Balancing efficacy and safety in the use of oral sedation in dental outpatients

BACKGROUND: Concerns about the safety of pediatric oral sedation and the incremental use of triazolam in adults prompted a workshop cosponsored by several professional organizations. OVERVIEW: There is a strong need and demand for adult and pediatric sedation services. Using oral medication to achieve anxiolysis in adults appears to have a wide margin of safety. Mortality and serious morbidity, however, have been reported with oral conscious sedation, especially in young children. Most serious adverse events are related to potentially avoidable respiratory complications. CONCLUSIONS: Clinical trials are needed to evaluate oral sedative drugs and combinations, as well as to develop discharge criteria with objective quantifiable measures of home readiness. Courses devoted to airway management should be developed for dentists who provide conscious sedation services. State regulation of enteral administration of sedatives to achieve conscious sedation is needed to ensure safety. PRACTICE IMPLICATIONS: Safety in outpatient sedation is of paramount concern, with enteral administration of benzodiazepines appearing safe but poorly documented in the office setting. Conscious sedation by the enteral route, including incremental triazolam, necessitates careful patient evaluation, monitoring, documentation, facilities, equipment and personnel as described in American Dental Association and American Academy of Pediatric Dentistry guidelines.     

右美托咪定与丙泊酚用于无痛拔牙术清醒镇静的临床观察

目的 观察右美托咪定与丙泊酚用于无痛拔牙术时清醒镇静的效果和手术安全性。方法 90例门诊拔牙患者随机分成3组,Ⅰ组(右美托咪定),Ⅱ组(丙泊酚),Ⅲ组(对照)。记录Ⅰ、Ⅱ两组患者入睡时间、自然清醒时间,术中药物追加次数、镇静评分及术后恶心、呕吐的发生率,监测3组患者脉搏血氧饱和度(Pulse oxygen saturation,SpO2)、平均动脉压(Mean arterial pressure,MAP)、心率(heartrate,HR)、呼吸频率(Respiratory rate,RR)生命体征。结果 患者入睡时间、自然清醒时间Ⅱ组短于Ⅰ组(P<0.05),术中镇静评分Ⅱ组与Ⅰ组差异有统计学意义(P<0.05),两组生命体征术前、术中、术后没有明显变化(P>0.05),对照组术中MAP和HR有明显波动,与术前、术后相比差异有统计学意义(P<0.05),与观察组相比差异有统计学意义(P<0.05)。两组术后恶心、呕吐的发生率差异没有统计学意义(P>0.05)。患者满意度Ⅰ组高于Ⅱ组和对照组,差异有统计学意义(P<0.05)。结论 右美托咪定用于门诊无痛拔牙术与丙泊酚相比,清醒镇静程度满意、术中配合好,使用安全,值得临床推广运用。     

Problem-based Learning in Undergraduate Dental Education: Faculty Development at the University of Southern California School of Dentistry

The University of Southern California School of Dentistry (USCSD) seeks to educate oral health professionals with a balanced curriculum covering health promotion, risk assessment and disease prevention, diagnostics, treatments, and therapeutics. Based on critical analyses of a 5-year educational demonstration project, the USCSD proposed to use problem-based learning (PBL) to achieve its goals. Among the many changes required to convert a traditional dental educational curriculum to PBL, none is more important than that of faculty development. To achieve this, the USCSD Curriculum Subcommittee on Faculty Development, Mentoring, and Evaluation has designed and implemented a series of workshops to train its faculty as facilitators. There are four Core Skills Workshops: PBL Process Workshop, Facilitation of Learning Workshop, Student Assessment and Feedback Workshop, and PBL in the Clinical Environment.     

An evaluation of the preclinical prosthodontic training at the Faculty of Dentistry, University of Bergen, Norway

The curriculum of the dental faculty at the University of Bergen was revised and a new curriculum was implemented in 2000. The first candidates graduated in 2003. In the new curriculum the theoretical teaching consists of an extended integrated lecture series in prosthodontics and biomaterials. The revised laboratory course includes an increased number of tooth preparations performed on phantom heads solely. Newer types of preparations based on bonding technique, such as ceramic crowns, veneers and inlays, have also been introduced. As a consequence of the reduced time allocated to the course, the amount of dental technical work has been considerably reduced. Demonstrations of practical procedures are video‐based. Several theoretical and practical tests are carried out during the course. The purpose of this study was to assess the outcome of the alterations made, by comparing former students’ opinions on different aspects of the two curricula. A questionnaire was mailed to the students graduated in 2003 with the new curriculum and graduates in 1997 and 2000 with the ‘old’ curriculum. The results indicate that the alterations tended to improve the students’ evaluations of some aspects of the course. In addition, the new curriculum appeared to be more relevant for the succeeding work in the clinic.     

Choosing Dentistry as a career - A profile of entering students (1992) to the University of Sydney, Australia

The present study is an investigation of motives students have for wishing to become dentists. The study population comprised 85 first year dental students of the class of 1992 at the University of Sydney. A questionnaire which sought information on student demography, attitudes to dentistry, and motive rankings was administered. Demographic findings indicated that the majority of students came from countries in the Pacific rim and the male/female ratio was 62 to 38 per cent. Responses to the attitude questionnaire showed that Australian student motives for becoming dentists did not differ from those of students in other countries. The most predominant of these motives was to serve others, to become independent, to enjoy job satisfaction, and to acquire financial security. The least important motives were manual and communication skills, science and knowledge, and surprisingly, status and prestige. To attribute meaning and value to these motives, however, reflects inconsistencies which are expressed as contradictions between motive categories, between items within categories, and between motive categories and motive rankings.
When one considers the basis upon which career decisions are made, disparity in the findings may be attributable to a decision-making process that rests on subjective rather than objective criteria.     

Laboratory Quality Assurance in the Department of Restorative Dentistry at the University of Illinois at Chicago,College of Dentistry

Purpose: The purpose of this study was to evaluate data collected in University of Illinois at Chicago College of Dentistry (UIC COD) laboratory quality assurance (QA) forms, analyze the collected data, and create a report of the findings. The goals of the study were to (1) identify the most common mistakes occurring during laboratory and clinical procedures when performing prosthodontic treatment, (2) note the incidence and trends of mistakes made by D3, D4, and IDDP2 students, and (3) observe any differences in the types of mistakes made by D3, D4, and IDDP2. Materials and Methods: QA data from June 1, 2007 to May 31, 2009 were evaluated based on forms gathered from the QA dental laboratory from all D3, D4, and IDDP2 students’ submissions. All students had graduated from the UIC COD at the time of collection. Data were recorded for type of errors made in submission of laboratory work (Indirect Restorations [IR], Removable Partial Dentures [RPD], Complete Dentures [CD]), year of student in dental school (D3, D4, IDDP2), and frequency of rejection for each respective student. The frequency of common mistakes were pooled, evaluated, and reported by respective class year. Results: The five most common laboratory submission errors for D3, D4, and IDDP2 students were nearly the same among student years for IR, RPD, and CD. D4 students had disproportionately higher numbers of work rejections compared to D3 and IDDP2 students. Conclusions: D4 students had a higher percentage of laboratory submission errors compared to D3 students for all laboratory procedures. There were similar types of errors noted between foreign‐trained students (IDDP2) and domestically trained students (D3, D4).     

Traumatic dental injuries in children presenting for treatment at the Department of Pediatric Dentistry, Faculty of Dentistry, University of Jordan, 1997–2000

Abstract  – Data pertaining to traumatic dental injuries of children seeking care at the teaching clinics of the Department of Pediatric Dentistry, Faculty of Dentistry, University of Jordan over a period of 4 years were analyzed. The prevalence of traumatic dental injuries was 14.2% from 2751 subjects. The peak incidence of injury was 10–12-year age group. Boys were more affected (18.3%) than girls (10.1%). Most injuries occurred at home (63.2%), and falls were the leading cause of injuries (49.9%). Most injuries involved one tooth (69.3%) and maxillary central incisors were the most affected teeth (90.4%). The commonest injury was uncomplicated crown fracture (62.5%), then complicated crown fracture (28.7%). Only 17.1% of children sought treatment the same day or the day after the injury. At the initial examination, cases seen after a long post-traumatic period required more complicated treatment than those presented within a short time period. Preventive educational program should be instituted in Jordan, directed at parents and school teachers to inform them about the importance of traumatic dental injuries and the benefit of immediate attendance for dental treatment. Furthermore, improving the knowledge of dental practitioners through continuing education would also help in minimizing sequelae of traumatic dental injuries.     

Video-Assisted Clinical Instruction in Dentistry (VACID) enhances real-time visualisation of clinical procedures

AIM: The use of Video-Assisted Clinical Instruction in Dentistry (VACID) in the training of dental students represents an innovative teaching medium. Despite the many advantages that this teaching medium promises to offer, little objective research has been published to substantiate its purported benefits. This article examines the students' response to the application of VACID to enhance real-time visualisation of clinical procedures while observing live clinical procedures in periodontics. METHOD: Forty third-year dental students, observing surgical procedures during their rotation in the Department of Periodontics, were invited to participate in a survey designed to examine perceptions relating to their learning experience to using conventional and video-assisted real-time visualisation of clinical procedures. Students' responses were obtained using a questionnaire administered immediately after the completion of the observational period. The survey employed attitude questions addressing both enabling and outcome criteria. Wilcoxon signed-rank test was used to compare the student's responses. An open-ended question was also included in the survey to give students the opportunity to provide additional feedback regarding their experience and suggestions to improve on it. RESULTS: Results suggest that the implementation of VACID in the clinical setting improves the student's learning experience, interest and satisfaction. Ninety per cent of students strongly agreed to have VACID implemented for their next clinical observation. Responses to the open-ended question indicated that improved visualisation was extremely helpful in understanding the progress of clinical procedures. CONCLUSION: The implementation of VACID in the clinical setting enhances real-time visualisation of surgical procedures beyond what is offered by the conventional observational format.     

Development and testing of the Test of Functional Health Literacy in Dentistry (TOFHLiD)

OBJECTIVE: This study aims to evaluate the reliability and validity of the Test of Functional Health Literacy in Dentistry (TOFHLiD), a new instrument to measure functional oral health literacy. METHODS: TOFHLiD uses text passages and prompts related to fluoride use and access to care to assess reading comprehension and numerical ability. Parents of pediatric dental patients (n = 102) were administered TOFHLiD, a medical literacy comprehension test (TOFHLA), and two word recognition tests [Rapid Estimate of Adult Literacy in Dentistry (REALD), Rapid Estimate of Adult Literacy in Medicine (REALM)]. This design provided assessments of dental and medical health literacy by all subjects, both measured with two different methods (reading/numeracy ability and word recognition). Construct validity of TOFHLiD was assessed by entering the correlation coefficients for all pairwise comparisons of literacy instruments into a multitrait-multimethod matrix. Internal reliability of TOFHLiD was assessed with Cronbach's alpha. Criterion-related predictive validity was tested by associations between the TOFHLiD scores and the three measures of oral health in multivariate regression analyses. RESULTS: The correlation coefficient for TOFHLiD and REALD-99 scores (monotrait-heteromethod) was high (r = 0.82, P < 0.05). Coefficients between TOFHLiD and TOFHLA (heterotrait-monomethod: r = 0.52) and REALM (heterotrait-heteromethod: r = 0.53) were smaller than coefficients for convergent validity Cronbach's alpha for TOFHLiD was 0.63. TOFHLiD was positively correlated with OHIP-14 (P < 0.05), but not with parent or child oral health. TOFHLA was not related to dental outcomes. CONCLUSIONS: TOFHLiD demonstrates good convergent validity but only moderate ability to discriminate between dental and medical health literacy. Its predictive validity is only partially established, and internal consistency just meets the threshold for acceptability. Results provide solid support for more research, but not widespread use in clinical or public health practice.     

Human Disease/Clinical Medical Sciences in Dentistry: Current state and future directions of undergraduate teaching in the UK and Ireland

In March 2017, a group of teachers of human disease/clinical medical science (HD/CMSD) representing the majority of schools from around the UK and Republic of Ireland met to discuss the current state of teaching of human disease and also to discuss how the delivery of this theme might evolve to inform improved healthcare. This study outlines how the original teaching in medicine and surgery to dental undergraduate students has developed into the theme of HD/CMSD reflecting changing needs as well as guidance from the regulators, and how different dental schools have developed their approaches to reach their current state. Each school was also asked to share a strengths, weakness, opportunities and threats (SWOT) analysis of their programme and to outline how they thought their HD/CMSD programme may develop. The school representatives who coordinate the delivery and assessment of HD/CMSD in the undergraduate curriculum have extensive insight in this area and are well‐placed to shape the HD/CMSD development for the future.