Managing change in dental education: is there a method to the madness?

The literature surrounding dental education in the United States is replete with calls for change in the way that dental students are being educated. These calls are being echoed with curriculum models and examples of best practices, but what is missing is specific information about how to implement a desired change-that is, discussion of the change process itself. Knowledge of the organizational change process in other settings, particularly in higher education and professional education, may be of interest to academic program managers in dental schools who are planning or are engaged in change. Historical and theoretical perspectives on organizations and change are presented in this article as groundwork for more detailed discussion about management of change. Seventeen research-based principles of change in higher education and factors in dental education that influence change processes and outcomes are presented and synthesized into guidelines for a hypothetical model for change in a dental school environment. Issues pertinent to the practical management of change are presented, including reframing organizational complexity, change leadership, values/competence/commitment, and organizational learning. An appreciation for change as an ongoing and manageable process will enhance a dental school's viability in a rapidly changing world and ultimately benefit dental graduates and the communities they serve.     

Family income and tooth decay in US children: does the association change with age?

This study explored whether the association of family income with tooth decay changes with age among children in the United States. A second objective was to explore the role of access to dental health care services in explaining the interrelationships between family income, child age and tooth decay. Data from 7,491 2- to 15-year-old children who participated in the 1999-2004 National and Health and Nutrition Examination Survey were analyzed. The association of family income with the prevalence of tooth decay in primary, permanent and primary or permanent teeth was first estimated in logistic regression models with all children, and then, separately in four age groups that reflect the development of the dentition (2-5, 6-8, 9-11 and 12-15 years, respectively). Findings showed that the income gradient in tooth decay attenuated significantly in 9- to 11-year-olds only to re-emerge in 12- to 15-year-olds. The age profile of the income gradient in tooth decay was not accounted for by a diverse set of family and child characteristics. This is the first study providing some evidence for age variations in the income gradient in tooth decay among children in the United States.     

Pneumatic tourniquets in maxillofacial surgery: do we need to change practice? A national study

The use of pneumatic tourniquets during the harvest of free flaps is an established practice in oral and maxillofacial surgery. Their use can be associated with severe but preventable complications, for which operating surgeons are ultimately responsible. The aim of this study was to find any pitfalls concerning the safe use of tourniquets by maxillofacial surgeons. An electronic questionnaire based on the Association of Perioperative Registered Nurses (AORN) guidelines was distributed to maxillofacial surgeons nationally. A total of 37 questionnaires were completed and analysed. The mean (range) score for the knowledge-based questions for all respondents was 72.8% (47.3%–94.7%). The number of clinicians who answered correctly on topics relating to cuff position, reperfusion time and contraindications for the use of tourniquets were 15, 10 and 6, respectively. A total of 35 clinicians had had no formal training on the application of a tourniquet. Our study shows that knowledge about their use by maxillofacial surgeons is poor, and it highlights the importance of formal education during basic and higher surgical training.     

Automatic external defibrillators--time for a change?

Defibrillation is the definitive treatment for cardiac arrest. Until relatively recently the use of defibrillators was restricted to medical staff and paramedics. The development of automatic external defibrillators (AEDs) now means that this life-saving equipment may be used by anyone with a short period of training. This article will review the patho-physiology of cardiac arrest, the use of AEDs and their significance to the dental team. A medical emergency could happen at any time in the dental practice. Cardiac arrest is the most serious emergency that can occur. Whilst life-threatening incidents are very rare, the dental team requires to be trained in the management of a cardiac arrest.     

Fixed prosthodontics: time to change the status quo?

The majority of indirect restorations placed in the United States are currently made by conventional procedures in 2 or more appointments, including standard impressions using VPS or polyether, use of dental laboratory technicians to make the restorations, and conventional cementation procedures. The likelihood of rapid change to digital impressions and/or in-office milling is not predicted. However, some dentists have changed to making digital impressions and sending the information to specific dental laboratories to have the crowns fabricated. In general, they are satisfied with the concept and the restorations thus produced. It is anticipated that digital impressions will slowly continue to grow until the concept eventually dominates the market. In-office milling of restorations by CEREC or E4D is now a reliable clinical process in spite of an arduous and long period of development. It is anticipated that this concept will continue to grow. At this time, any of the 3 concepts discussed in this article--conventional procedures, digital impressions sent to a laboratory, or digital impressions followed by in-office milling--are acceptable depending on the preferences of practitioners.     

Should our focus on inflammation change the way we practice?

Some scientists say, "Forget about bacteria; treat, or even better yet, prevent inflammation." We understand that periodontal diseases originate as bacterial assaults, but some two-thirds of the destruction comes from the inflammatory response to the bacterial invasion. There is growing evidence that inflammation can be transferred from the oral cavity to other parts of the body (and vice versa), explaining the possible association between periodontitis and other chronic inflammatory conditions. As a clinician, I find this intellectually interesting, but when I ask myself whether or not this shift from an infection model to an inflammation model changes the way I treat my patients, the answer is, "not really." But should it? Have I been so busy in my daily practice that I missed something important? Although I may not understand inflammation on the molecular level, I do know when my patients have inflammation, and when I do what I have been trained to do as a diagnostician and a clinician to eliminate it, most of my patients end up with a good clinical outcome. My job as a clinician is to translate what is going on in research and incorporate it into my practice to provide the best possible patient care. What I offer you in this commentary are the results of my journey to discover how or if our new emphasis on inflammation should affect how I care for my patients. My conclusion at this time is that I should err on the side of aggressive control of periodontal inflammation, since, until proven otherwise, the consequences of undertreatment could be more than the loss of a few teeth. It is your job to decide how this information influences the treatment of your patients.     

Field change and oral cancer: new evidence for widespread carcinogenesis?

Patients with oral squamous cell carcinoma (OSCC) are at risk of developing second or multiple primary cancers as a result of field cancerization in the upper aerodigestive tract. In order to quantify the incidence of field change observable in oral mucosa, 26 consecutive new (untreated) patients presenting with a unilateral OSCC (18) or a premaligant lesion (eight) underwent 'mirror image' biopsies from clinically normal-looking mucosa at corresponding anatomical sites. A total of 15 patients (58%) demonstrated histologically abnormal tissue upon microscopic examination: six showed reactive change/cellular atypia associated with chronic irritation, seven exhibited frank dysplasia, whilst two displayed carcinoma-in-situ (CIS) or microinvasive SCC. Although not statistically significant, there was an observable trend for the lateral/ventral tongue and floor of mouth to display increased vulnerability to dysplastic change.