Climate Study of the Learning Environment for Faculty, Staff, and Students at a U.S. Dental School: Foundation for Culture Change.

The aim of this study was to assess the culture and climate for diversity and inclusion and the humanistic learning environment for students, faculty, and staff at the University of Michigan School of Dentistry. From July 2014 to June 2015, two committees of 16 faculty members, staff members, and students, in partnership with trained program evaluators, used a participatory program evaluation (PPE) process to conduct the assessment using key informant interviews, surveys, and focus groups. The topics addressed were humanistic environment, learning environment, diversity and inclusion, microaggressions and bullying, and activities and space. All staff members, all faculty members (both full- and part-time), and all students in all four years were invited to participate in the parallel but distinctive versions of the survey from November 10 to 25, 2014. Response rates for each group were as follows: 50% (318/642) for students, 68% (217/320) for staff, and 40% (147/366) for faculty; numbers responding to individual items varied. Among the respondents, the majority (76% faculty, 67% staff, 80% students) agreed that the environment fostered learning and personal growth and that a humanistic environment was important (97% faculty, 95% staff, 94% students). Many reported having experienced/witnessed a micro-aggression or bullying. Many also reported having "ever had" dissatisfaction with the learning environment (44% faculty, 39% staff, 68% students). The students sought better relationships with the faculty; the staff and faculty members sought opportunities for professional development and mentoring. Recommendations included cultural sensitivity training, courses for interpersonal skills, leadership and team-building efforts, addressing microaggressions and bullying, creating opportunities for collaboration, and increasing diversity of faculty, staff, and students. These recommendations were incorporated into the school's strategic plan. In this study, a utilization-focused PPE process using mixed methods was effective for evaluating the dental school's climate for diversity and inclusion, as well as the learning environment for faculty, staff, and students.

A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life.

PURPOSE: This systematic review aimed to assess the literature for prevalence, severity, and impact on quality of life of salivary gland hypofunction and xerostomia induced by cancer therapies. METHODS: The electronic databases of MEDLINE/PubMed and EMBASE were searched for articles published in English since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies until 2008 inclusive. Two independent reviewers extracted information regarding study design, study population, interventions, outcome measures, results and conclusions for each article. RESULTS: The inclusion criteria were met by 184 articles covering salivary gland hypofunction and xerostomia induced by conventional, 3D conformal radiotherapy or intensity-modulated radiotherapy in head and neck cancer patients, cancer chemotherapy, total body irradiation/hematopoietic stem cell transplantation, radioactive iodine treatment, and immunotherapy. CONCLUSIONS: Salivary gland hypofunction and xerostomia are induced by radiotherapy in the head and neck region depending on the cumulative radiation dose to the gland tissue. Treatment focus should be on optimized/new approaches to further reduce the dose to the parotids, and particularly submandibular and minor salivary glands, as these glands are major contributors to moistening of oral tissues. Other cancer treatments also induce salivary gland hypofunction, although to a lesser severity, and in the case of chemotherapy and immunotherapy, the adverse effect is temporary. Fields of sparse literature included pediatric cancer populations, cancer chemotherapy, radioactive iodine treatment, total body irradiation/hematopoietic stem cell transplantation, and immunotherapy.

A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact.

PURPOSE: This systematic review aimed to assess the literature for management strategies and economic impact of salivary gland hypofunction and xerostomia induced by cancer therapies and to determine the quality of evidence-based management recommendations. METHODS: The electronic databases of MEDLINE/PubMed and EMBASE were searched for articles published in English since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies until 2008 inclusive. For each article, two independent reviewers extracted information regarding study design, study population, interventions, outcome measures, results, and conclusions. RESULTS: Seventy-two interventional studies met the inclusion criteria. In addition, 49 intensity-modulated radiation therapy (IMRT) studies were included as a management strategy aiming for less salivary gland damage. Management guideline recommendations were drawn up for IMRT, amifostine, muscarinic agonist stimulation, oral mucosal lubricants, acupuncture, and submandibular gland transfer. CONCLUSIONS: There is evidence that salivary gland hypofunction and xerostomia induced by cancer therapies can be prevented or symptoms be minimized to some degree, depending on the type of cancer treatment. Management guideline recommendations are provided for IMRT, amifostine, muscarinic agonist stimulation, oral mucosal lubricants, acupuncture, and submandibular gland transfer. Fields of sparse literature identified included effects of gustatory and masticatory stimulation, specific oral mucosal lubricant formulas, submandibular gland transfer, acupuncture, hyperbaric oxygen treatment, management strategies in pediatric cancer populations, and the economic consequences of salivary gland hypofunction and xerostomia.

Altered glycosylation of proteins in cancer: what is the potential for new anti-tumour strategies.

It is becoming increasingly apparent that cell surface oligosaccharides play pivotal roles as recognition molecules in a range of cell communication and adhesion processes. Alterations in cellular glycosylation are also associated with diseases, including cancer, and may have functional significance. This paper gives an overview of the complex topic of cellular glycosylation mechanisms and reviews the well-documented alterations in cellular glycosylation of proteins in malignancy. One particular type of cancer-associated glycosylation change, the incomplete synthesis of O-linked glycans, is highlighted, and its possible functional significance in cancer cell metastatic mechanisms is discussed. The significance that cancer-associated changes in glycoprotein glycosylation may have in new approaches to anti-tumour therapies is explored.

Phenotypic variation in dentinogenesis imperfecta/dentin dysplasia linked to 4q21.

Dentinogenesis imperfecta (DGI) and dentin dysplasia (DD) are allelic disorders that primarily affect the formation of tooth dentin. Both conditions are autosomal-dominant and can be caused by mutations in the dentin sialophosphoprotein gene (DSPP, 4q21.3). We recruited 23 members of a four-generation kindred, including ten persons with dentin defects, and tested the hypothesis that these defects are linked to DSPP. The primary dentition showed amber discoloration, pulp obliteration, and severe attrition. The secondary dentition showed either pulp obliteration with bulbous crowns and gray discoloration or thistle-tube pulp configurations, normal crowns, and mild gray discoloration. Haplotype analyses showed no recombination between three 4q21-q24 markers and the disease locus. Mutational analyses identified no coding or intron junction sequence variations associated with affection status in DMP1, MEPE, or the DSP portion of DSPP. The defects in the permanent dentition were typically mild and consistent with a diagnosis of DD-II, but some dental features associated with DGI-II were also present. We conclude that DD-II and DGI-II are milder and more severe forms, respectively, of the same disease.

Oral medicine: advances in diagnostic procedures.

In the latter part of the 20th century, the computer and molecular biology have facilitated great scientific progress in medicine and dentistry. In dentistry, emerging clinical methods based in molecular biology and digital technology have the potential to improve the early diagnosis of dental caries, periodontal disease, and oral cancer. In addition, saliva shows potential as a convenient substitute for blood in diagnostic testing for systemic and oral diseases. DNA chip technology, a new system that combines these two technologies, has potential diagnostic value in dentistry as well as medicine. For each of the three common oral disease processes, emerging diagnostic procedures are discussed, with an emphasis on their potential utility for the practicing dentist of the 21st century.

Cephalometric analysis of families with dominantly inherited Crouzon syndrome: an aid to diagnosis in family studies.

Crouzon syndrome (CS) is an autosomal dominant condition comprising orbital proptosis, midfacial hypoplasia, premature sutural synostosis, and altered proportions of bone lengths in the hands. In families the CS trait is highly variable. Several cases of affected sibs born to unaffected parents have been explained by germinal mosaicism. We hypothesized that cephalometric and metacarpophalangeal analysis may help to classify affected and unaffected subjects within families when clinical diagnosis is difficult. Posterior-anterior and lateral cephalometric radiographs and hand films were taken of 10 CS patients and 18 unaffected relatives. Sixty-two craniofacial and 19 hand linear and angular measurements were made on each subject and standardized by conversion to z-scores using published normal standards. Ten craniofacial variables were selected for use in a stepwise forward discriminant function analysis to develop an equation which could be used to discriminate CS patients from normal subjects. A two-group discriminant function using four craniofacial variables and one hand variable correctly classified the CS patients and relatives 100% of the time. The results suggest that relatively few facial variables are needed to differentiate most cases of CS but the addition of one or more hand variables may increase the sensitivity. DNA testing is necessary to adequately demonstrate incomplete penetrance in CS, but pretesting subjects for molecular studies using these methods may improve results.

Comparison of dental water quality management procedures.

The effectiveness of ADA-recommended approaches for reducing dental unit waterline, or DUWL, contamination was investigated using newly installed dental units. Over a 2-month period, the authors studied independent water reservoirs, a sodium hypochlorite disinfection regimen, daily draining and purging of DUWLs and point-of-use filters by assessing microbial contamination and biofilm development using scanning electron microscopy. The findings demonstrate that DUWL contamination can be controlled when dental personnel use available technologies and adhere to recommended maintenance protocols.

Metacarpophalangeal analysis in Crouzon syndrome: additional evidence for phenotypic convergence with the acrocephalosyndactyly syndromes.

Crouzon syndrome (CS) is characterized by premature craniosynostosis, orbital proptosis, and midfacial hypoplasia and is related to the acrocephalosyndactylies (ACS) with limb abnormalities. In CS the hands are considered to be normal, but a previous report indicated that there is consistent alteration in the proportions of the bones of the hands, as shown by metacarpophalangeal analysis (MCPP), in at least some cases of CS. The purpose of this study was to extend these findings by examining affected individuals and their supposedly unaffected first degree relatives. If CS does have an effect on hands, then this should only be evident in the affected individuals and, presuming complete penetrance, not present in their unaffected relatives. PA hand films were taken on 12 CS subjects and 16 of their normal relatives. The lengths of the metacarpals and phalanges were measured and the measurements standardized for age and sex by conversion to z-scores using published normal standards. Mean pattern profiles for the 2 groups were plotted. In CS the phalanges, especially the first and second proximal phalanges and the first distal phalanx, were shorter than average, and shorter than those of unaffected relatives. The metacarpals were not significantly smaller than the reference means in CS. The 19 hand measurements were entered into a stepwise forward discriminant function analysis (DFA) to develop a model that would discriminate between CS subjects and their normal first degree relatives. The function generated used the measurements of 8 hand bones to classify correctly CS subjects and their normal relatives 100% of the time. This study confirmed that there is a radiographically detectable abnormality of the hands in CS and that, at least in this sample, relatives did not display such abnormalities. Therefore, it seems that CS shares postcranial effects with true ACS and that these effects are, like the other aspects of CS, fully penetrant.

Clinical and radiographic features of the lacrimo-auriculo-dento-digital syndrome.

Lacrimo-auriculo-dento-digital syndrome is an autosomal dominant malformation complex that affects craniofacial structures including the teeth and salivary glands. There have been several cases of this syndrome reported to date. A family with three affected members is presented. In addition to several of the clinical manifestations of lacrimo-auriculo-dento-digital syndrome, these subjects also show previously unreported radiographic features of the syndrome as demonstrated by panoramic radiographic examination and corrected axis linear tomography of the temporomandibular joints.

Oral mucosal injury caused by denture cleanser tablets: a case report.

A case of chemical injury to the oral mucosa that resulted in obstructive sialadenitis of the submandibular glands is presented. The injury occurred when a patient chewed, swished, and expectorated an immersion-type denture-cleansing tablet attempting to clean a fixed bridge. The literature is reviewed for similar oral mucosal injury caused by improper use of denture-cleansing products. Suggestions for the prevention of such injuries are made.

Hypodontia and nail dysplasia syndrome. Report of a case.

The ectodermal dysplasias are a clinically and genetically heterogeneous group of more than 120 syndromes involving ectodermally derived structures. The syndrome that is autosomal dominantly inherited and characterized by hypodontia, dysplastic nails, and normal hair is known as hypodontia-nail dysplasia syndrome, or tooth-and-nail syndrome. Because of the minimal manifestations, this syndrome may be difficult to diagnose. Patients with hypodontia should be examined for dysplastic nails of the hands and feet and referred to medical and dental genetic specialists for verification of the diagnosis and counseling. We report a case of tooth-and-nail syndrome in a young woman.

Presurgical tomographic assessment for dental implants. 1. A modified imaging technique.

A modified technique for presurgical evaluation of intraosseous implant placement using linear tomography has been developed. The simplified technique is applicable to tomographic systems equipped with a cephalometric head positioner (cephalostat) and a fiberoptic positioning light system. It provides precise cross-sectional images for the assessment of bone morphology and associated anatomic structures. This technique is more comfortable for patients who are unable to tolerate the positioning of submentovertex projections used to estimate horizontal angulation of the head position and to determine the depth of radiographic cut. Instead, the positioning light and casts are used to make these two determinations.