Staining potential differences between an infiltrative resin and an esthetic, flowable composite.

OBJECTIVE: To compare color change magnitude of an infiltrative resin and a flowable composite resin after immersion in commonly consumed beverages. MATERIALS AND METHODS: Disks (1 × 9 mm) of a flowable composite (Filtek Supreme Ultra Flowable) and a resin-infiltrative product (Icon) were made. Specimens were dark-stored in tap water (24 hours). Baseline color parameters (CIE L*a*b*) were obtained using a colorimeter (Easyshade V4, VITA). Specimens were immersed (dark stored, 37°C, 1 week) in commercial beverages: Kool-Aid, coffee, Coca-Cola, and tap water (control). ΔE00 between final and baseline conditions for each material/beverage combination was determined (N = 10/group). Initial analysis of variance indicated significant impact of major factors/interactions on ΔE00 . Subsequently, t-tests between ΔE00 values of restorative materials within each beverage was performed: alpha 0.05. RESULTS: Kool-Aid produced the greatest color change for flowable composite, with a ΔE00 significantly greater than the infiltrative product. No significant ΔE00 differences were noted between products immersed in coffee, however color parameters causing these differences were not similar. Water or Coca-Cola immersion showed lowest ΔE00 values for both materials, considered visually imperceptible: ΔE00 values <0.8. CONCLUSIONS: Color change potential of infiltrative resin or resin composite was highly dependent on beverage type, with no general trends observed in which material was affected more. CLINICAL SIGNIFICANCE: Staining potential of an infiltrative restorative resin differs from that of a filled, flowable composite material on a beverage-by-beverage basis. The potential for color change seems not related to the presence or absence of fillers in the restorative material.

Mode of drinking fluoridated milk: effect on intraoral fluoride concentrations.

OBJECTIVE: To determine the effect of the mode of drinking fluoridated milk on salivary and plaque fluoride concentrations. METHODS: Fluoridated milk was ingested by 32 children in three ways: (a) directly from the container (1.0 and 5.0 mg F/litre), (b) through a straw with the tip between the lips (5.0 mg F/litre), and (c) with the tip deep in the oral cavity (5.0 mg F/litre). Saliva was collected at baseline and 2, 15, and 40 min and plaque at baseline and 20 min after drinking. Fluoride concentrations were determined using the electrode after HMDS-facilitated diffusion. RESULTS: The mode of drinking did not affect fluoride concentrations in saliva or plaque. The average 2-min salivary concentrations were 65 ng F/mL for the 1.0 mg F/litre group and 276 ng F/mL for the three 5.0 mg F/litre groups (P < 0.01). The average of the 15- and 40-min salivary concentrations was 22 ng F/mL for the 1.0 mg F/litre group and 41 ng F/mL for the 5.0 mg F/litre groups (P < 0.01). Plaque concentrations showed the same patterns as in saliva, that is, they were higher in the three 5.0 mg F/litre groups than in the 1.0 mg F/litre group and the differences among the 5.0 mg F/litre groups were not statistically significant. CONCLUSION: Salivary and plaque fluoride concentrations were independent of the mode of drinking but directly related to milk fluoride concentrations.

Incidental Finding of a Foreign Object on a Panoramic Radiograph.

This study's purpose was to describe a case involving the discovery of a foreign body in the ear canal of an eight-year-old boy, revealed during a recall evaluation to a dental clinic. A panoramic radiograph revealed a radiopaque object in the area of the external auditory meatus. The patient's mother reported one incidence of reported ear pain that resolved spontaneously, but the patient denied placing any object into his ear both in our clinic and at the time he reported ear pain to his mother. The patient was referred to an otolaryngologist, and the object was removed.

The utility of hybrid promotion and tenure tracks for dental school faculty.

The promotion and tenure process for faculty members varies, by design, for different disciplines, departments, and academic institutions. For many faculty members in U.S. dental schools, the process may thus appear nebulous and be difficult to navigate. In this article, we review the history, forces of change, and some of the mechanisms utilized for promotion and tenure of faculty in the health sciences, particularly for clinician-educators. Some institutions have successfully created hybrid tracks for clinician-educators in order to develop and recognize these faculty members' scholarly activity in addition to their clinical teaching. Hybrid tracks empower faculty members to successfully perform scholarly activities that realistically reflect institutional missions. The authors of this article conclude with a number of practical suggestions to enhance development and retention of faculty using the hybrid promotion and tenure mechanism. These include demonstrating the congruence of institutional mission, faculty activities, and promotion and tenure guidelines; developing scholarly activities for clinician-educators that can be measured in the promotion and tenure process; rewarding scholarly achievement for clinician-educators utilizing the promotion and tenure mechanism; and developing an evaluation system that accounts for changes in mission and faculty activities.

Imperfect hybrid layers created by an aggressive one-step self-etch adhesive in primary dentin are amendable to biomimetic remineralization in vitro.

Degradation of hybrid layers created in primary dentin occurs as early as 6 months in vivo. Biomimetic remineralization utilizes "bottom-up" nanotechnology principles for interfibrillar and intrafibrillar remineralization of collagen matrices. This study examined whether imperfect hybrid layers created in primary dentin can be remineralized. Coronal dentin surfaces were prepared from extracted primary molars and bonded using Adper Prompt L-Pop and a composite. One-millimeter-thick specimen slabs of the resin-dentin interface were immersed in a Portland cement-based remineralization medium that contained two biomimetic analogs to mimic the sequestration and templating functions of dentin noncollagenous proteins. Specimens were retrieved after 1-6 months. Confocal laser scanning microscopy was used for evaluating the permeability of hybrid layers to Rhodamine B. Transmission electron microscopy was used to examine the status of remineralization within hybrid layers. Remineralization at different locations of the hybrid layers corresponded with quenching of fluorescence within similar locations of those hybrid layers. Remineralization was predominantly intrafibrillar in nature as interfibrillar spaces were filled with adhesive resin. Biomimetic remineralization of imperfect hybrid layers in primary human dentin is a potential means for preserving bond integrity. The success of the current proof-of-concept, laterally diffusing remineralization protocol warrants development of a clinically applicable biomimetic remineralization delivery system.

Age and gender differences in the use of behavior management techniques by pediatric dentists.

PURPOSE: This study evaluated differences in the use of behavior management techniques among older and younger male and female pediatric dentists. METHODS: We surveyed all active members of the American Academy of Pediatric Dentistry residing in the U.S. and Canada. Responses were received from 2467 (59%). The survey contained items on age, gender, and use of behavior management techniques. RESULTS: Males respondents outnumbered females 2:1. Age categories were dichotomized as < 46 and > or = 46 years. Females constituted 53% of the younger group and 14% of the older group. Four gender/age categories were used. A minority indicated that they used hand-over-mouth and active immobilization of sedated patients. No significant differences by groups were seen for use of most basic behavior management techniques. Significant differences by gender/age distribution were seen for the use of non-verbal communication and advanced techniques. Most differences in anticipated changes in technique use were age-related. Most favored parental presence in the operatory, though older males were significantly less likely to allow parental presence for some procedures. CONCLUSIONS: Some statistically significant differences in the use of behavior management techniques exist between older and younger male and female pediatric dentists. Overall, however, the 4 gender/age groups report similar frequencies of use of the techniques surveyed in this study.

Survey of behavior management teaching in predoctoral pediatric dentistry programs.

PURPOSE: The purpose of this study was to survey directors of predoctoral pediatric dentistry programs regarding the teaching of behavior management techniques. METHODS: Surveys were mailed to all 56 dental schools in the United States. Follow-up mailings were sent to nonrespondents. The survey contained items on program demographics and the program's teaching of communicative and pharmacologic techniques. Information was also obtained on informed consent and parental presence in the operatory. RESULTS: Surveys were returned by 48 schools. Two schools declined to respond because they had not yet accepted or graduated students. The final response rate was 89%. The mean (+/-SD) percentage of total didactic time devoted to behavior management was 12% (+/-6). Communicative techniques were taught as "acceptable" by 96% to 100% of programs, with the exception of the hand-over-mouth exercise (HOME). HOME was taught as "unacceptable" by 62% of programs. Active and passive immobilization of sedated and nonsedated children was taught as "acceptable" by 69% to 85% of programs. Sixty-seven percent to 98% of programs taught that pharmacologic techniques (nitrous oxide, conscious sedation, general anesthesia) are "acceptable." There was little evidence that the teaching of behavior management techniques had changed over the previous 5 years, nor that they were likely to change in the near future. Parental presence in the operatory was common for some procedures, particularly among younger children. CONCLUSIONS: Predoctoral programs teach as acceptable communicative and pharmacologic management techniques, with the exception of HOME. Predoctoral program directors report they are not likely to increase the amount of curricular time devoted to behavior management in the near future.

A survey of members of the American Academy of Pediatric Dentistry on their use of behavior management techniques.

PURPOSE: The objective of this study was to survey members of the American Academy of Pediatric Dentistry (AAPD) regarding their use of behavior management techniques. METHODS: Surveys were mailed to 4,180 members, with a follow-up mailing to nonrespondents 2 months later. The survey contained items on demographic variables and use (current, past, and future) of communicative and pharmacologic techniques. Information was also obtained on informed consent, parental presence in the operatory, and parenting styles. RESULTS: Survey response was 66%. Communicative techniques are widely used, with the exception of the hand-over-mouth exercise (HOME). Immobilization for sedated and nonsedated children and pharmacologic techniques are used by a majority or near majority of respondents. Little change was reported in technique use over time, except that 50% of respondents indicated they use HOME less now than 5 years ago, and 24% plan to use it less over the next 2 to 3 years. Parental presence in the operatory appeared to be a common practice for some procedures and for children with special health care needs. The majority of respondents believed that parenting styles had changed in ways that adversely impacted children's behavior in the dental setting. CONCLUSIONS: Most practitioners have not changed their use of behavior management techniques in recent years, nor do they plan to change their use of them in the near future. HOME was the exception to these trends.

Survey of behavior management teaching in pediatric dentistry advanced education programs.

PURPOSE: The purpose of this study was to survey pediatric dentistry advanced education program directors regarding the teaching of behavior management techniques. METHODS: Surveys were mailed to all (65) advanced education programs in the United States. Follow-up mailings were sent to nonrespondents. The survey contained items on program demographics and the program's teaching of communicative and pharmacologic techniques. Information was also obtained on informed consent and parental presence in the operatory. RESULTS: Surveys were returned by 54 programs. Two programs declined to respond because they had not yet accepted or certified residents. The final response rate was 86%. The mean percentage (+/- SD) of total didactic time devoted to behavior management was 13% (+/-9.5). Communicative techniques were taught as "acceptable" by 98% of programs, with the exception of the hand-over-mouth exercise (HOME), which was taught as "unacceptable" by 54% of programs. Active and passive immobilization of sedated and nonsedated children was taught as "acceptable" by 76% to 98% of programs. All programs taught that pharmacologic techniques (nitrous oxide, conscious sedation, general anesthesia) are "acceptable." There was little evidence that the teaching of behavior management techniques had changed over the previous 5 years, nor that it is likely to change in the near future. Parental presence in the operatory was common for some procedures, particularly among younger children. CONCLUSIONS: Most programs do not teach HOME as an acceptable behavior management technique. The amount of curricular time devoted to behavior management is not likely to change appreciably in the near future.

Plaque fluoride concentrations are dependent on plaque calcium concentrations.

Despite the 1000-fold difference between the fluoride concentrations ([F]) in dentifrices and fluoridated drinking water, clinical and epidemiological studies have shown that they have similar cariostatic effects. This double-blind, crossover study was done to determine whether the [F] in dental plaque is related more to the [F] of the dentifrice used or to the plaque concentrations of calcium and magnesium. The subjects (n = 13) were adults and residents of a city served with fluoridated drinking water. After 1 week of using a fluoridated dentifrice (940 ppm) or a placebo dentifrice, whole saliva and plaque were collected 1.0 h and approximately 12 h after the last use of the dentifrices. The average salivary [F] after brushing with the F dentifrice was higher than after using the placebo. The average plaque [F] 1.0 h after brushing with the F dentifrice was higher than after using the placebo (p < 0.01), but the difference at 12 h was not significant. Plaque [Ca] and [F] were directly related under all experimental conditions (p = 0.0001). The relationships between plaque [Mg] and [F] were weaker and inconsistent. Based on these findings and reports in the literature it is concluded that, for persons whose drinking water is fluoridated, plaque [F] throughout much of the day is not significantly increased by the use of a fluoridated dentifrice. Instead they are directly related to plaque [Ca]. These findings offer at least a partial explanation for why fluoridated dentifrices and drinking water have similar cariostatic effects.