Developing an index of restorative dental treatment need.
The process undertaken to establish an initial pilot index for restorative dental treatment is described. Following consultation with a wide range of clinicians and others, an outline framework for the index was developed and comprised three main components: 1. Patient identified need for treatment: the data from the patient perceived need questionnaire were inconclusive; 2. Complexity of treatment (assessed by clinicians): this was found to be a practical tool capable of being used by a range of dentists. A booklet has been produced which describes the process of using the scoring system; 3. Priority for treatment (assessed by clinicians): three levels of priority were identified; the highest priority was assigned to patients with inherited or developmental defects that justify complex care (eg clefts of the lip and palate). The initial development of the index has had some success in a difficult area. The treatment complexity component is the most developed and may allow both referrers and commissioners of specialist restorative dentistry to determine appropriate use of skilled clinicians' expertise. (+info)
Student operator-assistant pairs: an update.
OBJECTIVE: To seek the opinions of undergraduates using the operator-assistant pairs system. DESIGN: A five-year evaluation of third-, fourth- and fifth-year students using a short, anonymous questionnaire OUTCOME MEASURES: This study set out to evaluate, but does not attempt to formally assess, the system. RESULT: Most students enjoyed working in pairs, citing mutual support and collaborative learning as being the main advantages. However, 67% of responding third- year students, 79% of fourth-year students and 54% of fifth-year students indicated that they did not know why paired working had been introduced. CONCLUSIONS: The majority of students found the pairs system advantageous over teacher-led situations. It encouraged greater efficiency, mutual support and help and collaborative learning. (+info)
Preliminary evidence for a general competency hypothesis.
Although predoctoral dental education is generally taught and evaluated by disciplines, there is no evidence bearing on whether the competencies necessary to begin independent practice are learned and practiced as a general set of skills, understanding, and values or as groups of discipline-specific skills, understanding, and values, which together constitute graduation competency. There is some support in the literature for each view In this preliminary investigation, 64,000 faculty ratings of student clinical competency were analyzed in a Year x Quarter x Discipline x Model design. The dependent variable was predictive validity of graduation quarter competency ratings using R-values from four prediction models. Results of a multiple repeated measures ANOVA show that models based on technical skills other than the one being predicted, clinical judgment and patient management, and the combination of these two models all predict graduation competency in each of four disciplines better than do ratings in the disciplines being predicted. As the time gap between predictive and predicted competence decreases, predictions become more accurate, but an asymptote is reached by the middle of the final clinical year. By using general models to evaluate students rather than discipline-specific ones, students needing intervention and remediation and those who could benefit from enrichment experiences can be identified as accurately at the beginning of their clinical careers as they can near the graduation deadline. This study provides preliminary support for a general competency hypothesis and suggests that research is necessary to better understand how students and dentists learn and practice rather than how they are taught. (+info)
Are traditional cognitive tests useful in predicting clinical success?
The purpose of this research was to determine the predictive value of the Dental Admission Test (DAT) for clinical success using Ackerman's theory of ability determinants of skilled performance. The Ackerman theory is a valid, reliable schema in the applied psychology literature used to predict complex skill acquisition. Inconsistent stimulus-response skill acquisition depends primarily on determinants of cognitive ability. Consistent information-processing tasks have been described as "automatic," in which stimuli and responses are mapped in a manner that allows for complete certainty once the relationships have been learned. It is theorized that the skills necessary for success in the clinical component of dental schools involve a significant amount of automatic processing demands and, as such, student performance in the clinics should begin to converge as task practice is realized and tasks become more consistent. Subtest scores of the DAT of four classes were correlated with final grades in nine clinical courses. Results showed that the DAT subtest scores played virtually no role with regard to the final clinical grades. Based on this information, the DAT scores were determined to be of no predictive value in clinical achievement. (+info)
A multimedia patient simulation for teaching and assessing endodontic diagnosis.
Teaching and assessing diagnostic skills are difficult due to relatively small numbers of total clinical experiences and a shortage of clinical faculty. Patient simulations could help teach and assess diagnosis by displaying a well-defined diagnostic task, then providing informative feedback and opportunities for repetition and correction of errors. This report describes the development and initial evaluation of SimEndo I, a multimedia patient simulation program that could be used for teaching or assessing endodontic diagnosis. Students interact with a graphical interface that has four pull-down menus and related submenus. In response to student requests, the program presents patient information. Scoring is based on diagnosis of each case by endodontists. Pilot testing with seventy-four junior dental students identified numerous needed improvements to the user interface program. A multi-school field test of the interface program using three patient cases addressed three research questions: 1) How did the field test students evaluate SimEndo I? Overall mean evaluation was 8.1 on a 0 to 10 scale; 2) How many cases are needed to generate a reproducible diagnostic proficiency score for an individual student using the Rimoldi scoring procedure? Mean diagnostic proficiency scores by case ranged from .27 to .40 on a 0 to 1 scale; five cases would produce a score with a 0.80 reliability coefficient; and 3) Did students accurately diagnose each case? Mean correct diagnosis scores by case ranged from .54 to .78 on a 0 to 1 scale. We conclude that multimedia patient simulations offer a promising alternative for teaching and assessing student diagnostic skills. (+info)
Improving performance on the endodontic section of the Florida Dental Licensure Examination.
In an attempt to improve performance of University of Florida College of Dentistry (UFCD) graduates on the endodontic section of the Florida Dental Licensure Examination, a retrospective analysis was conducted for classes graduating between 1996 and 2003 to assess potential relationships between passing and failing performance and three factors with potential impact on "first attempt" pass rates. The three factors were clinical endodontic experience, performance on the senior mock board examination, and dialogue with representatives of the licensure examination, which resulted in modification of the endodontic section of the licensure exam. Using ANOVA, we found no differences in performance on the endodontic section of the senior mock board exam between graduates who passed the endodontic section of the dental licensure exam and those who failed this section. Furthermore, no differences were found in the mean number of clinical endodontic experiences (number of teeth treated) between graduates who passed the endodontic section of the licensure exam and those who failed. However, in 2003 following dialogue between representatives of the Florida Board of Dentistry and endodontic faculty from the two dental schools in Florida, a significant difference in senior mock board endodontic scores (p>0.05) and a significant difference in performance on the endodontic section of the licensure exam scores (p>0.005) was observed for the 2003 graduates when compared to the 2002 graduates. The mean mock board scores and the mean state board endodontic section scores were higher for the 2003 graduates. In addition, the UFCD failure rate on the endodontic section of the state board exam dropped from 34 percent in 2002 to 6 percent in 2003. The primary factors believed responsible for these improvements were a direct result of dialogue between dental school faculty and state board representatives. They include a greater appreciation by the UFCD faculty for the performance criteria used by the Board of Dentistry to evaluate procedures and a change by the board in the tooth selection criteria for the endodontic experience. The options in tooth-type used in the board exams increased from a two-rooted maxillary premolar to any anterior or premolar tooth. In conclusion, this report supports the positive benefits from ongoing discussions between dental school faculty and representatives of the state licensure board. (+info)
A comparison of retreatment decisions among general dental practitioners and endodontists.
This study compared the difference in decision making regarding retreatment of endodontically treated teeth by general dental practitioners and endodontists. Thirty radiographs of endodontically treated teeth taken from undergraduate records with their respective case descriptions were submitted to fifteen endodontists and fifteen general dental practitioners. Seven treatment alternatives were given as choices; reasons for retreatment, if chosen, were also requested and presented as choices. The results showed statistically different decisions among these two groups regarding retreatment cases. More endodontists opted for retreatment of cases, while higher percentages of general dentists decided to observe, not treat or extract. To prevent misdiagnosis and eventually mistreatment, endodontic decision making should be taught. Currently, there are no specific guidelines for management of failed root canal retreatment. It is suggested that guidelines generated by evidence-based dentistry may produce less variation in clinical decision making. (+info)
Upregulation of intercellular adhesion molecule 1 and proinflammatory cytokines by the major surface proteins of Treponema maltophilum and Treponema lecithinolyticum, the phylogenetic group IV oral spirochetes associated with periodontitis and endodontic infections.
Treponema maltophilum and Treponema lecithinolyticum belong to the group IV oral spirochetes and are associated with endodontic infections, as well as periodontitis. Recently, the genes encoding the major surface proteins (Msps) of these bacteria (MspA and MspTL, respectively) were cloned and sequenced. The amino acid sequences of these proteins showed significant similarity. In this study we analyzed the functional role of these homologous proteins in human monocytic THP-1 cells and primary cultured periodontal ligament (PDL) cells using recombinant proteins. The complete genes encoding MspA and MspTL without the signal sequence were cloned into Escherichia coli by using the expression vector pQE-30. Fusion proteins tagged with N-terminal hexahistidine (recombinant MspA [rMspA] and rMspTL) were obtained, and any possible contamination of the recombinant proteins with E. coli endotoxin was removed by using polymyxin B-agarose. Flow cytometry showed that rMspA and rMspTL upregulated the expression of intercellular adhesion molecule 1 (ICAM-1) in both THP-1 and PDL cells. Expression of proinflammatory cytokines, such as interleukin-6 (IL-6) and IL-8, was also induced significantly in both cell types by the Msps, as determined by reverse transcription-PCR and an enzyme-linked immunosorbent assay, whereas IL-1beta synthesis could be detected only in the THP-1 cells. The upregulation of ICAM-1, IL-6, and IL-8 was completely inhibited by pretreating the cells with an NF-kappaB activation inhibitor, l-1-tosylamido-2-phenylethyl chloromethyl ketone. This suggests involvement of NF-kappaB activation. The increased ICAM-1 and IL-8 expression in the THP-1 cells obtained with rMsps was not inhibited in the presence of the IL-1 receptor antagonist (IL-1ra), a natural inhibitor of IL-1. Our results show that the Msps of the group IV oral spirochetes may play an important role in amplifying the local immune response by continuous inflammatory cell recruitment and retention at an infection site by stimulation of expression of ICAM-1 and proinflammatory cytokines. (+info)