Quo vadis: what is the future of periodontics? How will we get there?

Approximately 40 years ago periodontists began systematically developing the evidence to treat predictably and prevent gingivitis and periodontitis. More recently, periodontists have been among a small group of skilled dental-implant surgeons leading that revolution in dentistry. Today, much of the mild/localized moderate periodontitis is not treated by periodontists, and an increasing number of implants are placed by dentists with limited surgical training. The current field of periodontics includes a broad range of surgical skills and technologies to regenerate predictably destroyed tissues and manage complex interdisciplinary treatment that may, in some way, involve the tissues that support teeth and implants. In addition, periodontal researchers have shown that moderate-to-severe periodontitis increases the systemic inflammatory burden and transient bacteremias that result in a significant independent role for periodontitis in multiple systemic diseases. Although many periodontists have very advanced practices that incorporate certain aspects of the current and near-future dimensions of periodontics, the innovations and technologies have not yet fully integrated throughout the specialty. It is an appropriate time to ask the question: Quo vadis? Which paths have the potential to deliver great value to our patients and to the health-care system? And who will be our patients in the near future? We propose some key capabilities, knowledge and clinical applications. Perhaps most importantly, we propose new partnerships. Much of the vision centers around the application of special diagnostic technologies and surgical skills to help our dental colleagues better manage complex dental and periodontal cases and to deliver on the promise of reducing systemic inflammation sufficiently to enhance medical management of certain chronic diseases and reduce preterm births. The specialty has always been about retaining teeth in good health and in recent years has focused on controlling oral inflammation to enhance systemic health. We already have several of the key principles, concepts and technologies that are likely to define the role of periodontics in the evolving health-care delivery system. Perhaps it is time to define the mission and start moving toward the future periodontics.

Current Status of Postdoctoral and Graduate Programs in Dentistry.

Advanced dental education has evolved in the context of societal needs and economic trends to its current status. Graduate programs have positioned their role in the context of health systems and health science education trends in hospitals, interprofessional clinical care teams, and dental schools and oral health care systems. Graduate dental education has been a critical factor in developing teams in trauma care, craniofacial disorders, pediatric and adult medicine, and oncology. The misalignment of the mission of graduate dental programs and the demands of private practice has posed a challenge in the evolution of programs as educational programs have been directed towards tertiary and indigent care while the practice community focuses on largely healthy affluent patients for complex clinical interventions. Those seeking graduate dental education today are smaller in number and include more international dental graduates than in the past. Graduate dental education in general dentistry and in the nine recognized dental specialties now includes Commission on Dental Accreditation (CODA) recognition of training standards as part of its accreditation process and a CODA accreditation process for areas of clinical education not recognized as specialties by the American Dental Association. Current types of programs include fellowship training for students in recognized specialties. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Trends in Generalist and Specialty Advanced Dental Education and Practice, 2005-06 to 2015-16 and Beyond.

This article reviews the data on advanced dental education for the past decade and explores what advanced dental education might look like in the years leading up to 2040, including how its graduates will address the oral health needs of the population. The authors based these projections on published data about advanced dental education collected by the American Dental Association and other organizations. Nevertheless, a certain degree of speculation was involved. The article presents current data and trends in advanced dental education, environmental factors impacting advanced dental education, and lessons drawn from other areas of health care that support the potential scenarios that are described. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Hypoxia-based strategies for regenerative dentistry-Views from the different dental fields.

The understanding of the cell biological processes underlying development and regeneration of oral tissues leads to novel regenerative approaches. Over the past years, knowledge on key roles of the hypoxia-based response has become more profound. Based on these findings, novel regenerative approaches for dentistry are emerging, which target cellular oxygen sensors. These approaches include hypoxia pre-conditioning and pharmacologically simulated hypoxia. The increase in studies on hypoxia and hypoxia-based strategies in regenerative dentistry highlights the growing attention to hypoxia's role in regeneration and its underlying biology, as well as its application in a therapeutic setting. In this narrative review, we present the current knowledge on the role of hypoxia in oral tissues and review the proposed hypoxia-based approaches in different fields of dentistry, including endodontics, orthodontics, periodontics, and oral surgery.

Una experiencia preclínica de enseñanza y aprendizaje en una carrera de especialización en endodoncia / A pre-clinical teaching and learning experiencein a specialization program in endodontics

Objetivo: desarrollar una estrategia para la enseñanza yel aprendizaje, que pueda derivar en una nueva metodología deevaluación individual y grupal de los procedimientos pre clínicosen la Carrera de Especialización en Endodoncia de la Universidad del Salvador / Asociación Odontológica Argentina. Materiales y métodos: Se llevaron a cabo dos experiencias pre clínicas donde cada alumno realizó un tratamiento endodóntico en dientes humanos unir radiculares extraídos, alinicio del curso preclínico –con los saberes y las destrezas previos–y al finalizar. Se consignaron y evaluaron 19 errores procedimentales.Los datos fueron analizados mediante la pruebano paramétrica del signo de Wilcoxon, con un valor de p≤0,05. Resultados: En la primera experiencia se constataron 63errores procedimentales, y en la segunda, 14. Entre la valoracióninicial y la final se hallaron diferencias significativasen las variables procesamiento radiográfico (α=0,014), apertura cameral exagerada (α=0,0013), alteración dela anatomía (α=0,05), pérdida de la longitud de trabajo(α=0,007), falta de adaptación del cono principal(α=0,008), y falta de compactación lateral (α=0,008).En el resto de las variables analizadas no se encontraron diferencias significativas. El índice de la mejoríaindividual fue del 50 al 100%, y el grupal, del 78,7%. Conclusiones: De acuerdo con los resultados obtenidosen esta experiencia, podría considerarse que la propuestapedagógica resultó válida para los objetivos planteados.

Aim: to develop a strategy for teaching and learning, which may lead to a new methodology for individual and group evaluation of pre clinical procedures in the Specialization Course in Endodontics of the Universidad del Salvador /Asociación Odontológica Argentina. Materials and methods: Two preclinical experiments were carried out where each student performed an endodontic treatment in single-rooted extracted human teeth, at the beginningand after finishing the preclinical course with his/herprevious knowledge and skills. Nineteen different proceduralerrors were recorded and evaluated. Wilcoxon’s sign test wasused to compare before and after results setting significanceat p≤0,05. Results: In the initial experiment 63 procedural errors were found and in the second, 14. Between the initial and final evaluations, significant differences were found in thevariables radiographic processing (α=0.014), exaggerated chamber opening (α=0.0013), anatomic form modification(α=0.05), loss of working length (α=0.007), lack of adaptation of the main cone (α=0.008), and lack of lateralcompaction (α=0.008). In the other variables that were evaluated, no significant differences were found. The rateof individual improvement was 50 to 100%, and the group of 78.7%. Conclusions: According to the results obtained in this experience, the pedagogical proposal can be considered to bevalid to reach educational goals.

Evolución de la colegiación del ilustre colegio de odontólogos y estomatólogos de la i región en los últimos 12 años / The evolution of the professional association of the Colegio de Odontólogos y Estomatólogos de la Iª Region during the last 12 years

El presente estudio pretende analizar la evolución de la colegiación del Colegio de Odontólogos y Estomatólogos de la I Región durante los últimos doce años (2003-2014): número de colegiados por la distintas Juntas Provinciales que componen la I Región, altas y bajas colegiales, evolución de la edad y el sexo de los colegiados, así como universidades de las que proceden. Así mismo, se recuerdan los servicios que el Colegio presta a través de las vocalías y comisiones (AU)

This study analyzes the evolution of the professional association of the Colegio de Odontólogos y Estomatólogos de la I Región during the last twelve years (2003-2014): number of registered by the various Provincial Boards that comprise Region I, records and drop outs, evolution age and sex of the members, as well as Universities from which they come. Likewise, the services provided through the College of delegation ships and Commissions are remembered (AU)

Advanced prosthodontic training in the United States of America.

This article will consider prosthodontic specialty training in the United States. The history of prosthodontics as a specialty and the requirements necessary to be considered a prosthodontist will be explored. Today, a three-year postgraduate program is necessary to be considered an educationally qualified prosthodontist. Currently, there are 46 accredited advanced specialty education programs in the United States and approximately 3200 prosthodontists. The standards and training required for completion of these programs will be considered.

Current status and expected future direction of the prosthodontic speciality in India. JPS Global Workshop Kyoto 2012.

A person with a basic bachelors degree, BDS, from a college/university recognized by the Dental Council of India (DCI) becomes eligible for a Master of Dental Surgery (MDS) in prosthodontics at a college/university recognized by DCI. For this three (3) years Programme of Master of Dental Surgery course with a dissertation, the student/resident has to go through a syllabus as set by the university and approved by the DCI. The continued official approval/certification thereafter is not present in India but all dentists have to get 20 Continued Education points every year for renewal of their DCI registration (though it's only on trial basis right now). Although prosthodontists are officially approved in India but still the common man does not recognize who a prosthodontist is because of lack of awareness. Most general dentists do their prosthetic work themselves, only a small number of them ask for a prosthodontist. Referral to another office is rare, usually the prosthodontist visits the GP's office for consultation and treatment. There is undoubtedly need of continuous certification/evaluation system of the prosthodontists and so is the need of making the masses aware of presence and role of such specialists in India. The Indian Prosthodontic Society is taking initiative to address this issue.

Guidance for the core content of a Curriculum in Special Care Dentistry at the undergraduate level.

Given the rapidly changing demography of populations worldwide, dental professionals of the future need to be able to meet the challenge posed by the evolving landscape in health care needs. Leading institutions are now embedding teaching and learning in special care dentistry (SCD) within their curricula, to provide students with the knowledge, skills and attitudes to meet the oral health needs of vulnerable groups within their communities. The International Association for Disability and Oral Health (iADH) has initiated the development of undergraduate curriculum guidance in SCD through a consensus process. The curriculum in SCD is defined in statements of learning outcomes with many of the skills being transferable across the undergraduate course. This curriculum includes examples of teaching and assessment, designed to enhance critical thinking in relation to SCD and to promote positive attitudes towards disability and diversity. The learning outcomes are designed to be readily adapted to conform to the generic profiles and competencies, already identified in undergraduate frameworks by global educational associations, as well as meeting the requirements of professional regulatory bodies worldwide. Suggestions for teaching and learning are not intended to be prescriptive; rather, they act as a signpost to possible routes to student learning. Ideally, this will require that students have a sufficiently diverse patient case mix during their undergraduate studies, to achieve the required levels of confidence and competence by the time they graduate. Clinical care competencies in SCD emphasise the need for learners to broaden their theoretical knowledge and understanding through practical experience in providing care for people with special health care needs. It is crucial to the development of equitable dental services for all members of a community, that these learning outcomes are embedded into evolving curricula but most importantly, that they are evaluated and refined in a dynamic way with shared learning for all teachers.

Emerging trends in dental specialty choice in Nigeria.

Asymmetry in the distribution of dental specialists in Nigeria has the potential to negatively affect dental education at all levels. There is a dearth in Nigerian studies on the trends of influencing factors on the choice of dental specialty in Nigeria. Past efforts have not resulted in policy change thus necessitating the current study. One hundred and twelve (51 male, 61 female) Nigerian dental graduates aged 23-55 years with a mean age of 35.21 ± 8.21 years completed self-administered questionnaires to assess the impact of 16 influencing factors on their choice of dental specialty. The graduation period of respondents, which ranged between 0 and 30 years was recorded into three decades and cross-tabulated against 16 influencing factors to assess their relative impact on specialty choice. Diagnostic challenge, predictable work hours and patient type appeared to have maintained a consistent popularity while affluence and income, although less popular influences three decades ago are becoming increasingly relevant while length of programme, prestige and level of crowding exerted less influence on choice of specialty than other factors. The potential influence of incentives such as career counselling and grants for overseas training to encourage enrollment in less popular programmes was assessed based on recommendations from previous studies. However, these measures appeared to be unpopular among Nigerian dental graduates. Diagnostic challenges and predictable work hours remain popular as influencing factors on choice of dental specialty among Nigerian dental graduates. Affluence and income, although previously unpopular are now gaining popularity among Nigerian dental graduates.

Trends and attitudes regarding head and neck oncologic surgery: a survey of United States oral and maxillofacial surgery programs.

PURPOSE: The purposes of this study were to: 1) estimate the prevalence and trends of American oral and maxillofacial surgery (OMS) programs in recruiting head and neck oncologic surgery (HNOS) -trained faculty, performing HNOS oncologic procedures and microvascular reconstruction, and presenting HNOS research at academic meetings; 2) estimate whether HNOS and microvascular reconstruction involvement varies among programs with or without a program director or chair trained in HNOS; 3) estimate whether HNOS involvement varies among those OMS programs that regularly attend and do not attend tumor board; 4) estimate whether HNOS involvement varies among those programs that have and have not presented HNOS research at an academic meeting; 5) estimate whether HNOS involvement varies among doctor of medicine-integrated and 4-year OMS programs. MATERIALS AND METHODS: Investigators developed and distributed a survey to all US OMS program directors and/or chair composed of questions regarding faculty prevalence and recruitment, frequency and trends in cases, and the priority of applicants for residency with regard to HNOS. There were 18 close-ended questions, and one open-ended question. Responses were recorded in categorical, Likert, ordinal, and numerical format. Bivariate associations were calculated using Fisher exact test and logistic regression. RESULTS: Sixty-three of 101 surveys were returned (62.3%). Ten program directors or chair completed a fellowship in HNOS (15.9%). Programs with an HNOS-trained program director or chair were more likely to have another HNOS-trained faculty member (P = .01), performed more malignant tumor resections (P < .001), neck dissections (P < .001), and microvascular free-flap reconstructions (P = .02) than programs without program directors or chair trained in HNOS. Programs that regularly attended tumor board performed an increasing number of malignant tumor resections (P = .008); and neck dissections (P = .003) than programs that did not regularly attend their institution's tumor board. Presentations of HNOS-related research at national meetings did not differ between doctor of medicine-integrated and 4-year OMS programs (P = .7). There was no difference in the prevalence of HNOS-trained program directors and chair between doctor of medicine-integrated and 4-year programs (P = .7). CONCLUSIONS: This study's data and comments suggest that programs involved in HNOS have a strong involvement in expanded scope OMS and related academic activities.

[Oral medicine: a specialty placed between medicine and dentistry]. / Orale Medizin : Interdisziplinäre Zusammenarbeit zwischen Medizin und Zahnmedizin.

Oral medicine is a dental specialty that bridges the traditional areas of health between dentistry and medicine. International descriptions reflect this and oral medicine is defined as "the dental speciality placed at the interface between medicine and dentistry and is concerned with the diagnosis and management of (non-dental) pathology affecting the oral and maxillofacial region." Oral medicine specialists provide clinical care to patients with a wide variety of orofacial conditions, including oral mucosal diseases, orofacial pain syndromes, salivary gland disorders, and oral manifestations of systemic diseases. There is a growing need to implement this specialty globally: due to the rapid progress in both medicine and dentistry, and to the growing percentage of senior citizens in many countries, the adequate diagnosis and treatment of oral diseases will become even more complex in the future. In this article, the authors' intention is to point out that oral medicine is neither a recognized specialty nor a distinct field of study in Germany, Austria, or Switzerland; thus, the need for postgraduate training in this field in countries where oral medicine is not a specialization is emphasized.