Gender issues in clinical dental education.

In spring 2011, a study was initiated to investigate the nature and extent of gender issues in clinical dental education at the University of North Carolina at Chapel Hill School of Dentistry. Surveys were sent to 236 dental students in the second, third, and fourth years; eighty-six (36.4 percent) responded. Surveys were also sent to seventy-one full-time dental faculty members who had clinical contact with students, and thirty-four (47.9 percent) responded. Of the student respondents, fifty-one were female and thirty-five were male; the faculty respondents were ten women and twenty-four men. A significantly greater proportion of female than male student respondents reported that issues related to gender affected clinical training. The female students also responded that mentorship was less available and less in content for them compared to males, and significantly more female than male students reported lower self-confidence in clinical settings. Among faculty respondents, a higher proportion of women than men reported insufficient awareness of gender issues. These faculty members also reported thinking that female students showed more empathy toward patients than males. Both faculty and student respondents said that female faculty members received less respect from students than did male faculty members. Forty-eight percent of the students reported experiencing or witnessing gender-based prejudice in clinical settings, and 7.0 percent reported experiencing or witnessing unwelcome sexual advances or conduct. A more robust study to include other dental institutions is needed. With confirmation of specific gender issues, corrective measures could be recommended to improve the climate for both females and males in the clinical component of dental education.

Nightguard vital bleaching: side effects and patient satisfaction 10 to 17 years post-treatment.

STATEMENT OF THE PROBLEM: The long-term patient satisfaction and safety of nightguard vital bleaching (NGVB) requires further evaluation. PURPOSE OF THE STUDY: The purpose of this study was to evaluate patients' satisfaction and identify side effects of NGVB up to 17 years post-treatment. MATERIALS AND METHODS: Thirty-one participants who had completed previous NGVB studies using 10% carbamide peroxide were contacted at least 10 years post-treatment (range 10-17 years, average 12.3 years). Participants reported shade satisfaction (very satisfied [VS], partially satisfied [PS], or not satisfied [NS]) as well as potential complications. Participants had teeth # 6 to 11 examined for tooth vitality, gingival inflammation (Löe's Gingival Index [GI]), and radiographically for external cervical resorption (ECR). RESULTS: All of the participants had successful lightening of their teeth. Sixty-one percent (19) had not retreated their teeth. Of those who had not retreated their teeth and who responded to the question of whitening satisfaction, 31% (4/13) were VS, 54% (7/13) were PS, and 15% (2/13) were NS with their current shade. Of those who had retreated their teeth, all were VS or PS. Ninety-one percent of the examined teeth had GI = 0 (normal), 7% had GI = 1 (mild inflammation), and 2% had GI = 2 (moderate inflammation). Sixty-nine percent of teeth tested responded to a cold stimulus. Radiographs did not detect ECR or apical lesions. No participant reported having a gingival biopsy post-treatment, and 87% would whiten again. CONCLUSIONS: Patient satisfaction with NGVB may last as long as 12.3 years in average (range 10-17 years) post-treatment. GI and ECR findings were considered within the normal expectations for the sample studied, suggesting minimal clinical post-NGVB side effects up to 17 years. CLINICAL SIGNIFICANCE: Nightguard vital bleaching provides patient satisfaction with minimal side effects up to 17 years post-treatment.

Evaluation of side effects and patients' perceptions during tooth bleaching.

OBJECTIVE: The objective of this nightguard vital bleaching (NGVB) study was to compare tooth sensitivity (TS), gingival irritation (GIr), and other side effects, as well as patients' perceptions during tooth bleaching, from treatment with experimental 5 and 7% hydrogen peroxide (HP) bleaching solutions with those of a commercially available 10% carbamide peroxide (CP) product. MATERIALS AND METHODS: Sixty-one participants completed the study wearing a scalloped maxillary treatment tray without reservoirs with the different concentrations of bleaching gels for 30 minutes twice a day for 7 days. Parameters evaluated were changes in gingival index (GI), nonmarginal gingival index, nongingival oral mucosal index, and tooth vitality. Participants were seen pretreatment, after 7 treatment days, and 1 week post-treatment. A daily log form to record TS and GIr was completed by each participant as well as a sensitivity questionnaire at each appointment. Additionally, at 10 months post-treatment, a questionnaire was sent to the participants concerning TS and GIr relative to the treatment process. RESULTS: Data from end-of-treatment questionnaires, daily log forms, and clinical examination revealed a statistical difference (p < or = 0.05) in the patients' ranking of and days of TS and GIr between group S (7% HP) and group T (10% CP, control group) at the end of active treatment. There also existed a statistical clinical change in the GI levels for groups R and S compared with the control group T. There was no statistical difference (p > 0.05) in any of the parameters evaluated among the three products at 7 days or 10 months post-treatment. CONCLUSIONS: Participants in group S reported significantly more TS, GIr, and days of each compared with the control. There also existed a significant clinical change in the GI levels for groups R and S compared with the control group T. There was no significant difference among the three products at 7 days post-treatment. After ending treatment, TS/GIr was resolved in 2 to 3 days and did not recur during the 10 months post-treatment. CLINICAL SIGNIFICANCE: The experimental HP bleaching solutions, as described in this study, can be used in NGVB with no long-term side effects as evaluated in this study for up to 10 months post-treatment.

Urgent care in the dental school setting: analysis of current environment and future challenges in emergency dental education.

Urgent dental care education is a critical aspect of the D.D.S. curriculum as dental students must be adequately prepared to face real-world dental emergency challenges in practice. Dental emergency education is likely the most variable component of the dental curriculum. To assess potential differences in emergency education, a sixteen-question survey was sent to directors of urgent care of all fifty-six U.S. dental schools addressing clinic operation, demographics, treatment, integration into the D.D.S. curriculum, and provision of care for indigent populations. The response rate was 88 percent. Results indicate a need for earlier integration of urgent dental care education into the D.D.S. curriculum, more pediatric emergency experiences for D.D.S. students, and a more rigorous academic approach in assessing student competency while on rotation in the urgent care service. In addition, access to emergency dental care has become increasingly difficult for indigent populations due to lack of state-supported funds; further exploration of sources of external funding for such care is warranted.

Aspiration and ingestion in dental practice: a 10-year institutional review.

BACKGROUND: This article is an institutional retrospective review of incidents involving aspiration and ingestion of dental foreign objects at a large multidisciplinary dental educational facility. It was undertaken to determine which dental procedures were more likely to involve aspiration or ingestion, as well as to evaluate the outcome of these adverse incidents. METHODS: The inclusion criteria involved all patients who were documented to have experienced loss of dental instruments or material behind the posterior pharynx during a 10-year consecutive period. The dental and medical records of these patients were analyzed, and the outcomes of the adverse events fell into three categories: aspiration, ingestion, or neither aspirated nor ingested. The authors also noted the type of dental instrument and the specialty or area of dentistry in which this event occurred. RESULTS: There were 36 documented cases. Twenty-five of these were instances of ingestion and one was an aspiration. In 10 cases, aspiration and ingestion were ruled out through radiographic examination or the object was retrieved from the patient's mouth. CONCLUSIONS: Fixed prosthodontic therapy had the highest number of incidents of adverse outcomes. Ingestion was a more prevalent outcome than aspiration. Dental procedures involving single-tooth cast or prefabricated restorations involving cementation have a higher likelihood of aspiration. CLINICAL IMPLICATIONS: The implications for clinical practice include the recognition of risk that dental therapy demands in regard to the airway and posterior pharynx, documentation and follow-up of adverse outcomes, and the use of preventive measures such as rubber dams or gauze throat screens or floss ligatures.