Effectiveness of a simulated patient training programme based on trainee response accuracy and appropriateness of feedback.

INTRODUCTION: Simulated patients (SPs) need education and training in required skills to be effective resources in education. This study was conducted to examine the effectiveness of an SP training programme based on the accuracy of trainee responses and the appropriateness of their feedback. METHODS: Thirty-two applicants to the training programme and 35 experienced SPs were included in this study. The experienced SPs served as a reference group. The rate of accurate responses and the rate of appropriate feedback were assessed with pre- and post-training tests, and these two outcome measures were compared with those of the experienced SPs. RESULTS: No significant differences were found in trainee response accuracy or appropriateness of feedback between pre- and post-training tests. The response accuracy rate of the trainees on the pre-training test was significantly lower than that of SPs with 1-2 years of experience, whilst there was no significant difference between these SPs and the trainees on the post-training test. CONCLUSIONS: Although our study suggests that more training is needed to improve the skills of SPs, the training programme may contribute to helping trainees reach a novice level in the skill of providing accurate responses. SP training should be encouraged to contribute to the effectiveness of such teaching and to establish the validity of the assessment.

Short-term etidronate treatment prevents glucocorticoid-induced bone debility of the mandible in growing rats.

OBJECTIVES: To analyse the effects of short-term treatment with etidronate on the glucocorticoid-induced retardation of bone growth and deterioration of bone structure in the prepubertal rat mandible. MATERIALS AND METHODS: Fifty 5-week-old male rats were divided into five groups. Etidronate or vehicle treatment (5 mg/kg/day, daily, subcutaneous injection) was initiated after glucocorticoid administration (30 mg/kg/day, on alternate days, orally) for 6 weeks and was continued for 3 weeks. Then, bone growth was measured using lateral cephalometric analysis. Peripheral quantitative computed tomography was used to determine bone density, bone cross-sectional area and bone strength. RESULTS: Glucocorticoid-treated rats had significantly lower body weight, mandibular length, cortical bone density, bone strength and cross-sectional area in trabecular and cortical bone, but had significantly higher trabecular bone density than untreated rats. No significant difference in mandibular height was observed between the glucocorticoid-treated group and the untreated control group. Etidronate treatment improved the glucocorticoid-induced decrease in bone strength and increased density in trabecular and cortical bone above the untreated control level, but had no significant effects on the reduction in mandibular length. CONCLUSION: These findings suggest that etidronate can potentially reverse the glucocorticoid-induced deterioration of internal bone structure, but has no beneficial effects on the glucocorticoid-induced retardation of bone growth in the growing rat mandible.

Profile of the oral healthcare team in countries with emerging economies.

Health is a critical dimension of human well-being and flourishing, and oral health is an integral component of health: one is not healthy without oral health. Significant barriers exist to ensuring the world's people receive basic healthcare, including oral healthcare. Amongst these are poverty, ignorance, inadequate financial resources and lack of adequate numbers of educated and trained (oral) healthcare workers. Emerging economies are encouraged to develop a national strategic plan for oral health. International organizations have developed goals for oral health that can be referenced and adapted by emerging economies as they seek to formulate specific objectives for their countries. Demographic data that assess the nature and extent of oral diseases in a country are essential to sound planning and the development of an oral healthcare system that is relevant, effective and economically viable. Prevention should be emphasized and priority consideration be given to oral healthcare for children. The types and numbers of members of the oral healthcare team (workforce) will vary from country to country depending on the system developed. Potential members of the workforce include: generalist dentists, specialist dentists, dental therapists, dental hygienists, denturists, expanded function dental assistants (dental nurses) and community oral health workers/aides. Competences for dentists, and other members of the team, should be developed to ensure quality care and developed economies should cooperate with emerging economies. The development, by more advanced economies, of digital, virtual curricula, which could be used by emerging economies for educating and training members of the oral healthcare team, should be an important initiative. The International Federation of Dental Educators and Associations (IFDEA) should lead in such an effort.

Changes in temporomandibular disc position during growth in young Japanese.

PURPOSE: To detect the initial changes in temporomandibular disc position during growth with MRI examination in a prospective longitudinal study of a young Japanese population. METHODS: Forty-four temporomandibular joints in 22 healthy asymptomatic volunteers, mean age 11.8 years, age range 9-16 years, were examined by MRI. They were re-examined 2-3 years later. The mean age and age range at the second examination were 14.5 years and 12-19 years, respectively. The discs were assessed at three different locations by oblique sagittal planes at the lateral, central and medial parts, and the displacement was evaluated as a partial anterior or total anterior position. RESULTS: Six joints already had a partial anterior position of the disc at the initial examination and no developmental change in disc position was observed during the examination period. Nine joints developed partial disc displacement during the examination period. Every partial displacement was observed at the lateral part of the disc. One joint developed a total anterior position from the lateral to the medial images. CONCLUSIONS: Initial changes in the disc position are likely to start from the lateral part of the joint in the early teenage years and are often asymptomatic.

Intermittent force induces high RANKL expression in human periodontal ligament cells.

Intermittent compressive force stimulates bone resorption in orthodontic treatment. This study examined the molecular mechanism in human periodontal ligament (PDL) cells stimulated by an intermittent force. PDL cells were subjected to compressive force (2.0 or 5.0 g/cm(2)) for 2-4 days. Continuous or intermittent force was applied all day or for 8 hrs per day, respectively. At days 3 and 4, cell damage was less with intermittent force than with continuous force. At day 4, RANKL and IL-1beta expressions were greater with intermittent force than with continuous force. An IL-1 receptor antagonist inhibited the compressive force-induced RANKL expression. These findings indicate that IL-1beta is an autocrine factor regulating compressive force-induced RANKL expression in PDL cells, and that intermittent force can effectively induce RANKL in PDL cells with less cell damage.

Intermittent force in orthodontic tooth movement.

A single orthodontic activation lasting one hour can initiate tooth movement. The purpose of this study is to examine tooth movement, osteoclasts, and root resorption in rats following several one-hour activations. Rats (n = 144) were randomly assigned to intermittent (multiple activations of 1 hr/day), continuous, and sham appliances. Twelve rats were killed at 3, 5, 7, and 14 days. Tooth movement, osteoclasts, osteoclast %, and root resorption % were quantified. Continuous force moved molars mesially at days 3 and 14 (p < 0.05), but intermittent and sham did not. Intermittent and continuous force increased osteoclast numbers at days 3, 5, and 7 (p < 0.05). Continuous force increased osteoclast surface on days 3 and 14 (p < 0.05). Continuous force increased root resorption at days 5, 7, and 14 (p < 0.05). These results demonstrate that orthodontic force for one hour in 24 stimulates osteoclasts at compression sites but does not stimulate tooth movement or root resorption.