Dental Clinic Setting Research Articles

Oral Warts among Children Attending a Missionary Dental Clinic in Cameroon

To determine the prevalence of oral warts among children attending missionary dental clinic in Cameroon. This prospective study of children presenting in the Dental Clinic of Cameroon Baptist Convention with oral warts was conducted between January 2006 and August 2010. During the study period, 31 children out of 2912 children had oral warts giving a prevalence rate of 1.1%. Out of which, 15 (48.4%) of children with oral warts were aged between 7-10 years old, 20 (64.5%) were females, 3 (9.7%) were HIV positive. Lips were the most predominant oral site among the children. The recurrence rate following treatment with electrocautery was 1 (3.2%). The overall prevalence of oral warts among Cameroonian children in a dental clinic setting was low. It was commoner in children aged 7-10 years, females and HIV negative children. Lips were the most predominant oral site in children and recurrence rate following treatment with electrocautery was low.Key words: Oral warts, children, HIV, electrocautery, outcome.

A review of the clinical implications of bisphosphonates in dentistry

Bisphosphonates are drugs that suppress bone turnover and are commonly prescribed to prevent skeletal related events in malignancy and for benign bone diseases such as osteoporosis. Bisphosphonate associated jaw osteonecrosis (ONJ) is a potentially debilitating, yet poorly understood condition. A literature review was undertaken to review the dental clinical implications of bisphosphonates. The present paper briefly describes the postulated pathophysiology of ONJ and conditions with similar clinical presentations. The implications of bisphosphonates for implantology, periodontology, orthodontics and endodontics are reviewed. Whilst bisphosphonates have potential positive applications in some clinical settings, periodontology particularly, further clinical research is limited by the risk of ONJ. Prevention and management are reviewed, including guidelines for reducing cumulative intravenous bisphosphonate dose, cessation of bisphosphonates prior to invasive dental treatment or after ONJ development, and the use of serum beta-CTX-1 in assessing risk. In the context of substantial uncertainty, the implications of bisphosphonate use in the dental clinical setting are still being determined.

Evaluation of a Rapid HIV Testing Initiative in an Urban, Hospital-Based Dental Clinic

Performing rapid HIV testing in nontraditional clinical settings such as dental clinics is a potential method for targeting high-risk individuals who may not otherwise access health care settings that offer HIV testing. In March 2008, Harlem Hospital Center, located in New York City, launched a counselor-based rapid HIV testing initiative in its on-site dental clinic. A full-time, trained counselor consented and tested patients as they waited for their appointments. HIV screening was performed using a whole-blood, finger-stick rapid HIV test. Through this initiative, 3864 HIV tests were performed from March 1, 2008 to December 31, 2009, representing 3565 unique individuals and 97.6% of dental patients approached for testing. Of those tested, the mean age was 38.5 years, with 47.1% female, 75.5% black, and 20.6% Hispanic. Self-reported HIV risk behaviors included 73.5% with recent unprotected heterosexual intercourse, 4.6% with recent or past injection drug use, and 2.6% who identified as men who have sex with men. Nineteen previously undiagnosed individuals (0.53%) were confirmed HIV positive. Of these individuals, mean age was 38.3 years with males representing 84.2%. Fifteen newly diagnosed patients (78.9%) were linked to care. Of those linked to care, median initial CD4 cell count was 317 cells/mm(3); 6 of these individuals (40%) had CD4 cell counts below 200 cells/mm(3). Our results demonstrate that a counselor-based rapid HIV testing program with linkage to specialized HIV care can be successfully integrated into the dental clinic setting.

Facilitating Preceptor and Student Communication in a Dental School Teaching Clinic

Teachable moments in the dental clinic are rare and are not adequately exploited. Students often ask simple procedural questions, such as "What should I do next?" A preferred approach is one in which the clinic preceptor helps the dental student collect data about the patient's condition, analyze the data, and consider scientific evidence and the patient's profile in the formulation of diagnoses and treatment plans. The School of Dentistry at Oregon Health & Science University modified the one-minute preceptor method that was developed to instruct medical students in clinical office settings, using the acronym iCARE, which is an abbreviation for microskills that the dental preceptor and student follow when interacting in a dental clinic setting. From the preceptor's perspective, iCARE stands for Inquire, Cultivate, Advise, Reinforce, and Empower; from the student's perspective, iCARE is Initiate, Contribute, Apply, Reflect, and Execute. iCARE enhances the value achieved in preceptor and student interactions, promotes the student's critical thinking, and encourages the student's use of scientific evidence in formulating and supporting patient care decisions in the clinic.

Clinical Performance of Art Restorations in Primary Teeth: A Survival Analysis

To assess the survival of Atraumatic Restorative Treatment (ART) restorations in primary teeth performed in a dental clinical setting. One hundred and five single-surface ART restorations placed in 56 preschool children (mean age 31 months) were included. Final-year dental students performed the restorations using standard ART procedures with hand instruments. A resin-modified glass ionomer cement (Vitremer 3M/ESPE) was used as a restorative material. Performances of the restorations were assessed directly by the ART evaluation criteria. Follow-up period ranged from 6 to 48 months. Survival estimates for restoration longevity were evaluated using the Kaplan-Meier method. Log-rank test (P < or = .05) was used to compare the success rates according to demographic and clinical characteristics of the restorations at baseline (age, sex, arch and segment). Mean and median estimate times of survival were 37 (95% CI: 32-42) months and 38 (95% CI: 29-47) months respectively. Success rates for ART restorations were 89%, 85% and 72% in 6 to 11, 12 to 24 and 25 to 48 months of evaluation respectively. Differences in success rates among demographic and clinical characteristics were not statistically significant. High survivals rates of the ART restorations found in this study seem to indicate the reliability of this approach as an appropriate treatment option for primary teeth in a clinical setting.

Comparison of a high and a low intensity smoking cessation intervention in a dentistry setting in Sweden – a randomized trial

BackgroundTobacco is still the number one life style risk factor for ill health and premature death and also one of the major contributors to oral problems and diseases. Dentistry may be a potential setting for several aspects of clinical public health interventions and there is a growing interest in several countries to develop tobacco cessation support in dentistry setting. The aim of the present study was to assess the relative effectiveness of a high intensity intervention compared with a low intensity intervention for smoking cessation support in a dental clinic setting.Methods300 smokers attending dental or general health care were randomly assigned to two arms and referred to the local dental clinic for smoking cessation support. One arm received support with low intensity treatment (LIT), whereas the other group was assigned to high intensity treatment (HIT) support. The main outcome measures included self-reported point prevalence and continuous abstinence (≥ 183 days) at the 12-month follow-up.ResultsFollow-up questionnaires were returned from 86% of the participants. People in the HIT-arm were twice as likely to report continuous abstinence compared with the LIT-arm (18% vs. 9%, p = 0.02). There was a difference (not significant) between the arms in point prevalence abstinence in favour of the HIT-protocol (23% vs. 16%). However, point prevalence cessation rates in the LIT-arm reporting additional support were relatively high (23%) compared with available data assessing abstinence in smokers trying to quit without professional support.ConclusionScreening for willingness to quit smoking within the health care system and offering smoking cessation support within dentistry may be an effective model for smoking cessation support in Sweden. The LIT approach is less expensive and time consuming and may be appropriate as a first treatment option, but should be integrated with other forms of available support in the community. The more extensive and expensive HIT-protocol should be offered to those who are unable to quit with the LIT approach in combination with other support.Trial RegistrationTrial registration number: NCT00670514

Primer on Preclinical Instruction and Evaluation

This review summarizes the available literature for both instruction and evaluation of the novice dental and dental hygiene preclinical student. Effective instruction for dental and dental hygiene instrumentation requires knowledge of motor skills theory and mechanisms of fine motor skills attainment. The novice learner requires small, explicit steps that clearly define production. Prior to any performance, the skill to be performed should be envisioned accurately by the learner. Timely, precise feedback from the instructor to the learner contributes to learning. Novices are unable to judge their performance accurately, so self-assessment skills must be taught. Repetition enhances motor performance. Instruction is supported through well-designed evaluation instruments containing explicit criteria arranged in the correct order of production. Assessment tools should be designed to aid in providing specific, immediate feedback. Well-designed assessments may also aid in calibration of instructors. Examples of evaluation instruments are found in the literature, and several are reviewed in this article. For those responsible for preclinical performance assessment, application of current motor skills theory and development of appropriate instruction and evaluation instruments may result in improved student performance. Studies also indicate the instructional environment in the dental clinical setting may be less stressful if evaluation is based on achievement of target levels rather than multiple daily grades.

Patients' Attitudes about Rapid Oral HIV Screening in an Urban, Free Dental Clinic

The 2006 Centers for Disease Control recommendations for routine HIV screening in all health care settings could include dental clinics an important testing venue. However, little is known about patients' attitudes regarding the routine use of rapid oral HIV screening at an urban free dental clinic. This pilot study seeks to evaluate the patient perspective on rapid HIV screening in this setting. In June 2007, patients at a free dental clinic in Kansas City, Missouri, were provided an attitude assessment survey prior to their dental visit. This dental clinic serves a diverse patient population consisting of approximately 37% white, 47% black, 6% Hispanic, 4% Asian, and 1% Native American uninsured patients. Results were analyzed for acceptance of testing and potential barriers. Of the 150 respondents, 73% reported they would be willing to take a free rapid HIV screening test during their dental visit. Overall, 91% of Hispanics, 79% of Caucasians, and 73% of African American patients reported they would be willing to be screened. Patients with a history of multiple prior screening tests for HIV were more likely to agree to oral rapid HIV screening in the dental clinic. The majority (62%) reported that it did not matter who provided them with the screening result, although some (37%) preferred their dentist above any other provider. Low self-perception of risk (37%) and having already received screening elsewhere (24%) were the main reasons for not accepting a free, rapid HIV screening. Overall, dental clinic patients widely accepted the offer of rapid oral HIV screening. Rapid HIV screening in the dental clinic setting is a viable option to increase the number of individuals who know their HIV status.

Ultraviolet Illumination as an Adjunctive Aid in Dental Inspection*

Tooth-colored resin fillings have become increasingly popular as restorative materials. Their presence in the dentition presents a challenge to the clinician and the forensic odontologist, as detection of the fillings can be difficult both visually and radiographically. As they necessarily form part of the unique dentition of an individual, recognition of the resins is important for forensic identification. Alternative light sources have been used with success in various fields of forensic science. In recent years small LED flashlights emitting at specific wavelengths in the ultraviolet light (UV) range have been developed. Their low cost, small size, and ready availability makes their use practical in both forensic dental inspection and clinical settings. UV inspection is of interest because enamel, dentin and dental materials all have differing fluorescent properties when illuminated by UV light. It was one goal of this research to quantitatively assess the fluorescence properties of modern restorative resins in order to predict their behavior during inspection using UV illumination. The second goal was to demonstrate practical use of UV in dental inspection with examples of how different materials fluoresce. Quantitative measurements were obtained for optical emission wavelength and intensity for 15 modern resins using a spectrophotometer. Results indicated that resin brands fluoresce at different wavelengths and with varying intensities. Practical use and comparison of the flashlights revealed that the most useful excitation wavelengths for resin detection were in the UVA range (365 and 380 nm). Porcelain restorations and composite resin fillings exhibited different responses to these two wavelengths and thus use of both is recommended for forensic dental inspection.

The Origins of Fear of Occupational Exposure in the Clinical Dental Setting

Although there is a growing literature on the incidence of occurrence and reporting of occupational exposures in clinics in dental schools, the contributing factors to fear of such injuries and their dynamic evolution over time remain unstudied. It is hypothesized that fear of occupational exposures is a function of estimated likelihood of such events and their perceived importance. Individual personality factors and situational circumstances are also thought to play a role, although it is believed that these factors recede in importance as students gain direct knowledge through clinical experience. Path analysis methods are applied to longitudinal survey data in a single dental school to confirm these hypotheses.

Semi-automatic computer aided lesion detection in dental X-rays using variational level set

A semi-automatic lesion detection framework is proposed to detect areas of lesions from periapical dental X-rays using level set method. In this framework, first, a new proposed competitive coupled level set method is used to segment the image into three pathologically meaningful regions using two coupled level set functions. Tailored for the dental clinical setting, a two-stage clinical segmentation acceleration scheme is used. The method uses a trained support vector machine (SVM) classifier to provide an initial contour for two coupled level sets. Then, based on the segmentation results, an analysis scheme is applied. Firstly, the scheme builds an uncertainty map from which those areas with radiolucent will be automatically emphasized by a proposed color emphasis scheme. Those radiolucent in the teeth or jaw usually suggested possible lesions. Secondly, the scheme employs a method based on the average intensity profile to isolate the teeth and locate two types of lesions: periapical lesion (PL) and bifurcation lesion (BL). Experimental results show that our proposed segmentation method is able to segment the image into pathological meaningful regions for further analysis; our proposed framework is able to automatically provide direct visual cues for the lesion detection; and when given the orientation of the teeth, it is able to automatically locate the PL and BL with a seriousness level marked for further dental diagnosis. When used in the clinical setting, the framework enables dentist to improve interpretation and to focus their attention on critical areas.

Chemical Exposures: No Dental Dilemma for BPA

Among the many uses of bisphenol A (BPA) is the manufacture of resin-based dental composites and sealants. Recently a team of researchers from the CDC sank their teeth into questions about whether BPA monomer leaching from sealants could be harmful to people. The results of their human study, presented in the March 2006 issue of the Journal of the American Dental Association, suggest that although leaching does occur, sealants are still a safe means of preventing dental cavities. Low-level exposures to BPA monomer in pregnant rodents, at a level that humans could potentially receive from dental sealants, have been shown to disrupt reproductive development in their fetuses, and concerns have emerged about the possibility of human health effects from dental exposures. Scientific exploration of this question has yielded inconsistent results, says Renee Joskow, first author of the March paper. Much of this is due to limitations in laboratory detection and translation of animal studies to human health effects, as well as insufficiently addressing the parameters of exposure in a clinical dental setting. The CDC team, led by Joskow (now of the U.S. Public Health Service) and Dana Barr, looked at 14 nonsmokers receiving their first resin-based sealants as part of their routine dental care. Each subject received one of two brands of dental sealant manufactured by two well-established dental equipment and material supply firms. Then their saliva and urine were tested for BPA. All the patients had BPA in their saliva and urine, even before treatment. For patients receiving Helioseal F sealants, saliva BPA doubled immediately after treatment and returned to baseline within 1 hour. Urine BPA more than tripled 1 hour after treatment and returned to baseline within 24 hours. For patients receiving Delton LC sealants, saliva BPA increased nearly 126 times immediately after application and was still 23 times higher after 1 hour. Urine BPA jumped 10 times 1 hour after treatment and was still elevated 24 hours later. Both levels eventually returned to baseline. Barr believes the patients’ baseline BPA came from background exposures from environmental sources such as water and food packaging. These, she suggests, could be “a more chronic low-level source of exposure” than dental sealants. Barr adds that in her view, although point-source exposure from dental sealants might approach levels that induce health effects in rodents, “[it] is not the most significant source of exposure in humans.” Moreover, she holds that exposure to BPA from dental sealants, already variable and short-lived in the body, could be easily reduced further by having the patient spit frequently in the hours after application.

Glass-ionomer ART restorations may perform as well as occlusal amalgam restorations in Tanzanian children

Original Article Mandari GJ, Frencken JE, van't Hof MA. Six-year success rates of occlusal amalgam and glass-ionomer restorations placed using three minimal intervention approaches. Caries Res 2003 Jul-Aug;37(4):246-53. Level of Evidence 2b Purpose To assess the performance of 3 restorative approaches and 2 different materials (glass ionomer and dental amalgam) for the restorative treatment of occlusal caries lesions involving dentin: the ART approach in combination with a chemical caries removal agent; a modified-conventional approach carried out in a portable dental clinic setting; and a conventional approach carried out in a dental clinic. Source of Funding Government: The Muhimbili Dental School Project of the Univeristyh of Kuopio, Finland and the University of Nijmegen, The Netherlands. Type of Study/Design Randomized controlled clinical trial

Survival of glass ionomer restorations placed in primary molars using atraumatic restorative treatment (ART) and conventional cavity preparations: 2-year results

To compare the survival of glass ionomer cement (GIC) restorations placed in a dental clinic setting using both the atraumatic restorative treatment (ART) approach with hand instruments, and conventional cavity preparation with rotary instruments. Two encapsulated high-strength conventional GICs (Fuji IX GP, Ketac-Molar Aplicap) were placed in 82 Class I and 53 Class II preparations and one encapsulated non-gamma 2 amalgam alloy (GK-amalgam) was placed in 32 Class I preparations, in the primary molars of 60 Chinese children with a mean age of 7.40 +/- 1.24 (SD) years. Thus, 9 treatment groups were formed. After two years, there were no significant survival differences found among 7 of the 9 treatment groups (p = 0.99). However, two groups comprising Fuji IX GP and Ketac-Molar Aplicap placed in Class II cavities prepared using the ART approach showed significantly lower restoration survivals (p < 0.001). Only 3 of the 72 initially sealed fissures adjacent to the restorations appeared to retain any GIC material. In a clinic setting, both the ART hand instrument and conventional rotary instrument methods were equally suitable for high Class I restoration survival, but not for Class II restoration survival where the conventional cavity preparation method was preferable.

The role of the dental team in tobacco cessation.

The dental team can play an effective role in the creation of tobacco-free communities and individuals through participation in community and political action and in counselling their patients to quit. Maintaining a smoke-free environment is important. There are well-tried and cost effective methods for brief interventions in dental clinical settings, and team-work, to which both clinical and reception/administrative staff must contribute, is fundamental. Quit rates of the order of 10%, sustained over a year or more, can be achieved and this may be increased by prescription of nicotine replacement therapies, or of buproprion, to aid nicotine withdrawal. Prevention of smoking uptake, especially by young people, is much more difficult and has a weaker evidence base. In much of Central and Eastern Europe the situation is very severe because of high smoking rates and associated diseases and where, although governments are now acting with advertising bans and other legislation arising from the Framework Convention on Tobacco Control, the healthcare professions themselves have high smoking prevalences and a comparative lack of involvement in tobacco cessation and prevention practices. In South and South-East Asia, and in emigrant communities originating from these areas, the use of oral unsmoked tobacco, the chewing of areca nut, and various mixtures of these ingredients in the form of betel quids, is highly addictive and carcinogenic to the mouth, pharynx and oesophagus. Special and specific efforts are needed for cessation and coping strategies in these communities, for which there is a less well-developed evidence base.

A reliability study of clinical tooth wear measurements

Statement of Problem. Most studies examining tooth wear severity have been performed on dental casts. This indirect approach has limited applicability to dental practice because during the assessment of the casts, the identification of dentin exposure is difficult or even impossible. Purpose of Study. The purpose of this study was to assess occlusal and incisal tooth wear clinically to determine the reliability of the assessment procedure and to establish the influence of selected relevant clinical variables (dental quadrant, tooth type, and severity of wear) on the reliability. Material and Methods. Forty-five volunteers (17 men, 28 women; mean age 33.7 ± 10.7 years), 32 with temporomandibular disorders and 13 free from signs and symptoms of such disorders, were evaluated on 4 occasions. Two trained observers graded tooth wear at 2 different points in time with a 5-point ordinal scale developed for use in this study. The inter-rater and intra-rater reliability of the scale was expressed as Cohen's kappa. The influence of 2 clinical variables, dental quadrant and tooth type, on the values of kappa was tested with 1-way analysis of variance and post hoc Bonferroni tests. Probability levels of P<.05 were considered statistically significant. The influence of the final clinical variable, severity of wear, was assessed qualitatively. Results. The overall values of the inter-rater and intra-rater reliability were substantial (kappa = 0.632 to 0.678). The clinical variable dental quadrant did not influence the kappa values, whereas the inter-rater reliability during the first session was better for incisors and canines than for premolars (1-way analysis of variance: F3,23=4.577, P=.012; post hoc Bonferroni tests: P=.030 and.036). Qualitative assessment of severity of wear indicated that the more advanced the tooth wear, the more reliably it could be graded. Conclusion. By means of the developed 5-point ordinal scale and within the limitations of this study, it was concluded that tooth wear can be assessed reliably in the clinical dental setting. (J Prosthet Dent 2001;86:597-602.)

Motivating smoking cessation among dental patients: smokers' interest in biomarker testing for susceptibility to tobacco-related cancers.

This study examined interest in receiving biomarker testing for tobacco-related cancer susceptibility among 148 smokers seeking routine oral health care in a public dental clinic. Patients completed a brief, self-report survey assessing their smoking history, tobacco-related illness history, readiness to quit smoking, perceived risk and worry about cancer, and their interest in being tested for genetic susceptibility for tobacco-related cancers. Participants were socioeconomically and ethnically diverse, and were primarily long-standing, nicotine-dependent smokers. Most reported (83%) interest in biomarker feedback, and most (86%) understood that a certain genetic make-up could place them at increased risk for tobacco-related cancers. Those participants who felt that quitting smoking would reduce future cancer risk, were at least in the contemplation stage of quitting readiness, felt more worried and more at risk for developing cancer, women and younger smokers were more interested in genetic testing (all ps < 0.20). Multivariate logistic regression analyses indicated that gender and risk perceptions were associated with interest in testing. The public dental clinic setting holds potential for innovative smoking cessation interventions using personalized risk feedback.

A clinical evaluation of glove washing and re-use in dental practice

This study has assessed the durability of four brands of latex gloves, Ansell Medical ‘Medi-Grip’, Regent ‘Biogel D’, Surgikos ‘Microtouch’ and the London Rubber Company ‘Supreme’, under conditions of repeated washing and re-use in a clinical dental setting. The microbiological effectiveness of ‘Hibiscrub’ as a decontaminating washing agent was examined simultaneously. Examination by an electrical test for micropunctures in 200 unused gloves of each brand revealed such defects in 6(3%) of Ansell ‘Medi-Grip’, 3(1·5%) of ‘Biogel D’, 14(7%) of Surgikos ‘Microtouch’ and 2(1%) of LRC ‘Supreme’ gloves. Following repeated clinical use, micropunctures were detected in 18% of Ansell ‘Medi-Grip’, 10% of ‘Biogel D’, 75% of Surgikos ‘Microtouch’ and 56% of LRC ‘Supreme’. Microorganisms were isolated from the glove surfaces after 45% of the occasions on which the gloves were washed for 1 min in ‘Hibiscrub’ (ICI Dental). Eighty-five per cent of these isolates were environmental organisms, but oral streptococci were isolated from 8·4% of the pairs of gloves examined. The high rate of micropuncture development following repeated washing and re-use of latex gloves indicates that they cannot effectively perform their barrier function under such conditions. The microbiological data have also revealed the potential for cross-infection between patients through inadequate decontamination of glove surfaces. For operative dental surgery, the results suggest that heavier, surgical type gloves are to be preferred, and that multiple use of any glove type should be discouraged.

Prevalence of Legionella-specific IgG and IgM antibody in a dental clinic population.

This study was undertaken to determine the frequency of Legionella infection in a dental clinic setting. Serum samples from 270 dental clinic personnel were evaluated using an enzyme-linked immunosorbent assay to detect Legionella-specific IgM and IgG antibodies. The pooled-species whole-cell-antigen preparation used in these assays was derived from six Legionella pneumophila strains and one strain each from Legionella bozemanii and Legionella micdadei. Significant levels of IgG and IgM antibodies were found in 20% and 16%, respectively, of the samples. This compares with 8% and 10%, respectively, for a randomly selected non-clinical group from the region (P less than 0.005). Samples from clinic personnel with significant IgG titers (greater than 1:128) were also evaluated for activity to each of the eight single-species antigens, with the following results: L. pneumophila, 45% (combined six strains); L. micdadei, 37%; and L. bozemanii, 18%. Comparing individuals' "years spent in the clinic environment" with the incidence of significant antibody levels strongly suggests that the risk of Legionella infection increases proportionately with increased clinic exposure time (P less than 0.05). Analysis of these data implies that Legionella may be present in the dental clinic environment, thus creating an increased risk for clinical personnel or patients.

Electrocautery in orthodontics

Electrocautery has all but disappeared from the clinical dental setting. Through technical advances, there have been developed new instruments which must now challenge the profession to re-examine the use of electrocautery as a valuable adjunct, particularly in the field of orthodontics. This article will describe a simple yet effective battery-operated electrocautery unit. Indications and examples of its use will also be presented.