Browsing by Author "Capin, Oriana"
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Item Are new dentists prepared for clinical practice? A survey of the clinical abilities of new dental graduates in the U.S. military(2024) Chiodo, Kathleen; Cook, N. Blaine; Capin, Oriana; Diefenderfer, Kim; Adcook, RichardObjective: This study aimed to identify new dentists’ competence in preventive and restorative procedures, as self-assessed by the new dentists and evaluated by their clinical supervisors. Justification: Preventive and restorative dental procedures constitute the majority of treatment provided daily in a general dentistry practice. Exploring new dentist proficiency in these foundational skills within one year of dental school graduation provides crucial information regarding the knowledge and skills new dentists attain during dental school. The military dental system is structured so that all new dentists receive close clinical oversight during their first year following graduation. Hypotheses: (1) The majority of dentists who have graduated less than one year prior to this survey will self-assess their skills in basic preventive and restorative dental procedures as “competent” or higher. (2) The majority of supervisor evaluations of new dentists will also average a level of “competent” or higher. (3) New dentists will self-assess their competence levels higher than their supervisors will evaluate them. Methods: An electronic, anonymous Qualtrics survey was sent to U.S. Air Force, Army and Navy new dentists and their clinical supervisors November 2022. Using a modified-Dreyfus model of skill acquisition, new dentists completed a self-assessment of 20 preventive and restorative procedures. Their clinical supervisors also completed a survey evaluating the proficiency level of the new dentists they oversaw. Results: 60 new dentists and 25 supervisors, accounting for 151 new dentists, responded. The proportion of competence ratings at a level of “competent” or higher (“proficient,” “expert”) was estimated, along with a 95% confidence interval, and one-sample chi-square tests were used to compare the proportion against 50%. Supervisors’ ratings of the new dentists’ skill levels were significantly lower than the new dentists’ ratings for 19 of the 20 dental procedures. Supervisors’ ratings of competent or higher were significantly greater than 50% in caries diagnosis and treatment planning, caries risk assessment, Class III anterior composite resins and posterior composite resins. Overall, supervisors rated 71.3% of new dentists at Novice or Beginner skill level. Conclusion: Supervisor ratings of the new dentists’ skill levels were significantly lower than the dentists’ ratings for the majority of procedures. New dentists and supervisors significantly disagreed on new dentists’ skill levels in the treatment of class I and II amalgams, endodontically treated teeth without a post, and crown preparation and delivery. Overall, 28.7% of new dentists were evaluated as competent in preventive and restorative procedures during their first year following dental school graduation.Item The Effect of Silver Diamine Fluoride on Caries Lesion Remineralization as a Function of Lesion Baseline Mineral Distribution(2022) AlMady, Fahad; Lippert, Frank; Hara, Anderson; Al Dehailan, Laila; Capin, OrianaPurpose: The primary objective of this laboratory study was to investigate whether the ability of SDF to remineralize caries lesion is modulated by their baseline mineral distribution. The exploratory objective was to determine whether the staining caused by SDF is modulated by lesion mineral distribution. Materials and methods: This in vitro study utilized bovine permanent enamel specimens. SDF was compared to the clinical reference standard, 5% sodium fluoride varnish (FV), and deionized water (DIW) was the negative control. By utilizing three lesion creation protocols (methylcellulose [MeC], hydroxyethylcellulose [HEC], Carbopol [C907]), artificial caries lesions with different mineral distributions (n=20 per subgroup) were created in the enamel specimens Interventions were applied and the lesions remineralized using artificial saliva. Changes in mineral loss, lesion depth, mineral density of the surface zone, and lesion mineral distribution were determined using transverse microradiography. Throughout the study, color of the lesion and changes thereof were measured using a spectrophotometer. Data were analyzed by using two-way ANOVA. Pair-wise comparisons were performed using Fisher’s Protected Least Significant Differences to control the overall significance level at 5%. Results: For changes in mineral loss, DIW in MeC showed significantly greater change (more remineralization) than both SDF (p<0.01) and FV (p=0.01), which were not different from one another (p=0.13). There were no statistically significant differences between SDF and FV in the other lesions (C907 – p=0.18; HEC – p=0.56). For changes in lesion depth, there was no statistically significant interaction between study factors lesion protocol and treatments (p=0.23) as well as the individual factors lesion protocols (p=0.08) and treatments (p=0.82). For changes in surface zone mineral density, SDF showed significant change in mineral density compared to FV (p=0.02); however, SDF was not different from with DIW (p=0.25). For lesion mineral distribution, MeC exhibited the greater mineral loss in the lesion body and lowest mineral density at the surface zone. HEC lesions were the deepest but exhibited modest differences in mineral loss between the lesion body and the surface zone. C907 lesions were somewhat between MeC and HEC. SDF in MeC had the highest mineral gain in the surface zone, while DIW resulted in the highest mineral gain in the lesion body. SDF in HEC showed the highest mineral gain in the surface area compared to FV and DIW, with all treatments resulting in the largest mineral gain to a similar extent in the lesion body. In C907, SDF showed the most mineral gain in the lesion body compared to DIW and FV, while differences in the surface zone between treatments were less pronounced. For color changes post intervention, SDF showed more darkening in C907 and HEC lesions compared to MeC (p<0.01) and compared to FV and DIW. For post remineralization, SDF treated C907 lesions became significantly whiter (p<0.01) compared to SDF in MeC and HEC which continued to get darker. Conclusion: SDF did exhibit different remineralization abilities and behaviors and the modulation was based on lesion baseline mineral distribution. Staining resulting from SDF treatment varied significantly based on lesion mineral distribution.Item Longevity of Crown Margin Repairs Using Glass Ionomer: A Retrospective Study(2020) Watson, Justin I.; Cook, N. Blaine; Thyvalikakath, Thankam; Diefenderfer, Kim E.; Capin, OrianaObjectives: Repair of crown margins may extend the functional life of existing crowns. However, the longevity of such treatment is unknown. This study determined the survival time of crown margin repairs (CMR) with glass-ionomer (GI) and resin-modified glass-ionomer cements. Methods: We queried axiUm (Exan Group, Coquitlam, BC, Canada) database for permanent teeth that underwent CMR in the Graduate Operative Dentistry Clinic, Indiana University School of Dentistry (IUSD), Indianapolis, Ind., USA, from January 1, 2006 through January 1, 2018. Since there is no CDT code for the CMR procedure, CDT codes for resin-composite and GI restorations (D23XX) were queried; these patients also had treatment notes that indicated CMR. The final data set included patient ID, birth date, gender, dates of treatments, CDT codes, tooth type, tooth surface and existing findings. Two examiners developed guidelines for record review and manually reviewed the clinical notes of patient records to confirm CMR. Only records that were confirmed with the presence of CMR were retained in the final dataset for survival analysis. Survival time was calculated by Kaplan-Meier statistics and a Cox Proportional Hazards model was performed to assess the influence of selected variables (p < 0.05). Results: 214 teeth (115 patients) with CMR were evaluated. Patient average age was 69.4 11.7 years old. Posterior teeth accounted for 78.5 percent (n = 168) of teeth treated. CMRs using GI had a projected 5-year survival rate of 62.9 percent (K-M Analysis) and an 8.9 percent annual failure rate. Cox Proportional Hazards Regression analysis revealed that none of the factors examined (age, gender, tooth type) affected time to failure. Conclusion: CMRs may extend the longevity of crowns with defective margins. Larger EHR studies or case control studies are needed to investigate other variables, such as the caries risk status or the severity of defects that may affect the survival rate of CMRs.Item Mineral Content of Water From Public Fountains Along the Monon Trail in Central Indiana(2024) Bakhaider, Renad Fahad; Lippert, Frank; E. Soto Rojas, Armando; Capin, OrianaBackground: The Monon trail is one of the most popular trails located in central Indiana that the public uses for various physical activities, such as cycling, jogging, and walking. Physical activity, especially in the summer, causes the body to dehydrate and lose some of its electrolytes via sweating (e.g., calcium, magnesium, potassium, and sodium). These minerals are considered important in regulating some of the body’s chemical and biological reactions. Therefore, water fountains are located along the trail. However, no study has thus far investigated the mineral composition of water provided along the Monon trail and how it compares with commonly used bottled water. Fluoride is added to tap water in many communities in the US for the prevention of dental caries (community water fluoridation). However, whether water provided by these fountains meets the recommended fluoride level by the CDC for caries prevention has not been established. Therefore, this study aimed to determine the fluoride, calcium, magnesium, potassium, and sodium contents from water samples collected from all water fountains along the Monon trail and to compare their mineral concentrations to commercially available bottled waters. As an exploratory objective, we also assessed the utilization of theses fountains by the users of the Monon trail. Objectives: The primary aim of this study was to evaluate the fluoride, calcium, magnesium, potassium, and sodium contents of water from public drinking water fountains along the Monon trail in central Indiana. The secondary aim was to compare the nutritional value of the collected water samples to that of commercially available bottled waters. An exploratory objective will be to study the utilization of these fountains by users of the Monon trail. Methodology: Two 50-ml samples of water from each fountain along the Monon Trail were collected. The fluoride concentration was determined using a fluoride ion-specific electrode (Orion #96-909-00). The calcium, magnesium, sodium, and potassium contents were determined by atomic absorption spectrometer, equipped with deuterium and cathode lamps at wave lengths of 422.7 nm, 285.2 nm, 589.0 nm, and 766.5 nm, respectively. Data collected from water samples were compared to those of bottled water available in Indianapolis, Indiana, using data from a recently conducted study. Mineral data of water samples were compared to recommended dietary allowances (calcium and magnesium) or adequate intakes (potassium and sodium) as established by the Institutes of Medicine. The utilization of those fountains by cyclists, runners/joggers, and walkers was also investigated by conducting an observational study at each water fountain during a one-hour period in mid- to late afternoon during a weekday and weekend. Data collection was taken twice, one month apart. The statistical analyses of the study were carried out using two-sided two sample t-tests at 5-% significance level. Results: The author identified seven water fountains along the Monon trail during the study period. Fluoride concentration was generally high (mean 1.01 parts per million [ppm]). Calcium concentration ranged from 45 ppm to 81 ppm (mean, 60.9 ppm) which was greater than those of magnesium (range, 4.8 ppm to 13.7 ppm; mean 8.4 ppm), sodium (range, 14.7 ppm to 78.1 ppm; mean 40.5 ppm), and potassium (range, 1.2 ppm to 2.2 ppm; mean 1.6 ppm). Overall, water fountains provided meaningful contributions to adequate intake of fluoride. However, the contributions to adequate intake of sodium and potassium, or to the recommended dietary allowances for calcium and magnesium were lower. Moreover, water from fountains was found to contain higher mineral concentrations than most bottled waters. Conclusion: Within the limitations of this study, it was found that water fountains are a valuable source of rehydration and essential mineral replenishment during and after physical activity, as they provide greater nutritious values than most bottled waters. Furthermore, it was found that F concentration in water fountains satisfies the standards needed to prevent dental caries.