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INTRODUCTION: The purpose of this study was to evaluate the effects of 2 extraction patterns on incisor and molar movements in patients with growing Class II Division 1. METHODS: The sample included 54 patients 10-17 years of age treated by 2 private practice orthodontists using Tweed directional force mechanics, 4 premolar extractions, J-hook headgears, and Class II elastics or Saif springs. The sample was divided on the basis of having maxillary and mandibular first premolars (4/4) or maxillary first and mandibular second premolars (4/5) extracted. Each group included 27 patients. Treatment lasted 2.8 ± 0.60 years and 2.6 ± 0.54 years for the 4/4 and 4/5 groups, respectively. Pretreatment (T1) and posttreatment lateral cephalograms and dental casts were evaluated. Cranial base, mandibular, and maxillary superimpositions were performed to quantify tooth movements and displacements. RESULTS: There were no statistically significant T1 between-group differences in crowding or in the SNA, SNB, ANB, and MPA angles. Analyses of covariance, controlling for statistically significant (P <0.05) differences in T1 mandibular incisor position, showed that mandibular first premolars extractions produced greater (1.6 mm) mandibular incisor retraction than second premolar extractions. The mandibular first molars were protracted significantly more (0.7 mm) after the second premolar than the first premolar extractions. Within-group changes of the MPA, between-group differences in the changes in MPA, and the amount of vertical eruption of the maxillary and mandibular molars were not significantly different between the 2 extraction patterns. CONCLUSIONS: Extraction of mandibular second premolars enhances Class II molar correction, with greater mesial first molar movement and less distal incisor movement. Neither extraction pattern has an effect on the MPA or the vertical dimension (ie, there was no "wedge effect").
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Maloclusión Clase II de Angle , Mandíbula , Diente Premolar/cirugía , Cefalometría , Humanos , Maloclusión Clase II de Angle/terapia , Maxilar , Diente Molar , Extracción Dental , Técnicas de Movimiento DentalRESUMEN
PURPOSE: To compare the fracture resistance of implant-supported milled zirconia, milled lithium disilicate, and additively manufactured zirconia crowns. MATERIALS AND METHODS: Maxillary cast with a dental implant replacing right second bicuspid was obtained. Custom abutments and full-contour crowns for milled zirconia, milled lithium disilicate, and additively manufactured zirconia crowns (n = 10/group) were digitally designed and fabricated. The crowns were cemented to implant-supported zirconia abutments and mounted onto polyurethane blocks. Fracture resistance was determined by vertical force application using a universal testing machine at a crosshead speed of 2 mm/minute. Kruskal-Wallis test was used to analyze data and failure mode was determined for all the groups. RESULTS: Milled zirconia crowns demonstrated the highest median fracture resistance (1292 ± 189 N), followed by milled lithium disilicate (1289 ± 142 N) and additively manufactured zirconia (1243.5 ± 265.5 N) crowns. Statistical analysis showed no significant differences in fracture resistance between the groups (p = 0.4). All specimens fractured at the implant-abutment interface. CONCLUSION: Additively manufactured zirconia crowns demonstrated similar fracture resistance to milled ceramic crowns, when cemented to implant supported zirconia abutments. The results of this in vitro study signify the promising potential of additive manufacturing for the fabrication of all ceramic zirconia crowns.
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Coronas , Fracaso de la Restauración Dental , Cerámica , Diseño Asistido por Computadora , Pilares Dentales , Porcelana Dental , Análisis del Estrés Dental , Ensayo de Materiales , CirconioRESUMEN
Potential harm from ionizing radiation has led to the development of guidelines to protect patients and practitioners from unnecessary radiation exposure; however, these guidelines may or may not be followed in practice. This study surveyed US dental hygienists with regard to radiology policies in the workplace. The survey, consisting of 62 knowledge and practice items regarding use of dental radiography, was based on the 2012 publication by the American Dental Association (ADA) and the US Food and Drug Administration (FDA): Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure. The survey link was emailed to 10,000 subscribers of the Dimensions of Dental Hygiene magazine and posted on the magazine's Facebook page. Five hundred seventeen dental hygienists completed the survey. Data analysis included descriptive statistics, cross-tabulations, and chi-square analyses. Approximately 45.9% of respondents reported that the dentist determined the need for radiography, and 41.8% reported that the decision was made by the dental hygienist. The majority of respondents (82.4%) reported that there were times when a clinical examination was not performed before imaging, and 69.9% reported that images had been ordered on the basis of a set time interval. Approximately 35.6% reported that images had been requested on the basis of the patient's insurance reimbursement. For adult recall patients with no clinical caries and low caries risk, general and corporate dental practices made bitewing radiographs more frequently (every 12 months) compared with educational institutions (P < 0.05). In the case of children and adolescent recall patients without caries and with low caries risk, for children, corporate dental practices made bitewing radiographs more frequently (every 6 months) than educational institutions (P < 0.05); for adolescent patients, corporate and general dental practices preferred to make bitewing images every 12 months, whereas educational institutions preferred to make bitewing images every 18 months (P < 0.05). The findings suggest that some dental practices are not strictly following the ADA/FDA guidelines with regard to frequency of radiographic exposures.
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Higienistas Dentales , Odontología General , Radiografía Dental , Adolescente , Adulto , Niño , Caries Dental/diagnóstico por imagen , Humanos , Guías de Práctica Clínica como Asunto , Radiografía de Mordida Lateral , Encuestas y CuestionariosRESUMEN
PURPOSE: To measure and identify factors associated with treatment outcomes for patients with temporomandibular joint (TMJ) ankylosis treated with TMJ Concepts patient-fitted total joint prostheses and autogenous fat grafts. PATIENTS AND METHODS: This retrospective cohort study evaluated records of patients with TMJ ankylosis from a single private practice, treated from 1992 to 2011, who met the following inclusion criteria: 1) radiographic evidence of bony ankylosis, 2) limited incisal opening, 3) minimum of 12 months' follow-up, and 4) treatment with TMJ Concepts (Ventura, CA)/Techmedica (Camarillo, CA) total joint prostheses and fat grafts. For each patient, the number of previous TMJ surgical procedures, as well as the estimated age of ankylosis onset, age at surgery, and length of postoperative follow-up, was recorded. Subjective evaluations were made with Likert-like scales (from 0 to 10) for 1) TMJ pain, 2) headache and facial pain, 3) jaw function, 4) diet, and 5) disability. Objective evaluations included maximal incisal opening and excursion movements. Nonparametric statistics were used for analysis. RESULTS: There were 32 patients (22 female and 10 male patients) with 48 ankylosed TMJs (16 bilateral and 16 unilateral) in this study, with a mean age of 39 years (range, 11 to 68 years), 2 or more previous TMJ surgical procedures in 69%, and a mean follow-up period of 68 months (range, 12 to 168 months). Trauma was the major etiology of TMJ ankylosis, occurring in 17 of 32 patients (53%). The following improvements occurred: The median value for TMJ pain changed from 8.0 preoperatively to 1.5 at longest follow-up; headache, from 8 to 3.5; facial pain, from 8 to 4; jaw function, from 8 to 2.5; diet, from 7 to 3; and disability, from 7 to 1.5. The median incisal opening was 14.5 mm (interquartile range, 6.3 to 20 mm) preoperatively and 35 mm (interquartile range, 30 to 40 mm) at longest follow-up. The median left lateral excursion improved from 0.5 to 2 mm, and the median right lateral excursion improved from 1 to 1.3 mm. All of these improvements were highly significant (P < .001, Wilcoxon tests). Equally favorable outcomes were found in patients with 12 to 48 months of maximal follow-up and patients with more than 48 months of maximal follow-up. CONCLUSIONS: The treatment of TMJ ankylosis with the TMJ Concepts patient-fitted total joint prosthesis in combination with fat grafting around the articulation area of the prosthesis is a viable and predictable method for improving pain levels, function, and quality of life, as well as prevention of reankylosis of the TMJ.
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Anquilosis/cirugía , Artroplastia de Reemplazo , Trastornos de la Articulación Temporomandibular/cirugía , Tejido Adiposo/trasplante , Adolescente , Adulto , Anciano , Artroplastia de Reemplazo/métodos , Niño , Femenino , Humanos , Prótesis Articulares , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Trasplante de Tejidos/métodos , Adulto JovenRESUMEN
PURPOSE: The purpose of this study was to evaluate patients requiring unilateral total temporomandibular joint (TMJ) reconstruction and the risk for development of postsurgical contralateral TMJ pain and dysfunction over time requiring subsequent contralateral total joint reconstruction. Long-term subjective and objective outcomes of unilateral TMJ reconstruction also were evaluated. MATERIALS AND METHODS: Seventy patients underwent unilateral total joint reconstruction using a patient-fitted total joint prosthesis from a single private practice from 1990 through 2012. The inclusion criteria were 1) unilateral TMJ reconstruction with TMJ Concepts or Techmedica patient-fitted total joint prosthesis; 2) operation performed by 1 surgeon (L.M.W.); 3) minimum 12-month follow-up; and 4) adequate records. There were no specific exclusion criteria. The primary outcome variable was to evaluate the effects of unilateral TMJ reconstruction with a total joint prosthesis on the contralateral TMJ relative to development of pain and dysfunction requiring subsequent contralateral reconstruction with a total joint prosthesis. Secondary outcome variables for all patients included TMJ pain, facial pain, headaches, diet, disability, quality of life, maximum incisal opening (MIO), and lateral excursion movements after unilateral TMJ reconstruction with the patient-fitted total joint prosthesis. Student t test and Wilcoxon test were used for statistical analyses, with a P value less than .01 for statistical significance. RESULTS: Sixty-one of 70 patients (87%) met the inclusion criteria (47 women [77%] and 14 men [23%]; average age, 38 yr; age range, 11 to 69 yr; average follow-up, 44 months; range, 12 to 215 months). Eight of 61 patients (13%) subsequently required contralateral TMJ reconstruction with a total joint prosthesis related to contralateral pain, dysfunction, and arthritis, but all 8 (8 of 27 [29.6%]) had previous contralateral TMJ disc repositioning surgery. For the secondary outcomes, TMJ pain decreased 63%, jaw function improved 61%, facial pain decreased 59%, headaches decreased 57%, diet improved 52%, disability decreased 58.5%, and MIO increased from 31.4 to 38.8 mm (mean change, 7.4 mm). All subjective factors and MIO showed statistically significant improvements at longest follow-up (P < .01). CONCLUSIONS: Patients requiring unilateral TMJ reconstruction with a patient-fitted total joint prosthesis have a strong probability of improving their clinical condition and do not require bilateral reconstruction if the contralateral TMJ is healthy. Patients with previous or concomitant contralateral TMJ surgery (articular disc repositioning) have an approximately 30% chance of requiring a total joint prosthesis in the future.
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Artralgia/etiología , Artroplastia de Reemplazo , Dolor Facial/etiología , Prótesis Articulares , Complicaciones Posoperatorias/etiología , Falla de Prótesis/etiología , Articulación Temporomandibular/cirugía , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Reoperación , Factores de Riesgo , Factores de TiempoRESUMEN
PURPOSE: To evaluate subjective and objective outcomes of patients receiving Techmedica (currently TMJ Concepts) patient-fitted temporomandibular joint (TMJ) total joint replacement (TJR) devices after 19 to 24 years of service. PATIENTS AND METHODS: This prospective cohort study evaluated 111 patients operated on by 2 surgeons using Techmedica (Camarillo, CA) patient-fitted TMJ TJR devices from November 1989 to July 1993. Patients were evaluated before surgery and at least 19 years after surgery. Subjective evaluations used standard forms and questions with a Likert scale for 1) TMJ pain (0, no pain; 10, worst pain imaginable), 2) jaw function (0, normal function; 10, no movement), 3) diet (0, no restriction; 10, liquid only), and 4) quality of life (QoL; improved, the same, or worse). Objective assessment measured maximum incisal opening (MIO). Comparison analysis of presurgical and longest follow-up data used nonparametric Mann-Whitney and Wilcoxon signed rank tests. Spearman correlations evaluated the number of prior surgeries in relation to objective and subjective variables. RESULTS: Of the 111 patients, 56 (50.5%) could be contacted and had adequate records for inclusion in the study. Median follow-up was 21 years (interquartile range [IQR], 20 to 22 yr). Mean age at surgery was 38.6 years (standard deviation, 10 yr). Median number of previous TMJ surgeries was 3 (IQR, 4). Presurgical and longest follow-up data comparison showed statistically significant improvement (P < .001) for MIO, TMJ pain, jaw function, and diet. At longest follow-up, 48 patients reported improved QoL, 6 patients reported the same QoL, and 2 patients reported worse QoL. Spearman correlations showed that an increased number of previous surgeries resulted in lower levels of improvement for TMJ pain and MIO. CONCLUSIONS: At a median of 21 years after surgery, the Techmedica/TMJ Concepts TJR continued to function well. More previous TMJ surgeries indicated a lesser degree of improvement. No devices were removed owing to material wear.
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Prótesis Mandibular , Trastornos de la Articulación Temporomandibular/cirugía , Adulto , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida , Trastornos de la Articulación Temporomandibular/fisiopatologíaRESUMEN
BACKGROUND: Prolonged inflammation and oxidative stress can impede healing. To enhance healing efficiency, many solutions have been employed. This is an in vivo study comparing chlorhexidine (CHX) to a commercial antioxidant gel (AO). METHODS: Envelope flaps were created in the lower incisor gingival region of 60 Sprague-Dawley rats, and acellular dermal matrix (ADM) was inserted. Animals were randomly assigned to postsurgical treatment application of AO gel or 0.12% CHX twice daily. A control group received no postsurgical treatment. Data collected (before surgery, 24 h, and 72 h) included surgical images, tissue samples, and weights. Blinded scorers assessed images using a wound healing scale. Real-time polymerase chain reaction (RT-PCR) was used for gene expression of tumor necrosis factor-alpha (TNFα), interleukin-1 (IL-1), myeloperoxidase (MPO), and superoxide dismutase (SOD). RESULTS: The AO group scored higher than the CHX and control groups in clinical evaluation (p < 0.05). At 24 h, TNFα expression was upregulated in the AO group compared to CHX (p = 0.027) and controls (p = 0.018). The AO group had significantly higher expression of antioxidant enzyme (SOD) at 24 h compared to CHX (p = 0.021). All animals lost weight in the first 24 h. Animals treated with AO or CHX regained more weight at 72 h than control animals (p = 0.034 and 0.003, respectively). CONCLUSION: Animals treated with AO healed faster. AO led to earlier upregulation of TNFα and antioxidant enzyme SOD. We hypothesized that AO promoted an earlier inflammatory process while counteracting oxidative stress by increasing antioxidant responses via SOD.
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OBJECTIVES: To evaluate whether the amount of rapid maxillary expansion differentially affects the skeletal and dentoalveolar changes that occur. MATERIALS AND METHODS: This randomized controlled trial included 23 patients who had rapid maxillary expansion (RME). Subjects were randomly assigned to a conventional expansion control group (n = 12) or an overexpansion group (n = 11), who started treatment at 13.2 ± 1.5 and 13.8 ± 1 years of age, respectively. Cone beam computed tomography scans (11 cm) were obtained prior to rapid maxillary expander (RME) delivery and approximately 3.7 months later. Initial hand-wrist radiographs were used to determine the participants' skeletal maturity. RESULTS: The RME screws were activated 5.6 ± 1.2 mm and 10.1 ± 0.6 mm in the conventional and overexpansion groups, respectively. Overexpansion produced significantly greater expansion of the nasal cavity (2.1X-2.5X), maxillary base (2.3X), buccal alveolar crest (1.4X), and greater palatine foramina (1.9X). Significantly greater intermolar width increases (1.8X) and molar inclination (2.8X) changes were also produced. The nasal cavity and maxillary base expanded 23%-32% as much as the screws were activated. Skeletal expansion was positively correlated with RME screw activation (R = 0.61 to 0.70) and negatively correlated (R = -0.56 to -0.64) with the patients' skeletal maturation indicators (SMIs). Together, screw activation and the patients' SMI scores explained 48%-66% of the variation in skeletal expansion. CONCLUSIONS: This pilot study shows that overexpansion produces greater changes than conventional expansion, with greater skeletal effects among less mature patients.
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Maxilar , Técnica de Expansión Palatina , Tomografía Computarizada de Haz Cónico , Humanos , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Diente Molar , Proyectos PilotoRESUMEN
This report describes the impact of an R25 Oral Health Research Education Grant awarded to the Texas A&M Health Science Center-Baylor College of Dentistry (BCD) to promote the application of basic and clinical research findings to clinical training and encourage students to pursue careers in oral health research. At Baylor, the R25 grant supports a multi-pronged initiative that employs clinical research as a vehicle for acquainting both students and faculty with the tools of evidence-based dentistry (EBD). New coursework and experiences in all 4 years of the curriculum plus a variety of faculty development offerings are being used to achieve this goal. Progress on these fronts is reflected in a nascent "EBD culture" characterized by increasing participation and buy-in by students and faculty. The production of a new generation of dental graduates equipped with the EBD skill set as well as a growing nucleus of faculty who can model the importance of evidence-based practice is of paramount importance for the future of dentistry.
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Educación en Odontología , Odontología Basada en la Evidencia/educación , Facultades de Odontología , Competencia Clínica , Investigación Participativa Basada en la Comunidad , Educación Basada en Competencias , Congresos como Asunto , Curriculum , Investigación Dental/economía , Investigación Dental/educación , Docentes de Odontología , Humanos , National Institute of Dental and Craniofacial Research (U.S.) , Preceptoría , Apoyo a la Investigación como Asunto , Desarrollo de Personal , Estudiantes de Odontología , Enseñanza , Texas , Pensamiento , Estados UnidosRESUMEN
INTRODUCTION: Shorter miniscrew implants (MSIs) are needed to make orthodontics more effective and efficient. OBJECTIVE: To evaluate the stability, insertion torque, removal torque and pain associated with 3 mm long MSIs placed in humans by a novice clinician. METHODS: 82 MSIs were placed in the buccal maxillae of 26 adults. Pairs of adjacent implants were immediately loaded with 100g. Subjects were recalled after 1, 3, 5, and 8 weeks to verify stability and complete questionnaires pertaining to MSI-related pain and discomfort. RESULTS: The overall failure rate was 32.9%. The anterior and posterior MSIs failed 35.7% and 30.0% of the time, respectively. Excluding the 10 MSIs (12.2%) that were traumatically dislodged, the failure rates in the anterior and posterior sites were 30.1% and 15.2%, respectively; the overall primary failure rate was 23.6%. Failures were significantly (p= 0.010) greater (46.3% vs 19.5%) among the first 41 MSIs than the last 41 MSIs that were placed. Excluding the traumatically lost MSIs, the failures occurred on or before day 42. Subjects experienced very low pain (2.2% of maximum) and discomfort (5.5% of maximum) during the first week only. CONCLUSIONS: Shorter 3 mm MSIs placed by a novice operator are highly likely to fail. However, failure rates can be substantially decreased over time with the placement of more MSIs. Pain and discomfort experienced after placing 3 mm MSIs is minimal and temporary.
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Implantes Dentales , Métodos de Anclaje en Ortodoncia , Adulto , Tornillos Óseos , Implantación Dental Endoósea , Implantes Dentales/efectos adversos , Prótesis Dental de Soporte Implantado , Estudios de Factibilidad , Humanos , Maxilar/cirugía , TorqueRESUMEN
Respiration rate (RR) dynamics entrains brain neural networks. RR differences between mild cognitive impairment (MCI) and Alzheimer's disease (AD) in response to oral appliance therapy (OAT) are unknown. This pilot study investigated if RR during stable sleep shows a relationship to pathological severity in subjects with MCI and AD who snore and if RR is influenced following stabilization of the upper airway using OAT. The study cohort was as follows: cognitively normal (CN; n = 14), MCI (n = 14) and AD (n = 9); and a sub-population receiving intervention, CN (n = 5), MCI (n = 7), AD (n = 6) subjects. The intervention used was an oral appliance plus a mouth shield (Tx). RR maximum (max) rate (breaths/minute) and RR fluctuation during 2116 stable sleep periods were measured. The Montreal cognitive assessment (MoCA) was administered before and after 4 weeks with Tx. Baseline data showed significantly higher RR fluctuation in CN vs. AD (p < 0.001) but not between CN vs. MCI (p = 0.668). Linear mixed model analysis indicated Tx effect (p = 0.008) for RR max. Tx after 4 weeks lowered the RR-max in MCI (p = 0.022) and AD (p < 0.001). Compared with AD RR max, CN (p < 0.001) and MCI (p < 0.001) were higher with Tx after 4 weeks. Some MCI and AD subjects improved executive and memory function after 4 weeks of Tx.
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OBJECTIVE: To determine whether apical base size is related to dental crowding. MATERIALS AND METHODS: Digital scans of dental casts were taken of 75 untreated Class I adults to measure maxillary and mandibular tooth size, dental arch perimeters, intermolar widths, and intercanine widths. Cone beam computed tomography (CBCT) images were used to measure the apical base of the maxilla and mandible, including the total cross-sectional area, five basal arch perimeters and five basal arch widths. Principal components factor analyses were performed to evaluate the relationships between the apical base size and tooth-size-arch-length discrepancies (TSALD). RESULTS: The dental arch and maxillary apical base measures were significantly larger in males than females. There were only limited sex differences in mandibular apical base size. The dental arch measurements were smaller in subjects with greater upper and lower TSALD. Maxillary and mandibular apical base dimensions were positively interrelated. Low-to-moderate correlations were found between the size of the maxillary apical base and TSALD. The size of the mandibular apical base was not related to upper or lower TSALD. Tooth size showed little to no relationship with TSALD. CONCLUSIONS: Although maxillary apical base size is related to maxillary and mandibular crowding in subjects with Class I malocclusion, mandibular apical base size is not.
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Maloclusión , Mandíbula , Maxilar , Adulto , Cefalometría , Arco Dental , Femenino , Humanos , Masculino , Mandíbula/anatomía & histología , Maxilar/anatomía & histología , Modelos DentalesRESUMEN
Deficiencies in maxillary growth have often been implicated in suboptimal results of cleft lip and palate therapy. Cone-beam computed tomography provides an opportunity to look at the dimensions of the maxillary complex in three dimensions in a way that is not possible with lateral cephalograms or dental models. The purposes of this preliminary study were to outline a new set of 18 cone-beam computed tomographic measurements, apply them to 6 patients with unilateral cleft lip and palate (UCLP), and contrast them to a comparable sample of 7 normal young adults. The patients with UCLP were treated with a single protocol by a single surgeon and orthodontist. The 18 measurements had a mean intrarater reliability of 0.95 and ranged from 0.40 to 2.23 for the individual measurements. The mean interrater reliability was 1.01 and ranged from 0.40 to 2.45 for the individual measurements. Significant differences between the patients with UCLP and control subjects (combined sex samples) were found in palate length, anterior palate thickness, overall sagittal maxillary length, and premaxillary height (Mann-Whitney U tests, P Asunto(s)
Labio Leporino/diagnóstico por imagen
, Fisura del Paladar/diagnóstico por imagen
, Tomografía Computarizada de Haz Cónico
, Maxilar/diagnóstico por imagen
, Adolescente
, Labio Leporino/patología
, Labio Leporino/terapia
, Fisura del Paladar/patología
, Fisura del Paladar/terapia
, Terapia Combinada
, Estudios Transversales
, Femenino
, Humanos
, Masculino
, Maxilar/patología
, Desarrollo Maxilofacial
, Reproducibilidad de los Resultados
, Estadísticas no Paramétricas
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The aim of this study was to identify the extent of educational research conducted at one U.S. dental school and to assess faculty needs for engaging in it more fully. A task force developed and administered a survey to all the school's full-time faculty members in January 2014. The response rate was 73.6% (n=106/144). The majority of the respondents were clinicians (73%), had a primary responsibility for teaching (80%), and were non-tenure track (62%). Thirty-six percent (n=24) of the non-tenure-track respondents reported being expected to engage in scholarship as well as the 38% (n=40) who were on the tenure track, for a total of 60% (n=64/106). Overall, 51% of respondents reported they had a half-day or less for scholarship. Clinical faculty respondents had significantly less time for scholarship than non-clinical (p<0.001). Two-thirds (n=72, 68%) said they had not received research training, and over half (n=56, 53%) had never conducted educational research. The most common answers for why respondents did not conduct educational research were "do not know how" (n=32%) and "not required" (n=23%). Help with statistical analysis was reported as the most important support factor, followed by having collaborators, help with research design, time, funding, and travel. While overall interest in conducting educational research was moderate (median=5 on a 1-10 scale, IQR=3,8), a highly interested group (n=45) had produced more research than others (p≤0.041). This group desired more small grants (91%) and training opportunities (89%, p≤0.001). In response to one of the findings of this study, a small-grant program of $15,000 annually for educational research was implemented in May 2014. Funded by this program, 11 projects have been initiated with both scholarship and learning improvement outcomes.
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Investigación Dental , Educación en Odontología , Cultura Organizacional , Facultades de Odontología/organización & administración , Docentes Médicos/organización & administración , Docentes Médicos/estadística & datos numéricos , Humanos , Publicaciones/estadística & datos numéricos , Encuestas y Cuestionarios , Estados UnidosRESUMEN
BACKGROUND: The oral health status of older adults in North Texas is largely unknown. METHODS: This cross-sectional, pilot study used the Basic Screening Survey for older adults involving a self-administered questionnaire and oral screening examination of 155 adults aged 65 years and older, in four Dallas, TX settings, stratified socioeconomically. Recruitment occurred from July 2012 through March 2014. RESULTS: Participants were between 65 and 90 years of age. The sample was predominantly female (64%), reflecting Texas population diversity with 49.7% White, 34.2% Hispanic, 14.2% Black, and 1.8% others. Missing teeth number (P < .019), functional contacts, untreated decay, root decay (P < .05), tooth mobility, root fragments and need for emergency treatment (P < .021) differed significantly regarding site and ethnicity. Participants at the least affluent sites (two) evidenced significant unmet dental needs and suboptimal access to care. In contrast, those at the most affluent sites (also oldest participants) had good oral health and access to care. CONCLUSIONS: There are profound oral health disparities in urban North Texas based on socioeconomic status. These findings suggest that poor oral health is not inevitable in the elderly, as long as there is access to care. Larger-scale studies are required to broadly address oral health disparities among elderly Texans.
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Caries Dental , Salud Bucal , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Proyectos Piloto , Factores Socioeconómicos , TexasRESUMEN
The media has given much attention to the academic cheating crisis in America. A majority of college students believe that, in today's global environment, it is necessary to cheat in order to get ahead and to compete with their peers. The prevalence and attitudes concerning academic dishonesty of health professions students, including those in medical, dental, and nursing schools, have been extensively researched. No such studies exist in the discipline of dental hygiene. The purpose of this study was to investigate the prevalence of cheating in Texas dental hygiene programs. Four hundred surveys were mailed to twenty Texas dental hygiene schools for graduating students to complete. A total of 289 usable surveys was returned for a response rate of 72.25 percent. Data were analyzed using SPSS with frequencies and chi-square tests. Findings from this study reveal that 86.5 percent of graduating Texas dental hygiene students have cheated a minimum of one time during matriculation. Students identified the demands of what they considered academic overload as the primary justification for cheating behavior.
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Decepción , Higienistas Dentales/educación , Adolescente , Adulto , Actitud del Personal de Salud , Control de la Conducta , Complicidad , Higienistas Dentales/psicología , Fraude , Humanos , Prevalencia , Racionalización , Responsabilidad Social , Encuestas y Cuestionarios , Texas , Adulto JovenRESUMEN
OBJECTIVES: To determine the relative effects of Herbst appliance therapy in hypo- and hyperdivergent patients. MATERIALS AND METHODS: The treated group included 45 growing Class II, division 1, patients treated with stainless steel crown Herbst appliances, followed by fixed edgewise appliances. The untreated control group consisted of 45 Class II, division 1, subjects, matched to the treated sample based on Angle classification, age, sex, and pretreatment mandibular plane angle (MPA). Subjects were categorized as hypo- or hyperdivergent based on their MPAs. Pre- and posttreatment cephalograms were traced and superimposed on cranial base and mandibular structures. RESULTS: The primary effect of the Herbst in terms of maxillomandibular correction was in the maxilla. It significantly restricted maxillary growth, producing a "headgear effect." Mandibular treatment changes depended on divergence. Hyperdivergent patients experienced a deleterious backward true mandibular rotation with Herbst treatment. Hypodivergent patients, as well as untreated hypo- and hyperdivergent controls, underwent forward true mandibular rotation. However, hypodivergent chins did not advance any more than expected for untreated hypodivergent Class II patients. CONCLUSIONS: Hypo- and hyperdivergent patients benefit from the Herbst's headgear effect. While the mandibular growth of hypodivergent patients overcomes the negative rotational effects, hyperdivergent patients undergo a deleterious backward mandibular rotation and increases in facial height.
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Maloclusión Clase II de Angle/terapia , Desarrollo Maxilofacial , Aparatos Ortodóncicos Funcionales , Adolescente , Cefalometría , Niño , Femenino , Humanos , Masculino , Maloclusión Clase II de Angle/diagnóstico por imagen , Resultado del TratamientoRESUMEN
PURPOSE: This study evaluated the effectiveness of the Texas Medicaid First Dental Home (FDH) by comparing the oral health knowledge, practices, and opinions of participating vs. non-participating parents. METHODS: A 29-question survey (English & Spanish) was developed and administered to 165 parents of children under three years old (FDH=49, Non-FDH=116) who visited qualifying Medicaid clinics in Texas. RESULTS: Mann Whitney U tests showed that FDH parents scored higher on overall knowledge (P=0.001) and practice scores (P<0.001). FDH parents responded correctly more often than non-FDH about the recommended amount of toothpaste for toddlers (P<0.001). More FDH parents knew tap water was a potential source of fluoride (P<0.001). The FDH parents scored marginally higher about when a child should have the first dental visit (P=0.051). More Non-FDH parents let their child go to sleep with a bottle, sippy cup or pacifier (P<0.001). CONCLUSIONS: FDH visits are having a positive impact on Texas parents by increasing their oral healthcare knowledge and practices. This is the first step towards improving the oral health of children.
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Atención Dental para Niños , Educación en Salud Dental , Conocimientos, Actitudes y Práctica en Salud , Padres , Preescolar , Encuestas de Salud Bucal , Femenino , Humanos , Lactante , Masculino , Medicaid , Texas , Estados UnidosRESUMEN
INTRODUCTION: The effect of rheumatoid arthritis (RA) on the healing and pathophyisiology of apical periodontitis is unknown because there is no study in the literature evaluating the association of RA with the prevalence of periapical rarefying osteitis (PAR) and endodontic treatment. Therefore, the goal of this cross-sectional study was to evaluate the prevalence of PAR and root canal treatment in RA patients when compared with controlled individuals. METHODS: Full-mouth radiographs of 131 individuals with RA were examined and compared with 131 controls that were sex and age matched exactly with the diseased group. The total number of teeth, presence or absence of root canal filling, quality of root canal filling, quality of restoration, and periapical status were recorded. RESULTS: Overall, the prevalence of teeth with PAR was 4.0% in the diseased group and 3.5% in the control group (P > .05). The prevalence of root canal-treated teeth was 6.2% in the RA group and 5.6% in the control group (P > .05). Controls have significantly more teeth than those with RA (P = .027). CONCLUSIONS: The prevalence of PAR and endodontic treatment was not significantly different in individuals with RA compared with control patients.
Asunto(s)
Artritis Reumatoide/complicaciones , Osteítis/etiología , Ápice del Diente/patología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteítis/epidemiología , Periodontitis Periapical/etiología , Periodontitis Periapical/patología , Prevalencia , Estudios Retrospectivos , Tratamiento del Conducto Radicular/estadística & datos numéricos , Diente no Vital/epidemiología , Diente no Vital/etiología , Adulto JovenRESUMEN
Purpose: Culturally competent health care providers understand cultural attitudes, values, beliefs and practices and are able to use this knowledge to guide patient care. Rising oral health disparities among racial and ethnic minorities require that dental educators emphasize the attainment of cultural competence in order to prepare students to effectively care for patients with backgrounds different from their own. This study investigated the role of community rotations on the cultural competence of second-year Texas dental hygiene students.Methods: A modified version of the validated self-assessing Clinical Cultural Competency Questionnaire (CCCQ) was given to students at twelve Texas dental hygiene programs with a 100% response rate (239/239). Data analysis was performed using the Kendall tau correlation for associations and Kruskal-Wallis and Mann-Whitney U tests for differences among and between groups.Results: Students scored highest in attitude (86th percentile). Time spent in community rotations (p=0.009), number of community rotations (p=0.028), racial/ethnic diversity of program clinic patients (p=0.042), and training hours (p=0.044) were associated with increased cultural competence scores. Students with over 50 community rotation hours (p=0.006) scored significantly higher than students with less than 50 hours. Generally, those with four rotations (p=0.002) scored highest. Those with public clinic (p=0.049) and school (p=0.044) rotations scored significantly higher than those without these experiences. Those with nursing home (p=0.009) and hospital (p=0.026) experience scored lower than those without these experiences. Students seeing the most racially/ethnically diverse patients in program clinics scored higher (p=0.014) than students seeing less diverse patients. Those with 6-10 training hours scored higher (p=0.013) than those with other training levels. Hispanics scored significantly higher than whites in skill and overall cultural competence (p≤ 0.005).Conclusion: Dental hygiene programs should invest time in cultural competence training and choose a robust program of community rotations, while considering the diversity of the student body and clinic patient pool to enhance graduates' cultural competence.