Variability in caries management decision-making in a dental school setting.

OBJECTIVE: To assess variability in caries management decision-making by faculty and dental students. Understanding sources of variability during training can aid in implementing evidence-based clinical decision-making in caries management. METHODS: A voluntary, anonymous survey including clinical scenarios was distributed online to dental students in their first (D1) and third-year (D3) of training, and to faculty in the Department of Cariology, Restorative Sciences and Endodontics. RESULTS: The response rate was 100% (108/108) for D1 students, 56% (73/130) for D3 students, and 39% (34/88; 12 full-time and 22 part-time) for faculty. D1 students, who were completing a cariology course, were in general more conservative in restorative thresholds for less severe caries lesions than D3 students and sometimes clinical faculty (e.g., for lesions at the DEJ, a significantly [p < 0.05] higher percentage of D3 students would restore these [53%] compared to D1 students and faculty [19% and 18%, respectively; p > 0.05]). For all groups, the threshold for doing restorative intervention was shifted toward less severe caries lesions as the caries risk increased (e.g., very few respondents would restore an occlusal lesion confined to enamel, with significantly [p < 0.05] less percentage of D1 students [lower risk scenario-LR = 4%; higher risk scenario-HR = 22%] compared to D3 students and faculty [LR = 15% and 18%; HR = 66% and 62%, respectively; p > 0.05]). Class lectures/preclinical instructors were the most important factor influencing decision-making for D1 students, versus clinical experiences/instructors for D3 students. CONCLUSION: Although the majority of respondents used best-evidence deciding caries management, there was variability in how to manage less severe lesions, with caries risk influencing clinical thresholds, and clinical experiences influencing students' decision-making over time.

The Cycle of Violence Revisited: Childhood Victimization, Resilience, and Future Violence.

The individual and social protective factors that help break the cycle of violence are examined. Specifically, this study investigates (a) the individual and social protective factors that reduce violent offending among previously victimized children, and (b) whether certain protective factors are more or less important depending on the type and frequency of childhood victimization experienced. Data on young adults from Wave III of the National Longitudinal Study of Adolescent to Adult Health are used (N = 13,116). Negative binomial regression models are estimated to examine the protective factors that promote resiliency to violent offending among individuals who reported being physically and sexually victimized as children. Results indicate that a number of individual and social protective factors reduce violent offending in young adulthood. With a few exceptions, these factors are specific to the type, frequency, and comorbidity of abuse experienced. The results suggest a number of promising approaches to break the cycle of violence among previously victimized children. Future research should move beyond explaining the cycle of violence to examine how the cycle may be broken.