Contents of stomatological curricula in Europe.

The present study focuses on dental education in the Accession Countries to the European Union. Comparisons were made with data from EU dental schools [Eur J Dent Educ 1 (1997) 35]. The findings show a large variation in the hours allocated to individual subjects, medical and dental, both within and between AC and EU dental schools. Stomatology derived from General Medicine and the stomatologist is viewed as a doctor responsible for one part of the body. This was explained by the large proportion of time dedicated to medical subjects, especially in the first 2/3 years of the undergraduate curriculum. The percentage of hours for dental sciences varied inversely to those for bio-medical sciences and increase continuously from the first year to the final year. Curricula in the Stomatological schools tend to have a discipline-structured approach, generally utilising a large number of individual departments, resulting in a multitude of subjects being taught. Curricular extensions from 5 to 6 years were introduced in some schools from 1990 onwards in order to accommodate new dental subjects.

Policies and practices of European dental schools in relation to smoking; a ten-year follow-up.

OBJECTIVE: To investigate the policies and practices of European dental schools in relation to smoking as a ten-year follow-up. DESIGN: A postal survey questionnaire. SETTING: European dental schools in 2003. MATERIALS AND METHODS: Two hundred and one European dental schools were identified from the DentEd database. A postal questionnaire was sent to each with up to three follow-up letters to non-responders. MAIN OUTCOME MEASURES: Results were tabulated and compared with the previous study (1993). RESULTS: The effective response rate (allowing for errors in the database) was 149 of 199 schools (72%). Eighty schools (59%) had written tobacco policies, 132 (92%) banned smoking in clinical areas, 127 (89%) in non-clinical areas and 122 (85%) in public access areas. One hundred and seven (76%) expected students to take tobacco histories from all patients, while 79 (69%) and 100 (70%) respectively taught students anti-smoking advice and expected them to give such advice. The number of schools teaching the role of tobacco in oral cancer aetiology was 133 (93%), in periodontal disease was 135 (94%) and in osseointegrated implant failure was 127 (91%). There was considerable regional variation between northern, southern and eastern Europe. Direct comparison of the responses of the 78 schools that replied in both 1993 and 2003 showed some improvements in most of their policies and practices. However, there was some deterioration in the practices of southern European schools. CONCLUSIONS: While improvements were seen in the practices of most schools, comparison with recent US data suggests that European schools lag behind. However, self-selection of respondents may have introduced bias into the results.

Identification and expression of multidrug transporters responsible for fluconazole resistance in Candida dubliniensis.

Candida dubliniensis is a recently described Candida species associated with oral candidosis in human immunodeficiency virus (HIV)-infected and AIDS patients, from whom fluconazole-resistant clinical isolates have been previously recovered. Furthermore, derivatives exhibiting a stable fluconazole-resistant phenotype have been readily generated in vitro from fluconazole-susceptible isolates following exposure to the drug. In this study, fluconazole-resistant isolates accumulated up to 80% less [3H] fluconazole than susceptible isolates and also exhibited reduced susceptibility to the metabolic inhibitors 4-nitroquinoline-N-oxide and methotrexate. These findings suggested that C. dubliniensis may encode multidrug transporters similar to those encoded by the C. albicans MDR1, CDR1, and CDR2 genes (CaMDR1, CaCDR1, and CaCDR2, respectively). A C. dubliniensis homolog of CaMDR1, termed CdMDR1, was cloned; its nucleotide sequence was found to be 92% identical to the corresponding CaMDR1 sequence, while the predicted CdMDR1 protein was found to be 96% identical to the corresponding CaMDR1 protein. By PCR, C. dubliniensis was also found to encode homologs of CDR1 and CDR2, termed CdCDR1 and CdCDR2, respectively. Expression of CdMDR1 in a fluconazole-susceptible delta pdr5 null mutant of Saccharomyces cerevisiae conferred a fluconazole-resistant phenotype and resulted in a 75% decrease in accumulation of [3H]fluconazole. Northern analysis of fluconazole-susceptible and -resistant isolates of C. dubliniensis revealed that fluconazole resistance was associated with increased expression of CdMDR1 mRNA. In contrast, most studies showed that overexpression of CaCDR1 was associated with fluconazole resistance in C. albicans. Increased levels of the CdMdr1p protein were also detected in fluconazole-resistant isolates. Similar results were obtained with fluconazole-resistant derivatives of C. dubliniensis generated in vitro, some of which also exhibited increased levels of CdCDR1 mRNA and CdCdr1p protein. These results demonstrate that C. dubliniensis encodes multidrug transporters which mediate fluconazole resistance in clinical isolates and which can be rapidly mobilized, at least in vitro, on exposure to fluconazole.

Learning a clinical method to identify a mandibular reference position.

The teaching of clinical maxillomandibular relationships is an area of weakness in dental school curricula. Most difficulties arise when a reference position is required to adjust or reconstitute the maximum intercuspation of the dentition. The dentist-derived concept of the centric maxillomandibular relation position is used to solve this problem. There is no consensus on the definition of this term. In the descriptions of clinical technique for recording the centric maxillomandibular relation position, clinical criteria to judge whether or not the position required has been achieved usually are not given. The dorsal border paths of the envelope of movement were used to develop a clinical criterion to identify the centric maxillomandibular relation position. Force or "guidance" is not used in this method. Test-patients with normal masticatory systems were randomly selected and fitted with a mechanical tracking apparatus. 50 undergraduate dental students and dental nurses were randomly selected and given instruction in the clinical technique to identify the centric maxillomandibular relation position. The ability of these students to identify the reference position was assessed by having them perform the technique blindfolded on the test-patients on whom tracking apparatus was fitted. Sixty eight percent of the test-clinicians succeeded in using the method to identify the reference position. There was no significant difference in the abilities of subgroups to use the method successfully, e.g., women compared to men, 2nd year students to 3rd year students. It was concluded that the method was a satisfactory way of learning how to identify the centric maxillomandibular relation position in a gentle, non-invasive fashion.

Antifungal drug susceptibilities of oral Candida dubliniensis isolates from human immunodeficiency virus (HIV)-infected and non-HIV-infected subjects and generation of stable fluconazole-resistant derivatives in vitro.

Candida dubliniensis is a recently described species of Candida associated with oral candidiasis in human immunodeficiency virus (HIV)-infected individuals. Nineteen oral isolates of C. dubliniensis recovered from 10 HIV-positive and 4 HIV-negative individuals and one vaginal isolate from an additional HIV-negative subject were assessed for fluconazole susceptibility by broth microdilution (BMD), hyphal elongation assessment, and Etest. The susceptibilities of these 20 isolates to itraconazole and amphotericin B and of 10 isolates to ketoconazole were also determined by BMD only. Sixteen of the C. dubliniensis isolates were susceptible to fluconazole (MIC range, 0.125 to 1.0 microgram ml-1), and four (recovered from two AIDS patients) were fluconazole resistant (MIC range, 8 to 32 micrograms ml-1). Fluconazole susceptibility data obtained by hyphal elongation assessment correlated well with results obtained by BMD, but the corresponding Etest MIC results were one to four times higher. All of the isolates tested were found to be sensitive to itraconazole, ketoconazole, and amphotericin B. Sequential exposure of two fluconazole-sensitive (MIC, 0.5 microgram ml-1) C. dubliniensis isolates to increasing concentrations of fluconazole in agar medium resulted in the recovery of derivatives which expressed a stable fluconazole-resistant phenotype (BMD-determined MIC range, 16 to 64 micrograms ml-1), even after a minimum of 10 consecutive subcultures on drug-free medium and following prolonged storage at -70 degrees C. The clonal relationship between the parental isolates and their respective fluconazole-resistant derivatives was confirmed by genomic DNA fingerprinting and karyotype analysis. The results of this study demonstrate that C. dubliniensis is inherently susceptible to commonly used antifungal drugs, that fluconazole resistance does occur in clinical isolates, and that stable fluconazole resistance can be readily induced in vitro following exposure to the drug.

Undergraduate training in the European Union. Convergence or divergence?

A survey of dental schools in the European Union was carried out for two main reasons. Firstly to promote the exchange of information in respect of curriculum objectives in the different countries and secondly to ascertain the differences in the interpretation of the 1978 EU sectoral directives for dental education and training. Out of 127 schools, only 30 responded, yet the information provided is of considerable importance. It demonstrates wide divergence in the interpretation of the 1978 Directives and methods of assessment of clinical competence. There is a considerable difference throughout Europe in hours devoted to the various subjects included in the Dental Directives. There is little evidence of convergence in methods of assessment or quality assurance. The survey demonstrates the difference in resources, levels of staff, availability of clinical training places, output in research and patient treatments throughout the European Union. The results question the effectiveness of the 1978 Dental Directives in promoting convergence of standards. As there is free movement of dentists throughout the European Union, it is concluded that a different approach may be necessary to ensure that all European Union dental graduates achieve comparable standards in their education and training.

Molecular genetic approaches to identification, epidemiology and taxonomy of non-albicans Candida species.

The reported incidence of fungal infections associated with non-albicans species from the Candida genus is increasing. Most of these infections occur in immunocompromised patients, particularly those infected with HIV. The role of molecular genetic techniques alongside the existing techniques for the identification and typing of these organisms is discussed. Species-specific genomic DNA fragments cloned from C. tropicalis and C. krusei have been developed for identification and strain typing. Analysis of tRNA profiles has been shown to be effective for the identification of C. glabrata, C. guilliermondii, C. parapsilosis and C. tropicalis. A PCR method employing primers complimentary to large ribosomal subunit genes and the lanosterol-alpha-demethylase gene has been applied for several species, including C. glabrata, C. krusei and C. tropicalis. Strain typing by comparison of genomic DNA fingerprints has been demonstrated for C. tropicalis and C. krusei following hybridisation analysis with species-specific probes. Synthetic oligonucleotide probes--which do not have to be species-specific and which can detect minor polymorphisms--have also been used for strain typing of isolates of several non-albicans species. Random amplification of polymorphic DNA (RAPD) has also been used for analysis of C. glabrata, C. lusitaniae and C. tropicalis isolates. The potential for the application of these and other techniques to Candida spp. taxonomy--and the example of a recently discovered novel species, C. dubliniensis--is discussed.

Policies and practices of European dental schools in relation to smoking: the place of tobacco education in the undergraduate dental curriculum.

A postal questionnaire was used to ascertain policies and practices of European dental schools in relation to smoking and the teaching of the relationship of smoking to the aetiology and primary prevention or oral cancer. A majority of responding schools taught the role of smoking in the aetiology of oral cancer. A majority expected students to take smoking histories from patients. Half of schools taught anti-smoking advice to students and half expected students to impart such advice to patients. A majority banned smoking in clinical and non-clinical teaching facilities and associated public access areas. There is scope for considerable improvement in curricula in relation to anti-smoking counselling and in the practices of schools in expecting students to act as tobacco counsellors.

Oral Candida in HIV infection and AIDS: new perspectives/new approaches.

Oral candidosis has become an increasingly important problem in HIV-infected individuals. At present, the small body of published literature on the characterization of the Candida strains and species found in HIV+ patients is full of confusion and contradictions. Some of these difficulties are the result of the methodological shortcomings of a number of the techniques that have been used. Examples of the problems that may be encountered on primary isolation and subculture are described and the drawbacks associated with the systems used to date for phenotyping Candida are quoted. While molecular characterization techniques would appear to offer a reliable and objective alternative, they too have their strengths and weaknesses. An attempt is made to summarize the progress that has been made recently in the detection and identification of Candida albicans and also the non-albicans species from HIV-infected individuals. What emerges is that the commensal Candida species that inhabit the oral cavities of HIV+ patients are subjected to a number of significant pressures that probably promote the selection of organisms with unusual phenotypes and genotypes. These Candida are more difficult to characterize and behave differently compared to their counterparts in HIV- individuals. It is clear that uncovering the factors that are important for the selection of treatment regimens and will be predictive of outcome will not be easy. Candida organisms are neither as benign nor as simple as once thought.

Reduced azole susceptibility of oral isolates of Candida albicans from HIV-positive patients and a derivative exhibiting colony morphology variation.

Approximately 50% (15/28) of a selection of oral isolates of Candida albicans from separate individuals infected with the human immunodeficiency virus (HIV) exhibited low susceptibility to ketoconazole as determined by hyphal elongation assessment. Nine of these isolates exhibited colony morphology variation or switching at 37 degrees C, of which six expressed low ketoconazole susceptibility. To determine whether colony morphology variation could give rise to derivatives with reduced azole susceptibility, several high-frequency switching variants of three HIV-patient isolates were recovered and assessed. All but one of the variants expressed similar azole susceptibility profiles to their respective parental strains. However, the C. albicans derivative 132ACR expressed significantly reduced susceptibility to ketoconazole in comparison to its parental strain 132A. In whole cells, on the basis of total growth the switched derivative 132ACR was markedly less susceptible than its parental isolate 132A to ketoconazole at 10 microM. A much smaller difference was observed with fluconazole at 10 microM, with the switched derivative 132ACR exhibiting a threefold lower susceptibility compared with the parental isolate 132A. The incorporation of [14C]acetate in control and azole-treated cells of both organisms was higher for the parental strain. When cell lysates of strain 132A and its derivative 132ACR were incubated with [14C]mevalonic acid and ketoconazole, the IC50 for 14C-label incorporation into C-4 demethyl sterols was fivefold higher for lysates of the switched derivative 132ACR compared with those of the parental strain 132A. With fluconazole the IC50 value for the derivative 132ACR was 25-fold higher than for strain 132A. The 14-sterol demethylase of the switched derivative 132ACR was possibly less sensitive to azole inhibition than that of the enzyme of strain 132A. These studies indicated that colony morphology variation in vitro can generate derivatives with stable, reduced azole susceptibility without prior exposure to azoles.

In vitro and in vivo evaluation of a bondable compact for the prolonged delivery of triamcinolone acetonide to the oral cavity in patients with lichen planus.

Compacts weighing 40 mg and containing triamcinolone acetonide 70-90% and polyhydroxybutyric acid (PHB) 30-10% or poly (DL-lactic acid) 20% with a diameter of 5 mm were bonded onto the side-wall of molar teeth. In vitro dissolution studies showed the compacts to release 12% of drug in 30 days with an initial burst effect. Drug loading or polymer matrix type had little effect. In vivo studies in dogs showed that compacts containing 80% drug in PHB produced salivary levels of triamcinolone acetonide for 30 days. When evaluated in five patients with lichen planus resistant to conventional therapy, these compacts produce a slight clinical improvement in three subjects. Differential scanning calorimetry studies confirmed that the drug and polymer were present as a physical mix in these compacts.