Identifying work-related factors associated with work-family conflict of care workers in nursing homes: A cross-sectional study.

AIMS: To investigate which work-related factors are associated with work-family conflict of care workers in nursing homes, this study aimed to: (a) describe the prevalence of work-family conflict of care workers in nursing homes and (b) assess the association of work-related factors with work-family conflict. DESIGN: Cross-sectional multicentre sub-study based on data from the Swiss Nursing Homes Human Resources Project 2018. METHODS: Data were collected between September 2018 and October 2019. Work-family conflict of care workers was assessed with the Work-Family Conflict Scale (range 1-5). Prevalence was described in percentages. We used multilevel linear regression to assess the association of time-based factors (working overtime or during one's free time, employment percentage, presenteeism, shift working) and strain-based factors (staffing adequacy, leadership support) with work-family conflict. RESULTS: Our study sample consisted of 4324 care workers working in a total of 114 nursing homes. Overall, 31.2% of respondents stated to have experienced work-family conflict (>3.0 on the Work-Family Conflict Scale). The overall mean score of the study sample for work-family conflict was 2.5. Care workers experiencing presenteeism 10 or more days per year showed the highest scores for work-family conflict (mean: 3.1). All included predictor variables were significant (p < .05). CONCLUSION: Work-family conflict is multifactorial. Possible intervention points to tackle work-family conflict could be strengthening care workers' influence in planning work schedules, enabling flexible planning to ensure adequate staffing, lowering presenteeism and implementing a supportive leadership style. IMPACT: Care workers' jobs become less desirable when workplace demands interfere with family life. This study highlights the multifaceted nature of work-family conflict and suggests intervention options to prevent care workers from experiencing work-family conflict. Action is needed at nursing home and policy level.

Institutional Factors Associated with Residents' Malnutrition in Nursing Homes: A Cross-Sectional Study.

OBJECTIVES: Malnutrition is frequent in older adults, associated with increased morbidity, mortality, and higher costs. Nursing home residents are especially affected, and evidence on institutional factors associated with malnutrition is limited. We calculated the prevalence of malnutrition in Swiss nursing home residents and investigated which structure and process indicators of nursing homes are associated with residents' malnutrition. DESIGN: Subanalysis of the Swiss Nursing Homes Human Resources Project 2018, a multicenter, cross-sectional study conducted from 2018 to 2019 in Switzerland. SETTING AND PARTICIPANTS: This study included 76 nursing homes with a total of 5047 residents. METHODS: Malnutrition was defined as a loss of bodyweight of ≥5% in the last 30 days or ≥10% in the last 180 days. Binomial generalized estimating equations (GEE) were applied to examine the association between malnutrition and structural (staffing ratio, grade mix, presence of a dietician, malnutrition guideline, support during mealtimes) and process indicators (awareness of malnutrition, food administration process). GEE models were adjusted for institutional (profit status, facility size) and specific resident characteristics. RESULTS: The prevalence of residents with malnutrition was 5%. A higher percentage of units per nursing home having a guideline on prevention and treatment of malnutrition was significantly associated with more residents with weight loss (OR 2.47, 95% CI 1.31-4.66, P = .005). Not having a dietician in a nursing home was significantly associated with a higher rate of residents with weight loss (OR 1.60, 95% CI 1.09-2.35, P = .016). CONCLUSIONS AND IMPLICATIONS: Having a dietician as part of a multidisciplinary team in a nursing home is an important step to address the problem of residents' malnutrition. Further research is needed to clarify the role of a guideline on prevention and treatment of malnutrition to improve the quality of care in nursing homes.

They Saw a Debate: Political Polarization Is Associated with Greater Multivariate Neural Synchrony When Viewing the Opposing Candidate Speak.

With rampant polarization in current U.S. politics, it seems as though political partisans with opposing viewpoints are living in parallel realities. Indeed, prior research shows that people's impressions/attitudes toward political candidates are intertwined with their political affiliation. The current study investigated the relationship between political affiliation and intersubject neural synchrony of multivariate patterns of activity during naturalistic viewing of a presidential debate. Before the 2016 U.S. presidential election, 20 individuals varying in political affiliation underwent functional neuroimaging while watching the first debate between candidates Hillary Clinton and Donald Trump. Pairs of participants with more polarized political affiliations were higher in neural synchrony in a system of brain regions involved in self-referential processing when viewing the opposing candidate speak compared with that candidate's supporters regardless of which extreme of the political spectrum they occupied. Moreover, pairs of political partisans matching in the candidate they supported were higher in neural synchrony when watching the candidate they opposed compared with the one they both supported. These findings suggest that political groups' shared understanding may be driven more by perceptions of outgroups than of their own party/candidates.

Spatially and temporally defined lysosomal leakage facilitates mitotic chromosome segregation.

Lysosomes are membrane-surrounded cytoplasmic organelles filled with a powerful cocktail of hydrolases. Besides degrading cellular constituents inside the lysosomal lumen, lysosomal hydrolases promote tissue remodeling when delivered to the extracellular space and cell death when released to the cytosol. Here, we show that spatially and temporally controlled lysosomal leakage contributes to the accurate chromosome segregation in normal mammalian cell division. One or more chromatin-proximal lysosomes leak in the majority of prometaphases, after which active cathepsin B (CTSB) localizes to the metaphase chromatin and cleaves a small subset of histone H3. Stabilization of lysosomal membranes or inhibition of CTSB activity during mitotic entry results in a significant increase in telomere-related chromosome segregation defects, whereas cells and tissues lacking CTSB and cells expressing CTSB-resistant histone H3 accumulate micronuclei and other nuclear defects. These data suggest that lysosomal leakage and chromatin-associated CTSB contribute to proper chromosome segregation and maintenance of genomic integrity.

Dental Patient Safety in the Military Health System: Joining Medicine in the Journey to High Reliability.

INTRODUCTION: Delivering consistent high quality care in a safe environment is the goal of the modern dental delivery system. Preventable adverse events, however, are still commonplace in dentistry. As has been demonstrated in the medical field, a concerted and persistent effort will be required to objectively understand and begin to eliminate the sources of dental error. In civilian dental practice this effort is hampered by the underreporting of patient safety events in comparison to the medical field. Patient safety reporting in the Military Health System (MHS) is robust and includes dentistry. This provides an important opportunity to analyze these data as the foundation for improvements in dental care and the elimination of preventable harm. The purpose of this article is to review MHS dental patient safety data, identify the primary sources of dental error and describe current initiatives based on the adoption of the High Reliability Organization (HRO) model of care that has been profitably embraced by the medical community. METHODS: Dental patient safety report data from the Defense Health Agency Patient Safety Analysis Center (PSAC) for the period 2013-2016 were analyzed to determine the type, incidence, contributing factors, setting and trends for dental errors occurring within the MHS. Comparison to medical data was also performed. RESULTS: From 2013 to 2016, there was a 32.1% increase in dental patient safety reports in the MHS. For this period, dentistry accounted for the highest number of Sentinel Events (SEs) compared to other clinical specialties and accounted for 32.7% of all SEs for the period. From 2013 to 2016, there was a five-fold increase in reported dental SEs. Wrong-Site Surgeries (WSS) comprised the highest proportion of SEs followed by intraoperative or immediate post-operative/post-procedure or surgery issues (63% and 14%, respectively). Within the WSS category, wrong-site anesthesia and wrong-tooth treated were the two largest sub-categories (40% and 32%, respectively). The data reviewed are not rates and do not take into account the total number of procedures performed by dentistry in comparison to medicine. Root cause analysis identified communication failures and inconsistent adoption of the Universal Protocol as the leading contributing factors for WSSs. CONCLUSION: Safety initiatives in the dental profession remain immature in comparison to the medical field and the use of an HRO framework is just beginning to emerge in dentistry. The MHS benefits from a robust dental patient safety reporting system when compared to civilian practice in the United States. Review of these data demonstrates that a high priority focus should be the elimination of WSS. Initiatives based on high reliability strategies to address this issue will be discussed. A commitment to reporting and analyzing its performance and adopting the principles and behaviors of HROs will accelerate the MHS goal of providing ever increasing safety and quality in the dental care it provides.

The default-mode network represents aesthetic appeal that generalizes across visual domains.

Visual aesthetic evaluations, which impact decision-making and well-being, recruit the ventral visual pathway, subcortical reward circuitry, and parts of the medial prefrontal cortex overlapping with the default-mode network (DMN). However, it is unknown whether these networks represent aesthetic appeal in a domain-general fashion, independent of domain-specific representations of stimulus content (artworks versus architecture or natural landscapes). Using a classification approach, we tested whether the DMN or ventral occipitotemporal cortex (VOT) contains a domain-general representation of aesthetic appeal. Classifiers were trained on multivoxel functional MRI response patterns collected while observers made aesthetic judgments about images from one aesthetic domain. Classifier performance (high vs. low aesthetic appeal) was then tested on response patterns from held-out trials from the same domain to derive a measure of domain-specific coding, or from a different domain to derive a measure of domain-general coding. Activity patterns in category-selective VOT contained a degree of domain-specific information about aesthetic appeal, but did not generalize across domains. Activity patterns from the DMN, however, were predictive of aesthetic appeal across domains. Importantly, the ability to predict aesthetic appeal varied systematically; predictions were better for observers who gave more extreme ratings to images subsequently labeled as "high" or "low." These findings support a model of aesthetic appreciation whereby domain-specific representations of the content of visual experiences in VOT feed in to a "core" domain-general representation of visual aesthetic appeal in the DMN. Whole-brain "searchlight" analyses identified additional prefrontal regions containing information relevant for appreciation of cultural artifacts (artwork and architecture) but not landscapes.

Longitudinal Analysis of CAD/CAM Restoration Incorporation Rates into Navy Dentistry.

INTRODUCTION: Computer-aided design/computer-aided manufacturing (CAD/CAM) has gained increasing popularity since the first commercially viable dental system was introduced in the mid-1980s. Digitally milled dental restorations can be fabricated chairside in the course of one dental appointment, reducing time, cost, and manpower when compared with traditional laboratory-fabricated analog restorations. Clinical performance, physical properties, and esthetics of digital restorations have been shown to be comparable to traditional analog restorations. The Navy has incorporated CAD/CAM systems into dental clinics on multiple platforms to include ships. The efficiency of this technology has the potential to positively impact dental health and mission readiness. The objective of the present study was to evaluate placement rates of CAD/CAM restorations by Navy dental providers. MATERIALS AND METHODS: Placement rates of CAD/CAM restorations from October 2011 to June 2017 (Department of Defense created codes specific to CAD/CAM restorations in 2011) and of laboratory-fabricated analog restorations from January 2008 to June 2017 were queried from the Dental Common Access System (DENCAS) and Corporate Dental Access system (CDA) and evaluated. Scatterplots for each dental restoration category were generated using monthly production data and overlaid with simple linear regression lines and 95% confidence intervals. Regression analysis was performed to determine whether changes in the monthly percentages of placements before and after CAD/CAM were increasing or decreasing and to determine whether the monthly percent change from before CAD/CAM implementation and after CAD/CAM implementation was significantly different from one another. RESULTS: A total of 20,512 CAD/CAM restorations were placed by Navy providers over the 68-month period. A year-over-year increase in digitally fabricated restorations was observed. As a percentage of total indirect restorations, CAD/CAM units surged from 13.8% in 2012 to 38.1% in 2017. All ceramic restorations fabricated by the classical analog method also increased significantly through the period. Traditional analog porcelain fused to metal (PFM) restorations and large amalgam restorations, which frequently serve a similar clinical purpose as indirect or direct full or partial tooth coverage restorations, both decreased significantly after CAD/CAM productivity tracking was initiated. CONCLUSIONS: Implementation of CAD/CAM digital restorations has led to a significant decline in specific traditional analog procedures since productivity tracking of CAD/CAM was initiated in 2011. Navy dentistry has embraced CAD/CAM as an efficient means to prepare sailors and marines for deployments, improve operational dental readiness, and potentially decrease dental emergencies by reducing the need for provisional restorations. The trend toward increased utilization of digital dentistry is expected to continue for the following reasons: (1) incorporation of CAD/CAM technology into dental school curricula, (2) advancement of CAD/CAM systems equipped with fast-evolving user interfaces, (3) increased accessibility to CAD/CAM technology in Navy clinics, and (4) training of a greater proportion of dentists in digital CAD/CAM technology. Future studies should investigate the survival rate of CAD/CAM restorations placed within military settings, cost, and manpower of maintaining CAD/CAM units, and impact on military dental laboratories associated with increased CAD/CAM usage.

MicroRNAs and histone deacetylase inhibition-mediated protection against inflammatory ß-cell damage.

Inflammatory ß-cell failure contributes to type 1 and type 2 diabetes pathogenesis. Pro-inflammatory cytokines cause ß-cell dysfunction and apoptosis, and lysine deacetylase inhibitors (KDACi) prevent ß-cell failure in vitro and in vivo, in part by reducing NF-κB transcriptional activity. We investigated the hypothesis that the protective effect of KDACi involves transcriptional regulation of microRNAs (miRs), potential new targets in diabetes treatment. Insulin-producing INS1 cells were cultured with or without the broad-spectrum KDACi Givinostat, prior to exposure to the pro-inflammatory cytokines IL-1ß and IFN-γ for 6 h or 24 h, and miR expression was profiled with miR array. Thirteen miRs (miR-7a-2-3p, miR-29c-3p, miR-96-5p, miR-101a-3p, miR-140-5p, miR-146a-5p, miR-146b-5p, miR-340-5p, miR-384-5p, miR-455-5p, miR-466b-2-3p, miR-652-5p, and miR-3584-5p) were regulated by both cytokines and Givinostat, and nine were examined by qRT-PCR. miR-146a-5p was strongly regulated by cytokines and KDACi and was analyzed further. miR-146a-5p expression was induced by cytokines in rat and human islets. Cytokine-induced miR-146a-5p expression was specific for INS1 and ß-TC3 cells, whereas α-TC1 cells exhibited a higher basal expression. Transfection of INS1 cells with miR-146a-5p reduced cytokine signaling, including the activity of NF-κB and iNOS promoters, as well as NO production and protein levels of iNOS and its own direct targets TNF receptor associated factor 6 (TRAF6) and interleukin-1 receptor-associated kinase 1 (IRAK1). miR-146a-5p was elevated in the pancreas of diabetes-prone BB-DP rats at diabetes onset, suggesting that miR-146a-5p could play a role in type 1 diabetes development. The miR array of cytokine-exposed INS1 cells rescued by KDACi revealed several other miRs potentially involved in cytokine-induced ß-cell apoptosis, demonstrating the strength of this approach.

Interleukin-37 treatment of mice with metabolic syndrome improves insulin sensitivity and reduces pro-inflammatory cytokine production in adipose tissue.

Obesity and the metabolic syndrome are characterized by chronic, low-grade inflammation mainly originating from expanding adipose tissue and resulting in inhibition of insulin signaling and disruption of glycemic control. Transgenic mice expressing human interleukin 37 (IL-37), an anti-inflammatory cytokine of the IL-1 family, are protected against metabolic syndrome when fed a high-fat diet (HFD) containing 45% fat. Here, we examined whether treatment with recombinant IL-37 ameliorates established insulin resistance and obesity-induced inflammation. WT mice were fed a HFD for 22 weeks and then treated daily with IL-37 (1 µg/mouse) during the last 2 weeks. Compared with vehicle only-treated mice, IL-37-treated mice exhibited reduced insulin in the plasma and had significant improvements in glucose tolerance and in insulin content of the islets. The IL-37 treatment also increased the levels of circulating IL-1 receptor antagonist. Cultured adipose tissues revealed that IL-37 treatment significantly decreases spontaneous secretions of IL-1ß, tumor necrosis factor α (TNFα), and CXC motif chemokine ligand 1 (CXCL-1). We also fed mice a 60% fat diet with concomitant daily IL-37 for 2 weeks and observed decreased secretion of IL-1ß, TNFα, and IL-6 and reduced intracellular levels of IL-1α in the liver and adipose tissue, along with improved plasma glucose clearance. Compared with vehicle treatment, these IL-37-treated mice had no apparent weight gain. In human adipose tissue cultures, the presence of 50 pm IL-37 reduced spontaneous release of TNFα and 50% of lipopolysaccharide-induced TNFα. These findings indicate that IL-37's anti-inflammatory effects can ameliorate established metabolic disturbances during obesity.

Development of Electrospun Chitosan-Polyethylene Oxide/Fibrinogen Biocomposite for Potential Wound Healing Applications.

Normal wound healing is a highly complex process that requires the interplay of various growth factors and cell types. Despite advancements in biomaterials, only a few bioactive wound dressings reach the clinical setting. The purpose of this research was to explore the feasibility of electrospinning a novel nanofibrous chitosan (CS)-fibrinogen (Fb) scaffold capable of sustained release of platelet-derived growth factor (PDGF) for the promotion of fibroblast migration and wound healing. CS-Fb scaffolds were successfully electrospun using a dual-spinneret electrospinner and directly evaluated for their physical, chemical, and biological characteristics. CS-polyethylene/Fb scaffolds exhibited thinner fiber diameters than nanofibers electrospun from the individual components while demonstrating adequate mechanical properties and homogeneous polymer distribution. In addition, the scaffold demonstrated acceptable water transfer rates for wound healing applications. PDGF was successfully incorporated in the scaffold and maintained functional activity throughout the electrospinning process. Furthermore, released PDGF was effective at promoting fibroblast migration equivalent to a single 50 ng/mL dose of PDGF. The current study demonstrates that PDGF-loaded CS-Fb nanofibrous scaffolds possess characteristics that would be highly beneficial as novel bioactive dressings for enhancement of wound healing.

A clinical study comparing digital radiography and near-infrared transillumination in caries detection.

OBJECTIVE: The purpose of this study was to compare the effectiveness of detecting proximal carious lesions utilizing a new near-infrared transillumination (NIRTI) system (CariVu, Dexis) to traditional digital bitewing radiography (BWXR). MATERIALS AND METHODS: Thirty patients received four posterior BWXRs and all premolars and molars were individually imaged with the NIRTI device. Sixty-seven proximal carious lesions were classified based on their depth into enamel or dentin for both BWXR and NIRTI images. RESULTS: The caries depth classification between the two systems were strongly correlated (rs  = 0.66; Spearman range: 0.60-0.79 = strong) and significant (P < .001) with a median score of 3 for NIRTI and 2 for BWXR. CONCLUSIONS: The new NIRTI system (CariVu) may serve as an adjunct to BWXR in the diagnosis of proximal caries. CLINICAL SIGNIFICANCE: The NIRTI system could serve as an adjunct diagnostic system that could be used in high-caries risk programs where patients are closely monitored with regimented follow-up appointments. NIRTI could also be beneficial with pregnant or pediatric patients, and in situations where radiography may not be available such as remote humanitarian missions.

A Systematic Comparison of Purification and Normalization Protocols for Quantitative MicroRNA Expressional Profiling in Insulin-Producing Cells.

As microRNAs (miRs) are gaining increasing attention as key regulators of cellular processes, expressional quantification is widely applied. However, in the processing of relatively quantified data, the importance of testing the stability of several reference mRNAs and/or miRs and choosing among these for normalization is often overlooked, potentially leading to biased results. Here, we have optimized the purification of miR-enriched total RNA from pancreatic insulin-producing INS-1 cells. Additionally, we optimized and analyzed miR expression by a qPCR-based microarray and by specific qPCR and tested the stability of candidate reference mRNAs and miRs. Hence, this study gives a widely applicable example on how to easily and systematically test and decide how to normalize miR quantification. We suggest that caution in the interpretation of miR quantification studies that do not comprise stability analysis should be exerted.

Inductive ability of human developing and differentiated dental mesenchyme.

The development of cell-based therapeutic strategies to bioengineer tooth tissue is a promising approach for the treatment of lost or damaged tooth tissue. The lack of a readily available cell source for human dental epithelial cells (ECs) severely constrains the progress of tooth bioengineering. Previous studies in model organisms have demonstrated that developing dental mesenchyme can instruct nondental epithelium to differentiate into enamel-forming epithelium. In this study, we characterized the ability of fetal and adult human dental mesenchyme to promote differentiation of human embryonic stem cell (hESC)-derived ECs (ES-ECs) into ameloblast-lineage cells. ES-ECs were co-cultured either with human fetal dental mesenchymal cells (FDMCs) or with adult dental mesenchymal cells (ADMCs) in either a three-dimensional culture system, or in the renal capsules of SCID mice. When co-cultured with FDMCs in vitro, ES-ECs polarized and expressed amelogenin. Tooth organ-like structures assembled with epithelium and encased mesenchyme and developing enamel-like structures could be detected in the complexes resulting from in vitro and ex vivo co-culture of ES-ECs and FDMCs. In contrast, co-cultured ES-ECs and ADMCs formed amorphous spherical structures and occasionally formed hair. Transcription factors were significantly upregulated in FDMCs compared to ADMCs including MSX1, GLI1, LHX6, LHX8,LEF1 and TBX1. In summary, FDMCs but not ADMCs had the capacity to induce differentiation of ES-ECs into ameloblast lineage cells. Further characterization of the functional differences between these two types of dental mesenchyme could enable reprogramming of ADMCs to enhance their odontogenic inductive competence.

Leucine rich amelogenin peptide alters ameloblast differentiation in vivo.

Highly mineralized tooth enamel develops from an extracellular matrix chiefly comprised of amelogenins formed by splicing of 7 (human) or 9 (rodent) exons secreted from specialized epithelial cells known as ameloblasts. Here we examined the role of the 59 amino acid alternatively spliced amelogenin known as leucine rich amelogenin peptide (LRAP) on enamel formation, using transgenic murine models in which LRAP overexpression is driven by an amelogenin promoter (TgLRAP). Beginning in the secretory stage of mouse amelogenesis, we found a reduced thickness of enamel matrix and a loss of Tomes' processes, followed by upregulated amelogenin mRNA expression, inhibited amelogenin secretion and loss of cell polarity. In the presecretory stage (P0) amelogenin m180 mRNA expression was increased 58 fold along with a 203 fold increase in MMP-20 expression and 3.5 and 3.2 fold increased in respectively enamelin and ameloblastin. When LRAP was overexpressed on an amelogenin knockout mouse model, the ameloblasts were not affected. Further, expression of the global chromatin organizer and transcription factor SATB1 was reduced in secretory stage TgLRAP ameloblasts. These findings identify a cellular role for LRAP in enamel formation that is not directly related to directing enamel crystal formation as is reported to be the primary function of full length amelogenins. The effect of LRAP overexpression in upregulating amelogenins, MMP-20 and SATB1, suggests a role in protein regulation critical to ameloblast secretion and matrix processing, to form a mineralized enamel matrix.

Imaging Simulated Secondary Caries Lesions with Cross Polarization OCT.

The clinical diagnosis of secondary caries has been found to account for the replacement of the majority of intra-coronal restorations. Current methods to diagnose the presence of these lesions at early stages are considered insufficient due to their low sensitivity. Polarization-sensitive optical coherence tomography (PS-OCT) imaging studies have confirmed its effectiveness for imaging carious subsurface lesions in enamel and dentin. The objective of this study was to determine if PS-OCT can be used to nondestructively image demineralization through resin restorations on extracted teeth with both simulated and natural lesions. Simulated secondary caries lesions were created by exposing cavity preparations made in extracted human teeth to a demineralizing solution for 48 hours and subsequently restoring with resin. Negative control restorations were also prepared on each tooth. Optical changes in demineralized versus control preparations beneath restorations were measured as a function of depth using PS-OCT. PS-OCT images indicated that a significant increase in reflectivity and depth occurred in the simulated lesions compared with the control preparations. This study suggests that PS-OCT is well-suited to nondestructively detect early caries lesions in enamel beneath composite restorations.

Caries remineralization therapy: implications for dental readiness.

Caries remineralization therapy can effectively arrest or reverse the progression of incipient proximal caries lesions. Remineralization of tooth structure is accomplished via a series of topical fluoride applications over time using a combination of both in-office and at-home fluoride agents. Remineralization therapy should be considered a viable noninvasive alternative to restoration for all caries lesions that do not exhibit frank cavitation of the proximal enamel surface (i.e., all lesions in enamel, as well as most lesions in the outer dentin). Combining a conservative restorative approach with an aggressive caries remineralization program may provide substantial therapeutic benefit and significantly reduce both costs and long-term restorative need among military patient populations.

Rationale and protocol for the treatment of non-cavitated smooth surface carious lesions.

The decision to restore a smooth surface carious lesion should be based on whether the lesion has cavitated. All non-cavitated lesions should receive preventive therapy aimed at arresting and remineralizing the lesion. Dental caries is a disease based on an imbalance in the equilibrium of ion exchange between the tooth and dental plaque, resulting in a net mineral loss. This equilibrium often can be reversed prior to cavitation, eliminating the need for treating the tooth surgically. Dentists in the U.S. often are apt to restore all lesions that have radiographically penetrated the dentinoenamel junction; however, most of these lesions have not cavitated and can be treated with preventive therapy. Restorations have a limited lifespan and the preparation is enlarged every time a restoration is replaced; as a result, a surgical approach can lead to unnecessary removal of tooth structure and eventually lead to more extensive treatment such as root canal therapy. This article reviews the rationale for deciding when to restore or remineralize non-cavitated lesions on the smooth tooth surfaces in the permanent dentition (and when to provide no treatment at all), what preventive treatment should be administered, and how to determine if the disease has been arrested.

Accuracy of prescription medication reporting among active duty U.S. Army dental patients.

Dentist routinely ask patients about medication usage before dental treatment. The purpose of this study was to determine if active duty personnel relate accurate information about medications they have been prescribed in the 6 months before an annual dental examination. This study also examined whether patients knew the dosage of the medication they were prescribed. The information in this study was obtained from 100 active duty soldiers at their dental examinations. The data were verified through the Composite Health Care System computer information system. In this study, 35% of patients had been prescribed at least one medication. Fifty-one percent of the patients prescribed medication in this study accurately reported their prescription history in the 6 months before their dental examinations. Forty-five percent of the patients that reported being prescribed medication actually knew the correct dosage of the medication they were prescribed.