Evidence-based cariology in clinical and public health practice as part of the European Core Curriculum in Cariology.

This paper is part of a series of papers contributing towards a European Core Curriculum in Cariology for undergraduate dental students. The European Core Curriculum in Cariology is the outcome of a process starting in 2006 and culminating in a joint workshop of the European Organization for Caries Research together with the Association for Dental Education in Europe, which was held in Berlin from 27 to 30 June 2010. The scope of this paper is to present the evidence-based cariology in clinical and public health section of the European Core Curriculum in Cariology. This section was developed on the basis of international consensus on the current and future educational needs in the fields of cariology and disorders of dental hard tissues. The paper will deal with the core skills of evidence-based dental practice within the undergraduate curriculum underpinning the dual facets of clinical cariology (relating particularly to individuals) and public health cariology (relating particularly to groups/societies). Core competencies in evidence-based dentistry, which are generic to the undergraduate curriculum as a whole and not only cariology, are integral to lifelong learning skills within dentistry. As the clinical cariology competencies in assessment and management of caries for the individual patient are dealt with within other sections of the European Core Curriculum in Cariology, only a few relevant examples will be presented here, but for Public Health Cariology, the competencies will be explored within this document and their relationship to the principles of evidence-based dentistry discussed.

A new in vivo method for measuring caries activity with a colorimeter.

The aim of this in vivo study was to assess the association between caries prevalence and changes in mineralization measured with a colorimeter (Color Compare CC 400, JENOPTIK, Jena, Germany). After a clinical examination (defs/DMFS, initial caries lesions), an area of a deciduous tooth was etched in each of the 35 children (psi = 8.11+/-2.41 years) with 37% phosphoric acid gel for 1 min. Immediately after, this demineralization was stained with 2% aqueous methylene blue and the red/green/blue spectrum measured with a colorimeter. Twenty-four hours later, the remineralization of this area was measured following the same staining procedure. Color measurements were clearly reduced after 24 h, indicating remineralization, and they correlated highly with the age of the children (Spearman correlation coefficient r = -0.48, p = 0.004). Correlations between the number of initial caries lesions in the deciduous and permanent dentition and color measurements after demineralization were statistically significant (r = 0.41 and 0.37, p = 0.02 and 0.045, respectively). The difference between the first and second measurements correlated significantly with the number of initial caries lesions in the permanent dentition (r = 0.42, p = 0.02). The values after artificial demineralization correlated with the number of initial lesions for the permanent (r = 0.368, p = 0.045) and deciduous (r = 0.408, p = 0.015) dentition. This resistance to artificial demineralization had stronger correlation coefficients with the caries incidence than the caries experience and initial lesions, which are considered to be the most valid caries predictors. In conclusion, these data suggest that the degree of demineralization after etching and its changes with time could be associated with caries parameters. Its use in prospective clinical trials on caries activity could be a successful approach.

[Application of muscle relaxants in Germany. A survey of German anaesthesia departments]. / Anwendung von Muskelrelaxanzien in Deutschland. Eine Umfrage an Deutschen Anästhesieeinrichtungen.

AIM: The aim of this study was to evaluate the use and application of muscle relaxants and neuromuscular monitoring in Germany. METHODS: A total of 2,996 questionnaires were sent out to the heads of German anaesthesia departments and private anaesthesia practices. The questions covered frequency of muscle relaxants used,how they were used, and neuromuscular monitoring. Influences on the way muscle relaxants were used could be derived from the desire for specific properties of a muscle relaxant, the desire for different monitoring conditions and from the size of the institution. We correlated these features with application practice using logistic regression analyses. RESULTS: Of the 2,996 questionnaires 2,058 could be analysed (68.6%). Amongst those were 102 level one hospitals (5%) and 903 private practices (44%). The replies from 350 (17%) departments were based on surveyed data, 1,613 (78.5%) were based on estimations. The desire for certain properties of muscle relaxants correlated with the use in practice, as were the desire for a non-depolarizing replacement for succinylcholine, the size of the department and the frequency of use of neuromuscular monitoring. Over 50% of all German anaesthesia departments limited the use of muscle relaxants to three. The use of laryngeal masks reduced the use of muscle relaxants. CONCLUSIONS: The survey regarding use of muscle relaxants in Germany could for the first time give an overview on the use of anaesthesia-specific substances in Germany. From the different frequencies of use and use modalities,conclusions could be drawn towards a standard of application for the year 2000. Changes in this standard would raise the need for further trend surveys. The methods of statistical analysis and survey evaluation can be used as a base for further surveys.