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1.  An Objective Evaluation of Clinical Signs Used to Assess Sedation with Intravenous Diazepam 
Anesthesia Progress  1980;27(1):18-20.
In the majority of dental schools there are insufficient numbers of clinical patients for all students to receive optimal experience in intravenous sedation. This investigation was carried out to assess whether the signs and symptoms for intravenous sedation taught to the undergraduates were sufficiently objective to ensure that this clinical deficiency was not detrimental to competency of the graduating student. The signs of ptosis, altered speech and blurred vision were used by both experienced dentists and novice students to assess the level of intravenous sedation. Blurred vision was found to be unreliable while altered speech was more accurate than ptosis. The more experienced the operator the earlier the signs were observed.
The “Guidelines for the Teaching of Pain and Anxiety Control in Dentistry” were initially formulated by the American Dental Association in 1971 and revised in 19781 while similar guidelines were accepted by the House of Delegates of the Association of the Canadian Faculties of Dentistry in 19752 Both of these documents outlined the course of instructions necessary for the teaching of all modalities of pain and apprehension control at the undergraduate, postgraduate and continuing education level. Implementation of these guidelines at the undergraduate level has proven to be particularly difficult in the area of intravenous sedation because of the lack of suitable patients. This has resulted in many students graduating, having had little practical experience in sedating a patient with an intravenous drug. It is the hope of educators in this field that lectures, seminars, and demonstrations given to dental students are sufficient to overcome this deficiency.
Since the most critical clinical aspect of intravenous sedation is titrating the amount of drug required without overdosing or underdosing the patient, it was decided to investigate this ability in students with no clinical experience with intravenous diazepam. Although many drugs and techniques are advocated3,4,5 it was decided to limit the study to intravenous diazepam as it may be used alone and has a high therapeutic index.
With the introduction of diazepam to clinical practice the symptomatology of the drug was established and described by clinicians.6,7 Objective methods of measuring recovery from diazepam have been described by several authors8,9,10 but the signs and symptoms used to assess the initial level of sedation have been subjective. This can be attributed to the fact that sedation is an ill-defined clinical effect and can, therefore, only be calibrated by individual arbitary signs. The most frequently used signs for intravenous diazepam sedation are ptosis, also referred to as “the Verrill sign,”11 altered speech and blurred vision.7 This investigation was designed to test the reliability of these signs and to examine the variability of observations between clinicians and students.
PMCID: PMC2515966  PMID: 6933870
2.  Transitioning Toward Evidence-Based Research in the Health Sciences for the XXI Century 
This article discusses some of the misconceptions of evidence-based research in the health sciences. It proposes that since not all treatments in medicine and dentistry can be evidence-based, clinical applications of the evidence-based process should become a specialty. The case is particularly evident in dentistry. Therefore dentistry is taken in this article as a model for discussion. We propose that to approach dentistry from the viewpoint of the patient-oriented evidence that matters (POEM) is perfectly acceptable so far as we also engage in the process of research evaluation and appraisal in dentistry (READ). We distinguish between dentistry based on the evidence, and evidence-based dentistry. We argue that when invoking an evidence-based approach to dentistry or medicine, it is not sufficient to establish the ‘levels of evidence’, but rather that all evidence-based clinical intervention must undergo the stringent process of evidence-based research so that clinical practice guidelines be revised based on the best available evidence.
PMCID: PMC2396483  PMID: 18604263
evidence-based research; levels of evidence; clinical practice guidelines
3.  Practical Patient Management: The Integrated Approach 
Anesthesia Progress  1988;35(1):19-25.
Pharmacologic agents have been traditionally used in dentistry for the management of patient fears. Results have been mixed, depending on the drugs and techniques used, the skill and training of the operator, and the degree of anxiety of the patient. Pharmacology alone may be unsuitable and even hazardous for some patients. All forms of sedation and anesthesia should be administered in an environment of trust, empathy, and competence in both the behavioral and clinical sciences. Such an integrated approach will result in reduced drug dosages, decreased need for multiple drug techniques, improved patient safety, and better control of anxiety. For optimum benefits, the teaching of behavioral sciences, including interpersonal and communication skills, should be integrated with the teaching of pharmacologic methods of anxiety and pain control at both undergraduate and continuing education levels.
PMCID: PMC2190051  PMID: 3422796
4.  Knowledge of drug prescription in dentistry students 
Students in schools of dentistry attend to patients with illnesses, and often prescribe medication. Because students are still learning, they are influenced by a variety of factors: the different teaching approaches of the professors at the clinics and in the pharmacology course, fellow students, and even the information provided by the pharmaceutical industry.
The aim of this pilot study was to assess the prescription knowledge and common mistakes in fourth-year students at the School of Dentistry at the Universidad Nacional Autónoma de México.
In March 2010, a survey was conducted among 66 fourth-year students at the School of Dentistry, applying a previously validated questionnaire consisting of six open-ended questions The following factors were assessed: the most frequent illness requiring dental prescription; the most prescribed nonsteroidal anti-inflammatory drugs and antibiotics; the most frequent errors; sources of information used for prescribing drugs; and whether the students knew and followed the World Health Organization Guide to Good Prescribing.
The most frequent response for each question was considered the most significant. The most common reason for prescribing medication was infection (n = 37, 56%), followed by pain (n = 24, 38%); the most used painkillers were ibuprofen and acetaminophen at equal levels (n = 25, 37.8%), followed by ketorolac (n = 7, 10.6%), naproxen (n = 6, 9.1%), diclofenac (n = 2, 3%), and aspirin (n = 1, 1.5%); the most widely prescribed antibiotics were amoxicillin (n = 52, 78.9%), ampicillin (n = 7, 10.6%), and penicillin V and clindamycin (n = 3, 4.5%). The most frequent errors reported by students were: lack of knowledge about drug posology (n = 49, 74.2%), improperly filled prescriptions (n = 7, 10.7%), not knowing the brand names and uncertainty about the correct drug indicated for each case (n = 3, 4.54%), not knowing the duration of treatment (n = 2, 3%), not asking the patient about possible allergies, and not giving prescriptions (n = 1, 1.5%). The sources of information used by students for prescribing drugs included the professors at the clinics (n = 49, 74.2%), the pharmacology course (n = 7, 10.7%), medical dictionary consultation (n = 15, 22.72%), classmate support (n = 3, 4.54%), and information provided by medical representatives from pharmaceutical companies (n = 1, 1.5%). Finally, only 20 students (30.3%) followed the WHO Guide to Good Prescribing, 40 students acknowledged not following it (60.6%), and six students (9.1%) had no knowledge of it.
The knowledge of pharmacology among fourth-year students in the School of Dentistry has gaps that could affect patient safety. More studies are needed to determine whether this issue affects the quality of patient care and the effectiveness and safety of treatments. Since prescribing accurately is extremely important, it is necessary to develop therapeutic guidelines, and to provide pharmacological therapy courses. The implementation of educational programs, including the WHO Guide to Good Prescribing and Patient Safety Curriculum Guide, would be beneficial in helping students develop prescribing skills.
PMCID: PMC3396048  PMID: 22807647
prescription; dentistry prescription; most used NSAIDs by dentists; most used antibiotics; dentist prescribing errors; sources of information for prescribing; WHO Guide to Good Prescribing
5.  Pain Management in Cancer Patients Using a Mobile App: Study Design of a Randomized Controlled Trial 
JMIR Research Protocols  2014;3(4):e76.
Despite the availability of effective medications and clinical guidelines for pain management, pain control is suboptimal in a sizeable proportion of patients with cancer pain. The National Comprehensive Cancer Network guidelines recommend a comprehensive and multimodal approach for management of cancer pain. We developed a mobile phone application, ePAL, based on clinical guidelines to empower patients for cancer pain management by prompting regular pain assessments and coaching for self-management.
The objective of this study is to evaluate the effect of a multidimensional mobile phone-based pain management application, ePAL, on controlling cancer pain and improving quality of life in patients with cancer pain being treated at an academic palliative care clinic.
The study will be implemented as a 2-arm randomized controlled trial with 110 adult patients with CP who own a mobile phone over a follow-up period of two months. Participants will be randomized to either the intervention group receiving ePAL and usual care or to a control group receiving only usual care. The brief pain inventory will be used to assess our primary outcome which is pain intensity. We will also evaluate the effect of the intervention on secondary outcomes which include the effect of the intervention on hospital utilization for pain crisis, quality of life, adherence to analgesic medications, barriers to pain control, anxiety and patient engagement. Instruments that will be used in evaluating secondary outcomes include the Brief Pain Inventory, Morisky Medication Adherence Scale, Barriers Questionnaire-II, Functional Assessment of Cancer Therapy–General, Edmonton Symptom Assessment System, Generalized Anxiety Disorder 7-item scale, and the Functional Assessment of Chronic Illness Therapy-Fatigue. The intention-to-treat approach will be used to evaluate outcomes. Our primary outcome, pain intensity, measured longitudinally over eight weeks, will be assessed by mixed model repeated analysis. Effect sizes will be calculated as mean group differences with standard deviations.
The study is still in progress. We hope to have results by the end of 2015.
The multidimensional approach to pain management implemented on a mobile phone application could lead to significant improvements in patient outcomes.
Trial Registration NCT02069743; (Archived by WebCite at
PMCID: PMC4275494  PMID: 25500281
cancer pain; mobile application; randomized controlled trial; self care; palliative care; mHealth
6.  Survey of Curriculum and Instruction: Continuing Education Courses in Pain Control* 
Anesthesia Progress  1977;24(6):198-204.
Pain and anxiety control is taught at the continuing education level in a large number of diverse courses. This paper reports the results of a survey of those courses held in 1976. The majority of courses centered on the use of inhalation or intravenous sedation. Relatively few courses were offered on the other aspects of pain and anxiety control. Very little attempt is being made at formally evaluating the competence of participants in these courses. Few courses appear to adequately cover the prevention and management of complications. Suggestions for changes in the teaching of pain and anxiety control at the continuing education level are made based on these findings.
Pain and anxiety control encompasses the application of various physical, chemical and psychological modalities in the prevention and treatment of peri-operative patient apprehension and pain. Patient apprehension about dental procedures is felt to influence the seeking of remedial and preventive dental care by a significant portion of the population. Efforts to improve the training of dentists in pain and anxiety control modalities have included several workshops sponsored by the American Dental Society of Anesthesia, the formulation of guidelines for courses at the predoctoral, postdoctoral and continuing education levels, and the establishment of postdoctoral pain control training programs at several dental schools.
Recent graduates have been trained in pain control in predoctoral programs which vary widely in content and length. A large number of practitioners seek training in pain control through continuing education courses offered by dental schools, hospitals and a variety of other institutions. This paper reports the results of a survey of these courses and suggests several recommendations based on the findings.
PMCID: PMC2516152  PMID: 276282
7.  Syringe micro vibrator (SMV) a new device being introduced in dentistry to alleviate pain and anxiety of intraoral injections, and a comparative study with a similar device 
Neurologically, it is proven that stimulation of larger diameter fibers - e.g. using appropriate coldness, warmth, rubbing, pressure or vibration- can close the neural "gate" so that the central perception of itch and pain is reduced. This fact is based upon "Gate-control" theory of Melzack and Wall.
Presentation of the hypothesis
Syringe Micro Vibrator is a new design being introduced for the first time in the field of Dentistry. This device is a promising breakthrough in pain and anxiety management and may deliver solution for clinicians plagued with patient pain phobia. It has an off-set rotating micro vibration creator with ultra high frequency and ultra low altitude that can be easily placed on any standard dental syringe and some disposable syringes. This device was registered as an invention in dentistry and received Iran National Patent number of 63765.
Testing the hypothesis
By creating micro vibration, this device would be effective in reducing the pain and anxiety confronted with most types of intraoral injections as palatal, mandibular block, intraligamental and local infiltration. From the aspect of the patient pain management, this device contributes both physiologically (based on Gate Control Theory of pain) and psychologically (based on the device function as will be explained by dentist to the patient as a modern pain reducing technology). From the aspect of clinician, SMV motor provides vibrations with ultra high frequency to alleviate pain, but since it has ultra low vibration altitude, it has no adverse effect on the clinician dexterity and accuracy during injection and it does not interfere with pin point localization of injection site.
Implications of the hypothesis
Upon mounting on a conventional dental anesthesia injection syringe, SMV is switched on and the clinician then uses normal injection technique to administer the anesthetic. This device is not only a useful accessory device for ordinary patients, but also more useful for pediatric patients and those who have a phobia of intraoral injection or pain.
PMCID: PMC3025000  PMID: 21211061
8.  Natural Model Training, an Alternative Way to Enhance Learning in Pediatric Dentistry 
Educational teaching of the diagnosis of resorbed root for pulpectomy in deciduous teeth radiography has always been a big challenge in pediatric dentistry.
The purpose of the study was to propose a new practical methodology to improve the quality of learning in students of dentistry.
Materials and Methods:
Extracted deciduous teeth were molded in the transparent epoxy resin as their real position in the jawbone. Then, their own pre-extraction radiographs were attached to them. Forty dental students were randomly allocated to the control group of conventional teaching and experimental group of natural model training. All participants were attended in a validated exam and the data were analyzed. A questionnaire was designed with an answer choice in Lickert scale to measure the students' attitude towards the new method and finally the data were reported with descriptive statistics.
The mean of the learning degree in the experimental group was graded 9.2± 3.2 and was significantly higher than 5.8± 1.1 which belongs to the participants of the conventional method as control (p= 0.04 <0.05).
Considering the limitation of this study, using natural models in radiography training will improve the diagnostic competency and the student’s educational satisfaction in pediatric dentistry.
PMCID: PMC4290772  PMID: 25628679
Pediatric Dentistry; Radiology; Pulpectomy; Medial Education Term
9.  Development and initial validation of a content taxonomy for patient records in general dentistry 
International journal of medical informatics  2013;82(12):10.1016/j.ijmedinf.2013.06.007.
Develop and validate an initial content taxonomy for patient records in general dentistry.
Phase 1–Obtain 95 de-identified patient records from 11 general dentists in the United States. Phase 2–Extract individual data fields (information items), both explicit (labeled) and implicit (unlabeled), from records, and organize into categories mirroring original field context. Phase 3–Refine raw list of information items by eliminating duplicates/redundancies and focusing on general dentistry. Phase 4–Validate all items regarding inclusion and importance using a two-round Delphi study with a panel of 22 general dentists active in clinical practice, education, and research.
Analysis of 76 patient records from 9 dentists, combined with previous work, yielded a raw list of 1,509 information items. Refinement reduced this list to 1,107 items, subsequently rated by the Delphi panel. The final model contained 870 items, with 761 (88%) rated as mandatory. In Round 1, 95% (825) of the final items were accepted, in Round 2 the remaining 5% (45). Only 45 items on the initial list were rejected and 192 (or 17%) remained equivocal.
Grounded in the reality of clinical practice, our proposed content taxonomy represents a significant advance over existing guidelines and standards by providing a granular and comprehensive information representation for general dental patient records. It offers a significant foundational asset for implementing an interoperable health information technology infrastructure for general dentistry.
PMCID: PMC3840041  PMID: 23838618
Dental Informatics; Delphi Technique; Dental Records/standards; Dentists’ Practice Patterns/standards; Information Management; Information Storage and Retrieval
10.  Vinegar as a disinfectant of extracted human teeth for dental educational use 
Extracted human teeth are routinely used in dentistry to learn technical and preclinical skills. Centers for Disease Control and Prevention (CDC) has adopted guidelines for infection control of extracted teeth used for research and teaching, requiring that teeth be sterilized before use. Many of the proposed disinfection methods starting from use of formalin, sodium hypochlorite and to autoclaving have their own drawbacks and may not be practical.
To assess the effectiveness of vinegar for disinfection/sterilization of extracted human teeth.
Materials and Methods:
A total of 80 extracted non-carious human teeth were kept in seven disinfectant media—10% formalin, 3% hydrogen peroxide, 5.25% sodium hypochlorite, 70% alcohol, vinegar, neem extract and normal saline. Ten samples were placed in each disinfectant individually for a period of 7 days, at room temperature. In all, 10 teeth were treated with microwave irradiation at 650 W for 3 min. Later, teeth from each group were placed individually in separate test tubes containing 10 ml of tryptic soy broth at 37°C for 48 h to observe the evidence of growth of microorganisms. Semiquantitative analysis of all the samples was done in Clade agar at 37°C for 48 h.
Statistical Analysis Used:
The number of teeth disinfected in each group was compared using Chi square test.
10% formalin, 3% hydrogen peroxide and vinegar were totally effective. The result was statistically significant with a Chi square value of 61.414 and P < 0.001.
Vinegar can be used as an effective disinfectant medium for extracted human teeth.
PMCID: PMC4065434  PMID: 24959031
Disinfection; extracted teeth; formalin; vinegar
11.  Predictive, preventive, personalised and participatory periodontology: ‘the 5Ps age’ has already started 
The EPMA Journal  2013;4(1):16.
An impressive progress in dentistry has been recorded in the last decades. In order to reconsider guidelines in dentistry, it is required to introduce new concepts of personalised patient treatments: the wave of predictive, preventive and personalised medicine is rapidly incoming in dentistry. Worldwide dentists have to make a big cultural effort in changing the actual ‘reactive’ therapeutic point of view, belonging to the last century, into a futuristic ‘predictive’ one. The first cause of tooth loss in industrialised world is periodontitis, a Gram-negative anaerobic infection whose pathogenesis is genetically determined and characterised by complex immune reactions. Chairside diagnostic tests based on saliva, gingival crevicular fluid and cell sampling are going to be routinely used by periodontists for a new approach to the diagnosis, monitoring, prognosis and management of periodontal patients. The futuristic ‘5Ps’ (predictive, preventive, personalised and participatory periodontology) focuses on early integrated diagnosis (genetic, microbiology, host-derived biomarker detection) and on the active role of the patient in which networked patients will shift from being mere passengers to responsible drivers of their health. In this paper, we intend to propose five diagnostic levels (high-tech diagnostic tools, genetic susceptibility, bacterial infection, host response factors and tissue breakdown-derived products) to be evaluated with the intention to obtain a clear picture of the vulnerability of a single individual to periodontitis in order to organise patient stratification in different categories of risk. Lab-on-a-chip (LOC) technology may soon become an important part of efforts to improve worldwide periodontal health in developed nations as well as in the underserved communities, resource-poor areas and poor countries. The use of LOC devices for periodontal inspection will allow patients to be screened for periodontal diseases in settings other than the periodontist practice, such as at general practitioners, general dentists or dental hygienists. Personalised therapy tailored with respect to the particular medical reality of the specific stratified patient will be the ultimate target to be realised by the 5Ps approach. A long distance has to be covered to reach the above targets, but the pathway has already been clearly outlined.
PMCID: PMC3703280  PMID: 23763842
Predictive periodontology; Preventive periodontology; Personalised periodontology; Participatory periodontology; Lab-on-a-chip; Gas chromatographs; Cone beam computed tomography; Host-derived diagnostic markers; Saliva; Gingival crevicular fluid
12.  Patient safety education at Japanese medical schools: results of a nationwide survey 
BMC Research Notes  2012;5:226.
Patient safety education, including error prevention strategies and management of adverse events, has become a topic of worldwide concern. The importance of the patient safety is also recognized in Japan following two serious medical accidents in 1999. Furthermore, educational curriculum guideline revisions in 2008 by relevant the Ministry of Education includes patient safety as part of the core medical curriculum. However, little is known about the patient safety education in Japanese medical schools partly because a comprehensive study has not yet been conducted in this field. Therefore, we have conducted a nationwide survey in order to clarify the current status of patient safety education at medical schools in Japan.
Response rate was 60.0% (n = 48/80). Ninety-eight-percent of respondents (n = 47/48) reported integration of patient safety education into their curricula. Thirty-nine percent reported devoting less than five hours to the topic. All schools that teach patient safety reported use of lecture based teaching methods while few used alternative methods, such as role-playing or in-hospital training. Topics related to medical error theory and legal ramifications of error are widely taught while practical topics related to error analysis such as root cause analysis are less often covered.
Based on responses to our survey, most Japanese medical schools have incorporated the topic of patient safety into their curricula. However, the number of hours devoted to the patient safety education is far from the sufficient level with forty percent of medical schools that devote five hours or less to it. In addition, most medical schools employ only the lecture based learning, lacking diversity in teaching methods. Although most medical schools cover basic error theory, error analysis is taught at fewer schools. We still need to make improvements to our medical safety curricula. We believe that this study has the implications for the rest of the world as a model of what is possible and a sounding board for what topics might be important.
PMCID: PMC3441650  PMID: 22574712
Patient safety; Education; Medical school; Nationwide survey; Japan
13.  Video-assisted feedback in general practice internships using German general practitioner's guidelines  
Introduction: The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine.
The demonstrated teaching method aims at giving feedback to the student based on video recordings of patient consultations (student-patient) with the help of a checklist.
Video-feedback is already successful used in medical teaching in Germany and abroad.
This feasibility study aims at assessing the practicability of video-assisted feedback as a teaching method during internship in general practice.
Teaching method: First of all, the general practice chooses a guideline as the learning objective. Secondly, a subsequent patient – student – consultation is recorded on video. Afterwards, a video-assisted formative feedback is given by the physician. A checklist with learning objectives (communication, medical examination, a structured case report according to the guideline) is used to structure the feedback content.
Feasibility: The feasibility was assessed by a semi structured interview in order to gain insight into barriers and challenges for future implementation. The teaching method was performed in one general practice. Afterwards the teaching physician and the trainee intern were interviewed.
The following four main categories were identified: feasibility, performance, implementation in daily routine, challenges of the teaching concept.
The results of the feasibility study show general practicability of this approach. Installing a video camera in one examination room may solve technical problems. The trainee intern mentioned theoretical and practical benefits using the guideline. The teaching physician noted the challenge to reflect on his daily routines in the light of evidence-based guidelines.
Conclusion: This teaching method supports quality control and standardizing of learning objectives during the internship in general practice by using general practice guidelines. The use of a checklist enhances this method in general practice. We consider the presented teaching method in the context of the planned modification of the Medical Licenses Act is part of quality control and standardisation of medical teaching during general practice internships. In order to validate these presumptions, further, evaluation of this method concerning the learning objectives using the guidelines of general practice need to be carried out.
PMCID: PMC3525913  PMID: 23255963
Video feedback; general practice; guideline; evidence based medicine; internship
14.  Teaching the placement of posterior resin-based composite restorations in Spanish dental schools 
Objectives: In an area of esthetic dentistry such as posterior composites, in which new materials and techniques are being devolved continuously, it is important to confirm that dental students have a clear understanding of the basic principles of clinical application of this knowledge. Considering that the preparation of dental graduates in Spain may be of interest to competent dental authorities and employers with whom they can work worldwide, this study investigated the teaching of posterior composite restorations in Spanish dental schools. Study design: In late 2009⁄ early 2010, a questionnaire seeking information on the teaching of posterior composites was emailed to the professor responsible for teaching operative dentistry in each of the fifteen dental schools having complete undergraduate dental degree programs in Spain. Results: The response rate was 100%. Most investigated topics did not show noteworthy differences depending on whether the schools were public or private. Variations were found among Spanish dental schools in both the amount and content of the teaching programs concerning posterior composite restorations. Differences were recorded in the teaching of cavity design, contraindications to composite placement, indications for liners and bases, matrix and wedging techniques, composite and bonding systems, light curing and finishing procedures for composite restorations. More consistency was observed in teaching methods of moisture-control, indirect composites and amalgam bonding. Conclusions: As recommended in previously surveyed countries, efforts must be made to promote harmonization of dental curricula to make it easier for graduates to work elsewhere, and to ensure they meet the needs of their patients on entering independent practice.
Key words:Aesthetic dentistry, composite restoration, dental education, teaching program, undergraduate dental student.
PMCID: PMC3476032  PMID: 22322491
15.  Evidence-Based Dentistry: What's New? 
The importance of evidence for every branch of medicine in teaching in order to orient the practitioners among the great amount of most actual scientific information's, and to support clinical decisions, is well established in health care, including dentistry.
The practice of evidence-based medicine is a process of lifelong, self-directed, problem-based learning which leads to the need for clinically important information about diagnosis, prognosis, therapy and other clinical and health care issues. Nowadays the practice of dentistry is becoming more complex and challenging because of the continually changing in dental materials and equipments, an increasingly litigious society, an increase in the emphasis of continuing professional development, the information explosion and the consumer movement associated with advances on the Internet.
The need for reliable information and the electronic revolution have come together to allow the “paradigm shift” towards evidence-based health care. Recent years have seen an increase in the importance of evidence-based dentistry, aiming to reduce to the maximum the gap between clinical research and real world dental practice. Aim of evidence-based practice is the systematic literature review, which synthesizes the best evidences and provides the basis for clinical practice guidelines. These practice guidelines give a brief review of what evidence-based dentistry is and how to use it.
PMCID: PMC1891443  PMID: 17589569
dentistry; evidence-based medicine; dental care/standards
16.  Digital Dental Photography: A Contemporary Revolution 
Introduction: Photographs are symbolic of memories and with the advent of digital photography it has become much easier to collect them in a second in a more comprehensive and qualitative manner. Technological advancements in the field of digital photography have revolutionized the concept of photography as a powerful medium of expression and communication. It also offers a spectrum of perception, interpretation and execution. Photography and dentistry go hand in hand for revelation of the hidden and overlooked defects in teeth and other parts of the cavity. This article emphasizes on the significance of digital photography in dentistry and guidelines for capturing orofacial structures and radiographs in a more accurate and informative manner.
Conclusion: Dental world constitutes of microstructures that have to be recorded in a detailed manner in order to perform patient education, documentation of records and treatment, illustration of lectures, publication and web connectivity of complicated cases.
How to cite this article: Desai V, Bumb D. Digital Dental Photography: A Contemporary Revolution. Int J Clin Pediatr Dent 2013;6(3):193-196.
PMCID: PMC4086602  PMID: 25206221
Digital photography; Photogrammetry; SLR cameras; Teledentistry
17.  Assessment of quality of prescription by dental students 
Journal of Applied Oral Science  2014;22(3):204-208.
The main objective of this study was to evaluate changes in prescribing pattern of Dentistry students throughout academic course.
A case of non-complicated dental extraction was presented to all students that had completed their pharmacology coursework (from 4th semester to the last semester). The students were grouped according to year of study and were asked to prescribe paracetamol for pain control. A maximal score of 5 points was calculated from three subscores for identification of professional and patient (1.0 point), drug concentration, dosage, and quantity (1.5 points); and drug information, instructions, and warnings (2.5 points). The data were expressed as medians [95% confidence intervals (CIs)] and were compared using the Kruskal-Wallis test followed by Dunn's post hoc test. A p<0.05 value was considered statistically significant. A total of 92 students participated the study (2nd year, N=12; 3rd year, N=32; 4th year, N=28; 5th year, N=20).
The quality of prescription showed improvement between 2nd-year students [2.0 (1.5-2.5)] and 4th-year students [3.2 (2.9-3.5), p<0.05]; 4th- and 5th-year students [3.6 (3.5-3.8)] performed similarly. Lack of information about pharmacological treatment, side effects, and administration route were the major deficiencies observed.
Although Dentistry students present a general improvement in their prescribing performance, deficiencies remain even in advanced students. The data suggest that the teaching of good prescription practices should extend throughout the later phases of preprofessional dental education.
PMCID: PMC4072271  PMID: 25025561
Teaching; Drug prescriptions; Dentistry
18.  Prevalence of dental anxiety and its relation to age and gender in coastal Andhra (Visakhapatnam) population, India 
Dental fear, anxiety and phobia have consistently been reported as widespread problems that persist despite the technological advances that have made dentistry less painful and less uncomfortable. The aim of this study was to assess the prevalence of dental anxiety (DA) and its relation to age and sex among Coastal Andhra (Visakhapatnam) population.
Materials and Methods:
A randomized controlled study was designed among 340 individuals at GITAM Dental College and Hospital, Visakhapatnam. The sample for the study consisted of 180 female and 160 male subjects between 15 and 65 years of age; all were supplied with two questionnaires (Corah DA scale [CDAS] and Clarke and Rustvold dental concerns assessment scale describing anxiety provoking stimuli. The Mann-Whitney U-test and the Kruskal-Wallis test were applied (significance level P < 0.05). The correlations between the two questionnaires were calculated using the Spearman's rank correlation coefficient.
Two questionnaires were collected from all 340 individuals and the Indian translation of both instruments was found to be internally reliable with a Cronbach's alpha of 0.093. Overall prevalence of DA was high (77.4%) but severe (22.6%) anxiety (phobia) was low. Kruskal-Wallis test showed a significant relation between age and DA. The mean CDAS scores were high in 25-35 (11.08) and low in 55-65 (9.45) year age groups. Mann-Whitney U test showed significant relation between sex and DA. Mean CDAS score levels were significantly higher in females (10.88) than in males (9.96) (P < 0.0001).
Patients anxious about dental procedures are often more difficult to treat. If Dentists become aware about the level of DA among their patients, they can anticipate patient's behavior and can be prepared to take behavioral/pharmacological measures to reduce anxiety levels.
PMCID: PMC4121925  PMID: 25097425
Dental anxiety; dental anxiety scale; dental concerns assessment scale; dental fear; prevalence
19.  Recognition, assessment and safe management of the medically compromised patient in dentistry. 
Anesthesia Progress  1990;37(5):217-222.
A method of common risk disease recognition, physical status assessment and safe management of the medically compromised patient in dentistry is presented. This routine applies to all dentistry treatment, with special attention to pain/anxiety/stress control by any modality.
PMCID: PMC2148601  PMID: 2151419
20.  Chronic pain and pain-related disability across psychiatric disorders in a clinical adolescent sample 
BMC Psychiatry  2013;13:272.
People who suffer from psychiatric disorders are burdened with a high prevalence of chronic illnesses and pain, but evidence on pain prevalence among adolescents with psychiatric disorders is scarce. The aim of this study was to investigate the frequency and location of self-reported chronic pain and pain-related disability in adolescent psychiatric patients.
This study was part of the larger Health Survey administered at the Department of Child and Adolescent Psychiatry (CAP) at St. Olav’s University Hospital, in Trondheim, Norway. All patients aged 13–18 years who visited the CAP clinic at least once between February 15, 2009 and February 15, 2011 were invited to participate. A total of 717 (43.5% of eligible/invited patients) participated; of these, 566 were diagnosed with one or more psychiatric disorders. The adolescents completed a questionnaire, which included questions about pain and pain-related disability. Clinical diagnoses were classified by a clinician according to International Statistical Classification of Diseases and Related Health Problems, 10th revision criteria.
In adolescents with psychiatric disorders, 70.4% reported chronic pain, and 37.3% experienced chronic pain in three or more locations (multisite pain). Chronic musculoskeletal pain was the most prevalent type of pain (57.7%). Pain-related disability was found in 22.2% of the sample. The frequency of chronic pain and multisite pain increased with age, and girls reported a higher frequency of chronic pain, multisite pain and pain-related disability than boys did. There was an increased risk of chronic pain among adolescents with mood or anxiety disorders versus those with hyperkinetic disorders, yet this was not present after adjusting for sex. Comorbidity between hyperkinetic and mood or anxiety disorders involved an increased risk of pain-related disability.
In this study, seven out of 10 adolescents with psychiatric disorders reported chronic pain. These findings indicate the importance of early detection of chronic pain in adolescents with psychiatric disorders, to provide targeted treatment and reduce poor long-term outcomes.
PMCID: PMC3853574  PMID: 24139217
Chronic pain; Disability; Prevalence; Psychiatric disorders; Adolescents
21.  Effects of the Revised HCFA Evaluation and Management Guidelines on Inpatient Teaching 
In 1996, the Health Care Financing Administration (HCFA) introduced new evaluation and management (E&M) guidelines mandating more intensive supervision and documentation by attending physicians. We assessed the effects of the guidelines on inpatient teaching.
Pretest-posttest, nonequivalent control group design.
A university hospital and an affiliated county hospital where the guidelines were implemented and an affiliated VA medical center where they were not.
Sixty-one full-time faculty who had attended on the general medical wards for at least 1 month for 2 of 3 consecutive years prior to July 1996 and for at least 1 month during the 18 following months.
We evaluated standardized, confidential evaluations of attending physicians that are routinely completed by residents and students after clinical rotations at all three sites. Comparing 863 evaluations completed before July 1, 1996 and 497 completed after that date, there were no significant differences at any of the hospitals on any items assessed. There were also no differences between the university and county hospitals as compared with the VA. Eighty-seven percent of 39 university and county attending physicians returned a survey about their perceptions of inpatient teaching activities before and after July 1, 1996. They reported highly significant increases in time devoted to attending responsibilities but diminished time spent on teaching activities.
Physicians reported a dramatic increase in overall time spent attending but a decrease in time spent teaching following implementation of the revised E&M guidelines. Yet, evaluations of their teaching effectiveness did not change.
PMCID: PMC1495480  PMID: 10940130
Medical education; teaching; Medicare
22.  Developing patient-friendly genetic and genomic test reports: formats to promote patient engagement and understanding 
Genome Medicine  2014;6(7):58.
With the emergence of electronic medical records and patient portals, patients are increasingly able to access their health records, including laboratory reports. However, laboratory reports are usually written for clinicians rather than patients, who may not understand much of the information in the report. While several professional guidelines define the content of test reports, there are no guidelines to inform the development of a patient-friendly laboratory report. In this Opinion, we consider patient barriers to comprehension of lab results and suggest several options to reformat the lab report to promote understanding of test results and their significance to patient care, and to reduce patient anxiety and confusion. In particular, patients’ health literacy, genetic literacy, e-health literacy and risk perception may influence their overall understanding of lab results and affect patient care. We propose four options to reformat lab reports: 1) inclusion of an interpretive summary section, 2) a summary letter to accompany the lab report, 3) development of a patient user guide to be provided with the report, and 4) a completely revised patient-friendly report. The complexity of genetic and genomic test reports poses a major challenge to patient understanding that warrants the development of a report more appropriate for patients.
PMCID: PMC4254435  PMID: 25473429
23.  Worldwide Predoctoral Dental Implant Curriculum Survey 
Predoctoral dental implant education is included in dental school teaching curricula in most of the developed and some developing countries; however, it was not introduced into undergraduate curriculum of some countries and Iranian dental schools.
Our purpose was to investigate the status of the predoctoral dental implant education of dental schools in the world.
Materials and Methods:
One hundred-thirty five dental schools were randomly selected representing 62 countries divided into two regions. The first region included North America and Europe, and the second region comprised of Asia, South America and Africa. A questionnaire including onset year, lecture hours, lectures available on the internet, required textbooks, department jurisdictions, the year of dental school the course was offered, clinical and laboratory courses, implant systems used surgically and in restorative phase, and type of restorations treated by predoctoral students was mailed electronically to the predoctoral implant dentistry directors.
Ninety-two (68%) schools responded; of which 79 (86%) incorporated implant dentistry in their predoctoral teaching curricula, 39 (49%) offered surgical and prosthodontics courses in which students mainly observe. Of these 39 dental schools, 28 (71%) and 11 (29%) dental schools are from the first and second region, respectively.
A large percentage of responding schools included implant education in the predoctoral dental curriculum. Onset year of course, topics included in lecture series, lecture hours, faculty to student ratio and practical course vary among schools. Fifty percent of responding dental schools including Iranian dental schools do not have curriculum guidelines for predoctoral implant dentistry.
PMCID: PMC3184726  PMID: 21998802
Dentistry; Education; Dental Implants; Interdisciplinary Studies; Curriculum
24.  A student-centered approach for developing active learning: the construction of physical models as a teaching tool in medical physiology 
BMC Medical Education  2014;14(1):189.
Teaching physiology, a complex and constantly evolving subject, is not a simple task. A considerable body of knowledge about cognitive processes and teaching and learning methods has accumulated over the years, helping teachers to determine the most efficient way to teach, and highlighting student’s active participation as a means to improve learning outcomes. In this context, this paper describes and qualitatively analyzes an experience of a student-centered teaching-learning methodology based on the construction of physiological-physical models, focusing on their possible application in the practice of teaching physiology.
After having Physiology classes and revising the literature, students, divided in small groups, built physiological-physical models predominantly using low-cost materials, for studying different topics in Physiology. Groups were followed by monitors and guided by teachers during the whole process, finally presenting the results in a Symposium on Integrative Physiology.
Along the proposed activities, students were capable of efficiently creating physiological-physical models (118 in total) highly representative of different physiological processes. The implementation of the proposal indicated that students successfully achieved active learning and meaningful learning in Physiology while addressing multiple learning styles.
The proposed method has proved to be an attractive, accessible and relatively simple approach to facilitate the physiology teaching-learning process, while facing difficulties imposed by recent requirements, especially those relating to the use of experimental animals and professional training guidelines. Finally, students’ active participation in the production of knowledge may result in a holistic education, and possibly, better professional practices.
PMCID: PMC4177070  PMID: 25223392
Active learning; Meaningful learning; Teaching-learning methodologies; Medical education
25.  An emphasis on the wide usage and important role of local anesthesia in dentistry: A strategic review 
Dental Research Journal  2012;9(2):127-132.
Local anesthesia forms the major part of pain-control techniques in dentistry. The prevention and elimination of pain during dental treatment has benefited patients, their doctors and dental hygienists, enabling the dental profession to make tremendous therapeutic advances that would otherwise have been impossible. Introduced in the late 1940s, the amide local anesthetics represent the most used drugs in dentistry. Local anesthetics also represent the safest and most effective drugs in all of medicine for the prevention and management of pain. They are also accompanied by various adverse effects which should be well known and be able to be controlled by the clinician. The article reviews the types of agents used as local anesthetics and their effects on the human body.
PMCID: PMC3353686  PMID: 22623926
Anesthesia; anesthetics; dental; local/adverse effects; pharmacology; vasoconstrictor agent

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