AIDS-infected doctors and dentists are urged to warn patients or quit.
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Acquired Immunodeficiency Syndrome↗
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New York won't tell doctors with AIDS to inform patients.
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AIDS Serodiagnosis↗
Clinical practice of the future. The future of dentistry.
The last 20 years have brought enormous change to the dental profession. The American Dental Association Future of Dentistry Report examines some of these advancements and discusses what changes to anticipate in the future. Among the most significant changes are those that will occur in the scope of clinical dental practice. This is largely due to anticipated shifts in patient demographics, provider availability, advancements in science and technology, and a changing role for the dentist in the health care community. Future dentists will maintain their role as experts on diseases of the oral cavity. However, their responsibilities will change and increase as they observe the interaction between oral and systemic health. Dental education, therefore, must reflect the changing role of the dentist.
Dental Auxiliaries↗
Broad support evident for the emerging specialty of orofacial pain.
The emerging field of orofacial pain is being considered by the American Dental Association for full status as a new dental specialty to improve the care for these patients. The broad support among dentists for this initiative stems from an awareness of the benefits the field can provide for dentists and their patients.
Adult↗
How does time-dependent dental unit waterline flushing affect planktonic bacteria levels?
The purpose of this study was to evaluate how time-dependent waterline flushing affects the presence of biofilm in otherwise-untreated dental unit waterlines (DUWLs). Water samples were obtained from twelve highspeed handpiece DUWLs located in the undergraduate treatment clinic at the University of Missouri-Kansas City, School of Dentistry. Baseline water samples (50 cc) were collected prior to the start of continuous flushing. Additional 50 cc samples were collected after two-, three-, and four-minute flushing intervals from the baseline. The levels of planktonic bacteria in DUWLs were quantified by counting colony forming units (CFUs). In addition, segments of water tubing from each of the highspeed handpiece waterlines were examined by scanning electron microscopy, which confirmed the presence of a residual biofilm in the lumen of each dental unit waterline. A one-factor repeated measures ANOVA showed a statistically significant (p<0.01) reduction in CFUs at all intervals compared to baseline and between each successive time interval. Indeed, after four minutes of continuous flushing, all waterlines still harbored CFU levels that exceed current American Dental Association (ADA) recommendations. It was concluded that water flushing of DUWLs produced a statistically significant reduction in planktonic bacteria at each time interval compared to the baseline and between each successive time interval. However, the level of CFUs after four minutes of continuous water flushing still exceeds the current ADA recommendations for acceptable levels of microorganisms.
Analysis of Variance↗
Banning live patients as test subjects on licensing examinations.
The use of live patients on the licensing examinations was a part of dentistry for almost the entire twentieth century and continues up until today. Considerable new debate about the appropriateness of using live patients as test subjects began in the mid-1990s and culminated in the passage of a resolution in the American Dental Association's year 2000 House of Delegates calling for an end to this practice by the year 2005. The live patient examination tests a narrow range of clinical skills, creates ethical dilemmas for candidates, for the host institution, and for the profession, and is unable to distinguish between those ready to assume independent practice from those who are not yet at that level of competence. There are other ways to test for such readiness including proposals in New York State to substitute a postdoctoral year or mannequins in place of live subjects. The public and the dental profession will be better off by developing alternative licensing tests to the use of live subjects.
Clinical Competence↗
The effectiveness of a Mock Board experience in coaching students for the Dental Hygiene National Board Examination.
A Mock Board is available through the American Dental Association to any student or dental hygiene program as a study aid for the Dental Hygiene National Board Examination (DHNBE). The purpose of this study was to evaluate the usefulness of this Mock Board as a learning activity to help students gain familiarity with the question formats and the overall board exam experience. A sensitivity-specificity model was applied to validate the Mock Board's accuracy in identifying students who would pass or fail the DHNBE. A survey was conducted to assess students' opinions of the Mock Board experience. The Mock Board accurately identified success or failure on the DHNBE for 75 percent of the participants. However, the Mock Board's sensitivity was much better than its specificity. A majority of students reported the Mock Board motivated them to study and prepared them well for the national board experience. Comments showed, however, that students did not feel the Mock Board experience was as intense as taking the DHNBE. Findings indicate the Mock Board can be a valid and effective addition to board preparation activities. Dental hygiene faculty members are urged to consider incorporating the Mock Board experience with more traditional methods of coaching in preparing students for the DHNBE.
Attitude↗
Properties of encapsulated and hand-mixed zinc phosphate dental cement.
PURPOSE: Dental cements can be supplied as loose powder and liquid or as encapsulated syringes. This study assessed the compressive strength of a recently marketed zinc phosphate encapsulated cement compared with a hand-mixed system according to the American Dental Association Specification. MATERIALS AND METHODS: The mean fracture strength, standard deviations and associated Weibull Moduli (m) of the encapsulated and hand-mixed cements were determined by compressive fracturing 30 cylindrical specimens (height 6.0 +/- 0.1 mm, diameter 4.0 +/- 0.1 mm). Scanning electron microscopy was employed to assess crack growth from indentations and cement morphology. Image analysis was used to investigate the influence of mixing regime on pore distribution within the cement samples. RESULTS: The compressive strength data showed variation in magnitude and reliability ranging from 42 +/- 8 MPa (m = 5.2 +/- 1.0) for the encapsulated cement filled directly from the capsule to 71 +/- 11 MPa (m = 6.3 +/- 1.3) for the hand-mixed cement. The encapsulated cement matrix was extensively porous, consisting of pores between 0.1-0.5 microm diameter, compared with the non-porous hand-mixed cement matrix. Larger pores (over 18 microm diameter) were related to air entrapment in the encapsulated cement on mixing while small pores (0.1-0.5 microm diameter) were indicative of vaporization porosity commonly seen with exothermic reactions.
Air↗
The effect of dental insurance on the ranking of dental treatment needs in older residents of Durham Region's homes for the aged.
The effect of dental insurance on the ranking of dental needs in older adults has not been reported previously. We examined this effect using data obtained from a cross-sectional survey of older adults living in homes for the aged in Durham Region, Ontario. History of dental insurance was obtained during interviews. Dental needs, assessed during clinical examinations, were ranked from no need to urgent need according to the guideline of the American Dental Association. The associations between the rank of dental needs, dental insurance and other factors were analyzed with the Kruskal Wallis test, chi-square test, analysis of variance and multiple logistic regression. Of the 252 participants, 80 (31.7%) had been insured continuously since 1974, 69 (27.4%) had no need for dental treatment and 59 (23.4%) needed urgent dental care. More of the continuously insured than the uninsured residents were dentate (46/80 [57.5%] vs. 75/172 [43.6%], p = 0.04). Ranking of the need for care was not significantly influenced by dental insurance; need of any kind was explained by being dentate (odds ratio 12.3, 95% confidence interval 5.6 27.3).
Aged↗
The Gies Report and Research.
In the eyes of the intellectually curious William Gies, dentistry and dental education in 1926 was mechanical, empirical, commercial, reparative, and isolated from other disciplines. The solution proposed in the Gies Report included making dental schools parts of universities and collaborative equals with medical schools, increasing full-time teachers, promoting graduate study, and especially, grounding dentistry in science. Early attempts by the American Dental Association to develop and support a research agenda floundered, and scholarship was left to the universities and the government, and more recently to commercial interests. To a disappointing extent, the separation of practice from science remains today as the technologies of the scientific spirit remain unfamiliar and vaguely threatening.
Dental Research↗
Clinical efficacy of an optimized stannous fluoride dentifrice, Part 2: A 6-month plaque/gingivitis clinical study, northeast USA.
The objective of this 6-month, double-blind clinical study, conducted following the American Dental Association guidelines, was to investigate the efficacy of Colgate Optimized Stannous Fluoride (COSF) dentifrice for the control of supragingival dental plaque and gingivitis. This dentifrice contains 0.454% stannous fluoride, stannous chloride, polyphosphate, and citrate in a silica base. At the 3- and 6-month study examinations, the COSF dentifrice group exhibited statistically significant reductions in both plaque and gingivitis compared to the control dentifrice group. At the 6-month examination, the magnitude of these percent reductions exceeded 20% for all 4 parameters measured. Thus, the results of this study support the conclusion that the COSF dentifrice is efficacious for the control of supragingival plaque and gingivitis.
Adult↗
Clinical efficacy of an optimized stannous fluoride dentifrice, Part 3: A 6-month plaque/gingivitis clinical study, southeast USA.
This 6-month, double-blind clinical study, also following the American Dental Association guidelines, investigated the efficacy of Colgate Optimized Stannous Fluoride (COSF) dentifrice in controlling supragingival dental plaque and gingivitis. The same dentifrice, containing 0.454% stannous fluoride, stannous chloride, polyphosphate, and citrate in a silica base was used. Adult men and women from the Atlanta, Georgia, area 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. As in the first study, plaque and gingivitis examinations were conducted after 3 months and again after 6 months of using the dentifrices. At both the 3- and 6-month study examinations, the COSF dentifrice group exhibited statistically significant reductions in both plaque and gingivitis compared to the control dentifrice group. At the 6-month examination, the magnitude of these percent reductions exceeded 20% for all 4 parameters measured. Thus, the results of this study reflect those found in the New Jersey study, i.e., supporting the conclusion that the COSF dentifrice is efficacious for the control of supragingival plaque and gingivitis.
Adolescent↗
The study of temporomandibular disorders and orofacial pain from the perspective of the predoctoral dental curriculum.
This paper addresses questions 2 to 6 posed in the charge to the conference to discuss the study of temporomandibular disorders (TMD) and orofacial pain from the perspective of the predoctoral dental curriculum. This paper lends itself to an additional query: how much diagnostic and therapeutic skill relative to TMD and orofacial pain should a new graduate possess and demonstrate to be deemed competent in accordance with the definition of competence of the American Dental Association's Commission on Dental Accreditation? Although much of the content of this and the accompanying articles from the conference pertain to the TMD and orofacial pain curricula of dental schools in North America, most of what is presented here is universal to the teaching of the subject matter; therefore, it could be applied to educational institutions in other parts of the world. Indeed, an international survey relative to the teaching of TMD and orofacial pain would be of interest and value to dental schools worldwide.
Accreditation↗
Delayed linear expansion of improved dental stone.
STATEMENT OF PROBLEMS: Specification 25 of the American Dental Association (ADA) states that final setting expansion measurements of improved dental stone are made 2 hours after mixing. In a limited pilot study on selected type IV and V dental stones, measurements showed delayed linear expansion or early contraction continuing up to 120 hours. PURPOSE: The objectives of this in vitro study were to measure the linear setting expansion of 6 ADA type IV and V dental stones, to compare their expansion at 2 hours relative to ADA Specification 25, and to characterize expansion changes up to 120 hours. MATERIAL AND METHODS: The improved dental stones tested in this study were Die-Keen, Jade Stone, Vel-Mix, ResinRock, Fuji Rock, and Silky Rock. Mixing was performed in accordance with a standardized technique and the manufacturers' instructions. The mixes were poured into an electronic expansion-measuring device, and setting expansion values were continuously measured and recorded for 120 hours. The collected data were subjected to a 2-way repeated-measures multivariate analysis of variance at alpha=.05. Planned comparisons between the 2-hour experimental and 2-hour manufacturer expansion values were made at the 95% confidence interval. RESULTS: All stones showed higher mean linear expansion values at 120 hours than at 2 hours. Expansion was essentially complete at 96 hours for all stones except ResinRock. Die-Keen exhibited the highest total mean setting expansion (0.35% +/- 0.013%), and Silky Rock exhibited the lowest mean linear expansion (0.14% +/- 0.008%) at 120 hours. Multivariate analysis of variance revealed significant interactions between stone and time (P<.0001). Mean expansion values at 2 hours were comparable to those stated by the manufacturer except for Die-Keen and Jade Stone. CONCLUSION: Within the parameters of this study, all dental stones tested exhibited continued expansion while setting under clinical conditions. The amount of expansion varied significantly among the materials, with 22% to 71% of the expansion occurring after 2 hours. Die-Keen exhibited the highest total mean expansion but had the least amount of expansion after 2 hours; both Die-Keen and Silky Rock remained stable after 72 hours.
Calcium Sulfate↗
Reducing bacterial counts in dental unit waterlines: tap water versus distilled water.
BACKGROUND: The maximum recommended level of microbial contamination of water from dental unit waterlines (DUWL) is 200 colony-forming units per milliliter (CFU/mL). This article addresses the importance of water selection in achieving that standard. METHODS: Microbial contamination in water samples from 75 new dental units, with a closed-circuit water system, were compared using combinations of tap water and sterile distilled water with and without two chemical disinfectants (bleach and 0.12% chlorhexidine gluconate, Bio2000) over a six-week period. Baseline tap water samples were collected and tested initially. RESULTS: The microbial plate counts of seven tap water specimens (controls) ranged from 4 to 95 CFU/mL. These results were well below both the 500 CFU/mL standard for public drinking water and the 200 CFU/mL goal for dental treatment water. However, when passed through dental units, no significant bacterial reduction was achieved for samples of tap water (Group 1), tap water treated with bleach (Group 2), or tap water treated with Bio2000 (Group 4). Only water samples from dental units using Bio2000 alone (Group 3) or a combination of sterile, distilled water with Bio2000 (Group 5) met or exceeded the 200 CFU/mL standard. CONCLUSIONS: Using tap water alone or tap water with bleach did not improve water quality. However, the American Dental Association (ADA) standard for reduced microbial contamination of dental unit waterlines was met using Bio2000 and distilled water treated with Bio2000. CLINICAL SIGNIFICANCE: The ADA standard of 200 CFU/mL was achieved using a closed water system and distilled water treated with Bio2000. Using 100% Bio2000 is also effective, but more costly.
Analysis of Variance↗
A laboratory comparison of evacuation devices on aerosol reduction.
PURPOSE: Aerosols are defined as airborne particles that range in size from 0.5 to 10 microns (micron). They are produced during ultrasonic instrumentation, but they can be reduced. Irrigant solutions, which produce the therapeutic effects of lavage, also combine with blood, saliva, and bacteria to produce potentially harmful airborne particulates. The American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC) recommend utilization of high volume evacuation, rubber dam, and patient positioning for aerosol control. But for the non-assisted dental hygienist, these recommendations are difficult to implement. This study was designed to compare the concentration of airborne particulates from ultrasonic scaling, utilizing three different methods of evacuation. METHODS: In a laboratory setting, ultrasonic airborne particulates were generated utilizing a 25,000 cps magnetostrictive ultrasonic scaling instrument. Three evacuation devises were compared for effectiveness: a standard saliva ejector intraorally positioned; and two extraorally positioned, hands-free high-volume evacuation (HFHVE) techniques. One of these devices had a standard attachment, and, the other had a funnel-shaped attachment. Measurement of airborne particles was performed with a DataRAM Real-Time Aerosol Monitor. RESULTS: This study (N = 21) found a significant reduction in the number of airborne particulates with either form of extraoral HFHVE attachment in place. Standard attachments and funnel-shaped attachments to HFHVE resulted in reduction of particulates by 90.8% and 89.7%, respectively, when compared to the intraorally positioned standard saliva ejector. CONCLUSIONS: Utilizing either form of HFHVE during ultrasonic instrumentation significantly reduced the number of aerosolized particulates that reached the breathing space of the client and clinician. This lends support for the ADA and CDC recommendation that HVE be used during aerosol producing procedures. Currently, no preventive measure is 100% effective; therefore, clinicians are encouraged to use additional methods to minimize the number of airborne particulates produced during intraoral instrumentation.
Aerosols↗
Comparison of two dentifrices with respect to efficacy for the control of plaque and gingivitis, and with respect to extrinsic tooth staining: a six-month clinical study on adults.
The objective of this six-month, double-blind clinical study, conducted in harmony with American Dental Association guidelines, was to provide a comparison between Colgate Total Toothpaste and Crest Gum Care Toothpaste with respect to their levels of efficacy for the control of supragingival dental plaque and gingivitis, and with respect to the levels of tooth staining associated with their use. Adult male and female subjects from the Edinburgh, Scotland area were entered into the study and stratified into two treatment groups which were balanced for age, sex, baseline Quigley-Hein Plaque Index scores and baseline Löe-Silness Gingival Index scores. Subjects received an oral prophylaxis, and were instructed to brush their teeth twice daily (morning and evening) for one minute with their assigned dentifrice, using a soft-bristled toothbrush. Examinations for plaque, gingivitis and extrinsic tooth staining were conducted after three months' and again after six months' use of the study dentifrices. One-hundred and nine (109) subjects complied with the protocol and completed the entire six-month clinical study. At both the three- and six-month study examinations, the Colgate Total Toothpaste group exhibited statistically significantly less plaque, gingivitis and extrinsic tooth staining compared to the Crest Gum Care Toothpaste group. At the six-month examination, the magnitude of these differences exceeded 18% for all six parameters measured (18.7% for Plaque Index, 60.5% for Plaque Severity Index, 22.2% for Gingival Index, 85.1% for Gingivitis Severity Index, 45.3% for stain intensity, and 46.3% for stain area). Thus, the results of this six-month clinical study support the conclusion that Colgate Total Toothpaste provides a statistically significant, substantive advantage in efficacy for the control of plaque and gingivitis over Crest Gum Care Toothpaste, while, at the same time, providing better control against the development of extrinsic tooth staining.
Adult↗
PGD training and its impact on general dentist practice patterns.
This study compares the practice patterns of general dentists with and without formal advanced training in AGED or GPR programs. The UCLA School of Dentistry surveyed a random selection of dentists from graduating years 1989, 1993, and 1997 as part of a Health Resources Services Administration (HRSA)-supported evaluation of the impact of federal funding on postgraduate general dentistry (PGD) programs. Using a sample drawn by the American Dental Association (ADA), 6,725 dentists were surveyed about their practice, advanced training, patients served, and services provided. Of the 2,029 dentists (30 percent) who responded, 49 percent were practicing dentists with no formal advanced training in general dentistry or one of the eight ADA specialties; 7 percent had Advanced Education in General Dentistry (AEGD) experience; 20 percent trained in a General Practice Residency (GPR); and 24 percent were specialists. Additionally, 7 percent of respondents had PGD training and a clinical specialty. GPR-trained dentists were significantly more likely to be on a hospital staff and to treat medically compromised patients even after ten years of practice. PGD dentists were less likely to seek specialty training. Major reasons for seeking PGD training were increasing treatment speed, learning to treat medically compromised patients, and wanting hospital experience. Primary reasons for not selecting training were starting a practice and having a great practice opportunity. Our conclusion is that PGD training has an enduring impact on practice patterns and improves access to dental care for underserved populations.
Analysis of Variance↗