A Quality Improvement Project to Optimize Fluoride Varnish Use in a Pediatric Outpatient Clinic with Multiple Resident Providers.

The pediatric clinic at Kapi'olani Medical Center provides dental varnish to prevent decay. A chart review (conducted August 1-31, 2017) revealed that only 49.6% of eligible children received varnish. Among those who did not receive varnish, no explanation was provided in 83.9% of the charts. This quality improvement project was designed to increase delivery and documentation of dental varnish. The participants were 14-15 pediatric and psychiatry residents (11 present for all cycles). Cycle 1 interventions were a 5-minute resident educational session on the importance and process of fluoride varnish, and visual reminders on all order entry computers in the clinic. Cycle 2 intervention consisted of a prompt added to the clinic's default well child visit templates requiring notation of whether varnish was given and a reason if not. Data for cycle 2 was collected over 6 weeks as some residents chose to use their own templates, serving as an unplanned comparison group. Application of varnish increased to 77.7% (P < .001) after cycle 1, and was statistically unchanged for cycle 2 (74% (P = .24)). Documentation of reason for lack of varnish was missing in 80% (P = .59) after cycle 1 and 17 % (P < .001) after cycle 2 (with prompt). In the cycle 2 comparison group using their own templates, the varnish application rate was 71% (P < .001) with no explanation for lack of varnish 84% of the time (P = .95). Brief educational interventions may result in increased use of fluoride varnish in resident-based clinics. Task based prompts or stop measures in electronic medical record templates can improve documentation, which can inform efforts to improve varnish application.

Improving oral health through dental fluoride varnish application in a primary care paediatric practice.

Dental caries affect 97% of people during their lifetime. A total of 59% of children aged 12-19 will have at least one documented cavity. The American Academy of Pediatrics recommends fluoridated toothpaste to all children starting at tooth eruption, regardless of caries risk. Besides, fluoride varnish is recommended for all children every 3-6 months from tooth emergence until they have a permanent dental home. This project aimed to increase oral fluoride varnish application for children starting at 6 months or the time of tooth eruption up to 3 years of age by at least 50% over 18 months. The stakeholders identified were physicians, nurses, medical assistants and the health information team. We obtained baseline data about oral health screening and fluoride varnish from both the clinic sites. The quality improvement (QI) project was based on Plan-Do-Study-Act (PDSA) cycles with a 6-month gap in-between the three cycles. For the first cycle, all medical staff members participated in 2-hour knowledge and skills training on dental caries and current recommendations on fluoride varnish. PDSA cycle 2 involved having automatic reminders for providers in electronic medical records. PDSA cycle 3 planned to have automatic fluoride orders for the recommended age groups. The QI team analysed the results after every 6 months, and improvements were made based on the input from data and medical staff. The number of patients who had fluoride varnish applied increased from 14% (n=50) to 55% at the end of PDSA cycle 3. Administration of the varnish did not affect the flow of the patients in busy primary care practice. The rate of improvement was across all the age groups, providers and in both clinical sites. It is possible to adhere to the oral fluoride varnish guidelines in a busy primary care practice, which may help benefit young children who are at risk for caries.

Dental students' ability to assess their performance in a preclinical restorative course: comparison of students' and faculty members' assessments.

Dental education consists of both theoretical and practical learning for students to develop competence in treating patients clinically. When dental students encounter practical courses in their first year as a new educational experience, they must also learn to evaluate themselves. Self-evaluation is an essential skill to learn for dental professionals to keep increasing their competence over the course of their careers. The aim of this study was to compare the assessment scores of second- and third-year dental students and the faculty in two consecutive preclinical practical exams in restorative dentistry courses in a dental school in Turkey. Faculty- and student-assigned scores were calculated from two consecutive preclinical examinations on tooth restorations performed on both artificial casts and phantom patients. The students were formally instructed on grading procedures for tooth preparations, base and restoration placement, and polishing criteria. After each step, each item was assessed by faculty members, the student, and another student. The results indicated that the initial differences between second-year students' assessments of their own preclinical practical ability and that of the faculty decreased among the third-year students. Self-evaluation scores did not indicate whether the third-year students tended to over- or underestimate the quality of their own work. However, the second-year students not only overestimated themselves but thought they were above average. The results point to the need to develop students' self-insight with more exercises and practical training.

Effects of cleaning agents on bond strength to dentin.

The cleaning of cavity walls aims to improve adhesive restorative procedures and longevity of restorations. This study has compared the effect of three cleaning agents--sodium bicarbonate jet (Profi II, Dabi Atlante, São Paulo, Brazil); pumice paste plus a biologic detergent (Tergestesim, Probem, São Paulo, Brazil); air water spray--on the bond strength between dentin and two different adhesive systems: Clearfil SE Bond (Kuraray, Kioto, Japan) and Scotchbond Multi-Purpose Plus (3M-ESPE, São Paulo, Brazil). Six groups (n: 10) of dental fragments obtained from young adult extracted teeth were prepared, and each one received one of the listed surface cleaning techniques. After the adhesive application, a cone-shaped test body was built with AP-X (Kuraray, Kioto, Japan) or Z100 (3M-ESPE, São Paulo, Brazil) composite resins, using a Teflon matrix. The specimens were tested for tensile bond strength after one-week storage in distilled water at 37 degrees C. Two pairs of fractured specimens of each group were randomly chosen and processed for scanning electron microscopy (SEM) analysis. ANOVA test of the bond strength values showed no statistical differences among the cleaning agents and neither between their interactions with the bonding systems. Upon SEM analysis, most surfaces showed mixed fractures of adhesive and cohesive failures in bonding resin to dentin. Based on statistical and SEM analysis, it was concluded that the cleaning agents studied did not interfere with the bond strength of the adhesive systems used to dentin.

Effects of cleaning agents on bond strength to dentin

A limpeza das paredes cavitárias é um passo importante na clínica odontológica e visa otimizar os procedimentos adesivos e a longevidade das restauracões. O presente estudo comparou o efeito de três agentes de limpeza cavitária - jato abrasivo de bicarbonato de sódio/ar/água (Profi II, Dabi Atlante, São Paulo, Brasil); pasta de pedra-pomes e água, somada a um detergente biológico (Tergestesim, Probem, São Paulo, Brasil); e spray de ar/água - na resistência adesiva entre dentina e dois tipos de adesivos dentais: Clearfil SE Bond ("self-etching") (Kuraray, Kioto, Japão) e Scotchbond Multi-Purpose Plus ("all-etching") (3M-ESPE, São Paulo, Brasil). Seis grupos de espécimes (n = 10) obtidos a partir de elementos dentais humanos extraídos por indicacão foram preparados e cada um recebeu um dos tratamentos de superfície. Após aplicacão dos adesivos, uma porcão tronco-cônica de resina composta (AP-X, Kuraray, Kioto, Japão/Z-100; 3M-ESPE, São Paulo, Brasil) foi construída sobre os espécimes, com o auxílio de uma matriz bipartida de teflon e uma mesa metálica adaptadora para adaptacão na máquina de ensaio de tracão. Após armazenamento em água destilada a 37ºC por 7 dias, os mesmos foram submetidos às provas de tracão. Dois pares de cada grupo foram escolhidos aleatoriamente e processados para observacão ao microscópio eletrônico de varredura (MEV). A análise estatística dos valores obtidos demonstrou que não houve diferencas significantes entre as técnicas de limpeza empregadas e nem entre a interacão destas com os adesivos dentais, e as observacões ao MEV revelaram uma predominância de fraturas mistas ocorridas na interface dentina/resina. Baseados nas análises estatísticas e nas observacões ao MEV, concluiu-se que as técnicas de limpeza empregadas não interferem na resistência adesiva entre a dentina e os sistemas adesivos estudados, nas condicões experimentais adotadas.

Influence of humidity on dimensional stability of a range of ion-leachable cements.

The dimensional changes of a variety of dental restorative materials, occurring during and after setting, were investigated. The materials were tested under four different environmental conditions: 25 degrees C at laboratory humidity, 25 degrees C at 100% humidity, 37 degrees C at laboratory humidity and 37 degrees C at 100% humidity. Two materials setting by an acid-base reaction were also examined when protected with both a conventional varnish and a low-viscosity light-curable resin. The dimensional changes were recorded continuously using linear variable displacement transducers (LVDTs) over periods of up to 2 h. The materials investigated showed varying magnitudes of dimensional change. The shrinkage of conventional glass-ionomer cements (Fuji II and Opusfil) were the highest at 37 degrees C in air. This was attributed to the highest rate of water loss in the most desiccating environment. The shrinkage observed for the materials which set, even only in part, by a polymerization reaction will probably be due to the water loss and/or polymerization shrinkage. Exposure of these materials to a high-humidity environment reduced the shrinkage because of the swelling associated with water absorption. Application of the varnish and the protective resin over the cement surfaces also reduced shrinkage in Fuji II due to prevention of water exchange. The apparatus used in this study provided a simple and reliable method for measuring linear dimensional change. Data obtained in this study were comparable, where appropriate, to the values found in the literature.

[Animal experimental short and long-term study of a calcium hydroxide line]. / Tierexperimentelle Kurz- und Langzeituntersuchung eines Kalziumhydroxid-Liners.

Thirty-two cavities (class 5) out of total of 64 were coated either with the test substance Hydroxyline or with the control substance Dycal and closed with the standard compound Adaptic. Statistical analysis of seven criteria evaluated histologically (rating: 0-3) revealed no significant differences between the tested characteristics of the control substance Dycal and Hydroxyline in either the short-term or the long-term study.

[Animal experimental studies on a new dentin and pulp-protective lacquer (Bayer D-520)]. / Tierexperimentelle Untersuchung über einen neuartigen Dentin- und Pulpenschutzlack (Bayer D-520).

In an ADA experiment on the protective qualities of a new polyurethane varnish (D-520 Bayer) 72 class 5 cavities were prepared on 3 monkeys and treated by the following 4 methods: -- 18 silicate cement (Bio-Trey) with varnish -- 18 silicate cement (Bio-Trey) without varnish -- 18 composite (Adaptic) fillings with varnish -- 18 composite (Adaptic) fillings without varnish. After an observation time of 14 days, a significant positive result for the 520 varnish could be obtained. An experiment lasting 12 weeks was subsequently undertaken.

A simulated clinical appraisal of base materials for amalgam restorations.

Eight materials were placed as bases on the pulpal surface of cavities prepared in extracted teeth. Seven minutes after mixing of the material commenced, amalgam was condensed on to the lined cavity. The restored teeth were sectioned subsequently for microscopic examination. The results suggested that all uniformly mixed, carefully placed base forming materials that have reached the state of "clinical set" are able to withstand loads applied during amalgam condensation irrespective of their strength.

Sealing properties of intermediary bases and effect on rat molar pulp.

Five "cream-like" intermediary bases (Hypocal¿, Dycal¿, Reocap¿, Cavitec¿ and Dropsin¿) were studied using ZnO-eugenol (ZOE) and phosphate cement for comparison. The in vitro experiments, which were designed to reveal the penetration of a dye and an etching liquid, showed that Dropsin and Hyypocal were permeable to dye and that Dropsin was permeable to acid as well. The in vivo experiments revealed no definite differences between the different cream-like base materials, nor were there differences between those and the conventional cements. The overall mildness of the dentin-pulp reactions and the suitability of the rat molar for this kind of research are discussed.