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Approaches for managing carious tissues during cavity preparations vary considerably among clinicians, which may reflect inconsistencies in the teaching of this subject by dental schools. The aims of this study were to investigate practices related to the preclinical and clinical teaching of caries removal at U.S. dental schools and the relationship between that teaching and requirements for U.S. dental licensure examinations. The electronic survey included questions about terminology, methods, instruments and materials, treatment planning, criteria for clinical exams, faculty calibration sessions, and licensure exams. The faculty members at U.S. dental schools responsible for teaching cariology were invited to participate; 54 of the 65 schools had identified a contact person at the time of the survey in October 2015. Of those 54 invited to participate, 43 completed the survey (response rate of 79.6%). Most of the respondents indicated that depth of carious lesions was a clinical determinant of the amount of carious dentin being removed in cavity preparations. Caries removal was used as a criterion in restorative clinical examinations by 95% of responding schools. Marked differences were observed regarding the criteria used for assessment and removal of carious tissues, management of deep carious lesions, and definition of "caries remaining at cavity preparations," which is considered a critical error on licensure exams. Faculty calibration sessions on caries removal were reported to occur in 65% of these schools and at different time frames. Overall, the study found a wide range of teaching practices related to caries removal. Best evidence in caries management needs to be aligned with teaching and the criteria used to calibrate faculty members and examiners. [ABSTRACT FROM AUTHOR]

Rehabilitation of a patient with amelogenesis imperfecta (AI) from both the functional and esthetic standpoints represents a challenge. The complexity of the condition requires an interdisciplinary approach for optimal treatment outcomes. A number of treatment options have been proposed. Recently, the use of bonded restorations has gained popularity because of the many benefits associated with these materials; excellent esthetics, conservative approach, and improved wear make their use advantageous. This article describes a direct approach with resin composite restorations for the transitional treatment of an adolescent with hypoplastic AI who had not completed skeletal growth. Protection against further wear, sensitivity, and plaque accumulation while significantly enhancing the patient's esthetic appearance made this case a success. Furthermore, this article describes the use of a “Clear matrix” technique, which considerably helped simplify the placement of the bonded restorations. CLINICAL SIGNIFICANCE This article highlights (1) the importance of an interdisciplinary approach to the successful treatment planning of a patient with hypoplastic amelogenesis imperfecta (AI), and (2) the conservativeness and suitability of full coverage direct resin composite restorations for the transitional treatment of AI-affected teeth on an adolescent patient who has not yet completed skeletal growth. [ABSTRACT FROM AUTHOR]

The purpose of this article is to describe the Rampant Caries Control Program established in the operative dentistry third-year clinic at the University of Iowa College of Dentistry. This program represents a new approach to the management of high caries risk and high caries activity patients who come to the school. The patients are referred initially to the third-year operative clinic only for disease control (phase I) to help them decrease the caries risk and activity. The disease control phase has three important components: 1) caries risk assessment evaluation and reevaluation throughout their treatment, in which individual risk factors are identified and recommendations are made; 2) caries removal and placement of transitional restorations using fluoride release restorative materials (glass ionomers); and 3) chemotherapeutic agents and preventive treatment in which a therapeutic regimen for prevention and nonsurgical treatment is established according to each patient's individual risk factors. About 50 percent of patients have dropped from the program, 36 percent currently are under disease control treatment, and 14 percent have finished the disease control phase of the program. After the disease is controlled through modification of risk factors and activity, the patients can be referred for reevaluation prior to beginning the rehabilitation phase. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate fluorescence changes of remineralized and nonremineralized enamel margins adjacent to glass ionomer restorations during a pH cycling sequence. Methods: One hundred permanent molar and premolar teeth were placed in a demineralizing solution for 3 days and restored with a glass ionomer restoration (simulating Atraumatic Restorative Treatment [ART]). Half were placed in a remin solution for 7 days to create a remineralization (remin) group. Specimens were randomly divided into 4 groups (N=25): (a) 2 remin groups; and (b) 2 nonremin groups. One half of the remin and nonremin group specimens were treated with a 5,000-ppm sodium fluoride solution during pH cycling with remin fluid and an acidic beverage over 20 days. Fluorescence changes were recorded with quantitative light fluorescence (QLF). Higher fl uorescence values indicated less lesion porosity. Statistical comparisons between the groups over the 5 measurement sessions of cycling were performed using repeated measures of analysis of variance with a post-hoc test, paired-sample t test and 2-sample t tests (a=0.05). Results: The remin groups experienced significantly less lesion porosity than the nonremin groups. Fluoride groups experienced less lesion porosity than the nonfluoride groups. Conclusions: A brief period of remineralization and use of a prescription strength fluoridated rinse improved the enamel substrate surrounding glass ionomer restorations, resulting in less lesion porosity. [ABSTRACT FROM AUTHOR]

Maintenance of health and preservation of tooth structure through risk-based prevention and patient-centered, evidence-based disease management, reassessed at regular intervals over time, are the cornerstones of present-day caries management. Yet management of caries based on risk assessment that goes beyond restorative care has not had a strong place in curriculum development and competency assessment in U.S. dental schools. The aim of this study was to develop a competency-based core cariology curriculum framework for use in U.S. dental schools. The Section on Cariology of the American Dental Education Association (ADEA) organized a one-day consensus workshop, followed by a meeting program, to adapt the European Core Cariology Curriculum to the needs of U.S. dental education. Participants in the workshop were 73 faculty members from 35 U.S., three Canadian, and four international dental schools. Representatives from all 65 U.S. dental schools were then invited to review and provide feedback on a draft document. A recommended competency statement on caries management was also developed: "Upon graduation, a dentist must be competent in evidence-based detection, diagnosis, risk assessment, prevention, and nonsurgical and surgical management of dental caries, both at the individual and community levels, and be able to reassess the outcomes of interventions over time." This competency statement supports a curriculum framework built around five domains: 1) knowledge base; 2) risk assessment, diagnosis, and synthesis; 3) treatment decision making: preventive strategies and nonsurgical management; 4) treatment decision making: surgical therapy; and 5) evidence-based cariology in clinical and public health practice. Each domain includes objectives and learning outcomes.

Although dental caries in the pediatric and adolescent population has consistently declined in the United States, it is still the most common childhood disease. Dental problems are the number one reason for missing school next to the common cold. Dental caries are an infectious, communicable disease resulting in destruction of tooth structure by acid-forming bacteria found in dental plaque, an intraoral biofilm, in the presence of sugar. The etiology of rampant disease is very complex. It is multifactorial and has a close relationship to a number of risk factors. It is important that school nurses identify patients at risk for dental caries early to determine their risk and refer them for disease prevention and control.

To evaluate the correlation between microtensile dentin bond strength (microTBS) and silver ion penetration, two total-etch 3-step and one self-etch 2-step system were investigated. OptiBond FL adhesive was applied to flat occlusal dentin on six non-carious human molars, and a resin composite "crown" was formed in 2 mm increments. After 24-hour water storage, the teeth were sectioned with a low-speed diamond saw to obtain four-square sticks (approximately 2 mm X 2 mm) per tooth. Cylindrical tensile test specimens were formed with an 0.5 mm2 cross-sectional area. Nail varnish was applied to the dentin within 0.5-1.0 mm of the interface before immersing in 50% silver nitrate for 15 minutes. Following silver fixation, tensile testing was performed in a Zwick UTM at 1 mm/minute using a passive gripping fixture to obtain 72-hour microTBS [23.9 MPa]. The percentage area of silver penetration was measured on debonded specimens using light microscopy and Image-Pro Plus Software [89%]. The procedures were repeated using Scotchbond Multi-Purpose Plus [microTBS = 27.8 MPa; nanoleakage = 67%] and Clearfil SE bond [microTBS = 36 MPa; nanoleakage = 55%]. No significant correlation between microtensile bond strength and nanoleakage was found for all systems. A weak-to-moderate negative relationship was found between microTBS and nanoleakage for OptiBond FL (Spearman r = -0.3844). No correlation was found for the remaining adhesive systems. The correlation between these two common laboratory measurements appears to be adhesive-system dependent.