FINDINGS AND FUTURE DIRECTIONS FROM A SMOKING CESSATION TRIAL UTILIZING A CLINICAL DECISION SUPPORT TOOL.

BACKGROUND: Tobacco smoking is the leading cause of disease, death, and disability in the United States. Dental practitioners are advised to provide evidence-based smoking cessation interventions to their patients, yet dental practitioners frequently fail to deliver brief smoking cessation advice. OBJECTIVES: To test whether giving dental practitioners a clinical decisions support (CDS) system embedded in their electronic dental record would increase the rate at which patients who smoke (1) report receiving a brief intervention or referral to treatment during a recent dental visit, (2) taking action related to smoking cessation within 7 days of visit, and (3) stop smoking for 1 day or more or reduce the amount smoked by 50% within 6 months. METHODS: Two-group, parallel arm, cluster-randomized trial. From March through December 2019, 15 nonacademic primary care dental clinics were randomized via covariate adaptive randomization to either a usual care arm or the CDS arm. Adult smokers completed an initial telephone survey within 7 days of their visit and another survey after 6 months. RESULTS: Forty-three patients from 5 CDS and 13 patients from 2 usual care clinics completed the 7-day survey. While the proportion of patients who reported receipt of a brief intervention or referral to treatment was significantly greater in the CDS arm than the usual care arm (84.3% vs 58.6%; P = .005), the differences in percentage of patients who took any action related to smoking cessation within 7 days (44.4% vs 22.3%; P = .077), or stopped smoking for one day or more and/or reduced amount smoked by 50% within 6 months (63.1% vs 46.2%; P = .405) were large but not statistically significant. CONCLUSIONS: Despite interruption by COVID-19, these results demonstrate a promising approach to assist dental practitioners in providing their patients with smoking cessation screening, brief intervention and referral to treatment.

Snus use and rejection in the USA.

OBJECTIVE: To determine whether snus might become a strategy for reducing the harm associated with cigarette smoking in the USA as appears to be the case in Sweden, we examined receptivity to snus use in two cities with the greatest exposure to the major brands. METHODS: A dual frame, telephone survey and a brief mail survey were conducted in 2011 and 2012 in Indianapolis, Indiana and Dallas/Fort Worth Texas. Over 5000 adults completed surveys. Trial, ever use, current use and reasons for using or quitting snus after trial were measured. RESULTS: Among male smokers, 29.9% had ever tried snus (CI 22.7 to 38.1) and 4.2% were current users (CI 1.6 to 10.7). Among female smokers, 8.5% ever tried snus (CI 4.4 to 15.7) and current use was unknown. Current use was virtually absent among former smokers and never smokers. A major predictor of any level of snus use was current use of conventional smokeless tobacco. Those who tried and gave up snus cited curiosity (41.3%) and the fact that it was available at low or no cost (30%) as reasons for trial; reasons for not continuing included preferring another form of tobacco (75.1%) and disliking the mouth feel (34.6%). Almost all current snus users indicated that they were trying to cut down on cigarettes, but few (3.9%) were using it to quit smoking entirely. CONCLUSIONS: The low rate of adoption of snus suggests that neither the hopes nor the fears surrounding this new product are likely to be realised in the USA with the current marketing patterns.

American Dental Education Association Compendium Entrustable Professional Activities Workgroup report.

PURPOSE: Entrustable professional activities (EPAs) are discrete clinical tasks that can be evaluated to help define readiness for independent practice in the health professions and are intended to increase trust in the dental graduate. EPAs provide a framework that bridges competencies to clinical practice. This report describes the work of the American Dental Education Association (ADEA) Compendium EPA Workgroup to develop a list of EPAs for dental education and supportive resources, including specifications and a glossary. METHODS: Preliminary work including literature and resource review, mapping of existing competencies, and review of other health professions' EPAs informed the development of our EPAs list. Workgroup members achieved consensus using a modified Delphi process. A Qualtrics survey using a validated rubric for the assessment of EPAs as described in peer-reviewed literature was used. Dental educators, including academic deans, were surveyed for feedback on the content and format of the EPAs. RESULTS: Based on findings in the literature analysis of existing EPAs and competencies in health professions, a list of EPAs was developed along with a description of specifications. The EPA workgroup (nine members from multiple institutions) used the Delphi process in receiving feedback from various experts. A list of 11 core EPAs was vetted by dental educators including academic deans (n = âˆ¼23), and the process of development was reviewed by EPAs experts outside dental education. A glossary was developed to align language. CONCLUSION: These EPAs define the scope of dental practice. This report represents Phase 1 of the EPA framework development and vetting process. Future directions will include a broader vetting of the EPA list, faculty development, and national standardized technology that support this work to optimize implementation.

Tobacco use and health risks in two dental clinic populations: Implementation and evaluation of a brief targeted intervention.

The present study compared emergency dental clinic and hygiene clinic patients in terms of tobacco use and health risks, and began and evaluated an Ask/Advise/Refer intervention in the emergency clinic. Randomly selected records (N = 820) of patients from both clinics were reviewed and demographics, tobacco, and health data were recorded and analyzed. After a brief training period, student dentists delivered a five-week emergency clinic tobacco intervention and completed a post-intervention evaluation survey. Tobacco use was higher in the emergency clinic and was correlated with systemic and oral disease. Of the 327 emergency clinic patients seen during the pilot study, 50% were smokers, 46% of whom expressed an interested in quitting and 35% of whom obtained cessation referral. Thirty students (86%) completed the evaluation; perceptions of the intervention were neutral to favorable. The emergency clinic Ask/Advise/Refer intervention was well-received by patients and clinicians.

Financial assessment of the community-based dental education program at the Indiana University School of Dentistry.

BACKGROUND: There is a gap in access to oral health services for millions of Americans residing in health professional shortage areas. The community-based dental education program at the Indiana University School of Dentistry is an innovative model that aims to improve access to oral health services in rural underserved Indiana. OBJECTIVE: With this study, our goal was to assess the financial implications of the program over a period of 3 years (2018-2021). METHODS: Proxy estimates for the revenue generated by students at the community clinic sites were calculated and compared against the implementation costs of the program as well as revenue lost by the school during the rotation period. Descriptive statistics were used to assess the quantitative impact of the program over the 3 years. RESULTS: The total of 7460 patients who were offered care as part of this program were mostly from the uninsured group or were covered under Medicaid. According to our cost-benefit analysis which was conducted during the peak of the coronavirus disease 2019 (COVID-19) pandemic, the total revenue of $1,777,097 was generated by students at the community sites through the 3-year period. The revenue generated was still more than the dollar amount invested in running the program, given the timeline of the study was when elective services were mostly suspended. CONCLUDE: We conclude community programs like these have an impact beyond the dollar value; they can be modeled to be cost-effective, improve access to oral health services for millions of Americans in underserved settings and at the same time provide a great learning experience for dental students.

Analyzing Medication Documentation in Electronic Health Records: Dental Students' Self-Reported Behaviors and Charting Practices.

The aim of this two-part study was to assess third- and fourth-year dental students' perceptions, self-reported behaviors, and actual charting practices regarding medication documentation in axiUm, the electronic health record (EHR) system. In part one of the study, in fall 2015, all 125 third- and 85 fourth-year dental students at one U.S. dental school were invited to complete a ten-item anonymous survey on medication history-taking. In part two of the study, the EHRs of 519 recent dental school patients were randomly chosen via axiUm query based on age >21 years and the presence of at least one documented medication. Documentation completeness was assessed per EHR and each medication based on proper medication name, classification, dose/frequency, indication, potential oral effects, and correct medication spelling. Consistency was evaluated by identifying the presence/absence of a medical reason for each medication. The survey response rate was 90.6% (N=187). In total, 64.5% of responding students reported that taking a complete medication history is important and useful in enhancing pharmacology knowledge; 90.4% perceived it helped improve their understanding of patients' medical conditions. The fourth-year students were more likely than the third-year students to value the latter (p=0.0236). Overall, 48.6% reported reviewing patient medications with clinic faculty 76-100% of the time. The respondents' most frequently cited perceived barriers to medication documentation were patients' not knowing their medications (68.5%) and, to a much lesser degree, axiUm limitations (14%). Proper medication name was most often recorded (93.6%), and potential oral effects were recorded the least (3.0%). Medication/medical condition consistency was 70.6%. In this study, most of the students perceived patient medication documentation as important; however, many did not appreciate the importance of all elements of a complete medication history, and complete medication documentation was low.

Evolution of a tobacco cessation curriculum for dental hygiene students at Indiana University School of Dentistry.

Barriers to consistent implementation of tobacco cessation strategies by dental hygiene students in practice may be overcome through mentoring by expert faculty members. This article describes a pilot study using an innovative method to achieve higher levels of student-perceived confidence and skill in delivering cessation messages to patients. Following completion of the didactic course content, each student selected a tobacco user to complete the Indiana University Nicotine Dependence Program Patient Assessment Questionnaire (PAQ). Detailed analysis of the questionnaire and development of specific cessation strategies were accomplished in a one-to-one interchange with expert faculty members. Students provided suggestions to patients, wrote papers summarizing their experiences, and were asked to complete an anonymous survey. Forty-four of forty-six students completed the survey. Eighty percent reported the mentored session was useful in learning specific cessation strategies; 83 percent reported the session helped to boost their confidence levels in approaching patients in tobacco cessation; 83 percent believed they would use learned strategies with other patients; and 86 percent recommended this educational approach for future students. Additional mentoring may overcome barriers to approaching patients in tobacco cessation by increasing levels of confidence and skill when delivering cessation messages. This may translate into continued application of these strategies in private practice, resulting in potential benefits to the health of the public.

Tobacco dependence education: A survey of US and Canadian dental schools.

BACKGROUND: Tobacco use is the leading preventable cause of morbidity and premature mortality and is a significant factor in the development of oral disease. Tobacco dependence education (TDE) has not, however, been consistently integrated into predoctoral education. The authors conducted a study assessing the content and extent of TDE and intervention skills in US and Canadian dental schools. METHODS: In 2013, the authors contacted the academic deans of the 74 accredited US and Canadian dental schools to identify the educator who would be most appropriately described as the tobacco-use cessation "champion" at their institution. The authors e-mailed an introductory letter to each school's champion with a hyperlink to a 45-item survey; 2 follow-up emails were sent with links to the survey. RESULTS: The response rate was 66% (N = 49). TDE was taught at 92% of dental schools; 90% of respondents indicated that faculty members were confident to extremely confident in teaching tobacco-related pathology. Only 49% reported this level of confidence in teaching students how to help patients quit tobacco. TDE is taught in periodontics (82%), oral pathology (77%), clinic (66%), oral diagnosis (59%), public health dentistry (55%), pharmacology (55%), oral medicine (52%), and other disciplines (less than 50%). CONCLUSIONS: The survey responses revealed that TDE is not a curricular component in all US and Canadian dental schools. Faculty members were most confident in teaching tobacco-related pathology but may lack the interest and skills needed to integrate TDE as part of patient care. PRACTICE IMPLICATIONS: Patients who use tobacco in any form are at an increased risk of developing periodontitis, developing oral cancer, and having poorer surgical outcomes, emphasizing the need for the dental team to be well-prepared through predoctoral dental education.

Increasing Tobacco Intervention Strategies by Oral Health Practitioners in Indiana.

PURPOSE: To implement and assess an evidence-based 7-hour continuing education program for Indiana oral health care practitioners on tobacco use, dependence and treatment using a team-based approach. Program effectiveness was assessed by participants' reported increase in knowledge and the extent to which they implemented course concepts and strategies into dental practice. METHODS: Course attendees' study participation was based on agreeing to provide their contact information and to complete two surveys (an 18 item post-session and 14 item 3-month follow-up) which captured their self-reported knowledge and application of course concepts. Surveys included open-ended and multiple choice (dichotomous or 5-point Likert scale) items. Follow-up surveys were mailed / delivered electronically to participants; non-responders were sent two reminders. De-identified data were analyzed in an aggregate using descriptive statistics, percentages and counts. RESULTS: Eleven programs were attended by 626 practitioners. Initial survey response rate was 91% (565); hygienists (70%), dentists (25%); unidentified (5%). Most indicated the program enhanced their knowledge of most course concepts; 98% (522) planned to use learned communication strategies. Of dentists, 90% (113) planned to refer to the Indiana quitline and 60% (71) planned to provide patient cessation materials. Follow-up response rate was 40% (250); 79% (184) reported implementing cessation communication strategies. One-third of respondents reported referring patients to the quitline for counseling. CONCLUSION: Continuing education for oral health providers in understanding tobacco use, dependence and treatment may be beneficial to enhance their capacity and willingness to integrate tobacco cessation interventions into oral healthcare settings. However, this does not necessarily assure that they will change their practice behaviors by utilizing the learned concepts and skills with patients.

Tobacco dependence education in U.S. Dental assisting programs' curricula.

The aim of this study was to assess the level of tobacco dependence education (TDE) in the curricula of U.S. dental assisting programs and to compare the findings to those from a similar assessment of dental hygiene curricula. In the 2012-13 academic year, a 51-item survey was sent to directors of all 298 accredited dental assisting programs. Assessed were curricular TDE content, time spent on each topic, expected levels of clinical competence, and resources used. Of the 298 potential participants, 89 programs returned completed surveys, for a response rate of 30%. Of the 13 TDE-related content areas, those most often covered were oral disease related to tobacco use (100%) and general diseases related to tobacco use (93%); those least often covered were stages of (behavior) change (29%), how to develop a comprehensive tobacco intervention program in a private office setting (23%), and strategies for community-based tobacco control (22%). Responding program directors indicated the following levels of tobacco cessation intervention at which students should demonstrate competence: brief, 44%; moderate, 55%; intensive, 8%. Less than half of the reporting programs conducted a formal assessment of clinical competence in any TDE-related skills; however, skills in assessing patient tobacco use and associating head and neck findings to tobacco use were formally or informally assessed by 74% and 61%, respectively. Compared to dental hygiene programs, TDE appeared to play a smaller role in the curricula of dental assisting programs, and dental assisting programs were less likely to formally assess clinical competence in TDE.

GABA and glutamate levels in occlusal splint-wearing males with possible bruxism.

OBJECTIVE: The inhibitory neurotransmitter γ-aminobutyric acid (GABA) plays an important role in the pathophysiology of anxiety behavioural disorders such as panic disorder and post-traumatic stress disorder and is also implicated in the manifestation of tooth-grinding and clenching behaviours generally known as bruxism. In order to test whether the stress-related behaviours of tooth-grinding and clenching share similar underlying mechanisms involving GABA and other metabolites as do anxiety-related behavioural disorders, we performed a Magnetic Resonance Spectroscopy (MRS) study for accurate, in vivo metabolite quantification in anxiety-related brain regions. DESIGN: MRS was performed in the right hippocampus and right thalamus involved in the hypothalamic-pituitary-adrenal axis system, together with a motor planning region (dorsal anterior cingulate cortex/pre-supplementary motor area) and right dorsolateral prefrontal cortex (DLPFC). Eight occlusal splint-wearing men (OCS) with possible tooth-grinding and clenching behaviours and nine male controls (CON) with no such behaviour were studied. RESULTS: Repeated-measures ANOVA showed significant Group×Region interaction for GABA+ (p = 0.001) and glutamate (Glu) (p = 0.031). Between-group post hoc ANOVA showed significantly lower levels of GABA+ (p = 0.003) and higher levels of Glu (p = 0.002) in DLPFC of OCS subjects. These GABA+ and Glu group differences remained significant (GABA+, p = 0.049; Glu, p = 0.039) after the inclusion of anxiety as a covariate. Additionally, GABA and Glu levels in the DLPFC of all subjects were negatively related (Pearson's r = -0.75, p = 0.003). CONCLUSIONS: These findings indicate that the oral behaviours of tooth-grinding and clenching, generally known as bruxism, may be associated with disturbances in brain GABAergic and glutamatergic systems.

Lysophosphatidic acid modulates the regenerative responses of human gingival fibroblasts and enhances the actions of platelet-derived growth factor.

BACKGROUND: Platelet-derived growth factor (PDGF) has been used to promote healing in many in vitro and in vivo models of periodontal regeneration. PDGF is known to interact extensively with another platelet mediator, lysophosphatidic acid (LPA), to enhance regenerative responses in non-oral systems. PDGF and LPA are both liberated by platelets in the blood clot, which is known to be critical in stabilizing early periodontal wound healing. The purpose of this study was to evaluate the basic interactions of LPA with primary human gingival fibroblasts (GF) alone and with PDGF-BB for promoting GF growth and migration, as well as their effects in an in vitro oral wound-healing model. METHODS: GF regenerative responses were measured using 1 and 10 microM LPA in the absence or presence of 1 or 10 ng/ml PDGF-BB. Cell growth was determined using [3H]thymidine incorporation and cell counting. Migration responses were measured using a microchemotaxis chamber. For the in vitro wound-healing experiments, GF were grown to confluence on glass slides, and a 3 mm wide wound was mechanically inflicted. Percent wound fill on days 4, 6, and 9 was analyzed using computer-assisted histomorphometry. RESULTS: GF exhibited proliferative and chemotactic responses to LPA. These responses were synergistic when LPA and PDGF-BB were present together. LPA on its own did not stimulate statistically significant wound fill, but when combined with PDGF-BB, wound fill was equivalent to the 10% serum positive control group by day 6 (5.5-fold of negative control, [P<0.001]) and again on day 9 (6-fold of negative control, [P<0.001]). CONCLUSIONS: These studies provide the first evidence that LPA stimulates human GF regenerative responses and that it interacts positively with PDGF-BB to regulate these actions. The results suggest that LPA needs to be further investigated in the oral system as a factor that should be considered for incorporation when designing new periodontal wound-healing therapies using PDGF.

Concrescence: report of a rare case.

Concrescence represents an uncommon developmental anomaly in which juxtaposed teeth are united in the cementum but not in the dentin. The incidence of concrescent teeth is reported to be highest in the posterior maxilla. The presence of concrescent teeth may influence surgical procedures as well as periodontal, endodontic and even orthodontic diagnoses and treatment. Therefore, consideration should be given to the possible occurrence, recognition, and implications of this anomaly in diagnosis and treatment planning. The purpose of this article is to report a case of concrescence between an impacted third molar and an erupted second molar that was identified postextraction.

Using experiential learning and OSCEs to teach and assess tobacco dependence education with first-year dental students.

Previous research has indicated that dentists do not routinely engage in tobacco cessation interventions with their patients due, in part, to a lack of training in the predoctoral curriculum. From 2010 to 2012, this study at one U.S. dental school evaluated the effectiveness of experiential learning and objective structured clinical examinations (OSCEs) to improve first-year dental students' knowledge and beliefs about tobacco dependence and cessation interventions. Analysis indicated acceptable reliability and student performance for the OSCE. In all three years, there were statistically significant increases in student knowledge (p<0.001). In each year, there were also statistically significant shifts in student perceptions of preparedness (p<0.001 to p=0.034) and willingness (p<0.001 to p=0.005) to provide tobacco dependence treatment to patients. Results suggest that OSCEs utilizing standardized patients may be an effective method for assessing tobacco dependence education. Preparing for and participating in an OSCE with a standardized patient may help increase student knowledge and shape the beliefs of early dental students about engaging in patient tobacco cessation interventions. Findings were mixed on the impact of experiential learning on OSCE performance, suggesting further research is needed.

Can midlevel dental providers be a benefit to the American public?

The use of midlevel dental providers (MLDPs) is being debated as a means of reducing oral health disparities and increasing access to care among underserved populations. Midlevel dental providers include the advanced dental hygiene practitioner, community dental health coordinator, dental health aide therapist, and dental therapist. While midlevel providers are new to the U.S. dental profession, medicine has utilized these positions for years. Medical literature has shown mixed results as to whether midlevel providers improve access to care and increased practice efficiency, however, it has demonstrated clearly that the quality of care outcomes of these providers have been comparable to those of physicians. Studies of MLDPs suggest potential practice and public health benefits. With appropriate training, licensure, supervision, and deployment to geographical areas of significant need, we believe MLDPs could increase access to care to underserved populations and help in the prevention of deaths attributable to untreated dental disease.

Using the patient's medication history as a learning tool in clinical pharmacology instruction for dental students.

The purpose of this study was to determine if a pharmacology medical history assignment would enable dental students to demonstrate improved knowledge and understanding of pharmacology by researching the drugs their patients were taking and recording pharmacological information in their patients' health records. The study followed a pretest-posttest design and evaluated students' knowledge of ten commonly prescribed drugs. Students were given the pretest prior to entry into the clinic. Subsequently, for an eight-month period, students completed the medication history assignment. Pretest and posttest scores were compared and analyzed with one-way ANOVA and Pearson product moment correlation statistics. The Pearson product moment correlation showed a positive correlation between the drugs per patient and the change in score between the pre- and posttests (correlation coefficient=0.254, p=0.016) and between the assignment grade and the change in pre- and posttest scores (correlation coefficient=0.198, p<0.001), as well as a significant correlation between the number of times a drug was charted and the change in score on the pretest-posttest item concerning that drug (correlation coefficient=0.798, p=0.006). By documenting patient drug information, dental students can improve their pharmacology knowledge base and enhance their potential to positively impact patient care and safety.

Relationship of biomedical science content acquisition performance to students' level of PBL group interaction: are students learning during PBL group?

This study assessed biomedical science content acquisition from problem-based learning (PBL) and its relationship to students' level of group interaction. We hypothesized that learning in preparation for exams results primarily from individual study of post-case learning objectives and that outcomes would be unrelated to students' group involvement. During dental curricular years 1 and 2, student-generated biomedical learning issues (LIs) were identified from six randomly chosen PBL cases. Knowledge and application of case concepts were assessed with quizzes based on the identified LIs prior to dissemination of the learning objectives. Students and facilitators were surveyed on students' level of group involvement for the assessed LI topics. Year 1 students had significantly higher assessment scores (p=0.0001). For both student classes, means were significantly higher for the recall item (Q1) than for the application item (Q2). Q1 scores increased along with the student's reported role for Year 1 (p=0.04). However, there was no relationship between the student's reported role and Q1 for Year 2 (p=0.20). There was no relationship between the student's reported role and Q2 for Year 1 (p=0.09) or Year 2 (p=0.19). This suggests that students' level of group involvement on the biomedical learning issues did not significantly impact students' assessment performance.

Motor control of jaw movements: An fMRI study of parafunctional clench and grind behavior.

Jaw-clenching and tooth-grinding associated with bruxism can contribute to abnormal tooth wear and pain in the masticatory system. Clench and tooth-grinding jaw-movement tasks were evaluated in a block-design fMRI study comparing a dental-control (DC) group with a tooth-grinding (TG) group. Group classification was made prior to imaging based upon self-reported parafunctional clench and grind behavior and clinical evidence of abnormal tooth wear. Group differences in brain activation patterns were found for each task compared to the resting baseline. The DC group showed a more widely distributed pattern; more extensive activity in the supplementary motor area (SMA) proper that extended into the pre-SMA; and, for clench, activity in the left inferior parietal lobule (IPL). The DC group activated more than the TG subjects the left IPL for clench, and pre-SMA for grind. Neither task elicited more activity in the TG than DC subjects. Our group findings suggest that jaw-movement tasks executed by the TG group elicited (1) more efficient brain activation pattern consistent with other studies that found less extensive activity with executing "over-learned" tasks; (2) "underactive" SMA activity that underlies reduced motor planning; (3) decreased inferior parietal activity that is associated with lesser motor-attentional demands. Thus orofacial parafunctional habits may influence brain circuits recruited for jaw movements, providing a possible basis for understanding involuntary jaw movements in bruxism and oral movement disorders in general.

Controlling bacterial contamination of dental impression guns.

BACKGROUND: Dental impression material handgun cartridge dispensers are contaminated easily during clinical use. The authors attempted to quantify contamination by bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), of impression guns used in an academic dental clinic after five infection-prevention protocols were followed. METHODS: The authors obtained samples from four commercially available impression guns at four specific sites (button, handle, latch, trigger) after routine clinical use, disinfection, steam sterilization (also known as autoclaving), steam sterilization followed by use of plastic impression gun covers and steam sterilization followed by use of plastic impression gun covers and disinfection. RESULTS: The authors found that after routine clinical use, bacteria-including MRSA-heavily contaminated the impression guns. After the impression guns underwent disinfection, there was a 6 percent decrease in bacterial counts. The use of steam sterilization achieved sterility without harming the impression guns. Use of steam-sterilized impression guns with plastic impression gun covers decreased bacterial isolates by approximately 60 percent. Use of steam-sterilized impression guns plus covers and disinfection resulted in an approximately 95 percent reduction in contamination. CONCLUSIONS: The use of common infection-prevention methods appears to reduce the bacterial counts, including those of MRSA. Bacterial contamination was lowest after steam sterilization, followed by the use of plastic impression gun covers and disinfection. CLINICAL IMPLICATIONS: Use of contaminated impression guns on successive patients could increase the risk of causing cross-transmission of disease. The use of sterilization, plus plastic impression gun covers and disinfection, for impression guns after each use could be an effective and practical infection-control method for dental practices.