What impact does postgraduate clinical training have on empathy among Japanese trainee dentists?

BACKGROUND: Enhancing empathy in healthcare education is a critical component in the development of a relationship between healthcare professionals and patients that would ensure better patient care; improved patient satisfaction, adherence to treatment, patients' medication self-efficacy, improved treatment outcomes, and reduced patient anxiety. Unfortunately, however, the decline of empathy among students has been frequently reported. It is especially common when the curriculum transitions to a clinical setting. However, some studies have questioned the significance and frequency of this decline. Thus, the purpose of this study was to determine the impact of postgraduate clinical training on dental trainees' empathy from cognitive, behavioral, and patients' perspective. METHODS: This study included 64 trainee dentists at Okayama University Hospital and 13 simulated patients (SPs). The trainee dentists carried out initial medical interviews with SPs twice, at the beginning and the end of their clinical training. The trainees completed the Japanese version of the Jefferson Scale of Empathy for health professionals just before each medical interview. The SPs evaluated the trainees' communication using an assessment questionnaire immediately after the medical interviews. The videotaped dialogue from the medical interviews was analyzed using the Roter Interaction Analysis System. RESULTS: No significant difference was found in the self-reported empathy score of trainees at the beginning and the end of the clinical training (107.73 [range, 85-134] vs. 108.34 [range, 69-138]; p = 0.643). Considering the results according to gender, male scored 104.06 (range, 88-118) vs. 101.06 (range, 71-122; p = 0.283) and female 109.17 (range, 85-134) vs. 111.20 (range, 69-138; p = 0.170). Similarly, there was no difference in the SPs' evaluation of trainees' communication (10.73 vs. 10.38, p = 0.434). Communication behavior in the emotional responsiveness category for trainees in the beginning was significantly higher than that at the end (2.47 vs. 1.14, p = 0.000). CONCLUSIONS: Overall, a one-year postgraduate dental training program neither reduced nor increased trainee dentists' empathy levels. Providing regular education support in this area may help trainees foster their empathy.

Fibronectin-induced ductal formation in salivary gland self-organization model.

BACKGROUND: Recent advances in tissue regeneration approaches including 3D organoids, were based on various 3D organogenesis models. However, 3D models are generally technique-sensitive and time-consuming. Thus, we utilized an existing model of submandibular salivary gland (SMG) to modify a simple and highly reproducible in vitro 3D culture model of primary SMG cells self-organization into a well-developed cell spheroid inside Matrigel substrate. We used this model to observe the collective multicellular behavior during spheroid formation. Further, we applied various quantitative approaches including real-time live imaging and immune histochemical image analysis to dissect the cellular dynamics during tissue patterning. RESULTS: On a time-scale of hours, we observed marked size and shape transformations in the developed 3D spheroid which resulted in a spatially-controlled growth differential from the canter to the periphery of the formed aggregates. Moreover, we investigated the effect of fibronectin (FN) on SMG cells self-organization using our simplified culture model. Interestingly, we discovered a novel role of FN in inducing duct-like elongation during initial stages of SMG bud formation. CONCLUSION: This in vitro model provides an excellent tool for analyzing the intercellular dynamics during early SMG tissue development as well as revealing a novel role of FN in SMG ductal expansion.

MCSF orchestrates branching morphogenesis in developing submandibular gland tissue.

The importance of macrophages in tissue development and regeneration has been strongly emphasized. However, the specific roles of macrophage colony-stimulating factor (MCSF), the key regulator of macrophage differentiation, in glandular tissue development have been unexplored. Here, we disclose new macrophage-independent roles of MCSF in tissue development. We initially found that MCSF is markedly upregulated at embryonic day (E)13.5, at a stage preceding the colonization of macrophages (at E15.5), in mouse submandibular gland (SMG) tissue. Surprisingly, MCSF-induced branching morphogenesis was based on a direct effect on epithelial cells, as well as indirectly, by modulating the expression of major growth factors of SMG growth, FGF7 and FGF10, via the phosphoinositide 3-kinase (PI3K) pathway. Additionally, given the importance of neurons in SMG organogenesis, we found that MCSF-induced SMG growth was associated with regulation of neurturin expression and neuronal network development during early SMG development in an in vitro organogenesis model as well as in vivo These results indicate that MCSF plays pleiotropic roles and is an important regulator of early SMG morphogenesis.

Coating method for smooth and reinforced surface layer of highly translucent zirconia.

Due to the recent evolution of dental ceramic materials, highly translucent zirconia materials have been developed. While this material has high aesthetics, there is still room for improvement in strength. In this study, we investigated to strengthen the high translucent zirconia material. In the study, monoclinic zirconia (mZrO2) nanoparticles were used as a coating agent. The surface of the highly transparent zirconia was coated with mZrO2 nanoparticle dispersion by dipping and sintered. Thereby, the high translucent zirconia could obtain about 1.3 times higher strength than the untreated one. The post-coating method introduced in this study would be effective as a simple and economical method for improving highly translucent zirconia strength.

Toughening of highly translucent zirconia by monoclinic ZrO2 and SiO2 particle coating.

The mechanical properties of highly translucent partially stabilized zirconia (PSZ) need to be improved; however, improvement of mechanical properties often decreases translucency. To overcome this problem, a monoclinic ZrO2 (mZrO2)/SiO2 dispersion was prepared and applied as a coating material for PSZ. The influence of surface treatment by the mZrO2/SiO2 dispersion on the surface topography, crystallography, and mechanical properties of highly translucent PSZ was investigated in this study. Following the treatment, the mechanical strength of highly translucent PSZ improved by 170% compared with control, for the best mZrO2/SiO2 dispersion ratio and heating temperature condition, while maintaining its translucency. The proposed coating is promising for improving the mechanical properties of highly translucent PSZ.

Influence of anteroposterior mandibular positions on facial attractiveness in Japanese adults.

INTRODUCTION: Our aims in this study were to determine the anteroposterior facial relationship that is regarded as most attractive by Japanese laypersons in a questionnaire survey and to evaluate which analysis of the soft-tissue profile is most suitable for Japanese people. METHODS: We showed 262 Japanese laypersons (121 male, 141 female) 9 morphed profile images with Point B and menton anteriorly or distally moved by software and asked them to number them sequentially according to their attractiveness. To examine which analysis best reflects facial attractiveness as judged by laypersons, we made 5 types of analyses of the facial profile with 11 variables in the 9 images. RESULTS: The normal face was judged favorably; however, an attractive profile might be different for each subject. The 3 highest ranking profiles (normal face and moderate mandibular retrusions) were often favorites, and 2 profiles (severe mandibular protrusions) were liked the least for most subjects. However, the other images showed a wide range of distribution. Mandibular retrusion was generally more favored than mandibular protrusion and bimaxillary protrusion (severe chin retrusion) had a high attractiveness ranking and was well accepted in the Japanese population. CONCLUSIONS: To evaluate the profiles of Japanese subjects, it is important to evaluate not only the esthetic line defined by the nose and chin, but also the balance of the upper and lower lips defined by the posterior reference line--ie, Burstone's Sn-Pog' line.

Optimal sandblasting conditions for conventional-type yttria-stabilized tetragonal zirconia polycrystals.

OBJECTIVE: To assess the influence of sandblasting conditions applied to conventional-type yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) on surface roughness, phase transformation, and biaxial flexural strength. METHODS: Commercially available Y-TZP (Lava Frame, 3M Dental Products) disks were used after sintering (specimen dimensions: 14mm in diameter and 1.2mm in thickness). The surfaces of specimens were ground, and then sandblast treatments were conducted at different pressures (0.20, 0.25, 0.30, 0.35 and 0.40MPa) and distances (1, 5, 10 and 20mm) with 50µm alumina particles. Surface roughness measurements were performed and scanning electron microscopy (SEM) images were taken for surface characterizations. Phase transformation of Y-TZP was identified by X-ray diffraction (XRD). Biaxial flexural strength was measured using the piston-on-three-ball test. RESULTS: The surface roughness increased significantly by increasing the sandblasting pressure, and microcracks were observed at high sandblasting pressure at 0.40MPa. The shortest sandblasting distance (1mm) was not effective to increase the surface roughness compared with other sandblasting distances. A tetragonal to monoclinic phase transformation was observed after grinding. The degree of the phase transformation tended to increase with sandblasting pressure, and significant effect was independent of the sandblasting distance. The biaxial flexural test showed improved mechanical strengths for the samples after sandblasting at 0.20-0.35MPa, with the maximum strength at 0.25MPa. Sandblasting at 0.40MPa decreased the strength as compared with 0.25MPa. SIGNIFICANCE: The surface roughness increased with increasing the sandblasting pressure, whereas there was an optimal sandblasting pressure range to increase biaxial flexural strength of Y-TZP.

Improvement of mechanical properties of Y-TZP by thermal annealing with monoclinic zirconia nanoparticle coating.

OBJECTIVE: To assess whether a thermal annealing with a monoclinic zirconia (mZrO2) nanoparticle coating can improve the reliability of sandblasted yttria-stabilized tetragonal zirconia polycrystals (Y-TZP) and maintain its mechanical strength. METHODS: Commercially available Y-TZP (Lava Frame, 3M Dental Products) disks were sintered and surface-treated as follows: AS (as sintered, with no treatment); SB (sandblasting); SB-TA (sandblasting followed by thermal annealing at 1000 °C); and SB-mZr-TA (sandblasting followed by thermal annealing at 1000 °C with the mZrO2 nanoparticle coating). The mZrO2 nanoparticles of 21 nm in size were prepared by a hydrothermal method, and coated onto Y-TZP sintered disks as a 5 g/L ethanol dispersion. Biaxial flexural strength (S) was measured using the piston-on-three-ball test, and reliability was evaluated by the Weibull modulus (m). RESULTS: Biaxial flexural tests showed a significant increase in the strength of Group SB (SSB = 1445 ± 191 MPa) compared with Group AS (SAS = 1071 ± 112 MPa). The thermal annealing improved the reliabilities of the sandblasted Y-TZP (mSB-TA = 20.14 and mSB-mZr-TA = 21.33), as compared with Group SB (mSB = 7.77). However, the conventional thermal annealing without the mZrO2 coating caused a significant decrease in the strength of sandblasted Y-TZP (SSB-TA = 1273 ± 65 MPa). Importantly, the mZrO2 coating prevented the decrease in the strength caused by conventional thermal annealing (SSB-mZr-TA = 1379 ± 65 MPa). SIGNIFICANCE: The thermal annealing with the mZrO2 nanoparticle coating can improve the reliability of sandblasted Y-TZP and maintain its mechanical strength, which would otherwise be decreased by the conventional annealing process.

Relationship of trainee dentists' self-reported empathy and communication behaviors with simulated patients' assessment in medical interviews.

OBJECTIVES: We aimed to clarify the communication behaviors between trainee dentists and simulated patients (SPs), to examine how the level of trainee dentists' self-reported empathy influences assessment by SPs in medical interviews. MATERIALS AND METHODS: The study involved 100 trainee dentists at Okayama University Hospital and eight SPs. The trainee dentists conducted initial interviews with the SPs after completing the Japanese version of the Jefferson Scale of Empathy (JSE). All interviews were recorded and analyzed using the Roter Interaction Analysis System (RIAS). The SPs assessed the trainees' communication immediately after each interview. The trainee dentists were classified into two groups (more positive and less positive) according to SP assessment scores. RESULTS: Compared with less-positive trainees, the more-positive trainees scored higher in the RIAS category of emotional expression and lower in the medical data gathering category. There was no difference in dental data gathering between the two groups. SP ratings for more-positive trainees were higher for use of positive talk and emotional expression and lower for giving medical information and dental information. Trainees with more positive ratings from SPs had significantly higher JSE total scores. CONCLUSION: The results of this study suggest that responding to the emotions of patients is an important behavior in dentist-patient communication, according to SPs' positive assessment in medical interviews. Further, SPs' assessment of trainees' communication was related to trainees' self-reported empathy, which indicates that an empathic attitude among dentists is a significant determinant of patient satisfaction.

Resin adhesion strengths to zirconia ceramics after primer treatment with silane coupling monomer or oligomer.

Resin bonding to zirconia ceramics is difficult to achieve using the standard methods for conventional silica-based dental ceramics, which employ silane coupling monomers as primers. The hypothesis in this study was that a silane coupling oligomer -a condensed product of silane coupling monomers- would be a more suitable primer for zirconia. To prove this hypothesis, the shear bond strengths between a composite resin and zirconia were compared after applying either a silane coupling monomer or oligomer. The shear bond strength increased after applying a non-activated ethanol solution of the silane coupling oligomer compared with that achieved when applying the monomer. Thermal treatment of the zirconia at 110°C after application of the silane coupling agents was essential to improve the shear bond strength between the composite resin cement and zirconia.

MSCs feeder layers induce SMG self-organization and branching morphogenesis.

Dysfunction of salivary glands leads to several oral health problems, including dental caries, mastication and swallowing dysfunctions and multiple oral infections. Conventional treatments for such condition fell short of providing satisfying therapeutic results. Recent advances in organ regeneration therapy which utilize tissue stem cells to fabricate bioengineered 3D organ buds, have introduced a promising therapeutic tool for full functional organ regeneration. However, finding a sustainable and easily accessible cell source for such approaches is still challenging, especially in case of severely atrophied tissues such as irradiated salivary glands. In response to this, we hypothesized that bone marrow derived mesenchymal stem cells (MSCs) could be used as feeder cells to induce salivary epithelial tissues/cells branching. Indeed, in 2D cultures, MSCs supported branching of embryonic submandibular salivary gland (SMG) epithelium. Interestingly, this enhancing effect was dependent on the initial number of MSC feeder cells. In addition, MSCs supported the self-assembly of SMG epithelial progenitor cells into well-patterned and branched 3D salivary organoids. Therefore, these findings propose MSCs as a valuable candidate cell source for induced SMG epithelial branching, which can potentially be applied in future methods for SMG regeneration approaches.

Functional peptide KP24 enhances submandibular gland tissue growth in vitro.

INTRODUCTION: Salivary gland hypofunction, also known as xerostomia, occurs as a result of radiotherapy for head and neck cancer, autoimmune diseases, or aging. Xerostomia leads to oral health problems and thus affects the quality of life. Biological salivary gland tissue generated in vitro would provide an alternative mode of treatment for this disease. METHODS: To develop a novel method for modulating salivary gland tissue growth in vitro, we prepared a KP24 peptide-immobilized hydrogel sheet, wherein the peptide comprised repeating proline and lysine sequences, and evaluated the effect of this peptide on salivary gland tissue growth. RESULTS: We found that the KP24 peptide has the potential to enhance glandular tissue growth in vitro. This enhancement is associated with neurite outgrowth and increasing neural innervation. CONCLUSION: KP24 peptide modified material would be a promising material for the modulation of salivary gland tissue growth in vitro.

Peptide-modified Substrate for Modulating Gland Tissue Growth and Morphology In Vitro.

In vitro fabricated biological tissue would be a valuable tool to screen newly synthesized drugs or understand the tissue development process. Several studies have attempted to fabricate biological tissue in vitro. However, controlling the growth and morphology of the fabricated tissue remains a challenge. Therefore, new techniques are required to modulate tissue growth. RGD (arginine-glycine-aspartic acid), which is an integrin-binding domain of fibronectin, has been found to enhance cell adhesion and survival; it has been used to modify substrates for in vitro cell culture studies or used as tissue engineering scaffolds. In addition, this study shows novel functions of the RGD peptide, which enhances tissue growth and modulates tissue morphology in vitro. When an isolated submandibular gland (SMG) was cultured on an RGD-modified alginate hydrogel sheet, SMG growth including bud expansion and cleft formation was dramatically enhanced. Furthermore, we prepared small RGD-modified alginate beads and placed them on the growing SMG tissue. These RGD-modified beads successfully induced cleft formation at the bead position, guiding the desired SMG morphology. Thus, this RGD-modified material might be a promising tool to modulate tissue growth and morphology in vitro for biological tissue fabrication.