Rainer Haak

A European consensus on learning objectives for a core communication curriculum in health care professions

OBJECTIVE To develop learning objectives for a core communication curriculum for all health care professions and to survey the acceptability and suitability of the curriculum for undergraduate European health care education. METHODS Learning objectives for a Health Professions Core Communication Curriculum (HPCCC) in undergraduate education were developed based on international literature and expert knowledge by an international group of communication experts representing different health care professions. A Delphi process technique was used to gather feedback and to provide a consensus from various health care disciplines within Europe. RESULTS 121 communication experts from 15 professional fields and 16 European countries participated in the consensus process. The overall acceptance of the core communication curriculum was high. 61 core communication objectives were rated on a five-point scale and found to be relevant for undergraduate education in health care professions. A thematic analysis revealed the benefits of the HPCCC. CONCLUSIONS AND PRACTICE IMPLICATIONS Based on a broad European expert consensus, the Health Professions Core Communication Curriculum can be used as a guide for teaching communication inter- and multi-professionally in undergraduate education in health care. It can serve for curriculum development and support the goals of the Bologna process.

Assessment of interfacial defects at composite restorations by swept source optical coherence tomography

Abstract. In clinical dental practice, it is often difficult or even impossible to detect and assess interfacial adhesive defects at adhesive restorations by means of visual inspection or other established diagnostic methods. However, nondestructive optical coherence tomography (OCT) may provide a better picture in this diagnostic scenario. The aim of this study was to evaluate the suitability of swept source OCT (SS-OCT) for the nondestructive assessment of interfacial deficiencies at composite restorations and the evaluation of cohesive defects within composite material. Ten class V composite restorations that were not adhesively luted were taken as validation objects and examined for frequency of interfacial gaps, air entrapments, and defects between composite layers using SS-OCT with a 1325-nm center wavelength. Light microscopy was used to inspect for inherent structures. SS-OCT detected 79.5%±1.8% of the total gap lengths at the enamel interface and 70.9%±0.4% at the dentin interface. Additionally, defective structures in composite restorations were displayed. It was shown that OCT imaging has the potential to nondestructively assess the interfacial adaptation of composite restorations and to detect internal defects in the layered composite material.

A controlled trial on the effect of hypnosis on dental anxiety in tooth removal patients

OBJECTIVE Empirical evidence concerning the efficacy of hypnosis to reduce anxiety in dental patients is limited. Hence we conducted a controlled trial in patients undergoing tooth removal. The study aims at assessing patients attitude toward hypnosis and comparing the course of dental anxiety before, during and subsequent to tooth removal in patients with treatment as usual (TAU) and patients with treatment as usual and hypnosis (TAU+HYP). METHODS 102 patients in a dental practice were assigned to TAU or TAU+HYP. Dental anxiety was assessed before, during and after treatment. All patients were asked about their experiences and attitudes toward hypnosis. RESULTS More than 90% of patients had positive attitudes toward hypnosis. Dental anxiety was highest before treatment, and was decreasing across the three assessment points in both groups. The TAU+HYP group reported significantly lower levels of anxiety during treatment, but not after treatment compared with TAU group. CONCLUSION Our findings confirm that hypnosis is beneficial as an adjunct intervention to reduce anxiety in patients undergoing tooth removal, particularly with regard to its no-invasive nature. PRACTICAL IMPLICATION The findings underline that hypnosis is not only beneficial, but also highly accepted by the patients. Implementation of hypnosis in routine dental care should be forwarded.

A three-year clinical evaluation of a one-step self-etch and a two-step etch-and-rinse adhesive in non-carious cervical lesions

OBJECTIVES The aim of the study was to assess a one-step self-etch adhesive (Futurabond M, 1-SE) and a two-step etch-and-rinse adhesive (Solobond M, 2-ER) used in combination with the nano-hybrid composite (Amaris) in a prospective clinical study on non-carious cervical lesions. METHODS 110 restorations were placed in 40 patients and graded over 36 months according to aesthetical, functional and biological criteria (Clinical Oral Investigations 2007;11:5). The four-step etch-and-rinse adhesive Syntac classic (4-ER) combined with the nano-hybrid composite Tetric EvoCeram was used as a control. Cumulative failure rates (CFR), retention rates and Kaplan-Meier survival curves were calculated for each observation period. RESULTS After 3 years, the CFR of 33.3% in the 2-ER group was significantly higher compared to those of the 1-SE group (9.1%, p = 0.019) and of the 4-ER group (8.3%, p = 0.035). Additionally, retention rates in the 1-SE and the 4-ER groups were higher compared to 2-ER (p = 0.012 each) after 36 months. Annual failure rates ranged between 2.8% for 4-ER, 3.0% for 1-SE and 11.1% for 2-ER. During the study, restorations in all groups showed progressive marginal deterioration within the limits of clinical acceptance. After 3 years, restorations in the 2-ER and the 4-ER group showed more small defects at dentin than at enamel margins. CONCLUSIONS The 1-SE group was clinically as successful as the 4-ER, with both performing better than the 2-ER group. Futurabond M/Amaris can be recommended for the restoration of sclerotic non-carious cervical lesions. CLINICAL SIGNIFICANCE Number protocol 192/2008.

Assessment of defects at tooth/self-adhering flowable composite interface using swept-source optical coherence tomography (SS-OCT).

OBJECTIVES Assessment of adhesive defects of a self-etch adhesive and a self-adhering flowable composite at the tooth/composite interface before and after water storage by optical coherence tomography (OCT). METHODS 16 extracted human molars (n=8 each) with box-shaped, class-V cavities were restored either with an experimental self-adhering flowable composite (EF, DMG) or with the filling system Adper™ Prompt™ L-Pop™/Filtek™ Supreme XT Flowable composite (PLP, 3M ESPE). Restorations of both groups were non-invasively imaged using swept-source OCT before and after storage in water. The OCT signal for adhesive defects at the tooth/composite interface was quantified. RESULTS At enamel, significantly fewer adhesive defects were detected at EF restorations than at PLP restorations, before water storage (4%/48%, p<0.001) and thereafter (8%/49%, p<0.001); in contrast, at dentin more interfacial defects were observed with EF (before water storage: 75%/11%; p<0.001, after water storage: 77%/52%; pi=0.001). In the case of slight initial adhesive defects, water storage caused a statistically verifiable increase in adhesive defects at the enamel interface with EF (before/after storage: 4%/8%; p=0.023) and at dentin with PLP (before/after storage: 11%/52%; p=0.008). SIGNIFICANCE Given the high proportion of adhesive defects with the experimental self-adhering flowable composite, its use as the definitive restorative material in class-V cavities must be critically scrutinized and clinical indications must be investigated further with in vitro and in vivo trials.

Cytotoxic effects of octenidine mouth rinse on human fibroblasts and epithelial cells - an in vitro study.

Abstract Objectives: This study compared the cytotoxicity of a new octenidine mouth rinse (MR) against gingival fibroblasts and epithelial cells with different established MRs. Methods: The following MRs were used: Octenidol (OCT), Chlorhexidine 0.2% (CHX), Listerine (LIS), Meridol (MER), Betaisodona (BET); and control (medium only). Human primary gingiva fibroblasts and human primary nasal epithelial cells were cultivated in cell-specific media (2 × 105 cells/ml) and treated with MR for 1, 5, and 15 min. Each test was performed 12 times. Metabolism activity was measured using a cytotoxicity assay. A cellometer analyzed cell viability, cell number, and cell diameter. The data were analyzed by two-way analysis of variance with subsequent Dunnett’s test and additional t-tests. Results: The cytotoxic effects of all MRs on fibroblasts and epithelial cells compared to the control depended on the contact time (p < 0.001). OCT and BET showed less influence on cell metabolism in fibroblasts than other MRs. OCT also demonstrated comparable but not significant results in epithelial cells (p > 0.005). Cell numbers of both cell types at all contact times revealed that OCT showed a less negative effect (p > 0.005), especially for epithelial cells compared to CHX after 15 min (p < 0.005). OCT and BET showed the best results for viability in fibroblasts (p > 0.005), but MER showed less influence than OCT in epithelial cells (p < 0.005). Conclusions: OCT is a potential alternative to CHX regarding cytotoxicity because of its lower cell-toxic effect against fibroblasts and epithelial cells.

Detection of five potentially periodontal pathogenic bacteria in peri-implant disease: A comparison of PCR and real-time PCR

The aim of this study was to compare the microbial analysis methods of polymerase chain reaction (PCR) and real-time PCR (RT-PCR) in terms of detection of five selected potentially periodontal pathogenic bacteria in peri-implant disease. Therefore 45 samples of healthy, mucositis and peri-implantitis (n = 15 each) were assessed according to presence of the following bacteria using PCR (DNA-strip technology) and RT-PCR (fluorescent dye SYBR green-system): Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Treponema denticola (Td), Tanerella forsythia (Tf), and Fusobacterium nucleatum (Fn). There were no significant correlations between the bacterial and disease patterns, so the benefit of using microbiological tests for the diagnosis of peri-implant diseases is questionable. Correlations between the methods were highest for Tf (Kendalls Tau: 0.65, Spearman: 0.78), Fn (0.49, 0.61) and Td (0.49, 0.59). For Aa (0.38, 0.42) and Pg (0.04, 0.04), lower correlation values were detected. Accordingly, conventional semi-quantitative PCR seems to be sufficient for analyzing potentially periodontal pathogenic bacterial species.

MicroRNAs as Salivary Markers for Periodontal Diseases: A New Diagnostic Approach?

The aim of this review is to discuss current findings regarding the roles of miRNAs in periodontal diseases and the potential use of saliva as a diagnostic medium for corresponding miRNA investigations. For periodontal disease, investigations have been restricted to tissue samples and five miRNAs, that is, miR-142-3p, miR-146a, miR-155, miR-203, and miR-223, were repeatedly validated in vivo and in vitro by different validation methods. Particularly noticeable are the small sample sizes, different internal controls, and different case definitions of periodontitis in in vivo studies. Beside of that, the validated miRNAs are associated with inflammation and therefore with various diseases. Furthermore, several studies successfully explored the use of salivary miRNA species for the diagnosis of oral cancer. Different cancer types were investigated and heterogeneous methodology was used; moreover, no overlap of results was found. In conclusion, five miRNAs have consistently been reported for periodontitis; however, their disease specificity, detectability, and expression in saliva and their importance as noninvasive markers are questionable. In principle, a salivary miRNA diagnostic method seems feasible. However, standardized criteria and protocols for preanalytics, measurements, and analysis should be established to obtain comparable results across different studies.

Active matrix metalloproteinase‐8 and periodontal bacteria depending on periodontal status in patients with rheumatoid arthritis

BACKGROUND AND OBJECTIVES The aim of this clinical cross-sectional study was to determine the level of active matrix metalloproteinase-8 (aMMP-8) and periodontal pathogenic bacteria in gingival crevicular fluid in patients with rheumatoid arthritis (RA) with varying periodontal conditions. MATERIAL AND METHODS In total, 103 patients with RA and 104 healthy controls (HC) were included. The assessment of periodontal status included periodontal probing depth, bleeding on probing and clinical attachment loss. Periodontal disease was classified as healthy/mild, moderate or severe. For the determination of aMMP-8 levels using enzyme-linked immunosorbent assay and periodontal pathogenic bacteria using polymerase chain reaction, samples of gingival crevicular fluid were taken from the deepest gingival pockets. The statistical analyses used included a Mann-Whitney U-test, a chi-squared test or a Fishers exact test, and the significance level was set at α = 5%. RESULTS We found that 65% of patients with RA and 79% of HC had moderate to severe periodontal disease (p = 0.02). The prevalence of periodontal pathogens was almost equal (p > 0.05). Furthermore, depending on periodontal disease severity only minor differences in bacterial prevalence were detected. With increasing severity of periodontal disease, higher aMMP-8 levels were observed. Accordingly, a significant difference in patients with moderate periodontal disease (RA: 15.3 ± 13.8; HC: 9.1 ± 9.1; p ≤ 0.01) and severe periodontal disease (RA: 21.7 ± 13.3; HC: 13.1 ± 8.6; p = 0.07) was detected, with a greater tendency in the latter group. CONCLUSION The increased aMMP-8 levels in the RA group indicate that the presence of RA appears to have an influence on the host response at a comparable level of bacterial load and periodontal disease severity.

Complex integrated analysis of lncRNAs-miRNAs-mRNAs in oral squamous cell carcinoma

OBJECTIVES This study aims to reveal regulatory network of lncRNAs-miRNAs-mRNAs in oral squamous cell carcinoma (OSCC) through gene expression data. MATERIAL AND METHODS Differentially expressed lncRNAs, miRNAs and mRNAs (cut-off: False discovery rate (FDR)<0.05 and |fold change|>1.5) were unveiled by package edgeR of R. Cox regression analysis was performed to screen prognostic factors in OSCC related with overall survival (OS) and relapse-free survival (RFS). Protein-protein interaction (PPI) network was constructed for differentially expressed mRNAs using BioGRID, HPRD and DIP. Key hub genes were identified from top 100 differentially expressed mRNAs ranked by betweenness centrality using recursive feature elimination. LncRNA-miRNA and miRNA-mRNA regulatory network were constructed and combined into ceRNAs regulatory network. Gene ontology biological terms and Kyoto Encyclopedia of Genes and Genomes pathways were identified using Fishers exact test. RESULTS A total of 929 differentially expressed mRNAs, 23 differentially expressed lncRNAs and 29 differentially expressed miRNAs were identified. 59 mRNAs, 6 miRNAs (hsa-mir-133a-1, hsa-mir-1-2, hsa-mir-486, hsa-mir-135b, hsa-mir-196b, hsa-mir-193b) and 6 lncRNAs (C10orf91, C2orf48, SFTA1P, FLJ41941,PART1,TTTY14) were related with OS; and 52 mRNAs, 4 miRNAs (hsa-mir-133a-1, hsa-mir-135b, hsa-mir-196b, hsa-mir-193b) and 2 lncRNAs (PART1, TTTY14) were associated with RFS. A support vector machine (SVM) classifier containing 37 key hub genes was obtained. A ceRNA regulatory network containing 417 nodes and 696 edges was constructed. ECM-receptor interaction, cytokine-cytokine receptor interaction, focal adhesion, arachidonic acid metabolism, and p53 signaling pathway were significantly enriched in the network. CONCLUSION These findings uncover the pathogenesis of OSCC and might provide potential therapeutic targets.