Evaluation of computer aided learning in developing clinical decision-making skills.
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AIM: The aim of this study was to determine whether an educational intervention delivered by a computer aided learning package improved the sensitivity and specificity of dentists' restorative treatment decisions. METHOD: The study was a randomised controlled study using a Solomon three-group design. Ninety-five dentists were randomly allocated to the three study groups. One group of dentists read the radiographs pre and post an educational intervention, a second group read the radiographs once, after the intervention, and a third group read the radiographs twice, but received no intervention. On each occasion the dentists read 24 surfaces on each of 15 radiographs and made 360 decisions on how certain they were about restoring the tooth surface. Comparisons of mean sensitivity, specificity and areas under ROC curves were made within and between the study groups. Kappa values were used to assess changes in the level of agreement between dentists. RESULTS: There were no significant changes in sensitivity, specificity or area under ROC curves caused by the intervention. There was no evidence that the level of agreement between the dentists improved after the intervention. CONCLUSION: A computer aided learning package had no effect on dentists' treatment decision-making behaviour. (+info)
Adverse reactions triggered by dental local anesthetics: a clinical survey.
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One hundred and seventy-nine patients completed a questionnaire focusing on adverse reactions to dental local anesthetics as manifested by 16 signs and symptoms. Twenty-six percent of the participants reported having at least 1 adverse reaction. It was found that most of the adverse reactions occurred within the first 2 hours following the injection of local anesthetics. Pallor, palpitations, diaphoresis, and dizziness were the most common adverse reactions reported in the study. The results pointed to a significant relationship between anxiety, gender, injection technique, and procedure with a higher incidence of adverse reactions. (+info)
Dental enamel formation and its impact on clinical dentistry.
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The nature of tooth enamel is of inherent interest to dental professionals. The current-day clinical practice of dentistry involves the prevention of enamel demineralization, the promotion of enamel remineralization, the restoration of cavitated enamel where demineralization has become irreversible, the vital bleaching of dental enamel that has become discolored, and the diagnosis and treatment of developmental enamel malformations, which can be caused by environmental or genetic factors. On a daily basis, dental health providers make diagnostic and treatment decisions that are influenced by their understanding of tooth formation. A systemic condition during tooth development, such as high fever, can produce a pattern of enamel defects in the dentition. Knowing the timing of tooth development permits estimates about the timing of the disturbance. The process of enamel maturation continues following tooth eruption, so that erupted teeth can become less susceptible to decay over time. Mutations in the genes encoding enamel proteins lead to amelogenesis imperfecta, a collection of inherited diseases having enamel malformations as the predominant phenotype. Defects in the amelogenin gene cause X-linked amelogenesis imperfecta, and genes encoding other enamel proteins are candidates for autosomal forms. Here we review our current understanding of dental enamel formation, and relate this information to clinical circumstances where this understanding may be particularly relevant. (+info)
The sealant restoration: indications, success and clinical technique.
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In this paper we have considered the available literature which demonstrates that sealant restorations perform at least as well as amalgam restorations and are more conservative. Success depends on retention of the overlying sealant and if this is fully retained it is unlikely that any residual caries will progress. The diagnosis of occlusal caries and indications for sealant restorations are discussed and the clinical technique is described. We have concluded that sealant restorations are the optimum restoration in small and discrete occlusal cavities. (+info)
Good occlusal practice in simple restorative dentistry.
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Many theories and philosophies of occlusion have been developed. 1-12 The difficulty in scientifically validating the various approaches to providing an occlusion is that an 'occlusion' can only be judged against the reaction it may or may not produce in a tissue system (eg dental, alveolar, periodontal or articulatory). Because of this, the various theories and philosophies are essentially untested and so lack the scientific validity necessary to make them 'rules'. Often authors will present their own firmly held opinions as 'rules'. This does not mean that these approaches are to be ignored; they are, after all, the distillation of the clinical experience of many different operators over many years. But they are empirical. In developing these guidelines the authors have unashamedly drawn on this body of perceived wisdom, but we would also like to involve and challenge the reader by asking basic questions, and by applying a common sense approach to a subject that can be submerged under a sea of dictate and dogma. (+info)
Clinical decision-making for caries management in primary teeth.
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The aim of this review of clinical decision-making for caries management in primary teeth is to integrate current knowledge in the field of cariology into clinically usable concepts and procedures to aid in the diagnosis and therapy of dental caries in primary teeth. The evidence for this paper is derived from other manuscripts of this conference, computer and hand searches of scientific articles; and policy statements of councils or commissions of various health organizations. Current evidence regarding the carious process and caries risk assessment allows the practitioner to transcend traditional surgical management of dental caries in primary teeth. Therapy can focus on patient-specific approaches that include disease monitoring and preventive therapies supplemented by restorative therapies. The type and intensity of these therapies should be determined utilizing data from clinical and radiograph examinations as well as information regarding caries risk status; evidence of therapy outcomes; assessment and reassessment of disease activity; natural history of caries progression in primary teeth; and preferences and expectations of guardians and practitioners. Changes in the management of dental caries will require health organizations and dental schools to educate students, practitioners, and patients in evidence- and risk-based care. (+info)
Clinical decision-making for coronal caries management in the permanent dentition.
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Optimal conservative treatment decisions to prevent, arrest, and reverse tooth demineralization caused by caries require probability estimates on caries risk and treatment outcomes. This review is focused on the use of the best scientific evidence to recommend treatment strategies for management of coronal caries in permanent teeth as a function of caries risk. Evidence suggests that assigning therapeutic regimens to individuals according to their risk levels should yield a significantly greater probability of success and better cost effectiveness than applying identical treatments to all patients independent of risk. Depending on caries risk levels, treatment decisions based on risk can minimize unnecessary surgical intervention by incorporating the best evidence to prescribe treatment regimens for the use of fluoride-releasing agents, sealants, chlorhexidine, or combinations of these products. (+info)
Clinical decision-making for caries management in root surfaces.
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This report presents the results of an evidence-based approach to obtaining the best available information on the natural history, prevalence, incidence, diagnosis, and treatment of root caries. Searches of electronic databases produced 807 references; from these and from citations in the selected articles, a final 161 references were used. We found that the information on the natural history of the disease does not provide practitioners with probabilities of, or time estimates for, progression of the disease through stages. For patients aged thirty and older, the prevalence of root caries is roughly 20 to 22 percent less than a person's age. Severity reaches over one lesion by age fifty, two lesions by age seventy, and just over three lesions for those seventy-five and older. About 8 percent (odds of 1:11) of the population would be expected to acquire one or more new root caries lesions in one year. The accuracy of current systems of diagnosis is unknown, although color has been shown to have little validity. Using the criteria of "softness" to define active lesions has been validated by the presence of microbes in the lesion. One strong study and other studies with weaker design or shorter duration add consistent support for the use of fluorides in the remineralization of root caries. Every three-month application of chlorhexidine varnish was shown to be efficacious in one arm of one study. Evidence for restoration of root caries is tentative since the studies were of limited design and duration. (+info)