups, the majority of patients said they would prefer RD to be used at their next appointment, and most had a positive opinion of the experience. No statistically significant association between age, sex, procedure, application time or duration of use and preference for rubber dam was found. Prolonged RD use showed some association with a negative opinion of the experience of RD. Compared with the dentists, students took longer to apply rubber dam and it was in place for longer. Fewer student patients preferred RD next time, and were less positive about its use than the dentists' patients. CONCLUSIONS: Further evidence is presented that (i) Patients generally are not averse to RD. (ii) Placement of rubber dam does not take long. (iii) Operator experience improves patient compliance.     

Impact of teaching requirements for students on the activity of a university dental hospital

Objectives: This study aimed at investigating the influence of teaching requirements on the clinical activity of a dental hospital. Method: The annual clinical activity of seven classes of fifth-year students (n = 294) was monitored between 1994 and 2001 within the conservative dentistry and endodontic departments of a French dental hospital. The variables chosen were: (i) the mean number of procedures performed per student, and (ii) the proportion of different types of treatment within the global activity (i.e. endodontic treatment, anterior, and posterior restorations). These data were analysed in relation to changes in student assessment criteria over time. Results: Quantitative clinical teaching requirements were removed for the academic year 1998-99 and student clinical activity subsequently decreased by 32.7%, going from 51.9 +/- 12.2 dental procedures on average per student in 1997-98, to 29.1 +/- 7.2 in 2000-01. The mean number of patients treated per student also declined significantly during this period. The size of the minimum clinical requirement altered over the years prior to being removed altogether and a positive correlation existed between the volume of activity and the minimum requirement over this time. The types of treatment provided changed independently from the assessment criteria over the study period. There was a decrease in the percentage of amalgams placed and an increase in the number of posterior composites. A negative correlation existed between the evolution of these two types of treatment. Conclusion: This study demonstrates that the clinical activity of a department in a dental teaching hospital is directly related to the assessment criteria fixed by the university. This may have repercussions for hospital services.     

Prevention-oriented practice of Iranian senior dental students

OBJECTIVES: To investigate self-reported preventive practice of Iranian senior dental students in dental caries management. SUBJECTS AND METHODS: To obtain an estimated sample size of 250 subjects, seven state dental schools were selected based on a stratified random sampling approach. All the senior dental students (n = 327) were asked to voluntarily fill in a self-administered pre-tested questionnaire during the spring term in 2005. In the questionnaire two hypothetical patient cases (a high-risk and a low-risk patient) were presented and the students were asked to express their conceptions on a five-point Likert scale about including each of nine given alternatives in the patients' treatment plans. The respondents' self-reported oral self-care (OSC), preventive knowledge, attitude towards prevention and self-perceived competency in giving preventive care were also assessed. Chi-squared test and logistic regression model served for statistical analyses. RESULTS: A total of 270 students filled in the questionnaire (response rate = 82%). Acquiring high scores of preventive practice as assessed by patient cases was found to be more frequent among those reporting recommended OSC (P = 0.007) and those with higher attitude scores (P < 0.001). Also, those reporting being competent in giving preventive care had higher scores of preventive practice compared with the others (P = 0.02). In the regression model, recommended OSC (P = 0.05, OR = 1.9) and positive attitudes towards preventive dentistry (P = 0.001, OR = 3.3) showed significant association with acquiring highest scores of preventive practice. CONCLUSION: To improve their preventive practice in the future, more emphasis should be placed on the dental students' own oral health behaviour and attitudes related to it.     

Expanded polytetrafluoroethylene and dental rubber dam barrier membranes in the treatment of periodontal intrabony defects A comparative clinical trial

Abstract. As observed in previous case reports. Dental Rubber Dam (DRD) can be utilized as a barrier membrane in the guided tissue regeneration (GTR) technique for the treatment of periodontal intrabony defects. The purpose of the present study was (1) to confirm the validity of DRD as a suitable material in regenerative procedures and (2) to compare. in a split-mouth clinical trial, the effectiveness of DRD-made membranes in the treatment of periodontal intrabony defects versus that of expanded polytetrafluoroethylene (e-PTFE) barriers. 22 systemically healthy non-smoker adult periodontitis patients (7 male, 15 female) aged between 35 to 58 years were selected for the study. In each patient, a couple of 2–3 wall intrabony defects, located in different quadrants, were treated by a GTR technique using DRD (test sites) and e-PTFE (control sites), respectively. Performing a strict control of the oral hygiene level and of the marginal gingival health during the whole period of study, clinical (pocket probing depth, PPD; probing attachment level, PAL; gingival recession, GR) and intrasurgical (depth of the defect's intraosseous component, IOC; level of the alveolar crest, ACL) parameters were recorded at baseline and at the 1-year re-entry procedure in each experimental site. Furthermore, the coronal level of the newly formed tissue from the base of the defect (NFTL) and the vertical bone gain (VBG) were calculated at the time of membrane removal and after the re-entry procedure respectively. Membranes were removed from both test and control sites after 5 weeks; however, exposure of the membrane always occurred in test sites whereas it was observed in only 6 out of 22 control sites, this fact leading to an incomplete coverage of the regenerated tissue by the gingival flap in 18 out of 22 test sites. In both test and control sites, a statistically significant improvement of clinical and intrasurgical parameters occurred at the end of the study period; however, a significantly greater improvement was observed in control sites for PAL (+4.0 mm versus +3.0 mm;p < 0.05) and VBG (3.9 mm versus 2.9 mm; p < 0.05) although at the time of membrane removal, NFTL was similar between the experimental sites (test; 5.8; control; 5.6;p > 0.05). Conversely, test sites exhibited a statistically significant greater increase in giagival recession +1.9 versus +1.2; p < 0.05) and alveolar crest resorption (-1.1 versus -0. 3, p < 0.01) in comparison to controls. It was concluded that (1) DRD is a suitable material to be used as a barrier membrane in GTR procedures although (2) e-PTFE metnbranes can provide a greater improvement in PAL and VBG, probably because of the difficulty in completely covering the regenerated tissue due to the fact that the gingival tissues have undergone a consistent recession in DRD-treated sites. Further studies are needed to demonstrate if an adequate coverage of the regenerated tissue in DRD-treated sites can eliminate these differences.     

Attitudes toward National Health Insurance: dentists, dental students, and dental hygiene students

The attitudes toward National Health Insurance held by 126 second year dental students and 108 second year dental hygiene students enrolled in the state of Wisconsin, U.S.A., were measured and compared with the attitudes held by practicing dentists in the U.S.A. Although some similarities were noted, marked differences were revealed, with students, generally, preferring broader coverage and more government involvement than practicing dentists. There is virtually no published data in this area, and more research is needed, as the success or failure of any National Health Insurance plan depends critically on the altitudes of both health care providers and those studying to become health care providers.     

Analysis of anxiety variables in dental students

Personality, stress factors, gender and personal circumstances have been studied in dental students and a change in anxiety levels has been discovered over the different academic years that make up the degree course. OBJECTIVES: To analyse the variation in anxiety over the different years and to determine any variation between the genders, in dental students at the Madrid Complutense University. METHOD: Eight scales of the Inventory of Anxiety Situations and Responses were administered to 110 students, of both genders, from the 1st, 3rd and 5th years. RESULTS: Mean scores were obtained for the eight scales, separately by year and for gender. In general the women showed a higher anxiety level in the scales for cognitive, physiological, motor, general and assessment anxiety responses. Anxiety in the 3rd year was higher than in the 1st year. The lowest levels were found in the 5th year. DISCUSSION: High anxiety levels increase the risk of suffering illness and make it necessary to plan educational control strategies bearing in mind the factors which stress men or women and the activities carried out in each academic year.     

Attitudes of Italian dental and dental hygiene students toward tobacco-use cessation

Objective:  The aim of this study was to investigate the smoking habits of Italian dental and dental hygiene students and to assess their knowledge on the health effects of cigarette smoking and their attitudes toward tobacco-use cessation (TUC) in dental practice.
Materials and methods:  Data was collected from 220 students attending the Dental and Dental Hygiene Schools (DS and DHS, respectively) at the University of Palermo (Italy).
Results:  The percentage of smokers amongst DS and DHS students was similar (32.78% vs. 32.5%) with 67.77% of DS students and 77.5% of DHS agreeing that the damages to health caused by smoking were covered in their didactic course work. A high percentage of DS (63.33%) and DHS (67.5%) students reported the relationship between smoking and a number of associated health conditions. Both DS and DHS students showed poor knowledge of TUC interventions. Both DS and DHS students reported to be conscious of their own role as a counsellor, with DHS students feeling more comfortable in approaching counselling in clinical practice. Although DS and DHS students reported a positive attitude toward TUC interventions, almost half of the students had some concerns about the effectiveness of smoking cessation activities.
Discussion:  The introduction of a comprehensive tobacco education curriculum in DS and DHS programs could further improve students' perceptions and attitudes and provide knowledge and clinical experience which would lead to the incorporation of TUC into subsequent professional practice.     

Attitudes of dental and medical students in their first and final years of undergraduate study to oral health behaviour

OBJECTIVE: To compare differences in attitude to oral health behaviour amongst medical and dental students when they were in years 1 and 5 of University study respectively. METHODS: Medical and dental students of Peking University in Beijing, China were invited to take part in this study. The original version of the Hiroshima University-Dental Behavioural Inventory (HU-DBI) was written in Japanese. After testing the validity of both English and Chinese versions, the revised Chinese version of the HU-DBI was administered to new medical and dental students. In their final year of University study, the same questionnaire was again administered. RESULTS: Significant differences were found for 13 of 21 items, reflecting an improvement in oral health attitudes and behaviour in final year dental students when compared with the time they were entrants. This difference was not found to be significant in the sample of medical students. CONCLUSIONS: There were significant differences in oral health attitudes and behaviours in dental students between entrance to University and the final year of their study. The same was not found to be true for medical students.     

Stress amongst dental students: a systematic review

The present study was conducted to provide future researchers and dental educators with an overview of stress amongst undergraduate dental students reported in the literature. This overview is needed for the development of a new questionnaire measuring the level of stressors including students, staff and process of dental education. In addition, the review can be used to modify dental curricula to decrease such stress and produce better dentists. Our study consisted of a systematic review of 49 peer‐reviewed articles published between 1966 till October 2008 in English, discussing different aspects of stress amongst undergraduate dental students. These aspects are demographic variables of stress, sources of stress, impact of stress, indicators of stress, instruments measuring stress level and management of stress. Major sources of reported stress were related to examinations, clinical requirements and dental supervisors. Studies suggest using signs and symptoms for early detection of stress and proper intervention.     

Acceptance of psychology teaching in paediatric dentistry by undergraduate dental students

By means of a questionnaire, 4 cohorts of undergraduate students (n = 144) were asked before and after the clinical course in paediatric dentistry about their acceptance of the teaching of psychological aspects in dentistry. A generally very high interest was found for psychology as well as for child-related psychology. The teaching of this topic by means of lectures was thought to be useful, but other didactic means were demanded to supplement teaching. For many of the aspects taught, more information was requested. Moreover, teaching of aspects not taught in the lectures was also requested. The more obvious the practical relevance of each topic appeared, the greater was the students' interest. Psychology was thought to be useful as an aid to paediatric treatment. However, interest dropped after the completion of the paediatric dentistry course. It is concluded that undergraduate dental students have no particular inclination towards the treatment of children but rather a need for guidelines to avoid potential problems in dealing with this demanding group of patients.     

Acceptance of video-based teaching in paediatric dentistry by undergraduate dental students

Five cohorts of undergraduate students (n = 160) were filmed on video tape while performing paediatric treatments. Sequences of these recordings were shown 1 day later and discussed. Thus, within one term each student was able to view himself as well as fellow students on video. After the completion of the clinical course in paediatric dentistry, students were asked by means of a questionnaire about the acceptance and benefits of video-based teaching in paediatric dentistry. 95.5% welcomed the use of video in paediatric dentistry. Concerning the benefits gained from the video showing the treatment that had been performed by the student himself, 83.4% said they had gained new insights in their own behaviour and 80.3% thought these insights to be useful for their clinical work. For the video showing treatments by fellow students, numbers were higher: 84.7 and 89.8%, respectively. Gender-specific differences revealed that women feel more disturbed by the fact that they are being filmed (7.8% vs. 14.9%), some even think that they would have performed a better treatment without the video. Out of four didactical means, video gained the highest vote, followed by seminars, lectures and slides. It is concluded that the use of video is a valuable didactical means that should be considered in teaching undergraduate students.     

Rubber dam application in endodontic practice: an update on critical educational and ethical dilemmas

Proper isolation is an essential prerequisite for successful endodontic treatment. This article aims to provide an update on the prevalence of rubber dam (RD) use, and the role of education along with attitudes of general dental practitioners (GDPs) and patients towards the application of RD in endodontics. Critical ethical issues are also highlighted. Using certain keywords, an electronic search was conducted spanning the period from January 1983 to April 2013 to identify the available related investigations, and the pooled data were then analysed. The results show that although RD is the Standard of Care in endodontic practice, there is a clear discrepancy in what GDPs are taught in dental school and what they practice after graduation. There is little scientific evidence to support the application of RD; however, patient safety and clinical practice guidelines indicate that it is unnecessary and unethical to consider a cohort study to prove what is already universally agreed upon. A few clinical situations may require special management which should be highlighted in the current guidelines. This would pave the way for clear and straightforward universal guidelines.     

Technical quality of root fillings performed by dental students at the dental teaching centre in Reims, France

Aim  To evaluate the technical quality of root fillings performed by undergraduate students at a dental teaching centre in France.
Methodology  A random sample of 419 records of patients who received dental treatment at the dental service of the teaching Hospital, in Reims, France between 2005 and 2006 was investigated. Evaluation of root filled was based on radiographical criteria defined by the French National Health Service. The length of root fillings, the radiodensity and the presence of voids in the root filling or between root filling and root canal walls were recorded and scored. Chi-square analysis was used to determine statistically significant differences between the technical quality of root fillings and tooth type.
Results  Of the 304 teeth included in the study, 69% had an adequate length of root filling and 42.7% had a dense root filling without voids; only 30.3% of teeth fulfilled these criteria at the same time. The relationship between the technical quality of root fillings and tooth type was statistically significant ( P  < 0.001), the highest percentage of adequate root fillings occurred in single-rooted teeth (36.1%). The highest percentage of inadequate root fillings according to the criteria of root filling length and lateral adaptation was found in molar teeth (71.9%).
Conclusion  Overall, the technical quality of root fillings performed by undergraduate students was poor.     

Effects of autoclave sterilization on properties of dental rubber dam as related to its use as barrier membrane in guided tissue regeneration

BACKGROUND AND OBJECTIVE: Dental rubber dams (RDs) were used as barrier membranes in guided tissue regeneration for the treatment of periodontal intraosseous defects with acceptable clinical results. The aim of the present study was to investigate the effects of autoclave sterilization on properties of RD as related to its use as a barrier membrane in guided tissue regeneration. METHODS: RDs were sterilized by either an autoclave, gamma irradiation, or chemical agents and then co-cultured with human gingival fibroblasts. The cell responses to sterilized RDs were investigated by inverted phase contrast microscopy, scanning electron microscopy (SEM) and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) technique. The surface alterations of the autoclaved RDs were observed under SEM. The tensile strength, tear strength and elongation at break of the autoclaved RDs were tested by a universal testing machine. RESULTS: The results from cell culture, microscopic and MTT studies showed that RDs sterilized by autoclave and gamma irradiation did not deteriorate gingival fibroblasts and provided surfaces suitable for cell attachment, whereas chemical-sterilized RDs were toxic to these cells. Ultrastructurally, surface changes from the non-autoclaved RDs, including some melted areas, small pores and folds were observed on the autoclaved RD surface. The tensile strength and tear strength of the autoclaved RDs were significantly lower than those of the non-autoclaved RDs (p = 0.042, p < 0.001, respectively). In contrast, the elongation at break of the autoclaved RDs was higher than that of the non-autoclaved RDs (p < 0.001). CONCLUSION: These results suggest that the autoclave sterilization deteriorated the physical properties of RDs even though they seemed to be compatible to the cultured human cells. Therefore, the sterilization method should be taken into consideration when RDs are utilized as barrier membranes.     

Preventive practice of Mongolian dental students

To investigate the preventive practice of Mongolian dental students, in relation to their knowledge of preventive care, self-perceived competency, oral self-care, and dental health status, a questionnaire was distributed to all (n = 79) clinical-year students of The Dental School of the Mongolian National Medical University. Dental students' reported preventive practice was explained by their knowledge of preventive care (P = 0.002) and self-perceived competency (P = 0.002), whereas their study-year, oral self-care, and dental health status, expressed as the Tissue Health Index (THI), remained statistically non-significant in the linear regression model. This explained 28% of the variation in the parameters examined. In logistic regression analysis, a student's study year (OR = 2.5), knowledge of preventive care (OR = 1.1), and THI (OR = 1.8) were related to their highest scores on preventive practice. Preventive practice among Mongolian dental students could be improved by increasing their knowledge, particularly in modern methods for caries-prevention such as fluoride, sealants, and xylitol. Preventive methods should be integrated into all topics of the dental curriculum and the learning environment should support such training for future oral health professionals.