Impact of an executive-level management program.

Program teaches management skills beyond those taught in pharmacy school. Pharmacists benefit not only from educational growth but also from networking opportunities. Alumni report that the program has had a positive impact on their personal and career objectives, their department, and their organization. Involvement of administrators helps pharmacy directors take home solutions to specific problems for immediate implementation.

The real issue of health care reform.

Perhaps a better title would be, Health Care Reform: Does it affect dentistry? This query arises because only one of the major legislative proposals includes dentistry to any significant degree and as of now the American Dental Association is opposed to the inclusion of dentistry (except for indigent children) in Health Care Reform. Of course, however, the answer to this question is yes. The suggested legislation will bring about changes of such magnitude that dentistry can't avoid their influence. We will briefly outline the main issues involved in health care reform and summarize what the proposals mean for dentistry.

Traditional and emerging forms of dental practice. Cost, accessibility, and quality factors.

The traditional and predominant manner of delivering dental care is through a fee-for-service, private practice system. A number of alternative dental care delivery systems have emerged and are being tested, and others are just emerging. These systems include department store practices, hospital dental services, health maintenance organizations, the independent practice of dental hygiene, and denturism. Although it is too soon to draw final conclusions about the efficacy and effectiveness of these systems, we examine them for their potential to compete with and change the way dental care is currently delivered. Using the parameters of cost, accessibility, and quality, we compare these systems to traditional dental practice. Some of these emerging forms clearly have the potential to complete favorably with traditional practice. Other seem less likely to alter the existing system substantially. The system which can best control costs, increase accessibility, and enhance quality will gain the competitive edge.

The future of dental specialization: policy issues.

There has been a shift in the fundamental values placed by society on its health care system, as reflected by public insistence on greater accountability, a more influential role in policy decisions, and a more effective use of system resources. This change in values will profoundly influence the future of dental specialization. The role of the generalist, expanding as a result of various public and internal pressure, will shape the future role of the specialist more than anything else. No new dental specialties are likely to emerge, but there will be changes in emphasis and consolidation among the specialties. Graduate dental education will require a reorganization and a variety of sharing arrangements for its survival. Some form of demonstrating continuing competence will be required for maintenance of specialty status.

Dental education and public policy: a research agenda.

The Work Group on the Education of the Health Professions and the Nation's Health offers the theme of discontinuity to describe why so little useful knowledge has been derived from research in this area and to suggest a more productive approach for future studies. Discontinuities are evident among the needs of patients and populations and how dentists practice and in what dentists do in practice versus the content of dental education. The Work Group recommends six areas directly applicable to dentistry in which research might alleviate these discontinuities.

Blood flow, collagen components of oral tissue and salivary kallikrein in young to senescent, germfree and conventional rats. A study on the etiologic factors of periodontal disease.

In oral tissues of rats, progress of age resulted in a gradual reduction of regional blood flow and in decreased levels of eluable (labile) hydroxyproline from the collagen component. These were paralleled by an increment of salivary kallikrein. The presence of the microbial flora in the oral cavity, portrayed by the comparison of conventional and germfree rats, caused an elevation of blood flow in all age groups, without exerting a marked effect on eluable hydroxyproline. In addition to aging and flora effects, the action of chronic hypoxia and of mechanical stress has been observed on the mentioned parameters. The presently used animal models and experimental design permit a critical study of etiologic agents and characteristic lesions of peridontal disease.

A curriculum for primary care dentistry.

This paper is a discussion of curricular planning with respect to primary care dentistry. It is meant to be anticipatory, although the proposals contained are transitional and evolutionary rather than abrupt. It is intended to be suggestive rather than authoritarian and exemplary rather than definitive. Many of the recommendations and suggestions are already operative in dental education, albeit in limited or experimental form. An overview of both the content and the process of a primary care dental curriculum is presented, and several specific recommendations for curricular change are submitted. Among the more salient recommendations are (1) changing the admissions process to attract to dentistry those most qualified for primary care; (2) moving the basic sciences into the predental curriculum during the initial phase in the development of primary care dentistry; (3) substantially increasing the amount of behavioral science in the dental curriculum; (4) placing curricular emphasis initially on diagnosis and expanding the competence of the primary care dentist in endodontics, periodontics, pedodontics, orthodontics, and prevention; (5) initiating student group practice as the vehicle for patient care; (6) including intradisciplinary and interdisciplinary training as integral components of primary care curricula; (7) extending the curriculum; (8) establishing general practice or primary care residencies either as an intracurricular experience or as a postdoctoral requirement; (9) reorganizing dental school clinics and clinical training to reflect primary care curricular goals; (10) making more rational use of existing auxiliaries, the eventual goal being auxiliaries who perform most of the routine functions; and (11) ultimately integrating dentistry into medicine so that the future primary care practitioner receives both medical and dental training. It is obvious that the extent to which any of these recommendations will be implemented depends on a great deal more than what happens within a dental school. There are many putative countervailing forces which can make implementation difficult; on the other side of the ledger, these same forces might be propitious. As an illustration, the staggering financial constraints imposed on the dental schools can cause us to throw up our hands in despair or can impel us to look carefully at what we are doing, ask why we are doing it, and by building on what is sound and discarding the antiquated and irrelevant, reassemble our curricula to meet public need better than we have been doing...

Aggressive growth and neoplastic potential of odontogenic cysts: with special reference to central epidermoid and mucoepidermoid carcinomas.

An aggressive form of odontogenic cyst known as the keratocyst has been reviewed with a report on the findings of 70 new instances. Recurrence after 2 years of followup was found to be 20%. From both a review of the literature and original cases, carcinomatous and ameloblastomatous transformation in odontogenic keratocysts seems to be an extremely rare phenomenon. Alternatively, epidermoid carcinoma and mucoepidermoid carcinoma arising centrally within the jaws are often associated with other types of dental cycts. Review of 36 instances of central epidermoid carcinoma has disclosed that 75% were associated with a cyst lining; the 2-year survival rate was found to be 53%. Central mucoepidermoid carcinoma was associated with a dental cyst or impacted tooth in 48% of the cases, and enjoyed a 100% 2-year and 5-year survival; however, 2 patients were recorded alive with disease at 4 months and 10 years, whereas another patient succumbed to disease 14 years postoperatively.