Use of silver diamine fluoride for the maintenance of dental prostheses in a high caries-risk patient: A medical management approach.

A technique for using silver diamine fluoride (SDF) as part of a regimen to help maintain dental prostheses in a patient with scleroderma and at high risk of caries is presented. Medically compromised, xerostomic, or elderly patients generally face greater risk of caries and specifically with prosthetic retainer teeth. SDF is a minimally invasive solution to this problem. A technique is described for using SDF to arrest and prevent new caries with the goal of maintaining fixed and removable prostheses and supporting teeth in a cost-effective manner.

Different labs.

In this case a young dentist has signed onto a managed care plan that has several attractive features. Eventually, however, he notices that he makes little or no net revenue for some of the work that he does. A colleague recommends that he use different labs for different patients, with labs matched to each patient's dental plan and coverage. Offshore labs are used for managed care patients. Three knowledgeable experts comment on the case, two with many years of private practice experience, two who are dental educators holding master's degrees in philosophy and bioethics.

Effects of clinical experience and explorer type on judged crown margin acceptability.

PURPOSE: This study was undertaken to simultaneously compare instrumentation type and operator characteristics in judgments of clinical acceptability of crowns exhibiting a controlled range of marginal gaps. The research was conducted in a laboratory setting and generalizability analysis was used as a statistical technique to identify the sources contributing to variation in the judgment outcome. MATERIALS AND METHODS: A crown was seated on an ivorine tooth in a device that permitted continuous adjustment in intervals of 25 mum to produce known marginal gaps ranging from zero to 250 microm. Forty-nine students and six faculty members used five types of explorers each to determine, by tactile examination, the point on the controlled increasing marginal gap where they would no longer regard the gap as clinically acceptable. RESULTS: There were no differences across type of explorer. Operators with clinical experience had a threshold that rejected crowns at a smaller gap than did those operators without clinical experience (p= 0.007). Faculty members maintained a higher individual degree of consistency in their personal judgments than did students (p= 0.02); however, the inter-operator consistency was significantly lower for faculty members than for students (p < 0.05). CONCLUSIONS: Differences among operators in a simulation of the decision regarding gaps in crowns accounted for 63% of the variance; type of explorer used in assisting this decision accounted for about half as much variance. Faculty members making such judgments exhibited high intra-operator consistency but significantly lower inter-operator consistency than did students. The study suggests that the internal standards dentists use for clinical decision making deserves further study as they may be as significant as the equipment used.

The dental patient who is "high:" ethical and scientific recommendations for the standard of care.

Patients sometimes appear for dental appointments after consuming alcohol or marijuana. There is presently no consensus standard of care in this area, and dentists vary in their responses to such patients. This paper includes interviews with practitioners and a review of the relevant biochemical and physiological science. The ethics of various ways to handle this challenging situation are examined, and evidence-based recommendations for dental practice are offered. While there is reason for caution, the authors conclude that a blanket "do not treat" policy is unwarranted. Informed consent and transportation safety issues pose significant moral challenges when a dental patient is "high."

Fabrication of a caliper device for interalveolar dimension measurement in the complete denture patient.

A method is presented for measuring interalveolar dimension (IAD) of existing dentures using a caliper. Directions for construction of an IAD gauge are included. This device is easy to construct and "zeroes out" in the closed position. The measurement is useful for determining occlusal vertical dimension (OVD) in new dentures and for monitoring changes over time. Its dimension is entered in the patient record for future reference.

The Controlled Palatal Harvest (CPH) Technique for Harvesting a Palatal Subepithelial Connective Tissue Graft.

The use of methamphetamines is a significant public health concern not only in America but worldwide. The consequences of this drug's use are widespread, having major physiologic and psychological effects that are damaging to users' bodies and well-being. Meth use wreaks havoc on one's oral health, with the effects including demineralization of tooth surfaces, carious lesions, inflammation of the periodontium, and more. In addition to examining the neurotoxic effects that methamphetamines have on the brain, this article will discuss how dental professionals can approach treatment of individuals who are affected by this debilitating drug, utilizing a strategy that combines caries arrest with oral hygiene improvement and disease prevention. It will also review the use of various products to help establish a neutral oral pH and enhance enamel remineralization.

Addressing problems in complete dentures.

The authors have compiled a set of solutions to the most common issues influencing the success of complete denture cases. A brief review and discussion of occlusal vertical dimension is presented, followed by a troubleshooting guide to problems such as inadequate retention and stability, discomfort, and other problems affecting treatment outcome.

A simplified method for fabrication of new complete dentures.

This article discusses a simple technique for fabricating a new set of complete dentures when there is a reasonable existing upper and lower denture pair. This method reduces the number of appointments needed, and may be very helpful in treating patients with transportation difficulties, especially when the dentist is able to perform some simple laboratory procedures such as mounting the case on the articulator. The technique is well-suited for a "worn-out" set of complete dentures.

Teaching Skill Acquisition and Development in Dental Education.

Development of dental faculty members is paramount to providing outstanding education and role modeling for students. With the large number of second career educators in dental schools, an efficient method of acquiring teaching skills is important for new faculty members. Knowing the skill progression and learning experiences identified by dental educators of varying rank may lead to more efficient, effective faculty development. The aims of this study were to identify the perceptions of a group of faculty members about the knowledge, skills, attitudes, and learning experiences that contribute to developing teaching expertise and to compare and contrast the perceptions of new and more senior faculty members on these subjects. The Dreyfus skill acquisition continuum of novice to expert performance was used as a construct reference. The study used a mixed-methods approach in which qualitative and quantitative data were collected concurrently in an electronic survey of faculty members at one U.S. dental school. Of the 492 total faculty members, 80 survey responses were received, for a 16% response rate. Open coding and analysis of responses revealed some common themes. Building rich content knowledge and learning varied methodologies for teaching and assessment, supported by an awareness of peer role models, were perceived to be features of early growth. Content prioritization, clarity, and customization appropriate for the learner characterized mid growth. As theorized in the Dreyfus model, more experienced faculty members described a fluid, less structured teaching process, increased reflection, and appreciation of the strength of the educational community. The results of this study may help increase dental educators' understanding of teaching skill acquisition and inform faculty development and support.