Department of Comprehensive Care and Allied Professions

Permanent URI for this community

https://hdl.handle.net/1805/8267

Browse

Now showing 1 - 10 of 85

Diagnostic thinking and information used in clinical decision-making: a qualitative study of expert and student dental clinicians
(BMC, 2010-05-13) Maupomé, Gerardo; Schrader, Stuart; Mannan, Saurabh; Garetto, Lawrence; Eggertsson, Hafsteinn; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
Background It is uncertain whether the range and frequency of Diagnostic Thinking Processes (DTP) and pieces of information (concepts) involved in dental restorative treatment planning are different between students and expert clinicians. Methods We video-recorded dental visits with one standardized patient. Clinicians were subsequently interviewed and their cognitive strategies explored using guide questions; interviews were also recorded. Both visit and interview were content-analyzed, following the Gale and Marsden model for clinical decision-making. Limited tests used to contrast data were t, χ2, and Fisher's. Scott's π was used to determine inter-coder reliability. Results Fifteen dentists and 17 senior dental students participated in visits lasting 32.0 minutes (± 12.9) among experts, and 29.9 ± 7.1 among students; contact time with patient was 26.4 ± 13.9 minutes (experts), and 22.2 ± 7.5 (students). The time elapsed between the first and the last instances of the clinician looking in the mouth was similar between experts and students. Ninety eight types of pieces of information were used in combinations with 12 DTPs. The main differences found in DTP utilization had dentists conducting diagnostic interpretations of findings with sufficient certainty to be considered definitive twice as often as students. Students resorted more often to more general or clarifying enquiry in their search for information than dentists. Conclusions Differences in diagnostic strategies and concepts existed within clearly delimited types of cognitive processes; such processes were largely compatible with the analytic and (in particular) non-analytic approaches to clinical decision-making identified in the medical field. Because we were focused on a clinical presentation primarily made up of non-emergency treatment needs, use of other DTPs and concepts might occur when clinicians evaluate emergency treatment needs, complex rehabilitative cases, and/or medically compromised patients.
An In-Vitro Study to Determine Anti-Caries Efficacy of Fluoride Varnishes
(Office of the Vice Chancellor for Research, 2013-04-05) Al Dehailan, Laila; Mier, E. Angeles Martinez; Lippert, Frank
Fundamental research on fluoride varnishes (FV) and how different formulations affect adherence to teeth, fluoride release into saliva and uptake by teeth is virtually non-existent. The objective of this in vitro study was to investigate the anti-caries efficacy of five commercially available FV: Enamel Pro® Varnish Clear, Flor-Opal® Varnish White, MI Varnish™, PreviDent® and Vanish™. Ninety bovine enamel specimens (4x4mm) were prepared and assigned to five groups (n=18). Early caries lesions were created in the specimens and characterized using Vickers microhardness (VHN). FV was applied to each group of specimens. Immediately afterwards, 7.5ml of artificial saliva (AS) were pipetted over each group, collected and renewed every 15min for 6h. AS samples were analyzed for fluoride using a ion-specific electrode and meter. FV was removed using chloroform and part of the specimens protected to determine enamel fluoride uptake (EFU) using the acid etch technique. Each group was then subjected to pH cycling consisting of a 4h/day acid challenge and two, one-minute treatments with Crest Cavity Protection. Post-pH cycling microhardness was measured and compared to baseline values to determine the ability of the FV to enhance remineralization/prevent demineralization. One-way ANOVA was used for data analysis (p<0.05). Specimens treated with Enamel Pro® revealed an increase in VHN that was significantly higher than all other groups. There was no significant difference in ΔVHN for Flor-Opal® compared to MI Varnish™, PreviDent® and Vanish™. Specimens treated with MI Varnish™ showed significantly higher ΔVHN than Vanish™ only. No significant difference in EFU was found among groups. Total fluoride release over 6h was MI Varnish™(303μg/ml) > Enamel Pro® (217μg/ml) > Flor-Opal® (153μg/ml) > PreviDent® (84μg/ml) > Vanish(28μg/ml). In conclusion, anti-caries efficacy (measured through EFU, fluoride release and VHN) differs among FV products and this difference may be attributed to different composition, fluoride source and other active ingredients.
Effectiveness and Mechanisms of Action of Whitening Dentifrices on Enamel Extrinsic Stains
(Office of the Vice Chancellor for Research, 2013-04-05) Alshara, Salem; Lippert, Frank; Hara, Anderson T.
Whitening dentifrices utilize different approaches for stain removal and/or prevention, including the use of abrasive, oxidizing and chemical cleaning agents. The objectives of this in vitro study were: 1. to compare the whitening effect of commercial whitening and non-whitening dentifrices; 2. to verify the mechanism of action of whitening dentifrices by contrasting two experimental models: chemical (toothpaste exposure only) and chemo-mechanical (toothpaste exposure with tooth brushing abrasion). Two hundred fifty six bovine enamel specimens (10x10mm) were prepared and partially stained. They were assigned to 8 groups: 6 whitening dentifrices, 1 non-whitening reference dentifrice and deionized water (control); and further divided in 2 subgroups (n=16) according to the experimental models: chemical or chemo-mechanical. Specimens were daily exposed to dentifrice slurries 2x/day for 1min and brushed or not, according to each model. In between dentifrice treatments, specimens were exposed to the staining solution for 5h. This protocol was repeated for 5 consecutive days and enamel color changes (Delta E) were measured by spectrophotometry, after each day. The abrasivity of the toothpastes was determined using standard test (ISO 11609). Significantly higher Delta E values (whitening effect) were observed for all groups (p<0.05), except control, when tested in the chemo-mechanical model. In this model, the whitening ability of the toothpastes was mainly determined by their abrasive levels. For the chemical model, no significant differences were observed among groups (p>0.05). Whitening dentifrices can be effective preventing/removing enamel surface staining, when associated to tooth brushing abrasion. This seemed to be modulated mainly by the abrasive level of the tested toothpastes, with no action attributed to the chemical agents.
Comparison Between Radiotracer and Surface Profile Methods for the Determination of Dentifrice
(Office of the Vice Chancellor for Research, 2013-04-05) Sabrah, Alaa; Lippert, Frank; Kelly, Adam B.; Hara, Anderson T.
Introduction: ISO11609 states that a surface profile (Sp) method can be used to determine dentifrice abrasivity in relation to dentin (RDA) as an alternative to the traditional radiotracer method (Rt). A comparison between both methods was performed in this study. Methods: Specimens from human root dentin were prepared for each method and randomly assigned to 8 dentifrice/abrasive groups (n=8), which represented a wide abrasivity range. Aqueous dentifrice slurries or abrasive suspensions in a solution containing 0.5% carboxymethylcellulose and 10% glycerin were used to brush specimens in a custom-made V-8 cross-brushing machine. Two independent studies (Sp, Rt) were carried out. For Rt, the specimen preparation, study design, analysis and calculation of the abrasive level (RDA) followed the ISO11609/Annex A guidelines. Similarly for Sp, the ISO11609/Annex B recommendations were followed, except by the number of brushing strokes, which was pre-determined to be 2000 strokes (instead of 10000) in a preliminary test. Data were analyzed using ANOVA and Tukey tests, with significance level set at 5%. The correlation between methods was also investigated. Results: Overall, higher variation and RDA values were observed for the Sp method compared to Rt. While good correlation was found between methods (R2=0.841), group ranking was dissimilar and better statistical differentiation among groups was observed in Rt. Conclusions: The Rt method showed to be a more standardized and robust method compared to Sp for the determination of RDA values of dentifrices/abrasives. Sp needs to be further developed before being considered as an equivalent test method for RDA. The determination of the abrasive levels of toothpastes using standard testing methods is important to guide oral care professionals and patients on the prevention of toothbrushing abrasive wear.
Advancing cognitive engineering methods to support user interface design for electronic health records
(Elsevier, 2014-04) Thyvalikakath, Thankam P.; Dziabiak, Michael P.; Johnson, Raymond; Torres-Urquidy, Miguel Humberto; Acharya, Amit; Yabes, Jonathan; Schleyer, Titus K.; Department of Cariology, Operative Dentistry and Dental Public Health, IU School of Dentistry
Background Despite many decades of research on the effective development of clinical systems in medicine, the adoption of health information technology to improve patient care continues to be slow, especially in ambulatory settings. This applies to dentistry as well, a primary care discipline with approximately 137,000 practitioners in the United States. A critical reason for slow adoption is the poor usability of clinical systems, which makes it difficult for providers to navigate through the information and obtain an integrated view of patient data. Objective In this study, we documented the cognitive processes and information management strategies used by dentists during a typical patient examination. The results will inform the design of a novel electronic dental record interface. Methods We conducted a cognitive task analysis (CTA) study to observe ten general dentists (five general dentists and five general dental faculty members, each with more than two years of clinical experience) examining three simulated patient cases using a think-aloud protocol. Results Dentists first reviewed the patient’s demographics, chief complaint, medical history and dental history to determine the general status of the patient. Subsequently, they proceeded to examine the patient’s intraoral status using radiographs, intraoral images, hard tissue and periodontal tissue information. The results also identified dentists’ patterns of navigation through patient’s information and additional information needs during a typical clinician-patient encounter. Conclusion This study reinforced the significance of applying cognitive engineering methods to inform the design of a clinical system. Second, applying CTA to a scenario closely simulating an actual patient encounter helped with capturing participants’ knowledge states and decision-making when diagnosing and treating a patient. The resultant knowledge of dentists’ patterns of information retrieval and review will significantly contribute to designing flexible and task-appropriate information presentation in electronic dental records.
Fluoride Release from Fluoride Varnishes under Acidic Conditions
(2014-09) Lippert, Frank; Department of Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
Objective: The aim was to investigate the in vitro fluoride release from fluoride varnishes under acidic conditions. Study design: Poly(methyl methacrylate) blocks (Perspex, n=3 per group) were painted with 80±5 mg fluoride varnish (n=10) and placed into artificial saliva for 30min. Then, blocks were placed into either 1% citric acid (pH 2.27) or 0.3% citric acid (pH 3.75) solutions (n=3 per solution and varnish) for 30min with the solutions being replaced every 5min. Saliva and acid solutions were analyzed for fluoride content. Data were analyzed using three-way ANOVA (varnish, solution, time). Results: The three-way interaction was significant (p>0.0001). Fluoride release and release patterns varied considerably between varnishes. Fluoride release in saliva varied by a factor of more than 10 between varnishes. Some varnishes (CavityShield, Nupro, ProFluorid, Vanish) showed higher fluoride release in saliva than during the first 5min of acid exposure, whereas other varnishes (Acclean, Enamel-Pro, MI Varnish, Vella) showed the opposite behavior. There was little difference between acidic solutions. Conclusions: Fluoride release from fluoride varnishes varies considerably and also depends on the dissolution medium. Bearing in mind the limitations of laboratory research, the consumption of acidic drinks after fluoride varnish application should be avoided to optimize the benefit/risk ratio.
Network science and oral health research
(Wiley Blackwell (Blackwell Publishing), 2015) Maupome, Gerardo; McCranie, Ann; Department of Cariology, Operative Dentistry and Dental Public Health, IU School of Dentistry
The present overview of research methods describes a scientific enquiry paradigm that is well established in other disciplines, including health research, but that is fairly new to oral health research. Social networks analysis (SNA) or network science research is a set of relational methods purporting to identify and characterize the connections between members of a system or network, as well as the structure of the network. Persons and communities making up the members of networks have commonly been the focus of SNA studies but corporations or living organisms might just as well be organized in networks. SNA is grounded in both graphic imagery and computational models. SNA is based on the assumptions that features and structure of networks are amenable to characterization, that such information sheds light on the ways members of the network relate to each other (sharing information, diseases, norms, and so on), and that through these connections between members the overall network structure and characteristics are shaped. The overview resorts to examples specific to oral health themes and proposes a few general avenues for population-based research.
Exploratory randomized clinical trial of an experimental gel-to-foam fluoride dentifrice formulation using an in situ caries model
(2015) Barlow, Ashley; Butler, Andrew; Mason, Stephen; Zero, Domenick; Department of Cariology, Operative Dentistry, and Dental Public Health, IU School of Dentistry
OBJECTIVE: To evaluate the in situ caries performance and safety of two experimental fluoride dentifrice formulations (1450 ppm fluoride) with and without 2% isopentane as an excipient, in comparison to a positive control, currently marketed dentifrice (1450 ppm fluoride) and a negative control dentifrice (0 ppm fluoride). METHODS: This was a single-center, examiner-blind, randomized, controlled, four-treatment cross-over study. During each treatment period, the subject wore a modified mandibular partial denture fitted with two gauze-covered, partially demineralized human enamel specimens, and brushed at home for one timed minute, twice daily, for two weeks. At the end of each treatment period, the enamel specimens were removed from the dentures for analysis. During the week between treatment periods, subjects returned to their usual dental hygiene practices for four to five days, received a dental prophylaxis, and used a study-designated non-fluoride dentifrice for two to three days before starting the next treatment. Treatment effect on enamel specimen remineralization was assessed by surface microhardness (SMH). Enamel fluoride uptake was assessed using microdrill enamel biopsy. RESULTS: All fluoride-containing dentifrices demonstrated significant, superior SMH recovery and levels of fluoride uptake compared to the negative control dentifrice. No significant differences were observed for either efficacy variable between the experimental dentifrice formulations and the positive control dentifrice. No significant difference was observed between the 2% isopentane dentifrice and the 0% isopentane dentifrice for SMH recovery. CONCLUSION: The addition of 2% isopentane did not positively or negatively affect fluoride efficacy in this model.
A Potential Biofilm Metabolite Signature for Caries Activity - A Pilot Clinical Study
(OMICS Publishing Group, 2015-03) Zandona, F.; Soini, H. A.; Novotny, M. V.; Santiago, E.; Eckert, G. J.; Preisser, J. S.; Benecha, H. K.; Arthur, R. A.; Zero, D. T.; Department of Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
BACKGROUND: This study's aim was to compare the dental biofilm metabolite-profile of caries-active (N=11) or caries-free (N=4) children by gas chromatography-mass spectrometry (GC/MS) analyses. METHODS: Samples collected after overnight fasting, with or without a previous glucose rinse, were combined for each child based on the caries status of the site, re-suspended in ethanol and analyzed by GC/MS. RESULTS: Biofilm from caries-active sites exhibited a different chromatographic profile compared to caries-free sites. Qualitative and quantitative analysis suggested a special cluster of branched alcohols and esters present at substantially higher intensity in biofilms of caries-active sites. CONCLUSIONS: This pilot study indicates that there are metabolites present in the biofilm which have the potential to provide a characteristic metabolomics signature for caries activity.
In vitro Detection of Occlusal Caries on Permanent Teeth by a Visual, Light-Induced Fluorescence and Photothermal Radiometry and Modulated Luminescence Methods
(Karger, 2015-10) Jallad, Mahmoud; Zero, Domenick; Eckert, George; Ferreira Zandona, Ag; Department of Cariology, Operative Dentistry, and Dental Public Health, IU School of Dentistry
Background: The paradigm shift towards the nonsurgical management of dental caries relies on the early detection of the disease. Detection of caries at an early stage is of unequivocal importance for early preventive intervention. Objective: The aim of this in vitro study is to evaluate the performance of a visual examination using the International Caries Detection and Assessment System (ICDAS) criteria, two quantitative light-induced fluorescence (QLF) systems - Inspektor™ Pro and QLF-D Biluminator™ 2 (Inspektor Research Systems B.V., Amsterdam, The Netherlands) - and a photothermal radiometry and modulated luminescence, The Canary System® (Quantum Dental Technologies, Toronto, Ont., Canada) on the detection of primary occlusal caries on permanent teeth. Methods: A total of 60 teeth with occlusal surface sites ranging from sound to noncavitated lesions (ICDAS 0-4) were assessed with each detection method twice in a random order. Histological validation was used to compare methods for sensitivity, specificity, percent correct, and the area under the receiver operating characteristic curve (AUC), at standard and optimum sound thresholds. Interexaminer agreement and intraexaminer repeatability were measured using intraclass correlation coefficients. Results: Interexaminer agreement ranged between 0.48 (The Canary System®) and 0.96 (QLF-D Biluminator™ 2). Intraexaminer repeatability ranges were 0.33-0.63 (The Canary System®) and 0.96-0.99 (QLF-D Biluminator™ 2). The sensitivity range was 0.75-0.96 while that of specificity was 0.43-0.89. The AUC were 0.79 (The Canary System®), 0.87 (ICDAS), 0.90 (Inspektor™ Pro), and 0.94 (QLF-D Biluminator™ 2). Conclusion: ICDAS had the best combination of sensitivity and specificity followed by QLF-D Biluminator™ 2 at optimum threshold.

Browse

Browsing Department of Comprehensive Care and Allied Professions by Issue Date

Results Per Page

Sort Options