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Abstract Background Dental caries incidence in adults is similar to that in children and adolescents, but few caries preventive agents have been evaluated for effectiveness in adults populations. In addition, dentists direct fewer preventive services to their adult patients. Xylitol, an over-the-counter sweetener, has shown some potential as a caries preventive agent, but the evidence for its effectiveness is not yet conclusive and is based largely on studies in child populations. Methods/Design X-ACT is a three-year, multi-center, placebo controlled, double-blind, randomized clinical trial that tests the effects of daily use of xylitol lozenges versus placebo lozenges on the prevention of adult caries. The trial has randomized 691 participants (ages 21-80) to the two arms. The primary outcome is the increment of cavitated lesions. Discussion This trial should help resolve the overall issue of the effectiveness of xylitol in preventing caries by contributing evidence with a low risk of bias. Just as importantly, the trial will provide much-needed information about the effectiveness of a promising caries prevention agent in adults. An effective xylitol-based caries prevention intervention would represent an easily disseminated method to extend caries prevention to individuals not receiving caries preventive treatment in the dental office. Trial Registration ClinicalTrials.Gov NCT00393055

This study assessed professional satisfaction among 558 California general dentists using the Dentist Satisfaction Survey. Among findings were that dentists were most dissatisfied with the threat of malpractice, level of income, demands of managing the practice, and amount of personal time. Findings have implications for counseling predoctoral students. (Author/DB)

A case-control study is conducted to examine the risk indicators of posterior cusp fracture. The presence of a fracture line in the enamel and proportional volume of the restoration are the clinical features strongly associated with the risk of cusp fracture.

Dentists should examine all their patients carefully to assess their risk of developing cavities or periodontal disease. In a study of 15 dental offices, the participating dentists identified 4% of patients who were at high risk of developing cavities and 7% who had a high risk of developing periodontal disease. About 30% had a moderate risk of developing cavities or periodontal disease.

There are very few studies to show whether HIV patients are more likely to experience complications from invasive dental surgery. These types of procedures include removing a tooth, implanting an artificial tooth, braces, root canal treatment, periodontal treatments, and cleaning procedures such as scaling and root planing.

The loss of a tooth in the back that is not replaced will not have serious consequences in most people. In a study of 111 such patients, most lost 1 millimeter or less of space between teeth adjacent to the space and 1 millimeter or less of bone loss.

Restoration of a missing tooth with a partial denture does not necessarily improve the survival of adjacent teeth. Researchers compared the outcomes of 569 posterior bounded edentulous spaces bridged with removable partial dentures or left untreated, and found that the rate of adjacent tooth survival was unchanged by treatment. A slight increase in adjacent tooth survival was seen in patients treated with a fixed partial denture. Dentists believe that teeth adjacent to an unrestored missing tooth are a high risk of loss. Additional research may determine if treatment is necessary.

Approximately one person in 20 may break a tooth each year, which may result in a range of consequences. During a two week period, researchers studied the rate and consequences of tooth fractures in a group of 74,503 adults. These people had 143 completely fractured teeth. Complete fractures occur when a piece of the crown breaks away from the tooth. Eighty-seven percent of the complete fractures involved back teeth. Twenty-five percent of the fractures extended below the gumline and 8% involved the pulp chamber. Eighty-eight percent had been filled previously. Sixty-two percent were restored with permanent fillings, 18% were restored with temporary fillings, and 4% were smoothed or left untreated. Each year, approximately five people in 100 will break a tooth.

The majority of dentists and the American public believe that effective diagnosis and treatment, ethical practice, communication, and disease prevention are very important aspects of dental care. Researchers surveyed 647 households and 300 practicing dentists. Approximately 85% of the public had a moderate or great deal of trust in dentists. Older respondents and those with higher incomes had greater trust in the dental profession than younger people and those with lower incomes. More than 90% of the public and at least 85% of the dentists cited ethical conduct, effective diagnosis and treatment, communication, and disease prevention as very important aspects of dental care. At least 80% of the dentists felt that they had received good or excellent training in all of these areas except communication. Only 52% felt that they had received good or excellent training in communication.

Dental fillings are regularly replaced with new fillings that may be progressively larger. Sixty-six dentists examined 62 adults with numerous dental fillings and made treatment decisions about the need to replace existing fillings in premolars and molars. Thirty-six percent of dental assessments yielded a recommendation to rerestore a back tooth. Seventy percent of these rerestoration recommendations increased the number of restored tooth surfaces. Most fillings were replaced because of tooth fracture or risk of tooth fracture, the need for esthetic improvement, problems with contact or contour, new cavities, or as part of a treatment plan for an adjacent tooth. Recurrent cavities and faulty restorations necessitated an increase in the number of restored surfaces in approximately half of the back teeth.

Dentists must evaluate clinical practice guidelines before incorporating them into their practice. According to modified standards established by the Institute of Medicine (IOM), guidelines should be properly developed, reliable, valid, and practical. Most of the primary professional dental organizations are involved in developing clinical practice guidelines in 1995. Government agencies, nonprofit groups, and other organizations including insurers and dental group practices have also developed guidelines for dentistry. None of the existing guidelines embody all of the desirable characteristics cited by the IOM. Many lack a thorough analysis of the dental literature, overlook patient preferences, or are based on expert consensus rather than scientific evidence from outcome studies. Most organizations do not have a clear dissemination strategies for guidelines.

Some dentists may not follow published recommendations when restoring root-canal treated teeth. Researchers reviewed dental insurance claims data to study how 423 general dentists restored 1,199 teeth after root canal therapy. Dentists' restoration patterns were compared with the recommendations in the literature. Dentists placed dowels (posts) in similar percentages of front and premolar teeth although the literature states that front teeth require posts more often than back teeth. Between 37% and 40% of back teeth were not treated with crown restorations as recommended in the literature. Ten to 15% of teeth received posts without the subsequent crown restorations in contrast to published recommendations. When dentists did not place a crown in back teeth, they used silver fillings four times as often as composite restorations, although composites are preferred in literature reports.

Prompted by a decline in dental school applicants, a rise in dental school closures and concerns about rising malpractice suits, declining patient loads, declining income, dentists' well-being, and the care [...]

Disciplinary action taken against dentists may vary widely between different states. The state board of dental examiners administers an entrance examination and monitors the performance of licensed dentists. The state peer review committee reviews complaints against dentists. A study examined disciplinary actions taken by dental boards in 21 states over a five-year period or more between 1979 and 1987. The number of disciplinary actions taken against dentists varied widely between different states. Colorado had one of the highest rates of disciplinary action, and California had one of the lowest. The activity of peer review committees from 44 states was also evaluated using cases initiated during 1988. The amount of peer review activity differed significantly between the states. A considerable amount of variation existed between the number of cases decided in favor of the patient and the number decided in favor of the dentist in different states.

Treatment of non-carious cervical lesions may vary between different dentists. A cervical lesion is the loss of hard tissue in the junction between the connective tissue covering the root and the tooth enamel. A non-carious lesion is one that occurs in the absence of a cavity. A study surveyed 959 dentists about the treatment of four different types of non-carious cervical lesions. The dentists varied in the terminology used to describe the four different types of lesions. They also did not agree on the underlying cause of the lesions. Treatment varied depending on type of the lesion. The dentists advocated the use of restorative dentistry to treat certain types of lesions more often than others. They agreed that tooth brushing instruction was important for patients with non-carious cervical lesions.

Surveys conducted to (1) investigate why dental hygienists choose to become dentists, (2) evaluate their success in dental school, (3) assess the experience of those who had entered dental school, and (4) gauge the level of interest among dental hygienists in applying to dental school are discussed. (Author/MLW)

An elective course designed to create dental student awareness of the potential adverse effects of hazards and stress in dental school and practice, and methods to avoid and cope with such problems, is described. Results from one- and two-year course evaluations are included. (MSE)

A student evaluation system is described that maximizes characteristics of formative evaluation, uses multiple forms of assessment to evaluate competency, and provides timely and detailed feedback and opportunities for remediation. Student and faculty opinions of the program have been positive. (Author/MSE)