The basis for everyday real-life operative dentistry.
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PURPOSE: The purpose of this study was to report the results of a survey of pediatric dentistry post-doctoral program directors regarding education of post-doctoral students about management of caries in children 3 years-of-age or younger. METHODS: Fifty-two pediatric dentistry advanced education program directors were sent questionnaires inquiring about payer sources in their programs, distribution of caries in children 3 years of age or younger within the payer sources, the methods they teach and use to treat the caries, and the effectiveness of treatment and outcome data about the success of their treatment. RESULTS: Twenty-nine programs responded (56%). On average, two-thirds (66%) of the patients in post-doctoral pediatric dentistry programs are Medicaid patients. Program directors are fairly uniform in how they define methods of caries management, and they rate definitive therapy as the most effective method to manage all types of caries. Literature/textbooks were most frequently cited as the major source of scientific evidence to support treatment decisions. Fewer than 20% of program directors have outcome data on the effectiveness of their methods of treatment. CONCLUSIONS: Medicaid is the major payer source for patients in post-doctoral programs and definitive therapy is considered by program directors to be the most effective approach to managing caries in this patient population. Program directors rely on the literature and textbooks and few have outcome data.
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An investigation conducted over dental surgeons of 52 dental offices in Dakar and it's near suburb (40 from private sector and 12 from public and quasi-public) has shown that the use of retro-alveolar radiography during endodontic treatment was not systematic, due to the price of retro-alveolar film, waste of time and relative facility of the endodontic treatment of monoradicular teeth. The preparatory negative is favored (32.70%) particularly by private dental surgeons, who use two retro-alveolar films for endodontic treatment: pre and post operative radiography (30%). The immediate post operator control is executed only in case of post-operator pains by public and quasi-public dental surgeons (16.67%) with one retro-alveolar film on average for the endodontic treatment; at term any radiographic control is done. Three retro-alveolar films per endodontic treatment were exceptionally used (9.61%) and offset incidences (15%) are not much used as well as support-films (angulators). The retro-alveolar radiography is still a reliable guide for a clinical success in endodontic treatment with a minimum of three retro-alveolar films and offset incidences.
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PURPOSE: Didactic predoctoral dental implant education is part of the curriculum in most US dental schools. However, fewer than half offer laboratory instruction, and only a few allow dental students to place and restore dental implants. The additional time necessary for laboratory and clinical experience encroaches on an already crowded curriculum. Is the additional time necessary in the curriculum for laboratory and clinical experience by dental students reflected by the practice patterns of graduates who have completed such a program over the past 10 years? MATERIALS AND METHODS: A survey was designed to determine the implant practice patterns of graduates of the Creighton School of Dentistry, Omaha, Nebraska, for the 10-year period 1988 to 1997. These graduates had all participated in a formal undergraduate didactic and laboratory curriculum in implant dentistry. Approximately half also had the opportunity to place and/or restore dental implants while students. The survey was also sent to graduates (also 1988 to 1997) from a midwestern dental school without a formal laboratory or clinical component (used as a control group). The data were analyzed statistically. RESULTS: In comparison to the control group (56% versus 23%), more than twice as many Creighton graduates restore dental implants as a part of their general practice, surgically place more dental implants, refer more implant patients to surgical specialists, and seek more continuing education hours related to implant dentistry. These conclusions were all supported by statistical analysis of the data. DISCUSSION: Student clinical experience with implant dentistry appears to significantly increase the incorporation of implant dentistry into future dental practices. Even if clinical experience was not an option, a school curriculum which included both didactic and laboratory participation still significantly increased the number of graduates who included implant dentistry in their practices. CONCLUSION: The inclusion of laboratory and clinical experience in implant dentistry in the CUSD undergraduate curriculum resulted in significantly greater participation in implant dentistry at the general practice level.
A postal questionnaire was used to ascertain the views of practitioners on postgraduate education, and on the way they performed endodontic treatment. Attendance at postgraduate courses was low and was influenced by the style and content of courses as well as financial considerations. Hands-on courses were the preferred mode of delivery for postgraduate education. Most practitioners wished to change the way they carried out their endodontic treatment, and the majority felt this could only occur with an increase in fees.
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PURPOSE: The paper presents results of a survey of members of the American College of Prosthodontists (ACP) conducted to determine experiences and practices with dental implants. MATERIALS AND METHODS: Preliminary survey questions regarding the prosthetic and surgical use of dental implants were developed. The master list of questions was distributed to communities of interest to establish the most pertinent items of interest. The final questionnaire was distributed to all members of the ACP living or practicing in the United States and members engaged in the U.S. armed services. Responses were compiled and analyzed to determine correlation of responses using the chi-squared test for count data (level of significance alpha = 0.05). Fisher's exact test was applied to all significant responses. RESULTS: Surveys were distributed to 1815 ACP members. A total of 554 (31%) surveys were completed. On the basis of age distribution of survey respondents, it was determined that the respondents were representative of the ACP membership. The majority of the respondents (82%; CI, 79% to 85%) treat patients with implant-supported prostheses, while 12% (CI, 10% to 15%) surgically place implants. Of those not placing implants, 24% reported a desire to place implants, while 43% of all respondents expressed a desire for an ACP-sponsored course in implant placement. Increased age of the prosthodontist correlated negatively with a desire to place implants (p < 0.0001). Dissatisfaction with implant placement by others correlates with willingness to surgically place implants (p < 0.0001). CONCLUSIONS: Most prosthodontists (82%) use implant-supported prostheses in their practices, but most of the implants are placed by non-prosthodontists. There is general satisfaction with implant placement regardless of the specialty of the practitioner placing the implants. Younger prosthodontists expressed a greater desire to surgically place implants but were not statistically more likely to do so.
In response to interest by dental students and patient needs, an elective program in implant dentistry was started at the University of Detroit Mercy School of Dentistry (UDM) in the summer of 1994. The 1-year program is offered to a group of 10 senior students out of a class of 72. Implant treatment is provided to selected edentulous and partially edentulous patients. Predoctoral students participate in diagnosis and treatment planning, assist in surgical placement, and perform the prosthodontic procedures. A survey was sent to 160 UDM graduates, and 90 responded. Out of the 90 respondents, 35% had participated in the elective implant program and 65% had not. A Pearson correlation matrix was used to analyze their responses. A stronger positive correlation with offering and restoring implants was seen in graduates who had completed the elective program in implant dentistry.
The purpose of this article is to introduce evidence-based concepts and demonstrate how to find valid evidence to answer clinical questions. Evidence-based decision making (EBDM) requires understanding new concepts and developing new skills including how to: ask good clinical questions, conduct a computerized search, critically appraise the evidence, apply the results in clinical practice, and evaluate the process. This approach recognizes that clinicians can never be completely current with all conditions, medications, materials, or available products. Thus EBDM provides a mechanism for addressing these gaps in knowledge in order to provide the best care possible. In Part 1, a case scenario demonstrates the application of the skills involved in structuring a clinical question and conducting an online search using PubMed. Practice tips are provided along with online resources related to the evidence-based process.
The aim of this review of clinical decision making for caries management in children is to integrate current knowledge in the field of cariology into clinically usable concepts and procedures. Current evidence regarding the carious process and caries risk assessment allows the practitioner to go beyond traditional surgical management of dental caries. Therapy should focus on patient-specific approaches that include disease monitoring and preventive therapies supplemented when necessary by restorative care. The type and intensity of these therapies should be determined utilizing clinical data as well as knowledge of the caries process for that child. Changes in the management of dental caries will require health organizations and dental schools to educate students, practitioners, and patients in evidence- and risk-based care.