Problem-based learning: effects on standard outcomes

Dental students at the Harvard School of Dental Medicine (HSDM) participate fully in the first two years of the curriculum with the Harvard Medical School (HMS) while also taking parallel dental classes. HSDM students were first exposed to problem-based learning (PBL) in 1987 when the "New Pathway" curriculum was introduced at HMS in the first two years of the medical school curriculum (the HSDM courses remained traditional lecture-based classes). In 1994, HSDM incorporated PBL into the first, second, and third (clinical year) year dental courses, and the curriculum shifted from a five-year curriculum to a four-year curriculum. The purpose of this study was to evaluate the effect of PBL and program length on measurable outcomes for dental education: NBDE Part I scores, attrition and graduation rates, and percentage of graduates entering postdoctoral training programs. This study was designed as a retrospective analysis of outcomes data from 1980 to 2002. Univariate linear regressions were computed for each measure against each outcome. Subsequent bivariate regression analyses revealed that the implementation of PBL has markedly affected NBDE Part I scores, graduation rates, attrition rates, entrance into postdoctoral plans, and percentage of graduates entering GPR/AEGD programs, while program length has had an effect on graduation rates, attrition rates, entrance into postdoctoral programs, and percentage of graduates entering GPR/AEGD programs. The findings of this report suggest that the implementation of PBL combined with a change in program length has been successful for all outcomes measured and that PBL alone has contributed to the rise in NBDE Part I scores among HSDM graduates.     

Relative levels of mRNA encoding enamel proteins in enamel organ epithelia and odontoblasts

Amelogenin, enamelin, sheathlin (ameloblastin/ amelin), enamelysin (MMP-20), and KLK4 (EMSP-1) are the major structural proteins and proteinases in developing tooth enamel. Recently, odontoblasts were reported to express amelogenin, the most abundant enamel protein. In this study, we hypothesized that odontoblasts express all enamel proteins and proteases, and we measured their relative mRNA levels in enamel organ epithelia and odontoblasts associated with porcine secretory- and maturation-stage enamel by RT-PCR, using a LightCycler instrument. The results showed that amelogenin mRNA in secretory-stage EOE is 320-fold higher than in odontoblasts beneath secretory-stage enamel, and over 20,000-fold higher than in odontoblasts under maturation-stage enamel. Similar results were obtained for enamelin and sheathlin. Enamelysin mRNA levels were equivalent in these two tissues, while KLK4 mRNA was higher in odontoblasts than in secretory-stage EOE. These results support the conclusion that odontoblasts are involved in the formation of the enamel layer adjacent to enamel-dentin junction.     

Pain experienced by patients during periodontal maintenance

BACKGROUND: The aims of this study were to determine: 1) the degree of pain experienced by patients during probing and debridement; 2) whether the treating hygienists could estimate the degree of pain experienced by the patients; and 3) whether the patients' pain responses could be predicted by factors such as the patients' age, gender, number of residual periodontal lesions, and answers to a questionnaire on dental anxiety. METHODS: Prior to periodontal maintenance procedures, two groups of 20 adult patients to be treated by two hygienists completed an anxiety questionnaire. Subsequently, measurements of probing depths were performed, followed by pain ratings by each patient using a visual analog scale (VAS). The hygienists also completed a VAS, estimating the pain level they perceived their patient to have experienced. The same protocol was repeated for instrumentation (debridement). RESULTS: Most patients showed low pain responses to both probing and instrumentation. However, using an arbitrary threshold of VAS > or = 40 mm, 20% to 33% of the patients had a significant pain experience. The hygienists were quite accurate in their relative estimates of their patients' pain experiences. Regression analyses disclosed that significant portions of the pain responses could be predicted by the patients' answers to one of the dental anxiety questions. CONCLUSIONS: Recognition of patients who are likely to experience significant pain during periodontal treatment may be facilitated by the use of one question on dental anxiety. During treatment, the ability to gauge and respond to patients' pain experiences would seem to be an important component of a therapist's clinical skills.     

Decontamination of tried-in orthodontic molar bands

Molar bands are commonly used to retain orthodontic attachments on posterior teeth and due to the variation in the size of such teeth, it is usually necessary to 'try in' several bands before the correct one is selected. A possible concern with re-using such bands is the lack of cross-infection control, even following autoclaving, due to the presence of one or more small bore lumen (the archwire and headgear tubes). The aim of this experiment was, therefore, to determine whether such bands could be successfully decontaminated so that they could be re-used without a cross-infection risk. Two hundred orthodontic molar bands that had previously been tried in patients' mouths, but not cemented into place, were tested. Each band was decontaminated using an enzymatic cleaner/disinfectant and then sterilized using either a downward displacement (n = 100) or a vacuum cycle autoclave (n = 100). Following autoclaving each band was inoculated into brain heart infusion culture broth and incubated at 37 degrees C for 5 days. None of the decontaminated bands exhibited growth after 5 days. It would appear that, using this methodology, there is little risk of a cross-infection hazard occurring with the re-use of previously tried-in and decontaminated molar bands.     

Biocompatibility of resin-based materials used as pulp-capping agents

AIM: To evaluate and compare the response of pulps of rats capped with resin-modified glass-ionomer cement (RMGIC) or self-etching adhesive system. METHODOLOGY: Class I cavities were prepared on the occlusal surface of 54 maxillary first molars of 27 rats. Pulp exposure was performed on the cavity floor. The following resin-based materials were applied as pulp-capping agents: G1, Clearfil Liner Bond 2V (CLB 2V; Kuraray Co., Japan); G2, Vitrebond (VIT; 3M/ESPE, USA). In group 3 (control group), a calcium hydroxide/saline paste (CH; Labsynth, Brazil) was used. The cavities were restored with amalgam. After 7, 30 and 60 days, the animals were sacrificed and the jaws were processed for microscopic evaluation. RESULTS: Despite the inflammatory response caused by the experimental and the control materials at 7 days, pulpal healing associated with calcified barrier formation was observed at 60 days following the pulp therapy. Both resin-based materials promoted a large zone of cell-rich fibrodentine matrix deposition on the pulp horn related to the pulp exposure site, which was larger to VIT than to CLB 2V specimens. Tertiary dentine underneath the fibrodentine matrix was deposited by a layer of elongated pulpal cells. The remaining pulpal tissue exhibited normal histological characteristics. In the control group, healing and dentine-bridge formation was observed at 30 days. Pulpal breakdown occurred only when bacterial infection occurred. CONCLUSION: Both experimental pulp-capping agents allowed pulpal healing characterized by cell-rich fibrodentine and tertiary dentine deposition as well as calcified barrier formation.     

Lasers in dentistry. Epilogue

Laser use in the dental clinic requires scientifically demonstrated improvement for patient and/or dentist, easily obtainable equipment, adequate training and safety. These aspects are summarized for all laser applications. Improvement has not been shown for all applications. In the Netherlands manufacturer-independent training is little available. Safety requires care, but not a large investment. Economical aspects include an adequate compensation for the necessary investment. For only a few applications laser treatment leads to decreased cost or time of treatment. However, also increased compensation by insurers or patients may be possible; some patients will be willing to pay more when laser treatment is less unpleasant than traditional treatment or, in the case of diagnosis, leads to better information.     

Teething troubles?

The relationship between the eruption of the deciduous teeth and the general health of infants has been documented for over 5,000 years. A variety of physical disturbances (anything from minor upsets to potentially fatal illnesses) have historically been attributed to teething, however a number of recent publications have alluded to a clarification of some of the disputed features of teething. It is now accepted that the localised symptoms of teething vary between individuals, however, 'teething' continues to be an inappropriate diagnosis proffered by both healthcare professionals and lay people. Severe systemic upsets are unrelated to teething and, if present, the infant should be promptly referred to a physician for an accurate diagnosis and appropriate treatment. The treatment modalities used in teething have been diverse throughout the ages, frequently depending on the tenets of the medical profession and lay people, but now principally involve pain relief. This article examines the signs and symptoms frequently attributed to teething and their possible alternative causes. The contemporary principles of the management of teething are discussed, including supportive measures, the diverse range of available topical and systemic pharmacological preparations and the 'alternative' holistic therapies.     

Local application of n-3 or n-6 polyunsaturated fatty acids in the treatment of human experimental gingivitis

BACKGROUND: Polyunsaturated fatty acids have the potential to attenuate inflammation by the synthesis of mediators of the 15-lipoxygenase pathways, which show opposite effects to the pro-inflammatory arachidonic acid metabolites such as leukotriene B4 (LTB4). AIMS: The aim of this clinical study was to evaluate the effects of topical application of n-6 or n-6 polyunsaturated fatty acids in patients with experimental gingivitis. METHODS: In each subject, similar teeth served as experimental and control over a 21-day non-hygiene phase and a 9-day resolving phase. Efficacy assessment was based on the bleeding on probing frequency (BOP) and the gingivocrevicular fluid volume (GCF). GCF was determined by inserting a filter paper strip for 30 s and measurements were performed on a Periotron 8000. The LTB4 concentration was analyzed by reversed-phase high-pressure liquid chromatography. RESULTS: After 21 days of plaque growth, the BOP, GCF and LTB4 levels were significantly increased in all groups, with no differences between the control and experimental side. Rinsing of an area with established gingivitis for a 9-day period significantly reduced the GCF in the n-6 group (71.9 (18.7) versus 47.4 (11.4) Periotron Units, median (inter quartile range)). CONCLUSION: The topical application of n-6 or n-6 fatty acids failed to inhibit the development of experimental gingivitis. Rinsing with n-6 fatty acids could reduce the level of GCF in established experimental gingivitis.     

Biomechanical response of bovine temporomandibular joint disc to prolonged tensile stress

This study was designed to evaluate the influence of prolonged tensile stress on the viscoelasticity of the temporomandibular joint (TMJ) disc. Twenty discs from 10, 3-year-old cattle were used. Tensile stress of 1.5 MPa was applied to specimens from the discs for 10, 20, 40 and 60 min. Following the prescribed period of tension for creep, the specimens were removed from the tension device and any recovery observed for 20 min. In all specimens, strain increased at the onset of stress application and reached almost steady conditions after 5 min. Although, the strain became slightly larger when the creep time was longer, no significant differences were found in the strains between any two tests with different periods of creep. The residual strain increased significantly with creep duration, and similarly the degree of recovery decreased significantly. In 10- and 20-min creep tests, the residual strains were 0.1 and 1.0%, the specimens in 40- and 60-min tests revealed irreversible changes in length. It was concluded that continuous loading for >40 min causes creep damage in bovine TMJ disc, and that prolonged sustained tension affects the recovery of joint homeostasis.