On the reliability of a dental OSCE, using SEM: effect of different days.

AIM: The first aim was to study the reliability of a dental objective structured clinical examination (OSCE) administered over multiple days, and the second was to assess the number of test stations required for a sufficiently reliable decision in three score interpretation perspectives of a dental OSCE administered over multiple days. MATERIALS AND METHODS: In four OSCE administrations, 463 students of the year 2005 and 2006 took the summative OSCE after a dental course in comprehensive dentistry. The OSCE had 16-18 5-min stations (scores 1-10), and was administered per OSCE on four different days of 1 week. ANOVA was used to test for examinee performance variation across days. Generalizability theory was used for reliability analyses. Reliability was studied from three interpretation perspectives: for relative (norm) decisions, for absolute (domain) and pass-fail (mastery) decisions. As an indicator of reproducibility of test scores in this dental OSCE, the standard error of measurement (SEM) was used. The benchmark of SEM was set at <0.51. This is corresponding to a 95% confidence interval (CI) of <1 on the original scoring scale that ranged from 1 to 10. RESULTS: The mean weighted total OSCE score was 7.14 on a 10-point scale. With the pass-fail score set at 6.2 for the four OSCE, 90% of the 463 students passed. There was no significant increase in scores over the different days the OSCE was administered. 'Wished' variance owing to students was 6.3%. Variance owing to interaction between student and stations and residual error was 66.3%, more than two times larger than variance owing to stations' difficulty (27.4%). The SEM norm was 0.42 with a CI of +/-0.83 and the SEM domain was 0.50, with a CI of +/-0.98. In order to make reliable relative decisions (SEM <0.51), the use of minimal 12 stations is necessary, and for reliable absolute and pass-fail decisions, the use of minimal 17 stations is necessary in this dental OSCE. CONCLUSIONS: It appeared reliable, when testing large numbers of students, to administer the OSCE on different days. In order to make reliable decisions for this dental OSCE, minimum 17 stations are needed. Clearly, wide sampling of stations is at the heart of obtaining reliable scores in OSCE, also in dental education.

Dental anxiety and psychological functioning in children: its relationship with behaviour during treatment.

AIM: In this study the relationship between the levels of dental anxiety, psychological functioning and earlier experience with dental injections are examined and the possible influence of these factors on children's behaviour before and during a local anaesthesia injection. METHODS: A total of 128 children (4-11 years) were included. The level of dental anxiety and the psychological functioning were measured using the 'Children's Fear Survey Schedule' (CFSS-DS) and the 'Strengths and Difficulties Questionnaire' (SDQ). Based on video recordings the anxiety behaviour was scored on the Venham-scale. RESULTS: There was a positive correlation between levels of dental anxiety, psychological functioning and anxiety behaviour before and during the dental injection. In particular children with emotional problems or peer problems tended to show more anxiety behaviour before the injection and children with emotional or hyperactivity problems tend to show more anxiety behaviour during the injection. Furthermore, the younger children (below 6 years of age), with previous dental experience in the past 6 months, tended to display more anxiety behaviour both before and during the injection than children without or with experience from longer ago. CONCLUSION: The level of dental anxiety and psychological functioning and recent previous dental experience are important factors in determining which child is likely to display more anxiety and uncooperative behaviour during treatment and therefore potentially need more attention to be able to cope well with dental treatment.

Pain behaviour and distress in children during two sequential dental visits: comparing a computerised anaesthesia delivery system and a traditional syringe.

OBJECTIVE: To compare the pain and distress response of children receiving a local anesthesia injection using a computerised device (Wand) or a traditional syringe over two consecutive treatment sessions and to study whether the response to the two injection techniques was different for high or low dentally anxious children. DESIGN: Randomised controlled trial. SETTING: Secondary dental care practice specialised in treating children. SUBJECTS AND METHODS: Children were selected and randomly allocated to the Wand or traditional injection condition. Parents completed the Dental Subscale of the Children's Fear Survey Schedule (CFSS-ds). Based on video recordings of the injections, for each 15 seconds, the occurrence of five pain related behaviours was registered and a score was given on the Venham distress scale. Children rated their pain after each injection. INTERVENTION: Over two consecutive treatment sessions one group received two local anaesthesia injections with the traditional syringe and the other group received two injections with the Wand. OUTCOME MEASURES: The mean number of pain related behaviours, the mean distress scores and the self-reported pain scores were compared. Based on the CFSS-ds subjects were split into highly and low dentally anxious children. RESULTS: One hundred and forty-seven subjects participated in the study: aged 4-11 years, 71 girls. Based on the behaviour displayed during the local anaesthesia injection and the self-reported pain after the injection, no difference could be found between an injection with the traditional syringe or the Wand over the first or second treatment session. However, on the first treatment session, highly anxious children reported more pain (p = 0.001), displayed more pain related behaviour (p = 0.002) and more distress (p <0.001) than low anxious children in reaction to the local anaesthesia injection. CONCLUSION: No clear difference in the response of referred children could be found between an injection with the Wand or the traditional syringe. Level of dental anxiety was found to be an important factor in the response of children to a local anaesthesia injection.

[Amalgam. XVIII. Group characteristics in the attitude to and perception of amalgam]. / Amalgaam. XVIII. Groepskenmerken in de houding ten aanzien van amalgaam.

Based upon their answers to a questionnaire, 1147 respondents could be divided into four groups. One group has a critical attitude to amalgam, the second is 'uncritical', the third 'uninformed' and the fourth, among which many with health complaints attributed to amalgam fillings, is named 'imaginary group'. The division is based upon nine out of 15 variables: 1. potential harmfulness of amalgam; 2. worry about the general health because of amalgam; 3. attribution of existing health complaints to amalgam; 4. reading/hearing about harmfulness of amalgam; 5. visits to alternative healers and quacks; 6. knowing that fish contains mercury; 7. knowing that amalgam contains mercury; 8. opinions on homeopathic medicines; 9. presence of dental amalgam. Among others preventive health and environmental actions were not of importance. The respondents, distinguished by sex, age and education, are not evenly distributed. An analysis of a second sample is considered in general to corroborate the findings. Although the analysis cannot reveal causal relationships, the results suggest the possibility that the population is kidded into distrust towards amalgam by the mass media and alternative healers.

Dental treatment of fearful children, using nitrous oxide. Part I: Treatment times.

This study investigated the influence of nitrous oxide on treatment time when it is used as an additional aid to behavior management. Different parts of the treatment of highly anxious child dental patients may vary during sequential dental visits, and separate consecutive parts of the treatment were considered in terms of their duration. Fifty-six children between the ages of six and eleven, each with a previous negative dental experience, were selected. They were randomly assigned into one of two matching groups: one with behavioral management only (control); the other also having nitrous oxide sedation (experimental). Interval 1, involved getting used to the procedures; interval 2 was sedation; interval 3, local anesthesia; and interval 4, preparation and filling. Most children required between four and six sessions. Results show that in terms of total treatment time (TTT), the use of nitrous oxide does not save time, although dental treatment did not require a greater number of sessions. For the dentist to erase the negative imprint of a previous dental experience, special skills are required. Further research is advised concerning the anxiety levels of this age-group.