Doing endorsements right. ADA's 67-year-old approval program offers a model.
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American Dental Association↗
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Efficacy of a dentifrice containing zinc citrate for the control of plaque and gingivitis: a 6-month clinical study in adults.
The objective of this 6-month, double-blind, clinical study, conducted in harmony with American Dental Association (ADA) guidelines, was to evaluate the efficacy of a dentifrice containing 2% zinc citrate and 0.76% sodium monofluorophosphate in a silica base (zinc citrate dentifrice) for the control of supragingival plaque and gingivitis, compared to a control dentifrice containing 0.76% sodium monofluorophosphate in a silica base (control dentifrice). Adult men and women from the Atlanta, Georgia, area were entered in the study and stratified into two treatment groups, which were balanced for baseline Quigley-Hein Plaque Index scores and baseline Löe-Silness Gingival Index scores. Participants received an oral prophylaxis and were instructed to brush their teeth twice daily (morning and evening) for 1 minute with their assigned dentifrice, using a soft-bristled toothbrush. Examinations for supragingival plaque and gingivitis were conducted after 3 months and again after 6 months' use of the study dentifrices. Ninety-nine participants complied with the protocol and completed the entire 6-month clinical study. At both the 3- and 6-month study examinations, the zinc citrate dentifrice group exhibited statistically significant reductions in both plaque and gingivitis compared to the control dentifrice group, based on whole-mouth data. At the 6-month examination, the magnitude of these reductions met or exceeded 18% for both plaque and gingivitis (25.3% for plaque; 18.8% for gingivitis). The effect of the zinc citrate dentifrice was most pronounced on the more severe manifestations of plaque and gingivitis, indicating a statistically significant (50.2%) reduction in severe plaque and a statistically significant (66.7%) reduction in severe gingivitis over the control dentifrice after 6 months of use. Similar findings were observed for data obtained from proximal, lingual, and posterior sites. Among the sites that indicated a tendency toward high levels of plaque or gingivitis based on the baseline scores, substantially fewer sites tended to continue to present such high levels at follow-up exams in the zinc citrate dentifrice group than in the control dentifrice group. Thus, in accordance with the 1986 guidelines published by the ADA and the 1994 revision published by the Task Force on Design and Analysis in Dental and Oral Research, the results of this study support the conclusion that a dentifrice containing 2% zinc citrate and 0.76% sodium monofluorophosphate in a silica base is clinically efficacious for the control of supragingival plaque and gingivitis.
Adolescent↗
Efficacy of a mouthrinse containing 0.05% cetylpyridinium chloride for the control of plaque and gingivitis: a 6-month clinical study in adults.
The objective of this 6-month, double-blind, clinical study, conducted following the American Dental Association (ADA) guidelines, was to provide an assessment of the effectiveness of a newly developed mouthrinse containing 0.05% cetylpyridinium chloride (CPC) for the control of supragingival dental plaque and gingivitis. Adult men and women from the Manchester, England, area were entered in the study, and stratified into two treatment groups (CPC mouthrinse and control mouthrinse), which were balanced for baseline Quigley-Hein Plaque Index scores and baseline Löe-Silness Gingival Index scores. Participants were given an oral prophylaxis and instructed to brush their teeth twice daily (morning and evening) for 1 minute with a soft-bristled toothbrush and fluoride dentifrice provided, immediately followed by rinsing for 30 seconds with 15 cc of their assigned mouthrinse. Examinations for supragingival plaque and gingivitis were conducted after 3 months' and again after 6 months' participation in the study. One hundred eleven participants complied with the protocol and completed the entire 6-month clinical study. At both the 3- and 6-month study examinations, the CPC mouthrinse group exhibited statistically significantly less supragingival plaque and gingivitis than did the control mouthrinse group. At the 6-month examination, the magnitude of these differences met or exceeded 24% for all 4 parameters measured (28.2% for Quigley-Hein Plaque Index, 63.4% for Plaque Severity Index, 24.0% for Löe-Silness Gingival Index, and 66.9% for Gingivitis Severity Index). The magnitude of the reductions in supragingival plaque and gingivitis were adequately large to support a claim of efficacy, in accordance with the criteria provided by the published guidelines of the ADA for the demonstration of the efficacy of a chemotherapeutic agent for the control of supragingival plaque and gingivitis. Thus, the results of this 6-month clinical study support the conclusion that a newly developed mouthrinse containing 0.05% cetylpyridinium chloride provides a statistically significant, clinically relevant level of efficacy for the control of supragingival plaque, and for the control of gingivitis, in accordance with the criteria provided by current ADA guidelines.
Adolescent↗
Outcomes assessment in dental hygiene programs.
In 1996, the American Dental Association's Commission on Dental Accreditation instituted a revised accreditation standard for dental hygiene educational programs entitled Standard 12-Outcomes Assessment. As a result of this standard, all dental hygiene programs were required to assess the attainment of goals through a formal outcomes assessment process. This study examined and analyzed the implementation process used by dental hygiene programs. Twenty-two dental hygiene program directors were interviewed to collect information regarding their experiences. The directors indicated that their programs routinely and effectively assess student outcomes and use the acquired information to make needed program improvements and to demonstrate accountability to groups having a vested interest in the program. Several factors, such as the policy itself, as well as gaining faculty and administrative support, were viewed as important to implementation. Time constraints were identified as a major barrier. Outcomes assessment data have also been used by dental hygiene programs as leverage for funding requests that resulted in significant program enhancement.
Accreditation↗
Sorption and solubility of soft denture liners after accelerated aging.
PURPOSE: To determine the sorption and solubility properties of soft liners in relation to the aging process. MATERIALS AND METHODS: Five soft liners (Flexor, Molloplast B, Ufigel L, heat-cured; Simpa, Ufigel P, cold-cured) were used. The sorption and solubility tests were performed as outlined in the American Dental Association (ADA) specification 12 for denture base polymers. Ten specimens of each material were fabricated. One set of five specimens was subjected to accelerated aging process in the Weather-Ometer instrument. The test materials were dried in a desiccator and then immersed in distilled water at 37 +/- 1 degrees C for 15, and 30 days. The sorption behavior of the test specimens was calculated. The solubility behavior of the test materials was determined only after 30 days. RESULTS: Aged materials immersed in water for 15 days showed different sorption properties related to the material. After water immersion for 30 days, the materials showed increased sorption properties. Negative increase in solubility was determined after aging for all liners except Flexor.
Absorption↗
Doing better in the 1990s--but not by much.
American Dental Association and federal agency reports indicate that during the past fifteen years, 1) the number and size of dental establishments have continued to increase, and 2) the number of dental assistant and dental hygienist program enrollees have fluctuated but remain lower than in earlier years (particularly dental assistant enrollees). Despite a tighter market for dental auxiliaries and improving dental practitioner income, dental assistant wages in the 1980s did not maintain parity with the rates of inflation and barely outpaced the levels of inflation in the first half of the 1990s. Dental hygienists fared only slightly better in the '90s.
Dental Assistants↗
Splitting fees or splitting hairs? Fee splitting and health care--the Florida experience.
Attorneys Jacobs and Goodman review the prohibitions against fee-splitting under Florida law and argue that Florida and other states need a clear statutory definition of prohibited activities. In addition, the authors argue that the Florida Board of Medicine has applied the prohibition against fee-splitting arbitrarily and in contrast to legal precedent set by the Second District Court of Appeals. Finally, the authors suggest that Minnesota provides clear legislative guidance on the issue of fee-splitting and that the approach adopted by Minnesota is more practical in today's complex health care reimbursement environment.
American Dental Association↗
Evaluation of sterilization of dental handpieces by heating in synthetic compressor lubricant.
The Centers for Disease Control and Prevention and the American Dental Association guidelines recommend sterilization of dental handpieces after each use. Steam autoclaving is the most commonly used sterilization method. However, pressurized steam causes corrosion and partial combustion of the handpiece lubricant, leaving a sticky carbon residue on the turbine which must then be replaced after several usages. Replacement of autoclave-damaged dental handpieces represents a major expense for dentists that may be avoided through the use of less destructive sterilization techniques.
Dental High-Speed Equipment↗
Evaluation of an illuminated mirror.
The viewing of oral structures with an adequate level of illumination is necessary to make accurate diagnoses of normalities and abnormalities in the oral cavity. The purpose of this study is to determine if a device with an illuminated mirror is heat sterilizable, easy to use, and compares in illumination potential to a traditional overhead dental operating light. We sterilized the Denlite in both chemical vapor and autoclave units (including a group that was cleaned ultrasonically prior to autoclave), testing the illuminance level every 10 cycles, for 100 cycles. We installed devices in the Graduate Operative Dentistry Clinic and requested those operators assigned to the units to rate the devices. Their acceptance rate was high in visibility, ease of use, acceptable temperature of handle, and lack of problems with the device. The device had an illuminance level of 14,200 lux, which is just below the maximum level of illuminance required by the American Dental Association's Specification on Dental Operating Lights.
Dental Instruments↗
Attitudes toward and use of pit and fissure sealants.
The results indicate that attitudes toward and use of sealants are generally low. There are, however, some dentists who use sealants proportionately more than other dentists, these being less recent graduates, dentists who practice in the northeast, and those dentists who are oriented generally more toward preventive procedures. The reasons selected by dentists for not using pit-and-fissure sealants were surprising. Despite considerable published evidence to the contrary and the provisional acceptance of two by the American Dental Association, Council on Dental Materials and Devices, most dentists are not yet convinced of the effectiveness of the procedure in preventing caries. In addition, many dentists were concerned that the material did not last long in the mouth, although high retention rates for periods in excess of one to three years had been reported. Also, a great concern for the possible sealing in of decay seems unsubstantiated by either clinical experience or reports from studies designed to monitor the activity of bacteria sealed in pits and fissures of teeth. Conversely, dentists infrequently selected either the cost of equipment and material or the time required for the procedure as reasons for not using pit-and-fissure sealants. The demanding technical requirements for proper application of the sealant, however, especially the avoidance of any moisture contamination, does require skilled personnel and substantial chair time. These factors are important considerations in the determination of the cost-effectiveness of this procedure in comparison to other preventive procedures for pit-and-fissure caries. These inconsistencies indicate a problem in the transmission of knowledge regarding sealants. Increased use of sealants, then, seems to be dependent on improving communication regarding their function and value to the dental profession. Data on the effectiveness of sealants over periods of three or more years have recently been reported and additional evaluations of this procedure are being reported. It would be expected that reports published since this research during the winter of 1974 will have an effect on both attitudes toward and use of sealants.
Attitude of Health Personnel↗
Comparison of sensitometric and diagnostic performance of two films.
The sensitometric properties of Kodak Ektaspeed Plus and Flow E-speed film as well as their diagnostic efficacy for detecting proximal surface caries were compared. Flow and Kodak E-speed films were exposed and processed according to American National Standards Institute and American Dental Association (ADA) specifications, and film speed, contrast, and density of base plus fog were measured. Additionally, 80 premolar and molar teeth were imaged and their proximal surfaces scored by 12 dentists for the presence of caries. The actual depth of the caries was determined by microscopic examination of the teeth after sectioning. Kodak Ektaspeed Plus and Flow E-speed films, although labeled E-speed by the manufacturers, are both slow F-speed films. They have comparable base plus fog densities and comparable contrast curves. Dentists detected carious lesions equally well using both film types. The sensitivity, specificity, accuracy, and receiver operating characteristic area for detecting enamel and dentinal caries were not significantly different between the two films. Kodak Ektaspeed Plus and Flow E-speed films both meet or exceed the ADA performance specifications in terms of sensitometric properties. Both offer equal diagnostic utility for detecting caries.
Absorptiometry, Photon↗
Detail reproduction, contact angles, and die hardness of elastomeric impression and gypsum die material combinations.
PURPOSE: This study compared surface detail parameters, interfacial contact angles, and die hardness for some combinations of elastomeric impression and die materials. MATERIALS AND METHODS: Representative polyvinyl siloxanes, polyether, polysulfide, and reversible hydrocolloid impression materials and Type IV, Type V, and resin reinforced-Type IV die materials were evaluated using a factorial design. For the evaluation of surface detail reproduction, the width of the thinnest continuous line observed and the visually observed shape of the thick line were determined from samples formed using a master die conforming to American Dental Association specification 19. The contact angle of freshly mixed die material on the set impression was measured using a contact angle goniometer. Finally, hardness of the die material was determined. After conversion of the data to ranks if necessary, 2-way analysis of variance with Ryan-Einot-Gabriel-Welsch (REGWQ) multiple comparison tests where appropriate were used to determine statistical significance. RESULTS: The thinnest continuous line demonstrated statistically significant impression material effects, and the observed shape of the thick line showed both statistically significant impression material and die material effects. For both contact angle and die hardness, a statistically significant interaction between the impression and die materials was found. CONCLUSION: Although statistically significant differences in each property were found, no specific combination of impression and die materials was identified as superior to another for all surface properties studied.
Analysis of Variance↗
Effect of 3 medicaments on the dimensional accuracy and surface detail reproduction of polyvinyl siloxane impressions.
OBJECTIVE: The purpose of this study was to determine the effect of retraction cord medicaments (aluminum chloride, ferric sulfate, and ferric subsulfate/ferric sulfate) on the dimensional accuracy and surface detail reproduction of polyvinyl siloxane impressions. METHOD AND MATERIALS: Polyvinyl siloxane impressions were made of standardized metal dies (American Dental Association [ADA] specification No. 19) treated with 1 of the 3 retraction cord medicaments. Dimensional accuracy was evaluated by comparing the average length of a line in the impressions to the standard die. Surface detail reproduction was evaluated by viewing the impressions under low-angle illumination at x10 magnification. Reproduction was considered satisfactory if 2 of 3 horizontal lines were reproduced continuously. The dies were also evaluated under the microscope before the impression was made. RESULTS: The medicaments did not significantly effect the dimensional accuracy; mean shrinkage was within ADA guidelines in the treatment groups. All of the medicaments had an adverse effect on surface detail reproduction. These effects were statistically significant compared to the untreated control. CONCLUSION: Although the changes in dimensional accuracy were within ADA guidelines, the surface detail reproduction was modified such that the impression would be considered clinically unacceptable. For optimal results, care must taken to remove all traces of these retraction cord medicaments prior to recording of a polyvinyl siloxane impression.
Aluminum Chloride↗
In vitro study of the effect of aged eugenol on the flow, setting time and adhesion of Grossman root canal sealer.
In the present study, the effect of aged eugenol (up to 180 days) on the flow, setting time and adhesion of Grossman root canal sealer was evaluated, following the American Dental Association specification number 57 for root canal sealers. An Instron Universal testing machine 4444 was used for testing adhesion. There were statistically significant differences between groups, with a higher flow, lower setting time and adhesion for aged eugenol. It can be concluded that time affects eugenol, with consequent effects on Grossman sealer.
Adhesiveness↗
Infection control procedures used in conjunction with computed dental radiography.
Infection control guidelines for dental radiography have been modified since 1986, when the American Dental Association and the Centers for Disease Control and Prevention supported the concept of "universal blood and body fluid precautions." With the introduction of computed digital radiography, hardware manufacturers recommend that alternative infection control techniques are necessary to prevent potential damage to the digital x-ray sensors placed inside the patient's mouth. Thirty first-year dental hygiene students were asked to insert and remove a Schick CDR number 2 size intraoral digital x-ray sensor into modified Rinn XCP bitewing bite blocks and a modified Rinn Snap-a-ray five times with each of the recommended infection control covers. Reduced rates of cross contamination are possible if the plastic barrier envelope has an additional latex finger cot stretched over it and the x-ray sensor. Sole usage of a latex finger cot will result in a reduced incidence of contamination, but still not to acceptable levels. However, a plastic barrier envelope placed over the x-ray sensor and over the modified XCP bite block together or a covered sensor in a Snap-a-ray under normal conditions does not result in a perforation and is least likely to result in cross contamination.
Humans↗
Trends in allied dental education: an analysis of the past and a look to the future.
Allied dental healthcare providers have been an integral part of the dental team since the turn of the 19th century. Like dental education, allied dental education's history includes a transition from apprenticeships and proprietary school settings to dental schools and community and technical colleges. There are currently 258 dental assisting programs, 255 dental hygiene programs, and 28 dental laboratory technology programs according to the American Dental Association's Commission on Dental Accreditation. First-year enrollment increased 9.5 percent in dental hygiene education from 1994/95 to 1998/99, while enrollment in dental assisting programs declined 7 percent and declined 31 percent in dental laboratory technology programs during the same period. Program capacity exceeds enrollment in all three areas of allied dental education. Challenges facing allied dental education include addressing the dental practicing community's perception of a shortage of dental assistants and dental hygienists and increasing pressure for career tracks that do not require education in ADA Commission on Dental Accreditation accredited programs. The allied dental workforce may also be called upon for innovative approaches to improve access to oral health care and reduce oral health care disparities. In addition, allied dental education programs may face challenges in recruiting faculty with the desired academic credentials. ADEA is currently pursuing initiatives in these and other areas to address the current and emerging needs of allied dental education.
Credentialing↗
Disinfection of dental unit waterlines with an oral antiseptic.
The problem of potential pathogens in biofilm within dental unit waterlines is real. Even though some chemical agents can disinfect biofilms, there remains concern that all remnants of the biofilm matrix are not eliminated, even with periodic treatments, and the bacterial populations in dental unit waterlines recur rapidly. Toxic and caustic residual chemicals are also a concern. In multiple trials following overnight treatment of dental unit waterlines with Listerine Antiseptic (LA), recurrence was investigated by evaluating effluent and biofilm specimens by plate culture. The presence or absence of biofilm within the dental unit waterlines was evaluated, pre- and post-treatment, by scanning electron microscopy. Baseline evaluations of dental unit waterlines determined the effluent and biofilm to harbor an average of 1 x 10(5) CFU per ml and 1 x 10(4) CFU per cm2, respectively, prior to treatment. Overnight, 18-hour treatment with LA rendered effluent and biofilm samples free of recoverable bacteria in all cases immediately following treatment. Viable bacteria in the effluent of treated dental unit waterlines recurred to near pre-treatment levels by Day 7. The minimum inhibitory concentrations for each of the recovered isolates did not change following overnight treatment. Repeated overnight treatments at the beginning of a one-week study were effective in inhibiting recurrence of viable bacteria in the biofilm and effluent indefinitely, but still failed to completely remove the biofilm matrix. New tubing treated prior to use and then daily with LA did not develop a detectable biofilm by scanning electron microscopy during the study. One-month long follow-up clinical trials have demonstrated that a maintenance solution of a 1:50 concentration of LA and sterile distilled water in self-contained dental units with new tubing is effective for prolonged periods in maintaining the effluent within the American Dental Association's recommendation for the year 2000 of < 200 CFU per ml. The clinical significance of these findings is that a solution to the problem of dental unit waterline contamination may be currently available. Since antimicrobial LA is safe for patient use, it may be one of the most viable options suggested to date.
Anti-Infective Agents, Local↗
Medical units lag on AIDS guidelines.
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AIDS Serodiagnosis↗