Self-Perceived Knowledge, Skills, Attitudes, and Use of Evidence-Based Dentistry Among Practitioners Transitioning to Dental Educators.

Dental practitioners transitioning to dental educators (PTEs) have an integral role in dental education. While PTEs intrinsically apply some form of evidence-based dentistry (EBD) in patient care, it may not be a standardized, systematic approach. The aims of this study were to determine the self-perceived knowledge, skills, attitudes, and behaviors of PTEs regarding EBD at one U.S. dental school and to identify areas where formal calibration may be warranted to facilitate their competence and confidence as dental educators. Participants voluntarily completed a 32-question survey regarding their EBD training and self-perceived EBD skills in several areas: use of the clinical evidence pyramid; systematic, objective, and critical appraisal of the evidence; application of the evidence to patient care; and integrating clinical expertise, scientific evidence, and patient's preferences to formulate a treatment plan. The PTEs were invited to participate in the anonymous survey during regularly scheduled calibration sessions held between May and July 2014. After study information was distributed, 100% of the attendees (n=43) completed the survey. The percentage of total PTEs at the school could not be calculated. Of the responding PTEs, 69% rated themselves better than satisfactory (70% proficiency) in their knowledge, skills, and attitudes regarding EBD skills application. However, only 33-42% of the respondents indicated that they frequently used the evidence pyramid and systematically, objectively, and critically appraised the evidence, even though 65% indicated they applied the evidence to improve patient care over 70% of the time. In addition, the participating PTEs identified a need for more frequent use of formal EBD skills. Providing case-based EBD projects involving PTEs as mentors may provide more opportunities for the judicious and effective use of these important skills and may improve PTEs' self-perceived confidence.

Interventions for prevention of herpes simplex labialis (cold sores on the lips).

BACKGROUND: Herpes simplex labialis (HSL), also known as cold sores, is a common disease of the lips caused by the herpes simplex virus, which is found throughout the world. It presents as a painful vesicular eruption, forming unsightly crusts, which cause cosmetic disfigurement and psychosocial distress. There is no cure available, and it recurs periodically. OBJECTIVES: To assess the effects of interventions for the prevention of HSL in people of all ages. SEARCH METHODS: We searched the following databases up to 19 May 2015: the Cochrane Skin Group Specialised Register, the Oral Health Group Specialised Register, CENTRAL in the Cochrane Library (Issue 4, 2015), MEDLINE (from 1946), EMBASE (from 1974), LILACS (from 1982), the China National Knowledge Infrastructure (CNKI) database, Airiti Library, and 5 trial registers. To identify further references to relevant randomised controlled trials, we scanned the bibliographies of included studies and published reviews, and we also contacted the original researchers of our included studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) of interventions for preventing HSL in immunocompetent people. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials, extracted data, and assessed the risk of bias. A third author was available for resolving differences of opinion. MAIN RESULTS: This review included 32 RCTs, with a total of 2640 immunocompetent participants, covering 19 treatments. The quality of the body of evidence was low to moderate for most outcomes, but was very low for a few outcomes. Our primary outcomes were 'Incidence of HSL' and 'Adverse effects during use of the preventative intervention'.The evidence for short-term (≤ 1 month) use of oral aciclovir in preventing recurrent HSL was inconsistent across the doses used in the studies: 2 RCTs showed low quality evidence for a reduced recurrence of HSL with aciclovir 400 mg twice daily (risk ratio (RR) 0.26, 95% confidence interval (CI) 0.13 to 0.51; n = 177), while 1 RCT testing aciclovir 800 mg twice daily and 2 RCTs testing 200 mg 5 times daily found no similar preventive effects (RR 1.08, 95% CI 0.62 to 1.87; n = 237; moderate quality evidence and RR 0.46, 95% CI 0.20 to 1.07; n = 66; low quality evidence, respectively). The direction of intervention effect was unrelated to the risk of bias. The evidence from 1 RCT for the effect of short-term use of valaciclovir in reducing recurrence of HSL by clinical evaluation was uncertain (RR 0.55, 95% CI 0.23 to 1.28; n = 125; moderate quality evidence), as was the evidence from 1 RCT testing short-term use of famciclovir.Long-term (> 1 month) use of oral antiviral agents reduced the recurrence of HSL. There was low quality evidence from 1 RCT that long-term use of oral aciclovir reduced clinical recurrences (1.80 versus 0.85 episodes per participant per a 4-month period, P = 0.009) and virological recurrence (1.40 versus 0.40 episodes per participant per a 4-month period, P = 0.003). One RCT found long-term use of valaciclovir effective in reducing the incidence of HSL (with a decrease of 0.09 episodes per participant per month; n = 95). One RCT found that a long-term suppressive regimen of valaciclovir had a lower incidence of HSL than an episodic regimen of valciclovir (difference in means (MD) -0.10 episodes per participant per month, 95% CI -0.16 to -0.05; n = 120).These trials found no increase in adverse events associated with the use of oral antiviral agents (moderate quality evidence).There was no evidence to show that short-term use of topical antiviral agents prevented recurrent HSL. There was moderate quality evidence from 2 RCTs that topical aciclovir 5% cream probably has little effect on preventing recurrence of HSL (pooled RR 0.91, 95% CI 0.48 to 1.72; n = 271). There was moderate quality evidence from a single RCT that topical foscarnet 3% cream has little effect in preventing HSL (RR 1.08, 95% CI 0.82 to 1.40; n = 295).The efficacy of long-term use of topical aciclovir cream was uncertain. One RCT found significantly fewer research-diagnosed recurrences of HSL when on aciclovir cream treatment than on placebo (P < 0.05), but found no significant differences in the mean number of participant-reported recurrences between the 2 groups (P ≥ 0.05). One RCT found no preventive effect of topical application of 1,5-pentanediol gel for 26 weeks (P > 0.05). Another RCT found that the group who used 2-hydroxypropyl-ß-cyclo dextrin 20% gel for 6 months had significantly more recurrences than the placebo group (P = 0.003).These studies found no increase in adverse events related to the use of topical antiviral agents.Two RCTs found that the application of sunscreen significantly prevented recurrent HSL induced by experimental ultraviolet light (pooled RR 0.07, 95% CI 0.01 to 0.33; n = 111), but another RCT found that sunscreen did not prevent HSL induced by sunlight (RR 1.13, 95% CI 0.25 to 5.06; n = 51). These RCTs did not report adverse events.There were very few data suggesting that thymopentin, low-level laser therapy, and hypnotherapy are effective in preventing recurrent HSL, with one to two RCTs for each intervention. We failed to find any evidence of efficacy for lysine, LongoVital® supplementation, gamma globulin, herpes simplex virus (HSV) type I subunit vaccine, and yellow fever vaccine in preventing HSL. There were no consistent data supporting the efficacy of levamisole and interferon, which were also associated with an increased risk of adverse effects such as fever. AUTHORS' CONCLUSIONS: The current evidence demonstrates that long-term use of oral antiviral agents can prevent HSL, but the clinical benefit is small. We did not find evidence of an increased risk of adverse events. On the other hand, the evidence on topical antiviral agents and other interventions either showed no efficacy or could not confirm their efficacy in preventing HSL.

A qualitative examination of patient awareness and understanding of type 2 diabetes and oral health care needs.

AIMS: The study examined awareness and understanding of the bidirectional relationship between type 2 diabetes and oral health care in adult patients with type 2 diabetes. METHODS: Focus groups were held with 30 participants with type 2 diabetes. Groups were comprised of African Americans (n=16), Hispanics (n=6), and Caucasians (n=8). A grounded theory approach was used to analyse and interpret findings. RESULTS: Participants were unaware of the relationship between type 2 diabetes and oral health but were concerned about the influence of poor oral health on quality of life. Having diabetes was reported as a potential challenge for the coordination and receipt of dental care. Patient-provider communication of diabetes and oral health needs were perceived to be inadequate. CONCLUSIONS: Patients with type 2 diabetes are at-risk for poor oral health, yet have limited awareness and understanding of the specific oral health care needs and risks associated with type 2 diabetes. This lack of awareness and understanding of the relationship between diabetes and oral health may be an indicator of inadequate oral health literacy. Addressing the relationship between diabetes and oral health with patients may improve dental outcomes, increase quality of life, and promote oral health literacy in at-risk populations.

Diabetes and oral health: the importance of oral health-related behavior.

PURPOSE: The objective of this study was to explore oral health-related behavior, how patients with diabetes differ from patients not diagnosed with diabetes in their oral health and whether oral health-related behavior moderates the oral health status of patients with diabetes. METHODS: Survey and chart review data were collected from 448 patients (52% male, 48% female, average age: 57 years) of which 77 were diagnosed with diabetes (17%). RESULTS: Patients with diabetes had a higher percentage of teeth with mobility than those not diagnosed with diabetes (14% vs. 8%, p=0.023), as well as gingival recession (16% vs. 12%, p=0.035) and more teeth with recession in the esthetic zone (1.17 vs. 0.88, p=0.046). They also had more decayed, missing and filled surfaces due to caries (101 vs. 82, p<0.001) and more missing teeth due to caries (11 vs. 7, p<0.001). Patients with diabetes brushed and flossed less frequently. Patients with diabetes who did not brush regularly had poorer periodontal health (percentage of teeth with probing depth of <4 mm: 82% vs. 60%, p=0.039, 4 to 6 mm: 34% vs. 17%, p=0.059) and more caries (percentage of decayed teeth: 32% vs. 15%, p=0.033) than regularly brushing patients with diabetes. CONCLUSION: Educating patients with diabetes about the importance of good oral self care needs to become a priority for their oral health care providers.

Developmental oronasal fistula of the incisive papilla.

Various terms (including patent nasopalatine fistula and patent nasopalatine duct) have been used to describe the presence of a developmental fistulous tract that connects the oral and nasal cavities through an oral opening located at the incisive papilla. Reportedly, this condition is a rare developmental variant; approximately 40 cases have been reported in the literature. Because awareness of this entity is important to avoid misdiagnosis, this article presents the clinical and conebeam computed tomography findings of two cases. Based on a review of the development of the nasopalatine structures in man, the authors propose that this entity be classified as a developmental oronasal fistula of the incisive papilla.

Effectiveness of gloves and infection control in dentistry: student and provider perspectives.

The objectives of this study were to explore dental and dental hygiene students', graduate students', and dental professionals' preferences for certain types of gloves and the reasons for these preferences (Aim 1), as well as determining their knowledge, attitudes, and behavior concerning the use of dental gloves as a means of barrier protection (Aim 2). Data were collected from 198 dental and forty-six dental hygiene students, thirty-five graduate students, and seventy-nine dental professionals (twenty-eight dentists and fifty-one dental hygienists in private practice). The subjects responded to a self-administered anonymous survey. Professionals (dentists: 96.4 percent and dental hygienists: 92.2 percent) were found to be more likely to have a preference for certain types of gloves than students (dental students: 79.2 percent and dental hygiene students: 76 percent) and graduate students (77.1 percent; p=.033). "Comfort" was most frequently reported as a reason for glove preference. Large percentages of respondents wrongly believed that gloves provide full protection (students: 50.8 percent; graduate students: 25.7 percent; professionals: 30.4 percent), thought that gloves provide protection as long as there is no visible tear (students: 39.7 percent; graduate students: 28.6 percent; professionals: 18.2 percent), and reported that they would not change gloves during an uninterrupted three-hour long procedure (students: 32.2 percent; graduate students: 23.5 percent; professionals: 22.7 percent). These findings should alert dental educators about the importance of educating their students as well as practicing professionals clearly and comprehensively about infection control and the science and rationale supporting recommended guidelines.

Treating patients with herpes simplex virus infections: dental and dental hygiene students' knowledge, attitudes, and professional behavior.

Dental and dental hygiene students frequently interact with patients with herpes simplex virus (HSV) infections, often simply referred to as cold sores. The objectives of this study were to assess dental and dental hygiene students' knowledge, attitudes, and professional behavior concerning the treatment of patients with HSV infections and to investigate the relationships among knowledge, attitudes, and professional behavior. Questionnaire data were collected from 337 dental and seventy-three dental hygiene students at regularly scheduled classes. Dental and dental hygiene students did not differ in their overall knowledge concerning HSV infections. Dental hygiene students were more apprehensive about treating patients with these infections, but used more appropriate professional behavior compared to dental students. Dental students' knowledge and appropriateness of professional behavior increased over the course of their education. Overall, it was found that an increase in student knowledge was associated with increased apprehension related to treating these patients. However, the more apprehensive they were, the more they engaged in appropriate professional behavior. Educating future health care providers about the treatment of patients with infectious and communicable diseases can potentially increase the students' apprehension/negative attitudes concerning providing care, while at the same time increasing appropriate professional behavior during their education. Addressing students' apprehensions might be a crucial moderator that will determine whether they will provide the best possible care for these patients in their future professional lives.