An evaluation of the relationship between clinical requirements and tests of competence in a competency-based curriculum in dentistry.

BACKGROUND: The development of competencies in dentistry is a complicated process that calls for the development of not just cognitive and psychomotor abilities but also behaviors and attitudes that change as technical proficiency increases and meaningful patient encounters occur. This study examined the relationship between the number of clinical requirements completed by dental students and subsequent performance on tests of competence. The null hypothesis stated there would be no significant linear relationship different from zero between absolute clinical requirements and grades attained in various tests of clinical competence. METHODS: Retrospective assessment data for 81 students were used in this analysis. Data included the amounts of clinical requirements completed for operative dentistry, endodontics, periodontics, and fixed prosthodontics together with data on the respective performance in tests of competence. Correlation was ascertained between grades for tests of competence and the corresponding clinical requirements using a non-parametric Spearman's Rho test at an alpha level of 0.05. RESULTS: Fixed prosthodontics and posterior endodontics were the least common procedures completed by dental students. Statistically significant weak correlations were found between the amounts of clinical requirements performed for posterior endodontic(p = 0.005) and operative procedures (p = 0.006) and associated performance in tests of competence. A moderate correlation was found between the number of fixed prosthodontic procedures completed and associated performance in tests of competence. This latter correlation, however, was not statistically significant (p = 0.654). A significant weak correlation was found between requirements completed for periodontics and the associated test of competence (p = 0.04). A highly statistically significant moderate correlation was found between clinical requirements for anterior endodontics and the associated performance in the tests of competence (p < 0.001). CONCLUSION: The null hypothesis was rejected since a positive correlation was found between the absolute clinical requirements completed and grades in tests of competence. However, only a weak to moderate degree of correlation was found between the completion of clinical requirements and performance in tests of competence for common clinical procedures that new dental graduates should be able to perform.

Prevalence of oral habits in a child population in Trinidad, West Indies

Objectives: The purpose of this study was to determine the prevalence of oral habits (both nutritive and non-nutritive) in children in Trinidad, West Indies and to determine if there are any associated factors such as age, gender, ethnicity, social/familial factors, dietary practices and parental perception. Methods: 155 children aged 4e16 years and their parents were questioned using a struc- tured interview about breast and bottle feeding history, history of oral habits, sibling habit history, parental education level and habit history and parental belief and perception. Oral habits such as pacifier use, digit sucking, tongue sucking, lip biting and sucking, nail biting, and object chewing were recorded. Results: There was a very high prevalence of oral habits (91.6%) with 63.9% of children having two or more habits. The most common oral habit was nail biting (52.9%) and ice crunching was most commonly found in females. Tongue sucking was predominant in children of African ethnicity. Oral habits were more common in children whose parents had a post primary education. 51% of parents were not concerned about oral habits and 64.5% believed that the child would stop the habit without any intervention. Conclusion: The prevalence of both nutritive and non-nutritive oral habits in Trinidad are high and some associations were found with gender, ethnicity, social, dietary and familial factors.

A Comparative Assessment of the Surface Roughness of Thermoplastic Denture Base Resins Following Adjustment and Re-Polishing

This study assessed the roughness of two injection-molded, thermoplastic materials used for denture bases compared with a polyamide material and compression molded Polymethylmethacrylate (PMMA) after the adjustment and re-polishing with either a laboratory protocol or a chair side protocol. Methods: Forty specimens, each of PMMA, Valplast, DuraFlex, Dura Cetal were fabricated and finished according to individual manufactures' instructions. These materials were adjusted with tungsten carbide (TC) burs to mimic gross adjustments, and then re-polished either on a lathe or bonded silicon carbide (B-SC). Following instrumentation, the specimens were assessed using contact profilometry and scanning electron microscopy. Two-factor ANOVA was used to determine significant differences in mean surface roughness (Ra and Rmax), with included factors being material type and re-polishing regimen. Results: Mean Ra values ranged from 0.26 (DuraFlex control) to 1.82 (Valplast adjusted with TC burs). Mean Rmax values ranged from 1.88 (Dura Flex control) to 13.76 (Valplast adjusted with TC burs). Two-factor ANOVA revealed that interaction of both factors was significant (p < 0.05) for Ra and Rmax. There was a statistically significant increase in both Ra (p < 0.05) and Rmax (p < 0.05) for all material types following the gross adjustment. With the exception of DuraFlex, re-polishing of samples that were previously adjusted with TC burs, on the dental lathe produced surfaces that were comparable to control samples. Conclusion: Adjustment of DuraFlex should be kept to a minimum since the adjustment produced the significant surface detriment that could not be corrected with either of the polishing regimens.

A Nano-hybrid investigated: The correlation between surface characteristics and color after instrumentation

There is no evidence in the literature on the correlation between surface roughness of dental nanocomposites following application of instruments for finishing compared to instruments for both finishing and polishing and how this relates to the final color of the restoration. This study evaluated the correlation between roughness parameters (Ra and Rmax), of a nano-hybrid composite following finishing alone or finishing and polishing, and color. 70 specimens (8mmX8mmX2mm) of the nano-hybrid Heritage 7 were fabricated. One group of 10 specimens served as control. The remaining specimens of 10 per group were either finished sequentially with (a) diamonds (b) stones (c) carbides or finished and polished with (d) diamonds and Sof-lex discs (e) stones and Sof-lex discs, (f) carbides and Sof-lex discs. Following instrumentation the specimens were assessed using profilometry for surface roughness. Immediately following surface roughness measurements color was assessed using a spectrophotometer. Roughness and color data were assessed using a one-way analysis of variance (ANOVA) and post-hoc Bonferroni. Correlations between the color coordinates (L*a*b*) and ΔE and roughness parameters (Rmax and Ra) were analyzed at a 0.05 level of significance. There were no statistical changes in Ra measurements between finishing and finishing and polishing, however specimens finished with stones showed a dramatic change in Rmax values compared tocontrol and all the other finishing and finishing and polishing regimens. There was a correlation between Ra and color parameters L* and a* and ΔE. Green and white stones produced the most surface detriment in terms of surface roughness and color.

A pilot investigation into the definition of cultural competence of dental health professionals in a Trinidad context

Accreditation bodies in the United States, Europe and the Caribbean mandate have developed standards relating to cultural competence and the impact of culture on the provision or oral health care. The population and culture of Trinidad is diverse and dissimilar to the United States and Europe. The purpose of this study is to define what cultural competence means in a Trinidad context. Semi-structured elite interviews were conducted by one author of three persons from each of the following groups: dental academics, dental clinicians, Catholics, Hindus, Muslims and Protestants. Trinidadians were generally categorized as 'easy-going' and forgiving of errors in cultural competence. Communication and the ability to put the patient at ease were considered important skills. Knowledge of the various religions was considered to be important especially as it related to their diets- especially during religious festivals and their preferences for the treatment of females. The role of the extended family was identified as being important in history taking and in the management of paediactric patients. Aside from the knowledge specific to Trinidad, the introduction of cultural competence training may be guided by the publications and guidelines of the American Association of Medical Colleges.

Taper of full-veneer crown preparations by dental students at the University of the West Indies.

PURPOSE: The ideal taper recommended for a full-veneer crown is 4° to 14°, but this is very difficult to achieve clinically, and studies on taper achieved by dental students have found mean taper measurements ranging from 11° to 27°. The objective of this study was to examine and compare the taper of teeth prepared for full-veneer crowns by dental students on typodonts in the laboratory and on patients, and also to compare the results with those of other dental schools. MATERIALS AND METHODS: Preparations were scanned by specialized metrology equipment that gave the taper of the preparation in a buccolingual (BL) and mesiodistal (MD) plane. RESULTS: No undercut was detected on any of the laboratory specimens; however, 12.5% of clinical specimens were undercut. The mean taper of the laboratory anterior specimens were 26.7° BL and 14.9° MD, and the laboratory posterior specimens were 18.2° BL and 14.2° MD. The mean taper of the clinical anteriors were 31.6° BL and 16.8° MD, and the clinical posteriors were 16.8° BL and 22.4° MD. CONCLUSIONS: This study shows that although the taper achieved by dental students in the University of the West Indies when preparing teeth for full-veneer crowns was outside the ideal range of 4° to 14°, it is comparable to those achieved by dental students in other schools.

Cusp fracture resistance of maxillary premolars restored with the bonded amalgam technique using various luting agents.

Objective. This in vitro study uses measurements of fracture resistance to compare maxillary premolars restored with the bonded amalgam technique using a new resin luting cement, glass ionomer, and resin-modified glass ionomer as the bonding agents. Materials. Eighty-five sound maxillary premolars were selected and randomly assigned to one of five test groups of 17 teeth each. One group of intact teeth served as the control. The remaining groups were prepared to a standard cavity form relative to the dimensions of the overall tooth and restored with amalgam alone or a bonded amalgam using one of three luting agents: RelyX Arc (a new resin luting cement), RelyX luting (a resin-modified glass ionomer), or Ketac-Cem mu (a glass ionomer) as the bonding agents. Each tooth was then subjected to compressive testing until catastrophic failure occurred. The mean loads at failure of each group were statistically compared using ANOVA with a post hoc Bonferroni test. Results. It was found that regardless of the luting cement used for the amalgam bonding technique, there was little effect on the fracture resistance of teeth. Conclusion. Cusp fracture resistance of premolars prepared with conservative MOD cavity preparations is not improved by using an amalgam-bonding technique compared to similar cavities restored with amalgam alone.

Cusp fracture resistance of maxillary premolars restored with the bonded amalgam technique using various luting agents

OBJECTIVE. This in vitro study uses measurements of fracture resistance to compare maxillary premolars restored with the bonded amalgam technique using a new resin luting cement, glass ionomer, and resin-modified glass ionomer as the bonding agents. MATERIALS. Eighty-five sound maxillary premolars were selected and randomly assigned to one of five test groups of 17 teeth each. One group of intact teeth served as the control. The remaining groups were prepared to a standard cavity form relative to the dimensions of the overall tooth and restored with amalgam alone or a bonded amalgam using one of three luting agents: RelyX Arc (a new resin luting cement), RelyX luting (a resin-modified glass ionomer), or Ketac-Cem ì (a glass ionomer) as the bonding agents. Each tooth was then subjected to compressive testing until catastrophic failure occurred. The mean loads at failure of each group were statistically compared using ANOVA with a post hoc Bonferroni test. RESULTS. It was found that regardless of the luting cement used for the amalgam bonding technique, there was little effect on the fracture resistance of teeth. CONCLUSION. Cusp fracture resistance of premolars prepared with conservative MOD cavity preparations is not improved by using an amalgam-bonding technique compared to similar cavities restored with amalgam alone.

Cusp fracture resistance of maxillary premolars restored with the bonded amalgam technique using various luting agents.

Objective. This in vitro study uses measurements of fracture resistance to compare maxillary premolars restored with the bonded amalgam technique using a new resin luting cement, glass ionomer, and resin-modified glass ionomer as the bonding agents. Materials. Eighty-five sound maxillary premolars were selected and randomly assigned to one of five test groups of 17 teeth each. One group of intact teeth served as the control. The remaining groups were prepared to a standard cavity form relative to the dimensions of the overall tooth and restored with amalgam alone or a bonded amalgam using one of three luting agents: RelyX Arc (a new resin luting cement), RelyX luting (a resin-modified glass ionomer), or Ketac-Cem æ (a glass ionomer) as the bonding agents. Each tooth was then subjected to compressive testing until catastrophic failure occurred. The mean loads at failure of each group were statistically compared using ANOVA with a post hoc Bonferroni test. Results. It was found that regardless of the luting cement used for the amalgam bonding technique, there was little effect on the fracture resistance of teeth. Conclusion. Cusp fracture resistance of premolars prepared with conservative MOD cavity preparations is not improved by using an amalgam-bonding technique compared to similar cavities restored with amalgam alone.

Percutaneous injuries of dental personnel at the University of the West Indies, School of Dentistry.

AIM: To report the results of a survey of all percutaneous injuries occurring in 2003-2004 to staff and students at the dental school in Trinidad. METHOD: Data were collected via 163 questionnaires administered to all dental surgery assistants, the current clinical students (years 3, 4 & 5), the interns, part-time and full-time academic staff. RESULTS: A 71% response rate was obtained. The number of persons reporting one or more sharps injuries at the dental school was 42 (37%). Of these, 17 (40%) were percutaneous. Needlesticks and periodontal scaler injuries were the most common. There was no significant correlation (p>0.05) between injury and gender, age group, dominant hand or needle recapping technique. 75% of respondents described their concern of contracting a blood-borne disease from a sharps injury as "high" and 59% of the respondents followed the school's recommended protocol following the injury. 50% of the injuries among the students and interns were not reported. CONCLUSIONS: A more rigorous programme of risk management with respect to sharps injuries needs to be designed and implemented at the school. There is also a need to improve surveillance of and reduce the underreporting of these injuries.

Percutaneous injuries of dental personnel at The University of the West Indies, School of Dentistry

AIM: To report the results of a survey of all percutaneous injuries occurring in 2003-2004 to staff and students at the dental school in Trinidad. METHOD: Data were collected via 163 questionnaires administered to all dental surgery assistants, the current clinical students (years 3, 4 & 5), the interns, part-time and full-time academic staff. RESULTS: A 71% response rate was obtained. The number of persons reporting one or more sharps injuries at the dental school was 42 (37%). Of these, 17 (40%) were percutaneous. Needlesticks and periodontal scaler injuries were the most common. There was no significant correlation (p>0.05) between injury and gender, age group, dominant hand or needle recapping technique. 75% of respondents described their concern of contracting a blood-borne disease from a sharps injury as "high" and 59% of the respondents followed the school's recommended protocol following the injury. 50% of the injuries among the students and interns were not reported. CONCLUSIONS: A more rigorous programme of risk management with respect to sharps injuries needs to be designed and implemented at the school. There is also a need to improve surveillance of and reduce the underreporting of these injuries