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Active learning engages students via interaction for deeper understanding and retention. A global pandemic resulted in an abrupt mid-semester transition from in-person to virtual learning. This study examined student reporting on active learning before and after this transition.First-year DDS candidates took an anonymous survey, reflecting on three Spring (January-April) 2020 courses (lecture-style, small-group case-based, and pre-clinical). Survey questions included: (1) basic demographics, (2) reporting frequency (1-Never, 2-Rarely, 3-Sometimes, 4-Often, 5-Always) of active learning elements from a pre-set list before/after the shift to online learning, and (3) Likert-style questions regarding effects on active learning and learning environment preference.The traditional lecture course manifested two active learning activities in the category Sometimes prior to the transition to virtual; one of those activities (question and answer) experienced the most significant difference (p 0.0001) in frequency change. The small group, case-based course incorporated nine activities in-person in the category Sometimes; although small significant differences (p ≤ 0.05) in frequency were noted for five of those activities between virtual and in-person, these differences may have not have made a difference in practice. The pre-clinical course incorporated four activities in the category Sometimes pre-transition, with no significant differences detected in frequency. Students slightly leaned toward preferring in-person for the small-group and pre-clinical courses, but had no preference for the traditional lecture course.Course structure may correlate more with student experience of the frequency of active learning activities and preference for in-person versus virtual environment than the environment itself.

PURPOSE The evaluation of the effectiveness of simulation training in dentistry has previously been focused primarily on psychomotor hand skills. This study explored the impact of simulated patient (SP) encounters in simulation on students' self-assessment of competency in their clinical and communication abilities with geriatric patients. METHODS Students from 2 cohorts were recruited for this study. Cohort 1 (n = 30) participated in the standard curriculum with no simulation training and served as the control group. Cohort 2 (n = 34) participated in a SP experience, simulating the initial stages of a care visit for 2 nursing home patients. Students' perceptions of competency to perform these clinical and communication tasks were assessed. A group debriefing session was held 5 weeks post-simulation where Cohort 2 completed a student feedback form. RESULTS A statistically significant change (P

Manufacturer instructions for 38% silver diamine fluoride (SDF) are limited to current FDA clearance for tooth desensitization. There is a need for instructions to provide best-practice recommendations for off-label use of SDF for caries prevention and arrest.The authors considered existing clinical approaches to the use of 38% SDF at pH 10 for the prevention and arrest of active dental caries, in light of the best current evidence. Application of SDF, with or without subsequent direct restoration, is included. The content was reviewed by stakeholders including but not limited to those listed on the consensus statement (Appendix A, below).38% SDF for the prevention and arrest of active caries lesions, as well as compatibility with common direct restorative materials, such as glass-ionomer cement and resin composite, has a foundation in the scientific literature. A practical decision-flow diagram and accompanying best practices for treatment of caries lesions, based on clinical access and intention to restore, were developed based on available evidence and expert clinical observation when no evidence was available.Based on the best available evidence, a logical approach can be adopted regarding the practical use of 38% SDF for caries prevention and arrest.SDF used as per these instructions for prevention on high-risk tooth surfaces and arrest of active caries lesions has a place in the practitioner's dental caries management armamentarium. When SDF is applied to active lesions, it can be used with or without subsequent restoration, depending on clinical context, expert judgment, and patient input.

PURPOSE This multi-site study examined dental students' postgraduate plans and factors affecting them, perceptions of pathways with the best future, and whether those postgraduate plans changed during dental school. METHODS An online survey was made available to all four dental classes (2018, 2019, 2020, and 2021) and advanced standing/international dental students at eight US dental schools. The survey questionnaire consisted of two parts: (1) 14 questions pertaining to demographic information and (2) 11 questions pertaining to career path choices and possible influencing factors. RESULTS Overall response rate was approximately 38.4% (1459/3800). For those responding 34.0% planned to enroll in a general dentistry residency, followed by associate dentist in a private practice (31.4%), and specialty residency (17.6%). Quality of life, to increase knowledge/clinical skills, and intellectual satisfaction were most often rated extremely important factors; Influence of family members in dentistry and prestigious specialty received the most responses of not important. General dentistry was perceived to have the best future in terms of overall impact on the profession, potential for positive impact on patient's quality of life, and personal quality of life; oral and maxillofacial surgery was believed to have the best future in terms of salary. Students changed their postgraduate plan during dental school 43.0% of the time, with race (p = 0.006) and year of progress toward degree (p

Though dentin hypersensitivity (DHS) is one of the most common complaints from patients in dental clinics, there are no universally accepted guidelines for differential diagnosis as well as selection of reliable treatment modalities for this condition. The neurosensory mechanisms underlying DHS remain unclear, but fluid movements within exposed dentinal tubules, i.e., the hydrodynamic theory, has been a widely accepted explanation for DHS pain. As several dental conditions have symptoms that mimic DHS at different stages of their progression, diagnosis and treatment of DHS are often confusing, especially for inexperienced dental practitioners. In this paper we provide an up-to-date review on risk factors that play a role in the development and chronicity of DHS and summarize the current principles and strategies for differential diagnosis and management of DHS in dental practices. We will outline the etiology, predisposing factors and the underlying putative mechanisms of DHS, and provide principles and indications for its diagnosis and management. Though desensitization remains to be the first choice for DHS for many dental practitioners and most of desensitizing agents reduce the symptoms of DHS by occluding patent dentinal tubules, the long-term outcome of such treatment is uncertain. With improved understanding of the underlying nociceptive mechanisms of DHS, it is expected that promising novel therapies will emerge and provide more effective relief for patients with DHS.

To compare the dentin bonded external marginal integrity and the internal surface indentation hardness of bulk-fill and conventional resin-based composite (RBC) placed in both bulk and increments.120 MO and DO cavities were prepared in 60 extracted human third molars. The teeth were randomly divided into four groups of 15 teeth per group to be restored as follows: BB (bulk-fill RBC, placed in a 4 mm bulk increment), BL (bulk-fill RBC, placed in 2 mm incremental layers), CB (conventional RBC, placed in a 4 mm bulk increment), and CL (conventional RBC, placed in 2 mm incremental layers). Marginal gaps were measured at mesial and distal dentin gingival cavosurfaces of each tooth using scanning electron microscopy of epoxy resin replicas and Knoop hardness (KHN) was measured at three different RBC depths (1.8, 2.8 and 3.8 mm). Statistical analyses included one-way ANOVA with post-hoc Tukey's HSD, and paired-sample t-test or a nonparametric Wilcoxon signed-rank test, as appropriate.There was no significant effect of RBC restoration type on external marginal gap at the distal surface or at the mesial surface among the four groups tested (P0.05 in each instance), while no significant difference in external marginal gap was found between the mesial and distal surfaces within groups (P0.05 in each instance). The mean RBC internal surface KHN at 1.8 mm depth was significantly greater than at 2.8 mm and 3.8 mm depths in all tested groups (P0.05 for all instances), with a similar mean internal hardness between all groups. The bulk-fill RBC restorations demonstrated similar marginal gap formation and Knoop hardness to conventional universal RBC restorations under the conditions of this study.Bulk-fill resin-based composite (RBC), from the perspective of marginal adaptation and internal hardness, may be a suitable alternative to conventional RBC.

Although dental education has traditionally been organized into basic sciences education (first and second years) and clinical education (third and fourth years), there has been growing interest in ways to better integrate the two to more effectively educate students and prepare them for practice. Since 2012, The University of Texas School of Dentistry at Houston (UTSD) has made it a priority to improve integration of basic and clinical sciences, with a focus to this point on integrating the basic sciences. The aim of this study was to determine the perspectives of basic and clinical science faculty members regarding basic and clinical sciences integration and the degree of integration currently occurring. In October 2016, all 227 faculty members (15 basic scientists and 212 clinicians) were invited to participate in an online survey. Of the 212 clinicians, 84 completed the clinician educator survey (response rate 40%). All 15 basic scientists completed the basic science educator survey (response rate 100%). The majority of basic and clinical respondents affirmed the value of integration (93.3%, 97.6%, respectively) and reported regular integration in their teaching (80%, 86.9%). There were no significant differences between basic scientists and clinicians on perceived importance (p=0.457) and comfort with integration (p=0.240), but the basic scientists were more likely to integrate (p=0.039) and collaborate (p=0.021) than the clinicians. There were no significant differences between generalist and specialist clinicians on importance (p=0.474) and degree (p=0.972) of integration in teaching and intent to collaborate (p=0.864), but the specialists reported feeling more comfortable presenting basic science information (p=0.033). Protected faculty time for collaborative efforts and a repository of integrated basic science and clinical examples for use in teaching and faculty development were recommended to improve integration. Although questions might be raised about the respondents' definition of "integration," this study provides a baseline assessment of perceptions at a dental school that is placing a priority on integration.

Xerostomia is the subjective feeling of dry mouth, and it is often related to salivary hypofunction. Besides medication-related salivary hypofunction, Sjögren syndrome and head-and-neck radiation are two common etiologies that have garnered considerable attention. Approaches to treating and/or preventing salivary hypofunction in patients with these conditions will likely incorporate gene therapy, stem cell therapy, and tissue engineering. Advances in these disciplines are central to current research in the cure for xerostomia and will be key to eventual treatment.

Objective: This study aimed to assess fluoride intake in infants from formula reconstituted with water, with fluorosis risk in mind. Study Design: Data on water source, formula brand/type, volume of formula consumption and infant weight were collected for infants at two-, four-, six-, nine- and twelve-month pediatrician well child visits. Identified formula brands and water types were reconstituted and analyzed for fluoride concentration. Patient body mass and volume consumed/day were used to estimate fluoride intake from reconstituted formula. Descriptive statistics, one-way analysis of variance and chi-square tests were utilized. Results: All infants consumed formula reconstituted with minimally fluoridated water (0.0– 0.3 ppm). 4.4% of infants exceeded the recommended upper limit (UL) of 0.1mg/kg/day. Although mean daily fluoride consumption significantly differed among all groups, the proportion of infants at each visit milestone that exceeded daily fluoride intake of 0.1mg/kg/day was not statistically significantly different (p>0.05) for any age group. Predicted values calculated with optimally fluoridated water (0.7ppm) resulted in 36.8% of infants exceeding the UL. Conclusions: Optimally fluoridated water may increase fluorosis risk for patients younger than six months. Future investigation should include multiple sites and multi-year follow-up to assess actual fluorosis incidence.

To assess if there was a perceptible difference in staining of restorations in silver diamine fluoride (SDF)-treated teeth, with or without the subsequent application of potassium iodide (KI).20 extracted teeth with frank cavitated carious lesions were prepared with a spoon excavator to remove superficial soft carious dentin and then randomly divided into two groups of 10. The control group was treated with 38% SDF and then restored with glass-ionomer. The experimental group received similar treatment, with the additional step of KI applied before restoration. All teeth were subjected to 500 thermocycles between 5°C and 55°C, followed by storage in artificial saliva at 37°C for 30 days. Three blinded examiners evaluated all 20 teeth for intensity of staining on a scale from 0-5. Wilcoxon rank sum test compared average staining intensity between control and experimental groups of teeth as perceived by each examiner.No significant differences were found (P values: 0.93, 0.67, and 0.97). An aggregate comparison of staining perception between control and experimental groups by repeated measure analysis was done treating the outcome as Poisson distribution also finding no significant difference (P= 0.82).The application of potassium iodide after silver diamine fluoride on caries-affected teeth may improve initial esthetic appearance, but after placement of a glass ionomer restoration, potassium iodide does not seem to result in any significant difference in staining.

Introduction The National Academy of Medicine recently published “A Multifaceted Systems Approach to Addressing Stress Within Health Professions Education and Beyond,” which calls for greater attention to the wellness of health care providers, students, and educators. Suggested actions include “creating and training positive role models.” In order for faculty to role-model behaviors of wellness, they need to understand what this means and how to incorporate it into their lives. At present, there is only one other MedEdPORTAL resource on wellness and resilience that includes faculty as audience members. Methods This 60-minute workshop is designed to provide faculty with a basic framework for wellness, with an emphasis on the emotional process aspect of resilience. Strategies for stress and anxiety management are reviewed. The workshop is interactive, with large- and small-group discussions, as well as a guided meditation. Results This workshop was given at the 2017 Council of Faculties Business Meeting at the American Dental Education Association Annual Session, with 40 participants. Workshop evaluations, completed by 34 (85%) attendees, showed an overall rating of 4.0 on a 5-point Likert scale, with 5 = excellent. The workshop was repeated at the School of Dentistry at the University of California, San Francisco, with 11 attendees; there, the overall rating was 4.7. Discussion In order to contribute to a culture of wellness and resilience in their organization, faculty need training on the concepts, as well as practical skills for implementation. This workshop provides introductory-level knowledge and skills.

Background When the future status of dentistry is considered, scholarship in the profession plays a key role. It is by scholarship that dentistry distinguishes itself as a learned and esteemed profession, and this position paper aims to explore and promote this vital core value. Methods As Fellows of the American Dental Education Association's selective Leadership Institute, the authors spent over a year critically examining the role of scholarship in dentistry, which was identified as a critical issue for the profession. A review of the health care literature was conducted to inform this paper's position. Results Scholarship is clearly the trait that distinguishes a profession from a trade, as evidenced by trends in other health care professions, as well as dentistry. Although dentistry is a learned profession rightly meriting that distinction, there are a few notable areas that can be improved. Conclusions Because scholarship defines a profession, dentists as doctors and the leaders in oral health should demonstrate the highest scholarship; absence of scholarship risks perception of dentistry as a trade. All dentists can consistently manifest scholarship by integrating basic science, as well as by incorporating the dental evidence-base, into daily practice.

The aim of this study was to examine the accuracy of dental faculty members' utilization of diagnostic codes and resulting treatment planning based on radiographic interproximal tooth radiolucencies. In 2015, 50 full-time and part-time general dentistry faculty members at one U.S. dental school were shown a sequence of 15 bitewing radiographs; one interproximal radiolucency was highlighted on each bitewing. For each radiographic lesion, participants were asked to choose the most appropriate diagnostic code (from a concise list of five codes, corresponding to lesion progression to outer/inner halves of enamel and outer/middle/pulpal thirds of dentin), acute treatment (attempt to arrest/remineralize non-invasively, operative intervention, or no treatment), and level of confidence in choices. Diagnostic and treatment choices of participants were compared to "gold standard" correct responses, as determined by expert radiology and operative faculty members, respectively. The majority of the participants selected the correct diagnostic code for lesions in the outer one-third of dentin (p

To characterize traditional Chinese medicine (TCM) use, emphasizing herbal remedies, for oral conditions among two Chinese pediatric populations in the United States.318 unique ethnic Chinese parental units in Houston and Boston with children younger than 12 years old were interviewed for themselves and their children. Questionnaire included age, gender, duration in the United States, frequency of TCM use, and the five selected oral conditions for which TCM agents might be used.Parents (45.6 percent) and children (19.1 percent) used TCM for oral conditions, most commonly for aphthous ulcers (64.2 percent). Most commonly used TCM agents included watermelon frost (37.4 percent), niuhuang jiedu pian (15.5 percent), and honey/propolis (9.9 percent). Chi-square tests with logistic regression (P0.05) showed duration of U.S. residency significantly affected (P=0.002), parental TCM usage, age group (P=0.003), and birth location (P=0.02) related to child use. Parental TCM use increased child likelihood of use (P0.0001).In this study, traditional Chinese medicine was widely used for oral conditions by Chinese immigrants. Factors such as duration of U.S. residency, age, birth location, and parental use affect utilization of TCM in this population. Future studies are needed to explore the therapeutic properties of the various components of TCM.

The esthetic management of enamel dysplasia presents an opportunity for the practitioner to integrate expertise in diagnosis, biomaterials, and technique. In addition to considerations of appearance, careful attention must be paid to occlusal function and restorative material properties. This case report highlights a combined approach of conservative lithium disilicate indirect restorations and composite resin direct veneers to electively restore the anterior teeth of a patient diagnosed with idiopathic enamel hypoplasia.

The aim of this study was to examine the impact of psychomotor operative video demonstrations on first-year dental students who are performing specific procedures for the first time in a preclinical setting. The class was randomly divided into two groups, and three restorative procedures were selected. On the date on which each procedure was to be performed in the preclinical laboratory for the first time, one group (experimental, n=50) was shown a technique video for that specific procedure immediately before commencing the exercise; the control cohort (n=50) did not view the video. Technical performance on procedures was evaluated by students and two calibrated and blinded examiners. The students' perceptions of the experience were also collected in a survey. All first-year students participated in the study, for a 100% response rate. A Mann-Whitney U test did not show any group differences in technical performance (mean values on preparation: 77.1 vs. 77.8; amalgam: 82.7 vs. 82.8; composite: 79.7 vs. 78.0). A Spearman rho test revealed a significantly higher correlation in 13 out of 25 evaluation categories between student self-assessment and blinded examiner assessment for the experimental group. A chi-square test of questionnaire responses revealed a positive student perception of administering these videos for the preparation (X(2)=4.8, p0.03), the amalgam restoration (X(2)=12.4, p0.001), and the composite restoration (X(2)=11.3, p0.001). The psychomotor video demonstrations did not immediately improve student performance on preclinical operative procedures, but they were well received by students and augmented self-assessment ability. These findings suggest that videos can be a useful teaching aid in a preclinical environment, especially regarding comprehension of concepts.

Historically, traditional elastomeric impression techniques for indirect fixed procedures have presented challenges for the operator, laboratory, and patient. Recent digital impression unit technology offers a compelling alternative to elastomeric impressions. The iTero system applies parallel confocal imaging to create a virtual impression that can be easily captured, edited, and uploaded electronically to the dental laboratory. Computer-aided design/computer-aided manufacturing technology is applied to the virtual impression to create an unlimited number of identical polyurethane models. This case report is presented from the perspectives of the clinicians and the laboratory technician using an iTero system to treat a left mandibular second premolar with a resin composite inlay.

SUMMARY Introduction Traditional detection techniques have limits in diagnosing occlusal caries. Thus, more accurate methods are needed. This study evaluates the ability of the Midwest Caries ID (Midwest) to detect caries. Methods Two hundred sixty-four extracted, nonrestored premolars and molars were cleaned and stored in 0.2% sodium azide. Teeth were divided into three groups of 88. One examination site on each occlusal surface was chosen. Each site was inspected by a calibrated examiner via visual, Midwest, and histologic exams. First, a visual exam was performed following the International Caries Detection and Assessment guidelines. Next, the same site was inspected using the Midwest device. Finally, the tooth was sectioned mesiodistally through the site. The half with greater caries progression was visualized under a stereomicroscope (64×). Histologic appearance was scored based on the Downer system. Data were analyzed using Kendall tau-b, partial correlation coefficients, and the receiver operating characteristics curve. Results Overall, the Midwest scoring assessment correlated with histologic assessments (tau = 0.32; p Conclusions Midwest Caries ID is a novel caries detection device that has limitations and should not be used as the sole means to detect occlusal caries.

Current American Dental Association evidence-based recommendations for prescription of dietary fluoride supplements are based in part on the fluoride concentration of a pediatric patient's drinking water. With these recommendations in mind, this study compared the relative accuracy of fluoride concentration analysis when a common apparatus is calibrated with different combinations of standard values. Fluoride solutions in increments of 0.1 ppm, from a range of 0.1 to 1.0 ppm fluoride, as well as 2.0 and 4.0 ppm, were gravimetrically prepared and fluoride concentration measured in pentad, using a fluoride ion-specific electrode and millivolt meter. Fluoride concentrations of these solutions were recorded after calibration with the following 3 different combinations of standard fluoride solutions: 0.1 ppm and 0.5 ppm, 0.1 ppm and 1.0 ppm, 0.5 ppm and 1.0 ppm. Statistical analysis showed significant differences in the fluoride content of water samples obtained with different two-standard fluoride solutions. Among the two-standard fluoride solutions tested, using 0.5 ppm and 1.0 ppm as two-standard fluoride solutions provided the most accurate fluoride measurement of water samples containing fluoride in the range of 0.1 ppm to 4.0 ppm. This information should be valuable to dental clinics or laboratories in fluoride analysis of drinking water samples.

SUMMARY The aim of this in vitro study was to investigate the effect of the cariostatic and preventive agent silver diamine fluoride (SDF) on the microtensile bond strength of resin composite to dentin. Forty-two caries-free, extracted molars were flattened occlusally and apically using a diamond saw, and the exposed occlusal dentin was polished with a series of silicon carbide papers, all under water irrigation. The teeth were then randomly divided into six groups of seven teeth each that were treated as follows: 1) Peak SE self-etch bonding agent; 2) 12% SDF + Peak SE; 3) 38% SDF + Peak SE; 4) Peak LC etch-and-rinse bonding agent; 5) 12% SDF + Peak LC; and 6) 38% SDF + Peak LC. Four-millimeter buildups of Amelogen Plus were incrementally placed on all teeth; after a 24-hour storage period in distilled water, the specimens were sectioned perpendicular to the adhesive interface to produce beams of cross-sectional surface area measuring approximately 1 mm2. The beams were placed on a microtensile testing machine, which utilized a single-speed pump motor and force gauge at 20 kgf × 0.01 second to record maximum tensile force before failure occurred. Two-way analysis of variance and post hoc Tukey tests were performed to compare the effects of the SDF on microtensile bond strength, with statistical significance set at α = 0.05. None of the experimental groups treated with different concentrations of SDF showed a significant difference in bond strength compared to the control groups, and there was no significant difference in bond strength between self-etch and etch-and-rinse groups. However, the effect of SDF on self-etch bonded teeth compared to etch-and-rinse bonded teeth was statistically significant (p=0.0363), specifically at the 12% concentration. SDF does not adversely affect the bond strength of resin composite to noncarious dentin.

Although various modes of delivery for professionally applied fluoride exist, one form has emerged that combines caries prevention efficacy with safety and versatility. The American Dental Association Council on Scientific Affairs recommends fluoride varnish as the only professionally applied fluoride for moderate to high risk patients of all age groups. In addition to demonstrating effectiveness equivalent to fluoride gels, fluoride varnish provides improved safety and acceptability. Furthermore, fluoride varnish has shown promise in preventing dental caries in special groups, such as orthodontic patients and the elderly.

This study sought to compare the relative accuracy of a commercially available hand-held water fluoride analysis unit with a standard laboratory bench-top fluoride-specific electrode/millivoltmeter apparatus, with the goal of identifying possible practical applications of the hand-held unit for preventive dentistry. The units analyzed identical gravimetrically prepared fluoride solutions ranging from 0.1 to 4.0 ppm. The average difference between the measurements from the hand-held unit and the nominal values of the fluoride solutions was 0.011 ppm (SD = 0.068), and the average difference between the hand-held unit's measurements and the bench-top unit's measurements was 0.030 ppm (SD = 0.115). T-test analysis demonstrated no statistical difference between measurements from the hand-held unit with either the nominal values of the fluoride solutions or the bench-top unit's measurements. Results indicate that the hand-held water fluoride analysis unit has an appropriate level of accuracy for the measurement of fluoride levels in drinking water samples by dental professionals.

Dental caries, a bacterial process that results in the acidic destruction of tooth structure, has historically been managed by the mechanical excavation of diseased tooth structure and then restoration with a synthetic material. The mechanical excavation of the infected site is most commonly achieved by a dental handpiece, or “drill”; this handpiece may induce stress and anxiety in many patients. Alternatively, a drill-less filling will involve the utilization of silver diamine fluoride (38%) to arrest and prevent dental caries, followed by restoration with a bonded filling material to achieve adequate seal at the lesion margins. This is a minimally invasive procedure that addresses both microbial and mechanical issues posed by dental caries.

This study sought to measure the fluoride concentration of various commercial bottled waters and to identify clinical implications in dental patient education and treatment. For this study, 105 different samples of bottled water were collected over a 30-day period (from October 15, 2007 to November 15, 2007), divided into six categories, and analyzed for fluoride concentration by utilizing a fluoride ion-specific electrode. Based on the present study, distilled bottled waters have an average fluoride content of less than 0.01 ppm, while drinking/purified bottled waters all (except for one sample) had an average fluoride content of less than 0.03 ppm. Spring/artesian bottled water had an average fluoride content of 0.08 ppm, compared with 0.32 ppm for mineral water bottled waters, 0.16 ppm for flavor-added bottled waters, and 0.63 ppm for fluoride-added bottled water.