Reviewing assessment strategies in European dental schools.

OBJECTIVES: Effectively assessing dental students' knowledge and skills is an important part of their education. Assessment techniques available to teachers, have become more diverse as new technologies are introduced. This study aimed to investigate what dental educators thought about current and future assessment techniques. METHODS: This was a mixed method study; quantitative data being collected at an annual dental educators' conference, via on-screen questions requesting: i) demographic information; ii) type of student assessment currently used; iii) impact of Covid-19 on student assessment, and iv) future perceptions of assessment. Questions were posed in real time using the 'Vevox' platform. Descriptive statistical analysis was employed. Qualitative data were collected on 'post-its' and analysed thematically. RESULTS: 101 participants attended the study. 59.1% (n = 60) had >11 years' experience. 64% (n = 55) considered their summative and formative assessments were effective in developing student learning. Few participants reported students' involvement in creating their own assessments (n = 8; 9.75%). 41.68% (n = 36) participants agreed it was a good idea for students to be involved in developing assessments, but only 9.75% (n = 8) reported it was already happening. Qualitative data indicated a reluctance to wholeheartedly embrace technology (including AI) when planning assessments. Most participants were not in favour of Co-creation or the use of some technologies. CONCLUSIONS: Participants, reflected on the challenges of adopting a universal assessment approach. Dental educators should be given the institutional support and autonomy to implement the best assessment methods for their students. Most of this cohort of experienced dental educators reported that assessments facilitated student learning. CLINICAL SIGNIFICANCE: The role of assessment for dental students is essential as dental educators must ensure that dental students graduate with appropriate knowledge and technical skills to be safe when in general dental practice. The use of various assessment techniques needs to reflect the diversity of skills the students need to demonstrate.

Teacher feedback and student learning-The students' perspective.

INTRODUCTION: Feedback from teachers to students plays an important role in informing students about the outcome of their assessments. It contributes to students' ongoing learning. The aim of this study was to investigate dental students' perceptions of the feedback given to them by their teachers in Europe. MATERIALS & METHODS: An online questionnaire was completed by dental students throughout Europe in this quantitative study. Data were collected via Google Forms, transferred to an excel spreadsheet and analysed using SPSS software Version 24. RESULTS: 234 students studying in 9 different European countries completed the questionnaire. These students were born in 36 different countries within and beyond Europe. 84% (n = 197) were undergraduate students. 20.3% (n = 48) students reported receiving feedback following summative assessments. 81.2% (n = 190) students reported constructive criticism as their preferred mode of receiving feedback. 11.3% (n = 26) students did not know who delivered the feedback to them. 71% (n = 166) students felt that the feedback they received had a significant impact on their future learning. CONCLUSION: It would appear that there is some diversity in dental students' perceptions of: i) who delivers feedback, ii) when feedback is given, iii) the consistency of feedback received, and iv) the style of feedback they preferred compared to that delivered by tutors. Feedback is being provided to dental students in an appropriate and helpful manner, although there is still room for improvement. Students were aware of the significance of feedback and its impact on future learning. CLINICAL SIGNIFICANCE: Most European dental students prefer to receive constructive feedback. Feedback was seen to have a significant impact on future learning despite over one in five students not knowing who had delivered their feedback. Feedback following clinical teaching should have a positive effect on students' skills and motivation to learn.

Teachers' feedback practices in COVID-19: Has anything changed?

OBJECTIVES: Feedback delivered by teachers to dental students has a profound impact on students' ongoing learning and development. The aim of this study was to investigate changes to feedback practices as a result of the global COVID-19 pandemic and the ensuing challenges to delivering quality dental education. METHODS: This was a mixed method study. Quantitative data were collected through a bespoke questionnaire delivered to attendees of the Association for Dental Education in Europe (ADEE) annual conference. Qualitative data were collected via four focus groups at the conference, each discussing a particular theme. The questionnaire and conference were delivered online via Gmail and MS Teams, respectively. Quantitative data were analysed descriptively; qualitative data were analysed narratively, and both were triangulated. RESULTS: 67 questionnaire responses were received which represented a 26% response rate. Respondents came from 12 different countries within Europe and beyond and reported having a variety of roles in their dental schools. 77.6% (n = 52) respondents indicated they had changed their delivery of feedback due to the pandemic. One-third of respondents reported giving more feedback and 76% (n = 51) increased their quantity of feedback delivered online. The increased incidence of online learning had resulted in a greater emphasis on teaching small groups, increased use of technology, increased emphasis on student centred learning and heightened awareness of changing the style of feedback delivery. CONCLUSIONS: The COVID-19 pandemic has enforced rapid changes to the delivery of feedback by teachers to dental students, which could pave the way for a more positive, inclusive, individualistic and effective approach for delivering feedback now and in the future. CLINICAL SIGNIFICANCE: The COVID-19 pandemic resulted in a significant shift from face-to-face teaching to online tuition, which promoted a need to re-evaluate the best method of delivering feedback to students. The ongoing changes in teaching approaches have a profound impact on clinical skills acquisition for dental students. The quality of the feedback students receive may help to enhance the synergies between theoretical online teaching and hands-on clinical skills acquisition, which has been altered and disrupted due to the ongoing pandemic.

Investigating working practices of dentists on shade taking: Evidence based good practice versus observed practice.

OBJECTIVES: The aim of this study was to investigate UK dentists' working practices on shade taking and to assess whether these clinical practices are in accordance with evidence-based guidelines. MATERIALS & METHODS: A cross-sectional survey was carried out using a questionnaire designed to elicit quantitative and qualitative data. This included two clinical scenarios (vignettes), which required respondents to describe the steps they would take during shade taking and the prescription sent to the dental technician. RESULTS: 170 completed questionnaires were analyzed. 167 respondents (98.9 %) used manual methods for shade taking. 98 (57.6 %; 95% CI: 50 %, 65 %) respondents followed guidelines on the first vignette, 73 (42.9 %; 95% CI:35 %,51 %) followed guidelines on the second and 41(26.5 %; 95% CI:20 %,33 %) followed guidelines for both. Specialist Professional status (χ24= 10.76;p = 0.03) and more frequent use of daylight (χ2 lin = 6.09;p = 0.01) were both predictive of good practice. Qualitative data analyses revealed several themes: a) the time shade was taken, b) light source used, c) shades for different aspects of the tooth, d) dental care professional (DCP) opinion, and e) photographic support. CONCLUSION: This study demonstrated that dentists needed to improve their shade taking techniques. A quarter of respondents consistently followed evidence-based good practice guidelines; the remaining three quarters undertook shade taking with a degree of chance and possibly guesswork, potentially generating errors in communication with dental laboratories, resulting in sub-optimal clinical outcomes. Appropriate training needs to be incorporated in the relevant dental curricula. This study highlighted the importance of compiling accurate and detailed laboratory prescriptions in relation to the shade of the restorations to be fabricated.

Patient perceptions of healthy weight promotion in dental settings.

INTRODUCTION: Excess weight is a risk factor for systemic and oral diseases. Since dental professionals are already involved in imparting overall health messages when certain conditions impact oral health, it should make sense that they also deliver related health messages such as promoting the maintenance of healthy weight for patients. OBJECTIVES: This study evaluated the perceptions of adult patients attending private dental clinics on healthy weight promotion by dental professionals. METHODS: A cross-sectional multicenter survey was designed and set in four private dental clinics (London/Hampshire) between April and July 2015. All eligible patients (≥ 18 years) completed a questionnaire. Body Mass Index (BMI; kg/m2) was calculated from height and weight measurements. Questionnaire content was centred on patient perceptions of 6 domains with the primary domain as to whether patients would accept healthy weight promotion by dental professionals. RESULTS: 213 adults (aged 20-85 years) participated in this study and 58.2% were females. Although the overwhelming majority endorsed healthy weight promotion by the dental team, the overweight/obese were significantly more sensitive (BMI screening χ2 trend = 6.840, p = 0.009; healthy weight information χ2 trend = 6.231, p = 0.013). Awareness of risk of periodontitis, carcinoma and overall adverse health outcomes associated with overweight or obesity was low. CONCLUSION: The study cohort was well primed for healthy weight advice. Routine healthy weight promotion and BMI screening should be considered in the private dental clinic settings. CLINICAL SIGNIFICANCE: This is an opportunity to collaborate with other health care professionals to support overall health monitoring/advice; a common risk factor strategy as recommended by the WHO. Future research is merited for this new initiative particularly perceptions of: dental teams' on healthy weight management, longitudinal interventions, NHS, children/parents and separate obese groups.

An investigation of complete denture teaching in the UK: part 2. The DF1 experience.

AIM: This paper, the second in a series of two (see 2013; 215: 177-181), investigates the opinions of a cohort of dental foundation year 1 (DF1) practitioners regarding their skills and competence in relation to their educational background in complete dentures. MATERIALS AND METHODS: With the permission of the Dean of the London Deanery a questionnaire was emailed to the ten London Foundation year 1 training schemes for distribution to approximately 100 DF1s. Five schemes responded with total of 56 completed questionnaires (56%). RESULTS: The average number of complete dentures made as undergraduates was three. Forty-six percent had no experience in making copy dentures. An average of 2 (median 2.05) immediate replacement dentures were made; only 10% made 8-15 dentures. None had experience in implant-supported dentures. Thirty-five percent enjoyed their undergraduate training whereas 45% did not. Thirty-seven percent felt that their training had given them experience and confidence in complete dentures but 32% were of the opposite opinion. Sixty-three percent felt complete dentures were an important or very important aspect of dentistry. Six percent completely disagreed. The majority were confident in making impressions while 39% lacked confidence in registering jaw relations. Thirty-five percent were confident with chairside adjustments at the intermediary treatment stages but 28% were not. Sixty-three percent were confident in the fitting of new dentures and 64% with the after-care. There was no significant gender difference in the responses. There was a significant difference between the London and non-London trained DF1s. The London trained respondents made significantly fewer dentures than the non-London trained cohort. The latter also rated complete denture treatment as being more important. The comments section revealed that 43% felt that they had a lack of experience; only 5% were confident, 16% thought that complete denture treatment would become obsolete and only 5% recognised the continuing importance of complete denture treatment. CONCLUSION: There is a disparity between the comments which indicate a lack of confidence in complete denture treatment and the response to the questionnaire. Other authors have commented on the lack of experience that has resulted in new graduates entering vocational training with little confidence in complete denture techniques. This report has highlighted these difficulties with respect to a current cohort of DF1s.

An investigation of complete denture teaching in the UK: part 1. A survey of undergraduate teaching.

AIM: This paper is the first in a series of two that investigate the undergraduate teaching of complete dentures in the UK. MATERIALS AND METHODS: A questionnaire was sent by email to 13 UK dental schools enquiring about the number of hours spent in the lecture theatre, laboratory and clinic. The schools were also asked to give their views about the preparedness of the new graduates for dealing with complete dentures in general practice. RESULTS: There was great disparity between schools in the overall number of lectures delivered. Two schools claimed 28 hours and the remainder varied between 6-15 hours. Four schools devoted more time to laboratory work whereas three schools spent more time in the clinic. One school reported no dedicated clinical time for complete dentures. There appears to be a regional variation with northern UK dental schools spending more time on the teaching of complete dentures. The quota for complete dentures varied from three in most schools to eight in one school and none in another. Comments from the dental schools varied from a reported lack of suitable complete denture cases, to concerns with insufficient curricular time devoted to the subject and a subsequent lack of clinical competence on graduation. Some schools have integrated complete denture teaching into the general prosthodontic course as it is considered inappropriate to teach different aspects of prosthetics in isolation. CONCLUSION: Competence in complete dentures falls short of what is expected. With a single exception all the schools seem to have low expectations for their undergraduate students to be practically trained and experienced in the production of complete dentures. Despite the advent of implants and the introduction of clinical dental technicians, there is and will continue to be a need for the competent treatment of the edentulous population by general practitioners.

BDJ UCL Eastman CPD programme: an online survey.

OBJECTIVE: To ascertain from participants of the BDJ UCL Eastman CPD programme its value to their professional endeavours, and in particular to determine whether they would object to making it more robust especially in the way that the CPD hours are achieved. DESIGN: An online questionnaire survey. METHOD: Participants were encouraged to complete an online survey of nine questions by 31 July 2012. RESULTS: Of the 3,292 participants who began the survey, it was completed by 3,070 (93.2%). Of those, 2,952 (91.1%) thought that additional learning tools would be helpful. The ability to resubmit incorrect answers was preferred by 2,549 (80.1%) of the respondents. Two thousand two hundred and fourteen participants (69.9%) raised no objection to making the scoring system more robust and 953 (30.1%) objections to this proposition were recorded. Ninety-eight percent (3,128) favoured the regular inclusion and flagging of core subjects and 95% of these respondents thought it would be useful to record these separately. The most preferred method of obtaining verifiable CPD was cited by 1,075 (39.5%) participants as reading journals followed by attending lectures and hands-on courses. The BDJ was the preferred journal to achieve both verifiable and general CPD. Most participants (1,930; 67.7%) use a home computer to take part in this initiative while a significant minority use tablets and smart-phones. CONCLUSION: This survey showed that the BDJ UCL Eastman CPD journal-based verifiable CPD programme remains a popular method of fulfilling the GDC regulations and that the majority of participants are in favour of making the process more rigorous.

Endodontic instrument fracture: causes and prevention.

Endodontic file fracture has traditionally been considered an uncommon event; however, a recent perception of increased fracture incidence with rotary nickel-titanium (NiTi) instruments has emerged. It is essential for the clinician to understand the likelihood of instrument fracture and the reasons for this unfortunate occurrence. Removal of fractured files is both technically difficult and time consuming and therefore it is of key importance to limit the probability of fracture. Over the last ten years, a range of NiTi alloy modifications have been made by instrument manufacturers, with varying reports of success, in an attempt to reduce the likelihood of file separation. The aim of this review was to investigate the incidence and aetiology of file fracture as well as analysing recommended prevention protocols. Additionally, the effectiveness of alloy modifications in reducing the incidence of file fracture was considered. Analysis demonstrated that the bulk of the literature relating to instrument fracture is in vitro evidence, which limits its clinical relevance. The reported incidence of NiTi instrument fracture is similar to stainless-steel (SS) files; however, inconsistent methodologies hamper accurate comparison. NiTi instruments are reported to fail by torsional overload and/or flexural fatigue, with file fracture occurring principally in the apical third of the canal or with inappropriate use. Finally, operator skill, manufacturer modifications and limiting file reuse have been demonstrated to be significant in reducing fracture incidence indicating the importance of a prevention strategy.

Clinical decision-making after endodontic instrument fracture.

When a file fractures during root canal treatment there are several treatment options available to the clinician. The definitive management should be based on a thorough knowledge of the success rates of each treatment option, balanced against potential risks of removal or file retention. Although integration of modern techniques into endodontic practice has improved the clinician's ability to remove fractured files, removal may not always be possible or even desirable. The aim of the third and final review in this series was to analyse the literature with regard to the management of fractured files. Analysis of the literature demonstrated that the presence of a fractured instrument need not reduce the prognosis if the case is well treated and there is no evidence of apical disease. Therefore, in cases without apical disease removal of the file may not be necessary and retention or bypass should be considered. If apical disease is present, file fracture significantly reduces prognosis indicating a greater need to attempt file removal or bypass. A plethora of different methods have been employed to remove fractured instruments and although successful, these techniques usually require the use of the operating microscope and specialist care. Removal of a fractured file is not without considerable risk, particularly in the apical regions of the root canal, therefore, leaving the fragment in situ should be considered if referral is not possible. Finally, it is imperative that the patient is informed (accompanied by appropriate record keeping) if instrument fracture occurs during treatment or if a fractured file is discovered during a routine radiographic examination.

The impact of fractured endodontic instruments on treatment outcome.

Instrument fracture complicates the endodontic procedure by obstructing debridement, delaying treatment completion and affecting the patient's dental experience. When a file fractures there are several treatment options that could be selected, however, the future management should be based on the effect of the fractured instrument on treatment outcome. The aim of the following review was to analyse the literature assessing the impact of endodontic instrument fracture, focusing on its influence on endodontic prognosis and treatment outcome. A comprehensive MEDLINE search including various keywords identified several publications that considered the variables. Analysis of the publications highlighted a paucity of quality long-term clinical outcome studies relating specifically to the influence of instrument fracture. The available studies demonstrated a wide variety of methodologies reporting conflicting findings; therefore, meaningful conclusions were difficult. Within the confines of the literature it appears that retained fractured instruments do not reduce the prognosis of endodontically treated teeth if apical periodontitis is absent, however, if disease is present healing is significantly reduced. Therefore, the stage at which an instrument fractures in infected cases appears likely to be significant as canal disinfection will be compromised accordingly. Considering the risks associated with file removal, perhaps this should only be attempted if apical disease is present. Although it is accepted that the nature of file fracture precludes integration into randomised prospective trials, there is a need for well designed long-term outcome studies investigating the influence of fractured files.

Color correspondence of different batches of TriLuxe CAD/CAM ceramic blocks.

TriLuxe ceramic blocks for chairside CAD/CAM procedures are color layered to allow natural esthetics, and only require subsequent glazing. The purpose of this study was to compare color repeatability of different batches of TriLuxe blocks. The three commercially available shades (1M2C, 2M2C, 3M2C) of TriLuxe blocks for the Cerec CAD/CAM system were examined. For each of the three colors, three different batches were tested, 5 blocks each. The measurements were made using a spectrophotometer equipped with an integrating sphere using the CIELab* colorimetric system. One-way ANOVA showed that the factor "Production Batch" was not statistically significant. Regarding deltaE, none of the 315 color comparisons (neither within the same shade, nor between specimens of the same batch, nor between specimens from different batches) exceeded the proposed deltaE = 3.3 threshold for clinical acceptability. All the different batches of the different shades of VITA TriLuxe blocks for the Cerec system showed the high degree of color correspondence necessary in industrially prefabricated CAD/CAM blocks.

An in vitro comparison of tooth whitening techniques on natural tooth colour.

OBJECTIVE: Tooth whitening has become a popular treatment regime but there is little quantitative evidence to compare techniques and so confusion may exist for the clinician as to which regime to prescribe for greatest efficacy. The aim of this study was to compare immediate and longer-term colour change on natural tooth colour in vitro, using five current tooth whitening techniques with blind matched control groups. METHODS: A total of 100 human teeth of matched size were cleaned, stored in sterile deionised water at 4 degrees C then randomly allocated to one of the five active treatment groups or five matched control groups. The active treatments were: 10% carbamide peroxide (CP) x 60 min, 35% CP x 30 min or 35% hydrogen peroxide (HP) treatment x 30 min activated by one of three sources of energy (diode laser, halogen light, and plasma arc curing light). Tooth colour was analysed with a colorimeter before and after treatment: immediate, one week and nine months post-bleaching designed to generate tooth colour value (L(*)) according to the L(*)a(*)b system. The change in colour was determined as DeltaL (the difference in the value of the colour) for each tooth, then the mean differences were obtained for each group and compared. Tooth surface temperature was monitored. RESULTS: Comparing active treatments with controls it was found that 10% CP, 35% CP, 35% HP with halogen provided significantly greater tooth whitening. Comparing the different treatments showed that 10% CP was significantly more effective (P <0.05) than all other treatments except 35% HP with halogen activation. The effect of each treatment regime over time showed that the 10% CP gave a significant gain immediately and one week later (P <0.05), however, all the whitening effects were lost over time following these single treatments. The temperature rise on the tooth surface was greatest when using laser activation during power whitening. CONCLUSION: This study suggests that 10% CP is an effective technique for tooth whitening and can offer significant benefits over alternative regimes.

Going interactive: six strategies to meet the challenge of teaching electrosurgery to general dental practitioners.

Mandatory continuing professional development has resulted in a recent expansion in postgraduate dental teaching. One popular type of teaching is the practical 'hands-on' course that combines the explanation of theory with the acquisition of practical skills in small groups. The challenge to dental teachers is to provide the best level of teaching on these courses where the course participants bring varied expectations and different levels of knowledge, skill or interest. This paper presents a new teaching model that has been developed for the postgraduate teaching of Electrosurgery. The key components of this course include an interactive theory lecture using multimedia, followed by hands-on practical teaching. The emphasis throughout is on the use of facilitation and group learning rather than traditional didactic teaching. A series of strategies for the effective delivery of such a hands-on course together with evaluation of findings from 31 courses are considered.

The role of gingival mechanoreceptors in the reflex control of human jaw-closing muscles.

Electromyographic (EMG) experiments were undertaken to investigate the jaw reflexes evoked by activation of gingival receptors in 12 humans. EMG recordings were made from an active masseter muscle whilst ramp-plateau mechanical stimuli were applied to the gingiva. Stimuli with a constant rate of rise (0.2 N/msec) and a variable plateau force (up to 2 N), evoked a complex set of short- and long-latency inhibitory and excitatory responses. These occurred as a sequence of inhibition-excitation-inhibition-excitation, although not all of these elements were seen on every occasion. The median thresholds of these four responses ranged from 0.5 to 1 N but overall there were no significant differences between them (p > 0.05, Friedman's ANOVA). In other experiments, the same reflexes were recorded in response to application to the gingiva of 1 N ramp-plateau stimuli (5 msec rise time) and 1 N tap stimuli applied to the adjacent tooth. The application of a local anaesthetic agent to the stimulated gingiva produced reductions in the mean magnitude of almost all the responses but these were significant (p < 0.05; ANOVA) only for the long-latency inhibitions evoked by ramping the gingiva and the long-latency excitations evoked by either stimulus. It is concluded that mechanoreceptors in the gingiva can mediate long-latency inhibitory and excitatory jaw reflexes, and that these receptors may also contribute to long-latency reflexes evoked by tapping teeth. The scarcity of effects of gingival anaesthesia on the short-latency reflexes may be due to such responses being mediated by receptors deeper in the periodontium.

The roles of periodontal ligament mechanoreceptors in the reflex control of human jaw-closing muscles.

Controlled mechanical stimuli were applied to an upper central incisor tooth in 19 human subjects and the resulting reflexes in the ipsilateral masseter muscle were examined electromyographically. In most cases the force profile of the stimuli consisted of a ramp leading to a sustained plateau at an intensity of 1 N. In addition 1 N tap stimuli were employed in some subjects. The 1 N ramp stimuli with a rise time of < or = 20 ms consistently evoked a single, short-latency (approximately 12 ms), inhibitory reflex which was often followed by an excitatory wave. The ramp stimuli with shorter rise times produced larger responses than those produced by ramp stimuli with longer rise times. By contrast the tap stimuli elicited a sequence of responses consisting of inhibitory-excitatory-inhibitory-excitatory components. The first inhibitory and excitatory responses evoked by tap stimuli had latencies similar to those of the responses evoked by the ramp stimuli. The latencies of the inhibitory responses evoked by 1 N ramps with rise times ranging between 2.5 and 20 ms did not vary significantly with the rise time. Consistent with this observation it was found that the median threshold force for evoking the short-latency inhibitory reflex was only 0.25 N. This was significantly less than the threshold for the excitatory response (median: 0.75 N). The responses to ramp-plateau forces were not dependent on the level of preloading of the tooth (at least within the range tested: < 0.25 to 1 N). These findings provide evidence that mechanoreceptors in the periodontal ligament contribute to the control of human jaw-closing muscles, notably to short-latency reflex responses. It may be concluded that the additional reflex responses produced by tapping stimuli result from the activation of receptors elsewhere due to vibration.