Faculty Bibliography

Dental schools are facing substantial financial challenges and a shortage of faculty members. One solution to address these issues has been to hire "shared" faculty members, i.e., faculty members whose primary appointment is at one institution who are hired by another institution to teach a course or part of a course. This is a controversial concept. A survey of academic deans at U.S. and Canadian dental schools was conducted for this study; thirty-nine (54 percent) of the seventy-two academic deans completed the online survey. This survey found that the use of shared faculty members is not rare amongst U.S. and Canadian dental schools and that the opinions of the academic deans about the use of shared faculty members ranged widely-from strong support to strong disapproval. Using shared faculty members has advantages and disadvantages for students, the shared faculty members, and both institutions. Many of the disadvantages could be potentially minimized by stakeholders' working together to develop collaborative arrangements. Networks could be developed in which institutions coordinate hiring of shared faculty members based on what expertise is needed. Financial challenges and shortages of faculty members are unlikely to be resolved in the near future, but use of shared faculty members is one promising approach to begin to meet these challenges.

OBJECTIVES/OBJECTIVE:The study aims to determine a) the extent of agreement between visual-tactile caries examination (VTE) and radiographic examination (RE) in detecting presumptive caries lesions on occlusal and proximal surfaces of posterior teeth of UNC Xylitol for Adult Caries Trial participants; and b) the additional caries diagnostic yield obtained by adding RE to VTE. METHODS:Data consisted of surface-level visual-tactile and radiographic classification of disease (cavitated and noncavitated caries lesions) or nondisease (sound surfaces). Participants (n = 114, adults with ≥12 erupted teeth and 1-10 caries lesions) received baseline VTE by a trained and calibrated examiner, and had interproximal radiographs obtained within 7 months before or after the VTE. Radiographs were assessed independently by two trained and calibrated examiners masked with respect to VTE results. The diagnostic threshold was surface-level disease/nondisease status. Kappa statistics provided an estimate of VTE-RE agreement on diseased surfaces. The additional diagnostic yield of the RE over VTE was calculated as the additional lesions detected radiographically as a percentage of the total number of lesions detected by VTE. RESULTS:Four-hundred ninety-four (51 occlusal, 433 proximal) lesions were detected; of these, 81 (2 occlusal, 79 proximal) lesions were detected by both VTE and RE. Kappa statistics were 0.18 (all surfaces), 0.04 (occlusal), and 0.18 (proximal). The additional diagnostic yield was 69 percent (all surfaces), 55 percent (occlusal), and 71 percent (proximal). CONCLUSIONS:There is poor agreement between VTE and RE to detect caries in posterior teeth of caries-active adults. However, an RE performed within 7 months of a VTE adds caries diagnostic yield in a clinical trial, especially on proximal surfaces.

BACKGROUND:Although caries is prevalent in adults, investigators have tested few preventive therapies in adult populations. In a randomized controlled trial, the authors evaluated the effectiveness of xylitol lozenges in preventing caries in adults at elevated risk of developing caries. METHODS:The Xylitol for Adult Caries Trial (X-ACT) was a three-site placebo-controlled randomized trial. Participants (n = 691) aged 21 through 80 years consumed five 1.0-gram xylitol or placebo lozenges daily for 33 months. They underwent clinical examinations at baseline and at 12, 24 and 33 months. RESULTS:Xylitol lozenges reduced the caries increment 10 percent. This reduction, which represented less than one-third of a surface per year, was not statistically significant. There was no indication of a dose-response effect. CONCLUSIONS:Daily use of xylitol lozenges did not result in a statistically or clinically significant reduction in 33-month caries increment among adults at an elevated risk of developing caries. CLINICAL IMPLICATIONS/CONCLUSIONS:These results suggest that xylitol used as a supplement in adults does not reduce their caries experience significantly.

The Xylitol for Adult Caries Trial was a three-year, double-blind, multi-center, randomized clinical trial that evaluated the effectiveness of xylitol vs. placebo lozenges in the prevention of dental caries in caries-active adults. The purpose of this secondary analysis was to investigate whether xylitol lozenges had a differential effect on cumulative caries increments on different tooth surfaces. Participants (ages 21-80 yrs) with at least one follow-up visit (n = 620) were examined at baseline, 12, 24, and 33 months. Negative binomial and zero-inflated negative binomial regression models were used to estimate incidence rate ratios (IRR) for xylitol's differential effect on cumulative caries increments on root and coronal surfaces and, among coronal surfaces, on smooth (buccal and lingual), occlusal, and proximal surfaces. Participants in the xylitol arm developed 40% fewer root caries lesions (0.23 D2FS/year) than those in the placebo arm (0.38 D2FS/year; IRR = 0.60; 95% CI [0.44, 0.81]; p < .001). There was no statistically significant difference between xylitol and control participants in the incidence of smooth-surface caries (p = .100), occlusal-surface caries (p = .408), or proximal-surface caries (p = .159). Among these caries-active adults, xylitol appears to have a caries-preventive effect on root surfaces (ClinicalTrials.gov NCT00393055).