Educational practices regarding anticoagulation and dental procedures in U.S. dental schools.

Evidence suggests that stopping oral anticoagulation with warfarin is not necessary in patients requiring low-risk dental procedures and may actually increase thrombosis risk. However, widespread belief remains among dentists that stopping oral anticoagulation for dental procedures is necessary. The purpose of this study was to investigate the teaching practice of U.S. dental faculty responsible for providing education to dental students about anticoagulation. Surveys were mailed in 2003 and 2004 to fifty-five U.S. dental faculties to assess their teaching practice regarding anticoagulation and dental procedures. Twenty-eight (50.9 percent) of the schools returned surveys. Contrary to evidence indicating anticoagulation does not need to be altered, many dental faculty responded that they teach dental students to discuss with medical providers/patients about altering warfarin therapy for several routine procedures: 21.4 percent (cleaning), 14.3 percent (restorative treatment), 46.4 percent (single simple extraction), 64.3 percent (multiple simple extractions), and 17.9 percent (root canal). However, 67.9 percent stated an International Normalized Ratio (INR) of 2.0-3.0 would be acceptable prior to dental procedures. A discrepancy was also found between the number of faculty recommending altering warfarin in intermediate- to high-risk individuals compared to those recommending heparin bridging for the same patients. Overall, this study identified inconsistencies between teaching practices in U.S. dental schools and medical evidence. Dental faculty should consider comparing their teaching material with evidence regarding anticoagulation and dental procedures. Continuing education may be necessary for practicing dentists regarding this topic.

Introducing dental students to clinical patient care: the Complete Denture Prosthodontics Transition Clinic.

Using complete denture treatment as an introduction to clinical patient care for dental students, the purposes of the Complete Denture Prosthodontics Transition Clinic at the University of Colorado School of Dentistry are to reduce the time lapse between the preclinical complete denture prosthodontics course and the first denture patient experience, and to encourage development of student self-confidence and skills. In the 2002 spring semester, faculty at the University of Colorado School of Dentistry initiated the Complete Denture Prosthodontics Transition Clinic for DS-II (second-year) dental students, as an introduction to clinical patient care. Each patient was assigned to a team of two dental students. Three Division of Prosthodontics faculty members staffed each clinic session, providing a student-to-faculty ratio of approximately 6.6:1 and a patient-to-faculty ratio of approximately 3.3:1. All DS-II students in the Class of 2004 delivered their first complete dentures no later than 8 months (average, 184 days) after the last day of the preclinical complete denture prosthodontics course. The time from the diagnostic appointment through the denture placement appointment averaged 39 days for patients treated in this program, compared with an average of 98 days or more for previous classes. The program was successful in achieving the goal of reducing the time lapse between the preclinical complete denture prosthodontics course and the first denture patient experience.