David C. Sarrett

The American Dental Association Caries Classification System for Clinical Practice: A report of the American Dental Association Council on Scientific Affairs

BACKGROUND The caries lesion, the most commonly observed sign of dental caries disease, is the cumulative result of an imbalance in the dynamic demineralization and remineralization process that causes a net mineral loss over time. A classification system to categorize the location, site of origin, extent, and when possible, activity level of caries lesions consistently over time is necessary to determine which clinical treatments and therapeutic interventions are appropriate to control and treat these lesions. METHODS In 2008, the American Dental Association (ADA) convened a group of experts to develop an easy-to-implement caries classification system. The ADA Council on Scientific Affairs subsequently compiled information from these discussions to create the ADA Caries Classification System (CCS) presented in this article. CONCLUSIONS The ADA CCS offers clinicians the capability to capture the spectrum of caries disease presentations ranging from clinically unaffected (sound) tooth structure to noncavitated initial lesions to extensively cavitated advanced lesions. The ADA CCS supports a broad range of clinical management options necessary to treat both noncavitated and cavitated caries lesions. PRACTICAL IMPLICATIONS The ADA CCS is available for implementation in clinical practice to evaluate its usability, reliability, and validity. Feedback from clinical practitioners and researchers will allow system improvement. Use of the ADA CCS will offer standardized data that can be used to improve the scientific rationale for the treatment of all stages of caries disease.

Visual and profilometric wear measurements

Wear of composites can be estimated by the degree of marginal discrepancy between the prepared cavity wall and the occlusal margins of composites. Such evaluations are done on casts by comparing and rating the marginal discrepancy with those on standard casts. We analyzed the reliability of this technique on metal and stone specimens. These specimens contained grooves of different width and depth. For the visual comparison we used stone casts of machined standards of known groove depth. We measured the depths of the metal specimens with a profilometer and made stone casts of these original specimens. Using the stone casts of the standards, five dentists estimated the unknown groove depths on the remaining stone casts. These estimates were done under standardized conditions and repeated by each dentist on five different occasions. The results showed that visual depth evaluations of die stone specimens underestimated the depths when compared with the values measured with a profilometer on the original metal models. One investigator gave significantly different (p less than 0.05) groove depth estimates at different occasions.

Heat generated when threaded pins are cut: a comparison of techniques.

The temperature rise of threaded pins was measured when cut under various conditions and with different instruments. The air-water coolant and intermittent cutting produced significantly lower temperature rises than the air coolant and constant cutting, respectively. No particular carbide bur or diamond stone is recommended since little difference existed among them with respect to heat generation.

Do dentists from rural areas practice in rural areas

A near-universal health policy challenge, both in lowincome and high-income countries, is the recruitment and retention of health care providers in rural areas. For oral health, this is one of if not the main health workforce challenge that state and federal policymakers in the United States must constantly grapple with. Several tactics have been implemented to try to increase recruitment and retention of dentists in rural areas. These include exposing dental students to rural settings during their training, providing student loan forgiveness for those practicing in rural areas or participating in the National Health Service Corps, and recruiting students from rural areas into dental school. Some of these strategies appear promising. For example, exposure to rural communities appears to positively influence student attitudes about treating underserved populations. In addition, dentists from rural areas are much more likely to return to rural areas to practice. In earlier research, the American Dental Association (ADA) Health Policy Institute (HPI) analyzed how many dental school graduates remained in state as well as how many settled in rural areas for every dental school in the United States. We found a lot of variation. For example, the College of Dentistry at the University of Nebraska Medical Center had the highest share of graduates practicing in rural areas (32%) compared with the College of Dental Medicine at Columbia University, which had the lowest (1%). In terms of the share of graduates who remained in state, the School of Dentistry at University of Texas Health Science Center at Houston had the highest (89%), whereas the School of Dentistry at Creighton University had the lowest (10%). Presumably, for state governments that subsidize the cost of dental education through funding state schools, these outcomes ought to be of interest. In this month’s column, we delve deeper into the issue of recruitment and retention by analyzing the relationship between where dental students come from—rural or urban areas—and their likelihood of settling in a rural area after graduation. We did this for a single dental school, the School of Dentistry at Virginia Commonwealth University (VCU). The figure shows the proportion of practicing dentists from the classes of 2000 through 2014 who are located in Virginia as well as the proportion who are located in a rural area, irrespective of their state of residence. We show these values separately for graduates from the School of Dentistry at VCU

Fabricating fixed partial dentures using existing restorations

Abstract A technique has been described for utilizing an existing fixed splint in the fabrication of a fixed partial denture to replace splinted teeth that are extracted.