Clinical Management of Interproximal and Occlusal Caries in Children and Adolescents by Canadian Dentists: A Survey.

PURPOSE: Early restorative interventions may have important implications in young patients, and the International Caries Classification and Management System strongly recommends non-surgical strategies in the management of dental caries. We aimed to assess management of interproximal and occlusal caries in children and adolescents (≤18 years of age) by Canadian dentists. METHODS: An electronic survey was created and sent to members of Canadian provincial regulatory dental bodies. The survey included 11 questions on demographic factors and 3 clinical situations on dental caries management. RESULTS: The response rate was 4.6% (n = 702). To treat interproximal carious lesions limited to enamel, 442 dentists (63.0%) reported using surgical caries removal on a permanent molar and 502 dentists (71.5%) did the same for a primary tooth. For occlusal carious lesions, the corresponding numbers were 300 dentists (42.7%) for a permanent molar and 269 (38.3%) for a primary molar. Age, year of graduation and province of practice appear to have a significant impact on the restorative threshold. CONCLUSIONS: According to the latest evidence-based recommendations for caries management, the presence of cavitated enamel should be the main indication to restore, and non-surgical interventions for non-cavitated lesions confined to enamel should be prioritized. Results show that a good proportion of respondents have a lower restorative threshold, particularly for interproximal lesions.

Five-year success rate of resin-bonded fixed partial dentures: A systematic review.

OBJECTIVES: To assess and compare the 5-year success rate of resin-bonded fixed partial dentures (RBFPDs) fabricated from different materials. METHODS: An electronic search on 3 databases from January 1965 to March of 2017 was done for human randomized clinical trials (RCTs), and prospective and retrospective cohort studies. The key words used in the search were: Bridge OR bridges OR fixed partial OR fixed dental AND resin bonded OR Maryland OR ceramic bonded. Quality assessment was done using the Newcastle-Ottawa scale. Success was defined as the RBFPDs remaining in situ and not having experienced debonding, biological failures, or mechanical failures at the examination visit. RESULTS: Meta analyses of the included studies showed an estimated 5-year success rate of 88.18% for the metal framework RBFPDs and 84.41% for the nonmetal framework RBFPDs. The estimated 5-year success rate for each nonmetal material category was 92.07% for zirconia, 94.26% for In-Ceram alumina, and 84.83% for fiber-reinforced composite. The failure rate was not statistically significant among the single, double, and multiple retainers RBFPDs (P > .05). Technical complications were the main reason for failures. CONCLUSION: The 5-year clinical performance of RBFPDs is similar to the performance of conventional fixed partial dentures (FPDs) and implant-supported crowns. CLINICAL SIGNIFICANCE: Clinicians should consider using RBFPDs more often because their clinical performance is similar to the performance of conventional FPDs and implant-supported crowns.

Education About Dental Erosion in U.S. and Canadian Dental Schools.

Dental erosion (DE) is a well-accepted multifactorial form of tooth wear involving acids. Due to its irreversible nature, recognizing the early signs is important to develop appropriate preventive strategies. However, its place in dental curricula remains unclear. Consensus has not been established regarding the integration of erosive tooth wear into core cariology curricula in North America. The extent to which DE is taught is questionable since etiology, risk assessment, and management are not all the same as for dental caries. The aim of this study was to survey U.S. and Canadian dental schools regarding their teaching of DE. Email invitations were sent to deans, chairs, and selected faculty members at all 76 U.S. and Canadian dental schools in 2016, asking them to either respond or forward the survey-link provided to the appropriate person in their school. Responses from the same school were combined for analysis. Respondents from 59 schools (77.6% response rate) responded to the survey, and all of them confirmed the inclusion of DE in their curricula. However, only 15.3% of respondents identified correctly all the clinical signs of DE. Although management through behavioral intervention was prioritized, diet analysis was often not a clinical requirement, and 45.8% of respondents did not teach any type of tooth wear index for monitoring. This study concluded that DE has a place in dental curricula, but whether this topic is adequately covered is questionable. There is a need to establish clearer topics and requirements emphasizing the diagnosis and management of DE, potentially in cariology curricula.

Teaching Silver Diamine Fluoride in U.S. Dental Schools' Predoctoral Curricula.

Silver diamine fluoride (SDF), a low-cost topical agent used in many countries to arrest dental caries, was cleared as a desensitizing agent by the Food & Drug Administration for the U.S. market in 2014. The aim of this study was to survey U.S. dental schools regarding their teaching of SDF. Email invitations were sent to all accredited U.S. predoctoral dental education programs (n=66) in September 2016. Deans, chairs, and selected faculty members were asked to respond or forward the survey-link provided to the appropriate person in their school. Under the assumption that some respondents from the same school were unaware of SDF implementation across departments, multiple responses from the same school were collapsed for analysis. A total of 62 schools (94% response rate) responded to the survey, and 67.7% of them reported that SDF was part of their curricula. There was a wide variation across dental schools' teaching about SDF indications and protocols of application. All but one school consistently agreed on using SDF for arresting caries on primary teeth. Only 18 respondents were able to confirm if there was an existing protocol at their school for the use of SDF. When re-application after initially arresting caries with SDF was taught, 50% of respondents advocated 2×/year re-application. Schools not teaching SDF (n=20) planned on including it in their curricula in the future. These findings suggest that, with the use of SDF increasing rapidly in the U.S. and its adoption in most dental schools, there is a need for the development of standardized evidence-based protocols.