Cross-cultural adaptation of a Spanish version of a previously validated HPV survey that evaluates dental students' knowledge, perception and clinical practices in Latin America.

BACKGROUND: The global incidence of oropharyngeal cancer (OPC) is increasing. Dental professionals play a key role in the detection of oral lesions that could lead to cancer. However, scientific-based HPV-OPC visual inspection guidelines are underdeveloped and HPV knowledge and awareness has been reported to be low among dental students and professionals. The present study adapted and performed pretesting of a multi-scale survey evaluating knowledge, perceptions, and clinical practices regarding HPV and HPV-OPC for Latin American Spanish-speaking populations. METHODS: A previously developed questionnaire for English-speaking dental students was translated to Spanish. The questionnaire was administered to first year dental students at two Latin American universities with dental programs. Internal consistencies were measured using Cronbach Alpha. Analyses were conducted in SAS Version 9.4. RESULTS: Data from a total of 114 students, a majority of the which were female (61%), and Hispanic/Latino(a)/Spanish (91%). The HPV, HPV-OPC, and HPV vaccine knowledge subscales demonstrated good internal consistency, the Cronbach's alpha was 0.83, 0.75, and 0.86 respectively. The Barriers subscale had a Cronbach's alpha of 0.93, showing excellent internal consistency. The Clinical Procedures subscale, focused on factors surrounding dental students' hypothetical clinical practice procedures, had a Cronbach's alpha of 0.86. The Scope of Practice scale had a Cronbach's alpha of 0.93. CONCLUSIONS: Ultimately, this survey demonstrated reliability and applicability for the assessment of dental students' knowledge, perceptions, and clinical practices regarding HPV and HPV-OPC in Latin America.

Minimally Invasive Techniques Used for Caries Management in Dentistry. A Review.

OBJECTIVE: Minimally invasive techniques that use silver compounds and glass ionomer cement are suggested for caries management due to their effectiveness, simplicity, and low cost. The aim of this review is to examine the evidence supporting the use of silver compounds and glass ionomer cement in dentistry. STUDY DESIGN: Literature was searched using PubMed, Elsevier, EBSCO, Google scholar, AAPD and UABC's database from 1958 to 2018 with the keywords: "Silver nitrate", "silver diamine fluoride", and "glass ionomer cement". The selected studies were then fully read to prove their relevance for this review. RESULTS: The use of glass ionomer cement and silver compounds were shown to be effective in arresting caries. These compounds reduce cariogenic microorganisms. Their chemical properties inhibit bacterial growth while promoting remineralization. They are simpler and less time consuming than conventional restorations. They also cause less discomfort and anxiety to patients. Silver compounds were shown to stain teeth and may burn the cornea if used in high concentration. These disadvantages limit the use of silver compounds to posterior teeth and require caution when handling. CONCLUSIONS: Minimally invasive therapies are easy to apply, non-invasive and affordable. Further studies should be done to provide more evidence of these techniques for caries management.

A Multi-state Evaluation of Oral Health Students' Knowledge of Human Papillomavirus-Related Oropharyngeal Cancer and HPV Vaccination.

Human papillomavirus-related oropharyngeal cancers (HPV-OPCs) are on the rise, yet HPV knowledge among dental professionals remains low. The purpose of this multi-state study was to examine sociodemographic factors associated with final year dental hygiene (DH), third year dental (DS3), and fourth year dental (DS4) students' knowledge regarding HPV, HPV-OPC, and HPV vaccination. Twenty dental programs in the USA were approached in the implementation phase to complete an online, 153-item, self-administered questionnaire that was developed and tested in a previous study. Descriptive statistics and chi-square analyses were conducted in SAS version 9.4 to examine the relationship between sociodemographic variables with HPV, HPV-OPC, and HPV vaccination knowledge levels. This study included the participation of students from 15 dental programs (n = 380) with an overall response rate of 28%. Although the results cannot be generalized to the entire population of dental students in the USA, most students had inadequate overall HPV knowledge (65%), HPV-OPC knowledge (80%), and HPV vaccination knowledge (55%). While all student groups displayed adequate general HPV knowledge levels (≥ 70% correct responses), gender, racial, religious, age, and regional differences were observed. Future dental professionals need to have adequate levels of HPV knowledge to aid in reducing the HPV-OPC burden. This study identified sociodemographic factors related to lower knowledge of HPV, HPV-OPC, and HPV vaccination, and highlights groups of students with greater needs for HPV education. This study provides a foundation for future research and interventions to be developed. Dental institutions can use findings to strengthen curricula development.

US oral health students' willingness to train and administer the HPV vaccine in dental practices.

HPV oropharyngeal cancers have now surpassed cervical cancer rates in the US. Dental providers' engagement in HPV education and vaccination efforts may help reduce the burden of HPV oropharyngeal cancers. We examined factors associated with oral health students' willingness to train and administer the human papillomavirus (HPV) vaccine in dental settings. US students in 15 oral health programs participated in an online survey in 2016. Unadjusted and adjusted multivariable logistic regression were conducted and odds ratios (OR) and 95% confidence intervals (CI) were reported. Analyses were conducted in SAS Version 9.4. Data from a total of N = 306 students were analyzed to examine sociodemographic, educational, practice, and attitudinal factors associated with willingness to train and administer the HPV vaccine. Majority of the participants were female (70.3%), non-Hispanic/Latino (90.8%), and White (62.1%). Perceiving that HPV vaccination recommendation (OR = 1.95, 95% CI = 1.14-3.35) and administration (OR = 3.79, 95% CI = 1.63-8.81) was in the dental professional's scope was positively associated with outcome measures when other factors were held constant. Students with greater patient contact time (OR = 4.47, 95% CI = 1.14-17.58) and lower role conflict (agreed that HPV vaccine administration was in the dental professional's scope) had higher odds of willingness to administer the HPV vaccine when other factors were held constant (OR = 5.9, 95% CI = 2.27-15.3). The major barrier to engaging oral health students in HPV vaccination efforts was role conflict. Professional organizations and oral health programs should strongly support the role of oral health professionals in HPV oropharyngeal prevention.

Photochemical crosslinking of caries-affected dentin combined with total- or self-etch systems.

PURPOSE: To evaluate the effects of collagen crosslinking with riboflavin 0.1% and ultraviolet-A (UVA) 5.4 J on bond strength of total-etch or self-etch adhesives on caries-affected dentin. METHODS: Sixty human caries-affected molars were randomly divided into three groups: control (C), riboflavin (R), and riboflavin + 3 minutes of UVA (R+UVA). After each treatment, either total-etch or self-etch adhesives were applied following the manufacturer's instructions, and composite stubs were built up on the treated surfaces. They were de-bonded in tension to measure bond strength. Twelve extra molars were used for scanning electron microscope (SEM) analysis. RESULTS: We observed that R+UVA-treated group yielded significantly higher bond strengths for carious dentin when the total-etch adhesive was applied. For the self-etch adhesive, no statistical differences were observed between the three pretreated-groups. CONCLUSION: Our results, for the first time, are suggesting that etching with phosphoric acid potentialized the benefits of R+UVA crosslinking on carious dentin. R+UVA dentinal collagen crosslinking improves bond strength for caries-affected dentin when using a total-etch adhesive, but did not affect it when using a self-etch adhesive.

Pilot Test of Survey to Assess Dental and Dental Hygiene Student Human Papillomavirus-Related Oropharyngeal Cancer Knowledge, Perceptions, and Clinical Practices.

This was the first study to develop and pilot test an assessment tool for the examination of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) knowledge, perceptions, and clinical practices of oral health students. An interdisciplinary team developed the tool using surveys that examined this topic in other populations. The tool was then pilot tested at two different dental programs. Results from the pilot informed revisions to the final version of the tool. Of the 46 student participants, 18 were first-year dental hygiene and 28 were first-year dental students. The majority of participants were female (N = 29, 63%) and ages 18 to 29 years old (N = 41, 89%). Four scales used in the questionnaire were analyzed for reliability. Of these, the HPV and HPV-OPC knowledge and the HPV vaccination knowledge scales had Cronbach alphas of 0.71 and 0.79, respectively. Questions assessing HPV and the role of dental professionals had a correlation coefficient of 0.71. Questions assessing willingness to administer vaccines in the dental office had a correlation coefficient of 0.85. Assessing oral health students' HPV-OPC knowledge, perceptions, and clinical practices are important for future assessment of possible HPV-OPC cases. Dental professionals may be optimally positioned to provide HPV patient education. The tool developed and pilot tested in this study can help schools assess their students' knowledge and guide their dental curriculum to address deficiencies. Since this topic has not been effectively examined with dental health students, the results could help improve dental education and dental care.

Analysis of interfacial structure and bond strength of self-etch adhesives.

PURPOSE: To determine the bond strength, nanoleakage and interfacial morphology of four self-etch adhesives bonded to superficial dentin. METHODS: Microtensile (MT) (n= 15) and single plane shear (SP) (n= 8) bond tests were performed using human dentin polished through 320-grit SiC paper. Clearfil Protect Bond (PB), Clearfil S3 Bond (S3), Prompt L-Pop (PLP) and G-Bond (GB) were used according to their manufacturers' instructions. Composite was applied as cylinders with a thickness of 4 mm with a 1 mm diameter and stored in water at 370C for 24 hours. Specimens were debonded with a testing machine at a cross-head speed of 1 mm/minute. Means and standard deviations of bond strength were calculated. Data were analyzed using ANOVA. Fisher's PLSD intervals were calculated at the 0.05 level of significance. Failure modes were determined at x100. The hybrid layer was revealed by treatment with 5N HC1/5% NaOCl or fractured perpendicular to the interface and sputter coated with gold. Specimens were viewed at x1,000, x2,500, and x5,000 in a field emission SEM at 15 kV. Teeth (n=2) sectioned into 0.9 mm-thick slabs were immersed in ammoniacal silver nitrate solution for 24 hours, rinsed and immersed in photo-developing solution for 8 hours. Specimens were sectioned (90 nm-thick) and observed under TEM. RESULTS: Means ranged from 25.0 to 73.1 MPa for MT and from 15.5 to 56.4 MPa for SP. MT values were greater than SP, but were highly correlated (R2 = 0.99, P= 0.003) and provided the same order for the systems studied. Fisher's PLSD intervals (P< 0.05) for bond strength techniques and adhesives results were 1.7 and 2.3 MPa, respectively. Failures sites were mixed. TEM showed that hybrid layers were -0.5 pm for PB, GB and S3 and approximately 5 microm for PLP. SEM showed morphologic differences among adhesives. Silver nitrate deposits were observed within the interfaces for all adhesive systems.

Bond strength of adhesives to dentin contaminated with smoker's saliva.

The purpose of this study was to determine the effects of contamination with smoker's and non-smoker's saliva on the bond strength of resin composite to superficial dentin using different adhesive systems. The interfacial structure between the resin and dentin was evaluated for each treatment using environmental scanning electron microscopy (ESEM). Freshly extracted human molars were ground with 600-grit SiC paper to expose the superficial dentin. Adhesives [One-Up-Bond-F-Plus (OUFP) and Adper-Prompt-L-Pop (APLP)] and resin composite (TPHSpectrum) were bonded to the dentin (n = 8/group, 180 total specimens) under five surface conditions: control (adhesive applied following manufacturers' instructions); saliva, then 5-s air dry, then adhesive; adhesive, saliva, 5-s air dry; adhesive, saliva, 5-s water rinse, 5-s air dry (ASW group); and adhesive, saliva, 5-s water rinse, 5-s air dry, reapply adhesive (ASWA group). After storage in water at 37 degrees C for 24 h, the specimens were debonded under tension at a speed of 0.5 mm/min. ESEM photomicrographs of the dentin/adhesive interfaces were taken. Mean bond strength ranged from 8.1 to 24.1 MPa. Fisher's protected least significant difference (P = 0.05) intervals for critical adhesive, saliva, and surface condition differences were 1.3, 1.3, and 2.1 MPa, respectively. There were no significant differences in bond strength to dentin between contamination by smoker's and nonsmoker's saliva, but bond strengths were significantly different between adhesive systems, with OUFP twice as strong as APLP under almost all conditions. After adhesive application and contamination with either smoker's or nonsmoker's saliva followed by washing and reapplication of the adhesive (ASWA group), the bond strength of both adhesive systems was the same as that of the control group.

Retention of gold alloy crowns cemented with traditional and resin cements.

The aim of this study was to measure in vitro retention of cast gold crowns cemented with traditional and resin cements. Forty-eight human molars were prepared on a lathe to produce complete crown preparations with a consistent taper and split into six groups, eight crowns in each group. Crowns were cast in a high-gold alloy and then cemented. After 24 hours, the retention force (N) was recorded and mean values were analyzed by one-way analysis of variance and the Fisher post-hoc least significant difference (PLSD) multiple comparisons test (a = .05). Failure sites were examined under 3100 magnification and recorded. Mean values (SD) for each group in increasing order of retention force were: Harvard Cement: 43 N (27), TempoCem: 59 N (16), PermaCem Dual: 130 N (42), RelyX Luting Cement: 279 N (26), Contax and PermaCem Dual: 286 N (38), and TempoCem with Contax and PermaCem Dual: 340 N (14). The Fisher PLSD interval (P = .05) for comparing cements was 29 N. Zinc-phosphate cement and provisional resin cements had the lowest retention forces. Resin cement with a bonding agent and the hybrid-ionomer cement had similar retention forces. Resin cement with a bonding agent applied after use of a provisional resin cement had a significantly higher retention force than the other cements tested.

SEM evaluation of resin-carious dentin interfaces formed by two dentin adhesive systems.

OBJECTIVES: We investigated the influence of dentin tubule direction and identifiable zone of carious dentin on the microstructure and the thickness of the hybrid-like layer (HL) formed by self-etch and etch-rinse adhesive systems. METHODS: An etch-rinse and a self-etching adhesive were bonded to dentin carious zones divided into groups with parallel or perpendicular orientation relative to the dentin tubules at the resin-carious dentin interface (N=5/variable). Bonds were prepared to each of the four zones of carious dentin apparent after staining with Caries Detector: pink, light pink, transparent and apparently normal; six non-carious third molars were controls. The microstructure and thickness of the HL were determined by SEM and compared using three-way ANOVA and Tukey's multiple comparisons (p<0.05). RESULTS: Etch-rinse controls gave thicker HLs than self-etching systems; orientation did not affect thickness for the self-etch system. Perpendicular orientations gave thicker HLs than parallel for the pink zone bonded with the etch-rinse system. For both adhesives, HL thickness in the pink zone was significantly greater than in light pink for the perpendicular group, but no significant differences were found among other variables. HL microstructure was more granular and rougher for the etch-rinse than for the self-etching system. Pores and cracks were obvious in the more demineralized zones. Resin tags were shorter and irregular in the transparent zone and often were completely absent in the outer demineralized zones (pink, light pink). SIGNIFICANCE: Microstructure of bonded interfaces varies markedly depending on adhesive system, tubule orientation and carious zone.

Effect of filler addition on the bonding parameters of dentin bonding adhesives bonded to human dentin.

PURPOSE: To determine the effect of filler addition on two total-etch, single component bonding systems on the bond strength, displacement at debonding, stiffness of debonding and energy absorbed to debonding of resin composites to human dentin. METHODS: Two dentin bonding systems with no-filler (OS and SB) and filler-added (OSP and SBP) versions were studied. The dentin surfaces of human teeth were exposed with 600-grit SiC. TPH Spectrum A2 was used to bond to the dentin surfaces in the form of a truncated cone, 3 mm in diameter at the bonding surfaces and 5 mm in diameter at the base. Bonded specimens were stored in distilled water at 37 degrees C for 24 hours. They were then debonded in tension with a universal testing machine at a cross-head speed of 0.5 mm/minute. Displacement at debonding, stiffness and energy to debonding were calculated based on the stress-displacement curve. RESULTS: Bond strength, displacement at debonding and energy to debonding (measured and elastic) were influenced by the brand of the adhesive (OS/OSP vs. SB/SBP), but were not influenced by the filler addition based on two-way analysis of variance. Bond strength was in the range of 24.4-30.1 MPa, and there were significant differences between the bond strengths of OS and SB. Displacement and energy to debonding (measured and elastic) were different between the adhesives. Bond strength, bond stiffness and energy to debonding (measured) showed significant correlations.

Bond strength of composite to astringent-contaminated dentin using self-etching adhesives.

PURPOSE: To determine the effects of contamination by ferric sulfate and aluminum chloride astringents on the bond strength of composite bonded to superficial dentin using self-etching adhesives. METHODS: Freshly extracted human teeth were ground to expose superficial dentin and polished to 600 grit. One of three self-etching adhesive systems and restorative composites were bonded to the specimens, with contamination by one of three astringents and five surface conditions (no contamination, moist dentin control; contaminant, air, adhesive; contaminant, water rinse, air, adhesive; contaminant, water rinse, glycolic acid scrub, rinse, adhesive; contaminant, water rinse, chlorhexadine scrub, rinse, adhesive). Composite was bonded to the surfaces in the shape of an inverted, truncated cone (n = 5, 180 specimens total). Specimens were stored in water at 37 degrees C for 24 hours, then de-bonded in tension with a testing machine at a crosshead speed of 0.5 mm/minute. Tensile bond strengths (MPa) were calculated. RESULTS: Means (SD) were compared using analysis of variance. Significant differences (Fisher's PLSD) were found among all variables. SE and ABF had the highest control values, but were affected most by astringent contamination. Ferric sulfate reduced bond strengths the greatest in most cases, and aluminum chloride putty reduced bond strengths the least. Chlorhexadine rinse was most effective in restoring bond strength values.

Factors affecting in vitro bond strength of bonding agents to human dentin.

Four generations of total-etch (fourth, fifth) and self-etching (sixth, seventh) bonding agents for use with resin composites are commercially available in the United States. Innovations in bonding agents include: filled systems, release of fluoride and other agents, unit dose, self-cured catalyst, option of etching with either phosphoric acid or self-etching primer, and pH indicators. Factors that can affect in vitro bond strength to human dentin include substrate (superficial dentin, deep dentin; permanent versus primary teeth; artificial carious dentin), phosphoric acid versus acidic primers, preparation by air abrasion and laser, moisture, contaminants, desensitizing agents, astringents, and self-cured restorative materials. This article reviews studies conducted at the Houston Biomaterials Research Center from 1993 to 2003. Results show that in vitro bond strengths can be reduced by more than 50% when bonding conditions are not ideal.