Teaching of posterior composite restorations in Japanese dental schools

AIM: This study was conducted to assess the teaching programmes for Class I and II composite restorations in Japanese dental schools to obtain an overview of what is being taught, the relative teaching volume, the criteria for the provision of posterior composite restorations and the placement techniques taught. DESIGN: Questionnaire forms mailed to the operative dentistry teaching departments in all 29 Japanese dental schools. RESULTS: The response rate was 93 per cent, with replies from 27 of the 29 dental schools. Twenty-five (93 per cent) responding schools taught the use of Class I and two schools stated that they did not teach the use of posterior composite restorations. One of the two schools had no plan to teach posterior composites within the next five years. The other school did not answer this question. Most schools anticipated that the proportion of teaching time devoted to posterior composite restorations would increase within the next five years. Diversities and similarities between teaching programmes were noted between Japanese, North American and European dental schools, the Japanese programmes being closer to those in Europe than those in North America. CONCLUSION: The diversities in the teaching of posterior composite restorations in Japanese dental schools are as great as in other parts of the world. Such diversities must affect the overall quality of restorations in general practice.     

Teaching of all-ceramic restorations in central European dental schools: a survey

The teaching of all-ceramic restorations in Central European dental schools in the mid 1990s has been surveyed. Based on a 65% response, the findings indicate that the majority of undergraduate (pre-doctoral) students receive instruction in all-ceramic restorations with >75% gaining clinical experience in the use of such restorations prior to graduation. When clinical experience was not received, formal instruction, either in the regular curriculum or in elective studies was generally available. All the schools, with one exception, anticipated that the importance of teaching all-ceramic restorations would increase or at least stay the same. In general, the findings were similar to those reported in studies of the teaching of all-ceramic restorations in North America, Scandinavia, and the UK and Ireland, especially in relation to luting systems, contraindications and finishing instrumentation. However, clinical requirements for all-ceramic restorations in Central European dental schools were more common than in dental schools in North America, Scandinavia and the UK and Ireland.     

Quality assessment of dental restorations provided to adult kibbutz residents in Israel

Abstract The purpose of the present study was to assess the quality of restorations provided to adult kibbutz residents. Two kibbutzim were selected for the study. A random sample of 72 adults aged 21–50 was drawn from a population of 670 adults residing in the kibbutzim. A total of 488 restorations were studied and recorded for quality under standardized conditions. The quality of restorations was assessed according to an index devised for this purpose. The quality of restorations was rather low. It was suggested that lack of standardization of performance levels in Israel is reflected in part in the observed low quality of dental restorations. This study points clearly to measures which can be initiated through dental education, financing and public health, planning sectors of society to increase awareness of this problem and to define specific steps for improving the quality of restorative dental care delivered in kibbutzim in Israel.     

The hierarchical cluster analysis of oral health attitudes and behaviour using the Hiroshima University--Dental Behavioural Inventory (HU-DBI) among final year dental students in 17 countries

OBJECTIVE: To explore and describe international oral health attitudes/ behaviours among final year dental students. METHODS: Validated translated versions of the Hiroshima University-Dental Behavioural Inventory (HU-DBI) questionnaire were administered to 1,096 final-year dental students in 17 countries. Hierarchical cluster analysis was conducted within the data to detect patterns and groupings. RESULTS: The overall response rate was 72%. The cluster analysis identified two main groups among the countries. Group 1 consisted of twelve countries: one Oceanic (Australia), one Middle-Eastern (Israel), seven European (Northern Ireland, England, Finland, Greece, Germany, Italy, and France) and three Asian (Korea, Thailand and Malaysia) countries. Group 2 consisted of five countries: one South American (Brazil), one European (Belgium) and three Asian (China, Indonesia and Japan) countries. The percentages of 'agree' responses in three HU-DBI questionnaire items were significantly higher in Group 2 than in Group 1. They include: "I worry about the colour of my teeth."; "I have noticed some white sticky deposits on my teeth."; and "I am bothered by the colour of my gums." CONCLUSION: Grouping the countries into international clusters yielded useful information for dentistry and dental education.     

Can organised dental care for children be both good and cheap?

Abstract Children's dental services evolved from emergency, pain-relieving and later amalgam-based care systems of the early and middle 20th century. The pattern of occurrence of dental caries is different today and young teenagers have very few teeth affected by caries. Restoration of lesions in permanent teeth, typically on occlusal or buccal/lingual surfaces, is technically simple. Paradoxically, dental students today are expected to master a vast amount of knowledge, including information on new dental materials and techniques. New dentists who choose to provide dental care for children as a career will spend most of their days placing fissure sealants, applying topical fluorides and inserting predominantly single-surface restorations. Because of their expensive training, new dentists will nevertheless expect high earnings, and this results in a high cost for children's dental care. The opportunity cost is other health services foregone, In developing countries where there are few dentists, they are almost not available for children at all. Costs could be reduced by reducing the number of interventions, and by reducing staff costs. Fewer interventions could be achieved by longer recall intervals: several studies and experience from places where this has been implemented indicate that this is safe and effective. Widespread delegation of operative work to appropriately trained dental hygienists or therapists would reduce staff costs. Dental therapists are better substitutes for dentists in children's care because they are trained to do most of the clinical procedures that are necessary in children's dentistry. In Western Australia and South Australia, most dental care for children is provided by dental therapists. The costs of care are much lower and the outcome, as measured by caries experience and numbers of treated patients, is equivalent to or even better than European dentist-based services. Already, in some places, politicians and others are querying the need for organised children's dental care. Increased effectiveness will make continuation of children's dental services easier to sustain.     

Teaching of posterior resin-based composite restorations in Brazilian dental schools.

OBJECTIVE: The purpose of this study was to evaluate the teaching program of Class I and Class II resin-based composite (RBC) restorations in Brazilian dental schools and to observe if any differences were found from similar surveys conducted in North American, European, and Japanese dental schools. METHOD AND MATERIALS: A questionnaire containing 15 questions was distributed to 92 Brazilian dental schools, and 64 (70%) schools returned the questionnaire. The questions inquired the amount of time the curriculum dedicated to teaching of posterior RBC restorations, future expectation regarding the teaching time, limitation in extension of the occlusal width and the proximal box in Class II, contraindications for placing posterior RBC restorations, protocol for using bases and liners, brand of bonding agents and RBC used, instruments and techniques employed for finishing, cost relative to amalgam restorations, and biologic reactions related to the use of posterior RBC. The responses were calculated as percentages based on the number of schools that responded to the questionnaire. Where appropriate, the Chi-squared test and the Fisher exact test were used for statistical analysis. RESULTS: Of the dental schools that responded, 88% dedicated 10% to 50% of the teaching time in operative dentistry to posterior RBC restorations. A significant correlation (P = 0.041) was found between the percentage of time dedicated to the teaching of posterior RBC restorations and the higher cost of posterior RBC compared to amalgam restorations. Resin-based composite restorations cost 30% to 70% more than amalgam restorations in the 40% of dental schools that charged a fee. Posterior composites for large restorations in molars were used by 14% of the dental schools. Base and liner were not placed by 10% of dental schools in deep Class I or Class II RBC restorations. One school did not recommend acid etching of the dentin. CONCLUSION: No major differences were found in the teaching philosophy of posterior RBC restorations by comparing the Brazilian data to the data from similar surveys done in North America, Japan, and Europe.     

A meta-analysis of the prevalence of dental agenesis of permanent teeth

OBJECTIVE: To gain more insight into the prevalence of dental agenesis. METHODS: Data from Caucasian populations in North America, Australia and Europe were included in a meta-analysis. For the prevalence of African American, Chinese and Arab groups only indications could be reported because of a limited number of studies. RESULTS: Agenesis differs by continent and gender: the prevalence for both sexes was higher in Europe (males 4.6%; females 6.3%) and Australia (males 5.5%; females 7.6%) than for North American Caucasians (males 3.2%; females 4.6%). In addition, the prevalence of dental agenesis in females was 1.37 times higher than in males. The mandibular second premolar was the most affected tooth, followed by the maxillary lateral incisor and the maxillary second premolar. The occurrence of dental agenesis was divided into three main groups: common (P2(i) > I2(s) > P2(s)), less common (I1(i) > I2(i) & P1(s) > C(s) & M2(i)) and rare (M2(s) & M1(s) > C(i) > M1(i) & I1(s)). Unilateral occurrence of dental agenesis is more common than bilateral occurrence. However, bilateral agenesis of maxillary lateral incisors is more common than unilateral agenesis. The overall prevalence of agenesis in the maxilla is comparable with that in the mandible, but a marked difference was found between both jaws regarding tooth type. Absence of one or two permanent teeth is found in 83% of the subjects with dental agenesis. A practical application of the results of the meta-analysis is the estimation of dental treatment need.     

Preclinical endodontology: an international comparison

AIM: The aim of this study was to compare preclinical endodontic teaching in Europe, Scandinavia and North America, and to place recent UK data in an international context. METHODOLOGY: A postal questionnaire was sent to all undergraduate dental schools in North America, Scandinavia, and Europe. Data were requested on a range of issues relating to endodontic teaching. RESULTS: Forty-three percent of the 170 schools surveyed returned completed questionnaires. There was considerable international consensus on the content of preclinical courses, with most schools advocating preflaring canal preparation techniques, sodium hypochlorite for irrigation, and cold lateral condensation as the standard obturation method. There was little consensus on the standard use of intracanal medicaments, though calcium hydroxide was universally popular. The practice of single visit treatment was advocated by at least 70% of schools in all geographical areas. A number of innovations appear to be gaining acceptance in preclinical teaching, with more than 20% of schools teaching the use of electronic apex locators, and a quarter of Western European, Scandinavian and North American schools embracing nickel-titanium instrumentation. Regional differences in the priority and resource given to endodontic teaching were striking. On average, UK schools had the worst staff:student ratios for preclinical endodontic teaching, and allocated substantially less time allocation for this teaching compared with Western European, Scandinavian and North American schools. CONCLUSIONS: It was concluded that although teachers in the UK were broadly advocating techniques recommended elsewhere, the academic infrastructure and priority given for endodontic teaching in the UK was limited in the international context. This may have some impact on the quality of endodontic provision within the UK General Dental Services.     

Past and present geographic location as oral health markers among older adults

OBJECTIVES: This study evaluated the association between oral health status of community-dwelling elderly adults visiting day health centers in Israel and geographic living location. METHODS: Oral status was assessed through clinical examination, with additional data obtained using a questionnaire addressing demographic characteristics, dental utilization, and perceived oral health needs. RESULTS: A representative sample of 338 subjects was examined. Fifty-four percent of the sample was edentulous. Higher rates of edentulism were found among subjects living in urban areas compared to subjects living in rural areas (P<.01). More edentate subjects were found among European immigrants than among immigrants from North Africa or subjects born in Israel (P<.01). Among dentate subjects, the mean number of remaining teeth was 10.4. The mean periodontal loss of attachment was 5.8 mm. Less than 10 percent had mean attachment loss <4 mm. Among subjects living in rural areas, mean attachment loss was higher than among those living in urban areas (P=.05). The mean DF score was 1.9. Forty-seven percent had at least one tooth with untreated caries. Subjects living in urban areas tended to utilize dental services more than subjects living in rural areas (P<.01). CONCLUSION: Results indicate that present (urban or rural) and past (country of origin) geographic location represented a significant oral health risk marker. The implementation of a comprehensive program for this target population was clearly indicated.     

The teaching of Class I and II restorations in primary molars: a survey of North American dental schools.

PURPOSE: The purpose of this study was to obtain an overview of materials and restoratives techniques taught for Class I and Class II restorations in primary molars in different pediatric dentistry departments in North America. METHODS: A form with response alternatives was mailed to 63 dental schools in the United States and Canada. The forms were addressed to the chairman/undergraduate program director of the department of pediatric dentistry. Questions regarding the restorative materials taught, indications and contraindications for the use of tooth-colored materials and the type of cavity preparation indicated for those materials were among the topics assessed. RESULTS: Eighty-six percent of the dental schools responded to the survey. Amalgam continues to be the material of choice for Class I and II restorations in primary molars, although hybrid composites and compomers are gaining some popularity. When tooth-colored materials were indicated, the slot-type of cavity preparation was the preferred one. CONCLUSIONS: The diversity in teaching may reflect uncertainty related to requirements for optimal restorations of primary teeth. Data from dental schools of other countries may be important to obtain to establish universally accepted criteria and standards for restorative techniques of primary teeth.     

The value of extended-setting-time amalgam in pre-clinical practice in undergraduate dental training

This is a single-blind controlled study investigating the advantages of extended-setting time dental amalgam compared to a standard amalgam in the training of undergraduate dental students. 50 dental students were randomly assigned 1 of the 2 alloys for each restoration placed in the study. Each student placed class I and class II restorations in extracted human teeth mounted in typodont arches. 449 completed restorations were available for assessment, 228 restorations in the experimental group and 221 restorations in the control group. The test restorations were overall marginally inferior to those of the control group. There appears to be no advantage in using extended-setting time dental amalgam in undergraduate training.     

Dental composite fillings and bisphenol A among children: a survey in South Korea

Aims: Bisphenol A (BPA)‐based dental composites have commonly been used to fill dental cavities or seal pits and fissures on teeth. However, epidemiological evidence with regard to the BPA exposure from dental composites among children has rarely been reported. This study investigated whether there is a relationship between the BPA concentration in urine and the presence of composite restorations and sealants among South Korean children. Methods: Oral examinations and urine sample analyses were conducted on a total of 495 children aged 8–9 years. We classified the participants into four groups by the number of resin composites and sealant surfaces (0, 1–5, 6–10 and 11+). Results: BPA concentrations in urine were higher in children with 11 or more surfaces restored with sealants and resin composites than in those with zero restored surfaces, although no difference was seen in the group with 1–10 surfaces. After adjusting for gender and age, the urinary BPA concentration in children with 11 or more resin composite surfaces was 2.67 μg/g creatinine, which was higher than the concentration found in those with no filling surfaces (P < 0.01). Conclusions: Having many dental composite filling surfaces on teeth may increase the urinary BPA concentration in children.     

Clinical decision making in restorative dentistry, endodontics, and antibiotic prescription

The purpose of this study was to evaluate the influence of geographic location of graduation (Israel, Eastern Europe, Latin America) on decision making regarding management of dental caries, periapical lesions, and antibiotic prescribing routines. A questionnaire was given to ninety-eight general practitioners regarding demographic and work habits. Photographs of lesions were shown on a screen. Participants reported recommended treatment and whether they would routinely prescribe antibiotics following regular endodontic treatment, retreatment, and impacted third molar surgical extraction in healthy patients. There was a 94 percent (n=92) response rate, of which eighty-five responses were used in the data analysis. Surgical treatment of asymptomatic enamel caries lesions was not recommended by most of the subjects, and surgery was recommended for DEJ caries lesions in low or moderate caries risk patients, both without significant differences between geographic regions of dental school graduation. Israelis had a lower frequency of retreatment in asymptomatic teeth that demonstrated periapical radiolucency with post restoration (without crown) compared to Latin Americans and East Europeans. Most of the participants would not retreat asymptomatic teeth that demonstrated periapical radiolucency with post and crown. After third molar surgery, 46 percent of participants routinely prescribed antibiotics. Significantly more Latin American graduates prescribed antibiotics following endodontic treatment, retreatment, and third molar extractions (p<0.05). Overmedication (antibiotics) and overtreatment (caries) among young practitioners reflect failure of undergraduate education in proper use of antibiotics and management of the carious lesions according to the patient's clinical presentation and caries risk assessment rather than routinely undertaking surgical caries treatment.     

Dental health behavior in a migrant perspective: use of dental services of Pakistani immigrants in Norway

The purpose of the present study was to assess the utilization pattern of dental services in a group of Pakistani immigrants in Norway. Use was related to sociodemographic characteristics, level of urbanization in Pakistan, knowledge and belief about dental diseases and evaluated and perceived dental health. A total of 160 immigrants were clinically examined and interviewed by a structured questionnaire. The effect change analysis was performed, and separate analyses were performed for men and women. Altogether 60% had visited the dentist during the last 3 yr. While 69% coming from the cities had been to the dentist in Norway, this was the case for only 38% of those from the villages of Pakistan. Pain was given as the main reason for dental visits, and the data indicated insufficient ability to perform self-assessment of own dental health. The independent variables could explain more of the variance in use of dental services among the Pakistani men (R2 = 40%) than among the women (R2 = 21%). While number of decayed teeth and level of urbanization were among the strongest predictors among the men, dental behavior in Pakistan and number of years in Norway were of importance among the women. The latter variable indicated that the women in terms of dental behavior had a higher degree of acculturation than the men, leading to a change in traditional health behavior.     

Influence of gender and social factors on oral health,treatment degree and choice of dental restorative materials in patients from a dental school

To cite this article:
Int J Dent Hygiene
DOI: 10.1111/j.1601‐5037.2009.00401.x
Willershausen B, Witzel S, Schuster S, Kasaj A. Influence of gender and social factors on oral health, treatment degree and choice of dental restorative materials in patients from a dental school. Abstract: Objective: The attitude towards oral health is influenced by gender, the level of education and the social background of the patients The aim of the present study was to determine a possible relationship of gender, the educational level and the oral health as well as the choice of dental restorations. Methodology: A total of 2374 outpatients (age: 18–80 years) from a University dental school were assessed. Inclusion criteria were 15 remaining teeth and good general health. In addition to anamnesis data, information concerning educational level and present occupation was collected. The dental assessment included number of teeth, endodontic treatment, type of restorations (root canal fillings, restoration materials) as well as dental panoramic radiographs (OPG). Results: The female patients demonstrated a statistically significant higher percentage of restoration, more teeth with crowns and more tooth coloured fillings compared to men (P < 0.01). Patients with a higher level of education preferred more expensive restorations, whereas patients with a low level of education exhibited more inexpensive restorations. However, patients with private health insurance showed lower levels of carious lesions. Conclusion: The examined patients showed no significant correlation between educational level and type of dental restorations but female patients had a lower number of teeth and more restoration.     

Dental caries experience, tooth loss, and factors associated with unmet needs of Haitian immigrants in New York City

OBJECTIVE: The aim of this study was to characterize the dental caries experience, tooth loss, and unmet need of a group of Haitian immigrant residents of New York City. METHODS: A purposive sample of 523 adults was obtained through community outreach activities during 1997-98. Clinical examinations were performed by calibrated examiners, according to NIDCR criteria. A comprehensive survey also was administered to all the participants. RESULTS: For the whole group, the mean number of missing teeth was 2.64 (SD = 4.12), the mean DMFT = 6.05 (SD = 5.26), the mean DMFS = 18.80 (SD = 21.04), and the mean DFS = 5.58 (SD = 6.17). Seventeen percent of the subjects had all their teeth sound, 59 percent had at least one tooth missing, 60 percent had at least one decayed tooth, and only 38 percent had restorations. Multivariate analyses showed that age, sex, education, dental insurance, frequency of dental visits, and dental floss use were predictors of unmet need. CONCLUSIONS: Although results showed a relatively low caries experience among this group of Haitian immigrants, the unmet need was very high. Furthermore, the tooth loss experience was relatively high for all age groups, further denoting a lack of access to preventive and restorative services.     

Basic science teaching in dentistry in Central/Eastern Europe. Towards harmonisation?

The present study was carried out to examine basic science teaching in dentistry in Central/Eastern Europe, and compare the situation with the EU. In order to collect the necessary data, a questionnaire has been sent to 25 dental schools of the region and 14 schools from 8 countries responded. According to the data obtained, the number of hours devoted to basic sciences and medical clinical sciences together are 2206 in Central/Eastern Europe, and 1416 in the EU. In the case of dental clinical subjects, the difference in the number of hours is just the opposite, much higher in the EU. Thus, for the Central-European region there are two real alternative ways of convergence to western Europe. One option is to decrease the level of basic science and medical science teaching and use the free capacity to increase the weight of dental clinical subjects in the curriculum. The other option is to leave the subjects that are at high levels as they are, and increase significantly the number of hours of the whole curriculum. It seems important to promote the convergence between Central/Eastern Europe and the EU. The EU has to define the trends of the next few decades and the Central/Eastern European countries should converge in this direction.     

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.