Assessing outcomes of curricular change: a view from program graduates.

Graduates of dental programs constitute a stakeholder group that is able to provide unique information concerning the effectiveness of the dental curriculum in preparing them for dental careers. Following the implementation of planned curricular changes, graduates of the former and the new curricula were surveyed. Results indicate that, while both groups perceive themselves to have been adequately prepared by their D.D.S. program for practice, graduates of the new curriculum indicated a higher level of preparedness in several areas, especially regarding selecting, prescribing and administering pharmacotherapeutic agents. In addition, the results suggest that the change in the first two years from an emphasis on basic sciences and preclinical laboratory work to an early introduction to live dental patients and the integration of foundation sciences and clinical courses were endorsed. The evidence gathered from this alumni survey indicates that the reforms implemented in the dental curriculum were appropriate. Areas requiring further investigation are also discussed.

Employing oral examinations (viva voce) in assessing dental students' clinical reasoning skills.

The development and evaluation of a comprehensive oral examination system are described. These examinations are designed to measure, in an authentic manner, graduating students' understanding and use of the clinical reasoning and professional communications skills employed in the diagnosis, treatment, and management of realistic clinical situations. The examination cases were developed from actual clinic cases, enhanced to fit the requirements of the examination. Faculty members were provided with training sessions designed to promote consistency of administration and scoring. A mock oral examination was held to acquaint students with the process and to help reduce their anxiety. The results suggest that the oral examination is a reasonably valid and reliable approach to assessing clinical reasoning skills and that graduating students demonstrated competency in the areas tested.

Scores on the Group Embedded Figures Test by undergraduates in information management.

The Group Embedded Figures Test was administered to 63 undergraduates in a program for a Bachelor of Applied Arts in Information management. Distribution characteristics, sex differences, reliability, and internal consistency measures for this sample were compared with those for Witkin's original sample. In addition, item difficulty and discrimination coefficients are provided. Scores for this group show desirable measurement characteristics.

Citric acid demineralization of cementum and dentin: the effect of application pressure.

Previous work has shown that a 25-30% citric acid solution was the most effective concentration with which to demineralize dentin. The purpose of this investigation was to study the topography, using a scanning electron microscope, of root surfaces treated with a 30% citric acid solution using various application pressures. 20 freshly extracted human teeth were collected and stored in physiologic saline at room temperature. 3 root specimens, approximately 3x5x5 mm in size, were prepared from the coronal periodontally healthy area of each tooth. 30 specimens were root planed to expose dentin (dentin group) while the remaining 30 specimens were lightly scaled to remove periodontal soft tissue (cementum group). A freshly made 30% citric acid (CA) solution, (pH = 1.60), was applied to each of the experimental areas. Cotton pellets soaked in the citric acid solution were either placed (CAP), lightly rubbed (CAR) or heavily burnished (CAB) on the prepared root surface for 3 min. Pellets were resoaked every 30 s. The root sections were rinsed, fixed in glutaraldehyde, dehydrated in graded ethanol, critically point dried in liquid CO2 and sputter coated in gold. The treated surfaces were assessed for fibril tufting using scanning electron microscopy. Assessment was made of: (i) the % of surface area tufted; (ii) tufting depth (0-3); (iii) tufting density (1-3). Results of the study showed significantly more tufted surface area and greater tufting depth on both dentin and cementum for CAR and CAB compared to CAP. CAP produced a flat/mat fibril surface with no evidence of tufting.(ABSTRACT TRUNCATED AT 250 WORDS)

Dentin demineralization. The effects of citric acid concentration and application time.

Preliminary work has shown that the rate of dentin demineralization increases with increasing concentrations of citric acid. This rate subsequently diminishes at much higher concentrations. The purpose of this study was to more precisely identify the citric acid concentration which produces peak dentin demineralization and to determine if this demineralization process is time dependent. Flat dentin surfaces were prepared on the buccal and lingual sides of 15 bovine molars. 8 depressions were made in each dentin surface using a #8 round bur in a high-speed handpiece with air-water coolant. Various concentrations of citric acid solutions (weight per cent) were prepared, e.g., 0%, 10%, 20%, 25%, 30%, 35%, 40%, 65% and their respective pH's recorded. 3 microliters of each citric acid solution were placed in individual depressions on the dentin surfaces and left undisturbed for 1, 2 or 3 min. Cotton pellets were used to soak up the citric acid solution, along with any dissolved calcium, and were subsequently placed in 10 ml of 18 Me omega water. The parts per million calcium found in each water sample were determined using atomic absorption spectrophotometry. Peak dentin demineralization for 1-, 2- and 3-min application times occurred at 30% (pH = 1.55), 25% (pH = 1.62) and 25% (pH = 1.62) citric acid concentrations/(pH), respectively. Dentin demineralization was found to be time-dependent for all citric acid solution concentrations. The clinical significance of these findings is discussed.

Surface topography of demineralized dentin preceded by formalin fixation.

Formalin treatment of dentin, prior to burnishing demineralization, results in a "tufted" collagen surface that may optimize bonding of hydroxyethyl methacrylate dentinal bonding agents. The purpose of this study was to determine if there is a clinically acceptable formalin treatment time that will yield a deeply tufted collagen surface. The exposed dentin of periodontally healthy and periodontally diseased human teeth was treated with formalin for various treatment times before "burnishing" demineralization with citric acid. Photographs of the specimens revealed that there was a statistically significant difference in the number of tufted surfaces found in the healthy group, as a whole, and the number found in the diseased group. No statistically significant difference was found among fixation times within either tooth group. It was concluded that 2 minutes of fixation was sufficient to produce a tufted fibrillar surface.

Ridge contour related to esthetics and function.

Maxillary anterior fixed prostheses may be compromised when pontics are adapted to deficient residual alveolar ridges. This study determined the effect of ridge contour on esthetics and function. Thirteen men and 17 women, 23 to 75 years of age, who had received maxillary anterior fixed prostheses during the period 1976 to 1986 participated. A six-item structured interview was conducted for each subject to determine causes of satisfaction or dissatisfaction with esthetics and function. Pontic esthetics were also determined by examination using a 12-point esthetic index that was developed and pretested for this study. Residual ridge contour was classified according to Siebert as being deficient buccolingually (I), deficient apicocoronally (II), or deficient in both areas in combination (III). The results showed that patients with class I ridges had a higher subjective level of satisfaction with their prosthesis than did those with class II or III ridges. Esthetic index scores were significantly higher (p less than 0.05) for type I (10) than for type II (7.4) or III (7.3) using a post hoc Scheffé comparison. These results suggest that consideration be given to ridge augmentation prior to construction of maxillary anterior fixed prostheses, particularly when class II or III defects are present.

Citric acid burnishing of dentinal root surfaces. A scanning electron microscopy report.

The integrity of formalin-fixed periodontally diseased root surfaces was assessed following root planing to dentin and citric acid application. Extracted human teeth (fixed in 10% formalin), with crowns removed, were vertically sectioned in half. A horizontal groove on each proximal surface marked the extent of attachment loss. The diseased root surface was vigorously root planed to expose dentin. Cotton pellets, soaked in a saturated solution of citric acid, were either "placed" (control) or "burnished" (vigorously rubbed using root planing pressure) (experimental) on the prepared root surface for 5 min. Pellets were changed 2 times/min. The teeth were fixed and prepared for scanning electron microscope viewing and photography. A representative print was selected for each specimen. To confirm differences between test and control groups, untrained raters were asked to perform 2 sorting exercises. First, they were asked to sort the representative photographs of each specimen into 2 piles based on surface characteristics. Second, they were asked to choose from pairs of photographs, representing matched specimens, the one photograph which appeared to have the greatest collagen surface area. The surfaces of experimental specimens revealed patent dentinal tubules and an intertubular area with a very distinct "shag carpet" appearance of deeply tufted collagen fibrils. Control samples also exhibited open dentinal tubules, yet the intertubular surface displayed a "matted collagen" surface. Results of the 2 sorting exercises confirm that burnishing of formalin-fixed dentin root surfaces for 5 min with cotton pellets soaked in a saturated solution of citric acid consistently produces a distinct tufted collagen fibril surface.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison of cefonicid and cefoxitin for preventing infections after vaginal hysterectomy.

One hundred women who underwent vaginal hysterectomy were randomly and prospectively divided into two study groups, one to receive a single, 1-g preoperative dose of cefonicid and the other to receive 2 g of cefoxitin preoperatively and postoperatively for a total of four doses. There were no differences between the two groups in the rates of febrile morbidity, urinary tract infection, serious infection, noninfectious morbidity or duration of hospitalization. Both cefonicid and cefoxitin were equally effective in preventing postoperative infectious morbidity and demonstrated little difference in side effects. The single-dose regimen of cefonicid provides the advantages of decreased cost and prolonged therapeutic tissue levels when compared to cefoxitin. Perioperative antimicrobial prophylaxis with this single-dose cephalosporin provides a cost-effective regimen that is both safe and prophylactically effective.