Endodontic practice amongst Nigerian dentists undergoing postgraduate training.

INTRODUCTION: this study aimed at finding out current practice of endodontics amongst Nigerian dentists undergoing postgraduate training (also referred to as dental resident doctors) in different institutions across the nation. METHODS: a questionnaire-based, cross sectional study was conducted amongst dentists undergoing postgraduate training. Questions were asked on demographics, protocol for root canal treatment (RCT), materials employed in different stages. Opinions were also sought on satisfaction with their practice and training needs in endodontics. Data were analyzed with SPSS version 20.0 and presented as tables and charts. Significance level was set at p≤0.05. RESULTS: ninety dentists undergoing postgraduate training (57 males and 33 females) with mean age of 34.81 ± 5.9 years participated in the study. Root canal treatment was mostly done in multiple visits in both single and multi-rooted teeth (p=0.01), only about 15% performed the procedure on multi rooted teeth. Sixty-five (72.2%) never used Rubber dam, stainless steel files were being used by 69%, step down technique of preparation by 53.9% and Sodium hypochlorite was the major irrigant (80%) used. Obturation was majorly with Cold lateral compaction technique (94%), 57.2% delayed definitive restoration for maximum of 1 week and amalgam was still the major material used for posterior teeth as reported by 62.9% of the participants. The majority (55.6%) were not satisfied with their current knowledge and practice and most were those that did not have good undergraduate training (p = 0.05). CONCLUSION: the practice of endodontics needs standardization across the nation as it is being advocated in other countries. There is need for hands on-training on endodontics to encourage adoption of new advances in technology, as well as improve the training of postgraduate dentists in endodontics. Also, emphasis should be placed on use of rubber dam in order to minimize the spread of infection and protect the patients from aspiration of small instruments involved in endodontic procedure.

Dental dam utilization by dentists in an intramural faculty practice.

Objectives: From casual observation of our colleagues, only a few individuals use the dental dam for operative procedures in their faculty practice. The purpose of this study was to obtain faculty perceptions of the dental dam, quantify its utilization in their intramural faculty practice, and determine the factors that influence dental dam usage. Material and Methods: A survey containing 11 questions was sent to 19 faculty members who teach full time and maintain an intramural dental practice involving operative dentistry. Thirty electronic dental health records of the 19 providers were reviewed to gather the following information from restorative procedures they completed: isolation methods, tooth location and involved surfaces, and dental restorative material. Results: Overall, dental dam was utilized for 30% of all restorative procedures and was used less than 20% of the time for placement of class II and class III composite resins. Dental dam utilization rate by general dentists was 37% and 17.6% for prosthodontists. Those general dentists with prior history of military dental practice had a utilization rate of 78.6% and nonmilitary dentists only 7.6%. Eight faculty members responded to the questionnaire for a 42% return rate. Those who practiced dentistry in the military strongly agreed that the dental dam is the standard of care, improves their quality of restorative work, and should be documented in the dental record. Conclusions: There were significantly different dental dam utilization rates between general dentists and prosthodontists and between dentists with prior military experience and those without.

Dental Dam and Isovac Usage: Factors Influencing Dental Students' Decisions on Isolation Techniques.

The Isovac system was introduced into the Virginia Commonwealth University dental curriculum with the intention that it would be used as a substitute when the dental dam could not be placed. The aim of this study was to determine the usage and factors that influenced dental students' decisions to use the dental dam or Isovac. All third-and fourth-year dental students (n=210) were asked in 2017 to complete a 26-item survey. The survey asked about students' operative procedures completed using the dental dam and Isovac, their own and their patients' preferences, basic dental dam knowledge, full-time and adjunct faculty recommendations of method, importance of factors influencing their decisions, and anticipated dental dam use after graduation. Comments were also allowed. A total of 164 students responded to the survey, for a 78% response rate. Of the respondents, 58% said they used the Isovac only when they could not use the dental dam. Among the eight general practice groups in which students are educated in delivery of comprehensive dental care, preference was significantly different for placement of Class II restorations. Overall, the students' dental dam knowledge was low, and the knowledge results were not associated with its use. According to the students, recommendations by full-time and adjunct faculty members were significantly different. Factors ranked by importance from greatest to least for determining which isolation method to use were as follows: moisture control, procedure, patient comfort, application time, ease of placement, and attending faculty. Student comments overwhelmingly favored dental dam usage if a dental assistant was available. This study found that dental dam and Isovac use was not standardized among the general practice groups and faculty. Student education, faculty calibration, and increased use of trained dental assistants are required to ensure education is consistent among all general practice groups.

Ten-year follow-up on adoption of endodontic technology and clinical guidelines amongst Danish general dental practitioners.

OBJECTIVE: The aim of this study was to re-assess the adoption of certain endodontic technology and central treatment principles of root canal treatments as advocated by guidelines presented by the European Society of Endodontology. MATERIAL AND METHODS: The questionnaire included the same questions in 2003 and 2013. The general dental practitioners (GDPs) anonymously reported how frequent ('often', 'occasionally', and 'never') they used certain endodontic technology and adhered to central treatment principles. The statistical analyses were performed using Chi-squared test and Goodman-Kruskal's γ-coefficient as an association measure. RESULTS: The overall response rate of the 2013 group was 46.5% (n = 531). The frequencies of GDPs reporting often use of rubber dam, apex locator and rotary NiTi instruments were significantly higher (p < .0001) than in 2003, as well as reporting the use of composite resin for coronal sealing (p < .019). Adoption was significantly influenced by the factors gender (p = .601) and time since graduation (p = .361), and the cluster analyses revealed the neglected use of rubber dam to be associated with no established postoperative recall system. CONCLUSIONS: After 10 years, there was a higher frequency of GDPs who had adopted certain endodontic technologies. However, progress towards high-quality root canal treatment might be obstructed as the majority of GDPs avoids consistent use of rubber dam, and routinely neglects recalls for postoperative controls of their endodontic treatments.

Estudo Comparativo entre dois anestésicos tópicos para a colocação de grampo no isolamento absoluto / Comparative study between two topical anesthetics in clamp placement for absolute isolation

O isolamento absoluto do campo operatório para realização de selante resinoso em fóssulas e fissuras tem sido apontado como um fator imprescindível no sucesso desta técnica, gerando maior qualidade e longevidade ao tratamento. Porém, o grampo utilizado no procedimento de isolamento exerce sobre o dente uma pressão e entra em contato com a gengiva, podendo causar dor e/ou desconforto. Esta situação indica a necessidade prévia de anestesia infiltrativa, que por sua vez, gera medo e ansiedade. Este ensaio clínico abrangeu um caráter experimental, terapêutico, de conveniência e duplamente cego, com delineamento boca dividida, cujo objetivo foi comparar a eficácia entre dois anestésicos tópicos, quando da colocação de grampo para a instalação do isolamento absoluto. Foram selecionadas 30 crianças, com idades entre sete e onze anos, com indicação de selantes de fóssulas e fissuras nos primeiros molares permanentes inferiores. Os anestésicos tópicos eleitos para a pesquisa foram: Cloridrato de Tetracaína (Líquido) e Benzocaína (Gel). O primeiro utilizado na Oftalmologia como anestésico em algumas cirurgias, e o segundo utilizado na Odontologia como pré-anestésico. Foram aplicadas escalas de dor, a fim de mensurar a sensibilidade e intensidade dolorosa das crianças. Efetuou-se a análise exploratória dos dados, com uma abordagem não paramétrica. Foi utilizado o teste de Sinais de Postos de Wilcoxon, nível de significância de 5%. Foi verificado que houve diferença estatisticamente significante para a Escala Numérica. Nesta pesquisa, o Cloridrato de Tetracaína mostrou-se mais eficaz que a Benzocaína. Não houve efeitos adversos aos fármacos experimentados. Concluiu-se que inserir o anestésico tópico oftálmico Cloridrato de Tetracaína na rotina da clínica odontológica consiste numa alternativa viável no controle da dor, proporcionando maior conforto e consequentemente controlando o medo e ansiedade dos pacientes(AU)

ABSTRACT The absolute isolation of the operative field for the realization of resinous sealant in pit and fissures has been pointed out as an indispensable factor in the success of this technique, generating greater quality and longevity to the treatment. However, the clamp used in the insulation procedure exerts a pressure on the tooth and comes into contact with the gums and may cause pain and/or discomfort. This situation indicates the prior need for infiltration anesthesia, which in turn generates fear and anxiety. This clinical trial covered an experimental, therapeutic, convenience and doubly-blind character, with split mouth design, whose objective was to compare the efficacy between two topical anesthetics, when the staple placement for the installation of the Absolute isolation. 30 children were selected, aged between seven and eleven years, with an indication of pit sealants and fissures in the first lower permanent molars. The topical anesthetics chosen for the research were: Tetracaine hydrochloride (liquid) and Benzocaine (Gel). The first used in ophthalmology as an anesthetic in some surgeries, and the second used in dentistry as preanesthetic. Pain scales were applied in order to measure the painful sensitivity and intensity of children. Exploratory analysis of the data was carried out, with a non-parametric approach. We used the Wilcoxon signal test, 5% significance level. It was verified that there was statistically significant difference to the numerical scale. In this research, tetracaine hydrochloride proved to be more effective than benzocaine. There were no adverse effects on the experienced drugs. It was concluded that inserting the topical anesthetic ophthalmic hydrochloride tetracaine in the routine of the dental clinic consists of a viable alternative in the control of pain, providing greater comfort and consequently controlling the fear and anxiety of patients(AU)

'Dam it - it's easy!' - or is it?

Dentists the world over seem to still have issues in making rubber dam application a routine part of practice, even in situations where patients are obviously at risk. In this article, the author - who has delivered hundreds of seminars and hands on tuition in a quick and easy method of dam application (the 'Dam it - it's Easy!' series) to dentists in the UK, Europe, North America and Asia - highlights the similarity of the misconceptions existing in regard to its use by dentists the world over. The valuable advantages to the environment in the dental treatment room by dental dam application are considered underused. The protection offered by routine rubber dam application is second to none in situations that are potentially physically hazardous to patients.

Precision and security in restorative dentistry: the synergy of isolation and magnification.

It is often presumed that, since its introduction in 1864, the use of rubber dam in multiple dental procedures has increased. However, its use is not as widespread as one might expect. There still seem to be many obstacles that prevent clinicians from adopting it as a standard of care. Furthermore, it appears very difficult to scientifically prove the impact of its use on the final outcome of a given procedure. The fundamental idea of isolating the operatory field and preventing contamination is simple; the practical execution of it is more demanding. In this article, the authors not only focus on the essential criteria for predictable isolation, they also present an isolation strategy that can be translated into a step-by-step procedure. It is suggested that by adopting this strategy, clinicians can eliminate the most commonly experienced obstacles and optimize the full potential of isolation, even in extremely difficult clinical situations.

[An overview on rubber dam application in dental treatments].

Rubber dam technique is the a method used in dentistry to isolate the operation field from the rest of mouth with rubber sheet. Rubber dam can protect both patients and dental workers effectively and provide patients with more professional, safe and comfortable experience. In recent years, this technique has gradually gained more and more recognition by dentists. However, the prevalence of using rubber dam technique in our country is still relatively low compared with those in developed countries. This condition involves many factors and need to be paid enough attention. This review summarized the current situation of rubber dam usage in various countries, the technique's application field, the effect analysis, the influencing factors and the modified products.

Why dentists don't use rubber dam during endodontics and how to promote its usage?

BACKGROUND: This survey study aimed at investigating the frequency of rubber dam use during root canal treatment, identifying influencing factors for not using it by Saudi general dental practitioners (GDPs) and endodontists. It also aimed at identifying measures that increase rubber dam usage. METHODS: After obtaining an ethical approval, two pilot studies were conducted on staff members at Taibah University College of Dentistry and a group of GDPs. A final online survey was constructed comprising 17 close-ended questions divided into six categories: demographics, endodontic practice, rubber dam use, alternative isolation methods, reasons for not using rubber dam, and measures and policies that increase its usage. The survey was emailed to 375 GDPs randomly selected from the dental register and all endodontists (n = 53) working in the western province, Saudi Arabia. Data were analyzed using the Chi-square and Linear-by-Linear association tests at p ≤ 0.05. RESULTS: The proportion of endodontists who used rubber dam (84.8 %) was significantly greater than that of GDPs (21.6 %) (p < 0.001). Significantly the highest proportion (40.5 %) did not use rubber dam because of unavailability at working place. Most rubber dam none-users (69.25 %) used a combination of other isolation means. The highest proportion of those who used rubber dam were working in the governmental sector (54.3 %). Among rubber dam users, the greatest proportion graduated from Saudi Arabia (57.8 %) compared to those graduated from Egypt (34.3 %) and Syria (22.4 %). There was a significant correlation between the patterns of rubber dam use during undergraduate training and its usage after graduation (p = 0.001). The highest proportion of participants (48.1 %) reported better undergraduate education as the most important factor that would increase rubber dam use in dental practice. CONCLUSIONS: Using of rubber dam was not common in Saudi general dental practice. Dentists must follow the recommended standards of care. Place of work and patterns of using rubber dam during undergraduate study were the most influencing factors. Better undergraduate education was the most important proposed measure to increase its usage. The combination of cotton rolls and saliva high-volume ejector or gauze was the most common alternative to rubber dam isolation.

An Assessment of Direct Restorative Material Use in Posterior Teeth by American and Canadian Pediatric Dentists: II. Rubber Dam Isolation.

PURPOSE: The purpose of this study was to assess usage, indications, and contraindications for rubber dam isolation (RDI) by pediatric dentists in Canada and the United States. METHODS: A cross-sectional, web-based, self-administered survey was utilized to collect the opinions of all active pediatric dentist members of the Royal College of Dentists of Canada and the American Academy of Pediatric Dentistry on the use of direct restorative materials in posterior teeth (n equals 4,648; 19.3 percent response rate). The main survey also included a domain on the RDI utilization and its perceived indications and contraindications. Bivariate and multivariate analyses for RDI usage and its predictor were performed at two-tailed P<0.05. RESULTS: A response rate of 19.3 percent was obtained. Most participants (72.5 percent) reported using RDI "all the time." The material with the lowest usage of RDI was composite (82 percent) in the primary dentition and stainless steel crown (80.7 percent) in the permanent dentition. The three top-noted reasons for not using RDI included decreased trauma to the patient (66.2 percent), being able to prevent soft tissue from interfering without using RDI (55.9 percent), and decreased time for appointments (45.6 percent). CONCLUSION: Rubber dam isolation was valued by the majority of pediatric dentists when restoring primary and permanent dentition for all materials.

Discordance between presumed standard of care and actual clinical practice: the example of rubber dam use during root canal treatment in the National Dental Practice-Based Research Network.

OBJECTIVES: Use of a rubber dam during root canal treatment is considered the standard of care because it enhances patient safety and optimises the odds of successful treatment. Nonetheless, not all dentists use a rubber dam, creating disconnect between presumed standard of care and what is actually done in clinical practice. Little is known about dentists' attitudes towards use of the rubber dam in their practices. The objectives were to: (1) quantify these attitudes and (2) test the hypothesis that specific attitudes are significantly associated with rubber dam use. SETTING: National Dental Practice-Based Research Network (NationalDentalPBRN.org). PARTICIPANTS: 1490 network dentists. OUTCOME MEASURES: Dentists completed a questionnaire about their attitudes towards rubber dam use during root canal treatment. Three attitude scales comprised 33 items that used a 5-point ordinal scale to measure beliefs about effectiveness, inconvenience, ease of placement, comparison to other isolation techniques and patient factors. Factor analysis, cluster analysis and multivariable logistic regression analysed the relationship between attitudes and rubber dam use. RESULTS: All items had responses at each point on the 5-point scale, with an overall pattern of substantial variation across dentists. Five attitudinal factors (rubber dam effectiveness; inconvenient/time-consuming; ease of placement; effectiveness compared to Isolite; patient factors) and 4 clusters of practitioners were identified. Each factor and cluster was independently and strongly associated with rubber dam use. CONCLUSIONS: General dentists have substantial variation in attitudes about rubber dam use. Beliefs that rubber dam use is not effective, inconvenient, time-consuming, not easy to place or affected by patient factors, were independently and significantly associated with lower rubber dam use. These attitudes explain why there is substantial discordance between presumed standard of care and actual practice.

General Dentists' Use of Isolation Techniques during Root Canal Treatment: From the National Dental Practice-based Research Network.

INTRODUCTION: A preliminary study done by a National Dental Practice-Based Research Network precursor observed that 44% of general dentists (GDs) reported always using a rubber dam (RD) during root canal treatment (RCT). This full-scale study quantified the use of all isolation techniques, including RD use. METHODS: Network practitioners completed a questionnaire about isolation techniques used during RCT. Network enrollment questionnaire data provided practitioner characteristics. RESULTS: One thousand four hundred ninety of 1716 eligible GDs participated (87%); 697 (47%) reported always using an RD. This percentage varied by tooth type. These GDs were more likely to always use an RD, do not own a private practice, perform less than 10 RCTs/month, and have postgraduate training. CONCLUSIONS: Most GDs do not use an RD all the time. Ironically, RDs are used more frequently by GDs who do not perform molar RCT. RD use varies with tooth type and certain dentist, practice, and patient characteristics.

The attitude of Czech dental patients to the use of rubber dam.

BACKGROUND: The most frequent arguments against rubber dam are that patients generally do not like it and the prolonged time of treatment. However, according to several studies, the attitude of patients towards rubber dam is rather positive. OBJECTIVE: To find out the attitudes of patients to treatment with rubber dam; to determine influence of the circumstances of treatment or factors about patients; and to establish a mean time needed for rubber dam placement. DESIGN: A questionnaire survey. SETTING AND PARTICIPANTS: Patients of general dental practitioners, university clinical specialists and undergraduate dental students. RESULTS: A total of 179 questionnaires were distributed, from which 150 were returned. The mean time needed for rubber dam placement was 4 min for students and < 2 min for dentists. For 56% of patients, this had been their first experience with rubber dam. A total of 77% of patients indicated a higher level of comfort during treatment with rubber dam. A preference to the future rubber dam usage was indicated by 86% of patients. The preference to the further rubber dam usage was statistically significantly affected by the level of comfort during the treatment with rubber dam (P < 0.001) and by the sufficiency of explanation of reasons for rubber dam usage (P < 0.05). The other factors presented no statistically significant influence on patients' attitude to rubber dam usage. CONCLUSIONS: The attitude of patients to rubber dam was rather positive in our study. The time needed for rubber dam application was rather short.

The effect of rubber dam usage on the survival rate of teeth receiving initial root canal treatment: a nationwide population-based study.

INTRODUCTION: It is well-known that the usage of rubber dams during root canal treatment (RCT) improves infection control and treatment efficacy and protects patients. However, the effect of rubber dam usage on endodontic outcomes remain uncertain. The aim of the present study was to investigate whether rubber dam usage affects the survival rate of initial RCT using a nationwide population-based database. METHODS: A total of 517,234 teeth that received initial RCT between 2005 and 2011 met the inclusion criteria and were followed until the end of 2011. Univariate and multivariate Cox proportional hazards models were used to estimate the effects of rubber dam usage on the risk of tooth extraction after initial RCT. RESULTS: Of the 517,234 teeth, 29,219 were extracted, yielding a survival rate of 94.4%. The survival probability of initial RCT using rubber dams after 3.43 years (the mean observed time) was 90.3%, which was significantly greater than the 88.8% observed without the use of rubber dams (P < .0001). After adjusting for age, sex, tooth type, hospital level, tooth scaling frequency per year after RCT, and systemic diseases, including diabetes and hypertension, the tooth extraction hazard ratio for the RCT with rubber dams was significantly lower than that observed for RCT without rubber dams (hazard ratio = 0.81; 95% confidence interval, 0.79-0.84). CONCLUSIONS: The use of a rubber dam during RCT could provide a significantly higher survival rate after initial RCT. This result supports that rubber dam usage improves the outcomes of endodontic treatments.

Current trends in endodontic treatment by general dental practitioners: report of a United States national survey.

INTRODUCTION: In the United States almost 70% of root canal treatment (RCT) is performed by general dentists (GPs), yet little is known about their treatment protocols. METHODS: A paper survey was mailed to 2000 United States GPs with questions about the types of endodontic cases treated, routine treatment protocols, use of newer technologies, and endodontic continuing education (CE). RESULTS: Completed surveys were returned by 479 respondents (24%). GPs who perform RCT (84%) reported providing anterior (99%), bicuspid (95%), and molar (62%) RCT and retreatment (18%). Rubber dam was used always (60%), usually (16%), sometimes (13%), and never (11%). Newer technologies used by GPs included digital radiography (72%), magnification (80%), electronic apex locator (70%), and nickel-titanium rotary instrumentation (74%). Compared with GPs with >20 years of experience, those in practice for ≤10 years were more likely to use rubber dam (P < .05), nickel-titanium rotary instrumentation (P < .001), apex locators (P < .001), and magnification (P < .01); in contradistinction, GPs in practice >20 years were more likely to perform retreatments (P < .05). Women were less likely to perform retreatment or molar RCT (both P < .05). GPs with >5 hours of CE were more likely to use rotary instrumentation (P < .001), irrigant activation devices (P < .01), and apex locators (P < .001) and perform molar RCT (P < .001) and retreatment (P < .05), but no more likely to use rubber dam. CONCLUSIONS: Recent GP graduates (≤10 years) were more likely to adopt new technologies and use rubber dam than those who practiced for >20 years. More experienced GPs were more likely to take on complicated cases than those with fewer years of practice. There was no association between hours of CE and compliance with rubber dam usage.

Evaluation of senior dental students' general attitude towards the use of rubber dam: a survey among two dental schools.

The purpose of this study was to evaluate the general attitude of senior dental students towards rubber dam use, specifically focusing on endodontic practices prior to starting to serve community. Questionnaires were distributed to senior year students of a private school and a state school in Istanbul. Questions were asked about areas where the students used rubber dam, its advantages and difficulties, and whether they agreed or disagreed with some aspects of the rubber dam. The private school students rated isolation whereas those of the state school selected prevention of aspiration which the top advantage rubber dam provides. Students of the state school agreed with the opinion that isolation cannot be achieved without rubber dam and it extended the procedure with a significantly higher ratio compared to the private school. Within the limitations of the present study, it can be concluded that the perceptions of dental students on rubber dam needs to be improved and strategies should be developed so that this valuable adjunct will comprise one of the indispensable elements of dental care.

Cluster Effects in a National Dental PBRN restorative study.

Items in clusters, such as patients of the same clinician or teeth within the same patient, tend to be more similar than items from different groups. This within-group similarity, represented by the intraclass correlation coefficient (ICC), reduces precision, yielding less statistical power and wider confidence intervals, compared with non-clustered samples of the same size. This must be considered in the design of studies including clusters. We present ICC estimates from a study of 7,826 restorations placed in previously unrestored tooth surfaces of 4,672 patients by 222 clinicians in the National Dental Practice-Based Research Network, as a resource for sample size planning in restorative studies. Our findings suggest that magnitudes of ICCs in practice-based research can be substantial. These can have large effects on precision and the power to detect treatment effects. Generally, we found relatively large ICCs for characteristics that are influenced by clinician choice (e.g., 0.36 for rubber dam use). ICCs for outcomes within individual patients, such as tooth surfaces affected by a caries lesion, tended to be smaller (from 0.03 to 0.15), but were still sufficiently large to substantially affect statistical power. Clustering should be taken into account in the design of oral health studies and derivation of statistical power estimates for these studies (ClinicalTrials.gov, NCT00847470).