Faculty Bibliography

Jan. 7 through 9, 2011, the California Dental Association Foundation hosted a symposium on caries management by risk assessment in which a diverse range of stakeholders from across the nation gathered to discuss current and future status of CAMBRA. The consensus of the group was to develop a national strategic plan for CAMBRA implementation which will chart the course to improve the standard in caries disease management within the next decade. This paper represents the initial start of this living document.

BACKGROUND: In this article, the authors present evidence-based clinical recommendations regarding the use of nonfluoride caries preventive agents. The recommendations were developed by an expert panel convened by the American Dental Association (ADA)Council on Scientific Affairs. The panel addressed several questions regarding the efficacy of nonfluoride agents in reducing the incidence of caries and arresting or reversing the progression of caries. TYPES OF STUDIES REVIEWED: A panel of experts convened by the ADA Council on Scientific Affairs, in collaboration with ADA Division of Science staff, conducted a MEDLINE search to identify all randomized and nonrandomized clinical studies regarding the use of non fluoride caries-preventive agents. RESULTS: The panel reviewed evidence from 50 randomized controlled trials and 15 nonrandomized studies to assess the efficacy of various nonfluoride caries-preventive agents. CLINICAL IMPLICATIONS: The panel concluded that certain nonfluoride agents may provide some benefit as adjunctive therapies in children and adults at higher risk of developing caries. These recommendations are presented as a resource for dentists to consider in the clinical decision-making process. As part of the evidence based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences.

Understanding the nature of the caries lesion, disease activity, and the patient's caries risk are all used in determining the nature of dental care to be delivered. An examination should include a health and social history and clinical examination using appropriate technologies. This allows proper assessment and suggests a logical management intervention. Minimally invasive dentistry is a concept based on an assessment of a patient's caries risk and the application of the current therapies to prevent, control, and treat the disease. The history of the dental examination and the variety of current technologies are discussed

In this study we evaluated the effect of a multicomponent intervention to implement the Public Health Service (PHS) guideline Treating Tobacco Use and Dependence in six randomly selected dental clinics in New York University's College of Dentistry. The main outcome measure-provider adherence to tobacco use treatment guidelines-was assessed by auditing a random selection of patient charts pre (698) and post (641) intervention. The intervention components included a chart reminder and referral system, free nicotine replacement therapy (NRT), and provider training and feedback. The results showed that rates of screening for tobacco use did not change between pre and post test chart audits. However, providers were significantly more likely to offer advice (28.4 percent pre, 49 percent post), assess readiness to quit (17.8 percent pre, 29.9 percent post), and offer assistance (6.5 percent pre and 15.6 percent post) in the post test period. Increases in NRT distribution were associated with booster training sessions but declined in the time periods between those trainings. Research is needed to further define sustainable strategies for implementing tobacco use treatment in dental clinics. The results of this study suggest the feasibility and effectiveness of using a tailored multicomponent approach to implement tobacco use treatment guidelines in dental clinics.

Even if a clinician possesses basic knowledge in esthetic dentistry and clinical skills, many cases presenting in modern dental practices simply cannot be restored to both the clinician's and the patient's expectations without incorporating the perspectives and assistance of several dental disciplines. Besides listening carefully to chief complaints, clinicians must also be able to evaluate the patient's physical, biologic, and esthetic needs. This article demonstrates the use of a smile evaluation form designed at New York University that assists in developing esthetic treatment plans that might incorporate any and all dental specialties in a simple and organized fashion

Objective. A patient presented to the dental office expressing dissatisfaction with the appearance of his teeth, and as a result, of his smile. Our objective was to satisfy his initial chief complaint: "I don't like how my teeth look when I smile." Methodology. Upon completing all initial exams and consultations, an esthetic dental treatment plan was formulated and agreed upon by both the practitioners and the patient. Results. The patient received periodontal treatment first to create esthetic gingival margins. Anterior ceramic crowns followed. Conclusion. The results surpassed all patient's expectations.