Clinical effects of interdental cleansing on supragingival biofilm formation and development of experimental gingivitis.

PURPOSE: The aim of the present study was to test the effects of interdental cleansing with dental floss on supragingival biofilm removal in natural dentition during a 3-week period of experimental biofilm accumulation. MATERIALS AND METHODS: The present study was performed as a single-blind, parallel, randomised, controlled clinical trial using the experimental gingivitis model (Löe et al, 1965). Thirty-two students were recruited and assigned to one of the following experimental or control groups: Group A used a fluoride-containing dentifrice (NaF dentifrice) on a toothbrush for 60 s twice a day, Group B used an unwaxed dental floss twice a day, Group C used a waxed dental floss twice a day in every interproximal space and Group D rinsed twice a day for 60 s with drinking water (control). RESULTS: During 21 days of abolished oral hygiene, the groups developed various amounts of plaque and gingivitis. Neither of the cleansing protocols alone allowed the prevention of gingivitis development. Toothbrushing alone yielded better outcomes than did any of the flossing protocols. Interdental cleansing with a waxed floss had better biofilm removal effects than with unwaxed floss. CONCLUSIONS: Toothbrushing without interdental cleansing using dental floss and interdental cleansing alone cannot prevent the development of gingivitis.

Periodontal conditions in Swiss army recruits: a comparative study between the years 1985, 1996 and 2006.

AIM: To compare the periodontal conditions of Swiss Army recruits in 2006 with those of previous surveys in 1996 and 1985. MATERIAL AND METHODS: A total of six hundred and twenty-six Swiss Army recruits were examined for their periodontal conditions, caries prevalence, stomatological and functional aspects of the masticatory system and halitosis. In particular, this report deals with demographic data, the assessment of plaque index (PlI), gingival index (GI) and pocket probing depth (PPD). RESULTS: Two per cent of all teeth were missing, resulting in a mean of 27.44 teeth per subject, and 77% of the missing teeth were the result of pre-molar extractions due to orthodontic indications. The mean PlI and GI were 1.33 and 1.23, respectively. On average, 27% of the gingival units bled on probing. The mean PPD was 2.16 mm (SD 0.64). Only 3.8% of the recruits showed at least one site of PPD > or = 5 mm, and 1.4% yielded more than one site with PPD > or = 5 mm. In comparison with previous, this survey yielded lower bleeding on probing (BOP) percentages than in 1985, but slightly higher scores than in 1996. This may be attributed to increased PlI scores in 2006. However, PPD remained essentially unaltered from 1996 to 2006 after having improved significantly from 1985. CONCLUSION: A significant improvement of the periodontal conditions of young Swiss males was demonstrated to have taken place between 1985 and 1996, but no further changes during the last decade were noticed.

Assessing behavioural change support abilities of the oral healthcare team.

Competent behavioural change intervention can be learned, practised and developed. Therefore, the teaching and assessment of this ability should be within the scope of both the undergraduate and post-graduate curriculum. Assessment should target knowledge base and skills in the areas of counselling, communication and behaviour. Assessment of the knowledge base should ideally be conducted in a comprehensive, multidisciplinary, centrally based manner in the pre-clinical curriculum. Assessment of skills in the areas of communication, counselling and behaviour change is a wider aim that should be integral throughout the curriculum. In continuing education (CE) environments, an initial 'screening' assessment would help educators to adjust the course to the participants' background and needs. Furthermore, three major assessment schemes are proposed: (1) assessment of knowledge and skills, (2) evaluation of the whole course by the participants, and (3) assessment of the implementation process, four to six months after completion.

The effects of an interactive software application on the self-assessment ability of dental students.

A randomised controlled trial was designed to test an Internet-based interactive application as a stand-alone support for the development of self-assessment skills among second-year dental students at the Faculty of Dentistry, University of Malmö, Sweden. Fifty-two students were randomised into an experimental (n = 26) and a control group (n = 26). Both groups went through four identical learning cases in elementary clinical Periodontology during a period of 1 month. The experimental group received the cases with the interactive software, while the control group received them through a static web page. After the end of the learning phase, both groups were assessed blindly by two assessors during the interactive examination methodology. There was a moderate agreement between the two assessors, but both failed to find any significant differences between the two groups with regard to self-assessment skills and overall performance of the students. Students positively received the Internet support, but several attitude differences were observed between the two groups during the study. Time on task and competence with computers were positively correlated to assessment results for both groups. On the basis of these findings, it remains unclear if computer-based applications with automated feedback can constitute an effective remedial support for the improvement of self-assessment skills of students. In addition, for such applications to be successfully accepted, two factors are critical: students must have a clear perception of the benefits deriving from the use of the software and the use of the software should be integrated in the curriculum, replacing some of the existing workload.

The interactive examination: assessing students' self-assessment ability.

BACKGROUND: The ability to self-assess one's competence is a crucial skill for all health professionals. The interactive examination is an assessment model aiming to evaluate not only students' clinical skills and competence, but also their ability to self-assess their proficiency. METHODS: The methodology utilised students' own self-assessment, an answer to a written essay question and a group discussion. Students' self-assessment was matched to the judgement of their instructors. As a final task, students compared their own essay to one written by an "expert". The differences pointed by students in their comparison documents and the accompanying arguments were analysed and categorised. Students received individual feedback on their performance and learning needs. The model was tested on 1 cohort of undergraduate dental students (year 2001, n = 52) in their third semester of studies, replacing an older form of examination in the discipline of clinical periodontology. RESULTS: Students' acceptance of the methodology was very positive. Students tended to overestimate their competence in relation to the judgement of their instructors in diagnostic skills, but not in skills relevant to treatment. No gender differences were observed, although females performed better than males in the examination. Three categories of differences were observed in the students' comparison documents. The accompanying arguments may reveal students' understanding and methods of prioritising. CONCLUSIONS: Students tended to overestimate their competence in diagnostic rather than treatment skills. The interactive examination appeared to be a convenient tool for providing deeper insight into students' ability to prioritise, self-assess and steer their own learning.

Feasibility of and satisfaction with the use of low-bandwidth videoconferencing for examination of undergraduate students.

We investigated the feasibility and students' acceptance of Internet-based videoconferencing as a communications method during examinations. Thirty-nine second-year dental students took an interactive examination in periodontology, comprising self-assessment, essay writing, discussion and feedback. The students were randomly divided into two groups, which were examined through the standard classroom procedure (n =15) or through Internet-based videoconferencing (n =24). Students evaluated the experience using a standardized questionnaire. The technology proved to be reliable. The interactive examination technique was well accepted, although there was significantly less satisfaction in the videoconference group (P <0.01). There were no significant differences in the performance of students between the two modalities. Interaction was stressed as one of the major strengths of the examination by students in the conventional group, but it appeared to be less appreciated by the videoconference group. Internet-based videoconferencing can successfully facilitate a highly structured assessment, although students seem to prefer classroom assessment.

Perceived risk of deteriorating periodontal conditions.

BACKGROUND: Interpretation of risk for periodontitis is critical for treatment planning. How periodontists assess risk for periodontitis is unclear. PURPOSE: To study (1) what factors periodontists use when assessing the risks for worsening periodontal conditions anticipating that no treatment would be provided, and (2) if risk assessment is consistent and independent of specialty background training. MATERIAL AND METHODS: Medical history, clinical dental data, full-mouth intra-oral radiographs, and slide pictures were obtained from each of 51 subjects, and the information was provided to 23 examiners. RESULTS: The mean age of the study subjects was 51.5 years (SD +/- 17.7, range 23-81), with 28 women included. In 10 of the subjects, only gingivitis was identified, while 22 subjects had advanced chronic periodontitis. Risk scores assigned for 2 and 4 years differed significantly between European- and US-trained periodontists (p < 0.001) and between graduate students in training and periodontists from either the US or Europe (p < 0.01) (Wilcoxon n-pair test), with European periodontists scoring the lowest risks. Risk scores were correlated between groups (p < 0.01 with rho range 0.82-0.89) (Spearman's rank correlation). The best-fit model (r2 = 0.86) to assess perceived risk for worsening periodontal conditions based on data from all examiners combined included the following variables: (1) overall horizontal alveolar bone loss (p < 0.000), (2) age-adjusted proportional radiographic bone height score for the worst site (p < 0.000), and (3) proportion of pocket probing depths > or = 6.0 mm. CONCLUSIONS: Differences exist on the scale of risk values based on specialty training. Consistency in scoring patterns exists. The examiners based their assigned risk scores almost exclusively on measures of existing disease severity, including radiographic bone loss and numbers of periodontal pockets > or = 6.0 mm, and excluding most known risk factors such as smoking, diabetes, and poor oral hygiene.

4.1 Web-based interactive learning programmes.

In the future, the training of competent dentists will need to take advantage of up-to-date digital technologies and learning practices. In order to accomplish this, the following goals should be considered: i) the design of 'customizable' web-based curriculum matrices that accommodate the training philosophies and resources of individual dental schools; ii) the development of digital instructional modules that can be incorporated or downloaded into specific parts of a curriculum; iii) the establishment of an e-consortium, which provides peer view and guidance in the design of teaching modules, and which is responsible for the storage, maintenance, and distribution of teaching modules within the consortium; iv) the development of central human and physical resources at each dental school to enable the seamless delivery of instructional modules in a variety of learning environments; and v) the assessment and provision of ICT training to students and faculty with respect to the use of computers and related digital technologies and educational software programmes. These goals should lead to the creation of a 'virtual dental school'. Within this project summative and formative evaluations should be performed during both the production and development of teaching material (e-learning material) and the learning process. During the learning process the following aspects should be measured and evaluated: i) students' behaviour; and ii) effectiveness, retention and the transfer of e-learned material into the clinical situation. To obtain evidence of the efficacy of e-learning material a certain amount of research has to be done in the near future. It is suggested that all parameters currently known have to be implemented during the development of a learning programme. Previous workers have evaluated the following elements with e-learning: i) planning, ii) programming and technical development, iii) learning behaviours, iv) learning outcomes of both the programme and the student, v) the acquisition of knowledge, skills and attitude and vi) the transfer of e-learned skills into clinical situations.

The effect of 1 percent chlorhexidine gel delivered with toothpicks on proximal dental plaque: a pilot study

The aim of this study was to determine the effect of 1//chlorhexidine gel delivered with toothpicks on interproximal dental plaque. Seven follow-up patients participated in two treatment periods of 1 week each, separated by a normal oral hygiene period of one week. The study had double-blind design. The plaque index by Silness and Löe (Acta Odontol Scand 22:121-135, 1964) was scored on mesial, distal, buccal and lingual surfaces of each tooth after plaque disclosure, with an aqueous solution of erythrosine and the measurements were performed by the same examiner, at the initial visit and at the end of every experimental week. The ability to use toothpicks was checked and upgraded to the individual need. The participants were instructed to carry out their normal oral hygiene procedures, with placebo gel or 1//chlorhexidine gel delivered interproximally with toothpicks once daily. No significant differences in the measurement of plaque were noted between placebo gel and 1//chlorhexidine gel at interproximal areas. After treatment with 1//chlorhexidine gel, the mean distribution of plaque score 0 was increased significantly (P<0.05), from 30.7 sites (52//) to 42 sites (71.1//) when all sites are taken into account and compared to the placebo period. 1//chlorhexidine gel delivered by toothpick on interproximal areas had a limited effect on reduction of dental plaque

Effect of the pre-brushing rinse, Plax, on dental plaque formation / Efeito do rinse pré-escovação, Plax, na formação de placa dentária

The aim of this double-blind cross-over study was to investigate plaque accumulation after the use of the pre-brushing rinse Plax, compared to placebo. 10 volunteers underwent 2 treatment periods of 1 week, separated by a wash-out period of 1 week. At the stars of each study period, professional tooth-cleaning was perfomed. On days 2, 4, and 7 of each treatment period, periodic identical photographs after plaque disclosure were taken for planimetric analyses of plaque extension on canines, premolars. During each treatment period, the subjects were supervised when rinsing twice daily for 30 seconds with 15 ml of placebo or Plax, followed by brushing. The subjects performed a standardized poor brushing technique without toothpaste. No significant differences were noted between placebo and Plax for plaque extension on days, 2, 4 and 7. The results show that buccal plaque growth is equal after 2x daily rinsing with Plax and placebo in subjects performing a poor oral hygiene