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Purpose: The purpose of this study was to evaluate the cytotoxicity of silver diamine fluoride (SDF) to human dental pulp stem cells (hDPSC). Methods: hDPSC were exposed to dilutions of 38 percent SDF ( 10-3, 10-4, and 10-5) and incubated for 24 hours. Cell viability was assessed with colorimetric detection assay at 24 hours. Fresh media was used as a negative control, and 0.1% sodium dodecyl sulfate was used as a positive control. Three independent experiments were performed in triplicate. Cell viability data were analyzed using analysis of variance and Tukey's multiple comparison test. Results: Cells exposed to dilution of 38 percent SDF 10-3 had an average cell viability of 17.0±3.5 (standard deviation) percent. Cells exposed to SDF 10-4 and 10-5 had an average cell viability of 101±2.5 percent and 94±4.4 percent, respectively. Dilution of 10-3 had significantly lower cell viability than the negative control (P<0.001). Dilution of 10-4 and 10-5 SDF had significantly higher cell viability than the positive control (P<0.001) and cells treated with a dilution of 10-3 (P<0.001). Conclusions: Thirty-eight percent silver diamine fluoride was cytotoxic to human dental pulp stem cells at a dilution of 10-3, but not at 10-4 and 10-5. In light of the cytotoxicity of SDF to hDPSC, this in vitro study supports the concern that exposure of the full concentration of 38 percent SDF to the pulp should be avoided.

Purpose: Active learning engages students via interaction for deeper understanding and retention. A global pandemic resulted in an abrupt mid-semester transition from in-person to virtual learning. This study examined student reporting on active learning before and after this transition., Methods: First-year DDS candidates took an anonymous survey, reflecting on three Spring (January-April) 2020 courses (lecture-style, small-group case-based, and pre-clinical). Survey questions included: (1) basic demographics, (2) reporting frequency (1-Never, 2-Rarely, 3-Sometimes, 4-Often, 5-Always) of active learning elements from a pre-set list before/after the shift to online learning, and (3) Likert-style questions regarding effects on active learning and learning environment preference., Results: The traditional lecture course manifested two active learning activities in the category Sometimes prior to the transition to virtual; one of those activities (question and answer) experienced the most significant difference (p < 0.0001) in frequency change. The small group, case-based course incorporated nine activities in-person in the category Sometimes; although small significant differences (p ≤ 0.05) in frequency were noted for five of those activities between virtual and in-person, these differences may have not have made a difference in practice. The pre-clinical course incorporated four activities in the category Sometimes pre-transition, with no significant differences detected in frequency. Students slightly leaned toward preferring in-person for the small-group and pre-clinical courses, but had no preference for the traditional lecture course., Conclusions: Course structure may correlate more with student experience of the frequency of active learning activities and preference for in-person versus virtual environment than the environment itself., (© 2022 American Dental Education Association.)

Purpose: This multi-site study examined dental students' postgraduate plans and factors affecting them, perceptions of pathways with the best future, and whether those postgraduate plans changed during dental school., Methods: An online survey was made available to all four dental classes (2018, 2019, 2020, and 2021) and advanced standing/international dental students at eight US dental schools. The survey questionnaire consisted of two parts: (1) 14 questions pertaining to demographic information and (2) 11 questions pertaining to career path choices and possible influencing factors., Results: Overall response rate was approximately 38.4% (1459/3800). For those responding 34.0% planned to enroll in a general dentistry residency, followed by associate dentist in a private practice (31.4%), and specialty residency (17.6%). Quality of life, to increase knowledge/clinical skills, and intellectual satisfaction were most often rated extremely important factors; Influence of family members in dentistry and prestigious specialty received the most responses of not important. General dentistry was perceived to have the best future in terms of overall impact on the profession, potential for positive impact on patient's quality of life, and personal quality of life; oral and maxillofacial surgery was believed to have the best future in terms of salary. Students changed their postgraduate plan during dental school 43.0% of the time, with race (p = 0.006) and year of progress toward degree (p < 0.001) being significant associations., Conclusions: General dentistry remains the most popular pathway. Many dental students change their plans during dental school; a better understanding of these trends and contributing factors may aid development of practice readiness curricula., (© 2021 American Dental Education Association.)

Manufacturer instructions for 38% silver diamine fluoride (SDF) are limited to current FDA clearance for tooth desensitization. There is a need for instructions to provide best-practice recommendations for off-label use of SDF for caries prevention and arrest., Methods: The authors considered existing clinical approaches to the use of 38% SDF at pH 10 for the prevention and arrest of active dental caries, in light of the best current evidence. Application of SDF, with or without subsequent direct restoration, is included. The content was reviewed by stakeholders including but not limited to those listed on the consensus statement (Appendix A, below)., Results: 38% SDF for the prevention and arrest of active caries lesions, as well as compatibility with common direct restorative materials, such as glass-ionomer cement and resin composite, has a foundation in the scientific literature. A practical decision-flow diagram and accompanying best practices for treatment of caries lesions, based on clinical access and intention to restore, were developed based on available evidence and expert clinical observation when no evidence was available., Conclusions: Based on the best available evidence, a logical approach can be adopted regarding the practical use of 38% SDF for caries prevention and arrest., Practical Implications: SDF used as per these instructions for prevention on high-risk tooth surfaces and arrest of active caries lesions has a place in the practitioner's dental caries management armamentarium. When SDF is applied to active lesions, it can be used with or without subsequent restoration, depending on clinical context, expert judgment, and patient input.

Purpose: To evaluate the effect of light cure, as well as various dentin surface treatment approaches, on the penetration depth of silver precipitating from 38% silver diamine fluoride into primary dentin tubules., Methods: The occlusal dentin surfaces of 42 non-carious primary molars were exposed and then sectioned into halves bucco-lingually. The halves from each tooth pair were randomly split in two mega-groups, and each mega-group was divided randomly as follows into six experimental groups: prepared by either carbide bur (G1, G2), ceramic bur (G3, G4), or erbium laser (G5, G6). SDF was then applied to all prepared surfaces, and finally even-numbered groups (G2, G4, G6) were light cured. One mega-group was assigned to quantitative evaluation of silver penetration depth along the axial wall, and the other mega-group was reserved for qualitative observation of relative silver distribution on the occlusal surface, both via scanning electron microscope., Results: No significant difference was observed in silver penetration depth between light cure and non-light cure groups (P= 0.8908). There was a statistically significant association between tooth preparation method and depth of silver penetration (P< 0.000001); laser-treated groups had significantly deeper silver penetration (1,148.9 µm G5, 1160.4 µm G6) than carbide bur (P< 0.05; 184.7 µm G1, 301.8 µm G2) or ceramic bur (P< 0.05; 184.1 µm G3, 131.0 µm G4) groups. A significant difference (P< 0.05) was noted in percentage occlusal surface coverage of particles between laser (51.4% G5, 35.8% G6) and carbide groups (21.1% G1, 19.3% G2). Light cure had no significant effect on the depth of silver penetration from 38% SDF in the dentin of primary teeth. Laser preparation resulted in deeper silver penetration than carbide or ceramic bur., Clinical Significance: Exposure of 38% silver diamine fluoride-treated dentin to light cure did not affect the depth of penetration of silver particles into the dentin tubules of primary teeth. Rather, tooth preparation approaches that reduce the smear layer, like laser ablation, resulted in the deepest penetration of silver into the tubules. Clinical application of these findings will depend on scenario and treatment aim., Competing Interests: The authors declared no conflict of interest., (Copyright©American Journal of Dentistry.)

Purpose: The evaluation of the effectiveness of simulation training in dentistry has previously been focused primarily on psychomotor hand skills. This study explored the impact of simulated patient (SP) encounters in simulation on students' self-assessment of competency in their clinical and communication abilities with geriatric patients., Methods: Students from 2 cohorts were recruited for this study. Cohort 1 (n = 30) participated in the standard curriculum with no simulation training and served as the control group. Cohort 2 (n = 34) participated in a SP experience, simulating the initial stages of a care visit for 2 nursing home patients. Students' perceptions of competency to perform these clinical and communication tasks were assessed. A group debriefing session was held 5 weeks post-simulation where Cohort 2 completed a student feedback form., Results: A statistically significant change (P < 0.00001) was noted for both cohorts in their self-reported competence to perform clinical tasks following exposure to an independent clinical experience. In addition to this gain, individuals in Cohort 2 demonstrated improvements following simulation and expressed different responses of impact to questions related to treatment, pharmacology, and managing a complex medical history., Conclusions: This study suggests that simulation of patient interactions using SPs can strengthen students' self-assessment of competency in their abilities, leading to more genuine interactions with actual patients. These findings will help inform the design of future SP encounters as a component of an evolving humanistic curriculum., (© 2020 American Dental Education Association.)

Purpose: To compare the dentin bonded external marginal integrity and the internal surface indentation hardness of bulk-fill and conventional resin-based composite (RBC) placed in both bulk and increments., Methods: 120 MO and DO cavities were prepared in 60 extracted human third molars. The teeth were randomly divided into four groups of 15 teeth per group to be restored as follows: BB (bulk-fill RBC, placed in a 4 mm bulk increment), BL (bulk-fill RBC, placed in 2 mm incremental layers), CB (conventional RBC, placed in a 4 mm bulk increment), and CL (conventional RBC, placed in 2 mm incremental layers). Marginal gaps were measured at mesial and distal dentin gingival cavosurfaces of each tooth using scanning electron microscopy of epoxy resin replicas and Knoop hardness (KHN) was measured at three different RBC depths (1.8, 2.8 and 3.8 mm). Statistical analyses included one-way ANOVA with post-hoc Tukey's HSD, and paired-sample t-test or a nonparametric Wilcoxon signed-rank test, as appropriate., Results: There was no significant effect of RBC restoration type on external marginal gap at the distal surface or at the mesial surface among the four groups tested (P> 0.05 in each instance), while no significant difference in external marginal gap was found between the mesial and distal surfaces within groups (P> 0.05 in each instance). The mean RBC internal surface KHN at 1.8 mm depth was significantly greater than at 2.8 mm and 3.8 mm depths in all tested groups (P< 0.05 for all instances), with a similar mean internal hardness between all groups. The bulk-fill RBC restorations demonstrated similar marginal gap formation and Knoop hardness to conventional universal RBC restorations under the conditions of this study., Clinical Significance: Bulk-fill resin-based composite (RBC), from the perspective of marginal adaptation and internal hardness, may be a suitable alternative to conventional RBC., Competing Interests: The authors declared no conflict of interest., (Copyright©American Journal of Dentistry.)

We studied how students in a Doctor of Dental Surgery (DDS) program perceived the importance of critical thinking and the extent to which critical thinking was perceived to be included in each of 25 courses of the first-year curriculum at The University of Texas School of Dentistry at Houston (UTSD). Sixty-nine of the 102 second-year students who were invited participated in an online survey. The survey had three parts, with all statements of each part evaluated on a five-point Likert scale ranging from strongly agree to strongly disagree. The first two parts assessed the importance of critical thinking in dental education and the criteria by which critical thinking in didactic curriculum can be measured. In the third part of the survey, students evaluated how well each course of the first-year curriculum achieved critical thinking. More than 90% of the respondents strongly agreed/agreed that critical thinking is essential to making clinical decisions. Students strongly agreed/agreed that 19 of 25 of the courses incorporated critical thinking. However, when students were asked to rank the top five of the 25 courses, only two courses (Human Biology, Neuroscience) emerged above all others in their weighted ranks, with another seven courses standing out, leaving 16 courses with low weighted rankings for their inclusion of critical thinking. In summary, students agreed on the importance of critical thinking in dental education, and on the criteria by which the incorporation of critical thinking should be measured in didactic and pre-clinical courses., Competing Interests: Conflict of InterestThe authors declare that they have no conflict of interest., (© International Association of Medical Science Educators 2020.)

The integrated curriculum is becoming a popular concept among dental schools. The purpose of this study was to query dental students at the University of Texas Health Science Center at Houston - School of Dentistry (UTSD) to elucidate their level of interest in the integrated curriculum, perception of how much integration is currently occurring, and identify challenges to integration. To address this question, dental students at UTSD were invited to participate in a survey. Participants reported their perspectives on integration of sciences. All survey participants agreed that it is beneficial to integrate clinical and basic sciences and that basic science educators were incorporating clinical relevance in their regular teaching. The third and fourth year classes, classes that had been exposed to general as well as all specialty dentistry clinics, agreed that basic sciences are being incorporated into most clinical teaching. Top two barriers to integration identified by the students were lack of crossover knowledge of faculty, and insufficient time to explore connections between basic sciences and clinical sciences because of the volume of information that needs to be covered. In conclusion, student perception at UTSD is that overall basic and clinical sciences are being integrated throughout the curriculum., Competing Interests: Conflict of InterestThe authors declare that they have no conflict of interest., (© International Association of Medical Science Educators 2019.)

Objective: This study aimed to assess fluoride intake in infants from formula reconstituted with water, with fluorosis risk in mind., Study Design: Data on water source, formula brand/type, volume of formula consumption and infant weight were collected for infants at two-, four-, six-, nine- and twelve-month pediatrician well child visits. Identified formula brands and water types were reconstituted and analyzed for fluoride concentration. Patient body mass and volume consumed/day were used to estimate fluoride intake from reconstituted formula. Descriptive statistics, one-way analysis of variance and chi-square tests were utilized., Results: All infants consumed formula reconstituted with minimally fluoridated water (0.0- 0.3 ppm). 4.4% of infants exceeded the recommended upper limit (UL) of 0.1mg/kg/day. Although mean daily fluoride consumption significantly differed among all groups, the proportion of infants at each visit milestone that exceeded daily fluoride intake of 0.1mg/kg/day was not statistically significantly different (p>0.05) for any age group. Predicted values calculated with optimally fluoridated water (0.7ppm) resulted in 36.8% of infants exceeding the UL., Conclusions: Optimally fluoridated water may increase fluorosis risk for patients younger than six months. Future investigation should include multiple sites and multi-year follow-up to assess actual fluorosis incidence.

Purpose: To evaluate if pre-treatment with silver diamine fluoride (SDF) adversely affects the bond strength of orthodontic brackets to enamel., Methods: 30 extracted non-carious permanent molar teeth were embedded in acrylic resin cylinders with buccal surfaces exposed and randomly divided equally into two groups. The experimental enamel surfaces were treated with 38% SDF applied for 1 minute between phosphoric acid etch and metal orthodontic bracket bonding with Transbond XT Light Cure Adhesive. Control groups were treated with 37% phosphoric acid etch followed by bonding. All samples were subjected to 500 thermocycles between 5°C and 55°C prior to shear load testing. Mean values and standard deviations of shear bond strengths for each group were analyzed using a general linear model at P< 0.05. Characteristics of bond failure were also recorded via Adhesive Remnant Index (ARI) and analyzed using an ordinal logistic regression at P< 0.05., Results: No significant difference in shear bond strength to enamel was observed between the control and experimental groups (P= 0.65). Comparison of ARI did demonstrate a significant difference between the groups (P= 0.013); SDF significantly altered the characteristic of bond failure, resulting in more adhesive remaining bonded to enamel after failure. No silver staining of treated surfaces was observed., Clinical Significance: The application of SDF to etched non-carious enamel in vitro prior to orthodontic bracket bonding does not adversely affect bond strength., Competing Interests: The authors declared no conflict of interest., (Copyright©American Journal of Dentistry.)

Although dental education has traditionally been organized into basic sciences education (first and second years) and clinical education (third and fourth years), there has been growing interest in ways to better integrate the two to more effectively educate students and prepare them for practice. Since 2012, The University of Texas School of Dentistry at Houston (UTSD) has made it a priority to improve integration of basic and clinical sciences, with a focus to this point on integrating the basic sciences. The aim of this study was to determine the perspectives of basic and clinical science faculty members regarding basic and clinical sciences integration and the degree of integration currently occurring. In October 2016, all 227 faculty members (15 basic scientists and 212 clinicians) were invited to participate in an online survey. Of the 212 clinicians, 84 completed the clinician educator survey (response rate 40%). All 15 basic scientists completed the basic science educator survey (response rate 100%). The majority of basic and clinical respondents affirmed the value of integration (93.3%, 97.6%, respectively) and reported regular integration in their teaching (80%, 86.9%). There were no significant differences between basic scientists and clinicians on perceived importance (p=0.457) and comfort with integration (p=0.240), but the basic scientists were more likely to integrate (p=0.039) and collaborate (p=0.021) than the clinicians. There were no significant differences between generalist and specialist clinicians on importance (p=0.474) and degree (p=0.972) of integration in teaching and intent to collaborate (p=0.864), but the specialists reported feeling more comfortable presenting basic science information (p=0.033). Protected faculty time for collaborative efforts and a repository of integrated basic science and clinical examples for use in teaching and faculty development were recommended to improve integration. Although questions might be raised about the respondents' definition of "integration," this study provides a baseline assessment of perceptions at a dental school that is placing a priority on integration.

The aim of this study was to examine the accuracy of dental faculty members' utilization of diagnostic codes and resulting treatment planning based on radiographic interproximal tooth radiolucencies. In 2015, 50 full-time and part-time general dentistry faculty members at one U.S. dental school were shown a sequence of 15 bitewing radiographs; one interproximal radiolucency was highlighted on each bitewing. For each radiographic lesion, participants were asked to choose the most appropriate diagnostic code (from a concise list of five codes, corresponding to lesion progression to outer/inner halves of enamel and outer/middle/pulpal thirds of dentin), acute treatment (attempt to arrest/remineralize non-invasively, operative intervention, or no treatment), and level of confidence in choices. Diagnostic and treatment choices of participants were compared to "gold standard" correct responses, as determined by expert radiology and operative faculty members, respectively. The majority of the participants selected the correct diagnostic code for lesions in the outer one-third of dentin (p<0.0001) and the pulpal one-third of dentin (p<0.0001). For lesions in the outer and inner halves of enamel and the middle one-third of dentin, the correct rates were moderate. However, the majority of the participants chose correct treatments on all types of lesions (correct rate 63.6-100%). Faculty members' confidence in their responses was generally high for all lesions, all above 90%. Diagnostic codes were appropriately assigned by participants for the very deepest lesions, but they were not assigned accurately for more incipient lesions (limited to enamel). Paradoxically, treatment choices were generally correct, regardless of diagnostic choices. Further calibration is needed to improve faculty use and teaching of diagnostic codes.

Purpose: To assess if there was a perceptible difference in staining of restorations in silver diamine fluoride (SDF)-treated teeth, with or without the subsequent application of potassium iodide (KI)., Methods: 20 extracted teeth with frank cavitated carious lesions were prepared with a spoon excavator to remove superficial soft carious dentin and then randomly divided into two groups of 10. The control group was treated with 38% SDF and then restored with glass-ionomer. The experimental group received similar treatment, with the additional step of KI applied before restoration. All teeth were subjected to 500 thermocycles between 5°C and 55°C, followed by storage in artificial saliva at 37°C for 30 days. Three blinded examiners evaluated all 20 teeth for intensity of staining on a scale from 0-5. Wilcoxon rank sum test compared average staining intensity between control and experimental groups of teeth as perceived by each examiner., Results: No significant differences were found (P values: 0.93, 0.67, and 0.97). An aggregate comparison of staining perception between control and experimental groups by repeated measure analysis was done treating the outcome as Poisson distribution also finding no significant difference (P= 0.82)., Clinical Significance: The application of potassium iodide after silver diamine fluoride on caries-affected teeth may improve initial esthetic appearance, but after placement of a glass ionomer restoration, potassium iodide does not seem to result in any significant difference in staining., Competing Interests: Dr. Miller is Editor of REALITY. Ms. Lopez and Dr. Quock reported no conflict of interest.

Xerostomia is the subjective feeling of dry mouth, and it is often related to salivary hypofunction. Besides medication-related salivary hypofunction, Sjögren syndrome and head-and-neck radiation are two common etiologies that have garnered considerable attention. Approaches to treating and/or preventing salivary hypofunction in patients with these conditions will likely incorporate gene therapy, stem cell therapy, and tissue engineering. Advances in these disciplines are central to current research in the cure for xerostomia and will be key to eventual treatment., (Copyright © 2016 Elsevier Inc. All rights reserved.)

The esthetic management of enamel dysplasia presents an opportunity for the practitioner to integrate expertise in diagnosis, biomaterials, and technique. In addition to considerations of appearance, careful attention must be paid to occlusal function and restorative material properties. This case report highlights a combined approach of conservative lithium disilicate indirect restorations and composite resin direct veneers to electively restore the anterior teeth of a patient diagnosed with idiopathic enamel hypoplasia.

Purpose: To characterize traditional Chinese medicine (TCM) use, emphasizing herbal remedies, for oral conditions among two Chinese pediatric populations in the United States., Methods: 318 unique ethnic Chinese parental units in Houston and Boston with children younger than 12 years old were interviewed for themselves and their children. Questionnaire included age, gender, duration in the United States, frequency of TCM use, and the five selected oral conditions for which TCM agents might be used., Results: Parents (45.6 percent) and children (19.1 percent) used TCM for oral conditions, most commonly for aphthous ulcers (64.2 percent). Most commonly used TCM agents included watermelon frost (37.4 percent), niuhuang jiedu pian (15.5 percent), and honey/propolis (9.9 percent). Chi-square tests with logistic regression (P<0.05) showed duration of U.S. residency significantly affected (P=0.002), parental TCM usage, age group (P=0.003), and birth location (P=0.02) related to child use. Parental TCM use increased child likelihood of use (P<0.0001)., Conclusions: In this study, traditional Chinese medicine was widely used for oral conditions by Chinese immigrants. Factors such as duration of U.S. residency, age, birth location, and parental use affect utilization of TCM in this population. Future studies are needed to explore the therapeutic properties of the various components of TCM.

The aim of this study was to examine the impact of psychomotor operative video demonstrations on first-year dental students who are performing specific procedures for the first time in a preclinical setting. The class was randomly divided into two groups, and three restorative procedures were selected. On the date on which each procedure was to be performed in the preclinical laboratory for the first time, one group (experimental, n=50) was shown a technique video for that specific procedure immediately before commencing the exercise; the control cohort (n=50) did not view the video. Technical performance on procedures was evaluated by students and two calibrated and blinded examiners. The students' perceptions of the experience were also collected in a survey. All first-year students participated in the study, for a 100% response rate. A Mann-Whitney U test did not show any group differences in technical performance (mean values on preparation: 77.1 vs. 77.8; amalgam: 82.7 vs. 82.8; composite: 79.7 vs. 78.0). A Spearman rho test revealed a significantly higher correlation in 13 out of 25 evaluation categories between student self-assessment and blinded examiner assessment for the experimental group. A chi-square test of questionnaire responses revealed a positive student perception of administering these videos for the preparation (X(2)=4.8, p<0.03), the amalgam restoration (X(2)=12.4, p<0.001), and the composite restoration (X(2)=11.3, p<0.001). The psychomotor video demonstrations did not immediately improve student performance on preclinical operative procedures, but they were well received by students and augmented self-assessment ability. These findings suggest that videos can be a useful teaching aid in a preclinical environment, especially regarding comprehension of concepts.

Background: When the future status of dentistry is considered, scholarship in the profession plays a key role. It is by scholarship that dentistry distinguishes itself as a learned and esteemed profession, and this position paper aims to explore and promote this vital core value., Methods: As Fellows of the American Dental Education Association's selective Leadership Institute, the authors spent over a year critically examining the role of scholarship in dentistry, which was identified as a critical issue for the profession. A review of the health care literature was conducted to inform this paper's position., Results: Scholarship is clearly the trait that distinguishes a profession from a trade, as evidenced by trends in other health care professions, as well as dentistry. Although dentistry is a learned profession rightly meriting that distinction, there are a few notable areas that can be improved., Conclusions: Because scholarship defines a profession, dentists as doctors and the leaders in oral health should demonstrate the highest scholarship; absence of scholarship risks perception of dentistry as a trade. All dentists can consistently manifest scholarship by integrating basic science, as well as by incorporating the dental evidence-base, into daily practice., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to determine the primary sources of water used for consumption and cooking by the patients of a university-based pediatric dental practice., Methods: A simple, prewritten questionnaire-consisting of seven questions and available in English and Spanish-was conducted verbally with the caregivers of 123 pediatric patients during a designated timeframe. Analysis of responses included descriptive statistics and a chi-square test for a single proportion., Results: Nonfiltered tap water accounted for the primary drinking water source in only 10 percent of the respondents. Firty-two percent of the respondents selected bottled water as the primary source of drinking water, and 24 percent selected vended water stations as a primary drinking water source. Nonfiltered tap water was much more likely to be utilized in cooking (58 percent)., Conclusions: The majority of the patients in this study's pediatric dental practice do not consume fluoridated tap water. With the vast majority of the patients primarily consuming bottled or vended water, these patients are likely missing out on the caries-protective effects of water fluoridation.

This study sought to measure the fluoride concentration of water derived from vended water stations (VWS) and to identify its clinical implications, especially with regard to caries prevention and fluorosis. VWS and corresponding tap water samples were collected from 34 unique postal zip codes; samples were analyzed in duplicate for fluoride concentration. Average fluoride concentration in VWS water was significantly lower than that of tap water (P < 0.001). Fluoride concentration in the VWS water ranged from <0.01 ppm to 0.04 ppm, with a mean concentration of 0.02 ppm (±0.02 ppm). Patients utilizing VWS as their primary source of drinking water may not be receiving optimal caries preventive benefits; thus dietary fluoride supplementation may be indicated. Conversely, to minimize the risk of fluorosis in infants consuming reconstituted infant formula, water from a VWS may be used.

Historically, traditional elastomeric impression techniques for indirect fixed procedures have presented challenges for the operator, laboratory, and patient. Recent digital impression unit technology offers a compelling alternative to elastomeric impressions. The iTero system applies parallel confocal imaging to create a virtual impression that can be easily captured, edited, and uploaded electronically to the dental laboratory. Computer-aided design/computer-aided manufacturing technology is applied to the virtual impression to create an unlimited number of identical polyurethane models. This case report is presented from the perspectives of the clinicians and the laboratory technician using an iTero system to treat a left mandibular second premolar with a resin composite inlay.

Current American Dental Association evidence-based recommendations for prescription of dietary fluoride supplements are based in part on the fluoride concentration of a pediatric patient's drinking water. With these recommendations in mind, this study compared the relative accuracy of fluoride concentration analysis when a common apparatus is calibrated with different combinations of standard values. Fluoride solutions in increments of 0.1 ppm, from a range of 0.1 to 1.0 ppm fluoride, as well as 2.0 and 4.0 ppm, were gravimetrically prepared and fluoride concentration measured in pentad, using a fluoride ion-specific electrode and millivolt meter. Fluoride concentrations of these solutions were recorded after calibration with the following 3 different combinations of standard fluoride solutions: 0.1 ppm and 0.5 ppm, 0.1 ppm and 1.0 ppm, 0.5 ppm and 1.0 ppm. Statistical analysis showed significant differences in the fluoride content of water samples obtained with different two-standard fluoride solutions. Among the two-standard fluoride solutions tested, using 0.5 ppm and 1.0 ppm as two-standard fluoride solutions provided the most accurate fluoride measurement of water samples containing fluoride in the range of 0.1 ppm to 4.0 ppm. This information should be valuable to dental clinics or laboratories in fluoride analysis of drinking water samples.

Dental caries, a bacterial process that results in the acidic destruction of tooth structure, has historically been managed by the mechanical excavation of diseased tooth structure and then restoration with a synthetic material. The mechanical excavation of the infected site is most commonly achieved by a dental handpiece, or "drill"; this handpiece may induce stress and anxiety in many patients. Alternatively, a drill-less filling will involve the utilization of silver diamine fluoride (38%) to arrest and prevent dental caries, followed by restoration with a bonded filling material to achieve adequate seal at the lesion margins. This is a minimally invasive procedure that addresses both microbial and mechanical issues posed by dental caries., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Although various modes of delivery for professionally applied fluoride exist, one form has emerged that combines caries prevention efficacy with safety and versatility. The American Dental Association Council on Scientific Affairs recommends fluoride varnish as the only professionally applied fluoride for moderate to high risk patients of all age groups. In addition to demonstrating effectiveness equivalent to fluoride gels, fluoride varnish provides improved safety and acceptability. Furthermore, fluoride varnish has shown promise in preventing dental caries in special groups, such as orthodontic patients and the elderly.

This study sought to compare the relative accuracy of a commercially available hand-held water fluoride analysis unit with a standard laboratory bench-top fluoride-specific electrode/millivoltmeter apparatus, with the goal of identifying possible practical applications of the hand-held unit for preventive dentistry. The units analyzed identical gravimetrically prepared fluoride solutions ranging from 0.1 to 4.0 ppm. The average difference between the measurements from the hand-held unit and the nominal values of the fluoride solutions was 0.011 ppm (SD = 0.068), and the average difference between the hand-held unit's measurements and the bench-top unit's measurements was 0.030 ppm (SD = 0.115). T-test analysis demonstrated no statistical difference between measurements from the hand-held unit with either the nominal values of the fluoride solutions or the bench-top unit's measurements. Results indicate that the hand-held water fluoride analysis unit has an appropriate level of accuracy for the measurement of fluoride levels in drinking water samples by dental professionals.

Although various modes of delivery for professionally applied fluoride exist, one form has emerged that combines caries prevention efficacy with safety and versatility. The American Dental Association Council on Scientific Affairs recommends fluoride varnish as the only professionally applied fluoride for moderate to high risk patients of all age groups. In addition to demonstrating effectiveness equivalent to fluoride gels, fluoride varnish provides improved safety and acceptability. Furthermore, fluoride varnish has shown promise in preventing dental caries in special groups, such as orthodontic patients and the elderly.

It continues to be the goal of the United States Department of Health and Human Services to fluoridate community water supplies to prevent dental caries. In Houston, Texas, where community water is assumed to contain in the range of 0.7-1.2 ppm fluoride, water samples were taken from the same source on approximately a weekly basis over a period of 52 weeks. The purpose of this study was to determine the extent of fluctuation of water fluoride concentration in these samples. Water fluoride analysis with an ion-specific electrode and millivolt meter of the data set showed a range of 0.33 to 1.00 ppm fluoride, with a mean of 0.70 ppm and a standard deviation of 0.15. This wide range of fluoride concentrations may create a risk for fluorosis in pediatric patients who are prescribed dietary fluoride supplements.

This study sought to measure the fluoride concentration of various commercial bottled waters and to identify clinical implications in dental patient education and treatment. For this study, 105 different samples of bottled water were collected over a 30-day period (from October 15, 2007 to November 15, 2007), divided into six categories, and analyzed for fluoride concentration by utilizing a fluoride ion-specific electrode. Based on the present study, distilled bottled waters have an average fluoride content of less than 0.01 ppm, while drinking/purified bottled waters all (except for one sample) had an average fluoride content of less than 0.03 ppm. Spring/artesian bottled water had an average fluoride content of 0.08 ppm, compared with 0.32 ppm for mineral water bottled waters, 0.16 ppm for flavor-added bottled waters, and 0.63 ppm for fluoride-added bottled water.