Expanding the functions of dental assistants in Bulgaria and perceptions about their role in the Bulgarian healhcare workforce.

AIM: The study queries a sample of dentists and dental assistants in Bulgaria about their understanding and perceptions of Expanded Function Dental Auxiliaries (EFDA). The study considers whether expanding the skillset of dental assistants to function in specific scenarios without personal supervision by the dentist may be a viable strategy to address various oral health inequities in the country. MATERIALS AND METHODS: An anonymous survey was conducted among 103 practicing dentists and 100 dental assistants throughout the country. The questionnaire consisted of 20 questions that probed respondents' understanding about the duties performed by EFDAs and their potential to increase productivity and efficiency of the dental workforce. Sociological (poll) and statistical (alternative analysis) methods were used in the survey. RESULTS: The majority of respondents were female. Most worked in the larger cities. One worked in a village. Most were ethnic Bulgarians and none were Roma, reflecting the racial imbalance in the national workforce. Two-thirds (67%) believed that dental assistants with appropriate training are capable of doing expanded dental procedures without personal supervision by a dentist. The majority (83.7%) believed that EFDAs could improve efficiency of a dental practice, while 58.1% indicated that with appropriate training, they could perform expanded duties as well as the dentist. However, only one third believed that EFDAs could increase practice output (38.9%); enhance the quality of the dentist's work (37.4%); or decrease patient anxiety (31.5%). Though most respondents (78.3%) believed that a patient would not be receptive to an EFDA placing a restoration without personal supervision by the dentist, two thirds of respondents (66.5%) would like to see dental assistants trained to perform expanded duties otherwise reserved for dentists. Most respondents felt that EFDAs could help to build a well-functioning dental team. CONCLUSIONS: Most respondents believed that EFDAs can benefit the efficiency of a practice, suggesting that Bulgarian dental professionals would respond favorably to enhancing the skillset of assistants with expanded functions. The study suggests they are skeptical about "general" versus "personal" supervision. EFDAs may potentially provide improved access by underserved communities, while building a more inclusive oral healthcare workforce reflective of the population.

Dental students' knowledge and reporting of child maltreatment: Where are we at today both here and abroad?

INTRODUCTION: The study investigates whether suspected child abuse/neglect (SCAN) training in dental school has increased dental student SCAN knowledge and, consequently, reporting. MATERIALS AND METHODS: A 25-question survey used to assess for SCAN knowledge in 2006 was readministered to a group of dental students at one US dental school in St. Louis, MO, which has integrated SCAN training into its curriculum for at least 3 years, and one dental school in Plovdiv, Bulgaria, which has not integrated SCAN training as a control. RESULTS: Of 16 questions assessing for SCAN knowledge, group US students answered 14 questions correctly and performed better than US students surveyed in 2006. By comparison, group Bulgaria students with no SCAN training answered 15 questions correctly. When asked what their legal responsibilities were concerning SCAN, 96.4% of group US students knew they were required to report, whilst only half of group Bulgaria (48.9%) responded correctly. The results suggest that integrating SCAN training into the curriculum is effective in conveying this important message. However, in a question asking students whether they encountered a child at dental school who they suspected was the victim of child maltreatment and if so, how did they act, there were no indications that students at either school made any reports as the question was either answered "no" or left blank. The number of SCAN cases reported by campus authorities was also zero. CONCLUSION: The results suggest that classroom training in SCAN is not motivating students to report SCAN at their dental school, despite increased knowledge.

Improved Yale Total Tic Severity Score Due to Craniofacial Manipulation With an Oral Appliance.

BACKGROUND: This study evaluated a novel treatment approach using the concept of cranial facial manipulation with an oral appliance, the TicTocStop Tic Guard (TTSTG), also known as the Tic Guard, to determine its safety and efficacy in the treatment of Tourette syndrome (TS) and chronic tic disorders (CTDs). METHODS: A two-center study was undertaken at the University of Tennessee Health Science Center and a facility on Long Island, New York. A total of 77 subjects enrolled between the centers upon referral from local neurologists and via Internet enrollment; 67 subjects started the study, and 58 completed the study. A licensed Cognitive Behavioral Intervention for Tics (CBIT) determined the subjects' Yale Total Tic Severity Score (YTTSS) for tics at enrollment, after 1-week sham appliance, after 1-week Tic Guard, and after 10-weeks Tic Guard. RESULTS: The results showed statistically significant improvement in the YTTSS with both the sham appliance and the Tic Guard with more robust improvement with the Tic Guard. The sham appliance resulted in a 25% overall reduction in tic severity, while the Tic Guard resulted in a 39% overall reduction in tic severity. There were no serious adverse events reported with either device. CONCLUSIONS: This study demonstrated significant reduction in YTTSS using the Tic Guard with no reported serious adverse events. As a result, this device could be considered for inclusion in treatment modalities offered to patients with TS/CTD.

An International Survey of Female Dental Students' Perceptions About Gender Bias and Sexual Misconduct at Four Dental Schools.

As women enter the dental profession in increasing numbers in North America and around the world, the questions of how they perceive their environment and what kind of barriers they face are important subjects to be addressed. The aim of this study was to assess and compare women dental students' perceptions of bias in their environment and experiences of sexual misconduct at one dental school in each of four countries. In spring 2017, 1,293 female students at four dental schools in the U.S., Bulgaria, Brazil, and India were invited to participate in a 24-item survey developed by researchers from the four countries; 990 students responded (response rate 76.6%). The overall majority of the respondents reported thinking the admissions process at their school was fair (79.7%); but a fifth of U.S. and Brazilian students perceived their school was not fully embracing of females, with most Bulgarian students agreeing (87.2%) and all Indian students disagreeing. Most respondents overall perceived that male faculty members did not favor male students (79.5%) and did not think there was discrimination against female students by faculty (87.1%), but half of the U.S. respondents reported feeling discriminated against by both male faculty and male students. When the responses "I've been verbally harassed" and "I've been somewhat verbally harassed" were combined, 10.1% of the U.S. respondents reported verbal harassment, compared to 20% of Brazilian, 15% of Bulgarian, and 2% of Indian respondents. When the responses "I've been sexually assaulted" and "I've been somewhat sexually assaulted" were combined, 6% of U.S. respondents reported being sexually assaulted, compared to 6.2% of Brazilian, 2.5% of Bulgarian, and none of the Indian respondents. Almost half (46.9%) of these students overall perceived their school was not or only somewhat vigilant about issues of sexual misconduct, and only 54% said they would feel comfortable or very comfortable reporting misconduct. These results suggest that academic dental institutions in all four countries need improvements to make their environments more equitable and free of bias and sexual misconduct.

A novel antimicrobial and remineralizing toothpaste containing CaCl2/chitosan microspheres.

PURPOSE: To investigate the feasibility of exploiting amorphous calcium phosphate (ACP) formed in situ from chitosan calcium microspheres and phosphate ions in water during brushing for caries control. METHODS: A prototype toothpaste, namely Chi-ACP paste, was specially formulated containing CaCl2/chitosan microspheres. The efficiency of Chi-ACP paste for remineralization on human tooth enamel was evaluated via an in vitro pH cycling approach. After 15 demineralization/remineralization cycles, the treated teeth were analyzed using scanning electron microscope (SEM) /energy dispersive X-ray spectroscopy (EDX), and polarized light microscope (PLM). RESULTS: EDX analysis showed the treated enamel in the Chi-ACP paste group had statistically significantly higher calcium content and Ca/P weight ratios than those in the negative control group, while the MI plus group had a slightly higher Ca content and a slightly higher Ca/P weight ratio. PLM analysis revealed that the Chi-ACP paste group had a larger remineralization band in treated enamel than the negative control group, although there was no statistically significant difference on the demineralization depths in the enamel among the three groups. CLINICAL SIGNIFICANCE: Antibacterial chitosan could be used to encapsulate CaCl2 and then formulated into toothpaste for caries control through in-situ formed amorphous calcium phosphate (ACP) during brushing.

Influence of a cylindrical crosshead on shear bond testing of composite-tooth interfaces.

The effect of a cylindrical crosshead on shear bond strength of composite to dentin was assessed by finite element analysis (FEA) after shear bond testing thirty mandibular molars restored with composite cylinders (Tetric EvoCeram-3 mm diameter) perpendicular to conditioned dentin. Cross-sectional geometric models were created with quadrilateral linear plane stress elements. Stress distributions for normal, shear, and major principal stresses were plotted. Mean shear bond strength for the experimental group was 23.9 MPa (±4.54), about 15-75% higher than values reported with other methods. FEA showed localized 'hot spots' (±16-20 MPa) at the corners of the base of the adhesive layer under a 20 N vertical load. Principal stresses across the composite-dentin interface were lower (±12-16 MPa), but significantly homogenous, approximating closely the nominal strength value. With uniform stress distributions across the adhesive layer, FEA confirmed that a cylindrical crosshead may be an optional tool to improve shear bond testing of dental materials.

Effects of atmospheric non-thermal argon/oxygen plasma on biofilm viability and hydrophobicity of oral bacteria.

PURPOSE: To evaluate the bactericidal effects of atmospheric non-thermal argon/oxygen plasma on in vitro oral biofilms constructed from S. mutans and/or S. sanguinis, and the influence of the plasma on the virulence properties of A. oris. METHODS: In vitro oral biofilms were constructed in the wells of 48-well plates from S. mutans and/or S. sanguinis. The wells containing constructed biofilms and various amounts of phosphate-buffered saline (PBS) were treated with non-thermal argon/oxygen plasma brush for 2 minutes. The methylthiazolyldiphenyl-tetrazolium bromide (MTT) assay and Live/Dead assay were used to evaluate the viability of biofilms in those wells after the plasma treatments. Meanwhile, A. oris suspensions were treated with the plasma and then evaluated for their virulence properties by measuring the hydrophobicity and co-aggregation capability of treated A. oris. RESULTS: The MTT assay showed that exposure to non-thermal plasma for 2 minutes significantly reduced the viability of bacteria in both single-species and two-species biofilms of S. mutans and S. sanguinis with the reductions of up to 99%. Meanwhile, plasma treatment also altered the hydrophobicity of A. oris, and reduced their capability to co-aggregate with S. sanguinis. CLINICAL SIGNIFICANCE: The results from this study demonstrated that atmospheric non-thermal argon/oxygen plasma could effectively deactivate oral bacteria biofilm by decreasing bacterial viability as well as reducing their hydrophobicity and co-aggregation capability.

Dental and Dental Hygiene Intraprofessional Education: A Pilot Program and Assessment of Students' and Patients' Satisfaction.

Interprofessional and intraprofessional education (when students from two or more professions or within the same profession, respectively, learn about, from, and/or with each other) is crucial for effective interdisciplinary collaboration. The aims of this study were to assess the effectiveness of a clinical intraprofessional education program for dental and dental hygiene students, based on students' expectations and satisfaction with the program and patients' satisfaction with the team-based care. The pilot program was developed at the University of Tennessee Health Science Center College of Dentistry, where dental hygiene students were paired randomly with dental students scheduled for prophylaxis, scaling and root planing, or periodontal maintenance. Surveys with questions about the students' expectations and satisfaction were distributed to 89 senior dental students and 27 senior dental hygiene students before and after team-based procedures. Another survey was distributed to 17 patients asking about their satisfaction with the team-based care. All 27 dental hygiene students (100% response rate), 51 dental students (57.3% response rate), and all 17 patients (100% response rate) participated in the surveys. The results showed that both the dental and dental hygiene students had high expectations and were overall satisfied with the intraprofessional education. The students' expectations and perceived educational gap (difference between expectations and satisfaction) differed for the dental and dental hygiene students (p<0.001). The male dental students were also more satisfied than the female dental students (p<0.01). Overall, the program met or exceeded the students' expectations, and the patients were overwhelmingly satisfied with the team-based care. These results suggest that this intraprofessional practice model provided an effective educational experience for both dental and dental hygiene students and patients. The differences between the dental hygiene and dental students' expectations will help in the design of more effective training that promotes intraprofessional and interprofessional teamwork.

Headache and jaw locking comorbidity with daytime sleepiness.

PURPOSE: To investigate the relationship between craniofacial pain symptoms (painful conditions present in the cranium and face, including jaw joint-related pathology and primary headache conditions) and daytime sleepiness, determined by the Epworth sleepiness scale (ESS), to correlate comorbidity as well as potential predictive factors. METHODS: 1,171 patients seeking care for chronic pain and/or sleep-related breathing disorders (SRBDs) at 11 international treatment centers were included in the study. Patients completed the ESS and identified their primary craniofacial pain and sleep pathology symptoms. Descriptive statistics and regression analysis were performed to determine comorbidities between craniofacial pain symptoms and daytime sleepiness, and factors predictive of higher ESS scores. RESULTS: There was high comorbidity of some craniofacial pain symptoms and high ESS scores, including headaches. In addition, for the first time to our knowledge, orthopedic craniofacial dysfunction (i.e., jaw locking) was correlated with, and predictive of, high ESS scores.

The SPA Factor or Not? Distinguishing Sex on the Basis of Stereotyped Tooth Characteristics.

OBJECTIVES: The study examines whether faculty, dental students, or laypeople can determine the sex of a patient solely by looking at the shape of their teeth. METHODS: Fifty faculty, 100 students, and 50 patients evaluated 40 photographed smiles for 8,000 observations. The subject group was comprised of 20 males and 20 females. Contingency table analysis was used to determine whether all study participants labeled the smiles similarly and to look for differences within each group. Care was taken to model the effect of individual variation. A nested logistic regression was employed to ascertain differences between faculty, students, and laypeople and to account for the correlation within subjects' responses. RESULTS: It was expected that 50% of the smiles would be labeled as male and 50% as female. Statistical differences were found for the total group, as all participants were more likely to rate a smile as female (χ2 = 38.19, P < .0001). Using the odds ratio, study participants were 1.32 times more likely to view a smile as female. CONCLUSION: Stereotyped "feminine" and "masculine" tooth anatomy characteristics could not predictably be related to the sample smiles either by faculty, students, or public.

A Novel Protocol to Evaluate Hard and Soft Tissue Relationships in Three Dimensions without the Use of Additional Radiographic Studies.

OBJECTIVE: The evaluation of hard and soft tissue relationships is an important part of the study of facial morphology, craniofacial development and orthodontic treatment and outcomes. Historically, this evaluation has occurred in two dimensions. The purpose of this study was to develop a protocol to study the relationships of hard and soft tissues in three dimensions without the use of additional radiation. MATERIALS AND METHODS: Stereo photogrammetric images created by the 3dMDTM Face system and models digitized using the Motion View scanner were utilized. Using a previous lateral cephalometric image from the orthodontic records appointment, these hard tissue and soft tissue images were integrated. RESULTS: The integration of all data sets was accomplished with an average error rate of less than .05mm. A method was developed, thus allowing measurement of soft tissue thicknesses and changes over treatment time in relation to the underlying dentition. CONCLUSIONS: Evaluation of hard and soft tissue relationship in three dimensions can be accomplished without the use of additional radiographic studies.

Changes in the Clinical Training of Dental Students at the University of Tennessee College of Dentistry.

Dental education is an ever evolving process due to continual advancements in patient treatment. This article provides the reader with a look into an educational process that affords the student with better clinical experience without an increase in clinical training hours. When a comprehensive care model of education is introduced into a traditional care setting, the comparison of procedures completed with the previous 5 years results indicate an increase in the number of amalgam and composite restorations placed of 26% and an increase in crowns placed of 32.9%. Integration of the dental hygiene program and additional remote sites afford new populations of patients where clinical skills can be developed which will result in a graduate more able to go directly into private practice.

Non-Orthodontic, Non-Restorative Closure of Acquired Diastemata.

AIM: To illustrate the reversibility of "pathologic tooth migration" in several patients that were managed by periodontal therapy alone, along with a review of the relevant literature. BACKGROUND: Pathologic tooth migration (PTM) is a common phenomenon among patients seeking dental care. Different etiologic factors have been implicated in PTM: loss of periodontal support, occlusal interferences, posterior bite collapse, and various oral habits such as: lip biting, tongue thrusting, and playing wind instruments. Identification of all the causative factors involved in PTM is crucial for a successful treatment outcome. Managing severe cases of acquired diastemata may necessitate a complex and a sequential intervention involving periodontic, orthodontic and prosthodontic measures. However, "spontaneous regression" of teeth to their original position may occur in certain cases after elimination of the offending factors. CONCLUSION: "Spontaneous" closure of acquired diastemata could occur following surgical and/or non-surgical periodontal therapy or removal of occlusal interferences. Correction of pathologically migrated teeth without orthodontic or restorative treatment is feasible, but unpredictable.

Efficacy of Philips Sonicare AirFloss compared to manual brushing and flossing: an in vitro study.

The purpose of this study was to investigate the difference in reduction of an interproximal surface coating with the use of Sonicare Airfloss, tooth brushing or dental flossing since there are currently no articles available comparing dental flossing to Sonicare Airfloss. Three groups of six typodont teeth were sprayed with Occlude Indicator Spray as a test surface coating. Each group was treated with one removal method: Sonicare Airfloss, tooth brushing or dental flossing. In all groups, when used as a single removal method, Sonicare Airfloss resulted in the least removal of the surface coating when compared to either tooth brushing or flossing.

A simplified approach to implant restorations using innovative digital technology.

Digital impressions and CAM/CAD systems are currently burgeoning dental technologies. This article presents a case study describing the clinical protocol necessary to produce multiple crown restorations supported by dental implants.

Student perceptions about the mission of dental schools to advance global dentistry and philanthropy.

In this study, 491 dental students at one dental school in the United States and one in Bulgaria were surveyed to assess their perceptions about the mission of dental schools to advance global dentistry and philanthropy. The study included questions about prior involvement in charitable dental missions. Many respondents felt that their dental school does not advance global dentistry nor adequately teaches students the virtues of philanthropy and volunteerism. The majority agreed, however, that dental schools have a moral obligation to raise the level of oral health care worldwide and help underserved communities access basic dental care. They reported that an opportunity to spend a semester at a foreign dental school would enhance their dental education in ways that are not presently fulfilled; help them better understand cultural diversity; and teach them about philanthropy and volunteerism. In their opinion, international exchange programs that provide clinical rotations and field experiences in economically challenged and underserved areas of the world would a) foster the global advancement of dentistry; b) promote an appreciation for cultural diversity and socioeconomic disparity in the communities that graduates will be serving; and c) teach students the virtues of philanthropy and volunteerism. This study may contribute to understanding factors affecting student involvement in programs to advance global dentistry.

The role of occlusal loading in the pathogenesis of non-carious cervical lesions.

PURPOSE: To evaluate the putative role of occlusal loading in the pathogenesis of non-carious cervical lesions (NCCLs) in subjects who exhibited mixed excursive guidance [i.e., immediate canine guidance on one side and group function (GF) on the other]. METHODS: 20 subjects with Angle Class 1 occlusion and having from 1 to 5 NCCLs on separate teeth were selected. Only subjects who displayed mixed excursive guidance were recruited so that they could serve as their own controls. Non-carious cervical lesions were recorded on casts mounted in semi-adjustable articulators. RESULTS: On the GF sides, 22.5% of all teeth that contacted in working excursions exhibited NCCLs; only 2.1% of the teeth on the canine guided sides exhibited NCCLs, which were found exclusively in canines. Although a case for the multifactorial etiology of NCCLs remains strong, our data, albeit limited, seems to support the dominant role of occlusion in lesion formation.

Abfraction lesions--where do they come from? A review of the literature.

The theory of non-carious cervical lesions (NCCLs) suggests that tooth flexure arising from cyclic, eccentric occlusal forces causes their formation and progression in vulnerable cervical regions of teeth. The etiology is still controversial. Attrition, corrosion, abrasion and stress-corrosion might act alone or in combination to initiate and perpetuate lesions. This review of the literature provides the basis for the diagnosis that can be used in consideration of treatment options.

An innovative behavioral science curriculum at the University of Tennessee College of Dentistry.

Communication skills have long been associated with practice success in dentistry. The Commission on Dental Accreditation's standards state that "Graduates must be competent in the application of the fundamental principles of behavioral sciences" and that "Graduates must be competent in managing a diverse patient population and have...interpersonal and communications skills." A recent survey of U.S. dentists found an underutilization of communication skills by general dentists. The University of Tennessee College of Dentistry strives for continuous improvement and has implemented an innovative behavioral science curriculum to improve students' communication skills, consistent with the College's "patient-centered, comprehensive care" philosophy. We describe the design and implementation of our "Patient-Centered Dentistry" course, in which third-year dental students practice communication skills with simulated patients in the Kaplan Clinical Skills Center on the UTHSC campus. The clinical simulations involve the following scenarios: The Initial Interview with a Patient, Presenting a Treatment Plan, Treating Patients with Fear and Anxiety, Interviewing Considerations for Difficult Patients, Delivering Distressing News to Patients, and Coping with a Drug-Seeking Patient. Student simulations were videotaped and assessed by course instructors as well as clinical faculty, and students received immediate feedback by instructors and clinical faculty after their simulations. Students were provided with the opportunity to view their simulation performance and to reflect on their performance in order to recognize their communication strengths as well as areas for improvement. The use of simulation experiences is becoming a widespread and expected practice in health care education. The Patient-Centered Dentistry course provides students with the opportunity to experience the kinds of real-life situations that they would experience in dental practice, without risks to patients. It provides students with the opportunity to assess their communication skills, make mistakes and improve.

Fluoride uptake by human tooth enamel: topical application versus combined dielectrophoresis and AC electroosmosis.

PURPOSE: To compare fluoride uptake by enamel after applying 1.23% acidulated phosphate fluoride gel to human tooth enamel topically (n = 12) or with combined dielectrophoresis and AC electroosmosis (DEP/ACE) at frequencies of 10, 400 and 5,000 Hz (n = 12) for 20 minutes. METHODS: DEP/ACE induced nonuniform electrical fields with three alternating current frequencies to polarize, orient, and motivate fluoride particles. Fluoride concentrations were measured at various enamel depths using wavelength dispersive spectrometry. Data were analyzed by ANOVA/Student-Newman-Keuls post hoc tests (P < or = 0.05). RESULTS: Fluoride concentrations in the diffusion group were significantly higher than baseline readings at 10, 20 and 50 microm depths. Fluoride concentrations in DEP/ACE-treated teeth were significantly higher than the diffusion group at 10, 20, 50, 100, 200 and 300 microm (ANOVA/Student-Newman-Keuls post hoc, P < 0.05). Fluoride uptake with DEP/ACE was substantially higher than diffusion at 10, 20, 50, 100, 200 and 300 microm depths (paired t test, P < 0.05). DEP/ACE transported fluoride up to 300 microm deep, whereas conventional fluoride application was comparatively ineffective beyond 20 microm depth (P < 0.05). Compared to passive diffusion, fluoride uptake in enamel was significantly higher in the DEP/ACE group at 10, 20, 50, 100, 200 and 300 microm depths (P < 0.05). DEP/ACE drove fluoride substantially deeper into human enamel with a difference in uptake 1,575 ppm higher than diffusion at 100 microm depth; 6 times higher at 50 microm depth; 5 times higher at 20 microm depth; and 7 times higher at 10 microm depth. Fluoride levels at 100 microm were equivalent to long-term prophylactic exposure.