Integration of Basic-Clinical Sciences, PBL, CBL, and IPE in U.S. Dental Schools' Curricula and a Proposed Integrated Curriculum Model for the Future.

The integration of basic and clinical sciences in dental curricula enhances the application of basic science principles to clinical decision making and improves students' critical thinking. The aim of this study was to define the characteristics of U.S. dental schools' curricula with regard to level of course integration and degree of incorporation of problem-based and case-based learning. A second aim was to propose a dental curriculum that supports effective integration of courses and addresses some of the concerns facing academic dentistry. A survey was sent to 58 academic deans in U.S. dental schools. The survey included questions about integrating courses in the schools' curricula and major changes in curricular structure or teaching pedagogy that respondents anticipated in the immediate future. A total of 31 schools responded to the survey, for a 53.4% response rate. The results showed that three-quarters of the responding schools still teach basic and clinical sciences separately, although 61.3% reported having an integrated curriculum. Among the responding schools, 16 had a PBL component integrated into their curricula (two had integrated PBL in all courses and 14 used a hybrid PBL approach). Two schools had CBL integrated in all courses, and ten had CBL integrated in >75% of courses. Only slightly more than half agreed that their curricula foster students' thinking "outside the box." Faculty shortages and lack of protected time and resources were the most frequent reasons given for a lack of integrated courses. The integrated model proposed in this article has the potential to provide a low stress environment for students and to address important issues like faculty shortages.

Nasal Septal Deviation and Facial Skeletal Asymmetries.

During ontogeny, the nasal septum exerts a morphogenetic influence on the surrounding facial skeleton. While the influence of the septum is well established in long snouted animal models, its role in human facial growth is less clear. If the septum is a facial growth center in humans, we would predict that deviated septal growth would be associated with facial skeletal asymmetries. Using computed tomographic (CT) scans of n = 55 adult subjects, the purpose of this study was to test whether there is a correlation between septal deviation and facial asymmetries using three-dimensional (3D) geometric morphometric techniques. We calculated deviation as a percentage of septal volume relative to the volume of a modeled non-deviated septum. We then recorded skeletal landmarks representing the nasal, palatal, and lateral facial regions. Landmark data were superimposed using Procrustes analysis. First, we examined the correlation between nasal septal deviation and the overall magnitude of asymmetry. Next, we assessed whether there was a relationship between nasal septal deviation and more localized aspects of asymmetry using multivariate regression analysis. Our results indicate that while there was no correlation between septal deviation and the overall magnitude of asymmetry, septal deviation was associated with asymmetry primarily in the nasal floor and the palatal region. Septal deviation was unassociated with asymmetries in the lateral facial skeleton. Though we did not test the causal relationship between nasal septal deviation and facial asymmetry, our results suggest that the nasal septum may have an influence on patterns of adult facial form.

Match or non-Match: at the crossroads.

INTRODUCTION: The National Matching Service provides an ethical and unbiased selection process between residency programs and candidates. Currently, 51 of the 66 accredited orthodontic residency programs in the United States participate in the matching service for orthodontic programs (the Match), and 15 do not. Our purpose was to identify the factors that contribute to an orthodontic residency program's decision to participate in the Match program or to refrain from doing so. METHODS: A survey was sent to 64 orthodontic programs regarding their perception of the Match. A qualitative content analysis of the survey responses was conducted. Common recurring themes were identified. Simple descriptive statistics were used to summarize the data. RESULTS: Fifty-six programs responded to the survey. Survey content analysis showed 2 prevailing themes: orthodontic programs participate in the Match because they believe it is a fair process, or they refrain from participating so that they can pressure selected candidates to accept positions early. CONCLUSIONS: Participation in the Match benefits candidates, schools, and orthodontic education in general. Candidates can interview at multiple schools and rank their choices without the pressure of early acceptance. Orthodontic programs are forced to compete for strong candidates; this ultimately strengthens the education their residents receive. The Match can accommodate complex requirements of different programs, including allowing them to recruit a certain mix or a diversity of students. We concluded that all orthodontic residency programs in the United States should participate in the Match.

Evaluation of crown-root angulation of lateral incisors adjacent to palatally impacted canines.

BACKGROUND: The objective of this study is to explore differences in crown-to-root angulation between lateral incisors adjacent to palatally impacted canines (PICs) and lateral incisors adjacent to normally erupted canines (NECs). METHODS: Orthodontic records of 100 subjects (51 with PICs and 49 with NECs) were reviewed. Crown-to-root angulations of all lateral incisors were measured manually on the final panoramic radiographs. Also, three experienced orthodontists were asked to visually inspect the morphology of the lateral incisors on the panoramic radiographs. A mixed model was used to test the difference in crown-to-root angulation of the lateral incisor between the experimental and the control groups. The association between the examiners' observations and the presence of a canine impaction was assessed by means of a chi-square test. All analyses were performed at the 0.05 level of statistical significance. RESULTS: A significant (p = 0.009) difference of 2.3° in crown-to-root angulation was found between groups. Also, 66.7% of the lateral incisors that were identified as "abnormal" by the panel of orthodontists were adjacent to a PIC. A percentage of 65.2 of lateral incisors that were identified as "normal" were located adjacent to NECs. CONCLUSIONS: The root of lateral incisors adjacent to PICs is angulated more mesially compared to lateral incisors adjacent to NECs. In addition, clinicians are somewhat able to predict if a canine is palatally impacted by visually observing the crown-to-root angulation of the adjacent lateral incisor. Evaluating the crown-to-root angulation of a lateral incisor on a panoramic image might facilitate an early diagnosis of palatally impacted canines.

Do bib clips pose a cross-contamination risk at the dental clinic?

Although multiple-use dental napkin holders have a relatively low risk of transmitting infection, they do require disinfection between patients. This study sought to: 1) determine the presence of bacterial load on two types of clips of reusable bib chains after dental procedures at the Endodontics and Orthodontics clinics at Tufts University School of Dental Medicine; and 2) evaluate the effectiveness of disinfecting the clips. These specialty clinics represent a wide spectrum of patients, procedures, and appointment times. Bacterial load on the bib clips was determined immediately following dental treatments-both before and after their disinfection-during morning and afternoon sessions. The results revealed that, after treatments, there was a statistically significant difference when comparing the two clinics for bacterial burden on the clips. Furthermore, there was a statistically significant difference in bacterial load on the two types of clips. Disinfection of the bib clips was highly effective in both clinics. Clinically, the results suggest that due to the nature of the treatment, the demographic population, and the type of bib clips used, patients in different clinics may be exposed to varying bacterial concentrations on the bib clips, and thus to different possible cross-contamination risks. Future analyses will be performed to identify the bacterial species in samples from both pre- and post-disinfected clips, and to determine if they harbor disease-causing bacterial species that can pose a potential, yet undetermined risk for cross-contamination.

Hospital-based emergency department visits with oral candidiasis in the USA.

OBJECTIVES: The aim of this study was to determine the number of hospital Emergency Department (ED) visits with a diagnosis of oral candidiasis for the year 2007 in the USA and to identify the comorbid conditions associated with it. STUDY DESIGN: The Nationwide Emergency Department Sample (NEDS) for 2007 was employed in this study. Patients who visited the ED with a diagnosis of oral candidiasis were selected, and the estimates were projected to the national levels using the discharge weights. Presence of comorbid conditions in these patients was also determined. RESULTS: A total of 249,092 ED visits had oral candidiasis. Most of the patients belonged to the lower socioeconomic strata. Patients presented with a wide range of comorbid conditions and a large percentage of the patients were subsequently hospitalized after ED visits. CONCLUSIONS: A significant number of patients in the US visited the ED with oral candidiasis in the year 2007.

Hospital-based emergency department visits with herpetic gingivostomatitis in the United States.

OBJECTIVES: The objectives of this study were to determine the number of hospital emergency department (ED) visits with a diagnosis of herpetic gingivostomatitis (HGS) for 2007 in the United States and to identify the possible comorbid conditions associated with HGS. STUDY DESIGN: The Nationwide Emergency Department Sample for 2007 was used in this study. Patients who visited the ED with a diagnosis of HGS were selected. Estimates were projected to the national levels using the discharge weights. Presence of comorbid conditions in these patients was also analyzed. RESULTS: A total of 23,124 patients had ED visits and received the diagnosis of HGS. Most of the patients were young females and those belonging to the lower socioeconomic strata. All patients with HGS also presented with comorbid conditions. CONCLUSIONS: Physicians should be trained to diagnose, manage, and refer common dental emergencies. In the long term, improving access to dental care for these patients is crucial to managing this problem.

Beneficial dysregulation of the time course of inflammatory mediators in lipopolysaccharide-induced tumor necrosis factor alpha factor-deficient mice.

To begin to understand the surprising survival of macrophage-specific lipopolysaccharide-induced tumor necrosis factor alpha factor-deficient (macLITAF(-/-)) animals after a lethal dose of lipopolysaccharide (LPS), as reported earlier, the present follow-up study focuses on the role of LITAF in the regulation of inflammatory cytokines secreted in response to lethal or sublethal doses of LPS administered to wild-type (WT) and macLITAF(-/-) mice. A time course study of kinase expression in peritoneal macrophages revealed increased phosphorylation of prosurvival kinases Akt, Erk1/2, and ribosomal S6 kinase (RSK) in macLITAF(-/-) mice compared to that in WT mice (n = 8), confirming their role in LPS-mediated diseases. macLITAF(-/-) mice (n = 8) survived a lethal dose of LPS plus d-galactosamine (d-GalN), expressing lower serum levels of pro- and anti-inflammatory cytokines than the WT levels. To extend our knowledge on LPS-induced inflammatory events, an effective sublethal dose of LPS was administered to the animals (n = 14). WT animals exhibited an acute inflammatory response that decreased after 4 h. Interestingly, macLITAF(-/-) mice exhibited an initial delay in the secretion of proinflammatory cytokines that peaked after 8 h and reached WT levels after 18 h. Anti-inflammatory cytokine secretions were initially delayed but increased after 4 h and remained elevated compared to WT levels, even after 18 h. Our results demonstrate that LITAF deficiency in vivo affects cytokines other than TNF-alpha and influences the balance between the pro- and anti-inflammatory cytokines, which protects the animals from the deleterious effects of an LPS-induced inflammatory response, resulting in a beneficial host regulation of inflammatory cytokines and in enhanced survival. Therapeutic intervention aimed at reducing LITAF via kinase modulators may prove useful in preventing LPS-induced mortality.

Amelioration of emphysema in mice through lentiviral transduction of long-lived pulmonary alveolar macrophages.

Directed gene transfer into specific cell lineages in vivo is an attractive approach for both modulating gene expression and correcting inherited mutations such as emphysema caused by human alpha1 antitrypsin (hAAT) deficiency. However, somatic tissues are mainly comprised of heterogeneous, differentiated cell lineages that can be short lived and difficult to specifically transfect. Here, we describe an intratracheally instilled lentiviral system able to deliver genes selectively to as many as 70% of alveolar macrophages (AMs) in the mouse lung. Following a single in vivo lentiviral transduction, genetically tagged AMs persisted in lung alveoli and expressed transferred genes for the lifetime of the adult mouse. A prolonged macrophage lifespan, rather than precursor cell proliferation, accounted for the surprisingly sustained presence of transduced AMs. We utilized this long-lived population to achieve localized secretion of therapeutic levels of hAAT protein in lung epithelial lining fluid. In an established mouse model of emphysema, lentivirally delivered hAAT ameliorated the progression of emphysema, as evidenced by attenuation of increased lung compliance and alveolar size. After 24 weeks of sustained gene expression, no humoral or cellular immune responses to hAAT protein were detected. Our results challenge the dogma that AMs are short lived and suggest that these differentiated cells may be a possible target cell population for in vivo gene therapy applications, including the sustained correction of hAAT deficiency.

Novel regenerative strategies to enhance periodontal therapy outcome.

BACKGROUND: Chronic periodontitis is a widely prevalent inflammatory condition of the supporting tissues of the teeth and is characterized by loss of teeth with an associated risk of systemic complications. Regenerative therapies such as guided tissue and bone regeneration form an important armamentarium in periodontics with a high degree of outcome predictability in certain ideal clinical scenarios. OBJECTIVE/METHODS: This review elaborates novel tissue regenerative treatment modalities based on sound understanding of developmental biology, tissue engineering, inflammation and wound healing. We focus on the role of biological mediators such as growth factors, gene-based therapy, cell therapy and pro-resolution lipid mediators in the regeneration of lost bone or periodontium. RESULTS/CONCLUSIONS: These therapies have the potential to regenerate both periodontium and bone, aiding in the treatment of even clinically challenging cases.