Recession coverage using the modified coronally advanced tunnel and connective tissue graft with or without enamel matrix derivative: 5-year results of a randomised clinical trial.

OBJECTIVES: To evaluate the 5-year results of single and multiple recession type (RT) 1 and 2 (Miller I to III) recessions treated with the modified coronally advanced tunnel (MCAT) and connective tissue graft (CTG) with or without an enamel matrix derivative (EMD). The main outcome variable was the stability of obtained root coverage from 6 months to 5 years. MATERIALS AND METHODS: In 24 patients, both complete and mean root coverage (CRC and MRC) and gain of keratinised tissue (KT) were assessed at 6 months and 5 years after recession coverage by means of MCAT and CTG with or without EMD. Aesthetic outcomes after 5 years were evaluated using the root coverage aesthetic score (RES). RESULTS: At 5 years, 24 patients with a total of 43 recessions were evaluated. Eight patients (57.14%) of the test and 6 (60.0%) of the control group showed complete root coverage. MRC revealed no statistically significant differences between the two groups, with 73.87 ± 26.83% (test) and 75.04 ± 22.06% (control), respectively. KT increased from 1.14 ± 0.57 mm to 3.07 ± 2.27 mm in the test group and from 1.24 ± 0.92 mm to 3.02 ± 1.55 mm in the control group, respectively. CONCLUSION: Treatment of single and multiple RT 1 and 2 recessions by means of MCAT and CTG with or without EMD yielded comparable clinical improvements which could be maintained over a period of 5 years. The additional use of EMD did not influence the clinical outcomes. CLINICAL RELEVANCE: The use of MCAT + CTG yielded successful coverage of single and multiple RT 1 and 2 gingival recessions, while the additional application of EMD did not seem to influence the results.

Dental students' self-perceived communication skills for patient motivation.

AIMS: The aim of this study was to evaluate dental students' self-perceived communication skills for patient motivation over the course of their training. MATERIALS AND METHODS: Pre-clinical and clinical dental students at the University of Bern School of Dental Medicine were surveyed annually from 2008 to 2011 utilising a written questionnaire. Self-reported data were pooled from all classes per time-point in the curriculum. RESULTS: A total of 157 students were surveyed from five classes with an overall response rate of 94.8%. A total of 393 questionnaires were available for analysis. The self-perceived skill-sets for general patient care and patient communication were rated at the end of the first clinical year with mean Visual Analog Scale values of 75.0 ± 1.6 and 75.1 ± 1.5, respectively. During the second clinical year, the self-perceived skills increased in both patient care (82.5 ± 1.2, P = 0.0004) and patient communication (81.4 ± 1.4, P = 0.0034). The students rated their competence higher when providing oral hygiene instructions as opposed to motivating patients to quit tobacco use, modify their diet or employ stress-reduction strategies (P < 0.005). At the end of the pre-clinical year, 74.5% of the students expressed interest in receiving more extensive communication training (P < 0.004). CONCLUSIONS: Though dental students in this study demonstrated a steady increase in their level of comfort motivating patients to utilise oral hygiene instructions, they also expressed the desire for more motivational training early in their curriculum. Therefore, these results may indicate the need to enhance communications training in patient motivation on all behavioural aspects early in the dental curriculum.

The implementation of a tobacco dependence education curriculum in a Swiss Dental Hygiene School - an 8-year review.

OBJECTIVE: The aim of our investigation was to review the implementation of a comprehensive tobacco dependence education (TDE) curriculum at the Medi School of Dental Hygiene (MSDH), Bern, Switzerland, 2001-2008. METHODS: In 2001, new forms to record patients' tobacco use history and willingness to quit were created for all the MSDH patients. In 2002, a new theoretically based tobacco dependence treatment protocol was implemented into the MSDH curriculum. Students received instruction on how to provide brief tobacco use dependence interventions as well as maintain detailed records of patient tobacco use and cessation interventions for every smoker at all dental hygiene visits. RESULTS: In 2002, 17 lecture hours were added to the following subjects: pathology, periodontology, preventive dentistry, pharmacology and psychology. During the same time period, 2213 patients (56.9% women) have visited the MSDH. Smoking status was recorded in 85.7% of all the patients (30.2% smokers). Brief tobacco use interventions were recorded in 36.8% of all smokers while 7.6% of these have reported to quit smoking. CONCLUSIONS: Overall, the new TDE curriculum was successfully implemented and accepted by the MSDH faculty. Applications in the clinical practice, however, may still be improved to better identify smokers and increase initial and follow-up interventions potentially leading to higher quit rates.

Evaluation of a web-based application versus conventional instruction in the undergraduate curriculum of fixed prosthodontics.

AIMS: The present study aims to investigate the implications of web-based delivery of identical learning content for time efficiency and students' performance, as compared to conventional textbook resources. MATERIALS AND METHODS: Two cohorts of third year undergraduate dental students in 2003 (n = 35) and 2006 (n = 32) completed the study. Following a baseline pre-test, the students were divided into two groups and given 3 weeks for studying identical content using a web-based application (group A) or a conventional paper manuscript (group B). Post-test, end of semester examination and a final retention test were taken. Test scores and studying time was registered for both cohorts in 2003 and 2006. RESULTS: Group A and B knowledge gain was highly significant between the average per cent scores from pre-test, post-test and end of semester examination in both cohorts in 2003 and 2006 (P < 0.005). Group A spent 1.6× (2003) to 2.6× (2006) less time studying than group B. The average total studying time recorded for group B was 5.1 h using 6.2 learning sessions in 2003 and 3.5 h using 4.4 sessions in 2006. With group A, significantly less time was measured for studying through web-based content using an average of 2.5 h over 4.4 learning sessions in 2003 and 1.5 h added over three sessions in 2006. CONCLUSIONS: Web-based delivery of identical content results in less overall studying time as compared to textbook delivery. These results appear independent of the students' own preference of the learning medium.

Curriculum survey on tobacco education in European dental schools.

BACKGROUND AND AIM: Dental professionals need adequate education in tobacco use prevention and cessation skills. The aim of this study was to identify the level of integration of tobacco education in undergraduate curricula of European dental schools. METHOD: In 2009, a total of 197 European dental schools were identified through web-based searches. An e-mail survey, containing 20 questions, was sent to each head of school/director of education with up to five follow-up e-mails to non-responders. RESULTS: Dental schools from 21 European countries responded to the survey. The overall return rate was 68 out of 197 schools (35%). In 14 (21%) dental schools, the students were requested to be tobacco free, 14 (21%) asked their students to quit tobacco use and 21 (31%) offered students cessation assistance. All responding schools reported that patients were asked about their tobacco use; 59% by taking an oral history, 75% using a general medical history form and 10% using a specific tobacco use history form. A total of 34% of the schools referred smokers to an external counselling clinic, 13% referred to a telephone counselling, and dental students provided brief counselling in 11 schools (16%). Forty-five (67%) dental schools reported to have tobacco education implemented in their curriculum, of these 30 (67%) stated their tobacco curriculum was mandatory. Theoretical education on tobacco culture and its impact on oral health were implemented in 45 (66%) dental schools. However, only 18 (40%) schools have introduced practical skills training to their students. Dental schools assessed their students' theoretical knowledge (27%) and practical training (4%), respectively. CONCLUSION: Even though theoretical tobacco education appears to be acknowledged by many European dental schools, further practical training of undergraduate dental students in tobacco prevention and cessation skills should be encouraged.

Saliva/pathogen biomarker signatures and periodontal disease progression.

The purpose of this study was to determine the role of saliva-derived biomarkers and periodontal pathogens during periodontal disease progression (PDP). One hundred human participants were recruited into a 12-month investigation. They were seen bi-monthly for saliva and clinical measures and bi-annually for subtraction radiography, serum and plaque biofilm assessments. Saliva and serum were analyzed with protein arrays for 14 pro-inflammatory and bone turnover markers, while qPCR was used for detection of biofilm. A hierarchical clustering algorithm was used to group study participants based on clinical, microbiological, salivary/serum biomarkers, and PDP. Eighty-three individuals completed the six-month monitoring phase, with 39 [corrected] exhibiting PDP, while 44 [corrected] demonstrated stability. Participants assembled into three clusters based on periodontal pathogens, serum and salivary biomarkers. Cluster 1 members displayed high salivary biomarkers and biofilm; 71% [corrected] of these individuals were undergoing PDP. Cluster 2 members displayed low biofilm and biomarker levels; 76% [corrected] of these individuals were stable. Cluster 3 members were not discriminated by PDP status; however, cluster stratification followed groups 1 and 2 based on thresholds of salivary biomarkers and biofilm pathogens. The association of cluster membership to PDP was highly significant (p < 0.0007). [corrected] The use of salivary and biofilm biomarkers offers potential for the identification of PDP or stability (ClinicalTrials.gov number, CT00277745).

Tobacco use cessation provided by dental hygienists.

Second to regular mechanical plaque control, tobacco use cessation has become the most important measure for the treatment of periodontal diseases. In contrast to general medical professionals, dental hygienists are seeing their patients regularly and are therefore available for supporting their patients to quit tobacco use. Tobacco use disease consists of both a physical addiction and a psychological dependence. Therefore, the combination of behaviour change support with pharmacotherapy is recommended for tobacco use cessation counselling. The use of brief motivational interviewing for tobacco use short interventions in the dental practice appears to be suitable. In addition to behavioural support, the use for nicotine replacement therapy is the treatment of choice for the dental practice. Following a critical review of the literature on this topic, a step by step approach for tobacco use cessation is presented for the dental hygienists to be implemented in their daily practice routine.