Ana Karina Mascarenhas

BACKGROUND: The authors evaluated the effectiveness of the oral brush biopsy technique as a diagnostic tool in detecting dysplastic oral lesions.METHODS: In this cross‐sectional study, pathologic reports (n = 152) from the scalpel biopsies (tissue samples) in patients who previously tested either “positive” (n = 3) or “atypical” (n = 149) for dysplasia by brush biopsy (OralCDx) were evaluated. Information on the age and sex of the patient, the site of the lesion, the brush biopsy results, and the histopathologic diagnosis of the scalpel biopsy was collected. The positive predictive values (PPVs) for “abnormal,” “atypical,” and “positive” brush biopsies were determined.RESULTS: Overall, the PPV of an abnormal brush biopsy was only 7.9% (95% confidence interval [CI], 4.2%‐13.4%), and the PPV of an “atypical” brush biopsy was 7.4% (95% CI, 3.7%‐12.8%). Of the 3 positive brush biopsies, only 1 was identified as dysplastic. The proportion of false‐positive biopsy results was as high as 92.1% (95% CI, 86.6%‐95.9%).CONCLUSIONS: The OralCDx technique overestimated dysplastic lesions and produced a high number of false‐positive results. Cancer 2009. © 2009 American Cancer Society.

The purpose of this clinical trial was to test the use of a primer and bonding agent to increase the retention of a fissuresealant in a group of Kuwaiti children. In 78 6- to 9-year-old children who required sealants in all 4 permanent frst molars, sealants were placed in 2 teeth using a primer and bond (3M Scotch Bond) and in 2 teeth without primer and bond. Sealant retention was evaluated 1 and 2 years later. Sealant retention was scored as: (1) complete retention; (2) partial loss of sealant; and (3) complete loss of sealant Caries was scored for those teeth in which the sealant was partially or completely lost At the 2-year examination, in teeth sealed with primer and bond (a) 64% of the sealants were completely retained; (b) 23% were partially lost; and (c) 13% were completely lost. In teeth sealed without primer and bond: (a) 68% of the sealants were completely retained; (b) 20% were partially lost; and (c) 12% were completely lost There was no difference in sealant retention (P=.22) and caries (P=.56) in teeth sealed with and without bond. In multivariate analyses after controlling for age, gender, tooth surface, and arch, no differences in sealant retention and caries were seen. If a proper technique is used in sealant placement, primer and bond does not enhance sealant retention.

Community‐based dental education programs such as externship programs have become an integral component of dental school education. Qualitative evaluation of externship programs has captured increased confidence, efficiency, skill, and independence among students. To better understand these findings, quantitative evaluation of the externship experience is necessary. The current study investigated the clinical care (defined as dental procedures) provided by Boston University School of Dental Medicine students who completed six‐week general dentistry externships compared to those completing ten‐week general dentistry externships. Results indicate that the scope of services provided in the ten‐week externship differed from the six‐week externship. The longer externships allowed for students to perform more complex procedures toward the latter part of their externships. Students participating in the ten‐week externship also provided more procedures per week than students in the six‐week externship. Because scheduling of patient appointments is generally a function of the site, number of patient visits and procedures performed per patient did not differ between the two groups. Our findings provide insight into the reason why longer externships increase clinical confidence, efficiency, and skill. In the continuing effort to improve the externship experience in dental schools, these findings should be taken into consideration.

The purpose of this study was to compare the quality of orthodontic care between orthodontists and pediatric dentists when measured by parental satisfaction. Six pediatric dentists and 5 orthodontists participated in the study. Quality of care was measured using the peer assessment rating (PAR) occlusal index, treatment duration, and parental satisfaction. Parental satisfaction was evaluated using a 25-item questionnaire measuring 3 dimensions: (1) treatment process; (2) psychosocial effects of treatment; and (3) treatment outcomes. The questionnaire items were scored on a scale of "strongly disagree" to "strongly agree." At baseline, no differences were seen in the gender, starting dentition, and permanent teeth extractions of patients treated by the orthodontist and pediatric dentists. Statistically significant differences were seen in patients': (1) pretreatment age; (2) race; (3) primary teeth extractions; (4) treatment stages; and (5) pre-PAR scores. No statistically significant differences between orthodontists and pediatric dentists were observed regarding overall parental satisfaction or the dimensions of satisfaction. These results did not change after controlling for potential confounding factors such as patient's age, gender, starting dentition, treatment stage, extraction recommendations, pre-PAR score, treatment duration, and percentage PAR reduction. The quality of orthodontic care, when measured by parental satisfaction, was similar between orthodontists and pediatric dentists. This indicates that, as far as parents are concerned, pediatric dentists performed orthodontic treatment to the same high standard as orthodontists.

To evaluate the effectiveness of battery-powered tooth brushing in removing plaque in Kuwaiti children. The subjects were 30 boys, aged 9-11 years. Prior to the start of the study, the children had never used a battery-powered toothbrush. At baseline, plaque accumulation was assessed for manual tooth brushing and battery-powered tooth brushing (Oral-B Kids battery-powered). All subjects then used the battery-powered toothbrush for two weeks at home. Plaque accumulation was again assessed for both manual and battery-powered tooth brushing. Plaque accumulation was assessed using the Soparkar modification of the Quigley-Hein Plaque Index. Differences in pre- and post-tooth brushing plaque, and change from baseline, were the outcome measures evaluated. At baseline, there was no difference in plaque removal between battery-powered tooth brushing and manual tooth brushing, either in difference between pre- and post-tooth brushing plaque measures (p = 0.44) or in percentage change (p = 0.51). After two weeks of use, there was a statistically significant difference in plaque removal between battery-powered tooth brushing and manual tooth brushing, both in the difference between pre- and post-tooth brushing plaque measures (p = 0.01) and in percentage change (p = 0.006). Mean plaque removal by manual tooth brushing was 0.97 +/- 0.45, and mean plaque removal by battery-powered toothbrush was 1.23 +/- 0.56. Mean percentage change in plaque removal by manual tooth brushing was 33.5 +/- 16.05, and mean plaque removal by battery-powered tooth brushing was 43.0 +/- 18.82, which represented a 9.5% improvement for battery-powered tooth brushing compared to manual tooth brushing. After two weeks use of a battery-powered toothbrush, the plaque removal was enhanced compared to baseline and to manual tooth brushing. Battery-powered tooth brushing also enhanced manual tooth brushing ability.

Objectives: Several oral pathologists have described oral leukoplakia of the maxillary vestibule in patients with no traditional risk factors for the condition. On questioning these patients, it was determined that Viadent® mouthrinse or Viadent® toothpaste was commonly used by them. A hypothesis was developed that Viadent® or a component of Viadent® caused the lesions. This paper evaluates the association between oral leukoplakia and use of Viadent® products. Methods: A matched case‐control study was designed to test the hypothesis that use of Viadent® products increases an individual's risk of oral leukoplakia. Cases included 58 patients diagnosed with oral leukoplakia identified through the biopsy service at the Ohio State University, College of Dentistry, Oral Pathology Section. The matched control was a friend or relative of the patient. Cases and controls were administered a questionnaire about their use of Viadent®, and other known risk factors for leukoplakia such as tobacco and excessive alcohol use. Results: An age difference was seen between cases and controls, the cases being older (P<.001). After controlling for confounding factors, results of exact conditional logistic regression analyses showed that use of Viadent® products was a risk indicator for oral leukoplakia (odds ratio= 10.0; 95% confidence interval=2.0, 89.2). Conclusions: Viadent® use is a risk indicator for oral leukoplakia, confirming our previous findings.

An accredited graduate orthodontic program provides advanced specialty education to meet standards of care mandated by the ADA, including both didactic and clinical components with defined outcome measures. To quantify these measures, the quality of care provided by graduate orthodontic students was compared to that of orthodontists in private practice. The quality of care was studied in two different delivery settings in the Columbus, Ohio, area—private practice orthodontists (PPO) and the OSU graduate orthodontic clinic (GOC). The Peer Assessment Rating (PAR) Occlusal Index was used as a measure of malocclusion severity and post‐treatment occlusal outcome. Quality of care was measured using post‐treatment PAR, percent PAR reduction, and treatment duration. At baseline, no differences were seen in the gender and pre‐PAR scores of patients treated by the PPO and GOC, but statistically significant differences were seen in patients' pre‐treatment age, race, and starting dentition. When the post‐treatment occlusal results were compared, no statistically significant differences were seen in post‐PAR scores and percent PAR reduction between the PPO and GOC. A statistically significant difference was seen in treatment duration (p=0.002), which was longer in the PPO even after controlling for confounding factors such as pre‐treatment age, gender, race, starting dentition, and treatment stages. Our conclusion is that there was no statistically significant difference in the occlusal outcome between the PPO and GOC, but there was a significant difference in the treatment duration.

In the summer of 1997, the College of Dentistry, The Ohio State University, changed its predoctoral clinics from the traditional model to the comprehensive care (CC) model. Although the CC model is considered the better model for delivery of care, from the patient perspective it has not been previously evaluated. The purpose of this study was to compare the two dental care delivery systems—the traditional model and the CC model—using patient satisfaction. The Dental Satisfaction Questionnaire (DSQ) developed by the Rand Corporation was used to assess patient satisfaction. The questionnaire consists of nineteen items, measuring overall satisfaction and subscales of access, pain management, and quality. The questionnaire was self‐administered to active and recall patients in the summers of 1997 and 1998 to evaluate satisfaction with care in the traditional and CC models respectively. The completed DSQ was returned by 119 respondents in 1997 and 116 respondents in 1998. There were no significant differences in age, gender, and self‐rated general and oral health of patients using the two delivery systems. No statistically significant differences were seen in the overall Dental Satisfaction Index and the subscales of access, pain management, and quality of care. Statistically significant differences were observed on only two of the nineteen individual items. We conclude that there was no difference in satisfaction levels of our patients between the two dental care delivery models.