Prevalence and Factors Associated with the Use of Denture Adhesives by Older Complete Denture Wearers.

This study investigated the prevalence and the factors affecting the use of denture adhesives (DA) by older complete denture wearers. One hundred patients were interviewed and clinically examined for dentures' retention, stability and occlusion. A total of 31% used DA on a regular basis or sometimes; 14% used DA on both dentures, 19% on the maxillary denture and 26% on the mandibular one. DA use on the maxillary denture was significantly associated with younger age (p=0.026) and lower frequency of dentures' use (p⟨0.005), while their use on the mandibular denture was associated with the lower frequency of dentures' use (p⟨0.05) and good retention and stability of the maxillary denture (p=0.007). Multiple logistic regression analyses revealed that the DA use on maxillary dentures was significantly associated with younger age (odds ratio=0.938, p=0.026), while their use on the mandibular one was associated with good retention and stability of maxillary denture (odds ratio=1.451, p=0.007). These findings suggested that patient-driven factors, such as patients' age and denture's use habits had more significant effect on DA use than the denture's technical characteristics. Those factors should be further investigated to guide dentists in personalised recommendations on DA use to improve denture patients' quality of life.

Dental participation in geriatric interprofessional education courses: A systematic review.

INTRODUCTION: Although the interdisciplinary management of the ageing individual is highly stressed, there is limited information on the outcomes of interprofessional education (IPE) activities of dental students in geriatrics. This systematic review aimed to identify studies with dentists participating in formal IPE courses in geriatrics and assess the outcomes reported. MATERIAL AND METHODS: Electronic databases (PubMed, EMBASE, CINAHL and Scopus), reference lists from relevant studies and cited papers were investigated. The inclusion criteria were as follows: about formal interactive learning; learners from at least 2 disciplines; including dentists; related to geriatrics; any study design; reporting any outcome; only full papers; published in peer-reviewed journals; English language. RESULTS: Of the 1259 records retrieved, 26 were assessed for eligibility based on defined inclusion criteria and 7 studies were included in the final analysis. Two studies reported specific outcomes for dentists with lower, or even negative, post-training scores for interprofessional collaborative practice competences compared to other disciplines, but only one of them used a previously validated scale. There were no reports on the effect of IPE courses on dental trainees' gerodontology skill improvements or on their attitudes towards the older persons. CONCLUSION: The existing evidence is insufficient to determine any outcomes of formal interprofessional training of dentists in geriatrics. More studies with better experimental design should be developed. Among the strengths of IPE in geriatrics are the interdisciplinary nature of geriatric care, the sharing of common geriatric competences among participating disciplines and the opportunity to use nursing homes as a training site.

The development and validation of a questionnaire to measure the clinical learning environment for undergraduate dental students (DECLEI).

AIM: The aim of this study was to develop and validate according to psychometric standards a self-administered instrument to measure the students' self-perceptions of the undergraduate clinical dental environment (DECLEI). MATERIALS AND METHODS: The initial questionnaire was developed using feedback from dental students, experts' opinion and an extensive literature review. Critical incident technique (CIT) analysis was used to generate items and identify domains. Thirty clinical dental students participated in a pilot validation that generated a 67-item questionnaire. To develop a shorter and more practical version of the instrument, DECLEI-67 was distributed to 153 clinical students at the University of Athens and its English version to 51 students from various dental schools, attending the 2012 European Dental Students Association meeting. This final procedure aimed to select items, identify subscales and measure internal consistency and discriminant validity. RESULTS: A total of 202 students returned the questionnaires (response rate 99%). The final instrument included 24 items divided into three subscales: (i) organisation and learning opportunities, (ii) professionalism and communication and (iii) satisfaction and commitment to the dental studies. Cronbach's α for the total questionnaire was 0.89. The interscale correlations ranged from 0.39 to 0.48. The instrument identified differences related to school of origin, age and duration of clinical experience. An interpretation of the scores (range 0­100) has been proposed. CONCLUSIONS: The 24-item DECLEI seemed to be a practical and valid instrument to measure a dental school's undergraduate clinical learning environment.

Continuing professional development systems and requirements for graduate dentists in the EU: survey results from the DentCPD project.

INTRODUCTION: By maintaining skills and keeping dentists up-to-date, continuing professional development (CPD) supports safe clinical practice. However, CPD for dentists across Europe is not harmonised. AIM: One aim of the 'DentCPD' project (www.dentcpd.org) was to identify and agree essential CPD requirements for EU dentists. As part of the process, data were collected on existing approaches to CPD for EU dentists. This paper reports those findings. METHODS: Informed by a review of the literature and internet search, the CPD for Graduate Dentists questionnaire gathered data from dental educators on CPD systems, requirements, provision and accreditation in Europe. It sought opinion on mandatory CPD and e-learning. RESULTS: Responses were received from 143 individuals from 30 EU countries. About half the countries had a compulsory CPD system which typically included mandatory core topics. Elsewhere CPD was optional or based on recommended hours. University dental schools and professional dental associations were the most common CPD providers. National regulatory bodies were the most common accrediting body. Only 41% of respondents thought they knew the criteria for successful accreditation of CPD. Eighty-one percent agreed that 'CPD should be obligatory for all dentists'. CONCLUSION: These results present an overview of the status of CPD for EU dentists. Despite a notable trend towards regulated CPD systems, current requirements for dentists to engage in CPD show variation. The harmonisation of requirements would enhance both dentist mobility and safe clinical practice.

Guidelines for the organisation of continuing professional development activities for the European dentist.

AIM: Free movement of dental professionals across the European Union calls for more uniform continuing education in dentistry to ensure up-to-date, high-quality patient care and patient safety. This article provides guidelines for the management and delivery of high-quality continuing professional development (CPD) by European dental schools and other CPD providers. METHOD: The guidelines are based on an extensive literature inventory, a survey of existing practices (both available as separate publications), discussions during meetings of the Association for Dental Education in Europe in 2011 and 2012 and debate amongst the members of the DentCPD project team representing six dental schools. RESULTS: On the basis of the literature review, survey and discussions, we recommend that (i) every dentist should be given the opportunity for CPD, (ii) providers should be quality-approved and impartial, (iii) educators should be approved, impartial, suitably trained, and with educational expertise, (iv) the mode of CPD delivery should suit the educational activity, with clear learning objectives or outcomes, (v) effort should be made to assess the learning, (vi) participant feedback should be collected and analysed to inform future developments and (vii) uniform use of the pan-European system of learning credit points (ECTS) should be implemented. CONCLUSION: Implementation of these guidelines should make dental CPD more transparent to all relevant parties and facilitate the transferability of earned credits across the European Union. It will also enable better quality control within dentistry, resulting in enhanced dental care and ultimately the improvement in patient safety.

Core continuing professional development (CPD) topics for the European dentist.

INTRODUCTION: In the context of free movement, EU-citizens need assurance that dental practitioners providing their care have a degree/license to practice that meets EU-standards and that they maintain their knowledge and skills through ongoing education. AIM: One aim of the 'DentCPD' project (HYPERLINK 'http://www.dentcpd.org' www.dentcpd.org) was to identify and agree essential CPD requirements for EU dentists. This paper reports the consensus process and outcomes. METHODS: Agreement on core components of CPD was achieved through a three stage process: an online survey of dental educators' (n = 143) views on compulsory topics; a paper-based questionnaire to practitioners (n = 411); leading to a proposal discussed at the Association for Dental Education (ADEE) 2011 Lifelong Learning special interest group (SIG). RESULTS: From the online survey and practitioner questionnaire, high levels of agreement were achieved for medical emergencies (89%), infection control (79%) and the medically compromised patient (71%). The SIG (34 attendees from 16 countries) concluded that these three CPD topics plus radiation protection should be core-compulsory and three CPD topics should be core-recommended (health and safety, pain management, and safeguarding children & vulnerable adults). They also agreed that the teaching of all topics should be underpinned by evidence-based dentistry. CONCLUSION: Building four core topics into CPD requirements and making quality-approved education and training available will ensure that all dentists have up-to-date knowledge and skills in topic areas of direct relevance to patient safety. In turn, this will contribute to patients having access to comparably high standards of oral health care across Europe.

The development of an exemplar e-module for the continuing professional development of European dentists.

AIM: To present the development of an exemplar e-module for dental continuing professional development (CPD) provided by dental schools and other dental educational providers. MATERIALS AND METHODS: The exemplar e-module covered the topic of 'Sterilisation and cross-infection control in the dental practice' as this is one of the most recommended topics for dental CPD in Europe. It was developed by a group of topic experts, adult learning and distance learning experts and a technical developer. Major concerns were pedagogy, interoperability, usability and cost reduction. Open-source material was used to reduce the cost of development. RESULTS: The e-module was pre-piloted in dental practitioners for usability and then evaluated by experts in the field and dental academics through an electronic questionnaire and an online presentation and discussion at the ADEE 2012 Special Interest Group on DentCPD-Lifelong learning. This facilitated refinement before final production. A Creative Commons License was implemented to ensure the developers' rights and facilitate wider distribution and access to CPD providers. DISCUSSION AND CONCLUSIONS: The e-module was developed according to well-defined pedagogical and technical guidelines for developing e-learning material for adult learners. It was structured to promote self-study by directing learners through their study, promoting interaction with the material, offering explanation and providing feedback. Content validity was ensured by extensive review by experts. The next step would be to expand the evaluation to practising dentists in various countries after relevant translations, and adaptations to local policies have been made.

Recommendations for the development of e-modules for the continuing professional development of European dentists.

AIMS: To provide evidence-based and peer-reviewed recommendations for the development of dental continuing professional development (CPD) learning e-modules. METHODS: The present recommendations are consensus recommendations of the DentCPD project team and were informed by a literature research, consultations from e-learning and IT expert, discussions amongst the participants attending a special interest group during the 2012 ADEE meeting, and feedback from the evaluation procedures of the exemplar e-module (as described in a companion paper within this Supplement). The main focus of these recommendations is on the courses and modules organised and offered by dental schools. RESULTS AND DISCUSSION: E-modules for dental CPD, as well as for other health professionals' continuing education, have been implemented and evaluated for a number of years. Research shows that the development of e-modules is a team process, undertaken by academics, subject experts, pedagogists, IT and web designers, learning technologists and librarians. The e-module must have clear learning objectives (outcomes), addressing the learners' individual needs, and must be visually attractive, relevant, interactive, promoting critical thinking and providing feedback. The text, graphics and animations must support the objectives and enable the learning process by creating an attractive, easy to navigate and interactive electronic environment. Technology is usually a concern for learners and tutors; therefore, it must be kept simple and interoperable within different systems and software. The pedagogical and technological proficiency of educators is of paramount importance, yet remains a challenge in many instances. CONCLUSIONS: The development of e-courses and modules for dental CPD is an endeavour undertaken by a group of professionals. It must be underpinned by sound pedagogical and e-learning principles and must incorporate elements for effective visual learning and visual design and a simple, consistent technology.

Core continuing professional development (CPD) topics for the European dentist.

INTRODUCTION: In the context of free movement, EU-citizens need assurance that dental practitioners providing their care have a degree/license to practice that meets EU-standards and that they maintain their knowledge and skills through ongoing education. AIM: One aim of the 'DentCPD' project (HYPERLINK 'http://www.dentcpd.org' www.dentcpd.org) was to identify and agree essential CPD requirements for EU dentists. This paper reports the consensus process and outcomes. METHODS: Agreement on core components of CPD was achieved through a three stage process: an online survey of dental educators' (n = 143) views on compulsory topics; a paper-based questionnaire to practitioners (n = 411); leading to a proposal discussed at the Association for Dental Education (ADEE) 2011 Lifelong Learning special interest group (SIG). RESULTS: From the online survey and practitioner questionnaire, high levels of agreement were achieved for medical emergencies (89%), infection control (79%) and the medically compromised patient (71%). The SIG (34 attendees from 16 countries) concluded that these three CPD topics plus radiation protection should be core-compulsory and three CPD topics should be core-recommended (health and safety, pain management, and safeguarding children & vulnerable adults). They also agreed that the teaching of all topics should be underpinned by evidence-based dentistry. CONCLUSION: Building four core topics into CPD requirements and making quality-approved education and training available will ensure that all dentists have up-to-date knowledge and skills in topic areas of direct relevance to patient safety. In turn, this will contribute to patients having access to comparably high standards of oral health care across Europe.

Continuing professional development systems and requirements for graduate dentists in the EU: survey results from the DentCPD project.

INTRODUCTION: By maintaining skills and keeping dentists up-to-date, continuing professional development (CPD) supports safe clinical practice. However, CPD for dentists across Europe is not harmonised. AIM: One aim of the 'DentCPD' project (www.dentcpd.org) was to identify and agree essential CPD requirements for EU dentists. As part of the process, data were collected on existing approaches to CPD for EU dentists. This paper reports those findings. METHODS: Informed by a review of the literature and internet search, the CPD for Graduate Dentists questionnaire gathered data from dental educators on CPD systems, requirements, provision and accreditation in Europe. It sought opinion on mandatory CPD and e-learning. RESULTS: Responses were received from 143 individuals from 30 EU countries. About half the countries had a compulsory CPD system which typically included mandatory core topics. Elsewhere CPD was optional or based on recommended hours. University dental schools and professional dental associations were the most common CPD providers. National regulatory bodies were the most common accrediting body. Only 41% of respondents thought they knew the criteria for successful accreditation of CPD. Eighty-one percent agreed that 'CPD should be obligatory for all dentists'. CONCLUSION: These results present an overview of the status of CPD for EU dentists. Despite a notable trend towards regulated CPD systems, current requirements for dentists to engage in CPD show variation. The harmonisation of requirements would enhance both dentist mobility and safe clinical practice.

Students' perceptions of the educational environment in a Greek Dental School, as measured by DREEM.

AIM: The aim of this study was to estimate the dental students' perceptions of their educational environment and to identify any differences related both to their gender and semester of studies. MATERIALS AND METHODS: The translated and validated in Greek Dundee Ready Education Environment Measure (DREEM) questionnaire was distributed to all 2nd- to 5th-year students of the Athens Dental School. The questionnaire consisted of 50 statements organised in five subscales (perceptions of learning, teachers, atmosphere, academic self-perceptions and social self-perceptions). Internal validity was checked with Cronbach alpha. Confirmatory factor analysis (CFA) was performed under the same conditions as the original inventory. Mean statement, subscale and overall scores were calculated and given as percentages. RESULTS: The response rate was 64%. Overall Cronbach alpha was 0.93 (excellent). CFA produced five meaningful subscales, not matching the original ones. The overall DREEM mean score was 56%. Gender did not influence the findings. The students' perceptions of the educational environment with the exception of the academic self-perceptions were more positive in the pre-clinical years. Statistically significant differences were revealed only for the 'learning' subscale between the 3rd- and the 4th-year students. Seventy-eight percent of the statements were in the positive side. The lowest scores were related to students' stress, tiredness and lack of appropriate feedback from the teachers, and the highest were related to accommodation, school friends and perceptions that they feel socially comfortable in class. CONCLUSIONS: Students' perceptions of the educational environment were reasonably positive, with no gender difference. However, some weaknesses were identified, particularly in the clinical years. Further research is needed to clarify appropriate interventions.

Development of a Gerodontology course in Athens: a pilot study.

AIM: To describe the development of an undergraduate Gerodontology course in Athens Dental School. BACKGROUND: Because of demographic changes, undergraduate dental curricula should place appropriate emphasis on the oral care of the elderly. Therefore, the Athens Dental School Curriculum Committee authorised the development of a new Gerodontology course. METHODS: The new course was introduced in the 10th (final) semester of undergraduate studies. Teaching responsibilities were shared amongst staff from various Dental School departments and the National Health System. The course was elective and mainly didactic, consisting of seminars within the Dental School, educational visits to hospitals and geriatric day centres and elective clinical work in the comprehensive care clinic. The students evaluated the course at the end of the semester and indicated its strengths and weaknesses from their perspective. CONCLUSION: The new course was generally satisfying. Based on the experience and evaluation of the first pilot year and taking into consideration the existing barriers, we plan to improve and expand educational activities, mainly including improved methods of teaching and assessment, and more clinical assignments.

Bilateral variation of the masseteric myotatic reflex and the silent period in young humans.

Increased bilateral differences in jaw reflexes have been considered as pathological findings. The aim of this study was to investigate the normal variation between sides in the jaw jerk and the silent period and determine the range of its boundaries, using the present experimental set-up. Electromyographic data were simultaneously recorded from the right and left masseter muscles by surface electrodes, using a computerized recording and analysis system. The reflexes were elicited by chin taps during mandibular rest and at moderate intercuspal clenching in 20 healthy dentate adults (10 males and 10 females) with a mean age of 26 years. The reflexes were always elicited bilaterally and no overall significant differences were observed between sides for occurrence, latency, duration and amplitude of the jaw jerk and for the latency and duration of the silent period (P > 0.05). However, in the individual analysis significant bilateral variation was occasionally recorded, particularly for the jaw jerk at rest and mainly in the amplitude measurements. On the other hand, in the silent period duration measurements individual variation was very limited. Bilateral individual latency differences for the jaw jerk did not exceed 1 ms at rest (x = 0.3 +/- 0.3 ms) and 0.7 ms at clench (x = 0.3 +/- 0.2 ms), while latency differences for the silent period did not exceed 0.8 ms for the early type (x = 0.4 +/- 0.2 ms) and 4.8 ms for the late phase of depression (x= 1.9 +/- 1.7 ms). Bilateral differences for the silent period duration did not exceed 7.1 ms (x = 2.2 +/- 2.3 ms) in the early type (simple + early phase of combined types) and 3.3 ms (x = 1.5 +/- 0.9 ms) in the total duration of the combined types.

Normal side-to-side variation of the exteroceptive suppression of masseter muscle in young dentate adults.

Previous studies have shown that various stimuli applied in the orofacial region, evoke bilateral inhibitory responses in the jaw elevator muscles. The exteroceptive supression (ES) of the masseter muscle after electrical stimulation of the mental nerve, often appears as a double phase of inhibition interrupting the voluntary sustained contraction of the muscle. The aim of the present study was to investigate the normal bilateral variation of the masseteric ES in a control group of 20 healthy dentate adults, and to determine the range of its boundaries. The reflex was elicited by electrical stimulation of the mental nerves, during maximum intercuspal clenching. Generally, the overall mean values for the latencies and durations were in line with those reported in previous investigations, while no significant differences were found between the left and the right masseter muscles, regardless of the side of stimulation. However, in the intra-individual analysis, significant bilateral variation was occasionally recorded, particularly in the latency and duration of the late exteroceptive suppression. It was concluded that the exteroceptive suppression of the masseter muscle is a repeatable and clear bilateral reflex response, although an increased number of observations is recommended in normal subjects, before its use could be extended for diagnostic purposes.

Socio-medical condition and oral functional status in an older institutionalised population.

OBJECTIVES: To investigate the association between the general medical condition, the socio-economic status, and some factors related to the functional status of the stomatognathic system. DESIGN: A survey in an elderly population. SUBJECTS: 257 older adults, with a mean age of 83.7 years. SETTING: Residential homes for the elderly. INTERVENTION: Examination of the medical records on the overall health and the drugs consumed, a structured interview on the socio-economic status, the complaints for xerostomia, the subjective chewing difficulties, and a clinical evaluation of the number of natural teeth and the number of posterior occluding pairs of teeth contacts (premolars and molars). RESULTS: Multiple pathology and polypharmacy were recorded. 25% of the residents had no occluding posterior tooth contact (natural or prosthetic) and 62% were edentulous. 43% of the residents reported complaints for xerostomia, and 46% for chewing difficulties when eating specific food types. Xerostomic feelings and chewing problems were not related to age. Chewing difficulties were not related to the number of natural teeth, but to the number of posterior occluding teeth contacts, natural or prosthetic (less than two). From all medical conditions examined, only the psychiatric disorders were significantly related to dental status (p < 0.05). Moreover, the number of remaining natural teeth was related to socio-economic status, while the number of posterior occluding teeth contacts was also inversely related to the duration of institutionalisation (p < 0.05). CONCLUSIONS: Psychiatric disorders, low socio-economic status and increased duration of institutionalisation were most closely related to poor dental status. The presence of more than two posterior occluding teeth contacts, natural or prosthetic, benefit the very old patient in terms of reduced subjective chewing difficulty. A formal oral care delivery system for the institutionalised elderly, and particularly for those suffering from psychiatric disorders, is imperative.

Surface EMG activity of the masseter muscle in denture wearers during chewing of hard and soft food.

Previous studies mainly on dentate subjects, have clearly shown that food texture affects the various chewing parameters. The purpose of this investigation was to study the influence of food texture on the surface electromyographic (EMG) activity of the masseter muscle in a sample of denture wearers. Nine experienced denture wearers (mean age of 68.7 years) with clinically satisfactory dentures consented to participate in this study. Carrots and peeled apples cut into equally sized pieces were chosen as representing a hard and a soft food respectively. The parameters studied from the raw and integrated EMG recordings were: chewing rate, mean peak RMS activity, chewing cycle and chewing burst duration and relative contraction period. The findings were in line with those earlier reported on dentate subjects, in that harder foods require higher chewing rates, higher electrical activity of the masseter muscle and higher relative contraction periods, accompanied by shorter cycle durations. Most of these differences were statistically significant (P< 0.05) as tested by paired t-test. Moreover a strong inverse correlation was found between chewing rate and cycle duration (r = -0.92, P < 0.05). We concluded that the texture of food has an obvious effect on all the studied parameters of EMG activity, and that those adjustments to food consistency are probably due to a combined powerful peripheral input mediated through receptors, other than the periodontal ones.

Jaw reflexes in healthy old people.

OBJECTIVE: to investigate variations in the masseteric myotatic reflex (jaw-jerk) and the silent period from the 5th to the 9th decades of life. SUBJECTS AND METHODS: electromyographic data were recorded from the masseter muscle of the preferred chewing side by surface electrodes, using a computerized recording and analysis system. Chin taps were applied with a neurologist's hammer during mandibular rest and at 40% intercuspal clenching in 30 healthy people aged from 49 to 87 years. The influence of age, gender and silent period type were analysed by multiple regression analysis (P < or = 0.05). RESULTS: even in the very old subjects all reflexes were elicited, at least once. However, with increasing age the overall occurrence of the jaw-jerk reflex at rest (%) and its amplitude, at rest and at clench, were reduced, while its latency at rest was significantly increased (P < or = 0.05). No age effects were recorded in most parameters of the jaw-jerk reflex at clench and in the silent period. Women showed a tendency for reduced latencies of the jaw-jerk and the early silent period and increased silent period duration (P < or = 0.05). They also had a steeper decline in myotatic reflex activity, particularly at rest. CONCLUSION: simple masseteric reflex activity is maintained until very old age, particularly when elicited during contraction of the jaw elevators.

Re-examination of the surface EMG activity of the masseter muscle in young adults during chewing of two test foods.

The purpose of this study was to investigate the effect of the texture of food on the masseter EMG activity during chewing. Fresh raw carrots and non-adhesive chewing gums of similar size and weight were used as representing a hard and a soft food respectively. The mean values for the IEMG activity, the duration of the chewing cycle, the chewing rate and the relative contraction time during chewing were significantly higher for the carrots while no significant difference was found in the chewing burst duration between the two test foods. Finally a strong inverse correlation was found between chewing rate and cycle duration. It was concluded that the texture of food has an obvious effect on EMG activity during chewing and that adjustments to changes in food consistency are made mainly by altering the chewing rate, the duration of the chewing cycle and the IEMG activity.

Variation in the masseteric silent period in older dentate humans and in denture wearers.

The masseteric silent period was elicited by chin taps at 40% clenching in the masseter muscle of the preferred chewing side in 22 younger dentate individuals, in 22 older dentate individuals, in 22 older experienced denture wearers and in 7 older inexperienced denture wearers. One simple and three combined types of silent period (combination of early and late phases of depression) were recorded in all groups. An early silent period was always elicited, the only exception being in some inexperienced denture wearers. Both the age and the extent of rehabilitation with dentures in the trained denture wearers affected reflex latencies (p < 0.05), while the variation in duration was not significant (p > 0.05). The duration of the silent period was, however, affected by the type of silent period, thus by the measuring technique (p < 0.05). Increased variation was observed in the inexperienced denture wearers, who were in a period of adaptation.