Why intravenous moderate sedation should be taught in graduate endodontic programs

The purpose of this opinion article is to present reasons why intravenous moderate sedation should be taught in graduate endodontic programs. Access to oral health care is an area of much interest and concern, but some patients are unable to get endodontic care because they have special needs. Special needs can refer to patients who fear dentistry itself and other aspects of dental treatment. A variety of phobias and medical, developmental, and physical conditions can make it difficult for some patients to tolerate the endodontic care they need and want. Moderate sedation can help many of these patients. Endodontists in general are not trained to provide intravenous moderate sedation. By incorporating intravenous moderate sedation into endodontic practice, many of these patients can be treated. The first step in achieving this goal is to add intravenous moderate sedation training to graduate endodontic programs. The long-term effect will be to make specialty endodontic care available to more people.

Stress and burnout in postgraduate dental education

INTRODUCTION

High levels of stress and burnout have been documented among dental students and practicing dentists, but evidence among dental residents and postgraduate students is lacking.

MATERIALS AND METHODS

Ninety-nine postgraduate students enrolled in clinical, non-clinical and PhD programmes in the Athens University School of Dentistry completed the Graduate Dental Environment Stress (GDES) questionnaire and the Maslach Burnout Inventory. Perceived stress was measured in two domains, academic (GDES-A) and clinical (GDES-C) and burnout was measured using the scales of emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). Analyses relied on descriptive, univariate and multivariate methods based on ANOVA and generalised linear models.

RESULTS

Participants' mean age was 30 years; two-thirds were women and practised dentistry independently of their graduate studies. Residents in clinical programmes reported significantly higher levels of perceived stress compared to non-clinical and PhD students (P<0.05). There were no gender differences in perceived stress. Forty per cent of respondents were burnout 'cases' on the EE scale, while this proportion was 38% for reduced PA and smaller, 13% for DP. Perceived stress was positively correlated with all burnout dimensions, whereas independent dental practice and higher age had a protective effect.

CONCLUSIONS

High rates of burnout manifestations were detected among this sample of Greek postgraduate dental students. Perceived stress correlated with burnout and was more pronounced among those enrolled in clinical residency compared to non-clinical and PhD programmes.

Stress and burnout among Swiss dental residents

Stress and burnout have been well-documented in graduate medical and undergraduate dental education, but studies among dental graduate students and residents are sparse. The purpose of this investigation was to examine perceived stressors and three dimensions of burnout among dental residents enrolled in the University of Bern, Switzerland. Thirty-six residents enrolled in five specialty programmes were administered the Graduate Dental Environment Stress (GDES30) questionnaire and the Maslach Burnout Inventory (MBI). Individual stress items and overall GDES30 scores were used to quantify perceived stress. To measure burnout, proportions of burnout "cases" and MBI subscale scores were computed in the domains of emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). Analyses relied on descriptive and bi-variate methods. The mean GDES30 score was 2.1 (SD = 0.4). "Lack of leisure time", "meeting the research requirement of the programme" and "completing graduation requirements" emerged as the top three stressors. Thirty-six percent of respondents were burnout "cases" on the PA scale, while this proportion was 17% for EE and 8% for DP. Both stress and burnout levels increased according to year of study, whereas younger residents and females had consistently higher stress and burnout scores compared to older ones and males. Overall, low levels of perceived stress and burnout were found among this group of Swiss dental residents.

Massachusetts needs a PGY-1 option for licensure

The American Dental Association (ADA) House of Delegates voted to eliminate live patient clinical exams in the year 2000. Canadian dental graduates take an objective structured clinical examination (OSCE) for licensure. Several states have changed their dental practice acts to permit licensure by mentored experience of a general residency or specialty Dental students have led the fight, with some results, to eliminate a practice--live patient exams--that perpetuates unprofessional and potentially illegal activity.

Use of mineral trioxide aggregate (MTA by postgraduates in restorative dentistry in the UK

All postgraduate trainees in Restorative Dentistry within the United Kingdom were contacted by e-mail and invited toparticipate in a structured on-line questionnaire regarding MTA usage. Responses were received from 46/65 (70.8%) postgraduate trainees. MTA was used by 15/46 (32.6%) trainees in the primary dentition and 46/46 (100%) in the permanent dentition. Barriers to the use of MTA in the permanent dentition related to material cost and in the primary dentition, the lack of an evidence base. Overall, 32/46 (69.6%) had received tuition during their postgraduate programme and 21/46 (45.7%) indicated an interest in further educational opportunities in material use.

Introduction of implants into postdoctoral endodontic residency programs

The purpose of this study was to survey the directors of postdoctoral endodontic programs in the United States to ascertain their attitudes and approaches regarding incorporation of implants into the endodontic curriculum. We hypothesized that program directors would agree that implant training should be incorporated into the endodontic curriculum. We also hypothesized that they would all prefer apical surgeries and retreatment over implants when plausible. A twenty-item online survey was emailed to all fifty-two postdoctoral endodontic program directors in the United States. A 100 percent response was received. The results showed that 78.6 percent agreed that implant training should be incorporated, 85.7 percent preferred the didactic approach, and 42.9 percent preferred clinical implant training. One hundred percent preferred apical surgeries and retreatment over implants when plausible, and 53.8 percent did not prefer implants over endodontic treatment for teeth with a questionable prognosis. This survey indicates that implant training has been incorporated into postdoctoral endodontic programs and that the Commission on Dental Accreditation standards are being met. The trend may be to become more hands-on in the future if program directors believe there is a need to provide training in actual placement of implants.

Implant dentistry in undergraduate dental curricula in South-East Asia: forum workshop at the University of Hong Kong, Prince Philip Dental Hospital, 19-20 November 2010

This paper reports on the discussions arising from a 2-day forum on implant dentistry education in South-East Asia. The 10 institutions present represented undergraduate and postgraduate dental curricula from seven countries, including Hong Kong, Indonesia, Malaysia, Taiwan, Thailand, the Philippines, and Singapore. While not aiming to reach consensus as in other such conferences, the outcome was positive in establishing realistic goals in university education in implant dentistry for curriculum leaders and developers.

Measuring the development of insight by dental health professionals in training using workplace-based assessment

INTRODUCTION

For health professionals, the development of insight into their performance is vital for safe practice, professional development and self-regulation. This study investigates whether the development of dental trainees' insight, when provided with external feedback on performance, can be assessed using a single criterion on a simple global ratings form such as the Longitudinal Evaluation of Performance or Mini Clinical Evaluation Exercise.

METHODS

Postgraduate dental trainees (N = 139) were assessed using this tool on a weekly basis for 6 months. Regression analysis of the data was carried out using SPSS, and a short trainer questionnaire was implemented to investigate feasibility.

RESULTS

Ratings for insight were shown to increase with time in a similar manner to the growth observed in other essential skills. The gradient of the slope for growth of insight was slightly less than that of the other observed skills. Trainers were mostly positive about the new criterion assessing trainees' insight, although the importance of training for trainers in this process was highlighted.

DISCUSSION

Our data suggest that practitioners' insight into their performance can be developed with experience and regular feedback. However, this is most likely a complex skill dependent on a number of intrinsic and external factors.

CONCLUSION

The development of trainees' insight into their performance can be assessed using a single criterion on a simple global ratings form. The process involves no additional burden on evaluators in terms of their time or cost, and promotes best practice in the provision of feedback for trainees.

A survey study of sedation training in advanced pediatric dentistry programs: thoughts of program directors and students

PURPOSE

The purpose of this study was to survey program directors and students of advanced pediatric dentistry training programs in the United States on sedation issues.

METHODS

Surveys were sent to the target audiences. Questions contained response categories ranging from fill-in-the-blank, Likert-order scale style, and categorical. The surveys resided on SurveyMonkey. A cover letter emphasizing such issues as anonymity of responses was sent via e-mail to participants using the American Academy of Pediatric Dentistry listserv. The responses were downloaded and subsequently analyzed using SPSS statistical software.

RESULTS

Data were obtained from 49% of program directors and 17% of students. Experience with different routes of sedative administration varied from "none" (even with the oral route) to "significant." Oral midazolam was the most-often used route and sedative. Restraint was reportedly used by the majority of programs.

CONCLUSIONS

Strategies should be developed to strengthen consistency of competencies in sedation practices across academic training programs.

The importance of student research projects in dental education

In this article, our aim was to summarise students' research over 15 years at Istanbul University Faculty of Dentistry and to evaluate both the research activities from the students' perspectives and the effect of this activity on their undergraduate and postgraduate success. In 1992, dental students formed 'a Student Research Club' (SRC), which new students attend voluntarily and carry out a scientific project out with the normal curriculum every year. In total, 409 different students have presented 193 research projects at these meetings over 15 years. Seventy-four of these students were from other universities and presented 37 projects. In this research, a questionnaire containing 20 items was administered to 93 students who were the members of SRC to learn their own perception of the development of their academic and research skills and the broader impact of the club on their career. It was evaluated using Likert scale (ranged from strongly disagree to strongly agree). Student feedback was very positive and over three quarters (81%) of answers ranged between 'agree' and 'strongly agree'. When the cumulative grade point average (CGPA) of the 88 SRC members in the last 6 years (2003/2004 to 2008/2009) was evaluated as the school success rate, significant difference was found between the grades obtained by members and non-members (P<0.001). There was also significant difference between the CGPA of 25 members of SRC who were randomly chosen, before and after membership to the club (P<0.001). While the 141 members of SRC applied to postgraduate education to Istanbul University Faculty of Dentistry over the last 5 years, 74 of them accepted for PhD (52.6%). There is a statistically significant difference between the member and non-member groups (P<0.001). In addition, of the 58 teaching assistants who stayed in academic life after postgraduate studies at Istanbul University Faculty of Dentistry, 16 of them had been a member of the SRC (31%). However, no statistical difference was found between members of SRC and non-members. These data showed that although the students had an intensive programme in the school, they were able to carry out this voluntary activity successfully and this activity contributed to their educational process. Students also believe that participation of them to this activity effects positively on both personal development and academic success.

An evaluation of cone-beam computed tomography use in postgraduate orthodontic programs in the United States and Canada

The purpose of this study was to evaluate the use of cone-beam computed tomography (CBCT) in postgraduate orthodontic residency programs. An anonymous electronic survey was sent to the program director/chair of each of the sixty-nine United States and Canadian postgraduate orthodontic programs, with thirty-six (52.2 percent) of these programs responding. Overall, 83.3 percent of programs reported having access to a CBCT scanner, while 73.3 percent reported regular usage. The vast majority (81.8 percent) used CBCT mainly for specific diagnostic purposes, while 18.2 percent (n=4) used CBCT as a diagnostic tool for every patient. Orthodontic residents received both didactic and practical (hands-on) training or solely didactic training in 59.1 percent and 31.8 percent of programs, respectively. Operation of the CBCT scanner was the responsibility of radiology technicians (54.4 percent), both radiology technicians and orthodontic residents (31.8 percent), and orthodontic residents alone (13.6 percent). Interpretation of CBCT results was the responsibility of a radiologist in 59.1 percent of programs, while residents were responsible for reading and referring abnormal findings in 31.8 percent of programs. Overall, postgraduate orthodontic program CBCT accessibility, usage, training, and interpretation were consistent in Eastern and Western regions, and most CBCT use was for specific diagnostic purposes of impacted/supernumerary teeth, craniofacial anomalies, and temporomandibular joint (TMJ) disorders.

Three-year clinical outcomes of implant treatments provided at a predoctoral implant program

PURPOSE

The aim of this study was to evaluate the clinical outcomes from a predoctoral implant clinic over 3 years.

MATERIALS AND METHODS

All patients who received implant-retained mandibular overdentures (IODs) or a single-tooth implant (STI) restoration in the Predoctoral Implant Program at the University of Illinois-Chicago College of Dentistry between 2006 and 2009 were included in this study. A two-stage surgical placement and healing protocol was followed by oral surgery, periodontic, and prosthodontic specialty clinics. The following potential prognostic information was collected: patient age and sex; implant diameter, length, and sites; and complications related to the treatment. Life-table and Kaplan-Meier survival analyses were performed for both IOD and STI patient groups.

RESULTS

A total of 371 implants were placed in 243 patients. There were 164 implants placed in 82 patients in the IOD group and 207 implants placed in 161 patients in the STI group. Two implants failed in the IOD group and 2 implants failed in the STI group. The cumulative survival rates for the implants in both the IOD and STI groups were 99%. Kaplan-Meier survival analysis showed no significant differences between the two groups. The most common complication observed in the IOD group was damage to the attachment inserts, and for the STI group, it was repair or remaking of the definitive prosthesis.

CONCLUSION

As demonstrated by the 3-year clinical outcomes, a predoctoral implant program can provide predictable patient-centered therapy with few complications. Patient therapy, guided by thoughtful diagnosis and driven by restorative outcome, can lead to favorable results.

Attitudes of postgraduate orthodontic students in India towards patient-centered care

The aim of our study was to assess the attitudes of postgraduate orthodontic students in India towards patient-centered care. Two hundred and two students from eighteen dental schools across India completed the modified Patient-Practitioner Orientation Scale (PPOS), a self-administered eighteen-item questionnaire that evaluates the practice orientation of the students in terms of doctor versus patient-centeredness. The results revealed that the attitudes of the orthodontic postgraduate students in India were generally more doctor-centered (mean PPOS score of 3.38). As compared to their male counterparts, the female students were more considerate of the role of psychosocial factors in health and the importance of warm doctor-patient relationships (mean caring subscale score of 3.8 vs. 3.54, p<0.05). The third-year students were relatively more patient-centered than their first-year colleagues (mean PPOS score of 3.56 vs. 3.27, p<0.05) and were more willing to share power and information with their patients (mean sharing score of 3.24 vs. 2.92, p<0.01). In general, the students became more patient-centered as they progressed through their postgraduate course. The results of the study clearly imply the need for more active measures in order to develop a more patient-centered orthodontic health care system in India.

A survey on variability in shade selection by practicing dentists

PURPOSE

To evaluate the variability in shade selection for general practitioners (GPs) and postgraduate (MDS) practitioners and to assess if a shade selection bias exists.

MATERIALS AND METHODS

2070 samples of the chosen shade(s) by 31 GPs and 18 MDS practitioners in the form of work authorization forms and slips were collected from dental laboratories. The mouth was divided into four quadrants: maxillary anteriors and posteriors, and mandibular anteriors and posteriors. The data was grouped and analyzed.

RESULTS

The same shade or combination was repeated by the GPs and the MDS practitioners 38% and 35% of the time, respectively. The GP group prescribed a single shade in 84% of cases and a combination of two shades per tooth in 14% of cases, in contrast to the MDS practitioners, who prescribed a single shade in 51% of cases and two shades in 47% of cases.

CONCLUSION

A shade selection bias exists among both general and MDS practitioners, as a particular shade or combination was repeated a significant number of times. However, MDS practitioners use a combination of two shades more frequently than general practitioners, who rely mostly on a single shade for a tooth.

Immediate loading as a vehicle for interdisciplinary training in implant placement and restoration

Recently, implant surgery has been introduced into postdoctoral prosthodontic programs; however, efficient training models to teach this have not been described to date. For training models to be effective and acceptable to all parties, a mutually beneficial situation must be created, and guidelines that can be followed easily need to be described. The purpose of this report is to suggest immediate loading of dental implants as an example for an interdisciplinary training model that integrates both the surgical aspects of implant therapy into the education of prosthodontic graduate students and the prosthodontic aspects of implant therapy into the training of periodontal graduate students. A flow chart of training steps is described for a patient treated with an immediately loaded mandibular fixed full-arch prosthesis on five interforaminal implants. Both the prosthodontic and the periodontal residents were involved in all phases of treatment. These postdoctoral students were in the final year of their program. Therefore, individual treatment steps could be taught interchangeably and accomplished by the student of the other specialty under the supervision of a clinical instructor. The unique characteristic of the immediate loading procedure, which includes surgical implant placement as well as immediate conversion of an existing denture into a fixed implant-supported provisional prosthesis, allows each postgraduate student to experience detailed surgical and prosthodontic treatment in a controlled environment on the day of surgery.

Immediate loading as a vehicle for interdisciplinary training in implant placement and restoration

Recently, implant surgery has been introduced into postdoctoral prosthodontic programs; however, efficient training models to teach this have not been described to date. For training models to be effective and acceptable to all parties, a mutually beneficial situation must be created, and guidelines that can be followed easily need to be described. The purpose of this report is to suggest immediate loading of dental implants as an example for an interdisciplinary training model that integrates both the surgical aspects of implant therapy into the education of prosthodontic graduate students and the prosthodontic aspects of implant therapy into the training of periodontal graduate students. A flow chart of training steps is described for a patient treated with an immediately loaded mandibular fixed full-arch prosthesis on five interforaminal implants. Both the prosthodontic and the periodontal residents were involved in all phases of treatment. These postdoctoral students were in the final year of their program. Therefore, individual treatment steps could be taught interchangeably and accomplished by the student of the other specialty under the supervision of a clinical instructor. The unique characteristic of the immediate loading procedure, which includes surgical implant placement as well as immediate conversion of an existing denture into a fixed implant-supported provisional prosthesis, allows each postgraduate student to experience detailed surgical and prosthodontic treatment in a controlled environment on the day of surgery.

Teaching methods and surgical training in North American graduate periodontics programs: exploring the landscape

This project aimed at documenting the surgical training curricula offered by North American graduate periodontics programs. A survey consisting of questions on teaching methods employed and the content of the surgical training program was mailed to directors of all fifty-eight graduate periodontics programs in Canada and the United States. The chi-square test was used to assess whether the residents' clinical experience was significantly (P<0.05) influenced by having a) a structured preclinical program or b) another dental residency program in the institution. Thirty-four programs (59 percent) responded to the survey. Twenty-six programs (76 percent of respondents) reported offering a structured preclinical component. Traditional teaching methods such as slides, live demonstration, DVD/CD, and animal cadavers were the most common teaching methods used, whereas online courses, computer simulation, and various surgical mannequins were least commonly used. The most commonly performed surgical procedures were conventional flaps, periodontal plastic procedures, hard tissue grafts, and implants. Furthermore, residents in programs offering a structured preclinical component performed significantly more procedures (P=0.012) using lasers than those in programs not offering a structured preclinical program. Devising new and innovative teaching methods is a clear avenue for future development in North American graduate periodontics programs.