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To find studies to include in the review, searches were made using Biomed Central, Cochrane Oral Health Reviews, Cochrane Library, the Directory of Open Access Journals, PubMed, Science Direct and the Research Findings Electronic Register.English language clinical trials [randomised clinical trials (RCT) or quasi-RCT; in situ or in vivo] or systematic reviews (with or without meta-analysis) of published trials were selected that reported on the efficacy of phosphopeptide-amorphous calcium phosphate (CPP-ACP) using any mode of delivery. Studies were reviewed and their quality assessed independently.Data was extracted by two reviewers independently. Trials that were considered clinically and methodologically homogenous and that reported on similar outcomes were pooled for meta-analyses.Twelve articles were included of which five in-situ RCT could be pooled for meta-analyses. The pooled in-situ results showed a weighted mean difference (WMD) of the percentage remineralisation scores in favour of chewing gum with 18.8 mg CPP-ACP, compared with chewing gum without CPP-ACP of -8.01 [95% confidence interval (CI), -10.54- -5.48; P 0.00001], and compared with no intervention of -13.56 (95% CI, -16.49- -10.62; P 0.00001). A significantly higher remineralisation effect was also observed after exposure to 10.0 mg CPP-ACP (WMD, -7.75; 95% CI, -9.84- -5.66; P 0.00001). One long-term in vivo RCT (24 months) with a large sample size (N = 2720) found that the odds of a tooth surface's progressing to caries was 18% less in subjects who chewed sugar-free gum containing 54 mg CPP-ACP than in control subjects who chewed gum without CPP-ACP (P 0.03).Within the limitations of this systematic review with meta-analysis, the results of the clinical in-situ trials indicate a short-term remineralisation effect of CPP-ACP. Additionally, the promising in-vivo RCT results suggest a caries-preventing effect for long-term clinical CPP-ACP use. Further RCT are needed in order to confirm these initial results in vivo.

A systematic review of the English-language literature was conducted to address three related questions concerning the diagnosis and management of dental caries: a) the performance (sensitivity, specificity) of currently available diagnostic methods for carious lesions, b) the efficacy of approaches to the management of noncavitated or initial carious lesions, and c) the efficacy of preventive methods among individuals who have experienced or are expected to experience elevated incidence of carious lesions. From 1,328 caries diagnostic and 1,435 caries management reports originally identified, thirty-nine diagnostic studies and twenty-seven management studies were included in the final evidence tables. Point estimates or reasonable range estimates for the diagnostic validity of methods for the diagnosis of carious lesions could not be established from the literature reviewed. There are insufficient numbers of reports of diagnostic performance involving primary teeth, anterior teeth, and root surfaces. For posterior occlusal and proximal surfaces, quality issues and the variation among studies precludes establishing such estimates. The apparent differences in sensitivity among methods are generally smaller than the variation reported within methods. The literature on the management of noncavitated carious lesions consisted of five studies describing seven experimental interventions. Because these interventions varied extensively in terms of management methods tested as well as other study characteristics, no conclusions about the efficacy of these methods were possible. The literature on the management of individuals at elevated risk of carious lesions consisted of twenty-two studies describing twenty-nine experimental interventions. The strength of the evidence for the efficacy of fluoride varnish for prevention of dental caries in high-risk subjects was fair, and the evidence for all other methods was incomplete. Because the evidence for efficacy for some methods, including chlorhexidine, sucrose-free gum, and combined chlorhexidine-fluoride methods, is suggestive but not conclusive, these interventions represent fruitful areas for further research.

It is common practice to record treatment rendered, but not the diagnostic basis for these treatment decisions. This practice appears to undervalue diagnosis, as well as hamper feedback to practitioners and the profession about the effectiveness of treatments relative to specific diagnoses. It also leaves dentists open to liability for litigation and impedes research. A case is made that dentistry should follow medicine in exploring the use of standardized computer-codable diagnoses as part of record keeping. A two-step process is suggested to promote initial acceptance.

For 4735 posterior complex amalgams and crowns placed in adults with continuous dental HMO coverage, all additional treatment received over the subsequent 5 years was determined. The restorations were placed under routine clinical conditions by 74 different dentists among a broad spectrum of insured dental patients. Treatment outcomes were described in terms of a hierarchical classification of additional treatments. At the extremes, a successful outcome was defined as no additional treatment or an additional one- or two-surface restoration on the same tooth, and a catastrophic outcome as extraction or endodontic treatment. Due to clinical protocols, teeth with guarded to poor prognosis prior to treatment are overrepresented in the five-surface amalgam cohort. Successful outcomes characterized 72% of four-surface amalgams, 65% of five-surface amalgams, 84% of gold crowns, and 84% of porcelain crowns. Catastrophic outcomes occurred for 10% of four-surface amalgams, 15% of five-surface amalgams, 8% of gold crowns, and 9% of porcelain crowns.

Employers are demanding information about the performance of the health care plans they purchase for their employees. As a result, "report cards" are now beginning to appear that provide standardized, population-based comparison data for managed medical care plans' quality of care, access and member satisfaction, utilization, and financial status. Although report cards for dental care plans have not yet been developed, it is likely that purchasers will soon expect such performance information. A prototype report card for dental managed care plans is proposed in an effort to facilitate the development of a consensus standard for dentistry. The thirty-eight measures proposed for the report card are designed to be obtainable with a realistic level of additional effort in most dental practices. They were selected to provide data on questions of importance to purchasers and to assess processes and outcomes important because there is strong evidence for their effectiveness. The rationale for the measures is discussed, as are the steps required to develop more sophisticated measures. While the responsibility for the procurement of the information needed for dental report cards will die initially with administrators of dental care plans, it is likely in the near future that individual practitioners will be expected to supply this information to both individual patients and potential contractors.

Restorative treatment recommendations made by dentists examining patients were compared with recommendations made by dentists examining simulations of the same patients. Simulations consisted of unmounted casts, full-mouth radiographs, three still video images of each tooth, periodontal charting, and a written dental history. Each of 117 teeth in five patients was examined by at least three and as many as 13 dentists under simulation and live conditions, with no dentists examining the same patient under both conditions. About three-fourths of teeth receiving a recommendation for treatment from at least one dentist received such a recommendation from at least one dentist examining under each of the two examination conditions. For these teeth, about three-fourths of all dentists examining under each condition recommended treatment. For teeth receiving a recommendation for treatment under only one examination condition, smaller proportions of dentists recommended treatment. Overall, there was three times as much variation in treatment recommendations among dentists in an examination condition than between the "average" treatment recommended by dentists in the two examination conditions.

Dentists' attitudes about the importance of formal training in a variety of skills were assessed as a part of the Pew Health Professions Commission initiative to help health professional schools prepare for the future. Through a telephone survey with a 54 percent participation rate, attitudes of a national sample of practitioners were determined concerning the importance of training in 16 competencies that reflect skills, attitudes, and behaviors identified by the commission. Most respondents indicated that competency in treating and preventing disease, practicing ethically, communicating with patients, applying problem solving techniques, and continuing to learn were very important. Conversely, less than half of dentists indicated that competency in managing information, responding to cultural diversity, supporting community agencies, and working in managed care settings were very important. The opinions of graduates since 1980 about their own training in the competencies tended to mirror their ratings of importance. These results demonstrate the continuing need for dental educators to consider prevailing opinion of practicing professionals as a part of any evaluation or planning effort.

This study sought to identify factors associated with dental hygienists' decisions to leave one dental office and commence practice in another. Although dental hygienists' decisions to leave the profession have been examined in some detail, this more common phenomenon of changing positions has not been carefully examined. All currently practicing dental hygienists in North Carolina were surveyed in 1990, as a part of a cooperative project addressing retention of dental office team members. The survey collected information concerning the 976 respondents' (51% response rate) employment experience, reasons associated with leaving past positions, current job and career satisfaction, and personal characteristics. These data were analyzed to determine factors associated with both reported position changes and respondents' predictions of their professional activity status five years hence. No one reason or group of related reasons predominated among respondents' indicated reasons for leaving past positions. Approximately 25% of all changes were related to family responsibilities or spouse relocation. A larger proportion of changes was associated with a variety of job-related factors. Length of time in current position was not strongly related to job or career satisfaction, or to specific employment arrangements. The satisfaction measures were strongly associated with respondents' predictions of future activity status, while the employment arrangements were not. The results indicate that position changes occur for a variety of reasons, most, but not all, of which represent problems amenable to resolution through interventions designed to improve aspects of management within the practice.

A survey of periodontal status and treatment needs among dental patients was performed using the CPITN criteria, with the worst score per sextant being recorded, based on examination of all surfaces of all teeth. Regularly attending patients (n = 1092) from 36 general dental practices in two North Carolina counties were examined. The most frequently found worst conditions-per-patient across all ages were the presence of calculus (35 per cent) and the presence of 4-5 mm pockets (35 per cent). The most common worst condition-per-sextant was bleeding (32 per cent) followed by calculus (28 per cent). Less than a fifth of all sextants exhibited pocketing, although half of the patients had at least a 4-5 mm pocket. The mean amount of treatment time required for these conditions was 33 minutes, reflecting the general absence of the need for complex periodontal treatment.

Attitudes toward social and professional issues in health care were examined for six successive entering classes in a single dental school. Attitudes were assessed on six scales derived by factor analysis of a larger set of questions presented to first-year students. The analyses focused on detection of annual variations and longer term differences in attitudes, and on associations between attitudes and students' background characteristics. Both annual variations and longer term differences were found, but no strong associations between students' characteristics and attitudes were noted. The finding that entering students' attitudes differ between classes can be of importance to educators' teaching strategies.

Dental caries is a disease that recently has undergone, and may still be undergoing, dramatic changes in distribution of incidence and prevalence. The most recent epidemiologic data available have been reviewed in this paper to illustrate that caries is becoming a disease primarily of pits and fissures, with less differentiation than previously acknowledged between fluoridated and fluoride-deficient areas. The present distribution of caries suggests that prevention may be accomplished more effectively through targeted sealant programs than through currently popular mass preventive programs. Existing information can be used to identify logical target groups for sealant programs, and age specific tooth eruption and caries attack information can be used to design delivery methods. Although the adoption of targeted sealant programs represents a departure from the traditional mass approach to prevention in dental programs, the present-day caries distribution requires that the initiation of such programs be given serious consideration. At the very least program administrators are encouraged to invoke the planning-implementation-evaluation process. Current programs should be evaluated carefully in view of today's disease patterns and the clinical significance of the results achieved. The content, design, and timing of future community-based programs should reflect individualized community diagnosis and the application of new epidemiologic data as well as a careful evaluation of the results achieved by current preventive procedures.