No matter what country you work in, the expectation of your patients is that you - as a dentist or hygienist – are highly educated and keep up with the latest scientific literature. And as many of you well know, in a busy practice this is extremely hard to do. The typical approach has been to participate in a weekend class or lecture, go to lectures at a dental convention, join in a study club with monthly lectures, or return to school for additional training. All of these approaches consume what little free time we have as professionals. So what is a dental clinician to do to pursue continuing education?
The answer is online education. With the advent of computers and the internet as well as advances in media software it is now possible to take courses that fit into the time frame of the dental clinician and not the other way around. And that is the beauty of online education that is available from a variety of sources. With CERP and other national certifications it is possible to take at your leisure and receive certification that can be displayed for patients to see in the office or posted to an online web site resume.
Online courses are offered by academics and practicing clinicians that are heavily credentialed in the subject matter that they are discussing. So on-line education is the way to pursue additional knowledge in the field of Dentistry, get credit, and show patients that you are involved in the scientific advances in Dentistry.
Warm Regards,
Jeff Burgess
DDS MSD, Editor in Chief
Recently in Oklahoma, USA, an Oral Surgeon was accused of a number of State practice act infractions associated with patient care including possible infection of patients with HIV, hepatitis B, and hepatitis C; with this arising out of problems with infection control procedures at two of his practices. What is specifically identified in reports is the use of ‘rusty instruments’ and ‘lax sterilization procedures’. Apparently over 7000 patients may have been exposed to these viruses.
One question that has arisen related to this clinician’s apparent unprofessional conduct is the role, if any, of dental assistant training as a potential contributor to the problem. The question is: should dental assistants have been certified to work in this practice involving surgical intervention as is the case within the medical profession where surgery is involved; and would this have made a difference in how infection control procedures were managed.
According to one report, a dental assistant working in the office stated that over her six year history of working no one kept track “of anything”. And apparently the instruments used for patients with known HIV and other viral problems (e.g. HBV) were soaked in bleach, which is known to cause rust on instruments and is no longer recommended in the management of instrument sterilization. Proper assistant training and certification would likely have reduced the use of such outdated infection control procedures and improved patient safety.
Given what happened in this Oklahoma City Oral Surgeon’s office it is time that formal State and or national certification of dental assistants be more seriously considered.
Warm Regards,
Jeff Burgess
DDS MSD, Editor in Chief
In relation to longevity, there has been concern about the use of CAD/CAM all-ceramic partial-coverage restoration systems and the long term survival of their fabricated restorations. Now a new seven year prospective split-mouth study published in the International Journal of Prosthodontics (Guess PC, et al. Int J Prosthodont. 2013 Jan-Feb;26(1):21-5) provides results that suggest that these fabricated all-ceramic partial-coverage posterior restorations, regardless of the type and system, are a reliable treatment option for restoring the posterior teeth (although all such restorations appear to be subject to deterioration over time).
An excellent review of the performance of dental ceramics fabricated by CAD/CAM systems is provided by E.D. Rekow and colleagues in their article published in J Dent Res, 2011 (August; 90(8):937). As the authors point out: “Challenges remain in both understanding and improving the clinical performance of all-ceramic restorations. These include improved consistency and breadth of information about factors in clinical studies, definition of failures, and laboratory testing procedures’. Much remains to be done in terms of providing the evidence base necessary to fully support all CAD/CAM restorations and CAD/CAM systems. But this much is certain: CAD/CAM technology continues to revolutionize the dental profession.
Dr Jeff Burgess
In the past 13 years a move has been made to develop scientifically based clinical guidelines to help dental professionals use evidence based decision making in their choices related to all manner of treatment procedures. In fact, according to at least one source, if one searches the US National Guidelines Clearing House there are over 232 guidelines covering an extensive array of dental procedures. See:
http://www.nature.com/ebd/journal/v5/n1/full/6400243a.html
http://www.guidelinecentral.com/summary-specialty/dentistry
http://ebd.ada.org/ClinicalRecommendations.aspx
However there is considerable overlap related to the published guidelines and in relation to specific ‘national’ standards.
In Canada the ‘Canadian Collaboration on Clinical Practice Guidelines in Dentistry (CCCGD) was formed as a national autonomous organization to promote responsible clinical practice guidelines for Canadian dentists. According to the ‘Journal of Evidence Based Dentistry’ as of 2004 this was the only evidence-based guideline group specific to dentistry (there are other organizations that include dentistry in their guidelines, such as the Scottish Intercollegiate Guidelines Network (SIGN) or the National Institute of Clinical Excellence (NICE)) but these latter groups cover the entire field of healthcare.
The creation of evidence based guidelines is important because they promote ‘best practices’ in clinical practice. However they do not constrain what a clinician might ultimately choose to do with respect to treatment in a given circumstance. A ‘guideline’ does not constitute a ‘standard’ of care but can and should be used to guide appropriate decision making.
An example of the importance of evidence based decision making is the study published in the Journal of the American Dental Association in 2012 (J Am Dent Assoc. 2012 Mar;143(3):241-52) titled ‘Evidence supporting the use of cone-beam computed tomography in orthodontics’. Authors van Vjiimen, Kuiipers, and colleagues provide a systematic review of the literature related to CBCT applications in orthodontics. 550 articles are reviewed and assessed in relation to 13 established criteria related to study design measurements and statistical analysis. Only 50 articles met their inclusion criteria, demonstrating the sad state of the science to date. And of these, the methodological quality averaged only 53 percent (range 15-77 percent). While the results of some of the studies suggested that CBCT allowed for improved diagnosis and better treatment planning, it was not found to be better than that provided by conventional imaging modalities. However, they did find that the area in which CBCT excelled was in relation to airway diagnostics.
This information, based on systematic review of the research literature, should be helpful to the clinician thinking of using CBCT in the evaluation of orthodontic patients. Hence, inceDental (incedental.com) recognizes the importance of evidence based clinical decision making and encourages its readers to review the available literature that has been accumulated to support their ‘best practices’. We also suggest that there be an International group similar to the Canadian group be established to broaden the reach of the developed evidence based clinical guidelines.
Warm Regards,
Jeff Burgess
DDS MSD, Editor in Chief
As Editor in Chief, I am pleased to announce that the 'Dental Hub' which was part of Health Imaging Hub previously has a new name: inceDental with standalone identity and website. Since its inception in October 2010, our dental portal has significantly increased its subscriber database and today is considered one of the top preferred online destinations for dental professionals worldwide. Because of increased visitors and substantial growth, NZH Tech, Inc., owner of the Hub, made the decision to make it a 'stand alone' site which has been renamed inceDental to fully define its uniqueness as a place for daily fresh news, commentary, scientific studies, white papers, case studies, online education and several other topics of interest for the international (and regional) dental community.
And one of the most exciting newer features of inceDental, resulting from a partnership with "xpAPce: Expert Dental CE", is the inclusion of CERP accredited (American Dental Association) dental continuing education courses. InceDental chose to partner with Expert Dental CE because it is an educational site that has no corporate sponsorship, has all courses vetted by internationally known scholars, has courses covering 17 clinical areas, and offers many unique modules for in-depth learning in specific topics. To encourage our visitors and subscribers to take these courses, inceDental offers a 20% discount simply by entering a code from the site. For more information and additional directions, please go to the Educational Section of inceDental and follow the provided instructions. The courses that are offered are of very high quality and will help professionals increase their knowledge base and clinical skills. You can go to our online courses by clicking here.
We thank you for continuing your support of inceDental and look forward to helping our professional visitors and subscribers in the future. Please let us know if there are ways we might improve the site. We would also be grateful if you let your professional colleagues know about us. Remember, it is now inceDental.
Warm Regards,
Jeff Burgess
DDS MSD, Editor in Chief