Cultural Context in the Effort to Improve Oral Health Among Alaska Native People: The Dental Health Aide Therapist Model

The Alaska Native people in rural Alaska face serious challenges in obtaining dental care. Itinerant care models have failed to meet their needs for more than 50 years. The dental health aide therapist (DHAT) model, which entails training midlevel care providers to perform limited restorative, surgical, and preventive procedures, was adopted to address some of the limitations of the itinerant model. We used quantitative and qualitative methods to assess residents’ satisfaction with the model and the role of DHATs in the cultural context in which they operate. Our findings suggest that the DHAT model can provide much-needed access to urgent care and is beneficial from a comprehensive cultural perspective

Provisional Crown Failures in Dental School Predoctoral Clinics

Following a preliminary study indicating that at least 10 percent of single-unit crown temporary restorations failed in patients who received treatment by predoctoral students, a comprehensive examination of provisional crown failure was initiated to identify strategies to reduce the failure rate. For all provisionalized, natural tooth, single-unit crown preparations in University of North Carolina School of Dentistry predoctoral clinics for one year (N=1008), we noted tooth type, type of crown, student level, faculty coverage experience, treatment clinic, temporary material and luting agent, and retreatment (failure) of the provisional restoration. For failures, we also noted the stage of crown preparation at failure and the time since initial placement of the temporary. We analyzed these data using simple cross-tabs and logistic regression on need for retreatment (alpha =0.05). The failure rate was 18.75 percent (N=189). The median time to failure was twelve days; the 25(th) and 75(th) percentiles were six and twenty-six days. Significant risk factors, in order of odds ratio estimates, were molar tooth, second- or third-year student, and inexperienced faculty. Most provisional failures occurred during the final preparation phase of treatment. Provisional restoration failure is more frequent than was initially suspected from preliminary studies. Strategies for institutional intervention to reduce provisional restoration failure include greater attention to evaluating provisional crowns placed by inexperienced students (sophomores and juniors) and placing more emphasis on the retentiveness of provisional restorations reused following the final impression. Review of provisional evaluation procedures is also indicated for faculty who do not routinely supervise these procedures

Evaluation of the Dental Health Aide Therapist Workforce Model in Alaska (Final Report)

In January 2008, the W.K. Kellogg Foundation, in collaboration with ANTHC, the Rasmuson Foundation, and the Bethel Community Services Foundation, requested that an experienced organization provide an independent, detailed, and objective evaluation of the initial implementation of the Dental Health Aide Therapist (DHAT) program

Root Caries Risk Indicators: A Systematic Review of Risk Models

To identify risk indicators that are associated with root caries incidence in published predictive risk models

Correlation between Laser Fluorescence Readings and Volume of Tooth Preparation in Incipient Occlusal Caries In Vitro

This study evaluated the correlation between laser fluorescence readings and the extent of incipient occlusal caries as measured by the volume of tooth preparation in vitro.One hundred and three permanent molars and premolars containing incipient occlusal pit-and-fissure caries and sound occlusal surfaces (1/4 of the sample, control) were selected. DIAGNOdent (KaVo Dental Corporation, Lake Zurich, IL, USA) readings were obtained according to manufacturer instructions. Caries was removed with 1/4 round burs in high speed. The volume of tooth preparation was measured using a surrogate measure based on the amount of composite needed to fill the preparations. Sensitivity and specificity using different cutoff values were calculated for lesions/preparations extending into dentin. The results were analyzed statistically.The Pearson correlation for preparation volume and DIAGNOdent reading measurements was low ( r  = 0.285). Sensitivity and specificity of DIAGNOdent for detection of dentinal lesions were 0.83 and 0.60, and 0.66 and 0.73 for the cutoff values of 20 and 30, respectively.Within the limitations of this study, laser fluorescence measured with DIAGNOdent does not correlate well with extent of carious tooth structure in incipient occlusal caries.Clinicians should not rely only on DIAGNOdent readings to determine the extension of incipient occlusal caries.( J Esthet Restor Dent 22:31–41, 2010)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78687/1/j.1708-8240.2009.00309.x.pd

Design of the Xylitol for Adult Caries Trial (X-ACT)

Abstract Background Dental caries incidence in adults is similar to that in children and adolescents, but few caries preventive agents have been evaluated for effectiveness in adults populations. In addition, dentists direct fewer preventive services to their adult patients. Xylitol, an over-the-counter sweetener, has shown some potential as a caries preventive agent, but the evidence for its effectiveness is not yet conclusive and is based largely on studies in child populations. Methods/Design X-ACT is a three-year, multi-center, placebo controlled, double-blind, randomized clinical trial that tests the effects of daily use of xylitol lozenges versus placebo lozenges on the prevention of adult caries. The trial has randomized 691 participants (ages 21-80) to the two arms. The primary outcome is the increment of cavitated lesions. Discussion This trial should help resolve the overall issue of the effectiveness of xylitol in preventing caries by contributing evidence with a low risk of bias. Just as importantly, the trial will provide much-needed information about the effectiveness of a promising caries prevention agent in adults. An effective xylitol-based caries prevention intervention would represent an easily disseminated method to extend caries prevention to individuals not receiving caries preventive treatment in the dental office. Trial Registration ClinicalTrials.Gov NCT0039305

Design of the Xylitol for Adult Caries Trial (X-ACT)

Abstract Background Dental caries incidence in adults is similar to that in children and adolescents, but few caries preventive agents have been evaluated for effectiveness in adults populations. In addition, dentists direct fewer preventive services to their adult patients. Xylitol, an over-the-counter sweetener, has shown some potential as a caries preventive agent, but the evidence for its effectiveness is not yet conclusive and is based largely on studies in child populations. Methods/Design X-ACT is a three-year, multi-center, placebo controlled, double-blind, randomized clinical trial that tests the effects of daily use of xylitol lozenges versus placebo lozenges on the prevention of adult caries. The trial has randomized 691 participants (ages 21-80) to the two arms. The primary outcome is the increment of cavitated lesions. Discussion This trial should help resolve the overall issue of the effectiveness of xylitol in preventing caries by contributing evidence with a low risk of bias. Just as importantly, the trial will provide much-needed information about the effectiveness of a promising caries prevention agent in adults. An effective xylitol-based caries prevention intervention would represent an easily disseminated method to extend caries prevention to individuals not receiving caries preventive treatment in the dental office. Trial Registration ClinicalTrials.Gov NCT0039305

The dynamic behavior of the early dental caries lesion in caries-active adults and implications

To describe the full range of behavior of the visible, non-cavitated, early caries lesion in caries-active adults with substantial fluoride exposure, and to consider implications

Four “Lessons Learned” While Implementing a Multi-Site Caries Prevention Trial

As the number of dental-related randomized clinical trials (RCTs) increases, there is a need for literature to help investigators inexperienced in conducting RCTs design and implement studies. This commentary describes four “lessons learned,” or considerations important in the planning and initial implementation of RCTs in dentistry that to our knowledge have not been discussed in the general dental literature describing trial techniques. These considerations are 1) preparing or securing a thorough systematic review, 2) developing a comprehensive set of study documents, 3) designing and testing multiple recruitment strategies, and 4) employing a run-in period prior to enrollment. Attention to these considerations in the planning phases of a dental RCT can help ensure that the trial is clinically relevant while also maximizing the likelihood that its implementation will be successful

Results from the Xylitol for Adult Caries Trial (X-ACT)

Although caries is prevalent in adults, few preventive therapies have been tested in adult populations. This randomized clinical trial evaluated the effectiveness of xylitol lozenges in preventing caries in elevated caries-risk adults