Stomatology and odontology: perspectives of Spanish professors and senior lecturers in dentistry.

The curricula of dental faculties in many countries of the European Union can be described as odontological. The faculties of some of the countries who have become and are becoming members of the European Community have traditionally educated dentists in the stomatological tradition. In 1987, the Spanish dental education system initiated movement from the stomatological model to the odontological. Both models have their respective strengths and weaknesses. This study surveyed professors and senior lecturers in Spain's public dental faculties to assess their perspectives on 10 items related to the tension between the odontological and the stomatological approach to preparing dentists. Amongst other things, the results of the study indicate that the respondents believe the odontological model, with its emphasis on strengthening technical qualifications, may not prepare individuals for dental practice better than the stomatology tradition; and that the odontological model results in the loss of the strength of the stomatological model, that is, the strong foundation in clinical medicine. The suggestion is advanced that European dental educators consider revising the odontology curriculum to strengthen the education of dental students in clinical medicine. A curriculum in which dental and medical students share the first 3 years of study could accomplish this. It is further suggested that subsequent years in the curriculum be flexible enough for students to earn degrees in both dentistry and medicine, if desired. Such an approach is not inconsistent with the accepted profile and competencies of the European dentist.

Hypertension in polycystic kidney disease without renal failure.

Hypertension occurring in patients with adult polycystic kidney disease (PKD) without substantially decreased glomerular filtration rate (GFRs) has not been sufficiently evaluated. Seven patients with bilateral PKD and serum creatinine clearances greater than 70 ml/min were studied to examine the roles of sodium retention and the renin-angiotensin system in their hypertension. These individuals demonstrated evidence of volume expansion and sodium-dependent hypertension. However, the renin-angiotensin system was not consistently depressed as a consequence, and two of the seven had significantly increased plasma renin activity values. It seems that patients with PKD who had normal GFRs retain rather than waste sodium and may become hypertensive. The contribution of the renin-angiotensin system is variable and seems to be a function of such factors as symmetry of the cystic involvement and the degree of intravascular volume expansion.

Diabetic glomerulosclerosis without glucose intolerance.

The pathophysiology of the microangiopathy of diabetes mellitus is poorly understood, and the relevance of carbohydrate intolerance remains uncertain. Four patients are presented with renal abnormalities suggestive of diffuse diabetic glomeruloscierosis. These patients have no evidence of carbohydrate intolerance by standard clinical technics. A familial incidence of diabetes mellitus and delayed insulin response to an oral glucose load support a classification of prediabetes or suspected diabetes mellitus for these patients. Early intercapillary nodule formation was seen in only two of the four patients. In the absence of this infrequent pathognomonic finding, an alternate approach to the diagnosis of diabetic glomerulosclerosis is suggested. Diffuse glomerular capillary basement membrane thickening, consistently present with diabetic glomerulosclerosis, is demonstrated by measurements utilizing the latex microsphere technic. The mean glomerular capillary basement membrane thickness of these patients was 4,403 A, compared with the control value of 3.098 A (P less than 0.001). Other pathologic findings suggestive of diabetic nephropathy include efferent arteriolosclerosis and linear immunofluorescence without electron dense deposits or inflammation. Skeletal muscle capillary basement membranes of all four patients also demonstrated significant thickening. The mean value for the patients was 1,510 A, as compared with a control value of 961 A (P less than 0.001). The importance of this muscle capillary basement membrane thickening to the diagnosis of diabetic microangiopathy is discussed. The pathologic alterations in the renal biopsy specimens and the demonstration of muscle capillary basement membrane thickening strongly suggest that diabetic glomerulosclerosis may occur in the absence of overt clinical carbohydrate intolerance.

Unilateral essential hematuria. Therapy with epsilon aminocaproic acid.

A case of severe, unilateral essential hematuria was managed with epsilon aminocaproic acid. An extended remission of the hematuria was achieved with 24 Gm given orally in four divided doses daily, maintained for two weeks, then tapered by 2 Gm per day. The risks reported with this therapy are considered.

A pragmatic primer ... lessons from natural science for the profession of dentistry.

Artificially supplementing our community water supplies with optimal amounts of fluoride to gain the benefits of a significant reduction in dental caries is a lesson we have learned from natural science, a lesson from nature we have appropriated for culture- and a very pragmatic lesson. Today, we have discovered through science additional principles of nature that can be instructive and that can be appropriated for the profession of dentistry's benefit. This paper reviews five principles of natural science and derives lessons for the profession from these principles. The principles include natural selection, environmental change, form follows function, symbiosis, and entropy. Lessons derived from these principles of natural science are, respectively: survival and thriving of the profession are dependent upon the environment; the status quo will not be maintained-the profession must acknowledge, encourage, and celebrate change; the form the profession assumes must be consistent with its function of serving society; the profession must acknowledge the interdependence and reciprocity existing in its relationship with society; and the profession must continuously, energetically, and creatively reconstruct and renew itself. The challenge before us is to transform dentistry into a profession that continuously anticipates environmental changes by energetically creating new forms or structures that will result in more effective fulfillment of our function: gaining the benefits of oral health for society.

Professional ethics and esthetic dentistry.

Esthetic dentistry has assumed an integral position in the provision of oral health care for society. Esthetics is a branch of philosophy dealing with beauty. Beauty is both enjoyable (subjective and cosmetic), and admirable (objective and definable). Ethics is a branch of philosophy dealing with morality. Morality relates humans to one another in a responsible way using rationality. Dentists assume unique moral duties in presenting themselves to society as being uniquely qualified to care for their oral health. Three principles of ethics relate directly to professional duties in esthetic dentistry: beneficence, autonomy, and justice. These principles have moral force in committing dentists to gain informed consent and to execute therapy in keeping with professional standards of care. Practical application of issues deriving from esthetics and ethics suggests that dentists must be sensitive to esthetics in their diagnosis and treatment planning and that a structured, formal consultation with a patient must be conducted to educate the patient regarding the goals of treatment, alternative therapies, prognosis, and costs. Only through such an effort can dentists gain informed consent. The goal of esthetic dentistry is the achievement of admirable (objective) and enjoyable (subjective) beauty, which is possible only through patient participation in decision making and excellence in technical performance.

Ethics in dentistry: review and critique of Principles of Ethics and Code of Professional Conduct.

This paper has reviewed an ethic for the profession of dental medicine, such an ethic being grounded in the classical characteristics of a profession. The Principles and Code of the ADA have been reviewed and critiqued. The following conclusions are drawn: The dental profession and the individual dentist have a duty to recognize the reciprocity of the relationship that exists with society, and the duty of covenantal fidelity. The dentist has a duty to conduct his or her professional life in accordance with the ethical principles rooted in the moral rules. These are the principles of beneficence: autonomy and justice, in both individual and societal contexts. The dentist has a duty to maintain his or her level of knowledge and skill current. The dentist has an obligation to participate in the professional community to help ensure just distribution of society's resources and to share the burden of professional self-regulation to the extent that such a privilege is granted by society. The current Principles and Code are helpful expressions of dentistry's professional obligations, but are deficient in: not speaking to reciprocity of relationship, the principle of self-determination, and not providing for societal participation in the covenant agreement.(ABSTRACT TRUNCATED AT 250 WORDS)

The nickel-chromium crown for restoring posterior primary teeth.

The differences between the recently marketed nickel-chromium crown and other crowns available for primary posterior teeth are compared. Indications for use of preformed crowns are reviewed and techniques of tooth preparation, crown adaptation, and cementation are described.

The use of contingent audiotaped material with pediatric dental patients.

Contingent reinforcement procedures such as those used in this study appear to be a practical and effective means of reducing uncooperative child behavior during dental treatment. The cost of the equipment is modest and, as the equipment can be operated by means of a foot pedal, contingent reinforcement procedures can be implemented without interfering with ongoing activities.

A profile of organizational characteristics of colleges of dentistry.

This study investigated the organizational characteristics of colleges of dentistry as perceived by their deans, associate deans, and department chairs. Likert's Profile of Organizational Characteristics is used to describe the administrative structures of the colleges on a continuum from exploitive/authoritative through benevolent/authoritative and consultative to participatory. In addition, administrators were asked to evaluate their colleges' effectiveness in adapting to an environment of change. The results indicate a relatively low level of participation in administration in contrast to a high desire for participation, and that administrators believe their colleges are only marginally effective in adapting to change.

Academic and disciplinary dismissal in dental education: the legal basis.

The courts have traditionally granted universities absolute discretion in determining whether a student has met the academic requirements of the institution and have not interfered in dismissals unless there was a clear indication that the action was arbitrary, capricious, or in bad faith. Recent court cases are cited that indicate that the courts are now beginning to require that students be informed of academic (including clinical) deficiencies and be provided the opportunity to correct the problem. When the dismissal is for disciplinary rather than academic reasons, more procedural due process is required. Although a formal judicial hearing is unnecessary, the dental administrator should be given an opportunity to hear both sides of the issue in considerable detail and the student should be given the essential elements of procedural due process of law.

Academic dismissal for clinical reasons: implications of the Horowitz case.

Dismissal of a student from the educational program of a school of dentistry has immeasurable impact on the student and results in considerable emotional trauma to the faculty and administration. The legalistic emphasis of today's society has resulted in an increasing amount of litigation subsequent to student dismissals. The U.S. Supreme Court's recent decision in the case of Ms. Charlotte Horowitz has provided helpful guidance regarding what is fair when considering student dismissal for clinical or academic reasons, or both. Inferences from this and related cases are drawn that can assist dental education administrators in developing sound dismissal procedures for the institutions they manage.

Dental education in the Netherlands.

Dental education varies throughout the world as a result of the unique circumstances and needs of each country. The dental educator can derive benefit by comparing and contrasting different systems. Dental education in the Netherlands is characterized in this paper by summarizing several of it components. Dental practice is reviewed and the development of dental education traced. The structure and functioning of a typical school of of dentistry is discussed as well as admissions, student finances, curriculum, and certification. In addition, postgraduate and auxilliary education are reviewed.

Instructional alternatives in pediatric dentistry.

In recent years several alternative instructional strategies have been recommended that were departures from traditional approaches. This paper describes several of these alternatives that have been adapted and applied to the curriculum in pediatric dentistry at West Virginia University. They include a systems approach to designing instruction, employment of single conceptual units of instruction, development of instructional objectives, use of audiovisual technology for conveying information, the opportunity for self-pacing, evaluation of students on a mastery model using a criterion-referenced system, and the opportunity for students to learn beyond mastery in programs of self-directed inquiry and contract grading. The methods used for implementing these strategies and the dynamics of their operation are discussed.

Distraction: its utilization and efficacy with children undergoing dental treatment.

We investigated the utilization and efficacy of distraction in reducing the anxious and disruptive behavior of 4 children undergoing dental treatment. During the distraction procedure, the children were shown a poster and told a story about it during dental treatment. They earned a prize if they attended to the poster and story and could correctly answer questions about them following each intervention visit. The children's disruptive behavior was assessed via direct observation, and results were analyzed within a multiple baseline design. The children exhibited high levels of anxious and disruptive behavior across baseline visits, regardless of the length of time in treatment or number of visits. Anxious and disruptive behavior decreased upon introduction of the intervention for all children. This was accompanied by the children meeting the criterion for correct answers on the distraction quiz. However, 2 of the children demonstrated an increase in their anxious and disruptive behavior across intervention visits. Results are discussed in terms of the need to evaluate treatment strategies that promote maintenance as well as initial changes.

"The profession of dentistry:" the University of Kentucky's curriculum in professional ethics.

Among the most important learning that occurs in our nation's colleges of dentistry is learning to be a professional. While knowledge, perceptual-motor skills, and problem-solving abilities are basic to becoming a dentist, helping aspiring colleagues to apply their newly developing skills with integrity must be a fundamental concern. Increasingly, we are realizing that the quality of health care depends as significantly on the character of the health professional as it does on the individual's knowledge and skills. Concern for character, virtue, and integrity is the domain of ethics. This paper advances a justification for including a curriculum in professional ethics in our dental educational programs. The professional ethics curriculum at the University of Kentucky, "The Profession of Dentistry," extends through all four years of the Doctor of Dental Medicine program. The paper describes the major goals pursued in the curriculum and outlines the content of each of the four, sixteen-clock-hour courses. Learning ethics experientially through living in a college community is reviewed in the context of the College of Dentistry's comprehensive Code of Professional Conduct and Academic Responsibility. An assumption of the curriculum is, if the professional relationship of dentistry with society is to be sustained, each new generation of dentists must understand the nature of the profession and the ethical obligations of becoming a member of the dental profession.