Continuing education: the good, the bad and the ugly

Dental CE is mandatory for ongoing competency in dental practice. There are numerous methods of obtaining CE, some of which are highly successful and others that are of minimal value. In this article, I have described and prioritized the various methods of obtaining CE according to their effectiveness as I perceive it. CE in dentistry can be enjoyable, will allow dentists to serve their patients at a higher level of competency and will keep practitioners mentally stimulated as they learn new concepts and techniques.     

Knowledge,attitudes, and experience of dentists living in Saudi Arabia toward child abuse and neglect

AimTo analyze the experience and knowledge of dental practitioners in Saudi Arabia regarding the identification of child abuse and neglect (CAN), to identify barriers that prevent the reporting of suspected cases of child maltreatment by dental practitioners, and to assess the need for training dentists in child protection.MethodsA self-administered, web-based questionnaire was emailed to all of the members of the Saudi Dental Society (n = 7352) in 2012.ResultsThe respondents (n = 122) demonstrated good knowledge of the forms and indicators of CAN. Moreover, a large proportion (59%) had experienced a case of child abuse or neglect in their practice over the previous five years. However, only about 10% of these respondents made a report. Fear of family reprisal, lack of certainty about the diagnosis of child maltreatment, and uncertainty about case management were critical barriers to the reporting of the suspected child maltreatment. In addition, only 20.9% of the respondents reported having knowledge of a child protection policy in their workplace.ConclusionsBased on the results of this survey, it appears that the level of knowledge among the respondents regarding the forms and indicators of CAN is good. However, a large proportion of respondents did not take action regarding suspected cases of CAN in their practice over the past five years. Therefore, additional resources and training are needed to support the identification and management of cases of child maltreatment by dental practitioners.     

Assessment of general pre and postoperative anxiety in patients undergoing tooth extraction: a prospective study

Our aim was to analyse the amount of anxiety and fear felt before, immediately after, and one week after, dental extraction. We studied 70 patients (35 men and 35 women (mean (SD) age 43 (±10) years), who were listed for dental extraction under local anaesthesia in a private clinic that specialised in oral surgery. Patients were evaluated on 3 consecutive occasions: immediately preoperatively, immediately postoperatively, and 7 days later. Each patient's anxiety was measured using Spielberger's State-Trait Anxiety Inventory (Spanish version), the Modified Corah Dental Anxiety Scale (MDAS) and the Dental Fear Survey. There were significant differences in the STAI-Trait scale between before and 7 days after extraction (p = 0.04), and in the MDAS between before and immediately after extraction (p = 0.02), and between immediately after and 7 days after extraction (p = <0.001). The DFS also differed between before and immediately after extraction (p = 0.002), and between immediately and 7 days after extraction (p < 0.001). Dental anxiety immediately after tooth extraction may be influenced by operative techniques (type of anaesthesia, duration of operation, or position of tooth extracted), but anxiety at 7 days after extraction is not.     

Avoidance of dental visits: the predictive validity of three dental anxiety scales

The purpose of this study was to determine the sensitivity, specificity, positive and negative predictive values for Corah's Dental Anxiety Scale (DAS) and two modified versions of it (MDAS; MDAS/4). A questionnaire was mailed to a simple random sample of 1,190 25-year-old residents in the west of Norway in 1997. Half the sample received DAS, the other half MDAS. The response rate after one reminder was 62%. The respondents completed the scales, gave demographic particulars and answered one question about dental visiting habits during the last 5 years plus an open-ended question about reasons for nonattendance. Using the answers to the latter question as validating criterion, it was found that, for all scales, sensitivity decreased while specificity improved when changing from a liberal to a stringent cut-off point. The scales gave low positive predictive values (≤0.26), but high negative predictive values (≥0.98). Since DAS and MDAS/4 gave almost identical findings, the two samples were combined. At a cut-off point ≥13 sensitivity was 0.83, specificity 0.84, positive predictive value 0.18 and negative predictive value 0.99. The corresponding estimates when the cut-off point was ≥15 were 0.67, 0.90, 0.22 and 0.98. It is concluded that, in this test, DAS and the two versions of MDAS gave acceptable, or near acceptable sensitivity, specificity and negative predictive values, but far too low positive predictive values to be useful for prediction at the individual level.     

正畸治疗前焦虑、抑郁水平与完美主义倾向的相关性

目的 探讨正畸患者治疗前的焦虑、抑郁水平和完美主义倾向之间的关系。方法 采用修改版Corah牙科焦虑量表（MDAS）、焦虑自评量表（SAS）、抑郁自评量表（SDS）、中文版《Frost多维度完美主义心理量表》（CFMPS）对170例口腔正畸初诊患者进行测试,采用SPSS16.0软件包对数据进行独立样本t检验、相关分析和多元逐步回归分析。结果 明显患有牙科焦虑症（MDAS得分≥11）的患者42例,占24.71%,在SAS、SDS得分上均显著高于无明显牙科焦虑症组（MDAS得分<11）（P<0.01）;在CFMPS的担心错误（CM）、个人标准（PS）、行动的疑虑（DA）和条理性（OR）4个维度上与无明显牙科焦虑症组存在显著差异（P<0.05）。牙科焦虑症患者在CM、PS、DA与SAS和SDS得分之间均呈显著正相关（P<0.01）;OR与SDS得分呈显著负相关（P<0.05）;回归分析显示,CFMPS的CM、OR维度得分以及年龄对SAS和SDS得分均具有较强的预测作用。结论 正畸治疗前牙科焦虑症患者的焦虑和抑郁水平较高,且与其完美主义倾向之间具有显著相关性。针对牙科焦虑症的早期干预,应结合患者的年龄和不同完美主义个性特征而区别对待。     

Operating gloves. The good and the bad.

The use of gloves in all types of dentistry has been a major benefit to both patients and dentists. However, operating gloves are not without challenges. Tight ambidextrous gloves can produce significant and debilitating hand pain; latex allergies are a problem for many dental personnel and patients; and the disagreeable taste; odor and powder of some brands of gloves has frustrated both professionals and patients. In spite of the challenges that glove use poses, it offers many advantages--foremost among them the protection of patient and dentist alike from infection.     

A comparison of cognitive therapy,applied relaxation,and nitrous oxide sedation in the treatment of dental fear

The aim of this study was to investigate the short-term efficacy of cognitive therapy and applied relaxation in dental fear treatment and to compare these methods with conventional pharmacological sedation (nitrous oxide sedation). Patients (n = 65) with severe dental fear were randomly assigned to the different treatment methods and received 10 weekly sessions of individual therapy. Dropout rates were low, and all patients who completed the therapy sessions were able to receive dental treatment. Scores on dental fear tests were significantly reduced compared with pretreatment level for all treatment groups. There were no major differences between treatment methods in this short-term perspective.     

Structural relationships of dental anxiety,mood, and general anxiety

The aim of this study was to explore the structural relationships between dental anxiety, mood, and general anxiety among 220 dentally anxious patients who participated in a clinical study. A structural equation modeling analysis (SEM) was applied by using the LISREL program on the hypothesized latent variables dental anxiety, mood, and general anxiety, which were measured by means of several psychometric tests. The final model showed that mood and general anxiety had positive factor loadings on dental anxiety. However, the impact of the general anxiety latent variable was not significant as compared with the mood factor. Another finding was that the residual variance for the latent variable dental anxiety was 0.68, indicating that a major portion of the variance is still unexplained by the tested variables. In conclusion, this study showed a relationship between dental anxiety, general anxiety, and mood among dentally anxious patients.