Validity of the American Board of Orthodontics Discrepancy Index and the Peer Assessment Rating Index for comprehensive evaluation of malocclusion severity.

OBJECTIVES: To assess the validity of the American Board of Orthodontics Discrepancy Index (ABO-DI) and Peer Assessment Rating (PAR) Index in evaluating malocclusion severity in Chinese orthodontic patients. SETTING AND SAMPLE POPULATION: A stratified random sample of 120 orthodontic patients based on Angle classification was collected from six university orthodontic centres. MATERIAL AND METHODS: Sixty-nine orthodontists rated malocclusion severity on a five-point scale by assessing a full set of pre-treatment records for each case and listed reasons for their decision. Their judgement was then compared with ABO-DI and PAR scores determined by three calibrated examiners. RESULTS: Excellent interexaminer reliability of clinician judgement, ABO-DI and PAR index was demonstrated by the Intraclass Correlation Coefficient (rho= 0.995, 0.990 and 0.964, respectively). Both the ABO-DI and US-PAR index showed good correlation with clinician judgement (r=.700 and r=.707, respectively). There was variability among the different Angle classifications: the ABO-DI showed the highest correlation with clinician judgement in Class II patients (r=.780), whereas the US-PAR index showed the highest correlation with clinician judgement in Class III patients (r=.710). Both indices demonstrated the lowest correlations with clinician judgement in Class I patients. CONCLUSION: With strong interexaminer agreement, the panel consensus was used for validating the ABO-DI and US-PAR index for malocclusion severity. Overall, the ABO-DI and US-PAR index were reliable for measuring malocclusion severity with significantly variable weightings for different Angle classifications. Further modification of the indices for different Angle classification may be indicated.

Can performance on summative evaluation of wax-added dental anatomy projects be better predicted from the combination of supervised and unsupervised practice than from supervised practice alone?

PURPOSE: The study explored the effects of adding student-directed projects in pre-clinical dental anatomy laboratory on improving the predictability of students' eventual performance on summative evaluation exercises, given the presence of intervening faculty-controlled, in-class practice. METHOD: All students from four consecutive classes (n = 555) completed wax-added home projects (HP), spending as much or as little time as desired and receiving no faculty feedback; followed by similar laboratory projects (LP) with time limits and feedback; and then summative practical projects (PP) in a timed format but without faculty feedback. Path analysis was used to assess if the student-directed HP had any effect over and above the laboratory projects. RESULTS: Average scores were HP = 0.785 (SD = 0.089); LP = 0.736 (SD = 0.092); and PP = 0.743 (SD = 0.108). Path analysis was applied to show the effects of including a student-controlled home practice exercise on summative exercise performance. HP contributed 57% direct effect and 37% mediated effect through the LP condition. CONCLUSION: Student-directed home practice provided a measureable improvement in ability to predict eventual performance in summative test cases over and above the predictive contribution of intervening faculty-controlled practice conditions.

Does our research tool kit equip us to make generalisable claims about dental education?

In this essay on the state of scholarship in dental education, I argue that we are best served by looking at the validity, generalisability and usefulness of claims rather than at the rigour of various research methods. All papers published in 2009 in the European Journal of Dental Education (a quarterly) and the Journal of Dental Education (published monthly), a quarterly journal of the Academy of Management, Learning & Education and the monthly American Journal of Orthodontics and Dentofacial Orthopedics were classified by the type of claim made, method by which evidence was collected and techniques of analysis. The dental education literature, compared with the two other journals, was largely focussed on surveys of opinion or particular practices and lacked scope in generalisability. The dental education literature was thin in use of randomisation, covariable analysis and theory-building.

Association amongst factors thought to be important by instructors in dental education and perceived effectiveness of these instructors by students.

It is hypothesised that dental educators have perceptions of their roles as effective teachers. It is expected that subject matter expertise would be amongst the components of such personal philosophies of education, but it is unclear whether faculty member self-perceptions carry over into student ratings of instructors' effectiveness. A 20-item survey of 'Teaching Characteristics' was completed by 86% of full-time and 64% of the part-time faculty members at the University of the Pacific. Respondents distributed 100 points amongst the descriptions of what makes an effective instructor. The responses were factor-analysed, resulting in four general faculty 'types' that explained about 50% of the variance in ratings: expert, enthusiast, judicial and good soldier. Student ratings for the 2 years running up to the date of the survey administration were used to gauge student perceptions of instructor effectiveness. Faculty members who placed emphasis on expertise as key to being a good instructor received significantly lower ratings for teacher effectiveness from students than did other faculty members. Faculty members who conceived their roles as motivating students, explaining difficult concepts, displaying interest in the subject, showing compassion and caring, and being proactive tended to receive high ratings for teaching effectiveness from students.

Crevicular fluid elastase levels in relation to periodontitis and metabolic control of diabetes.

The purpose of this study was to investigate the associations between gingival crevicular fluid (GCF) elastase levels, clinical measures of periodontal status, and metabolic control of diabetes in insulin dependent (type 1) diabetes (IDDM) and non-insulin dependent (type 2) diabetes (NIDDM) patients. Sixty patients were recruited from the Diabetes Center at the University of California in San Francisco. Thirty subjects were type 1 diabetics and 30 subjects were type 2 diabetics. Metabolic control was evaluated by glycosylatted hemoglobin (HbA1c) levels. Demographic information was obtained using a structured interview with the subjects. Clinical measurements and GCF samples were taken from the mesio-buccal surfaces of 2 premolars and 2 molars from the most diseased sextant. GCF elastase was determined by measurement of p-Nitroanalide resulting from hydrolysis of elastase specific peptide. Crevicular fluid elastase levels were significantly correlated with gingival index, bleeding index, probing depth and attachment level in both type 1 and type 2 diabetes groups (0.01

Longitudinal evaluation of GCF MMP-3 and TIMP-1 levels as prognostic factors for progression of periodontitis.

BACKGROUND: To determine whether matrix metalloproteinase-3 (MMP-3) and tissue inhibitor of metalloproteinases-1 (TIMP-1) in gingival crevicular fluid (GCF) could serve as prognostic factors for the progression of periodontitis, we monitored GCF MMP-3 and TIMP-1 and periodontal status of selected sites in 40 medically healthy subjects over a 6-month period. METHOD: Clinical measurements including gingival index (GI), plaque index, bleeding on probing, suppuration, probing depth (PD), attachment loss (AL), and GCF samples were taken from 2 healthy sites (including sites with gingival recession, GI=0 PD < or =3 mm; AL < or =2 mm) and 2 periodontitis sites (GI > or =1; PD > or =5 mm; AL > or =3 mm) of each patient at baseline, 3-month and 6-month visits by means of sterile paper strips. GCF levels of MMP-3 and TIMP-1 were determined by sandwich ELISA assays. RESULTS: The mean amounts of MMP-3 and TIMP-1 in diseased sites were significantly higher than in healthy sites (p<0.0001). Significantly higher GCF levels of MMP-3 and TIMP-1 were found at progressing sites than in nonprogressing periodontitis sites (0.001 or =2 mm loss of attachment during 6- month study period. GCF levels of MMP-3 were highly correlated with clinical measurements taken at baseline, 3-month and 6-month visits (p<0.001). TIMP-1 levels were only moderately correlated with probing depth and attachment level (p<0.01). Step-wise multiple regression analysis was performed to construct models for the prediction of probing depth and attachment loss increases. The most parsimonious regression models which had the best R2 values included the following variables and accounted for the indicated % of variability. The regression model for the prediction of probing depth increase included MMP-3, smoking pack-years, TIMP-1 and accounted for 53% of the variability. The best model for the prediction of attachment loss increase included MMP-3, smoking pack-years, age, TIMP-1 and explained 59% of the variability. CONCLUSION: These data indicate that sites with high GCF levels of MMP-3 and TIMP-1 are at significantly greater risk for progression of periodontitis.

A brief history of conflicting ideals in health care.

Three medical traditions were in conflict in fifth century B.C. Greece. The Aesculapian view was grounded in illness as a mystery and remedies based on authority. The Cnidian School emphasized early views of disease and science. The School of Cos, commonly associated with the name Hippocrates, was patient and practice based. The history of medicine is a complex intertwining of these traditions. Each developed its own epistemology--theory of how we come to know things and what basis is used to ground truth. These three traditions can be found in dentistry today. Even taken together, however, they fail to account for modern dental practice.

Red beads and funnels.

Dentists, like most managers, believe that unanticipated team results are evidence of poor performance on the part of employees. While this can be the case, it is much more likely that most variation is inherent in the system and is probably not under the control of staff. The dentist, as the manager, has full control and full responsibility for guaranteeing that the office runs effectively and for improving its operation.

The role of dentists in dentistry.

The extent to which dentists influence the outcomes of dental care, compared to the effects of dental technology or patient variation, has not been well studied. A review of the literature on the personality and value structures of dentists and dental students reveals general trends involving preferences of concrete, utilitarian, unambiguous, and conventional situations that are classified and judged in terms of their potential for dentists' power and control and for relationships of helping others but avoiding mutual dependency. These findings are summarized in a hypothesis that dentists seek situations where they can exercise control and establish paternalistic relationships with others. The evidence about career satisfaction of dentists is difficult to interpret. Between 20 percent and 50 percent of dentists report that they would not choose to enter the profession again if given a chance. Yet the number leaving the profession voluntarily is less than the number of career changers in the general population by a factor of about 1 to 15. Career satisfaction of practitioners can be partially predicted from an understanding of dentists' personality and values. Factors such as uncooperative patients, incompetent staff, and government and insurance intrusions are major dissatisfiers; they threaten dentists' core need for control. Factors such as quality of work, which is under the control of dentists, are major satisfiers. The personalities and values of dentists and the expression of these in professional norms may function to limit our understanding of dentistry. Based on this analysis, eight predictions are offered about the profession.

Preliminary evidence for a general competency hypothesis.

Although predoctoral dental education is generally taught and evaluated by disciplines, there is no evidence bearing on whether the competencies necessary to begin independent practice are learned and practiced as a general set of skills, understanding, and values or as groups of discipline-specific skills, understanding, and values, which together constitute graduation competency. There is some support in the literature for each view In this preliminary investigation, 64,000 faculty ratings of student clinical competency were analyzed in a Year x Quarter x Discipline x Model design. The dependent variable was predictive validity of graduation quarter competency ratings using R-values from four prediction models. Results of a multiple repeated measures ANOVA show that models based on technical skills other than the one being predicted, clinical judgment and patient management, and the combination of these two models all predict graduation competency in each of four disciplines better than do ratings in the disciplines being predicted. As the time gap between predictive and predicted competence decreases, predictions become more accurate, but an asymptote is reached by the middle of the final clinical year. By using general models to evaluate students rather than discipline-specific ones, students needing intervention and remediation and those who could benefit from enrichment experiences can be identified as accurately at the beginning of their clinical careers as they can near the graduation deadline. This study provides preliminary support for a general competency hypothesis and suggests that research is necessary to better understand how students and dentists learn and practice rather than how they are taught.

Technology innovation.

Technology is the way dentistry is practiced--the materials and methods, characteristics of the dentist and staff, and nature and values of patients. Innovation is a conscious process of improving that technology. Dentists, not researchers or manufacturers, are the source of most innovation in dentistry. Characteristics such a innate curiosity, sophistication, discretionary income, and practice isolation contribute to innovativeness. Innovation diffusion has a characteristic S-shape, with few early and late adopters and a rapid spread in the middle phase. Much is known regarding the personality and behavior of early and late adopters and those types of innovations that are likely to diffusion rapidly.

Emerging trends in professional development.

The shape of professional development in dentistry can better be guessed from imagining the emerging needs of practitioners than from the technology of education. Four predictions are offered: professional development is likely to involve a greater blend of learning and doing, customized to individual dentists, emphasizing value added rather than evaluation of dentists, and to be distributed in the sense that dentists will take their learning in smaller doses and at their own convenience.

Having your say.

Effectiveness in speaking at meetings is more a matter of fit with the emerging image the group has of itself than the persuasiveness of the speaker. In addition to rhetorical messages, people speak at meetings to confirm their right to membership, obtain or exercise status, achieve social goals, and provide or reinforce the structural and procedural needs of the group. Persuasive speeches should fit the flow of the meeting, state the desired result of the speech, and give a reason. Style points are also mentioned.