Dental Assessment Research Articles

Denture-related problems of patients in acute geriatric care.

BackgroundWith increasing frailty and complaint-oriented utilization of dental care, the prevalence of oral diseases also increases.AimTo clarify whether there is a need for dental prosthodontic treatment during residential acute geriatric rehabilitation.MethodsWithin 3 weeks in a hospital for acute geriatric patients, 79 out of 157 newly admitted patients were interviewed as study participants (age: median 79.0 years, range 66–96 years, female 51.9%), dental findings were recorded, treatment needs were determined but X‑rays were not taken.ResultsOf the participants 31.1% had not seen a dentist for more than 1 year and 18.2% were edentulous. The median number of teeth in dentate participants was 16 (range 1–28 teeth); based on all participants, there was a median of 12.0 teeth (range 0–28 teeth). Of the 52 denture wearers (45 upper jaw and 43 lower jaw), 5 each of the maxillary and mandibular dentures could not be assessed because they were not available at the hospital. Moderate denture deficiencies were present in 62.5% of participants wearing upper dentures (mandibular 55.3%).ConclusionDental treatment is needed in this vulnerable patient group. Therefore, the oral cavity should be assessed as part of the geriatric assessment. The available data confirm that the use of validated assessment instruments, such as the mini dental assessment as part of the comprehensive geriatric assessment would be useful. In addition to an oral examination, simple dental treatment should be provided to reduce infections and improve chewing ability. The geriatrician should be informed of the urgency of treatment. The overall rehabilitative approach of acute geriatric treatment would be complete if oral health would not be excluded.

Faculty Perceptions on Objective Structured Clinical Exam in Dental Education

Structured Clinical Exam (OSCE) uses standardized content and procedures to assess students across multiple domains of learning. The study is aimed to assess knowledge, attitudes, practices and observations of dental faculty on OSCE. The survey was distributed into dental faculty members in randomly selected government and private institutions in Saudi Arabia. The questionnaire was pre-tested and consisted of 4 categories including general characteristics of respondents, knowledge on utility of OSCE in curriculum and it’s reliability, attitudes regarding OSCE on a 5 point Likert scale, practices and observations on OSCE on Multiple choice questions (both single answer and multiple answer) and responses on a 5 point Likert scale. The sample size was determined to be 93 and the survey was sent electronically to 10 institutes. 101 complete responses from 7 institutions were considered from the 122 received. Faculty participation in OSCE was high within evaluators 94% (n=94) and administrators 61% (n=61). Majority of respondents (62%) believed that OSCE is most suited for competency based education, to assess cognitive skills (73%) and diagnostic interpretation (79%). Reliability of OSCE can be increased by standardization of evaluators (77%) with highest number believing that 6-8 stations (42%) are the minimum required in an OSCE. Institution guidelines (49%) coupled with workshops (47%) was the preferred method of preparation for OSCE. Majority felt that OSCE is most suitable for high stakes exams (mean=3.37) and it is an indispensable part of dental assessment (mean=3.78). Minimum number of stations for adequate reliability was reported to be lesser that in reported literature, specially so for high stakes assessments. Logistics required for arranging an OSCE and difficulty in standardized patients, may suggest that OSCE should be used in select situations.

Ocular and Dental Causes of Headaches Among School-Age Children in Jordan: A Retrospective Study.

IntroductionHeadache disorders are becoming increasingly prevalent among the younger population. In this study, we aimed to explore the varying causes of headaches among school-age children in Jordan.MethodologyThis was a retrospective observational study conducted at the Queen Rania Hospital for Children between June 2019 and June 2020. All the data of the patients were extracted from the patient files with the permission of the administration. All children who were referred to the ophthalmology and dental clinic with headaches as the presenting complaint were included in the study. A detailed history was initially obtained regarding age, gender, medical history, as well as the duration and characteristics of headaches. The patients underwent detailed ocular examination including best-corrected visual acuity (BCVA) using the Snellen chart, anterior and posterior eye segment examination, and intraocular pressure measurement. Refraction under the effect of cyclopentolate was performed for all patients. A detailed dental and oral exam was performed on all children at the dental clinic by the same dentist.ResultsA total of 712 patients aged between five and 13 years (mean ± SD: 9.3 ± 2.86 years) presented with headaches during the study period. Headaches were more frequent in males [n=441 (61.9%)], but a slight female predominance was found among patients aged 11 years and older. At the ophthalmology clinic, 230 (32.3%) patients with headaches had positive findings; the majority of these patients [n=228 (32%)] had refractive errors with astigmatism as the most common type. Of note, 515 patients (72.3%) had dental caries with a Decayed, Missing, and Filled Permanent Teeth (DMFT) score ranging from 1.5 to 4.3.ConclusionRefractive errors, particularly astigmatism, were found at higher rates among children with headaches. Also, temporomandibular disorders were more prevalent among children with headaches, particularly those aged between 11 and 14 years. Routine ophthalmic and dental assessment is recommended for children presenting with chronic headaches.

A comparison of pre-radiotherapy extractions prior to and during the pandemic at charing cross hospital

Osteoradionecrosis has considerable morbidity and can adversely affect the quality of life of patients who undergo radiotherapy as part of the treatment for their head and neck cancer. This can be reduced by a thorough dental assessment and extractions of teeth with poor prognosis prior to radiotherapy, ideally at least ten days before radiotherapy commences. Aim and objectivesThe dental department at Charing Cross Hospital has an established pathway to assess patients prior to radiotherapy. The aim of the audit was to evaluate whether during the coronavirus pandemic there was timely dental assessment prior to radiotherapy and extractions carried out in sufficient time before start of radiotherapy in accordance with the Royal College of Surgeons 2012 guidelines. MethodData was collected retrospectively from patient records over two eight monthly periods (May 2019 -Jan 2020 prior to the pandemic and April 2020 – November 2020 during the pandemic). Parameters analysed included: the number of patients referred; time interval between referral and assessment; number of patients requiring extractions and time interval between extraction completion and commencement of radiotherapy. ResultsSeventy-six patients with head and neck cancer were referred for dental assessment over the audit period. The most recent audit showed 96.4% of patients were assessed within ten days of referral. Extractions were undertaken on 63.6% of patients, 92.9% were in excess of ten days before radiotherapy, 42.9% over 20 days. ConclusionsNational guidelines for extractions are being met in 92.9% of cases and the majority in excess of minimum timing recommended. The dental clinic is providing quality care for this patient group as measured by this audit, showing a positive service outcome.

921 Audit of Pre-Radiation Therapy Extractions at Dublin Dental University Hospital

Abstract Introduction The time between diagnosis of head and neck cancer and commencing treatment involves multi – disciplinary input from several specialities. Dental assessments are carried out prior to radiotherapy in order to instigate preventive care and remove all unrestorable teeth. Post – radiation dental extractions have been shown to increase the risk of osteoradionecrosis (ORN). Method Our hospital handles the majority of the pre - radiotherapy dental assessments in the east of Ireland. We examined the patient records of all patients attending the radiotherapy clinics between January 2018 and December 2019, assessing the time interval between the removal of teeth prior to radiotherapy and the start of radiotherapy. A secondary aim was to determine from the patient records whether any diagnosis of ORN was established post – radiation. Results 15 out of 147 patients had extractions less than 2 weeks prior to radiotherapy. In total, three patients developed ORN. One had extractions less than 2 weeks prior to radiotherapy, one had post radiotherapy extractions, while the other’s timing was unknown. Conclusions Most patients received timely care. A referral for dental assessment early in treatment planning is desirable. Despite the small sample size, an association between ORN and extractions just before and following radiotherapy was found.

A nationwide survey assessing the satisfaction of dental colleges graduates with their undergraduate experience in Saudi Arabia

ObjectiveTo date, there are no publications on the Saudi graduates’ perceived value of their dental curriculum. The aim of this nation-wide survey was to investigate graduates’ satisfaction with specific disciplines of their dental education and training. The first part of this study addressed findings according to the respondents’ gender and the number of years of postgraduate experience (Graduate-related factors). MethodsAn electronic questionnaire was emailed to registrants of the Saudi Dental Society, specifically dental interns, general dentists, and specialized dentists who graduated from private and governmental dental colleges in Saudi Arabia (n = 2185). ResultsThe response rate was 36.4 %. The number of male respondents was (n = 352, 44.2 %), the remainder being female (n = 444, 55.8 %). The number of recent dentists (≤ 5 years since graduation) was (n = 428, 53.8 %) and experienced dentists (n = 368, 46.2 %). There were statistically significant gender variations in satisfaction levels, and among dentists with different post-graduation experiences. Although male and female dental students are taught similar curriculums and have similar graduation requirements, there were statistically significant differences in various subjects covered. Similarly, recent and experienced dentists reported statistically significant differences in satisfaction in various subjects. ConclusionThis study provides graduates’ perspectives on the strengths and weaknesses of their dental education in Saudi Arabia. The findings help in curriculum reform and collaborations between the dental colleges nationally. Ultimately this can lead to formulating a national dental accreditation and assessment body. Clinical significanceThe findings of this study provide graduates’ perspective on the dental education received in Saudi Arabia. This will help stimulate discussion and collaboration within and amongst the colleges on improving their curriculum in this fast-paced, evolving field of dentistry.

Dental treatment before haematopoietic stem cell transplantation - a service evaluation.

Introduction National guidance by the Royal College of Surgeons (England) recommends a dental assessment and necessary treatment before haematopoietic stem cell transplantation (HSCT). Within the special care dentistry department in Liverpool University Dental Hospital, patients are assessed before transplant; however, the efficiency and efficacy of the service was unknown and therefore a service evaluation was indicated.Aim To evaluate the current referral process and dental care provided before patients receive HSCT.Method Dental case notes were reviewed retrospectively for all patients who attended before allogeneic or autologous HSCT in the year 2016.Results There appeared to be a positive engagement of both the medical team and patients with regards to referral for a pre-HSCT dental assessment. In addition, it was evident that this patient cohort did require dental treatment before HSCT with diagnoses of caries, periradicular infections and periodontal disease being made.Conclusion Pre-HSCT dental assessment and treatment continues to be an important aspect of the medical pathway for this patient cohort. Developments to the care pathway and improvements in communication with the medical teams will help ensure the best-quality care is provided to the patients at the correct time. Future prospective studies are required to establish the overall benefit to patients of dental treatment before HSCT.

Conditional Uncorrelation and Efficient Subset Selection in Sparse Regression.

Given m d -dimensional responsors and n d -dimensional predictors, sparse regression finds at most k predictors for each responsor for linear approximation, 1 ≤ k ≤ d-1 . The key problem in sparse regression is subset selection, which usually suffers from high computational cost. In recent years, many improved approximate methods of subset selection have been published. However, less attention has been paid to the nonapproximate method of subset selection, which is very necessary for many questions in data analysis. Here, we consider sparse regression from the view of correlation and propose the formula of conditional uncorrelation. Then, an efficient nonapproximate method of subset selection is proposed in which we do not need to calculate any coefficients in the regression equation for candidate predictors. By the proposed method, the computational complexity is reduced from O([1/6]k3+(m+1)k2+mkd) to O([1/6]k3+[1/2](m+1)k2) for each candidate subset in sparse regression. Because the dimension d is generally the number of observations or experiments and large enough, the proposed method can greatly improve the efficiency of nonapproximate subset selection. We also apply the proposed method in real scenarios of dental age assessment and sparse coding to validate the efficiency of the proposed method.

Entrustable professional activities framework for assessment in predoctoral dental education, developed using a modified Delphi process.

The purpose of this study was to define and develop a set of Entrustable Professional Activities (EPAs) for dental education using a modified Delphi consensus approach. EPAs define the core tasks that a graduating dentist needs to perform independently in practice. The EPA framework facilitates assessment of competencies as they manifest in the tasks and independence needed to be ready for practice. Feedback was obtained from participants about a list of EPAs, with modifications made after each of the 3 rounds, using a modified Delphi approach. Phase 1 included attendees at the ADEA Fall 2017 meeting (n=35) who participated in an EPA workshop primarily composed of academic deans. The Phase 2 "reactor panel" consisted of 10 dental schools' academic deans and other individuals with expertise and interest in dental curriculum and assessment (n=31). Phase 3 participants were attendees at the ADEA CCI 2019 meeting (n=91) who also participated in a 2-day EPA workshop. In phase 1, overall ratings for acceptability of the EPAs were satisfactory. In phase 2, the next iteration of EPAs was judged as satisfactory for inclusion in curriculum, match well with clinical practice and clarity. In phase 3, the EPAs were judged as satisfactory for being an "entrustable, essential, and important task of the profession." Qualitative feedback suggested wording, measurability, and specific focus of EPA statements is important. A preliminary set of EPAs was designed for predoctoral dental education through a systematic, careful consensus building approach involving a diverse set of participants.

Attitude of children with autism spectrum disorder to the dental treatment and assessment of their parents’ knowledge about the oral disease prevention (survey data)

Relevance. Autism spectrum disorder (ASD) is a developmental disorder, showing up in children under 3 years old and characterized by the triad of symptoms (qualitative impairment of social interaction and communication, stereotype behavior and non-specific problems) and the dyad of impairment in social interaction, restricted and repetitive patterns of behavior and/ or interests. According to the Russian and international literature, the prevalence of ASD has tended to grow in the 21th century. Children with ASD experience difficulties in communication and manual skills. The oral hygiene in children with ASD is poor, they need their parents’ help brushing their teeth as well as preparing for a dental visit. Thus, improvement of communication techniques is an urgent challenge for these children.Materials and methods. 75 parents of children with ASD aged 4 to 16 years were surveyed.Results. The received results demonstrated that the parents of children with ASD have very little knowledge about the oral hygiene. While preparing for a dental visit the majority of parents do not use communication techniques, which leads to doctor-patient interaction difficulties.Conclusions. The received data showed that techniques for applied behavior analysis, alternative communication system prove to be highly effective in preparing children with ASD for a dental visit, thus, increasing the effectiveness of preventive procedures.

Cooperation between ENT surgeon and dentist in head and neck oncology.

SUMMARYHead and neck cancer (HNC) patients require specialized care throughout the continuum of cancer diagnosis, treatment, and survival. Cooperation between ENT and dentists is crucial, since all of the different anatomic areas affected by cancer have distinctive characteristics and the best results in terms of life expectancy and patients’ quality of life can only be achieved through a multidisciplinary approach. The synergic cooperation of all health care workers in the early diagnosis of HNC allows a better prognosis for such patients. As soon as dentists diagnose a Potentially Malignant Disorder (PMD), patients should undergo complete ENT screening for detection of lesions in any portion of the upper aerodigestive tract. Before and after cancer diagnosis and before any oncologic treatment, it is critical that these patients undergo an accurate and complete dental and periodontal assessment to optimize treatment and minimize complications or side effects. Multidisciplinary ablative, reconstructive and prosthetic programing in Head & Neck oncologic surgery has become imperative to offer patients the best functional and esthetic outcome. An improvement in oral function and associated quality of life is strictly related to correct prosthetic rehabilitation. Finally, after surgery and/or radiotherapy (RT), the main objectives of dental treatment in these patients are the prevention and therapy of dental diseases and the side effects of oncological therapies involving the oral cavity.

Effectiveness test of dental hypnosis monitoring device

Introduction: Dental hypnosis monitoring device is an innovative device due to the Student Creativity Program Universitas Padjadjaran. The device can monitor a patient's consciousness by monitoring the brain wave level so that dentists can determine what steps to take when handling a patient. The effectiveness of this device has not been tested yet. This study was aimed to determine the effectiveness of the dental hypnosis monitoring device. Methods: A descriptive study was conducted on this study population, all the patients of Universitas Padjadjaran Dental Hospital (RSGM Unpad) who filled out the MDAS questionnaire. The sample criteria were people with moderate to high MDAS score and aged 17 years or above. Twenty-four people were obtained through consecutive sampling in one day. The study was held at Universitas Padjadjaran Dental Hospital by comparing the dental hypnosis monitoring device's performance with opinion from the dental hypnosis expert. Results: The overall success rate for the dental hypnosis monitoring device's effectiveness was 100% since the LED was always lit green during the hypnosis session, which was following the dental hypnosis expert assessment during processes. Conclusion: The effectiveness of the dental hypnosis monitoring device was proven to be 100% effective.

Dental Sealant Composition-Retention Assessment in Young Permanent Molars.

Tooth decay in children and adolescents remains a public health problem, despite prophylaxis and preventive measures being largely available. The aim of our study was to evaluate the clinical behavior of four dental sealants, related to first permanent molar topography and patient age (when sealant was applied for the first time). We assessed, by means of visual inspection and palpation with a dental probe, a group of 200 children, enrolled corresponding to school age-grade (mean age of 7 years at baseline) and randomly divided according to the material used as dental sealant (Admira seal©, Embrace Wet Bond©, Fotoseal©, GC Fuji Triaje©) in 4 groups (n = 50). Sealant clinical evaluation was made at 6-, 12-, 18-month intervals for dental material retention assessment. At 6 months, the sealant detached the most from 3.6 molars, and the material used was Fotoseal© (27.6%). At 12 months, Fotoseal© (48.3%) and GC Fuji Triaje© (41.4%) from 3.6 molars express detachment. At 18 months, 4.6. molars sealed with Admira Seal© (25.7%) and Embrace Wet Bond© (28.6%) lost the sealant. We noticed less detachment in maxillary molars and if sealant was applied around 7 years of age. In conclusion, sealant application on first permanent molars must be encouraged and practitioners can choose between various materials available.

Improved dental student clinical skills performance through an integrated dental and medical student curriculum.

In light of a movement to eliminate the historical separation of dentistry and medicine to produce more collaborative and knowledgeable clinicians and to improve care, integrated education models are vital. This study aimed to demonstrate the effectiveness of an integrated medical and dental student curriculum at the University of Connecticut. It was hypothesized that a medical and dental student doctoring course within an already combined biomedical curriculum would result in statistically significantly increases in dental student clinical skills performance. Analysis of variance (ANOVA) was utilized for an overall test of scores from 2016 to 2019. When ANOVA indicated significant differences, post hoc pairwise comparisons using Tukey's adjustment classified pairs that differed significantly. Lastly, a contrast was constructed to test the difference before and after the course's introduction. A two-sided α of 0.05 was used. Dental students were assessed on three cases for history taking and master interview rating scale (MIRS) criteria. The mean averages in history taking and MIRS criteria after the implementation of this course increased by 7.81 (SE=1.83, p<0.0001) and 11.95 (SE=1.34, p<0.0001) for a toothache case, 11.37 (SE=1.98, p<0.0001) and 9.84 (SE=1.35, p<0.0001) for a loose bridge case, and 12.47 (SE=1.75, p<0.0001) and 10.07 (SE=1.28, p<0.0001) for a sensitive tooth case. An integrated doctoring course within a combined curriculum at the University of Connecticut Schools of Medicine and Dental Medicine resulted in a statistically significant increase in dental student clinical skills assessment scores, demonstrating this model's utility.

QUALITY OF LIFE ASSESSMENT IN PATIENTS AFTER PROSTHETIC TREATMENT USING THE DENTAL PROFILE QUESTIONNAIRE

Introduction. Quality of life, objective assessment criterion of which is level of human’s needs and interests satisfaction, is primarily connected with health status. This is why so called “health-related quality of life” is closely associated with patient’s well-being and satisfaction of those aspects of life, that are impacted by disease or treatment process. During the study of oral health related quality of life (OHRQoL, 1996), most authors take the OHIP (Oral Health Impact Profile, G.D. Slade, A.J. Spencer, 1994) approach as a basis, such as OHIP-EDENT (Short Version). Due to the fact, other methods of quality of life assessment are not widely used in dental practice, and it is important to develop new approaches in quality of life study, combined with prosthetic treatment results, considering the appropriate indicators of oral health.&#x0D; The aim of this study is to conduct a personalized dental health indicators assessment reflecting patients’ quality of life after restoration of mandibular dental arch with overdentures.&#x0D; Materials and methods. Main group (MG) comprised 23(54,8%) female patients and 19 (45,2%) males ones (n=42) aged 56-89, whom mandibular overdentures with ball attachments were constructed. Comparison group (CG) consisted of 17(47,2%) women and 19(52.8 %) men (n=36) aged 57-76, who have been using first-timely constructed complete removable mandibular dentures for three years. After use of the Dental Profile Questionnaire, and after detailed anamnestic study, the number of patients’ of both groups responses about possible unfavourable symptoms in use of dental prostheses and the mean value of frequency of those symptoms (1- sometimes, 2- often, 3- mainly) were estimated. Statistical processing of data obtained was performed by standard methods of variation statistics using Statistica 6.0 Program.&#x0D; Results and discussion. The subjective component of our treatment results evaluation of in-depth analysis, after all reflected in extended description of the clinical cases in MG patients development of the current disease — significant loss of teeth with mandibular single remaining teeth / roots (K08.9 according to ICD-10) indicated that quality of life level of these individuals has a close connection with their oral health. According to the overall subjective evaluation of prosthetic treatment results after answering 14 patient’s oral health- related questions, the number of reports of adverse events was markedly different -22.7% in MG patients after 12 months of observation vs. 77.3% of CG patients, and statistically significant (p &lt;0.05) - the decrease in the average score of their frequency.&#x0D; Thus, it can be argued, that in the MG patients satisfaction with the treatment results, that reflected the quality of life level, associated with oral health, was notably higher, than in the CG patiens. So, the dentures were identified applicable (pp.1-6) by 90.9% of MG patients vs. 54.6% of CG patients, accompanying signs (pp.7-12) were positively evaluated by 90.1% vs. 69.0%, and subjective well-being (pp.13-14) was acheived in 90.5% vs. 63.9% of patients in these groups.&#x0D; Conclusions. Results of the research have defined the improvement of all the 14 studied oral health indicators in patients of the main group after 1 year of the examination compared with the previous data after 1 and 6 months of mandibular overdentures use. Patients’ satisfaction with treatment results, reflecting the quality of life level, associated with oral health, confirms the higher efficiency of overdentures use compared to complete removable dentures in mandibular dental arch restoration.

Dental Age Assessment by I2M and I3M: Portuguese Legal Age Thresholds of 12 and 14 Year Olds.

ObjectiveBetter understanding of dental age assessment may help in cases of age estimation in Forensic Clinics. The first aim was to provide essential information on method reliability for upcoming studies using dental age assessment by second molar index (I2M), and third molar index (I3M) for age estimation on legal ages of 12 - 14 years. The second aim was to document forensic method outcomes of the Demirjian method which has already been used in forensic clinic.Material and MethodsTwo samples were used for this purpose: for I2M, 633 orthopantomographs (270 females / 363 males), the age range from 7 to 17 years and for I3M, 471 orthopantomographs (253 females / 218 males), the age range from 10 to 23 years, from the database population of Lisbon North University Hospital Center, approved by the Ethic Committee.ResultsThe I3M cut-off point (1.133) for 12- year- olds obtained better results than the cut-off point stated by the I2M (0.135). Besides, I2M cut-off point (0.001) for 14- year- olds showed better results when compared with the cut-off point (0.705) established by the I3M. Both methods are reliable for the legal age thresholds of 12 and 14 years. However, using I2M and I3M allows us to vary the cut-off value to privilege sensitivities or specificity, depending on which is more appropriate to the intended application.ConclusionsThe accuracy (88.94%) of I3M obtained better results for the 12- year- old cut-off point (1.133) and the accuracy (90.21%) of the I2M performed better for the 14- year- old cut-off point (0.001).

The Oral Status Survey Tool: construction, validity, reliability and feasibility among people with mild and moderate intellectual disabilities.

A lack of robust data about the oral health of people with intellectual disabilities (IDs) contributes to health disparities. Appropriate research tools are therefore needed. This study reports the construction and evaluation of the Oral Status Survey Tool (OSST), designed to be administered with people with disabilities by non-dental personnel. Oral Status Survey Tool construction and evaluation was achieved adopting a non-clinical construction and content validation phase and a clinical phase to test concurrent validity, reliability and feasibility. Final refinements were also made. The OSST conceptual framework covered oral function (tooth count, denture wear and opposing pairs of teeth) and oral disease/treatment need (soft tissue status, oral cleanliness, gum condition, carious teeth and oral pain). A systematic literature review identified no existing suitable indices. Candidate items were identified and validated by experts generating content validation ratios. This framework was modified later to expand the function construct. In the initial clinical phase, 49 out of 60 participants underwent examination with OSST and standard dental assessments. All had mild to moderate IDs. Mean age was 43years (SD=16), and mean number of teeth was 22.1 (SD=8.6). Data collectors included two dentists and three non-dentists. Later, a further 17 adults (nine female and eight male) with mild/moderate IDs were included for refinement. At this stage, data collectors included two dentists and five non-dentists. Concurrent validity was established for tooth count [intraclass correlation coefficient=0.99 (95% confidence interval, CI: 0.99-0.99)], carious teeth [Gwet's AC2=0.94 (95% CI: 0.89-0.99)] and gum condition [Gwet's AC1=0.84 (95% CI: 0.64-1)]. For all final OSST items, inter-rater reliability ranged from moderate to very good; median test-retest reliability ranged from moderate to good. Acceptability was demonstrated for data collectors and participants. Mean time to complete the OSST was 7min. The OSST is a novel tool that can record a range of clinical oral features including tooth count, denture wear, occluding pairs of teeth and functional dentition, oral cleanliness, gum condition, carious cavitation and oral pain that will be useful within health surveys of people with mild-moderate IDs and similarly neglected populations. The tool demonstrates promising attributes and acceptability. From this study, the OSST appears to be a robust tool that can be incorporated into general data collection for people with mild-moderate IDs and similar populations. A key feature is that it can be administered by well-trained non-dentists.

An analysis of an educational method to improve the shade-matching ability of dental students

Statement of problemThe predoctoral dental curriculum includes didactic lectures, demonstrations, and training on shade-matching techniques and protocols. However, a significant percentage of esthetic failures are still observed clinically. An assessment is required to determine whether reevaluation and modification of this training protocol would help future dental practitioners better perceive and communicate the dental shade. PurposeThe purpose of this study was to evaluate dental students’ knowledge of and skill in shade selection and effective prescription writing before and after educational training with 3 different shade guides. Material and methodsThirty predoctoral dental students (interns) who had completed their academic program and were undergoing clinical training were selected. After excluding color vision deficiency, the study participants were first asked to evaluate the shade of the right maxillary central incisor of 5 patient participants by using 3 different shade guides (Vitapan Classical, Vitapan 3D-MASTER, Chromascop) under standardized conditions. They were then asked to write an esthetic prescription, communicating the shade to a dental laboratory technician. A dental faculty member evaluated the baseline control shade for each participant, and a standardized prescription format was written. This was used as a reference by a dental laboratory technician to score the intern’s prescription as clear, unclear, poor, or illegible. After the assessment, focused small group learning with lectures, clinical demonstrations, and case-based discussion was provided to the interns on shade assessment over 10 to 15 days. All the interns were reassessed for their visual shade perception and prescription writing after a month’s interval. The mean percentage agreement, mean percentage shade match, and mean color difference between the shade selected and the control shade for each of the 5 participants, with all 3 shade guides, were evaluated along with the prescription scoring before and after the educational training. Statistical comparison of before and after values were made by using the paired-sample z-test for percentage agreement versus disagreement among the interns for the shade selected, paired t test for mean percentage agreement, mean percentage shade match, and mean color difference. The repeated measure ANOVA test was used for the prescription scorings (α=.05). ResultsA significant difference in prescription scoring (P<.001) was observed. A significant difference in the percentage shade match (P<.01) for all 3 shade guides and mean percentage agreement for Chromascop and Vita 3D-MASTER (P<.05) were observed. A nonsignificant mean color difference between the shade selected by the intern and the baseline shade was observed. ConclusionsA significant difference in prescription scoring was observed after training, along with a higher percentage shade match and percentage agreement. This indicated a need to reconsider the educational training provided for dental shade assessment and communication and to implement better protocols in the dental curriculum.

Symphyseal distraction : clinical cases

The discussion on whether to extract or not is still a source of debate. However, primacy must be given to the diagnosis based on a dental, skeletal, aesthetic and functional assessment. The therapeutic means are intended to achieve the goals resulting from this diagnosis which are the only way to individualize the treatment plan according to the patient. Symphyseal distraction is a surgical procedure intended to increase the mandibular bone base at the symphysis level and then allow an ideal positioning of the mandibular incisor. After explaining the procedure to integrate this intervention in the treatment plan, the author studied in 25clinical cases the displacement of the mandibular incisor according to the initial crowding and the increase of the distance between the mandibular cuspids before and after bone distraction. Symphyseal distraction is an effective alternative to the treatment of dental crowding to the mandible by helping to restore nasal breathing by its association with maxillary disjunction while respecting of physiology and balance facial.

Abstract P441: Dental Caries a Risk Factor for Intracerebral Hemorrhage

Introduction: Streptococcus mutans is a known cause of dental caries that contains a collagen-binding protein, Cnm, and shows inhibition of platelet aggregation and matrix metalloproteinase-9 activation. This strain has been linked to aggravation of experimental intracerebral hemorrhage (ICH) and may be a risk factor for intracerebral hemorrhage. Methods: Presence of dental caries was assessed in subjects from the Dental Atherosclerosis in Communities Study (DARIC) without prior stroke or intracerebral hemorrhage. This cohort was followed for a period of incident intracerebral hemorrhage, subsequently verified by chart abstraction. Cox regression with time-dependent covariate was used to compute crude and adjusted hazards ratio stratified as &lt;15 years and ≥15 years from the initial dental assessment. Results: Among 6506 subjects, dental caries were recorded in 1227 (19%) subjects. 47 (1%) had ICH over a period of 30 years. Those with dental caries versus those without dental caries had a greater proportion of younger (mean age 61.8±5.6 vs. 62.5±5.6, p&lt;0.001), male (24% vs. 16%, p&lt;0.001), African-American (53% vs 12%, p&lt;0.001) and hypertensive (24% vs. 16%, p&lt;0.001) patients. The association between dental caries and ICH in the first 15 years was not higher (crude HR 1.0, 95% CI 0.4-2.3) and remained so after adjusting for age, gender, race, and hypertension (adj. HR 1.1, 95% CI 0.5-2.9). The association between caries and ICH in the second 15 years was higher (crude HR 3.7, 95% CI 1.1-12.0) and strengthened after adjustment (adjusted OR 4.5, 95% CI 1.3-15.5). This is depicted in the Kaplan-Meier curve below. Conclusion: We report a significant association between dental caries and ICH. Future studies are needed to determine if early treatment of dental caries can reduce the risk of ICH.