Student Self-Assessment of Operative Dentistry Experiences: A Time-Dependent Exercise in Self-Directed Learning.

The aim of this study was to evaluate the process of student self-assessment on operative dentistry skills across four years at the University of Louisville School of Dentistry. First, a retrospective analysis of the Class of 2016 students' self-assessment and faculty assessment grade sheets was conducted to determine mean differences and correlations across time. Both preclinical (D2: n=120) and clinical (D3: n=120; D4: n=120) grade sheets were evaluated. Second, 25 students from each of the D1, D2, D3, and D4 classes in 2016 were asked to evaluate dentoform work, and 25 operative calibrated faculty members graded the same two dentoforms. The results of the retrospective analysis were that the D2 students' self-assessment scores were significantly higher than the faculty scores (t-test; p<0.05), and there was a negative correlation of scores (r=-0.503). The D3 students' self-assessment scores were also significantly higher than the faculty scores (t-test; p<0.05), and there was a negative correlation (r=-0.235). The D4 students' self-assessment scores were not significantly different from the faculty scores (t-test; p>0.05), and there was a positive correlation (r=0.408). In the prospective analysis, the D1, D2, and D3 students graded the dentoforms significantly higher (ANOVA; p<0.05) than did the D4 students and faculty members. There was an increasing correlation of scores directly related to experience (D1: r=-0.120; D2: r=0.255; D3: r=0.352; D4: r=0.689). These results support the concept that students' self-assessment is a learned process through experiential and continual encounters across time. The summative goal for all dental schools is to provide students with the skills and knowledge to critically evaluate their work for self-directed learning.

Wound Healing of the Laterally Positioned Flap: A Histomorphometric Assessment.

The aim of this study was to histomorphometrically assess the soft tissue anatomy in single gingival recessions (GR) treated with a laterally positioned flap (LPF). Five patients presenting maxillary first molars with GR to the apex of the buccal surface of the mesial-buccal root were invited to take part. The LPF-treated roots were removed en bloc (the root and the soft tissue covering the treated GR) 3 to 4 months postoperatively. Photomicrographs of Mallory trichrome stain sections were taken to allow reassessment of the specimens regarding the longitudinal dimensions of the crevicular/sulcular and junctional epithelia. The use of LPF resulted in new attachment with formation of crevicular epithelium, long junctional epithelium, and some connective tissue, re-establishing the normal anatomical characteristics of the soft tissues covering the previously exposed root.

Disparity in perception of the working condition of dental hygienists between dentists and dental hygiene students in Japan.

OBJECTIVES: In Japan, there continues to be a shortage of active dental hygienists. The scope of dental hygienists' practice is also considered to be unclear. One of the reasons for this is that dental hygienists find the working conditions during dental hygiene education different from those in reality. The purpose of this study was to clarify the actual working condition of dental hygienists in dental clinics, as well as evaluate the awareness of dental hygiene students and dentists regarding the working condition of dental hygienists. METHODS: Questionnaires were sent by post to 481 dentists and were distributed to 89 dental hygiene students. The awareness about the working condition of dental hygienists was compared between dentists and dental hygiene students. RESULTS: Two hundred twenty-two dentists and 89 dental hygiene students responded to questionnaires. Dental hygiene students considered the team of 'dental hygienist, dental technician and clerk' to be more effective in providing dental care than dentists (P < 0.001). Among the dentists, 37.1% did not find any clear distinction between hygienists and assistants in their clinics. However, 97.4% of dental hygiene students answered that dental team members should clearly inform patients of the distinction between hygienists and assistants. CONCLUSIONS: This study indicated that there was disparity between dentists' and dental hygiene students' perception of dental hygienists' working conditions, and dental team work was not always effective. For training high quality dental hygienists, all educational institutions related to dentistry must educate students regarding the more realistic dental hygienists' working condition, as well as benefits.

Safety and cost-effectiveness of bridge therapies for invasive dental procedures in patients with mechanical heart valves.

PURPOSE: Bridge anticoagulation therapy is mostly utilized in patients with mechanical heart valves (MHV) receiving warfarin therapy during invasive dental procedures because of the risk of excessive bleeding related to highly vascular supporting dental structures. Bridge therapy using low molecular weight heparin may be an attractive option for invasive dental procedures; however, its safety and cost-effectiveness compared with unfractionated heparin (UFH) is uncertain. MATERIALS AND METHODS: This study investigated the safety and cost-effectiveness of enoxaparin in comparison to UFH for bridge therapy in 165 consecutive patients (57±11 years, 35% men) with MHV who underwent invasive dental procedures. RESULTS: This study included 75 patients treated with UFH-based bridge therapy (45%) and 90 patients treated with enoxaparin-based bridge therapy (55%). The bleeding risk of dental procedures and the incidence of clinical adverse outcomes were not significantly different between the UFH group and the enoxaparin group. However, total medical costs were significantly lower in the enoxaparin group than in the UFH group (p<0.001). After multivariate adjustment, old age (≥65 years) was significantly associated with an increased risk of total bleeding independent of bridging methods (odds ratio, 2.51; 95% confidence interval, 1.15-5.48; p=0.022). Enoxaparin-based bridge therapy (ß=-0.694, p<0.001) and major bleeding (ß=0.296, p=0.045) were significantly associated with the medical costs within 30 days after dental procedures. CONCLUSION: Considering the benefit of enoxaparin in cost-effectiveness, enoxaparin may be more efficient than UFH for bridge therapy in patients with MHV who required invasive dental procedures.

Contemporary issues in the provision of restorative dentistry.

This review highlights current issues in the provision of restorative dentistry both in primary and secondary care settings. Current challenges in the provision of restorative procedures are reviewed and methods in improving care and efficiency are proposed. Possible changes to the infrastructure and delivery of care are suggested in order to improve effectiveness and the patient pathway.

Comparison of student productivity in four-handed clinic and regular unassisted clinic.

Although four-handed dentistry is routine in most dental practices in the United States, solo unassisted clinical practice is the norm for students at many North American dental schools. The objective of this study was to compare the clinical productivity of fourth-year dental students practicing in a four-handed model to the clinical productivity of those same fourth-year dental students practicing in a solo, unassisted mode at the University of Iowa College of Dentistry for the three academic years 2005-08. Students averaged 2.62 patient visits per day in the four-handed Dental Auxiliary Utilization (DAU) Clinic and 1.74 visits per day in the regular Family Dentistry Clinic. Charging fees that are approximately 50 percent of prevailing local private practice fees, the mean daily charges for services provided by individual students averaged $329 in the DAU Clinic and $190 in the Family Dentistry Clinic. The mean daily productivity differentials were 0.88 patient visits and $139. While students averaged 51 percent more patient visits and 75 percent higher charges daily in the DAU Clinic as compared to the regular Family Dentistry Clinic, the increased revenues might not be sufficient to offset increased expenses incurred in the four-handed clinical operation.

Selecting equipment for the ergonomic four-handed dental practice.

Practicing dental professionals are advised to work with equipment designed to address the need for productivity and stress reduction. Selection of dental equipment for use in an ergonomic, four-handed dentistry practice is integral to the success of the concept. In order for the dental assistant and dentist to work effectively as a team, they have to work in a safe, ergonomically sound working environment. This article examines various designs of dental equipment, the advantages and disadvantages of each, as well as identifies the criteria for equipment selection.

Infection control in practice. Infection control and clinical efficiency: are they compatible?

A frequently expressed concern regarding infection control guidelines is that they require too much time, effort and expense. This paper will address those concerns by examining the relationship between infection control and clinical efficiency. Infection control procedures can be minimized if proper attention is given to the concept of Limited Surface Contamination. Adherence to a clearly defined Zone of Contamination is essential. Emphasis should be on prevention rather than elimination of contamination. By following well-established principles of Dental Assistant Utilization (DAU), or 'four-handed dentistry', clinical efficiency is enhanced and infection control improved. Proper infection control in the dental surgery is virtually impossible without the cooperation and involvement of a well-trained, committed dental chairside assistant.