Dental school pathway programs: Best practices for increasing workforce diversity.

The chronic underrepresentation of racial/ethnic minority practitioners in the U.S. health professions workforce is an oft-cited factor for disparities in health and health-care access affecting communities of color. As non-White providers are more likely to serve uninsured patients and practice in underserved areas, pathway/pipeline programs have been used for many years to increase the numbers racial/ethnic minorities in the health professions workforce. These programs target precollege, college, and postbaccalaureate students from historically underrepresented minority (HURM) groups (defined as African American/Black, Hispanic/Latino, and Native American students) to stimulate interest in health professions careers and provide academic support, mentoring, enrichment experiences, and other resources to facilitate their successful admission to and completion of health professions school and entry into the workforce. This article examines dental pathway programs to identify best practices for increasing enrollment of HURM students in dental school and their successful entry into the dental workforce-as evidenced in the academic literature.

Pathogenesis, diagnosis and management of dentin hypersensitivity: an evidence-based overview for dental practitioners.

Though dentin hypersensitivity (DHS) is one of the most common complaints from patients in dental clinics, there are no universally accepted guidelines for differential diagnosis as well as selection of reliable treatment modalities for this condition. The neurosensory mechanisms underlying DHS remain unclear, but fluid movements within exposed dentinal tubules, i.e., the hydrodynamic theory, has been a widely accepted explanation for DHS pain. As several dental conditions have symptoms that mimic DHS at different stages of their progression, diagnosis and treatment of DHS are often confusing, especially for inexperienced dental practitioners. In this paper we provide an up-to-date review on risk factors that play a role in the development and chronicity of DHS and summarize the current principles and strategies for differential diagnosis and management of DHS in dental practices. We will outline the etiology, predisposing factors and the underlying putative mechanisms of DHS, and provide principles and indications for its diagnosis and management. Though desensitization remains to be the first choice for DHS for many dental practitioners and most of desensitizing agents reduce the symptoms of DHS by occluding patent dentinal tubules, the long-term outcome of such treatment is uncertain. With improved understanding of the underlying nociceptive mechanisms of DHS, it is expected that promising novel therapies will emerge and provide more effective relief for patients with DHS.

Sealants for Preventing and Arresting Pit-and-fissure Occlusal Caries in Primary and Permanent Molars.

BACKGROUND: National Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly onefourth of children and over one-half of adolescents experienced dental caries in their permanent teeth. The purpose of this review was to summarize the available clinical evidence regarding the effect of dental sealants for the prevention and management of pit-and-fissure occlusal carious lesions in primary and permanent molars, compared with a control without sealants, with fluoride varnishes, or with other head-to head comparisons. TYPE OF STUDIES REVIEWED: The authors included parallel and split-mouth randomized controlled trials that included at least 2 years of follow-up, which they identified using MEDLINE (via PubMed), Embase, LILACS, the Cochrane Central Register of Controlled Trials, and registers of ongoing trials. Pairs of reviewers independently conducted the selection of studies, data extraction, risk of bias assessments, and quality of the evidence assessments by using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Of 2,869 records screened, the authors determined that 24 articles (representing 23 studies) proved eligible. Moderate-quality evidence suggested that participants who received sealants had a reduced risk of developing carious lesions in occlusal surfaces of permanent molars compared with those who did not receive sealants (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.08-0.27) after 7 or more years of follow-up. When the authors compared studies whose investigators had compared sealants with fluoride varnishes, they found that sealants reduced the incidence of carious lesions after 7 or more years of follow-up (OR, 0.19; 95% CI, 0.07-0.51); however, this finding was supported by low-quality evidence. On the basis of the evidence, the authors could not provide a hierarchy of effectiveness among the studies whose investigators had conducted head-to-head comparisons. The investigators of 2 trials provided information about adverse events, but they did not report any adverse events. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Available evidence suggests that sealants are effective and safe to prevent or arrest the progression of noncavitated carious lesions compared with a control without sealants or fluoride varnishes. Further research is needed to provide information about the relative merits of the different types of sealant materials.

Sealants for preventing and arresting pit-and-fissure occlusal caries in primary and permanent molars: A systematic review of randomized controlled trials-a report of the American Dental Association and the American Academy of Pediatric Dentistry.

BACKGROUND: National Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly one-fourth of children and over one-half of adolescents experienced dental caries in their permanent teeth. The purpose of this review was to summarize the available clinical evidence regarding the effect of dental sealants for the prevention and management of pit-and-fissure occlusal carious lesions in primary and permanent molars, compared with a control without sealants, with fluoride varnishes, or with other head-to head comparisons. TYPE OF STUDIES REVIEWED: The authors included parallel and split-mouth randomized controlled trials that included at least 2 years of follow-up, which they identified using MEDLINE (via PubMed), Embase, LILACS, the Cochrane Central Register of Controlled Trials, and registers of ongoing trials. Pairs of reviewers independently conducted the selection of studies, data extraction, risk of bias assessments, and quality of the evidence assessments by using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Of 2,869 records screened, the authors determined that 24 articles (representing 23 studies) proved eligible. Moderate-quality evidence suggested that participants who received sealants had a reduced risk of developing carious lesions in occlusal surfaces of permanent molars compared with those who did not receive sealants (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.08-0.27) after 7 or more years of follow-up. When the authors compared studies whose investigators had compared sealants with fluoride varnishes, they found that sealants reduced the incidence of carious lesions after 7 or more years of follow-up (OR, 0.19; 95% CI, 0.07-0.51); however, this finding was supported by low-quality evidence. On the basis of the evidence, the authors could not provide a hierarchy of effectiveness among the studies whose investigators had conducted head-to-head comparisons. The investigators of 2 trials provided information about adverse events, but they did not report any adverse events. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Available evidence suggests that sealants are effective and safe to prevent or arrest the progression of noncavitated carious lesions compared with a control without sealants or fluoride varnishes. Further research is needed to provide information about the relative merits of the different types of sealant materials.

Evidence-based clinical practice guideline for the use of pit-and-fissure sealants: A report of the American Dental Association and the American Academy of Pediatric Dentistry.

BACKGROUND: This article presents evidence-based clinical recommendations for the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents. A guideline panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry conducted a systematic review and formulated recommendations to address clinical questions in relation to the efficacy, retention, and potential side effects of sealants to prevent dental caries; their efficacy compared with fluoride varnishes; and a head-to-head comparison of the different types of sealant material used to prevent caries on pits and fissures of occlusal surfaces. TYPES OF STUDIES REVIEWED: This is an update of the ADA 2008 recommendations on the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars. The authors conducted a systematic search in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other sources to identify randomized controlled trials reporting on the effect of sealants (available on the US market) when applied to the occlusal surfaces of primary and permanent molars. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the quality of the evidence and to move from the evidence to the decisions. RESULTS: The guideline panel formulated 3 main recommendations. They concluded that sealants are effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes. They also concluded that sealants could minimize the progression of noncavitated occlusal carious lesions (also referred to as initial lesions) that receive a sealant. Finally, based on the available limited evidence, the panel was unable to provide specific recommendations on the relative merits of 1 type of sealant material over the others. CONCLUSIONS AND PRACTICAL IMPLICATIONS: These recommendations are designed to inform practitioners during the clinical decision-making process in relation to the prevention of occlusal carious lesions in children and adolescents. Clinicians are encouraged to discuss the information in this guideline with patients or the parents of patients. The authors recommend that clinicians reorient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents.

Etiology and management of whitening-induced tooth hypersensitivity.

Tooth hypersensitivity has long been, and continues to be, the most commonly reported adverse effect of vital tooth whitening with peroxide gels. The complex etiology of whitening-induced tooth hypersensitivity has been a major obstacle in developing a definitive strategy for its prevention. This article reviews the multiple etiologic factors implicated in whitening-induced tooth hypersensitivity and the evidence for efficacy of various strategies for its management.

Effect of school environment on dental students' perceptions of cultural competency curricula and preparedness to care for diverse populations.

Reports of oral health disparities among racial, ethnic, and socioeconomic sectors of the U.S. population have hastened development of strategies to address this issue. Among these strategies is revising dental school curricula in order to develop more culturally competent graduates. The present study uses data from the 2003 American Dental Education Association (ADEA) survey of dental school seniors to assess students' perceptions of the adequacy of their cultural competency training. We hypothesize that these perceptions are influenced by multiple student characteristics and contextual factors, including a school's status with respect to the Pipeline, Professions, and Practice initiative of the Robert Wood Johnson Foundation and The California Endowment. Response data from ADEA survey items reflecting student perceptions of adequacy of curriculum time devoted to cultural competency and their preparedness to treat an ethnically and culturally diverse population were analyzed to assess the influence of selected student and contextual factors. Student gender, marital status, and level of educational debt were found to influence the curriculum time variable, and students at California schools reported higher perceived preparedness levels than students at dental schools nationwide. Dental school environments promoting acceptance and respect of diverse ethnicities/cultures and student race/ethnicity were significantly associated with students' perception of the adequacy of curriculum time for cultural competency and students' perception of their preparedness to provide oral health care for racially and culturally diverse groups. The findings provide insight for development of cultural competency curricula and direction for future study in this area.

Clinical considerations in adhesive restorative dentistry--influence of adjunctive procedures.

Several adjunctive procedures commonly performed during placement of adhesively bonded restorations can significantly influence a restoration's immediate and long-term clinical performance and the maintenance of pulp vitality. This article reviews some of these procedures to highlight and characterize their potential effects on the restorative outcome and to offer suggestions for appropriately incorporating these procedures into routine clinical practice.

Resin adhesion to enamel and dentin: a review.

This article reviews the current knowledge base regarding resin adhesion to enamel and dentin. A descriptive classification system for adhesive resin products as well as clinical considerations derived from the review are also presented to assist the clinician in the selection and application of these products.

Glass ionomers in contemporary restorative dentistry--a clinical update.

Glass ionomers are applicable to many restorative situations, both as stand-alone restoratives and in conjunction with composite resins. This article reviews the clinically relevant properties of glass ionomers, the differences between them and composite resins, and their clinical applications. An understanding of these concepts is into common restorative essential for the optimal incorporation of these material's attributes and utilization.