Preparedness and competency of New Zealand graduates for general dental practice - perceptions from the workforce.

BACKGROUND: Dental graduates need to demonstrate clinical competency. This mixed-methods study explored the perceptions of clinicians who employ or work with new graduates from the University of Otago, New Zealand, and identified themes reflecting graduates' preparedness for independent practice. METHODS: An online survey using a semantic differential scale and open-ended questions collected opinions and experiences from the workforce. Quantitative data were analysed using SPSS software, and qualitative data were analysed thematically. RESULTS: A representative sample of the workforce was obtained with a response rate of 35% (N = 83). Most clinicians engage new graduates to support the profession and/or rural communities. They perceived that graduates were well prepared in most areas, could translate theory to clinical practice and demonstrate professionalism. Graduates were reportedly stronger in basic dentistry, communication, ethics, and record keeping however were less strong in complex treatment planning, molar endodontics, fixed prosthodontics and exodontia. Clinical exposure during dental training was perceived as more limited, and mentoring and guidance in the transition to practice were deemed to be important. CONCLUSIONS: New Zealand dental graduates appear prepared for independent practice; however, maximising clinical opportunities during training, mentoring and early professional development in advanced areas of practice is essential to enhance competency and confidence.

Bone grafting from a restorative perspective--are we winning the space race?

The edentulous maxilla presents diverse and complex rehabilitation problems for the clinician that are often not addressed with a conventional removable appliance. Implant therapy, although revolutionizing the management of the edentulous mandible, has yielded less than favourable treatment outcomes in the maxilla. Poor bone quality and small bone volume in the maxilla, at the time of implant surgery has been associated with more implant and prosthesis failure. Bone grafting appears to improve the survival rate of implants in the atrophic maxilla and many studies have been published outlining techniques in which various types of implants have been used in conjunction with grafting materials. It is as yet not clear from the studies of maxillary grafting, whether various grafting materials are equally capable of supporting implants. The small number of patients and implants evaluated in many studies makes it difficult to predict specific outcomes for a single patient. The occurrence and frequency of complications with endosseous implant placement and with bone grafting is generally poorly defined. In the year 2000, our patients, third party insurers, the legal system and the scientific community are expecting more evidence to support the effectiveness of dental health care strategies. Evidence-based practice has become the catch cry for therapeutic intervention and yet the dental literature reveals a wide range of treatment modalities for which research can be at best considered weak. Studies to date into patient-based assessment of implant therapy provides little scientific evidence of substantially more benefit to edentulous patients with severe alveolar loss from implant therapy than was gained from alternative forms of treatment. Bone grafting and bone regenerative procedures do hold promise for the rehabilitation of the edentulous maxilla, however the Space Race is far from won.

Odontoblast differentiation: a response to environmental calcium?

The response of the dental pulp to calcium hydroxide has been well described but the process of pulpal repair leading to dentinal bridge formation appears complex and the mechanisms remain incompletely understood. Through the precise regulation of the free calcium ion in the cytosol, cells have been able to utilize anions such as phosphates for a wide range of activities such as energy production (oxidative phosphorylation). As anions are abundant in the cytosol, intracellular levels of calcium ions are kept low, several orders of magnitude less than that of the surrounding extracellular matrix. Consequently, cells are able to use calcium ions for the regulation of many cellular events. The binding of extracellular molecules such as cytokines, hormones or antibodies, with receptors on the plasma membrane may result in short- or long-term modifications to cellular metabolism, including the mechanisms of intracellular calcium homeostasis. Cell survival depends upon the ability to adapt to changes in the cell's micro-environment. Adaptation in turn results in altered cellular activity that may be interpreted as showing that the cell has become more or less specialised. In some instances this may include the resumption of mitotic activity. If the rate or magnitude of change exceeds a cell's adaptive capacity, the cell dies. Responses of cells to alterations in their environment are reviewed as they may provide an explanation for the success of calcium hydroxide in facilitating pulpal repair and the differentiation of odontoblasts.