Teaching alternatives to the standard inferior alveolar nerve block in dental education: outcomes in clinical practice

Surveys were sent to Harvard School of Dental Medicine students and graduates from the classes of 2000 through 2006 to determine their current primary means of achieving mandibular anesthesia. Orthodontists and orthodontic residents were excluded. All subjects received clinical training in the conventional inferior alveolar nerve block and two alternative techniques (the Akinosi mandibular block and the Gow-Gates mandibular block) during their predoctoral dental education. This study tests the hypothesis that students and graduates who received training in the conventional inferior alveolar nerve block, the Akinosi mandibular block, and the Gow-Gates mandibular block will report more frequent current utilization of alternatives to the conventional inferior alveolar nerve block than clinicians trained in the conventional technique only. At the 95 percent confidence level, we estimated that between 3.7 percent and 16.1 percent (mean=8.5 percent) of clinicians trained in using the Gow-Gates technique use this injection technique primarily, and between 35.4 percent and 56.3 percent (mean=47.5 percent) of those trained in the Gow-Gates method never use this technique. At the same confidence level, between 0.0 percent and 3.8 percent (mean=0.0 percent) of clinicians trained in using the Akinosi technique use this injection clinical technique primarily, and between 62.2 percent and 81.1 percent (mean=72.3 percent) of those trained in the Akinosi method never use this technique. No control group that was completely untrained in the Gow-Gates or Akinosi techniques was available for comparison. However, we presume that zero percent of clinicians who have not been trained in a given technique will use the technique in clinical practice. The confidence interval for the Gow-Gates method excludes this value, while the confidence interval for the Akinosi technique includes zero percent. We conclude that, in the study population, formal clinical training in the Gow-Gates and Akinosi injection techniques lead to a small but significant increase in current primary utilization of the Gow-Gates technique. No significant increase in current primary utilization of the Akinosi technique was found.     

Role of african-american fathers in child-rearing and oral health practices in an inner city environment--a brief communication

OBJECTIVE: This study assesses parenting behaviors, health behaviors and attitudes in a sample of disadvantaged African-American fathers and evaluates the potential of fathers as recipients of oral health promotion interventions. METHODS: Participants were 60 African-American fathers whose children were enrolled in a childhood caries prevention study at Women and Infant Child Program (WIC) (n=25) or who were members of a Young Fathers' Program (n=35) at an urban health center. Demographic factors, oral health knowledge, dental self-efficacy, parenting behaviors, readiness to change, and health promotion behaviors were assessed. RESULTS: Participants averaged 30.8 years of age (sd=8.6); children averaged 2.1 years (sd=0. 9). Half of the fathers always have lived with their own children and 92% had regular physical contact with their children. Almost half of the sample reported 'fair/poor' oral health status, while less than 25% reported 'fair/poor' general health. Fathers had high oral health knowledge scores (x=7.7 correct of 9 items), and high readiness for change scores at the action stage (X=12.2 of 15; sd=1.9). dental self-efficacy scores were moderate (X=15.7 of 24; sd=5.5). Half of the fathers shared or had sole responsibility for brushing their children's teeth; 90% report children's teeth were brushed daily. CONCLUSIONS: African- American fathers participated in childrearing and oral health promotion behaviors.     

A comparison of student performance in a simulation clinic and a traditional laboratory environment: three-year results

With simulation clinics, dental schools have improved their preclinical laboratories to provide a more realistic clinical teaching environment. However, there is very little data to support the assumption that these facilities actually improve student performance of technical skills. This study compared the scores of two fixed preparations for full cast crowns by third-year dental students. One of the preparations was made in the simulation clinic manikin, and the other was prepared on the bench top. Three prosthodontic faculty members scored the preparations in the areas of occlusal reduction, axial reduction, resistance and retention, and margination. The study also compared the performance of three classes of dental students: one class with no experience in the simulation clinic, one with one year of experience, and one with two years of experience. The amount of time since completing the fixed prosthodontics course among the students was also evaluated. This was done because the third-year students at the University of Iowa rotate through a series often-week clerkships rather than a comprehensive care model. (Therefore, not all students start clinical prosthodontics at the same time.) In addition, all student participants completed a questionnaire that addressed their perception of their clinical readiness prior to treating their first fixed prosthodontic patient. When we compared the classes of years 1, 2, and 3 by average preparation score, we found a significant difference among the scores for teeth prepared on the bench top (p = 0.0001) but not for the teeth prepared in the mannequin (p = 0.1176). For Year 1 (no simulation clinic experience), the amount of elapsed time following completion of the fixed prosthodontic course was not significant for the tooth prepared on the bench top or in the manikin (p = 0.57113 and 0.0661). For Year 2 (one year of simulation clinic experience), the elapsed time following completion of the fixed prosthodontic course was significant for the tooth prepared on the bench top (p = 0.0482), but it was not significant for the tooth prepared in the manikin (p = 0.2968). For Year 3 (two years of simulation clinic experience), the amount of elapsed time following completion of the fixed prosthodontic course was not significant for the tooth prepared on the bench top or in the manikin (p = 0.7275 and 0.6007). The questionnaire revealed that, in general, the majority of the students perceived their clinical readiness as more than adequate. These results are mixed in that students with more bench top experience scored better on the bench top, and students with more manikin experience scored equally in both environments.     

Evaluation of Stresses and Forces in Selected I-Bars Using the Finite Element Method

Purpose Three-dimensional models of half-round, tapered and full-round, untapered I-bar clasps of varying configurations and material properties were constructed. The purpose of this study was to examine the stresses and reaction forces produced within each model upon deflection to 0.01 in (0.254 mm), 0.02 in (0.508 mm), and 0.03 in (0.762 mm) at 1 mm from the tip using the finite element method. Materials and Methods Three-dimensional computer models of half-round and full-round clasps were constructed using solid eight-node brick elements. The half-round, tapered I-bar clasp model was 2.4 and 1.4 mm in diameter at the base and tip, respectively. The full-round, tapered I-bar clasp model was 1 mm in diameter. Three design groups were created for each clasp form. Group A had 25% of the total length in the straight anchor end of the I-bar clasp, B had 35%, and C had 50%. All models were 31 mm in length and had a radius of curvature of 5 mm. Different material properties were incorporated into the models. Each model was deflected at a point 1 mm from the tip to 0.01 in (0.254 mm), 0.02 in (0.508 mm), and 0.03 in (0.762 mm). Results The stresses and forces produced as a result of the deflection applied to each clasp were viewed and displayed graphically. The maximum von Mises stresses in megapascals and the reaction force in newtons (N) were recorded. Stresses varied in each clasp in the range of 0 to 154.3 MPa for the half-round, tapered I-bar clasp models, and 0 to 100.9 MPa for the full-round I-bar clasp models at 0.01-in deflection. Reaction force measured near the tip of the clasp models was between 1.60 N and 6.31 N for the half-round, and between 0.22 N to 2.13 N for the full-round I-bar clasp models. For all clasps studied, as the deflection increased, the location of stress within each group remained the same regardless of the material properties; however, the stress and force values increased linearly. Conclusions The location of maximum stress varied with the length of the anchor portion of the clasps studied. Maximum stresses were located on the flat side of the half-round, tapered I-bar clasp model.     

Oral aphthous-like ulceration due to tiotropium bromide

Unwanted side-effects of a drug therapy are well known to oral medicine specialists and other colleagues. Usually they manifest itself as dry mouth, taste disturbances, various allergic or toxic reactions on the lips and/or in the oral cavity. However, the list of the drugs which might induce unwanted reactions is everyday becoming longer as more and more drugs are introduced on the market. Certain problems when diagnosing and reporting unwanted side effects of the drugs exist as only accurate method of diagnosis is repeated drug use in controlled clinical setting where fatal consequences due to the anaphilactic shock could be avoided. We report a side effect reaction to tiotropium bromide (Spiriva) cap used with HandiHaler manifesting itself as an oral ulceration in a 65 yrs old male. On the third day of drug intake the patient developed oral ulceration two times in a period of few months. Other medications he has been using for several years. To our knowledge this is a first report as an oral side-effect of this drug used for treatment of chronic obstructive pulmonary disease (COPD).     

Morphological characteristics of the depository surface of alveolar bone of diabetic mice

Sharpey's fibers support teeth by attachment of periodontal ligament fibers to alveolar bone. The effects of diabetes mellitus on this support mechanism have not been described and were the subject of this study. Male Swiss mice were rendered diabetic by streptozotocin. Mandibles were removed 9 weeks after injections, the mineralizing front of the depository surface of the interdental septum was exposed by fracture through the periodontal ligament, rendered anorganic, and examined by scanning electron microscopy. No significant reduction in alveolar crest height was evident in diabetic as compared to control animals; however, significant changes in the a) mineralization patterns of bone depository surfaces and Sharpey's fibers, and b) number of Sharpey's fibers inserting into alveolar bone were evident in diabetics. Unmineralized fissures, characteristic of Sharpey's fibers of control, were nearly obliterated by mineralized tissue in diabetic animals. The mineralizing front of the middle and apical thirds of the diabetic alveolar wall was covered by numerous large calcified globules resembling enlarged calcospherites, which were not evident over the cervical third or control tissues. The mean Sharpey fiber density was greater in controls than in diabetics (p less than 0.001); however, there was no significant difference between their mean diameters. These observations suggest that, in early diabetes, Sharpey's fibers and depository surfaces of the middle and apical thirds of the interdental septum have morphologic evidence of aging, which precedes significant reduction in alveolar crest height. These changes may weaken the attachment of periodontal ligament fibers to bone and reduce resistance of the periodontium to intrusive forces.     

The influence of dental alloys on three-body wear of human enamel and dentin in an inlay-like situation

This in vitro study evaluated the effect of metal alloys on three-body wear resistance of enamel and dentin, and vice versa. Three-body wear of human enamel, dentin, a soft gold alloy (BiOcclus Inlay), a CoCr alloy (Remanium 2000), a resin cement (Variolink II) and a zinc oxide phosphate cement (Harvard) was investigated using the ACTA-machine. Sample chambers of eight sample wheels were prepared with pure materials or combinations of human tooth substance, alloys and cement, simulating an inlay-like situation. After 100,000 and 200,000 cycles in a millet suspension with a spring force of 20 N, the amount of abraded material was profilometrically measured and evaluated by 3D surface data analysis. After 200,000 cycles, the materials demonstrated a mean loss of 0.41 microm for CoCr, 51 microm for gold, 57 microm for enamel, 164 microm for dentin, 79 microm for Variolink and 369 microm for Harvard. Using ANOVA and the Games-Howell-test, resin cement, enamel and gold were a subset not shown to differ, as was zinc phosphate cement and dentin. CoCr demonstrated the least wear and differed significantly from all materials. Enamel wear was significantly reduced in mixed chambers with CoCr, and gold after 200,000 cycles compared to enamel in pure chambers. In summary, a soft gold alloy can be recommended for inlays when considering three-body abrasion since the wear rate of the "soft" gold alloy corresponded to that of human enamel.     

Microscopic Visualization of Metabotropic Glutamate Receptors on the Surface of Living Cells Using Bifunctional Magnetic Resonance Imaging Probes

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