An Audit; Evaluation of patient positioning and preparation errors on panoramic radiographs at The University of The West Indies Dental School, Trinidad

Objective: To evaluate the frequency of common operator errors seen on panoramic radiographs in the UWI Dental School in Trinidad and Tobago. Design and Methods: Previously published and established error categories were used to assess 400 panoramic radiographs. Each positioning error and its resultant identifying features on the panoramic radiographs were assessed. Microsoft Office Excel 2007 was used as the primary tool to record the presence or absence of each error on the radiograph. Results: 400 panoramic radiographs were analyzed at the University of the West Indies, School of Dentistry. Out of the 400 panoramic radiographs, 40.5% showed no preparation or positioning errors according to the 8 criteria. The most common error observed was where the patient's chin was tipped too low (21%), followed by rotation of the head (12.50%). The least frequent error observed was where the patient's head was positioned too far forward (0.50%). Conclusions: The high frequency of errors revealed in this research project highlight the need for additional training in panoramic radiography technique to increase the diagnostic yield of this imaging modality at the institution. However compared to the last audit conducted in Trinidad and Tobago, there has been a reduction in the number of radiographs showing multiple errors which can be attributed to increased awareness and training of operators since its publication.

Self-reported percutaneous injuries of students and interns at the School of Dentistry in Trinidad: A follow up study of an updated sharps protocol

Objective: To report the results of a survey of all percutaneous injuries that occurred between 2009 ­ 2014 among students and interns at the dental school in Trinidad and to evaluate compliance with the protocol for the management of percutaneous injuries. Methods: Data was collected via questionnaires administered to 186 clinical students and interns in 2012 and 2014. Data were analysed using SPSS® 17.0 Statistical software. Results: A 90% response rate was obtained. Forty-eight persons (29%) reported one or more sharps injuries at the dental school. Of the 76 sharps injuries reported, 55 were percutaneous. Needle sticks and burs accounted for the majority of injuries and mostly occurred while working on patients. There were no significant relationships (p>0.05) between sex nor student year with the occurrence of injuries. 76% of the respondents described their concern for contracting blood borne injuries from sharps injuries as "high." After injury, 41% of the respondents followed the school's protocol for sharps injuries. Conclusion: The prevalence of percutaneous injuries among students and interns at the UWI dental school in Trinidad is 23% and occur most commonly while working on patients. Compliance with the protocol for percutaneous injuries needs to be improved. The protocol needs to be audited to improve efficiency and reinforced to the students, interns and clinical supervisors during their clinical years.

Awareness of Forensic Odontology among undergraduate law students in Trinidad and Tobago

Dentistry has much to offer law enforcement in the detection and solution of crime or in civil proceedings. The aim of our study was to identify the extent of awareness of forensic odontology among lawyers in training with a possible view to improving their knowledge on the subject given the current state of crime in Trinidad and Tobago. A cross-sectional study using a self-administered, previously tested, structured questionnaire was conducted for 118 second year undergraduate law students. An overwhelming majority (97%) viewed forensic dentistry as a discipline that plays a role in criminal identification and the identification of the victim/deceased however, more than three- quarters (83%) responded that forensic dentistry did not comprise any part of their law school curriculum. Almost half (45%) of the respondents indicated that dental enamel was the hardest substance in the human body. Most participants (68%) were aware that a dentist can be used as an expert witness in civil and criminal cases, however more than half (54%) were unsure of the definition of dental jurisprudence. This study concluded that although the majority undergraduate law students in this cohort in Trinidad were aware of several aspects of forensic odontology, their knowledge of some of the basic aspects of the subject was lacking and more specifically forensic odontology is not included as part of their undergraduate curriculum.

Bimaxillary protrusion: Prevalence and associated factors in the Trinidad and Tobago population

Introduction: Bimaxillary protrusion is a malocclusion characterized by proclined upper and lower incisors and prognathic jaws which has been identified in different ethnic groups and populations. Trinidad and Tobago have a mixed ethnicity population suitable to assess the prevalence of bimaxillary protrusion and associated factors in different ethnicities. Method: An epidemiological survey of 972 children, 566 females (58.2%) and 406 males (41.8%) was conducted. The sample population was 11 - 12 year old (mean age 11.84 years) in high schools across the country. None of the subjects were undergoing or had previous orthodontic treatment. Occlusal and anterior posterior relationships were assessed based on BSI 1983 definitions. The two conditions that made up bimaxillary protrusion, bimaxillary prognathism and bimaxillary proclamation, were assessed using extraoral and intraoral parameters respectively. Results: Bimaxillary prognathism and proclination were found with 64.4% and 68.8% prevalence respectively. Both conditions were found across all ethnic groups but with significantly different prevalence rates. There was an association between oral habits and ethnicity. Class 1 incisor relationship, class 1 canines and average overbite were the most common occlusal relationships found. Conclusion: Bimaxillary protrusion is prevalent in the population of Trinidad and Tobago. Prevalence of bimaxillary protrusion is related to ethnicity. There is an association between ethnicity and oral habits.

Characterization of the patients who attended the admission, diagnosis and emergency clinic (CIDU) of the dentistry service of a higher education institution in southwestern Colombia - 2015 / Caracterización de los pacientes que acudieron a la clínica de ingreso, diagnóstico y urgencias (CIDU) del servicio de odontología de una institución de educación superior del suroccidente colombiano - 2015

Aim: To characterize the patients who came to the Insitute, Diagnosis and Emergency Clinic (ICID) of the dentistry service of an institution of higher education in southwes-tern Colombia during the year 2015. Materials and methods: We reviewed 772 patient admission formats, consolidated the data in a database and selected socio-demographic variables of clinical interest.Results: It was found that 63% were female patients, the main reason for consultation is oral rehabilitation with 30%, the most frequent medical precedent was surgery with 57%, 33% of men at the clinical examination presented values of arterial hypertension, but only 13% reported it; while 25% of women presented HTA, but 15% reported it and the treatment of choice was oral rehabilitation with 42%. Conclusions: We found important aspects related to the reason for consultation, medical history and the relevant specialty for its treatment, as well as the importance of education and awareness of systemic compromised diseases such as arterial hypertension.

Objetivo: Caracterizar a los pacientes que acudieron a consulta a la Clínica de Ingreso, Diagnóstico y Urgencias (CIDU) de las clínicas odontológicas de una institución de educación superior del Suroccidente Colombiano durante el año 2015. Materiales y Métodos: Se revisaron 772 formatos de ingreso de pacientes, se hizo el consolidado en una base de datos y se seleccionaron variables sociodemográficas y de interés clínico.Resultados: Se encontró que el 63% fueron pacientes femeninos, el motivo de consulta principal fue la rehabilitación oral con 30%, el antecedente médico que más se repitió fue el de cirugías con 57%, 33% de hombres al examen clínico presentaron valores de hipertensión arterial (HTA), pero solo 13% de ellos lo reportaron; mientras que 25% mujeres presentaron valores de HTA, sin embargo, fueron 15% quienes lo reportaron y el tratamiento de elección fue rehabilitación oral con un 42%. Conclusiones: Se encontraron aspectos importantes relacionadas con el motivo de consulta, antecedentes médicos y la especialidad pertinente para su tratamiento, así como se evidenció la importancia de la educación y concientización de enferme-dades de compromiso sistémico como el caso de la HTA.

Employer and graduate perceptions of the competence of graduates from a dental school in Trinidad

Objective: The objective of this study was to evaluate employers' and graduates' perceptions of the competence of dental graduates from the School of Dentistry, University of the West Indies (UWI). Method: Anonymous questionnaires were sent to employers of the dental graduates in 2013. Similar questionnaires were also completed by graduates of the class of 2011 and 2012. Respondents were asked to rate employees or self assess the UWI School of Dentistry (SoD) curriculum's 23 competency areas and 6 domains of dental practice including: professionalism, assessment of a patient, establishment and maintenance of oral health. Results: Response rates of 48.3%, 100% and 95.7% were obtained from the employers, class of 2011 and class of 2012 respectively. The graduates' self-rated competency means were satisfactory or higher (better) in all competency areas. Employers rated the competency of UWI graduates higher than average in all competency areas except temporomandibular joint/occlusion therapy, orthodontic therapy and dental office administration. Overall, the graduates consistently rated themselves significantly higher than the employers except for periodontal therapy, minor oral surgery, removable prosthodontics and dental office administration. The graduating class of 2011 rated themselves significantly higher than class of 2012 in most (15 out of 23) competency areas. Conclusion: Employers and graduates rated UWI dental graduate competency above average in all areas except orthodontics and dental office administration. UWI dental graduates have a better perception of their competency than do their employers. The School of Dentistry needs to pay particular attention to the areas highlighted and review the curriculum accordingly.

A Retrospective Study To Determine Patients' Satisfaction With Fixed Dental Prostheses Provided During The Period 2008 ­ 2012 at The School of Dentistry In Trinidad

Introduction : The School of Dentistry undertakes the training of dental students, where they provide fixed dental prostheses such as crowns bridges and onlays to patients of the dental polyclinic. The aim of this study was to determine the patient satisfaction with their ixed prostheses and the quantity of remakes at the School of Dentistry polyclinic during the period 2008-2012. Methods : The lab records of ixed prosthetic work during the period 2008-2012 were analyzed. Patients who received treatment during this period were contacted via telephone for a structured interview via a questionnaire. Results : Ninety-six (96) patients were contacted via telephone and 72% of patients were female. Fifty-six (56) crowns and onlays, 22 conventional bridges and 18 resin-retained bridges were provided for patients. Ninety-six (96%) of patients were satisied with the aesthetics (appearance) of their prosthesis immediately after itting and 90.7 % were still satisied with the appearance at the time of interview. 79.2% of prostheses were still in place at the time of interview but patients reported that 18% of crowns failed, 22.7% of conventional bridges and 27.8% of resin-retained bridges had failed. Fifteen (15%) of the ixed prostheses were remade. However, the majority of patients (99 %) were overall satisied with their services at the School of Dentistry in Trinidad. Conclusion : Patients are generally satisied with the ixed prosthetic work delivered at the School of Dentistry polyclinic and highly satisied with the services provided. The amount of remakes whilst small can be reduced with more stringent quality assurance measures.

A Nano-hybrid investigated: The correlation between surface characteristics and color after instrumentation

There is no evidence in the literature on the correlation between surface roughness of dental nanocomposites following application of instruments for finishing compared to instruments for both finishing and polishing and how this relates to the final color of the restoration. This study evaluated the correlation between roughness parameters (Ra and Rmax), of a nano-hybrid composite following finishing alone or finishing and polishing, and color. 70 specimens (8mmX8mmX2mm) of the nano-hybrid Heritage 7 were fabricated. One group of 10 specimens served as control. The remaining specimens of 10 per group were either finished sequentially with (a) diamonds (b) stones (c) carbides or finished and polished with (d) diamonds and Sof-lex discs (e) stones and Sof-lex discs, (f) carbides and Sof-lex discs. Following instrumentation the specimens were assessed using profilometry for surface roughness. Immediately following surface roughness measurements color was assessed using a spectrophotometer. Roughness and color data were assessed using a one-way analysis of variance (ANOVA) and post-hoc Bonferroni. Correlations between the color coordinates (L*a*b*) and ΔE and roughness parameters (Rmax and Ra) were analyzed at a 0.05 level of significance. There were no statistical changes in Ra measurements between finishing and finishing and polishing, however specimens finished with stones showed a dramatic change in Rmax values compared tocontrol and all the other finishing and finishing and polishing regimens. There was a correlation between Ra and color parameters L* and a* and ΔE. Green and white stones produced the most surface detriment in terms of surface roughness and color.

Surface Properties of Dental Nanocomposites After Finishing With Rigid Rotary Instruments

This study evaluated the surface characteristics of three nanoparticle resin composites (Z350, Heritage 7 Nanohybrid, and Ice) using profilometry and scanning electronic microscopy (SEM) after subjecting them to sequential finishing procedures using rigid rotary instruments. Fifteen 8 mm·8mm·2mmspecimens were fabricated for each tested composite and subjected to one of the following finishing regimens: finishing with green stones followed by white stones, finishing with 45-lm diamond followed by 15-lm diamond, finishing with a 12-fluted carbide followed by a 20-fluted carbide. After finishing, the surfaces were subjected to profilometric testing. Eight parallel tracings were used to scan the finished surface of each specimen. For each recorded profile, the average roughness (Ra ) and extreme value descriptor (Rmax ) were recorded. On completion of the profilometric testing, two specimens from each group were randomly selected for qualitative assessment by SEM. Profilometric data was analyzed using aone-way analysis of variance and post hoc Scheffe tests. The results demonstrated that the three control groups of the tested nanocomposites behaved as a coherent group with respect to surface roughness. With the exception of the nanohybrid Heritage 7 finished with the carbide instruments, all composites showed an increase in surface roughness. The Z350 and Ice finished with the carbide finishing instruments showed no statistically significant increase in Ra , but both of these composites showed significantly rougher surfaces when finished with diamonds compared with controls. The nanohybrids Ice and Heritage 7 demonstrated significantly higher roughness in terms of Rmax when finished with stones. The SEM correlated well with roughness measurements. The conclusion may be drawn that diamonds and stones produce unacceptable surfaces in terms of roughness on the tested nanocomposites whereas finishing carbides produce acceptable surfaces.

Radiographic evaluation of the technical quality of root canal fillings performed by dental students

The objective of this study was to evaluate radiographically the technical quality of root canal fillings performed by dental students at the School of Dentistry, University of the West Indies. The school's database between 2000 and 2004 was investigated for patients with completed root canal treatment. The final sample consisted of 198 patients with 288 root-filled teeth and 460 canals. The length, presence of voids, taper, curvature of canal and fractured instruments were recorded and scored. Chi-squared analysis was used to determine statistically significant differences between the technical quality of root fillings and tooth type. Sixty-three per cent, 27.6% and 72.2% of root-filled canals had adequate length, density and taper respectively. The overall acceptability of root fillings having adequate length and taper, absence of voids and no fractured instruments was found in 10.9% of canals. Changes in teaching methods may be required to improve the technical quality of root canal treatment done by dental students.

Effect of Reduced Exposure Times on the Microhardness of Nanocomposites Polymerized by QTH and Second-generation LED Curing Lights

This study investigated the effectiveness of polymerization of various curing regimes on five nanocomposite restorative materials­Z350, Grandio, Clearfil Majesty Esthetic, Ice and Tetric EvoCeram­by utilizingmicrohardnessmeasurements. Five (n=5) disc-shaped specimens of each material were subjected to one of three curing regimes: curing with a halogen light for 20 seconds, curing with an LED light for 20 seconds and curing with an LED light for 10 seconds. Immediately following curing, hardness measurements were made with a Vickers indenter at five different locations on both the top and bottom surfaces of each disc. The mean for each surface was calculated. Data were analyzed using a one-way ANOVA and post-hoc Tukey HSD (α=0.05). The results demonstrated that among the Z350 composite samples, top and bottom microhardness values showed no statistical differences when cured with the halogen 20 second or LED 20 second regimes (p>0.05). Comparison of the top and bottom values of discs cured with the LED 10 second regime demonstrated significant differences (p<0.0001). Grandio samples cured with the halogen 20 second regime showed no statistical differences between top and bottom microhardness values (p>0.05); however, the bottom values of Grandio discs cured with the LED 20 second and 10 second regimes were significantly lowerwhen comparedwith top surface values (p=0.001 and p<0.0001, respectively). Clearfil Majesty Esthetic, Ice and Tetric EvoCeram samples cured with the halogen 20 second regime produced significantly lower bottom microhardness values, while both LED regimes produced top and bottom surfaces that were statistically comparable. The conclusion may be drawn that LED 10 second curing regimes were insufficient to cure Z350 and Grandio, while they were adequate for curing Clearfil Majesty Esthetic, Ice and Tetric EvoCeram.

Dental manpower requirements in emerging countries

The training and use of dental auxiliaries in newly emerging countries are proposed as the solution in such countries to the prevalence of dental disease, the paucity of professional dentists and dental schools, and the competing demands on their economies. Statistically valid dental health surveys of many countries do not exist, but scattered evidence from Jamaica, Guatemala, Thialand, Senegal, and Kenya, among others, indicates that caries and periodontal infections are widespread, and malocclusion, malignant neoplasms of the mouth, and calcium defects are not infrequent. The ratio of dentists to population varies from 1 to 15,000 in Jamaica to 1 to 250,000 in Kenya. Only 130 to 150 dentists are gratuated each year from Africa's seven dental schools; half the countries of the world have no dental school and no prospects of attaining one. The cost of producing one professional dentist is prohibitive - $23,000 per dentist in Guatemala, for example. Auxiliaries can fulfil many basic dental needs of both children and adults in these countries. A program with three consecutive but overlapping phases is suggested. Phase one is to produce a small corps of superbly trained dentists. Phase two is to supplement this corps by giving existing paramedical and auxiliary health personnel 6 weeks of practical chairside training to develop specific cadres of trained dental auxiliaries. Single skill auxiliaries can be trained in 2 years. A dental surgeon and six auxiliaries can serve an estimated 25,000 persons. Multiple skill auxiliaries with 8 years of general education need 3 years of technical training, preferably in an institution where graduate dentists and dental hygienists are also prepared. The auxiliary's role is both as assistant to the dentist and, where supervision is remote, as his substitute. Producing two types of auxiliaries, one oriented to the dental care of children, and the second a curative care of adults, would permit the organization of dental health services on a rational priority basis. (Summary)