Expanding the functions of dental assistants in Bulgaria and perceptions about their role in the Bulgarian healhcare workforce.

AIM: The study queries a sample of dentists and dental assistants in Bulgaria about their understanding and perceptions of Expanded Function Dental Auxiliaries (EFDA). The study considers whether expanding the skillset of dental assistants to function in specific scenarios without personal supervision by the dentist may be a viable strategy to address various oral health inequities in the country. MATERIALS AND METHODS: An anonymous survey was conducted among 103 practicing dentists and 100 dental assistants throughout the country. The questionnaire consisted of 20 questions that probed respondents' understanding about the duties performed by EFDAs and their potential to increase productivity and efficiency of the dental workforce. Sociological (poll) and statistical (alternative analysis) methods were used in the survey. RESULTS: The majority of respondents were female. Most worked in the larger cities. One worked in a village. Most were ethnic Bulgarians and none were Roma, reflecting the racial imbalance in the national workforce. Two-thirds (67%) believed that dental assistants with appropriate training are capable of doing expanded dental procedures without personal supervision by a dentist. The majority (83.7%) believed that EFDAs could improve efficiency of a dental practice, while 58.1% indicated that with appropriate training, they could perform expanded duties as well as the dentist. However, only one third believed that EFDAs could increase practice output (38.9%); enhance the quality of the dentist's work (37.4%); or decrease patient anxiety (31.5%). Though most respondents (78.3%) believed that a patient would not be receptive to an EFDA placing a restoration without personal supervision by the dentist, two thirds of respondents (66.5%) would like to see dental assistants trained to perform expanded duties otherwise reserved for dentists. Most respondents felt that EFDAs could help to build a well-functioning dental team. CONCLUSIONS: Most respondents believed that EFDAs can benefit the efficiency of a practice, suggesting that Bulgarian dental professionals would respond favorably to enhancing the skillset of assistants with expanded functions. The study suggests they are skeptical about "general" versus "personal" supervision. EFDAs may potentially provide improved access by underserved communities, while building a more inclusive oral healthcare workforce reflective of the population.

Ring chromosome 14 syndrome: what the dentist should know to manage children with r(14) effec-tively.

INTRODUCTION: Ring chromosome 14 syndrome, or r(14), is a rare genetic disorder characterized by distinctive facial features, intractable epilepsy, delayed development, intellectual disability, and autism spectrum disorder. With less than 100 documented cases worldwide, the disease is not well known or fully studied. Furthermore, the literature offers little guidance to aid dentists in the management of these patients as r(14) remains undocumented in the dental literature. AIM: To investigate the manifestations and challenges faced by a group of subjects suffering from r(14), to raise awareness of this syndrome, and to provide tips and suggestions that dentists may find helpful to manage r(14) children effectively. MATERIALS AND METHODS: A voluntary survey was administered to the caretakers of 13 r(14) patients who, as of 2019, were registered in the NORD (National Organization for Rare Diseases) global data bank (Ring 14 USA Outreach). The patients were assessed for age, gender, geographic distribution, phenotype, physical appearance, maxillofacial characteristics, presence of oral conditions and abnormalities, malocclusion, epileptic seizures, cognitive abilities, speech, muscle tone, nutrition, autism, and other developmental and behavioral points of interest. RESULTS: Of the 13 patients queried, 7 were male and 6 were female. The age of the patients ranged from 5 to 49 years. Ten patients were of European ancestry and three were Hispanic, all residing across the U.S. The majority of patients were diagnosed as infants, shortly after commencement of uncontrollable seizures. All the patients had microcephaly and presented with Class II malocclusions. More frequent occlusal anomalies and conditions included diastemata of the anterior teeth, congenitally missing teeth, crowding, and drooling. The majority of subjects was unable to speak, suffered from intractable seizures, and frequently exhibited behavioral outbursts. CONCLUSIONS: A child with r(14) may present a considerable challenge to the dentist and staff, but the dental problems of r(14) children are, for the most part, like those of any other patient and can often be handled by the dentist. Depending on the severity of symptoms, some children with r(14) may be as treatable in the dental office as any other child.

Dental students' knowledge and reporting of child maltreatment: Where are we at today both here and abroad?

INTRODUCTION: The study investigates whether suspected child abuse/neglect (SCAN) training in dental school has increased dental student SCAN knowledge and, consequently, reporting. MATERIALS AND METHODS: A 25-question survey used to assess for SCAN knowledge in 2006 was readministered to a group of dental students at one US dental school in St. Louis, MO, which has integrated SCAN training into its curriculum for at least 3 years, and one dental school in Plovdiv, Bulgaria, which has not integrated SCAN training as a control. RESULTS: Of 16 questions assessing for SCAN knowledge, group US students answered 14 questions correctly and performed better than US students surveyed in 2006. By comparison, group Bulgaria students with no SCAN training answered 15 questions correctly. When asked what their legal responsibilities were concerning SCAN, 96.4% of group US students knew they were required to report, whilst only half of group Bulgaria (48.9%) responded correctly. The results suggest that integrating SCAN training into the curriculum is effective in conveying this important message. However, in a question asking students whether they encountered a child at dental school who they suspected was the victim of child maltreatment and if so, how did they act, there were no indications that students at either school made any reports as the question was either answered "no" or left blank. The number of SCAN cases reported by campus authorities was also zero. CONCLUSION: The results suggest that classroom training in SCAN is not motivating students to report SCAN at their dental school, despite increased knowledge.

An International Survey of Female Dental Students' Perceptions About Gender Bias and Sexual Misconduct at Four Dental Schools.

As women enter the dental profession in increasing numbers in North America and around the world, the questions of how they perceive their environment and what kind of barriers they face are important subjects to be addressed. The aim of this study was to assess and compare women dental students' perceptions of bias in their environment and experiences of sexual misconduct at one dental school in each of four countries. In spring 2017, 1,293 female students at four dental schools in the U.S., Bulgaria, Brazil, and India were invited to participate in a 24-item survey developed by researchers from the four countries; 990 students responded (response rate 76.6%). The overall majority of the respondents reported thinking the admissions process at their school was fair (79.7%); but a fifth of U.S. and Brazilian students perceived their school was not fully embracing of females, with most Bulgarian students agreeing (87.2%) and all Indian students disagreeing. Most respondents overall perceived that male faculty members did not favor male students (79.5%) and did not think there was discrimination against female students by faculty (87.1%), but half of the U.S. respondents reported feeling discriminated against by both male faculty and male students. When the responses "I've been verbally harassed" and "I've been somewhat verbally harassed" were combined, 10.1% of the U.S. respondents reported verbal harassment, compared to 20% of Brazilian, 15% of Bulgarian, and 2% of Indian respondents. When the responses "I've been sexually assaulted" and "I've been somewhat sexually assaulted" were combined, 6% of U.S. respondents reported being sexually assaulted, compared to 6.2% of Brazilian, 2.5% of Bulgarian, and none of the Indian respondents. Almost half (46.9%) of these students overall perceived their school was not or only somewhat vigilant about issues of sexual misconduct, and only 54% said they would feel comfortable or very comfortable reporting misconduct. These results suggest that academic dental institutions in all four countries need improvements to make their environments more equitable and free of bias and sexual misconduct.

Influence of a cylindrical crosshead on shear bond testing of composite-tooth interfaces.

The effect of a cylindrical crosshead on shear bond strength of composite to dentin was assessed by finite element analysis (FEA) after shear bond testing thirty mandibular molars restored with composite cylinders (Tetric EvoCeram-3 mm diameter) perpendicular to conditioned dentin. Cross-sectional geometric models were created with quadrilateral linear plane stress elements. Stress distributions for normal, shear, and major principal stresses were plotted. Mean shear bond strength for the experimental group was 23.9 MPa (±4.54), about 15-75% higher than values reported with other methods. FEA showed localized 'hot spots' (±16-20 MPa) at the corners of the base of the adhesive layer under a 20 N vertical load. Principal stresses across the composite-dentin interface were lower (±12-16 MPa), but significantly homogenous, approximating closely the nominal strength value. With uniform stress distributions across the adhesive layer, FEA confirmed that a cylindrical crosshead may be an optional tool to improve shear bond testing of dental materials.

A global probe into dental student perceptions about philanthropy, global dentistry and international student exchanges.

BACKGROUND: Training culturally competent graduates who can practice effectively in a multicultural environment is a goal of contemporary dental education. The Global Oral Health Initiative is a network of dental schools seeking to promote global dentistry as a component of cultural competency training. OBJECTIVE: Before initiating international student exchanges, a survey was conducted to assess students' awareness of global dentistry and interest in cross-national clerkships. METHODS: A 22-question, YES/NO survey was distributed to 3,487 dental students at eight schools in seven countries. The questions probed students about their school's commitment to enhance their education by promoting global dentistry, volunteerism and philanthropy. The data were analysed using Vassarstats statistical software. RESULTS: In total, 2,371 students (67.9%) completed the survey. Cultural diversity was seen as an important component of dental education by 72.8% of the students, with two-thirds (66.9%) acknowledging that their training provided preparation for understanding the oral health care needs of disparate peoples. A high proportion (87.9%) agreed that volunteerism and philanthropy are important qualities of a well-rounded dentist, but only about one-third felt that their school supported these behaviours (36.2%) or demonstrated a commitment to promote global dentistry (35.5%). In addition, 87.4% felt that dental schools are morally bound to improve oral health care in marginalised global communities and should provide students with international exchange missions (91%), which would enhance their cultural competency (88.9%) and encourage their participation in charitable missions after graduation (67.6%). CONCLUSION: The study suggests that dental students would value international exchanges, which may enhance students' knowledge and self-awareness related to cultural competence.

The SPA Factor or Not? Distinguishing Sex on the Basis of Stereotyped Tooth Characteristics.

OBJECTIVES: The study examines whether faculty, dental students, or laypeople can determine the sex of a patient solely by looking at the shape of their teeth. METHODS: Fifty faculty, 100 students, and 50 patients evaluated 40 photographed smiles for 8,000 observations. The subject group was comprised of 20 males and 20 females. Contingency table analysis was used to determine whether all study participants labeled the smiles similarly and to look for differences within each group. Care was taken to model the effect of individual variation. A nested logistic regression was employed to ascertain differences between faculty, students, and laypeople and to account for the correlation within subjects' responses. RESULTS: It was expected that 50% of the smiles would be labeled as male and 50% as female. Statistical differences were found for the total group, as all participants were more likely to rate a smile as female (χ2 = 38.19, P < .0001). Using the odds ratio, study participants were 1.32 times more likely to view a smile as female. CONCLUSION: Stereotyped "feminine" and "masculine" tooth anatomy characteristics could not predictably be related to the sample smiles either by faculty, students, or public.

AC electrokinetic drug delivery in dentistry using an interdigitated electrode assembly powered by inductive coupling.

AC electrokinetics (ACEK) has been shown to deliver certain drugs into human teeth more effectively than diffusion. However, using electrical wires to power intraoral ACEK devices poses risks to patients. The study demonstrates a novel interdigitated electrode arrays (IDE) assembly powered by inductive coupling to induce ACEK effects at appropriate frequencies to motivate drugs wirelessly. A signal generator produces the modulating signal, which multiplies with the carrier signal to produce the amplitude modulated (AM) signal. The AM signal goes through the inductive link to appear on the secondary coil, then rectified and filtered to dispose of its carrier signal, and the positive half of the modulating signal appears on the load. After characterizing the device, the device is validated under light microscopy by motivating carboxylate-modified microspheres, tetracycline, acetaminophen, benzocaine, lidocaine and carbamide peroxide particles with induced ACEK effects. The assembly is finally tested in a common dental bleaching application. After applying 35 % carbamide peroxide to human teeth topically or with the IDE at 1200 Hz, 5 Vpp for 20 min, spectrophotometric analysis showed that compared to diffusion, the IDE enhanced whitening in specular optic and specular optic excluded modes by 215 % and 194 % respectively. Carbamide peroxide absorbance by the ACEK group was two times greater than diffusion as measured by colorimetric oxidation-reduction and UV-Vis spectroscopy at 550 nm. The device motivates drugs of variable molecular weight and structure wirelessly. Wireless transport of drugs to intraoral targets under ACEK effects may potentially improve the efficacy and safety of drug delivery in dentistry.

Perceptions of Saudi dental students on cultural competency.

OBJECTIVES: To probe dental students' perceptions on their cultural competency and international student exchange programs as a way of improving cultural competency training. METHODS: A cross-sectional survey (n=460) was distributed to predoctoral students at the College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia in May 2014 at the male and female university campuses. Descriptive statistics were carried out using Statistical Package for Social Sciences (p=0.05).  RESULTS: It was found that 79.6% of students think that teaching them regarding cultural diversity is important. Only 41% of students thought their dental education teaches them on the importance of volunteerism and philanthropy. Most students (89.8%) think that international student exchanges can enhance their cultural competence. CONCLUSION: In this study, it was found that students believe that cultural competence is important and participation in international student exchange programs can enhance their training.

Incidence of Sleep Disorders Reported by Patients at UTHSC College of Dentistry: A Two-Year Follow-Up and Proposed Educational Program.

A 2011 study at one U.S. dental school found that patients were not routinely screened by dental students for obstructive sleep apnea and/or other related sleep disorders, nor were students being trained to screen. Consequently, the medical history questionnaire used in the clinic was updated to include five specific screening questions. The aim of this two-year follow-up study was to determine whether screening had improved at the school. A retrospective chart review of all patients (age 14-70+) in the third- and fourth-year dental clinics in 2012 and 2013 searched for "YES" responses to the five questions. Of 5,931 patients, 38% reported they snore or were told they snore. By age 50-59, their reports of snoring increased to 50%. About 5% reported incidents waking up choking. By age 50, between one-fifth and one-quarter indicated they woke up frequently during the night. One in six frequently felt overly tired during the daytime, often falling asleep. This problem was evenly reported by all age groups between ages 30 and 69. About half the patients reporting sleep problems also had hypertension and cardiovascular problems with an equal distribution between males and females. The results showed that updating the medical history form had dramatically improved screening for sleep-disordered breathing by these dental students. Though screening is neither a definitive diagnosis nor an attempt to distinguish among sleep disorders, the results correlate with national statistics. Screening is an important step to increase student awareness of this serious health trend as it prepares students to engage more constructively in its management and referral.

Student perceptions about the mission of dental schools to advance global dentistry and philanthropy.

In this study, 491 dental students at one dental school in the United States and one in Bulgaria were surveyed to assess their perceptions about the mission of dental schools to advance global dentistry and philanthropy. The study included questions about prior involvement in charitable dental missions. Many respondents felt that their dental school does not advance global dentistry nor adequately teaches students the virtues of philanthropy and volunteerism. The majority agreed, however, that dental schools have a moral obligation to raise the level of oral health care worldwide and help underserved communities access basic dental care. They reported that an opportunity to spend a semester at a foreign dental school would enhance their dental education in ways that are not presently fulfilled; help them better understand cultural diversity; and teach them about philanthropy and volunteerism. In their opinion, international exchange programs that provide clinical rotations and field experiences in economically challenged and underserved areas of the world would a) foster the global advancement of dentistry; b) promote an appreciation for cultural diversity and socioeconomic disparity in the communities that graduates will be serving; and c) teach students the virtues of philanthropy and volunteerism. This study may contribute to understanding factors affecting student involvement in programs to advance global dentistry.

Fluoride uptake by human tooth enamel: topical application versus combined dielectrophoresis and AC electroosmosis.

PURPOSE: To compare fluoride uptake by enamel after applying 1.23% acidulated phosphate fluoride gel to human tooth enamel topically (n = 12) or with combined dielectrophoresis and AC electroosmosis (DEP/ACE) at frequencies of 10, 400 and 5,000 Hz (n = 12) for 20 minutes. METHODS: DEP/ACE induced nonuniform electrical fields with three alternating current frequencies to polarize, orient, and motivate fluoride particles. Fluoride concentrations were measured at various enamel depths using wavelength dispersive spectrometry. Data were analyzed by ANOVA/Student-Newman-Keuls post hoc tests (P < or = 0.05). RESULTS: Fluoride concentrations in the diffusion group were significantly higher than baseline readings at 10, 20 and 50 microm depths. Fluoride concentrations in DEP/ACE-treated teeth were significantly higher than the diffusion group at 10, 20, 50, 100, 200 and 300 microm (ANOVA/Student-Newman-Keuls post hoc, P < 0.05). Fluoride uptake with DEP/ACE was substantially higher than diffusion at 10, 20, 50, 100, 200 and 300 microm depths (paired t test, P < 0.05). DEP/ACE transported fluoride up to 300 microm deep, whereas conventional fluoride application was comparatively ineffective beyond 20 microm depth (P < 0.05). Compared to passive diffusion, fluoride uptake in enamel was significantly higher in the DEP/ACE group at 10, 20, 50, 100, 200 and 300 microm depths (P < 0.05). DEP/ACE drove fluoride substantially deeper into human enamel with a difference in uptake 1,575 ppm higher than diffusion at 100 microm depth; 6 times higher at 50 microm depth; 5 times higher at 20 microm depth; and 7 times higher at 10 microm depth. Fluoride levels at 100 microm were equivalent to long-term prophylactic exposure.

Enhanced penetration of fluoride particles into bovine enamel by combining dielectrophoresis with AC electroosmosis.

Fluoride deposition into the pores of enamel is necessary at high concentrations to reduce enamel demineralization and with a high degree of penetration to account for loss by ingestion. Current diffusion and electrochemical methods are inadequate for effectively transporting fluoride greater than 20 µm into enamel. The study explores the coupling of dielectrophoresis (DEP) and AC electroosmosis (ACEO) to selectively concentrate fluoride particles from fluoride gel excipients and enhance their penetration into enamel. By measuring the frequency response of approximately 10-µm-sized sodium fluoride particles in an aqueous gel media, appropriate frequencies for positive DEP, negative DEP, and ACEO are identified. An assembly composed of two cross-planar interdigitated electrode (IDE) arrays with open slots is driven successively by fields at appropriate frequencies to drive fluoride particles through the slots of the IDE and into the enamel pores using a combination of DEP and ACEO methods. Fluoride uptake and penetration of 1.23% acidulated phosphate fluoride gel into bovine tooth enamel at various depths is measured using wavelength dispersive spectrometry to compare deposition by diffusion, DEP, and DEP plus ACEO. Fluoride levels in all DEP groups were significantly higher than diffusion groups at depths 10 and 20 µm. The highest fluoride concentrations at 10, 20, 50, and 100 µm depths occur under deposition conditions combining DEP with ACEO. Fluoride levels at 50 µm were equivalent to long-term prophylactic exposure. These methods may potentially benefit populations at high risk for development of caries and periodontal disease, including underserved children and disparate groups.

Comprehensive training in suspected child abuse and neglect for dental students: a hybrid curriculum.

Child abuse and neglect are tragic realities of American society. However, most U.S. dental schools do not provide students with adequate training to deal with the problem. This article proposes expanding the predoctoral dental curriculum with a problem-based learning model that can effectively stimulate critical thinking skills to assist graduates in screening and reporting suspected child abuse and neglect throughout their careers. The unique multicultural environment of dental school offers students an unprecedented opportunity to develop awareness about child abuse and domestic violence, while increased vigilance can potentially save innocent young lives. Educating students about proper protocol when they suspect child abuse or neglect is imperative, particularly for dental schools involving students in community sealant and other preventive programs in public schools. By expanding their curriculum to include recognition and intervention, dental schools can help break the cycle of violence and transform attitudes towards taking decisive action. Clinical curricula that have moved to private practice preceptor models are well suited to screen for child abuse. The goal is to motivate dental schools to deal with this critical issue, develop reporting protocols and procedures for appropriate response, and provide their students with consummate training.

A four-tier problem-solving scaffold to teach pain management in dental school.

Pain constitutes a major reason patients pursue dental treatment. This article presents a novel curriculum to provide dental students comprehensive training in the management of pain. The curriculum's four-tier scaffold combines traditional and problem-based learning to improve students' diagnostic, pharmacotherapeutic, and assessment skills to optimize decision making when treating pain. Tier 1 provides underpinning knowledge of pain mechanisms with traditional and contextualized instruction by integrating clinical correlations and studying worked cases that stimulate clinical thinking. Tier 2 develops critical decision making skills through self-directed learning and actively solving problem-based cases. Tier 3 exposes students to management approaches taken in allied health fields and cultivates interdisciplinary communication skills. Tier 4 provides a "knowledge and experience synthesis" by rotating students through community pain clinics to practice their assessment skills. This combined teaching approach aims to increase critical thinking and problem-solving skills to assist dental graduates in better management of pain throughout their careers. Dental curricula that have moved to comprehensive care/private practice models are well-suited for this educational approach. The goal of this article is to encourage dental schools to integrate pain management into their curricula, to develop pain management curriculum resources for dental students, and to provide leadership for change in pain management education.

Breaking the fluoride diffusion barrier with combined dielectrophoresis and AC electroosmosis.

PURPOSE: To compare the deposition of fluoride particles into bovine enamel by diffusion (n = 20); dielectrophoresis (DEP) at 10 Hz and 5000 Hz (n = 10); and DEP (10 Hz and 5000 Hz) combined with AC electroosmosis (ACEO) at 400 Hz (DEP/ACE) (n = 10). METHODS: Fluoride particle movements induced at 10, 400, and 5000 Hz frequencies, were analyzed with light microscopy and stack imaging in real time. Fluoride concentrations were measured at various enamel depths using wavelength dispersive spectrometry. Results were analyzed by ANOVA/Student-Newman-Keuls post hoc (P = 0.05). RESULTS: Fluoride levels in teeth treated with DEP were significantly higher than diffusion at depths 10 and 20 microm. DEP and diffusion were relatively ineffective at greater depths. The highest fluoride concentrations at 10, 20, and 50 microm depths were found in the DEP/ACE group. After 20 minutes, DEP/ACE increased fluoride uptake by 600% at 50 microm and 400% at 100 microm compared to baseline levels (P < 0.05). Fluoride particle movement was induced by negative DEP at 10 Hz; positive DEP at 5000 Hz; and ACEO at 400 Hz frequency.

Is there a place for teaching obstructive sleep apnea and snoring in the predoctoral dental curriculum?

The widespread prevalence of obstructive sleep apnea and apneic snoring is both alarming and well documented. Sleep disorders affect one out of five Americans. Yet, during an attempt to study the prevalence of obstructive sleep apnea and snoring among patients at the University of Tennessee Health Science Center College of Dentistry, a search through the entire school's database for the terms "sleep apnea" and "snoring" found only ninety-two patients who admitted to snoring. Currently, the condition "sleep apnea" is not even on the school's list of health/medical questions. These figures not only are inconsistent with national statistics, but confirm that more needs to be done to make dental students aware of these disorders, include them in patient medical histories, and ultimately educate patients about therapies that can help. Considering the health concerns related to this sleep disorder, the economic impact of insomnia and daytime sleepiness, as well as the fact that the dentist is well poised to reduce symptoms and increase the quality of life among sufferers, mandibular advancement devices should become an educational standard in the predoctoral clinical curriculum of dental schools. Predoctoral clinical curricula need to reflect this current health trend and train dentists to care for these patients comprehensively.

Microhardness recovery of demineralized enamel after treatment with fluoride gel or CPP-ACP paste applied topically or with dielectrophoresis.

PURPOSE: To evaluate the microhardness of demineralized enamel remineralized in saliva after applying 1.23% APF gel or CCP-ACP paste with dielectrophoresis (DEP) or diffusion for 3 minutes. METHODS: In this laboratory study, 25 enamel blocks of bovine incisors were soaked in demineralizing solution (10 mM HCl pH 2.5) for 10 minutes and remineralized in saliva for 1 hour, after applying 1.23% APF gel or CPP-ACP paste without fluoride with dielectrophoresis or conventional topical application for 3 minutes. The mean and percentage changes of surface microhardness in pre-demineralization, post-demineralization and remineralization stages were measured in the five groups. The results of all five groups during the three stages were compared by ANOVA and paired t-tests (P = 0.05). RESULTS: The average surface microhardness recovery of APF gel (12,300 ppm fluoride) applied with DEP was higher than APF gel applied topically, or CPP-ACP paste applied with DEP or topically, and water control (P < 0.05). The percentage of surface microhardness recovery for APF+DEP, APF+Diffusion, CPP-ACP+DEP, CPP-ACP+Diffusion, and water control were 88.17%, 13.62%, 7.14%, 5.45%, and 4.02%, respectively. Demineralization treatment decreased the surface microhardness of enamel in all groups and the surface microhardness recovery in the APF+DEP group was significant (P < 0.001). The only significant paired difference was between APF+DEP and all other groups. No other paired difference approached significance. Surface microhardness recovery of enamel with APF+DEP was 12 times or 1,200% greater than APF gel applied topically, and CPP-ACP paste either applied topically or with DEP in one 3-minute application.

Dielectrophoresis: a model to transport drugs directly into teeth.

The article describes an innovative delivery system based on the principles of dielectrophoresis to transport drugs directly into site-specific intraoral targets. The hypothesis that a drug can be driven into tooth enamel during the application of an applied electrical potential difference was tested by the authors in in vitro studies comparing dielectrophoresis to diffusion to transport carbamide peroxide and fluoride. The studies showed that these agents can be transported directly into teeth using an alternating current (AC) electric field more effectively than diffusion. It was found that a 20-min bleaching treatment on human teeth with dielectrophoresis increased carbamide peroxide absorption by 104% and, on average, improved the change in shade guide unit 14 times from 0.6 SGU to 9 SGU. After applying a 1.23% acidulated phosphate fluoride gel to bovine incisors for 20 min by dielectrophoresis or diffusion, analysis with wavelength dispersive spectrometry determined that dielectrophoresis doubled fluoride uptake in the superficial layers compared to diffusion, and drove the fluoride significantly deeper into enamel with an uptake 600% higher than diffusion at 50 µm depth. Finally, dielectrophoresis promises to be a viable model that can potentially be used clinically to deliver other targeted drugs of variable molecular weight and structure.

Epidermolysis bullosa acquisita: a rare challenge in dental management.

Dentists often have the opportunity to detect and intercept serious patient medical conditions. Their role may even be central in helping patients overcome fears about their condition and motivating them to obtain an accurate diagnosis and proper treatment. This article features the case of an elderly woman who presented for treatment of painful intraoral mucosal blisters and erosions beneath her dentures and was diagnosed with potentially fatal epidermolysis bullosa acquisita (EBA). Given how quickly improper diagnosis and treatment could lead to morbidity and potential mortality-especially in a susceptible elderly patient-this case illustrates the importance of good communication between all health professionals involved in the multidisciplinary management of patients with challenges as complex and rare as EBA. The successful outcome of this case was directly dependent on the propitious initiative and intervention of the dentist.