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Background Dentists strive to provide safe and effective oral healthcare. However, some patients may encounter an adverse event (AE) defined as "unnecessary harm due to dental treatment." In this research, we propose and evaluate two systems for categorizing the type and severity of AEs encountered at the dental office. Methods Several existing medical AE type and severity classification systems were reviewed and adapted for dentistry. Using data collected in previous work, two initial dental AE type and severity classification systems were developed. Eight independent reviewers performed focused chart reviews, and AEs identified were used to evaluate and modify these newly developed classifications. Results A total of 958 charts were independently reviewed. Among the reviewed charts, 118 prospective AEs were found and 101 (85.6%) were verified as AEs through a consensus process. At the end of the study, a final AE type classification comprising 12 categories, and an AE severity classification comprising 7 categories emerged. Pain and infection were the most common AE types representing 73% of the cases reviewed (56% and 17%, respectively) and 88% were found to cause temporary, moderate to severe harm to the patient. Conclusions Adverse events found during the chart review process were successfully classified using the novel dental AE type and severity classifications. Understanding the type of AEs and their severity are important steps if we are to learn from and prevent patient harm in the dental office.

In this review, we provide a comparative evaluation of different bone grafts for dental implants success. We performed a literature review to analyze dental implant success and survival rates after the use of various grafts for bone augmentation. A total of 41 studies were selected and analyzed based on parameters including study design, number of implants placed, total number of participants, type of graft used, site from which graft was obtained, time elapsed between bone augmentation and implant placement, implant survival, and success rates. Results indicate that after a follow-up period of 1-5 yr, respective success and survival rates are as follows: block grafts, 91.5% and 75%; blood derivatives, 91.5% and 96.7%; composite grafts, 80.9% and 94.2%; xenografts and particulate grafts, 100% for both success and survival. After evaluating the available studies, we can report that autologous block grafts, composite grafts, and blood derivatives were the most commonly used grafting materials for bone augmentation before placing dental implants. Xenografts and particulate grafts had 100% success and survival rates, but more studies are needed to assess the impact of these grafting materials.

Functional impairment affecting the quality of life results when a wide range of both muscular and joint pathologies affect the temporomandibular joint (TMJ). There are several total temporomandibular joint prosthesis systems available for total joint replacement (TJR). This systematic review provides an overview of the different TJR systems available and discusses their outcomes and efficiency. A systematic review on the outcomes of TJR was performed in October 2020. The five databases searched are PubMed, Europe PMC, Elsevier, SpringerLink, and British Journal of Oral and Maxillofacial Surgery. Outcome measurements were changes in maximal mouth opening (MMO), pain, diet, and functional limitation preoperatively and postoperatively. Seventeen follow-up studies were included in this systematic review, with 1,343 patients. All TMJ implant devices showed significant improvement after placement in all outcomes (pain, diet, MMO). All TJR prostheses showed great improvement comparing preoperative and postoperative outcomes. There was no significant difference between devices when comparing their outcomes.

Bone level as measured by clinical attachment levels (CAL) are critical findings that determine the diagnosis of periodontal disease. Deep learning algorithms are being used to determine CAL which aid in the diagnosis of periodontal disease. However, the limited field-of-view of bitewing x-rays poses a challenge for convolutional neural networks (CNN) because out-of-view anatomy cannot be directly considered. This study presents an inpainting algorithm using generative adversarial networks (GANs) coupled with partial convolutions to predict out-of-view anatomy to enhance CAL prediction accuracy.Retrospective purposive sampling of cases with healthy periodontium and diseased periodontium with bitewing and periapical radiographs and clinician recorded CAL were utilized. Data utilized was from July 1, 2016 through January 30, 2020. 80,326 images were used for training, 12,901 images were used for validation and 10,687 images were used to compare non-inpainted methods to inpainted methods for CAL predictions. Statistical analyses were mean bias error (MBE), mean absolute error (MAE) and Dunn's pairwise test comparing CAL at p=0.05.Comparator p-values demonstrated statistically significant improvement in CAL prediction accuracy between corresponding inpainted and non-inpainted methods with MAE of 1.04mm and 1.50mm respectively. The Dunn's pairwise test indicated statistically significant improvement in CAL prediction accuracy between inpainted methods compared to their non-inpainted counterparts, with the best performing methods achieving a Dunn's pairwise value of -63.89.This study demonstrates the superiority of using a generative adversarial inpainting network with partial convolutions to predict CAL from bitewing and periapical images.Artificial intelligence was developed and utilized to predict clinical attachment level compared to clinical measurements. A generative adversarial inpainting network with partial convolutions was developed, tested and validated to predict clinical attachment level. The inpainting approach was found to be superior to non-inpainted methods and within the 1mm clinician-determined measurement standard.

All-ceramic dental implants have been identified as a potential alternative to the traditional titanium-based implant systems used in dentistry to satisfy the demands for esthetic metal-free treatment of edentulous jaws. Among the all-ceramic implants introduced in dentistry, zirconia implants have emerged as the forerunner. The success of zirconia as an implant material has paralleled that of titanium in the short-term, however, few clinical studies assess success in the long-term. Failures of zirconia dental implants have been linked to improper operator techniques, manufacturing defects, and unfavorable loading, thereby necessitating optimal quality control measures by manufacturers and proper treatment planning by an experienced operator to reinforce the favorable properties of zirconia as an implant biomaterial. In this comprehensive review, the various implant-related, tissue-related, prosthesis-related, and patient-related factors affecting the success of zirconia implants have been discussed and compared with those of the titanium implant.

Controlled movement of teeth is both a science and an art that relies on applied forces and anchoring or resistance points. The temporary anchorage device (TAD) is a mini-implant that is used as an anchoring point. Applied to appropriate cases with optimal technique, TAD can enhance results. This article discusses the considerations behind increasing longevity of an implant in use and improving its success. Such considerations include implant placement, time before loading, amount of loading, and patient habits.

A person's right to access his or her protected health information is a core feature of the U.S. Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. If the information is stored electronically, covered entities must be able to provide patients with some type of machine-readable, electronic copy of their data. The aim of this study was to understand how academic dental institutions execute the Privacy Rule's right of access in the context of electronic health records (EHRs). A validated electronic survey was distributed to the clinical deans of 62 U.S. dental schools during a two-month period in 2014. The response rate to the survey was 53.2% (N=33). However, three surveys were partially completed, and of the 30 completed surveys, the 24 respondents who reported using axiUm as the EHR at their dental school clinic were the ones on which the results were based (38.7% of total schools at the time). Of the responses analyzed, 86% agreed that clinical modules should be considered part of a patient's dental record, and all agreed that student teaching-related modules should not. Great variability existed among these clinical deans as to whether administrative and financial modules should be considered part of a patient record. When patients request their records, close to 50% of responding schools provide the information exclusively on paper. This study found variation among dental schools in their implementation of the Privacy Rule right of access, and although all the respondents had adopted EHRs, a large number return records in paper format.

Caries indices, the basis of epidemiologic caries measures, are not easily obtained in clinical settings. This study’s objective was to design, test, and validate an automated program (Valid Electronic Health Record Dental Caries Indices Calculator Tool [VERDICT]) to calculate caries indices from an electronic health record (EHR). Synthetic use case scenarios and actual patient cases of primary, mixed, and permanent dentition, including decayed, missing, and filled teeth (DMFT/dmft) and tooth surfaces (DMFS/dmfs) were entered into the EHR. VERDICT measures were compared to a previously validated clinical electronic data capture (EDC) system and statistical program to calculate caries indices. Four university clinician-researchers abstracted EHR caries exam data for 45 synthetic use cases into the EDC and post-processed with SAS software creating a gold standard to compare the ­VERDICT-derived caries indices. Then, 2 senior researchers abstracted EHR caries exam data and calculated caries indices for 24 patients, allowing further comparisons to VERDICT indices. Agreement statistics were computed among abstractors, and discrepancies were resolved by consensus. Agreement statistics between the 2 final-phase abstractors and the VERDICT measures showed extremely high concordance: Lin’s concordance coefficients (LCCs) >0.99 for dmfs, dmft, DS, ds, DT, dt, ms, mt, FS, fs, FT, and ft; LCCs >0.95 for DMFS and DMFT; and LCCs of 0.92–0.93 for MS and MT. Caries indices, essential to developing primary health outcome measures for research, can be reliably derived from an EHR using VERDICT. Using these indices will enable population oral health management approaches and inform quality improvement efforts.

The objective of this paper is to assess clinical dental providers' baseline knowledge and attitudes about the implementation of three clinical decision support (CDS) tools built into the electronic health record (EHR) of a multi-specialty group dental practice.An electronic survey designed to examine predisposing factors for acceptance of EHR-based tools, caries and periodontal disease management by risk assessment and a risk assessment-based Proactive Dental Care Plan, was distributed to all Willamette Dental Group (WDG) employees. The survey collected demographic data, along with measures of job experience and satisfaction, comfort with dental information technology, and attitudes and knowledge of each CDS tool. WDG provided data on site-level patient and financing mix, patient satisfaction data, employee role (e.g. dentist) and tenure with company. The survey was conducted 3 months prior to the rollout of the CDS tools in November 2013. The survey was distributed electronically to all WDG employees (n = 1166), of whom 58.5% (n = 682) were clinicians, located in 53 sites in Oregon, Washington and Idaho. The overall response rate was 79.8% (n = 930), with a response rate of 83.1% (n = 567) from all clinicians. Of these, 24.3% were general and specialist dentists (n = 138); 26.6% were dental hygienists (n = 151), and 49% were dental assistants (n = 278).The clinicians surveyed reported being highly amenable to implementation of the three CDS tools. Clinicians' attitudes reflected higher expected improvement in patient care and quality than in business processes due to the implementation. The clinician characteristics most strongly correlated with a positive attitude toward the CDS tool implementation (as measured on Likert scale 1 = low to 5 = high) included satisfaction with the EHR (0.499, p0.001), job satisfaction (0.458, p0.001), finding change to be exciting (0.398, p0.001), degree of control perceived over work (0.352, p0.001), and a perception of having adequate tools to get work done (0.340, p0.001). Higher reported frequency (scale 1 = never, 7 = always) of feeling burned out (-0.297, p0.001), feeling emotionally drained (-0.265, p0.001), and feeling work is a strain (-0.205, p0.001) had the greatest correlation with negative attitudes.This is the first study to examine dental provider attitudes toward the implementation of CDS tools incorporated within an electronic health record. Provider attitudes toward CDS tools can shape the entire implementation process for better or worse. This study contributes to the literature by providing an understanding of factors related to positive attitudes at the outset of a system change and can help guide organizational administrators to better prepare their workforce and organization for adoption of evidence-based dentistry tools such as a CDS system.

Although standardized terminologies such as the International Classification of Diseases have been in use in medicine for over a century, efforts in the dental profession to standardize dental diagnostic terms have not achieved widespread acceptance. To address this gap, a standardized dental diagnostic terminology, the EZCodes, was developed in 2009. Fifteen dental education institutions in the United States and Europe have implemented the EZCodes dental diagnostic terminology. This article reports on the utilization and valid entry of the EZCodes at three of the dental schools that have adopted this standardized dental diagnostic terminology. Electronic data on the use of procedure codes with diagnostic terms from the three schools over a period from July 2010 to June 2011 were aggregated. The diagnostic term and procedure code pairs were adjudicated by three calibrated dentists. Analyses were conducted to gain insight into the utilization and valid entry of the EZCodes diagnostic terminology in the one-year period. Error proportions in the entry of diagnostic term (and by diagnostic category) were also computed. In the twelve-month period, 29,965 diagnostic terms and 249,411 procedure codes were entered at the three institutions resulting in a utilization proportion of 12 percent. Caries and periodontics were the most frequently used categories. More than 1,000 of the available 1,321 diagnostic terms were never used. Overall, 60.5 percent of the EZCodes entries were found to be valid. The results demonstrate low utilization of EZCodes in an electronic health record and raise the need for specific training of dental providers on the importance of using dental diagnostic terminology and specifically how to use the terms in the electronic record. These findings will serve to increase the use/correct use of the EZCodes dental diagnostic terminology and ultimately create a reliable platform for undertaking clinical, outcomes, and quality improvement-related research.

BACKGROUND: Patients with diabetes are at increased risk of developing oral complications, and annual dental examinations are an endorsed preventive strategy. The authors evaluated the feasibility and validity of implementing an automated electronic health record (EHR)-based dental quality measure to determine whether patients with diabetes received such evaluations. METHODS: The authors selected a Dental Quality Alliance measure developed for claims data and adapted the specifications for EHRs. Automated queries identified patients with diabetes across 4 dental institutions, and the authors manually reviewed a subsample of charts to evaluate query performance. After assessing the initial EHR measure, the authors defined and tested a revised EHR measure to capture better the oral care received by patients with diabetes. RESULTS: In the initial and revised measures, the authors used EHR automated queries to identify 12,960 and 13,221 patients with diabetes, respectively, in the reporting year. Variations in the measure scores across sites were greater with the initial measure (range, 36.4–71.3%) than with the revised measure (range, 78.8–88.1%). The automated query performed well (93% or higher) for sensitivity, specificity, and positive and negative predictive values for both measures. CONCLUSIONS: The results suggest that an automated EHR-based query can be used successfully to measure the quality of oral health care delivered to patients with diabetes. The authors also found that using the rich data available in EHRs may help estimate the quality of care better than can relying on claims data. PRACTICAL IMPLICATIONS: Detailed clinical patient-level data in dental EHRs may be useful to dentists in evaluating the quality of dental care provided to patients with diabetes.

Background Although some patients experience adverse events (AEs) resulting in harm caused by treatments in dentistry, few published reports have detailed how dental providers describe these events. Understanding how dental treatment professionals view AEs is essential to building a safer environment in dental practice. Methods The authors interviewed dental professionals and domain experts through focus groups and in-depth interviews and asked them to identify the types of AEs that may occur in dental settings. Results The initial interview and focus group findings yielded 1,514 items that included both causes and AEs. In total, 632 causes were coded into 1 of the 8 categories of the Eindhoven classification, and 882 AEs were coded into 12 categories of a newly developed dental AE classification. Interrater reliability was moderate among coders. The list was reanalyzed, and duplicate items were removed leaving a total of 747 unique AEs and 540 causes. The most frequently identified AE types were "aspiration and ingestion" at 14% (n = 142), "wrong-site, wrong-procedure, wrong-patient errors" at 13%, "hard-tissue damage" at 13%, and "soft-tissue damage" at 12%. Conclusions Dental providers identified a large and diverse list of AEs. These events ranged from "death due to cardiac arrest" to "jaw fatigue from lengthy procedures." Practical Implications Identifying threats to patient safety is a key element of improving dental patient safety. An inventory of dental AEs underpins efforts to track, prevent, and mitigate these events.

Background and objectivesCurrent clinical methods for diagnosing secondary caries are unreliable for identifying the early stages of decay around restorative materials. The objective of this study was to access the integrity of restoration margins in natural teeth using near-infrared (NIR) reflectance and transillumination images at wavelengths between 1300 and 1700-nm and to determine the optimal NIR wavelengths for discriminating composite materials from dental hard tissues.Materials and methodsTwelve composite margins (n=12) consisting of class I, II and V restorations were chosen from ten extracted teeth. The samples were imaged in vitro using NIR transillumination and reflectance, polarization sensitive optical coherence tomography (PS-OCT) and a high-magnification digital microscope. Samples were serially sectioned into 200-μm slices for histological analysis using polarized light microscopy (PLM) and transverse microradiography (TMR). Two independent examiners evaluated the presence of demineralization at the sample margin using visible detection with 10× magnification and NIR images presented digitally. Composite restorations were placed in sixteen sound teeth (n=16) and imaged at multiple NIR wavelengths ranging from λ=1300 to 1700-nm using NIR transillumination. The image contrast was calculated between the composite and sound tooth structure.ResultsIntensity changes in NIR images at wavelengths ranging from 1300 to 1700-nm correlate with increased mineral loss measured using TMR. NIR reflectance and transillumination at wavelengths coincident with increased water absorption yielded significantly higher (P

As dental schools continue to seek the most effective ways to provide clinical education for students, it is important to track the effects innovations have on students' clinical experience to allow for quantitative comparisons of various curricula. The aim of this study was to compare the impact of three successive clinical curricula on students' experience at one U.S. dental school. The three were a discipline-based curriculum (DBC), a comprehensive care curriculum (CCC), and a procedural requirement curriculum plus externships (PRCE). Students' clinic experience data from 1992 to 2013 were analyzed for total experience and in five discipline areas. Clinic experience metrics analyzed were patient visits (PVs), relative value units (RVUs), and equivalent amounts (EQAs). A minimum experience threshold (MET) and a high experience threshold (HET) were set at one standard deviation above and below the mean for the DBC years. Students below the MET were designated as low achievers; students above the HET were designated as high achievers. The results showed significant differences among the three curricula in almost all areas of comparison: total PVs, total EQAs, total RVUs, RVUs by discipline, and number of high and low achievers in total clinical experience and by discipline. The comprehensive care approach to clinical education did not negatively impact students' clinical experience and in many cases enhanced it. The addition of externships also enhanced student total clinical experience although more study is needed to determine their effectiveness. The insights provided by this study suggest that the methodology used including the metrics of PVs, EQAs, and RVUs may be helpful for other dental schools in assessing students' clinical experience.

Dentists, like physicians, routinely perform highly technical and risky procedures in complex environments, work in teams and use a multitude of devices and tools. Health care is considered one of the least safe industries—much less safe than the aviation and oil and gas industries—and less safe than regulated activities such as driving. Dentistry has seen several documented deaths, including, late in 2011, the death of a 17year-old whose heart rate and blood oxygen dropped to fatally low levels during third-molar extraction. Furthermore, even less grave events, such as the extraction of the wrong tooth, affect the quality of care. It is documented that reported errors in medicine are fewer than the actual occurrences; this also may be true in dentistry. Yet, the patient safety and quality revolution that has established itself worldwide in medicine has not yet taken hold in dentistry. We must have the courage to commit to change. Our medical colleagues blazed this trail. More than a decade ago, the Institute of Medicine’s Committee on Quality of Health Care in America released two reports, To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, which emphasized the importance of transformational reform in the health care system and that changes around the margin would be inadequate.

Standardized treatment procedure codes and terms are routinely used in dentistry. Utilization of a diagnostic terminology is common in medicine, but there is not a satisfactory or commonly standardized dental diagnostic terminology available at this time. Recent advances in dental informatics have provided an opportunity for inclusion of diagnostic codes and terms as part of treatment planning and documentation in the patient treatment history. This article reports the results of the use of a diagnostic coding system in a large dental school’s predoctoral clinical practice. A list of diagnostic codes and terms, called Z codes, was developed by dental faculty members. The diagnostic codes and terms were implemented into an electronic health record (EHR) for use in a predoctoral dental clinic. The utilization of diagnostic terms was quantified. The validity of Z code entry was evaluated by comparing the diagnostic term entered to the procedure performed, where valid diagnosis-procedure associations were determined by consensus among three calibrated academically based dentists. A total of 115,004 dental procedures were entered into the EHR during the year sampled. Of those, 43,053 were excluded from this analysis because they represent diagnosis or other procedures unrelated to treatments. Among the 71,951 treatment procedures, 27,973 had diagnoses assigned to them with an overall utilization of 38.9 percent. Of the 147 available Z codes, ninety-three were used (63.3 percent). There were 335 unique procedures provided and 2,127 procedure/diagnosis pairs captured in the EHR. Overall, 76.7 percent of the diagnoses entered were valid. We conclude that dental diagnostic terminology can be incorporated within an electronic health record and utilized in an academic clinical environment. Challenges remain in the development of terms and implementation and ease of use that, if resolved, would improve the utilization.

Objective: Secondary data are a significant resource for in‐depth epidemiologic and public health research. It also allows for effective quality control and clinical outcomes measurement. To illustrate the value of structured diagnostic entry, a use case was developed to quantify adherence to current practice guidelines for managing chronic moderate periodontitis (CMP).Methods: Six dental schools using the same electronic health record (EHR) contribute data to a dental data repository (BigMouth) based on the i2b2 data‐warehousing platform. Participating institutions are able to query across the full repository without being able to back trace specific data to its originating institution. At each of the three sites whose data are included in this analysis, the Dental Diagnostic System (DDS) terminology was used to document diagnoses in the clinics. We ran multiple queries against this multi‐institutional database, and the output was validated by manually reviewing a subset of patient charts.Results: Over the period under study, 1,866 patients were diagnosed with CMP. Of these, 15 percent received only periodontal prophylaxis treatment, 20 percent received only periodontal maintenance treatment, and only 41 percent received periodontal maintenance treatment in combination with other AAP guideline treatments.Conclusions: Our results showed that most patients with CMP were not treated according to the AAP guidelines. On the basis of this use case, we conclude that the availability and habitual use of a structured diagnosis in an EHR allow for the aggregation and secondary analyses of clinical data to support downstream analyses for quality improvement and epidemiological assessments.

A person's right to access his or her protected health information is a core feature of the U.S. Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. If the information is stored electronically, covered entities must be able to provide patients with some type of machine-readable, electronic copy of their data. The aim of this study was to understand how academic dental institutions execute the Privacy Rule's right of access in the context of electronic health records (EHRs). A validated electronic survey was distributed to the clinical deans of 62 U.S. dental schools during a two-month period in 2014. The response rate to the survey was 53.2% (N=33). However, three surveys were partially completed, and of the 30 completed surveys, the 24 respondents who reported using axiUm as the EHR at their dental school clinic were the ones on which the results were based (38.7% of total schools at the time). Of the responses analyzed, 86% agreed that clinical modules should be considered part of a patient's dental record, and all agreed that student teaching-related modules should not. Great variability existed among these clinical deans as to whether administrative and financial modules should be considered part of a patient record. When patients request their records, close to 50% of responding schools provide the information exclusively on paper. This study found variation among dental schools in their implementation of the Privacy Rule right of access, and although all the respondents had adopted EHRs, a large number return records in paper format.

BackgroundThe authors conducted a study to determine the frequency and type of adverse events (AEs) associated with dental devices reported to the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database.MethodsThe authors downloaded and reviewed the dental device-related AEs reported to MAUDE from January 1, 1996, through December 31,2011.ResultsMAUDE received a total of 1,978,056 reports between January 1, 1996, and December 31, 2011. Among these reports, 28,046 (1.4%) AE reports were associated with dental devices. Within the dental AE reports that had event type information, 17,261 reported injuries, 7,777 reported device malfunctions, and 66 reported deaths. Among the 66 entries classified as death reports, 52 reported a death in the description; the remaining were either misclassified or lacked sufficient information in the report to determine whether a death had occurred. Of the dental device-associated AEs, 53.5% pertained to endosseous implants.ConclusionsA plethora of devices are used in dental care. To achieve Element 1 of Agency for Healthcare Research and Quality's Patient Safety Initiative, clinicians and researchers must be able to monitor the safety of dental devices. Although MAUDE was identified by the authors as essentially the sole source of this valuable information on adverse events, their investigations led them to conclude that MAUDE had substantial limitations that prevent it from being the broad-based patient safety sentinel the profession requires.Practical implicationsAs potential contributors to MAUDE, dental care teams play a key role in improving the profession's access to information about the safety of dental devices.

The objective of this study was to examine the feasibility of sintering dental ceramic (e.g., zirconia) in a microwave oven, and compare the mechanical properties of these with similar materials sintered in a conventional furnace. Zirconia cylinders were heated to 1100°C, 1300°C, 1350°C, 1400 and 1450°C in microwave and conventional furnaces and sintered at varying dwell times. Our results showed that the mechanical and microstructural properties of samples sintered by microwave were comparable to those of the conventionally sintered samples. Indentation hardness and fracture toughness were found to be 1256 ± 7 and 6.4 ± 0.4 Mpa(m)0.5 respectively. The microwave samples were sintered in significantly less time had less voids and more uniform grain structure. Our results suggest that microwave sintering can produce rapid and reliable processing of complex dental ceramics with better microstructural properties and energy savings.

Fourteen dental copings (zirconia stabilized with 3 mol% yttria) were layered with Noritake dental glass-ceramic and sintered in the microwave furnace with various sintering temperatures. Sintered zirconia rectangular beams measuring 50 mm in length, 4 mm in width and 0.75 mm in height were coated with the dental glass-ceramic and sintered in the microwave furnace. These were subjected to a four-point bend test to calculate modulus of rupture. Sintering temperature of 800°C in the microwave furnace with ramp rates in excess of 100°C per minute was sufficient to attain good sintered crowns. Indentation hardness with 200g loads and 500g loads for the microwave-sintered teeth resulted in hardness values of 0.685 ± 0.0245 GPa and 6.56 ± 0.4 GPa. The indentation fracture toughness values with 200g and 500g were calculated to be 2.26 ± 0.8 MPa(m)0.5 and 0.97 ± 0.1 MPa(m)0.5 respectively and agreed well with the published values [1]. The failure load for the layered beams in the bend test was 81.8 ± 17.7 N and the resulting modulus of rupture was 632 ± 105 MPa.

Background Patients with diabetes are at increased risk of developing oral complications, and annual dental examinations are an endorsed preventive strategy. The authors evaluated the feasibility and validity of implementing an automated electronic health record (EHR)–based dental quality measure to determine whether patients with diabetes received such evaluations. Methods The authors selected a Dental Quality Alliance measure developed for claims data and adapted the specifications for EHRs. Automated queries identified patients with diabetes across 4 dental institutions, and the authors manually reviewed a subsample of charts to evaluate query performance. After assessing the initial EHR measure, the authors defined and tested a revised EHR measure to capture better the oral care received by patients with diabetes. Results In the initial and revised measures, the authors used EHR automated queries to identify 12,960 and 13,221 patients with diabetes, respectively, in the reporting year. Variations in the measure scores across sites were greater with the initial measure (range, 36.4-71.3%) than with the revised measure (range, 78.8-88.1%). The automated query performed well (93% or higher) for sensitivity, specificity, and positive and negative predictive values for both measures. Conclusions The results suggest that an automated EHR-based query can be used successfully to measure the quality of oral health care delivered to patients with diabetes. The authors also found that using the rich data available in EHRs may help estimate the quality of care better than can relying on claims data. Practical Implications Detailed clinical patient-level data in dental EHRs may be useful to dentists in evaluating the quality of dental care provided to patients with diabetes.

Although dentists perform highly technical procedures in complex environments, patient safety has not received the same focus in dentistry as in medicine. Cultivating a robust patient safety culture is foundational to minimizing patient harm, but little is known about how dental teams view patient safety or the patient safety culture within their practice. As a step toward rectifying that omission, the goals of this study were to benchmark the patient safety culture in three U.S. dental schools, identifying areas for improvement. The extensively validated Medical Office Survey on Patient Safety Culture (MOSOPS), developed by the Agency for Healthcare Research and Quality, was administered to dental faculty, dental hygienists, dental students, and staff at the three schools. Forty-seven percent of the 328 invited individuals completed the survey. The "Teamwork" category received the highest marks and "Patient Care Tracking and Follow-Up" and "Leadership Support for Patient Safety" the lowest. Only 48 percent of the respondents rated systems and processes in place to prevent/catch patient problems as good/excellent. All patient safety dimensions received lower marks than in medical practices. These findings and the inherent risk associated with dental procedures lead to the conclusion that dentistry in general, and academic dental clinics in particular, stands to benefit from an increased focus on patient safety. This first published use of the MOSOPS in a dental clinic setting highlights both clinical and educational priorities for improving the safety of care in dental school clinics.

Although standardized terminologies such as the International Classification of Diseases have been in use in medicine for over a century, efforts in the dental profession to standardize dental diagnostic terms have not achieved widespread acceptance. To address this gap, a standardized dental diagnostic terminology, the EZCodes, was developed in 2009. Fifteen dental education institutions in the United States and Europe have implemented the EZCodes dental diagnostic terminology. This article reports on the utilization and valid entry of the EZCodes at three of the dental schools that have adopted this standardized dental diagnostic terminology. Electronic data on the use of procedure codes with diagnostic terms from the three schools over a period from July 2010 to June 2011 were aggregated. The diagnostic term and procedure code pairs were adjudicated by three calibrated dentists. Analyses were conducted to gain insight into the utilization and valid entry of the EZCodes diagnostic terminology in the one-year period. Error proportions in the entry of diagnostic term (and by diagnostic category) were also computed. In the twelve-month period, 29,965 diagnostic terms and 249,411 procedure codes were entered at the three institutions resulting in a utilization proportion of 12 percent. Caries and periodontics were the most frequently used categories. More than 1,000 of the available 1,321 diagnostic terms were never used. Overall, 60.5 percent of the EZCodes entries were found to be valid. The results demonstrate low utilization of EZCodes in an electronic health record and raise the need for specific training of dental providers on the importance of using dental diagnostic terminology and specifically how to use the terms in the electronic record. These findings will serve to increase the use/correct use of the EZCodes dental diagnostic terminology and ultimately create a reliable platform for undertaking clinical, outcomes, and quality improvement-related research.

ObjectiveTreatment planning, an essential component of clinical practice, has received little attention in the dental literature and there appears to be no consistent format being followed in the teaching and development of treatment plans within dental school curricula. No investigation, to our knowledge, has been carried out to explore the subject of treatment planning since the advent of electronic health record (EHR) use in dentistry. It is therefore important to examine the topic of treatment planning in the context of EHRs.MethodsThis paper reports on how 25 predoctoral dental students from two U.S. schools performed when asked to complete diagnosis and treatment planning exercises for two clinical scenarios in an EHR. Three calibrated clinical teaching faculty scored diagnosis entry, diagnosis-treatment (procedure) pairing, and sequencing of treatment according to criteria taught in their curriculum. Scores were then converted to percent correct and reported as means (with standard deviations).ResultsOverall, the participants earned 48.2% of the possible points. Participants at School 2 earned a mean of 54.3% compared with participants at School 1, who earned 41.9%. Students fared better selecting the appropriate treatment (59.8%) compared with choosing the correct diagnoses (41.9%) but performed least favorably when organizing the sequence of their treatment plans (41.7%).ConclusionOur results highlight the need to improve the current process by which treatment planning is taught and also to consider the impact of technology on the fundamental skills of diagnosis and treatment planning within the modern educational setting.

Ever since Kumar Patel introduced lasers in 1960s’, researchers have been looking into its possible applications in the field of dentistry. Researchers have investigated the effects of laser radiation on teeth, bone, pulp and oral mucosal tissues (Taylor, Shklar, & Roeber, 1965). CO2 lasers have been used extensively in medical field and the first laser to be approved by FDA for dental application was Nd:YAG (Neodymium-Yttrium-Aluminum-Garnet) in 1990s. Since then many types of lasers including CO2, Er:YAG (Erbium-Yttrium-Aluminum-Garnet), Diode, Er Cr:YSGG (Erbium-Chromium-Yttrium-Scallium-Gallium-Garnet) have been approved for dental use. FDA approved Er:YAG for dental hard tissue in 1997 and has approved other types of lasers for soft and hard tissue procedures in many area of dentistry.

Quantitative light-induced fluorescence (QLF) method has been used in vitro, in situ and in vivo as a diagnostic method in assessing smooth surface caries over the last twenty years. Coincidentally, reversal or remineralization of early smooth surface lesion by remineralizing agents has been substantiated by in vitro and in situ studies over the last twenty years. However, there are very few reported clinical trials to assess the effectiveness of these remineralizing agents by using QLF. This research aims at exploring the remineralizing potential of a specially formulated remineralizing mouth rinse and the ‘gold-standard’ Sodium Fluoride (NaF) rinse by using QLF as a monitoring tool. Methods: Twelve Subjects at high-risk for caries progression with smooth surface caries on anterior teeth were selected and randomly assigned to the control and to the test group. Twice daily (after breakfast and after dinner) the subjects rinsed 1 oz of either the test (Calcium and Fluoride; 250 ppm F) or the control rinse (NaF; 250 ppm F). Baseline assessments of the progression of the smooth surface lesion were done by QLF at 0, 1, 2, and end of 3 months. A two-sided t-test, MANOVA and exact F-statistics were used to determine differences between treatment groups. Results: There was no significant difference between the two groups in preventing the progression of caries (p> 0.05). It was concluded that QLF could be a useful diagnostic tool to aid the clinician in caries management.

The use of materials to rehabilitate tooth structures is constantly changing. Over the past decade, newer material processing techniques and technologies have significantly improved the dependability and predictability of dental material for clinicians. The greatest obstacle, however, is in choosing the right combination for continued success. Finding predictable approaches for successful restorative procedures has been the goal of clinical and material scientists. This article provides a broad perspective on the advances made in various classes of dental restorative materials in terms of their functionality with respect to pit and fissure sealants, glass ionomers, and dental composites.

Background and Objectives Carbon dioxide (CO2) lasers are an important part of dental treatment. Advances in laser technology have produced microsecond pulse durations and small beam sizes. The histological effects of porcine intraoral soft tissue with a range of microsecond-pulsed CO2 laser parameters used for incision and sulcular debridement were evaluated in vitro and compared with historical histologic data. Study Design/Materials and Methods Fresh pig mandibles were used to perform incision and sulcular debridement using a microsecond-pulsed CO2 laser. λ = 10,600 nm, articulated arm delivered non-contact with spot size 200 µm, 500 µm, and 1 mm, and focal distance of 1 mm. For sulcular debridement, epithelium within periodontal pocket (6 mm×6 mm) was removed. Laser parameters for incision were from 30 Hz, 350 microseconds, 28 mJ and energy density of 143 J/cm2 to 90 Hz, 1,000 microseconds, 60 mJ, and 1,911 J/cm2. Width and depth of tissue removed, as well as coagulation effects of the tissue treated were measured. These were compared to historical histologic database. Laser-treated surfaces were observed qualitatively using scanning electron microscopy (SEM). Results All laser parameters studied were able to reach the defined simulation objectives in reasonable amounts of time, less than a minute for incision and

Functional impairment affecting the quality of life results when a wide range of both muscular and joint pathologies affect the temporomandibular joint (TMJ). Alloplastic reconstruction of joints using Christensen metal TMJ implants have been used since the 1960s for many such patients. To ensure the longevity of such TMJ prostheses, the wear rate of such implants should be minimal. Because surface roughness is an important factor that influences the wear rate, in this study we measured the surface roughness of the condylar and the fossa elements of the new and retrieved Christensen metal TMJ prostheses using the noncontacting optical interferometer (ZYGO-New View 5000). The roughness parameters of the retrieved specimens were statistically higher (p < 0.05) than those for the new specimens, but were less than the retrieved metal total knee implants as reported in the literature.

Although dentists perform highly technical procedures in complex environments, patient safety has not received the same focus in dentistry as in medicine. Cultivating a robust patient safety culture is foundational to minimizing patient harm, but little is known about how dental teams view patient safety or the patient safety culture within their practice. As a step toward rectifying that omission, the goals of this study were to benchmark the patient safety culture in three U.S. dental schools, identifying areas for improvement. The extensively validated Medical Office Survey on Patient Safety Culture (MOSOPS), developed by the Agency for Healthcare Research and Quality, was administered to dental faculty, dental hygienists, dental students, and staff at the three schools. Forty-seven percent of the 328 invited individuals completed the survey. The “Teamwork” category received the highest marks and “Patient Care Tracking and Follow-Up” and “Leadership Support for Patient Safety” the lowest. Only 48 percent of the respondents rated systems and processes in place to prevent/catch patient problems as good/excellent. All patient safety dimensions received lower marks than in medical practices. These findings and the inherent risk associated with dental procedures lead to the conclusion that dentistry in general, and academic dental clinics in particular, stands to benefit from an increased focus on patient safety. This first published use of the MOSOPS in a dental clinic setting highlights both clinical and educational priorities for improving the safety of care in dental school clinics.