Challenges to future dental education.

The future of dental education in the UK is currently in a very dynamic phase; the GDC is changing its role and Europe is taking the lead. In addition there have been significant changes in the workforce and the role of the dentist. These changes will affect the future of the dental profession.

A view of European challenges in dental education.

Since the Bologna declaration in 1999 there have been significant developments in undergraduate dental education. The GDC and the UK dental education community need to rise to these challenges.

A preliminary evaluation of pre-treatment hypodontia patients using the Dental Aesthetic Index: how does it compare with other commonly used indices?

There is currently no specific occlusal index related to hypodontia and there is a paucity of published literature on this subject. The aim of this study was to determine the relationship, if any, between the Peer Assessment Rating (PAR) Index, the Index of Complexity, Outcome and Need (ICON), and the Dental Aesthetic Index (DAI) score and the severity of hypodontia. All new patients attending the Newcastle Dental Hospital hypodontia clinic between February 2002 and March 2003 were included in the study. Of the 60 patients, two were excluded as the models were unavailable and one because they were predominantly in the primary dentition, making scoring impractical. The patient casts were scored with respect to PAR, ICON, and DAI. The mean patient age at presentation was 12 years, with a standard deviation of 1.89 and a range of 9-16 years, and a female to male ratio of 1.1:1. A significant positive correlation, using Kendall tau b, was found between the number of missing teeth, excluding third molars, and the DAI score (tau = 0.215, P = 0.027). There was no significant positive correlation between PAR (tau = -0.186, P = 0.056) and ICON (tau = 0.017, P = 0.861) score and the number of missing teeth. The results of this investigation indicate that further research is required in order to assess if the DAI could be used to determine whether or not to refer hypodontia patients for specialist advice.

Quality assurance and benchmarking: an approach for European dental schools.

This document was written by Task Force 3 of DentEd III, which is a European Union funded Thematic Network working under the auspices of the Association for Dental Education in Europe (ADEE). It provides a guide to assist in the harmonisation of Dental Education Quality Assurance (QA) systems across the European Higher Education Area (EHEA). There is reference to the work, thus far, of DentEd, DentEd Evolves, DentEd III and the ADEE as they strive to assist the convergence of standards in dental education; obviously QA and benchmarking has an important part to play in the European HE response to the Bologna Process. Definitions of Quality, Quality Assurance, Quality Management and Quality Improvement are given and put into the context of dental education. The possible process and framework for Quality Assurance are outlined and some basic guidelines/recommendations suggested. It is recognised that Quality Assurance in Dental Schools has to co-exist as part of established Quality Assurance systems within faculties and universities, and that Schools also may have to comply with existing local or national systems. Perhaps of greatest importance are the 14 'requirements' for the Quality Assurance of Dental Education in Europe. These, together with the document and its appendices, were unanimously supported by the ADEE at its General Assembly in 2006. As there must be more than one road to achieve a convergence or harmonisation standard, a number of appendices are made available on the ADEE website. These provide a series of 'toolkits' from which schools can 'pick and choose' to assist them in developing QA systems appropriate to their own environment. Validated contributions and examples continue to be most welcome from all members of the European dental community for inclusion at this website. It is realised that not all schools will be able to achieve all of these requirements immediately, by definition, successful harmonisation is a process that will take time. At the end of the DentEd III project, ADEE will continue to support the progress of all schools in Europe towards these aims.

Tutor perceptions of the use of a reflective portfolio within a pastoral tutor system to facilitate undergraduate personal development planning.

All Higher Education Institutions in the UK are now required to provide transcripts of student activity and outcomes of summative assessments. In addition, the student should be able to reflect on their learning and plan their own development. This article reports on the staff evaluation of the use of a reflective portfolio facilitating the production of highly individualised personal development plans within an existing tutor system. A number of significant issues are highlighted; tutor systems adopting this approach must maintain flexibility for managing student crises when they arise, the difference between appraisal and assessment needs clear definition for both students and tutors, training in basic mentoring skills should be provided for all tutors, tutors should be aware of the difficulties many students experience with reflection and also be alert to the over reflective learner.

Severe hypodontia in a set of triplets.

Hypodontia is the developmental absence of one or more teeth from the dentition and constitutes one of the most common developmental anomalies in humans with a reported prevalence of 1.6 to 9.6% in the permanent dentition. Hypodontia may occur in association with other genetic diseases, or as an isolated familial or sporadic form. This article describes the rare phenomenon of severe hypodontia in a set of triplets. The triplets presented with congenital absence of the second molars, second premolars in all quadrants and lower central incisors. An additional five teeth (upper canines, upper lateral incisors and upper left first premolar) were missing in one of the triplets. The treatment plan and the possible genetic mode of inheritance are discussed.

Orthodontic management of orofacial problems in young people with impairments: review of the literature and case reports.

OBJECTIVE: The aim of this paper is to present a series of cases illustrating possible options for the management of malocclusions in a group of young people with impairments. Design. The study took the form of a case series. METHODS: A review of the literature is presented and a series of illustrative cases are shown to indicate that orthodontic treatment is possible in patients with a range of impairments. RESULTS: Five children with varying intellectual and/or physical impairments, and a malocclusion that resulted in trauma or increased disability, are presented. CONCLUSION: The risks and benefits of the procedures, and the anticipated oral health outcomes, need to be considered carefully in this group of children.

A quantitative study of enamel acid etch patterns on surfaces used for retention of resin-bonded fixed prostheses.

This study investigated the quality of in vivo etch patterns on the bonding surfaces of 46 abutment teeth following acid etching with 37% phosphoric acid for 30 seconds. Two-stage putty and light bodied addition cured silicone impressions of the etched lingual surfaces were used to form replicas that were then viewed using the scanning electron microscope. Over 69% of the lingual bonding surface area of incisors, canine and premolars were unetched, 16% barely etched, 7% etched and less than 2% ideally etched. There was no significant difference in the quality of etch between different tooth types. There was a significantly greater proportion of poorly etched enamel towards the cervical margin in comparison with the occlusal half. This may have implications in retention of resin bonded bridges.

Undergraduate orthodontic teaching in the new millennium--the Newcastle model.

This paper identifies the main factors which have influenced the nature of the undergraduate orthodontic curriculum presently taught at Newcastle University. It also outlines the philosophy that underpins the teaching, states the professional aims of the tutors and spells out the clinical objectives set for the students.

The interdisciplinary management of hypodontia: the relationship between an interdisciplinary team and the general dental practitioner.

This paper will illustrate how the general dental practitioner can provide care for patients with hypodontia. It will demonstrate how an interdisciplinary team works for hypodontia patients and, in particular, for those with severe hypodontia.

The role of magnets in the management of unerupted teeth in children and adolescents.

This case report describes the use of magnets in the management of teeth that fail to erupt. Eight children aged between 10 and 15 years were treated. Magnetic traction was applied to two premolars and six molars. Seven teeth (one premolar and six molars) erupted successfully (mean treatment time with magnetic traction: 7.5 months). One premolar failed to erupt; serial radiographic assessment over a 9-month period revealed no evidence of movement and so the magnetic fixture was removed. Histological evaluation of tissue samples taken from around the fixture revealed no evidence of abnormal pathology.

The interdisciplinary management of hypodontia: restorative dentistry.

This paper considers the role of restorative dentistry in the management of hypodontia. The paper describes the general restorative considerations common to patients with hypodontia and illustrates the variety of restorative techniques available in the restorative management of hypodontia and oligodontia.

The interdisciplinary management of hypodontia: background and role of paediatric dentistry.

This paper is the first of a series on the comprehensive management of young people with hypodontia. The paper looks at the background to the condition, the possible aetiological factors, the prevalence of hypodontia and other related conditions. Lastly there is consideration of the role of the paediatric dentist in interdisciplinary management of the affected child and adolescent patient.

Relationship between enamel etch characteristics and resin-enamel bond strength.

OBJECTIVES: The aim of the study was to investigate the relationship between etch patterns produced on surface enamel by phosphoric acid and the corresponding bond strengths achieved. MATERIALS AND METHODS: Twenty-eight patients had the buccal surface of their teeth etched and replicated for examination under the scanning electron microscope, at the commencement of orthodontic treatment. Histometry was employed to assess the nature and quality of etch patterns using a four-point scale. Twenty of each tooth type (total of 240), were collected and A Company pre-adjusted orthodontic brackets, bonded using Transbond light-cured orthodontic adhesive according to the manufacturer's instructions and 24-hour bond strength testing was undertaken. The Adhesive Remnant Index (ARI) was recorded for the tooth and bracket surface for all specimens. RESULTS: The type of etch was not significantly affected by the side (left or right) of the mouth assessed (p = 0.532). Overall, there was no significant difference between etch types for upper and lower teeth (p = 0.218); however, there were significant differences between specific teeth in the upper and lower arch. The greatest amount of Type A etch (well-defined etched enamel prisms) was found on the lower incisors, yet in all cases this 'ideal' etch was found to occupy less than 5% of the etched buccal surface enamel. The greatest area of etched enamel surface was occupied by Type C (etched but enamel prisms not evident). The mean bond strength values varied significantly between different tooth types, with the lowest bond strength found on the upper first molar(6.5MPa) and the highest on the lower first molar (13.1 MPa). CONCLUSIONS: An ideal etch pattern is not essential in order to produce a strong bond.

Acid-etch patterns on the buccal surface of human permanent teeth.

Since the introduction of acid etching to aid adhesion to enamel, there has been much research into dental materials to improve bond strength, but little into the surface topography of etched enamel, particularly regarding possible variations between tooth types. This study was a systematic investigation into the quality and quantity of etch patterns found on the buccal surfaces of different human permanent teeth. Twenty-nine orthodontic patients had high-resolution silicone impressions taken of the buccal surface of incisor, canine, premolar and molar, upper and lower teeth, following etching for 30s with 37% phosphoric acid. Impressions (n=266) were replicated in epoxy resin and examined under high magnification in a scanning electron microscope. A modification of the classification of Galil and Wright was used, with histometric techniques, to quantify the quality of etch patterns on enamel surfaces where orthodontic brackets are typically bonded. There was no difference between right and left or between upper and lower teeth of the same type (P>0.05). There was a general trend toward the increasing occurrence of no etch (type D) from anterior to posterior teeth, and a trend toward fewer good-quality etches (types A and B) in the same direction. Etch types A and B were found to occupy the smallest area on the etched buccal surface enamel. The greatest amount of type A etch 'ideal' was found on the lower incisors, yet it occupied less than 5% of the etched buccal surface enamel. The greatest area of etched enamel surface was occupied by type C (etched, but enamel prisms not evident). It was concluded that there is a significant difference in the acid-etch patterns achieved on different tooth types, which suggests that bond-strength studies should be performed with a single tooth type or that an equal number of different tooth types be included.

Evaluation of a computer-assisted learning programme on the oro-facial signs of child physical abuse (non-accidental injury) by general dental practitioners.

A computer-assisted learning programme with tutorials and self assessment multiple choice questions has been developed. One hundred and two general dental practitioners were asked to evaluate the programme. Over 80% of respondents felt that the programme was easy to use, contained an appropriate level of supporting information, and had improved their knowledge of non-accidental injury. All users of the programme felt that it was a better way of learning than video, audio tapes, and journals or books on the subject. It is concluded that CAL programmes are worthwhile for providing continuing professional education for general dental practitioners.

The effect of moisture and blood contamination on bond strength of a new orthodontic bonding material.

The practice of orthodontics often requires the bonding of brackets under difficult conditions of moisture and/or blood contamination. Transbond MIP (3M Unitek, Monrovia, Calif) is a hydrophilic primer designed to bond in moist conditions. This study evaluated the bond strength of Transbond MIP under dry, moist, and blood-contaminated conditions. Ninety human premolars were bonded in 3 equal groups with Transbond MIP after acid etching; the enamel surfaces were either dry, moist, or contaminated with human blood. The shear bond strength was recorded. Dry bonding resulted in a significantly higher bond strength (15.69 MPa) than moist (12.89 MPa) or blood-contaminated (11.16 MPa) bonds. However, all bond strengths were in excess of previous reports of required clinical bond strength, and it was concluded that Transbond MIP is a suitable adhesive for bonding in conditions of poor moisture control or blood contamination.