Richard W. Valachovic

Dentofacial development in long‐term survivors of acute lymphoblastic leukemia: A comparison of three treatment modalities

Ninety‐seven children who were diagnosed with acute lymphoblastic leukemia before 10 years of age and treated with chemotherapy alone, chemotherapy plus 1800‐cGy cranial irradiation (RT), or chemotherapy plus 2400‐cGy RT were evaluated for effects of therapy on dentofacial development. All patients were seen at least 5 years postdiagnosis. Dental abnormalities were determined from panoramic radiographs, and craniofacial evaluations were made from lateral cephalometric radiographs. Ninety‐one (94%) of all patients and 41 (100%) of patients younger than 5 years of age at diagnosis had abnormal dental development. the severity of these abnormalities was greater in children who received treatment before 5 years of age and in those who received RT. Observed dental abnormalities included tooth agenesis, arrested root development, microdontia, and enamel dysplasias. Craniofacial abnormalities occurred in 18 of 20 (90%) of those patients who received chemotherapy plus 2400‐cGy RT before 5 years of age. Mean cephalometric values of this group showed significant deficient mandibular development. the results of this study suggest that the severity of dentofacial‐developmental abnormalities secondary to antileukemia therapy are related to the age of the patient at the initiation of treatment and the use of cranial RT.

Clinical efficacy of dental radiography in the detection of dental caries and periodontal diseases

This article reports the ability of dental radiographs to correctly detect evidence of dental caries and periodontal disease (sensitivity) and to correctly establish the absence of these diseases (specificity). The analysis used a unique data set that was collected as part of the Veterans Administration Dental Longitudinal Study in Boston. Periapical, panoramic, and posterior bitewing radiographs were independently compared with a consensus radiographic standard of all three radiographs read simultaneously. Findings showed that the sensitivities of all three radiographs to detect dental caries were lower than expected, at approximately 60%, whereas the sensitivities to detect evidence of periodontal disease averaged approximately 85%. Panoramic radiographs were substantially less sensitive for detecting dental caries than periapical and posterior bitewing radiographs, but no difference between these modalities was observed in the analysis of sensitivity to periodontal disease. The proportion of false-negative and false-positive readings from dental radiographs was substantial and requires further investigation.

Dental school vacant budgeted faculty positions: academic year 2003-04.

The total number of vacant budgeted positions (296) fell by eleven positions between 2002-03 and 2003-04. However, the reported number of lost positions increased from thirty-nine to 147. The average number of vacancies per school was 5.3. The average number of vacancies reported to be usual and normal at any one time was 3.6 per school, the same as last year. Forty-three percent of the vacancies had been vacant less than seven months, a decline from 55 percent in 2002-03, indicating an increase in the number of positions vacant longer than six months. Meeting position requirements was the most frequently reported factor cited as influencing the ability to fill a position. This is a change from recent previous years when the most influencing factors were salary/budget limitations and lack of response to position announcements. While there was no indication expressed in the survey that vacancies were adversely affecting the quality of dental education, almost 50 percent of the deans reported faculty recruitment and retention was a problem at their school, and over 55 percent indicated that they anticipated it would become more difficult over the next five years to fill vacated positions. Faculty recruitment, development, and retention remain priority issues in meeting the teaching, research, patient care, and administrative needs of the dental education community.

Examiner Reliability in Dental Radiography

In long-term investigations involving a large number of study participants, it is frequently necessary to employ the use of multiple examiners who must exhibit high levels of inter- and intra-examiner reliability in order to minimize examiner bias, which can distort scientific findings. This report on the calibration of four examiners in a large project investigating the efficacy of dental radiography shows high levels of examiner reliability using various statistical measures of agreement. Levels of intra-examiner agreement using Cohens Kappa index were 0.75 and higher at baseline, and remained at approximately the same level (0.80) throughout the 24-month period of the study. The Kappa index of inter-examiner agreement among the six pairings of the four examiners ranged from 0.68 to 0.80 for caries and 0.72 and 0.83 for periodontal disease. Values of four statistical measures of agreement (proportional agreement, Kendalls rank correlation, Cohens Kappa index, and Cohens weighted Kappa index) were determined to show the importance of using measures, such as the Kappa index, which take chance agreement into account.

Clinical indicators of radiographically detectable dental diseases in the adult patient.

A comprehensive analysis of the relationship between clinical observations in dental patients without symptoms and oral disease as detected by full-mouth and panoramic dental radiographs in a large population of patients has never been reported. Knowledge of these relationships is necessary in the design of a diagnostic decision process (clinical algorithm) that can predict which patients require dental radiographs for the diagnosis of dental caries or periodontal disease to be confirmed or refined. An accurate clinical algorithm could reduce the number of radiographs that are taken of certain routinely seen dental patients without symptoms, thus reducing unnecessary exposure x-radiation as well as potentially reducing health care costs for these patients. A sample of 602 adult men on whom a complete series of panoramic, posterior bitewing, and periapical dental radiographs and an independent oral examination were performed provided the opportunity to evaluate the relationship between clinically observed oral disease indicators and independent radiographic evidence of dental caries and periodontal disease. The analysis suggests that combinations of several clinical indicators can predict with some success which patients without symptoms will benefit most from oral radiographs. The presence of several carious lesions on oral examination was the best predictor of radiographic detection of dental caries. Clinical indicators tht appear to predict radiographic evidence of periodontal disease are clinical measures of pocket depth, mobility, and the patients denture status. An important finding is that because of the high prevalence of gingivitis and plaque, these indicators were not related to radiographic evidence of periodontal disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Longitudinal study of the diagnostic yield of panoramic radiographs in aging edentulous men

Participants in the Veterans Administration Dental Longitudinal Study who were edentulous and for whom longitudinal panoramic radiographs were available were followed through four examination cycles, representing approximately 10 years. It was observed that 13 (39%) of the 33 subjects examined had one or more positive radiographic findings at the initial examination. No changes occurred in the findings noted during the initial panoramic radiographic examination, and no new findings were observed over the study period. Although the initial baseline panoramic examinations yielded several positive radiographic findings, few were of a nature that materially affected the initial treatment plan.

Annual ADEA Survey of Dental School Seniors: 2017 Graduating Class

This report summarizes the key findings of the American Dental Education Association (ADEA) Survey of Dental School Seniors for the graduating class of 2017. The survey covers a wide range of topics related to dental education, including students’ motivation to pursue dentistry, perceived preparation in different subject areas, debt incurred, and career plans. The response rate for the survey was 77.1% and included responses from students at all 65 U.S. dental schools with graduating classes that year. Some of the key findings include a near equal representation of males and females, but a skewed distribution by gender within race/ethnic groups. In general, minority students had a higher ratio of females, while White students had a higher ratio of males. Average educational debt fell slightly at public schools but rose by

Interprofessional Collaborative Practice: How Could Dentistry Participate?

40,000 to

The Case for Change in Dental Education

287,405 at private schools. The two most common plans following graduation were to work in the private sector and to continue learning at an advanced dental education program. The majority of students planned at some point in their careers to teach and to work with underserved populations. Comparing the experiences and plans of seniors with different characteristics allows school administrators and policymakers to better understand these future dentists’ motivations and challenges.

Educational Strategies Associated with Development of Problem-Solving, Critical Thinking, and Self-Directed Learning

There is a remarkable phenomenon occurring among health professionals: the development of ongoing, routine collaboration, both in educating the next generation of providers and in delivering care. These new approaches, commonly referred to as interprofessional education and interprofessional collaborative practice, have been introduced into academic health settings and delivery systems throughout the U.S. and the rest of the world; however, the full integration of dentistry in health care teams remains unrealized. In academic settings, dentistry has found ways to collaborate with the other health professions, but most practicing dentists still find themselves on the margins of new models of care delivery. This article provides a perspective on the history and context of the evolution of collaborative approaches to health care and proposes ways in which dentistry can participate more fully in the future.