Continued competency in the specialties and academics.

The competency approach to education requires demonstration of a set of knowledge, skills, and values appropriate to the current practice situation. The Commission on Dental Accreditation requires that dental educational programs provide evidence that predoctoral programs, postgraduate dental education, dental hygiene, and specialty programs provide evidence that their programs make it possible for candidates to achieve competence, assess competence and provide remediation, and deny degrees or certificates to those who do not possess competence. All nine specialty programs recognized by the American Dental Association require additional periodic assessment for continued competence. These programs continue to experiment with cost-effective means for assessing competence at higher levels and on a continuing basis. Dental education programs also require demonstrations of on-going competence in the areas of teaching and scholarship, typically through formal peer-review processes.

Dental students persuade the Michigan Dental Association to strengthen its codes of ethics: do actions speak louder than words?

This is a case study of how four different groups viewed proposed language in professional ethics codes regarding personal relationships with patients. The ADA Council on Ethics, Bylaws, and Judicial Affairs; the House of Delegates of the Michigan State Dental Association; and first-year students at the University of Michigan School of Dentistry favored a strongly worded statement in their codes, while the House of Delegates of the ADA passed a statement that was more "advisory" in nature. Support material concerning the statement on personal relationships is presented as an ethics case, and suggestions are presented regarding the ethical principles underlying positions on the issue.

Trends in Basic Sciences Education in Dental Schools, 1999-2016.

The purpose of this study was to examine data published over the past two decades to identify trends in the basic sciences curriculum in dental education, provide an analysis of those trends, and compare them with trends in the basic sciences curriculum in medical education. Data published from the American Dental Association (ADA) Surveys of Dental Education, American Dental Education Association (ADEA) Surveys of Dental School Seniors, and two additional surveys were examined. In large part, survey data collected focused on the structure, content, and instructional strategies used in dental education: what was taught and how. Great variability was noted in the total clock hours of instruction and the clock hours of basic sciences instruction reported by dental schools. Moreover, the participation of medical schools in the basic sciences education of dental students appears to have decreased dramatically over the past decade. Although modest progress has been made in implementing some of the curriculum changes recommended in the 1995 Institute of Medicine report such as integrated basic and clinical sciences curricula, adoption of active learning methods, and closer engagement with medical and other health professions education programs, educational effectiveness studies needed to generate data to support evidence-based approaches to curriculum reform are lacking. Overall, trends in the basic sciences curriculum in medical education were similar to those for dental education. Potential drivers of curriculum change were identified, as was recent work in other fields that should encourage reconsideration of dentistry's approach to basic sciences education. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Psychometric Evaluation of a 13-Point Measure of Students' Overall Competence in Community-Based Dental Education Programs.

Since 2006, the University of Michigan School of Dentistry has used a 13-point measure of overall competence instrument to assess fourth-year dental students' end-rotation performance at community clinics. The aim of this study was to assess the reliability and validity of this instrument used by preceptors to rate students' overall competence during community-based dental education experiences. The measure was analyzed using performance ratings for all fourth-year DDS students in the graduating classes of 2012 and 2013 (combined n=201). The results were that interrater agreement was satisfactory and the measure scored high for internal consistency; also, the measure loaded highly on a single overall competence factor. Ratings on this measure did not correlate with students' final cumulative dental school GPA, but showed a significant positive correlation with their fourth-year fall patient management grades (which signify students' conscientiousness in managing patients and their families in a professional and ethical manner). There were differences in grading systems between the 2012 cohort (which used a pass/fail system) and the 2013 cohort (which used a letter grade system) and the mean ratings they received (higher for the 2013 cohort). Overall, the study found that the 13-point measure demonstrated excellent reliability and validity, suggesting it is useful in determining a student's clinical competence in these settings.

The status of ethics teaching and learning in U.S. dental schools.

The purpose of this study was to gather and analyze information about the status of ethics teaching and learning in U.S. dental schools and to recommend a curriculum development and research agenda for professional ethics in dental education. A survey to collect this information was developed by the authors and administered by the American Society for Dental Ethics. The results suggest that dental schools have adopted many of the recommendations for curricular content and learning strategies proposed in the 1989 American Association of Dental Schools (now American Dental Education Association) Curriculum Guidelines on Ethics and Professionalism in Dentistry. The survey was sent to the individual who directs the ethics curriculum at the fifty-six U.S. dental schools that had a full complement of enrolled predoctoral classes as of January 2008. All fifty-six schools responded to the survey. The data suggest that, in general, little time is devoted to ethics instruction in the formal curriculum. The mean number of contact hours of ethics instruction is 26.5 hours, which represents about 0.5 percent of the mean clock hours of instruction for dental education programs reported in the most recent American Dental Association survey of dental education. While the amount of time devoted to ethics instruction appears not to have changed much over the past thirty years, what has changed are what qualifies as ethics instruction, the pedagogies used, and the development and availability of norm-referenced learning outcomes assessments, which are currently used by a number of schools. We found that dental schools address a substantial list of topics in their ethics instruction and that there is general agreement as to the appropriateness of the topics and the ethics competencies that need to be developed and assessed. This study also identified the respondents' perceptions of unmet needs in ethics education. Four general themes emerged: the need for ethics to be more fully integrated across the curriculum, including carryover into the clinical years; the need to assess and ensure competence; the need for faculty development; and the need for more attention to method of instruction. Recommendations based on the study findings are offered for a curriculum development and research agenda for professional ethics in dental education.

The spectrum of antimicrobial activity of the bacteriocin subtilosin A.

BACKGROUND: Bacterocins are antimicrobial peptides produced by bacteria with a relatively narrow range of activity against closely related organisms. Subtilosin A is a bacteriocin produced by Bacillus subtilis that has activity against Listeria monocytogenes, which might indicate antimicrobial activity unusual for bacteriocins. OBJECTIVES: To examine the antimicrobial activity and factors affecting the activity of subtilosin A against a range of potentially pathogenic bacteria. METHODS: The peptide was purified from cultures of B. subtilis and the MIC determined for 18 species of bacteria using a microdilution methodology. The extent of capsule formation was determined using microscopic examination of cells mounted in India ink. Protease mutants of a susceptible bacteria and mild heat shock were used to examine the effect of environmental stress on subtilosin A activity. RESULTS: Subtilosin A proved to have antimicrobial activity against a wide range of bacteria including Gram-positive and Gram-negative bacteria and both aerobes and anaerobes. The peptide was less effective against capsulated forms of two Gram-negative bacteria than the non-capsulated strains of either. Heat shock but not protease activity also altered the effectiveness of the bacteriocin. CONCLUSIONS: Subtilosin A has limited antimicrobial activity against a number of human pathogens which, combined with its relative ineffectiveness against some capsulated pathogens, may limit its usefulness as a human therapeutic.

Induction of {beta}-defensin resistance in the oral anaerobe Porphyromonas gingivalis.

Induction of resistance of oral anaerobes to the effects of human beta-defensin 1 (hbetaD-1) to hbetaD-4 was investigated by pretreating cells with either sublethal levels of defensins or environmental factors, followed by a challenge with lethal levels of defensins. Cultures of Porphyromonas gingivalis were (i) pretreated with defensins at 1 ng/ml, (ii) heated to 42 degrees C (heat stress), (iii) exposed to normal atmosphere (oxidative stress), or (iv) exposed to 1 mM hydrogen peroxide (peroxide stress). Samples (10 microl) were distributed among the wells of sterile 384-well plates containing hbetaD-1 to -4 (100 microg/ml). Plates were incubated at 37 degrees C for 36 h in an anaerobe chamber. Growth inhibition was determined by a system that measures the total nucleic acid of a sample with a DNA binding dye. The MICs of the four defensins for P. gingivalis were 3 to 12 microg/ml. We found that sublethal levels of the defensins and heat and peroxide stress, but not oxidative stress, induced resistance to 100 microg of defensin per ml in P. gingivalis. Resistance induced by sublethal levels of hbetaD-2 lasted 90 min, and the resistance induced by each defensin was effective against the other three. Multiple strains exposed to hbetaD-2 all evidenced resistance induction. Defensin resistance is vital to the pathogenic potential of several human pathogens. This is the first report describing the induction of defensin resistance in the oral periodontal pathogen P. gingivalis. Such resistance may have an effect on the ability of oral pathogens to persist in the mouth and to withstand innate human immunity.