Decision Considerations and Strategies for Lip Surgery in Patients with Cleft lip/Palate: A Qualitative Study.

Objective: To qualitatively assess surgeons decision making for lip surgery in patients with cleft lip/palate (CL/P). Design: Prospective, non-randomized, clinical trial. Setting: Clinical data institutional laboratory setting. Patients Participants: The study included both patient and surgeon participants recruited from four craniofacial centers. The patient participants were babies with a CL/P requiring primary lip repair surgery (n=16) and adolescents with repaired CL/P who may require secondary lip revision surgery (n=32). The surgeon participants (n=8) were experienced in cleft care. Facial imaging data that included 2D images, 3D images, videos, and objective 3D visual modelling of facial movements were collected from each patient, and compiled as a collage termed the Standardized Assessment for Facial Surgery (SAFS) for systematic viewing by the surgeons. Interventions: The SAFS served as the intervention. Each surgeon viewed the SAFS for six distinct patients (two babies and four adolescents) and provided a list of surgical problems and goals. Then an in-depth-interview (IDI) was conducted with each surgeon to explore their decision-making processes. IDIs were conducted either in person or virtually, recorded, and then transcribed for qualitative statistical analyses using the Grounded Theory Method. Results: Rich narratives/themes emerged that included timing of the surgery; risks/limitations and benefits of surgery; patient/family goals; planning for muscle repair and scarring; multiplicity of surgeries and their impact; and availability of resources. For diagnoses/treatments, surgeons agreed, and level of surgical experience was not a factor. Conclusions: The themes provided important information to populate a checklist of considerations to serve as a guide for clinicians.

Assessing students' mental health in two American dental hygiene programs.

OBJECTIVES: Dental hygiene students adapt to new environments while learning technical skills and providing clinical care during their education. Understanding how stress affects students in their professional healthcare program warrants exploration. This study assessed stress among dental hygiene students in two educational settings in the Southeastern United States. METHODS: First and second-year dental hygiene students (N = 136) from a community college setting (n = 67) and a university setting (n = 69) were invited to complete an anonymous online survey on mental health in fall 2019. Validated surveys on depression, anxiety, social support, and burnout were included. Data analysis included chi-squared and Mantel-Haenszel statistics, depending on the scale of measurement, with the level of significance set at 0.05 for all analyses. RESULTS: Participants included 54 dental hygiene students from a community college (Response rate = 80.6%) and 69 dental hygiene students from a university (RR = 100%). There was a statistically significant difference in the proportion of students reporting moderately severe or severe anxiety (p = 0.007), with 56% (n = 30) of the community college respondents and 36% (n = 24) of the university reporting these anxiety levels. Students attending a community college were also more likely to express feelings of worry (n = 34) compared to students in a university setting (p = 0.005). There was no statistically significant difference in depression (p = 0.07) or suicidal thoughts (p = 0.41). CONCLUSION: Dental hygiene students enrolled in these two programs reported high levels of self-reported stress, mental and emotional concerns that may increase suicidal tendencies.

Impacts of Skeletal Anterior Open Bite Malocclusion on Speech.

Introduction: Articulation problems are seen in 80-90% of dentofacial deformity (DFD) subjects compared with 5% of the general population, impacting communication and quality of life, but the causal link is unclear. We hypothesize there are both qualitative (perceptual) and quantitative (spectral) differences in properties of stop (/t/ or /k/), fricative (/s/ or /∫/), and affricate (/t∫/) consonant sounds and that severity of anterior open bite (AOB) jaw disharmonies correlates with degree of speech abnormality. Methods: To test our hypotheses, surgical orthodontic records and audio recordings were collected from DFD patients (n=39 AOB, 62 controls). A speech pathologist evaluated subjects and recordings were analyzed using spectral moment analysis (SMA) to measure sound frequency distortions. Results: Perceptually, there is a higher prevalence of auditory and visual speech distortions in AOB DFD patients when compared to controls. Quantitatively, a significant (p<0.01) increase in the centroid frequency (M1) was seen in the /k/, /t/, /t∫/, and /s/ sounds of AOB subjects compared to the controls. Using linear regression, correlations between AOB skeletal severity and spectral distortion were found for /k/ and /t/ sounds. Conclusions: A higher prevalence of qualitative distortion and significant quantitative spectral distortions in consonant sounds were seen in AOB patients compared to controls. Additionally, severity of skeletal AOB is correlated with degree of distortion for consonant sounds. These findings provide insight into how the surgical and/or orthodontic treatment of AOB may impact speech.

Retrospective Study of Prenatal and Postnatal Gaps in Oral Health Care Utilization: Medicaid Policy Implications.

OBJECTIVE: To assess the frequency and timing of dental treatment completion among pregnant and post-partum women served through the University of North Carolina at Chapel Hill (UNC-CH) Prenatal Oral Health Program (pOHP) dental clinic in the context of North Carolina (NC) dental Medicaid policies. METHODS: We completed a retrospective chart review of pregnant women referred to the program between May 2015 and May 2019. Data were collected from the time of referral until up to 2 years after their estimated due date (EDD). We assessed pre- and post-delivery dental appointment timing and dental treatment completion. RESULTS: The initial study population included 264 pregnant women. Overall, 213 patients (81%) attended at least one appointment, and 32 patients (12%) completed recommended treatments prior to their EDD. Fifty patients (19%) returned after delivery to resume dental care, with only 25 patients (10%) completing their recommended treatment plan. Women re-entered dental care at a median of 67 days (range 5-613 days) after their EDD and completed treatment at a median of 378 days (range 52-730 days) following delivery. CONCLUSIONS FOR PRACTICE: Despite dental clinic referral, most pregnant women do not complete recommended dental treatment before giving birth, and women who resumed dental care after birth demonstrated a lag-time between delivery and care completion. These findings highlight the need for extending post-pregnancy dental care coverage, which is limited under current dental Medicaid policies, posing a major public health issue for new mothers to continue oral health care.

Orthognathic speech pathology: impacts of Class III malocclusion on speech.

INTRODUCTION: Patients with dentofacial disharmonies (DFDs) seek orthodontic care and orthognathic surgery to address issues with mastication, esthetics, and speech. Speech distortions are seen 18 times more frequently in Class III DFD patients than the general population, with unclear causality. We hypothesize there are significant differences in spectral properties of stop (/t/ or /k/), fricative (/s/ or /ʃ/), and affricate (/tʃ/) consonants and that severity of Class III disharmony correlates with the degree of speech abnormality. METHODS: To understand how jaw disharmonies influence speech, orthodontic records and audio recordings were collected from Class III surgical candidates and reference subjects (n = 102 Class III, 62 controls). A speech pathologist evaluated subjects and recordings were quantitatively analysed by Spectral Moment Analysis for frequency distortions. RESULTS: A majority of Class III subjects exhibit speech distortions. A significant increase in the centroid frequency (M1) and spectral spread (M2) was seen in several consonants of Class III subjects compared to controls. Using regression analysis, correlations between Class III skeletal severity (assessed by cephalometric measures) and spectral distortion were found for /t/ and /k/ phones. CONCLUSIONS: Class III DFD patients have a higher prevalence of articulation errors and significant spectral distortions in consonants relative to controls. This is the first demonstration that severity of malocclusion is quantitatively correlated with the degree of speech distortion for consonants, suggesting causation. These findings offer insight into the complex relationship between craniofacial structures and speech distortions.

Modified Carnoy's Compared to Carnoy's Solution Is Equally Effective in Preventing Recurrence of Odontogenic Keratocysts.

PURPOSE: Carnoy's solution (CS), the gold standard for adjunctive chemical cautery in treatment of odontogenic keratocysts (OKCs), has been banned for 7 years, leading to substitution with the non-chloroform containing modified Carnoy's solution (MC) without data to support its effectiveness. We performed this study to compare the earlier data with CS to the more current outcomes with MC. METHODS: A retrospective cohort study was conducted on patients diagnosed with OKC and treated by a single surgeon (GHB) with enucleation and curettage (EC), peripheral ostectomy, and application of CS or MC. The primary predictor variables were use of CS or MC. The primary outcome variables were recurrence (yes vs. no) and time to recurrence. Secondary variables included demographics, anatomic location, and whether teeth adjacent to the lesion were extracted. Statistical analyses included chi-squared test/Fisher's exact test, Wilcoxon rank sum test, and Kaplan-Meier curves. RESULTS: 77 patients, 36 patients in the CS group and 41 in the MC group, met inclusion criteria, including at least 1 year of follow-up time. Characteristics of the groups were similar: median age 41.5 and 46, 61% and 71% male gender, 81% and 90% posterior, and 64% and 50% mandibular lesions, respectively. Overall recurrence was similar, 14.29%, with 5 (13.9%) recurrences in the CS group and 6 (14.6%) in the MC group (P = 0.92). Median time to recurrence was 24 months for both groups. Preserving adjacent teeth was associated with a significant increase in recurrence (P = 0.0036). CONCLUSION: Based on this comparison of retrospective outcome data, we found no significant difference in recurrence rate or distribution of time to recurrence between OKCs treated with CS or MC. Aggressiveness of surgical technique is likely a predictive factor in recurrence rate. Future studies should focus on prospective studies and continuing follow-up of the MC group.

Implementing a Prenatal Oral Health Program in Dental Hygiene Curriculum.

Purpose: Inadequate prenatal oral health education in dental hygiene (DH) curricula can negatively impact patient care by graduating clinicians lacking competence in the provision of care for this population. The purpose of this study was to assess the knowledge, opinions, and willingness of DH students to provide oral care services to pregnant patients before and after participating in a prenatal oral health educational program (pOHP).Methods: Senior DH students were invited to complete a baseline and post-program survey to evaluate their experiences in the pOHP at the University of North Carolina, Chapel Hill. All senior DH students attended a one-hour lecture on prenatal oral health guidelines and practices prior to their clinical rotation in the pOHP. Each survey consisted of items on knowledge, confidence, and attitudes related to screening, counseling, and willingness to provide oral care services to pregnant patients.Results: Over a period of three years, 93 DH students (n=93) completed both the baseline and post-program surveys for a 96.8% response rate. Participants reported gains in knowledge and confidence for screening and counseling pregnant patients. Post-program survey respondents agreed that dental providers should deliver oral health counselling to pregnant women (99%, n=93) and perform an oral health examination during prenatal care (99%, n=92). Nearly all of the respondents, (98%; n=90) reported they are likely to take care of pregnant women upon graduation and deliver preventive oral health messaging to this population (98%, n=91).Conclusion: Dental hygiene student participants in a prenatal oral health program (pHOP) demonstrated positive trends in increasing knowledge and confidence in screening and counseling pregnant patients in the dental setting. Inclusion of a clinical experience played an influential role in changes in knowledge regarding the safety of care during pregnancy, indicating a need for both didactic and clinical immersion opportunities to enhance cognitive and affective transformations.

Periapical Microsurgery: Assessment of Different Types of Light-emitting Diode Transilluminators in Detection of Dentinal Defects.

INTRODUCTION: This study evaluated 4 different light-emitting diode (LED) transilluminators and the impact of operator experience in the detection of dentinal defects through an ex vivo TRUEJAW surgical model (Dental Engineering Laboratories, Santa Barbara, CA). METHODS: Forty-four extracted and endodontically treated mandibular premolar teeth were evaluated. Teeth were mounted in the models followed by surgical flaps and osteotomies to expose the apical third of the roots. After apical resection, the root-end surfaces were randomly inspected for the presence or absence of dentinal defects using a dental operating microscope (DOM) at ×19.4 magnification by experienced and novice LED evaluators. The assessment was made with the DOM light and 4 masked LED transilluminators of different diameters and luminous flux. The teeth were examined outside the models to establish the ground truth. The sensitivity, specificity, and kappa and McNemar test values of each light source by examiner were calculated. RESULTS: The use of LED transilluminators improved the diagnostic sensitivity of dentinal defects when compared with the DOM light alone for both examiners. For the LED-experienced evaluator, the medium-low transilluminator had statistically significant higher sensitivity than the DOM light and the small-low and small-high transilluminators (P < .05). For the novice LED evaluator, the medium-high transilluminator had the highest sensitivity. There was a statistically significant difference between the sensitivities of the medium-low transilluminator between the examiners (P < .05). CONCLUSIONS: Within the limitations of this ex vivo surgical study, dentinal defects were more often detected with the LED transilluminators with a larger diameter and increased lumens. The operator's LED transilluminator experience was found to have a positive effect on the detection of dentinal defects using transillumination.

Impact of an oral health education intervention among a group of patients with eating disorders (anorexia nervosa and bulimia nervosa).

BACKGROUND: It is recognized that eating disorders are serious psychosocial illnesses that affect many adolescents and adults. A pre and post survey study was developed to assess demographics, oral health knowledge and self-image of patients with eating disorders participating in a hospital-based eating disorder clinic using an original oral health education program. The program's aim is to change the self-image and oral health practices of patients with anorexia-binge eating/purging (AN-BP) and bulimia nervosa (BN) disorders. METHODS: A pre-survey was completed by each study participant prior to attending the three educational sessions over a six-week period. A post survey questionnaire was completed after participation in all the educational presentations. Forty-six patients attended all three educational sessions and completed the pre and post-questionnaires. RESULTS: Most patients knew in advance that AN-BP and BN behavior can cause erosion of the teeth but only 30% knew the most likely location for the erosion to occur. But, following completion of the educational interventions, 73% answered the location correctly. Patients who reported going to the dentist regularly were significantly more likely to respond that their teeth/mouth had a positive effect on how they looked to themselves and to others, their general health, and their general happiness. Positive responses to the effect of the teeth/mouth on kissing and romantic relationships were also significantly higher for those who go to the dentist regularly compared to those who do not. CONCLUSIONS: There is a need to further understand AN-BP and BP patients' oral health knowledge and self-image perceptions as it relates to their smile (teeth, mouth) to assist in developing a standardized oral health program for eating disorder centers to implement into their daily curricula. A dental team member in an interdisciplinary eating disorder treatment team is important. Including an oral health education program improves patients' oral hygiene and oral health knowledge, as well as provides a supportive environment to empower the patients to take control of their overall oral health. TRIAL REGISTRATION: This study was retrospectively registered on April 18, 2019 in ClinicalTrials.gov, Identifier: NCT03921632.

Factors Associated With Becoming Edentulous in the US Health and Retirement Study.

BACKGROUND/OBJECTIVE: To determine factors associated with older adults becoming edentulous (complete tooth loss). DESIGN: Longitudinal study over a 6-year period. SETTING: United States, 2006, 2012. PARTICIPANTS: Nationally representative US sample of adults, aged 50 years and older (n = 9982), participating in the Health and Retirement Study in 2006 and 2012. At the outset, they were dentate and not institutionalized. INTERVENTION: None. MEASUREMENTS: Self-report of being dentate or edentulous, demographic variables, dental utilization and other health behaviors, self-rated general health, and incidence between 2006 and 2012 of comorbid medical conditions, functional limitations, and disabilities. RESULTS: From 2006 to 2012, 563 individuals (5%) became edentulous and 9419 (95%) remained dentate. Adults who became edentulous by 2012 were more likely than those who remained dentate to be black/African American compared to white, to be less educated, were current smokers, had diabetes, and reported poorer self-rated general health, more functional limitations and disabilities, and fewer dental visits (all P < .0001), among other factors. Of those with regular dental visits (at least once every 2 years during the 6-year period), 2.3% became edentulous compared to 9.9% among those without regular dental visits. After adjusting for age and other potential confounders, there was a strong association with poor dental attendance and smoking. Nonregular dental attenders were more likely than regular attenders to become edentulous (odds ratio [OR] = 2.74; 95% confidence interval [CI] = 2.12-3.53), and current smokers were more likely than never smokers to become edentulous (OR = 2.46; 95% CI = 1.74-3.46). CONCLUSION: Although more contemporaneous data are needed to determine causality, regular dental utilization and smoking are modifiable factors that could prevent edentulism, even when many other comorbid conditions are present. J Am Geriatr Soc, 1-7, 2019. J Am Geriatr Soc 67:2318-2324, 2019.

Resilon: Assessment of Degraded Filling Material in Nonhealed Cases.

INTRODUCTION: The Resilon obturation system (Pentron Clinical Technologies, Wallingford, CT) was discontinued a few years after its introduction as an alternative to traditional gutta-percha and sealer. Ex vivo models support anecdotal reports of degraded Resilon filling material; however, there is no previous clinical report of this degradation. This may represent a significant health concern for the patient and contribute to a higher clinical failure rate of Resilon-obturated root canals. The aim of this study was to determine the proportion of Resilon degradation in nonhealed endodontic cases compared with gutta-percha and sealer. METHODS: Patients previously treated with Resilon or gutta-percha who had a nonhealed root canal that needed retreatment were enrolled. Upon access, the previous filling material was classified as either degraded or intact. If there was a lack of solid, dense material remaining within the canal confirmed by passively placing a size 15 K-file to the working length, the filling material was considered to be degraded. RESULTS: The proportion of degradation between the 2 materials was statistically significant, with Resilon having a higher likelihood of degradation than gutta-percha in the bivariate analysis (P = .0003). CONCLUSIONS: This clinical observational study indicates that Resilon has a higher rate of degradation when compared with gutta-percha in nonhealed cases.

Long-term Outcomes of Endodontic Treatment Performed with Resilon/Epiphany.

INTRODUCTION: Resilon (Resilon Research LLC, Madison, CT) with Epiphany Sealer (Pentron Clinical Technologies, Wallingford, CT) was introduced into the market in 2004 as a new method of root canal obturation. This material as well as the traditionally used gutta-percha with AH Plus sealer (Dentsply Maillefer, Tulsa, OK) were in use over a 9-year span in the University of North Carolina endodontic clinics. Although Resilon was initially thought to create a "monoblock" seal between the material and the canal, in vitro studies later suggested this concept not to be true. The long-term outcome of Resilon using a validated radiographic index and a systematic approach has not been reported. The purpose of this retrospective cohort study was to radiographically evaluate the outcome of Resilon/Epiphany-treated root canals compared with traditional gutta-percha/AH Plus. METHODS: One hundred twenty-five teeth were radiographically evaluated using the periapical index; 80 were treated with Resilon and 45 with gutta-percha. Age, sex, tooth position, and number of months to follow-up were documented, and a multivariate analysis with odds ratio was performed. RESULTS: Resilon-treated teeth were 5.3 times more likely to have a periapical index of 3 to 5 at follow-up compared with gutta-percha (P = .009). Teeth presenting with preoperative lesions, regardless of the material used, were also more likely to present with a lesion at follow-up (P = .04). CONCLUSIONS: Teeth obturated with Resilon were more likely to present with a lesion at follow-up compared with gutta-percha obturated teeth after controlling for the presence of a preoperative lesion and the length to follow-up.

Translating prenatal oral health clinical standards into dental education: results and policy implications.

OBJECTIVES: To evaluate characteristics of pregnant women served through the University of North Carolina's (UNC) prenatal oral health program (pOHP) dental clinic and community healthcare pathways to inform efforts in promoting prenatal oral health policies. METHODS: The pOHP provides medical and dental students and practitioners with interprofessional experiences caring for pregnant women. A retrospective chart audit captured 314 pregnant women who made appointments over 33 months. Descriptive statistics and bivariate comparisons were computed to assess factors associated with dental appointment attendance and treatment completion. RESULTS: There were 564 pregnant women, with mean age of 29 years and gestation of 25 weeks, referred to the pOHP dental clinic from UNC OB-GYN and 20 community sites. Only 56% (N = 314) scheduled an appointment. Of the 314 appointed women, 55% (N = 172) attended at least one appointment. The majority (87%) presented with acute and/or complex treatment needs. Medicaid status was positively associated with appointment attendance (P = 0.001). Less than half (42%) of the women completed treatment prior to delivery. Mean maternal age, gestational age, and weeks to estimated date of delivery (EDD) were not significantly associated with completed treatment. CONCLUSIONS: This study provides descriptive evidence of an academic, interprofessional program's ability to provide safety-net dental care to pregnant women in the state of North Carolina. Results underscore the need for dental services among pregnant women, signaling for promotion of prenatal oral health clinical standards and informing policy on the state and national levels to maximize dental coverage.

Diagnostic accuracy of intraoral photographic orthodontic records.

OBJECTIVE: The aims of this study were (1) to investigate how relevant intraoral photographs are to contemporary orthodontic diagnosis and (2) to assess orthodontists' ability to accurately diagnose angle classification and dental midlines using standardized intraoral photographs. METHODS: Study participants were orthodontists who completed a survey regarding photography protocols and their use of intraoral photographs for diagnosis. Each participant was randomized to complete 1 visual diagnostic task regarding either angle classification or midlines. Accuracy was compared across groups and camera angulations. RESULTS: In all, 80% of 192 respondents reported using photographs and clinic notes to plan orthodontic treatment; 50% also included dental casts. For the angle task, accuracy judging molar and canine classification was 79.9% and 51.3%, respectively with ideal standardized photographs. As camera angulation deviated, accuracy decreased significantly (P < 0.0001). For the midline task, accuracy judging the direction of deviation decreased with a small camera angulation change yet increased with a large change (P < 0.001). CONCLUSIONS: When using ideal intraoral photographs alone to diagnose angle classification and midline relationships, accuracy is not likely to be greater than 80%. As camera angulation becomes less ideal, by 15 degrees when judging angle classification or 4 degrees when judging midlines, accuracy is likely to significantly decrease. CLINICAL SIGNIFICANCE: For the clinician who wants to have the most accurate and complete records, our results suggest that intra-oral photos alone may not be adequate when it comes to judging occlusal relationships such as angle classification and esthetic parameters like midlines. When using ideal intraoral photographs to diagnose angle classification and midline relationships, accuracy is not likely to be greater than 80%. As camera angulation becomes less ideal, by as little as 15 degrees when judging angle classification or 4 degrees when judging midlines, accuracy is likely to decrease significantly. Understanding these limitations will allow clinicians to improve both their clinical photography technique and their diagnostic skills.

Dental Hygienists' Knowledge, Attitudes, and Comfort Level in Treating Patients with Dental Anxiety.

Purpose: Fear of dental treatment is a significant problem in the United States, impacting patients as well as oral health care providers. The purpose of this study was to identify the already-acquired knowledge, attitudes, and level of confidence of practicing dental hygienists with respect to the treatment of patients with dental anxiety.Methods: A paper survey was developed, pilot tested, and administered at a state-wide annual dental hygiene continuing education (CE) course in North Carolina. The survey domains studied included demographics, practice setting, practice behaviors, dental anxiety awareness, and opinions and attitudes. Item responses included multiple choice, a Likert Scale ranging from "extremely frequent to never" and "strongly agree to strongly disagree," and free response questions. Results were tabulated and descriptive statistics were performed.Results: Of the 157 attendees, 153 met the inclusion criteria (n=153) for a participation rate of 97%. Dental anxiety questionnaires were used "often" or "always" by 20% of the respondents. Less than half (43%) of the respondents stated that they knew the common signs and symptoms of a patient suffering from dental anxiety. However, 92% of the respondents (n=140) indicated confidence in their ability to perceive whether a patient felt stressed. A little more than half (58%) believed their dental hygiene education prepared them for treating patients with mild dental anxiety, 38% with moderate dental anxiety, and 22% with severe dental anxiety.Conclusion: Although the majority of dental hygienists in this study felt confident in their abilities to perceive stress in patients seeking dental care, they were less knowledgeable in recognizing the full range of signs and symptoms of dental anxiety. Questionnaires designed to specifically identify this population were used infrequently. Dental hygiene curricula and continuing education programs should include content on anxiety management for patients exhibiting all levels of dental anxiety.

Career perspectives of senior dental students from different backgrounds at a single Middle Eastern institution.

BACKGROUND: Differences between dental students in terms of social, economic and cultural backgrounds are likely to impact their professional career plans. The aim of this study was to explore the professional career plans among final year dental students from different backgrounds at a single Middle Eastern institution (Jordan university of Science and Technology-JUST). METHODS: Fifth year dental students at JUST were invited to fill out a paper based self-administered questionnaire. Data was collected on students` demographics, their future career plans and the impact of social and economic changes on such plans, their interest in postgraduate studies and the specialty of choice in addition to the influence of a group of factors on that choice. Data was also collected on the value of non-academic workshops, guidance regarding career plans, participants` preferred pattern of work (full-time versus part-time) and retirement plans. Students were categorized according to their nationalities. Pearson's chi squared test, one way ANOVA and post hoc tests were used to measure statistical significance between measured variables and backgrounds of participants. The level of significance was set at P ≤ 0.05. RESULTS: A total of 227 students completed the survey (response rate = 84%). 47% of the participants were Jordanians, 27% were Malaysians, 11% were from Gulf States (Saudi Arabia, Bahrain, Kuwait and Qatar), 10% were from conflict zones in the Middle East (Syria, Iraq, Palestine and Yemen) and 5% comprised students from other nationalities. Significant differences were found between students from different backgrounds in their funding sources (Chi square = 132, P < 0.01), practice plans (Chi square = 43, P < 0.01), the impact of social and economic changes on their career choices (Chi square = 34, P < 0.01), planned work pattern within the first 10 years post-graduation (chi square = 18, P < 0.05) and 10-20 years after graduation (69%, Chi square = 22, P < 0.01) and retirement plans (Chi square = 25, P < 0.05). Students from different nationalities agreed on most factors affecting their choice of a specialty, except for the reputation of the specialty (P < 0.05). CONCLUSION: Several differences in career plans were found between dental students from variable backgrounds studying a single institution. Many of these disparities could reflect variations in socioeconomic backgrounds.

Periapical Microsurgery: Do Root Canal-retreated Teeth Have More Dentinal Defects?

INTRODUCTION: This microsurgical clinical study evaluated if teeth that have undergone endodontic retreatment are associated with more dentinal defects than primary root canal-treated teeth. METHODS: One hundred fifty-five patients who underwent periapical microsurgery treatment in a private practice setting were evaluated. The root ends were resected, and the roots were inspected for the presence of dentinal defects through the surgical operating microscope with the help of a 0.8-mm-diameter light-emitting diode probe light and methylene blue dye. The root canal treatment history (primary vs retreatment) of the teeth was documented and related to the presence or absence of dentinal defects. Bivariate analysis was performed using the chi-square test, and a multivariate analysis was performed using logistic regression to evaluate possible confounding effects of patient age, sex, and tooth location on the association between treatment and the presence of dentinal defects. RESULTS: Of the 155 treated teeth, 33 were excluded (3 fractured and 30 missing treatment history). Of the remaining 122 included teeth, 73 (59.8%) had undergone primary root canal treatment and 49 (40.2%) retreatment. Sixteen teeth (22.5%) of the primary root canal group versus 33 (64.7%) of the retreatment group had dentinal defects. The proportion of retreated teeth with dentinal defects compared with primary treatment was statistically significant (P < .001) with a higher proportion of retreated teeth having dentinal defects. In the multivariate analysis, only the type of treatment was statistically significant (P < .001). CONCLUSIONS: This clinical study showed that root canal-retreated teeth are associated with more dentinal defects than primary root canal-treated teeth.

A multimodal analgesic protocol may reduce opioid use after third molar surgery: A pilot study.

OBJECTIVE: This study was designed to assess the number of opioid doses available to patients from filled prescriptions after adoption, in 2017, of a multimodal analgesic protocol that included opioid prescribing to manage postoperative pain. STUDY DESIGN: Data were retrieved from records of the first 24 patients having third molar surgery in 2017 identified from appointment schedules. Inclusion criteria were American Society of Anesthesiologists risk classification I or II, age 18 to 35 years, and at least 2 lower third molars removed. The exclusion criterion was being treated for opioid addiction/abuse. The primary outcome variable was the number of opioid doses filled by prescriptions at each patient's discretion. The primary predictor variable was the multimodal analgesic protocol. RESULTS: Data from records of 24 consecutive patients were analyzed; 83% were females. Median age was 25 years (interquartile range [IQR] 12-29 years). Median surgery time was 35 minutes (IQR 27-32 minutes). The median number of opioid doses filled in 2017 was 4 (IQR 0-4). CONCLUSIONS: The outcomes from this pilot study suggest that implementation of a multimodal analgesic protocol to manage postoperative pain, while limiting the number of opioid doses available to the patient, may be an effective strategy for a wider range of patients and procedures.

Executive Function as a Risk Factor for Incisor Trauma.

BACKGROUND/AIM: Executive function is the ability to guide behavior to achieve goals or complete tasks. This study explored the relationship between executive function, as assessed by the Behavior Rating Inventory of Executive Function Parent Form Questionnaire (BRIEF® ) and incisor trauma. MATERIAL AND METHODS: This study included children in the mixed dentition with recent incisor trauma (n=28) and a control group (n=30) without recent incisor trauma. Subjects' parents completed the BRIEF® , while a clinical examination assessed subjects' occlusal relationships. Parents also completed a custom questionnaire that investigated their child's medical history and daily activities. Fisher Exact and unpaired t-tests compared BRIEF® scores, occlusal characteristics, medical history, and reported daily activities of the two groups. RESULTS: The trauma group had a greater percentage of participants with a Class II dental relationship (p=0.01). There was no significant difference between groups with respect to mean BRIEF® t-scores within the Global Executive Composite. There was a statistically significant difference between groups with respect to the percentage of subjects with clinically significant (≥65) BRIEF® t-scores within the Inhibit (p=0.05) and Emotional Control (p=0.02) subscales and Behavioral Regulation Index (p=0.02). There were no statistically significant differences between groups with respect to age, gender, overbite, overjet, medical history, body mass index, or daily activities. CONCLUSIONS: Children in the mixed dentition with a Class II dental relationship are at greater risk for incisor injury, as well as those involved in outdoor activities. Specific executive dysfunctions such as impulsivity and poor emotional control may increase the risk for incisor trauma. This article is protected by copyright. All rights reserved.

Self-Directed Digital Learning: When Do Dental Students Study?

The Growth and Development (G&D) curriculum at the University of North Carolina at Chapel Hill School of Dentistry uses self-directed web-based learning modules in the place of lectures and includes scheduled self-study times during the 8 am-5 pm school hours. The aim of this study was to use direct observation to evaluate dental students' access patterns with the self-directed, web-based learning modules in relation to planned self-study time allocated across the curriculum, proximity to course examinations, and course performance. Module access for all 80 students in the DDS Class of 2014 was recorded for date and time across the four G&D courses. Module access data were used to determine likelihood of usage during scheduled time and frequency of usage in three timeframes: >7, 3 to 7, and 0 to 2 days before the final exam. The results showed a statistically significant difference in the likelihood of module access during scheduled time across the curriculum (p<0.0001). Among the students, 64% accessed modules at least once during scheduled time in G&D1, but only 10%, 19%, and 18% in G&D2, G&D3, and G&D4, respectively. For all courses, the proportion of module accesses was significantly higher 0-2 days before an exam compared to the other two timeframes. Module access also differed significantly within each timeframe across all four courses (p<0.001). There was no association between module access and course performance. In this non-traditional, non-lecture, self-directed curriculum, students rarely accessed learning modules during syllabus-budgeted self-study time and accessed modules more frequently as course exams approached.