Biomedical subjects

I H A Aartman

Publications and source records attributed to I H A Aartman.

14 recordsLinked to original sources

PubMed2006

Implementing an Objective Structured Clinical Examination (OSCE) in dental education: effects on students' learning strategies.

OBJECTIVES: To investigate the effect of an Objective Structured Clinical Examination (OSCE) on dental students' learning strategies and competence to manage periodontal diseases in patients. The implemented OSCE was expected to be superior to the existing Written Exam in fostering the acquisition of clinical competencies in terms of study strategies that are more oriented towards clinical practice, longer study time, greater clinical proficiency, and more realistic self-assessment. MATERIAL AND METHODS: After a clinical course in periodontology, 72 third year dental students were assessed summatively, either using a Written Exam or an OSCE (P-OSCE). The students were informed beforehand about the assessment formats. The self-assessed clinical competence, study time and strategies (i.e. practice with a manikin, peers and patient case) were evaluated by means of a questionnaire. After a comprehensive dental care course, all 72 students were assessed by an overall end-of-year OSCE, in which three periodontal stations were included 'measuring pockets', 'educating patients' and 'tracing an X-ray with bone-loss'. The competence of the previous Written Exam group and the P-OSCE group was investigated by determining the mean scores and pass-fail scores of three periodontal test-stations as well as the total score of the end-of-year OSCE. The degree of realistic self-assessment was studied by correlating the self-assessed competencies as evaluated by means of the questionnaire with the total score of the end-of-year OSCE. RESULTS: Self-assessed clinical competence, study time and study strategies showed no differences between the P-OSCE and the Written Exam-group. The clinical competence determined in the test-station 'measuring pockets' in the end of year overall OSCE was higher for the P-OSCE group (P = 0.05) when compared with the Written Exam group; the two groups performed equally well in the test station 'educating patients', whereas the performance in 'tracing an X-ray with bone-loss' was better in the Written Exam group. This group also had a higher total score in the end-of-year OSCE (P = 0.05). The degree of realistic self-assessment was higher in the P-OSCE group than in the Written Exam group: in the P-OSCE group the self-assessed clinical competencies correlated significantly with the total score of the overall end-of-year OSCE (P < or = 0.05). CONCLUSIONS: No effects of the implementation of an OSCE in undergraduate periodontal education were observed in study strategies, but the implementation of an OSCE in undergraduate periodontal education appears to stimulate learning, resulting in greater achievement of specific clinical competence and a greater level of realistic self-assessment.

Adult↗

PubMed2005

The reliability and validity of the Index of Complexity, Outcome and Need for determining treatment need in Dutch orthodontic practice.

The Index of Complexity, Outcome and Need (ICON), based on international opinion, has been proposed as a multipurpose occlusal index. The aim of this study was to validate the ICON for treatment need in the Netherlands by relating it to Dutch orthodontic opinion. Furthermore, the reliability of this index was explored, for both a calibrated orthodontist and non-calibrated orthodontists. A sample of 102 patients was chosen which represented the actual distribution of severity of malocclusion experienced by orthodontists in every day practice. The ICON was scored, based on complete patients records of those 102 patients, by an examiner calibrated in the use of this index. The results were compared with the opinion about treatment need of seven Dutch orthodontists - the 'gold standard'. Nine non-calibrated orthodontists also scored the ICON for 49 patients. The intra-examiner agreement of both the non-calibrated and the calibrated orthodontists was moderate to high [0.52-0.86 and 0.89, respectively, measured with the Intraclass Correlation Coefficient (ICC)]. The inter-examiner agreement of the ICON score of the nine orthodontists was moderate measured with the single estimate of the ICC (0.60), and high measured with the average estimate (0.93). Spearman's correlation coefficient between the ICON score (calibrated) and the gold standard was sufficient: 0.78. The sensitivity and specificity were 1 and 0.36, respectively. The best compromise between sensitivity and specificity was at a cut-off point of 52, instead of the international ICON cut-off point of 43. There was a significant difference in ICON score between the non-calibrated orthodontists and the calibrated orthodontist, mainly based on the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). It can be concluded that the ICON needs to be adjusted when used to determine treatment need in the Dutch orthodontic population.

Dental Health Surveys↗

PubMed2005

The influence of force magnitude on intrusion of the maxillary segment.

The purpose of this study was to determine whether the magnitude of intrusive force to the maxillary incisors influences the rate of incisor intrusion or the axial inclination, extrusion, and narrowing of the buccal segments. Twenty patients between the ages of nine and 14 years who needed at least two mm of maxillary incisor intrusion were assigned to one of two equal groups. In group 1 patients, the teeth in the maxillary anterior segment were intruded using 40 g, whereas in group 2 patients, 80 g was used. Records were taken from each patient at the beginning and end of intrusion. There was no statistically significant difference between the 40- and 80-g groups in the rate of incisor intrusion, or the amount of axial inclination change, extrusion, and narrowing of the buccal segments.

Adolescent↗

PubMed2005

The relation between the point of force application and flaring of the anterior segment.

The purpose of this study was to determine whether application of an intrusive force by an intrusion arch at the distal wings of the lateral incisor brackets causes a change in the axial inclination of the anterior segment. Maxillary incisor intrusion was performed, and records were taken from 40 adolescent patients at the beginning and end of intrusion. Intrusion of the maxillary anterior segment caused a statistically significant mean increase in axial inclination of the central incisor of 8.74 degrees. The following correlations were investigated and found not statistically significant. The correlation between the (1) distance from the point of force application to the center of resistance at the start of intrusion and the change in axial inclination of the incisor, (2) distance from the point of force application to the center of resistance at the start of intrusion and the change in distance from the incisal edge to the distal side of the first molar, (3) distance from the point of intrusive force application to the center of resistance at the start of intrusion and at the end of intrusion, (4) distance from the point of intrusive force application to the center of resistance at the start of intrusion and the change in this distance between start and end of intrusion, and (5) amount of intrusion and the change in axial inclination.

Adolescent↗

PubMed2005

Dental age in Dutch children.

Dental age was studied in a sample of 451 Dutch children (226 boys and 225 girls) according to the method of Demirjian. They were born between 1972 and 1993 and were between 3 and 17 years of age at the time a dental pantomogram (DPT) was obtained. All children were placed in the age group closest to their chronological age. All 451 DPTs were scored by one examiner. A subset of 52 DPTs was scored by a second examiner and the intra-class correlation coefficient (ICC) and Cohen's kappa were calculated. The ICC was 0.99 and Cohen's kappa 0.68. Boys and girls were analysed separately.A significant difference was found between chronological age and dental age. On average, the Dutch boys were 0.4 years and the girls 0.6 years ahead of the French-Canadian children analysed by Demirjian. Therefore, the French-Canadian standards were not considered suitable for Dutch children. New graphs for the Dutch population were constructed using a logistic curve with the equation Y = 100*{1/(1 + e(-alpha(x - x0)))} as a basis. The 90 per cent confidence interval was calculated. To determine whether the logistic curve was correct, a residual analysis was carried out and scatter plots of the differences were made. The explained variance was 93.9 per cent for the boys and 94.8 per cent for the girls. Both the residual analysis and the scatter plots indicated that the logistic curve was appropriate for use with Dutch children. In addition to the graphs, tables were produced which transfer the maturity scores calculated by the method of Demirjian into Dutch dental age.

Adolescent↗

PubMed2004

Stimulation of bone cell differentiation by low-intensity ultrasound--a histomorphometric in vitro study.

Several investigations have established a stimulatory effect of low-intensity ultrasound treatment on osteogenesis and fracture healing. The objective of this study was to examine whether the stimulatory effect of low-intensity ultrasound results in increased bone cell activity and/or proliferation. Twenty-four paired triplets of metatarsal bone rudiments of twelve 17-days-old fetal mice were dissected and divided into two groups. One group of bone rudiments was treated with pulsating low-intensity ultrasound (30 mW/cm(2); 1.5 MHz) for 20 min/day for a period of 3 or 6 days. The other group served as controls. After culture, the metatarsal bone rudiments were prepared for computer aided light microscopy. The following histomorphometric parameters were determined: length, width and volume of the calcified cartilage and of the bone collar, and cell number. GLM analysis demonstrated that bone collar volume and calcified cartilage percentage were significantly higher in the ultrasound-stimulated rudiments compared to untreated controls. Further, the calcified cartilage volume bordering the hypertrophic zone was significantly higher than in the center of the bone rudiment. Ultrasound treatment did not change the number of the cells. These results suggest that the stimulatory effect of low-intensity ultrasound on endochondral ossification is likely due to stimulation of bone cell differentiation and calcified matrix production, but not to changed cell proliferation.

Animals↗

PubMed2004

The role of a high pull headgear in counteracting side effects from intrusion of the maxillary anterior segment.

Intrusion of incisors is often the preferred treatment of a deep overbite. This study focuses on deep overbite correction by intrusion of maxillary incisors. The purpose of this study is to determine whether high-pull headgear wear can prevent steepening of the buccal segment, extrusion of the buccal segment, maintain arch width, and increase the rate of incisor intrusion. The number of patients needed for this study was calculated to be 20. Patients were between nine and 14 years of age and assigned to one of two groups. In each group, intrusion of maxillary incisors was performed. Patients in one group wore a high-pull headgear at night, and patients in the other group did not. For each patient, a lateral head film, impressions with a wax bite in centric occlusion, and intraoral photographs were taken at the beginning and end of intrusion. This study demonstrated that high-pull headgear had no effect on steepening and extrusion of the buccal segments or on the rate of intrusion but did have an effect on narrowing of the buccal segments. By performing intrusion as described in this study, no statistically significant side effects were observed in the buccal segments, whereas a statistically significant amount of incisor intrusion of 2.24 mm in the no-headgear group and 2.37 mm in the headgear group was observed.

Adolescent↗

PubMed2004

Dental anxiety and behavioural problems: what is their influence on the treatment plan?

AIM: This was to investigate the influence of emotional and behavioural problems on the choice of treatment type. In addition, the actual contents of the treatment of dentally fearful children was studied in an attempt to develop dental treatment protocols for children with such problems. METHODS: The parents of 265 children (144 girls, mean age 88.4 months, SD+/-34.2 months), referred to a centre for special dental care, were asked to complete the Child Behaviour Check List (CBCL) before their first appointment. The CBCL was used to assess behavioural problems. All selected children were dentally anxious (score >or=35 on the Children's Fear Survey Schedule Dental Subscale, CFSS-DS). After treatment, the children's records were analysed on treatment type and contents. RESULTS: The CBCL score was related to the type of treatment. Children treated with the aid of nitrous oxide sedation scored significantly higher on the CBCL than children treated with behavioural management or under intravenous anaesthesia (IVA). In the IVA group more surfaces were treated than in the other groups. The CBCL score was not related to the treatment contents (number of surfaces filled, amount of radiographs, sealants, stainless steel crowns or pulpotomies), the time spent on the child's treatment or the number of sessions. CONCLUSION: Dentally anxious children with behavioural problems as assessed by the CBCL have dental treatment (contents and length) comparable with that of dentally anxious children without those problems. However, anxious children with behavioural problems are more often treated with nitrous oxide sedation. Therefore, there seems to be an urgent need for access to nitrous oxide sedation for dentists working in special dentistry.

Anesthesia, Dental↗

PubMed2003

Effects of TMJ anesthesia and jaw gape on jaw-stretch reflexes in humans.

OBJECTIVE: To study the roles of afferent sensory inputs in the temporomandibular joint (TMJ) and of muscle length in the modulation of the jaw-stretch reflex in humans. METHODS: Reflexes were evoked in both the masseter and temporalis muscles under standardized conditions in 11 young women. The study was performed in two sessions; experimental conditions were jaw gape and injection of local anesthetics. For jaw gape, 4, 14, and 24 mm were used in random order. One milliliter TMJ injections (carbocaine, 10 mg/ml, versus isotonic saline, 0.9%) were given in a randomized, double blind manner. When a participant received carbocaine during the first session, isotonic saline was injected during the second one. A total of 480 reflexes were evoked in every participant. RESULTS: No significant differences were found between carbocaine and isotonic saline. ANOVA and post hoc paired t tests did show, however, a significant effect of jaw gape for the left masseter and anterior temporalis muscles, with the 14 mm gape having the highest amplitude. CONCLUSIONS: Blocking the afferent sensory input (including the mechanoreceptors) from the TMJ seems to have no influence on the sensitivity of the human jaw-stretch reflex. Instead, muscle spindles are the most likely receptors to be responsible for the reflex modulation that was observed in the present study.

Adult↗

PubMed2003

Trauma-related phenomena in anxious dental patients.

OBJECTIVES: The main purpose of this descriptive study was to investigate whether dental anxiety is associated with the occurrence of trauma-related symptoms (i.e. recurrent memories and a tendency to avoid these memories) associated with earlier traumatic dental experiences. METHODS: A sample of 37 consecutive anxious patients attending a dental fear clinic was assessed prior to dental treatment. The results were compared with those of a sample of 32 consecutive patients of a general dental practice, who served as a reference group. RESULTS: The proportion of patients who indicated they had had a horrific dental experience at least once in their life did not significantly differ between the anxious group and the reference group. Conversely, significantly more patients (76%) in the anxious group reported suffering from memories of these events. They also showed a higher level of trauma-related symptomatology as indexed by the Impact of Event Scale (IES). About half of the anxious patients suffered from symptoms typically reported by patients with posttraumatic stress disorder (PTSD). Severity of dental anxiety showed a high correlation with both frequency of intrusions (r = 0.64, P < 0.001) and avoidance of the memories (r = 0.62, P < 0.001). CONCLUSIONS: The results suggest that in anticipation of treatment dentally anxious individuals suffer from a high level of intrusive recollections of earlier dental experiences.

Adolescent↗

PubMed2003

Approximal caries increment: a three-year longitudinal radiographic study.

AIM: To determine, for different age groups, the approximal caries increment in a three-year longitudinal retrospective study and to investigate the relationship between the caries increment and self-reported measures for oral health behaviour, dental knowledge and attitude (cynicism, health concern and motivation). SUBJECTS: 14, 17, 20 and 23-year-olds, who participated in a clinical epidemiological survey. Bitewings were taken of approximately 52% of the participants. Longitudinally, three cohorts were followed radiographically for three years. The self-reported measures were derived from questionnaires with sufficient reliability. RESULTS: For all participants, on average, 3.7 enamel lesions and 1.2 dentine lesions were found. The number of sound surfaces, adequate restorations and the D1FS score showed significant differences over a three-year period, for all age groups. Stepwise regression analysis showed that for the explanation of the change in number of sound surfaces, number of enamel lesions and D1S between the age of 17 and 20, the variable 'health concern' contributed significantly to the regression. The change in D3FS score was explained by the variable 'behaviour', while the change in D1Fs score was explained by both 'behaviour' and 'health concern'. Neither of the dental variables, 'dental knowledge' or 'motivation' contributed significantly. For the ages 14-17 and 20-23 no significant contributions were found. CONCLUSIONS: A considerable caries increment was found in this three-year retrospective radiographic study, which was not related to dental knowledge and motivation, and only for one age group (17-20) to oral health behaviour and health concern.

Adolescent↗

PubMed2003

Referring children to a Special Dental Care Centre in the Netherlands: parents' experiences and expectations.

AIM: The aim of the present study was to assess the relation between treatment at the family dentist versus referral and different aspects of treatment at a Special Dental Care Centre (SDCC), including the choice to return to their family dentist or not. The same study was performed for a group of patients recently referred to and still treated at a Special Dental Care Centre ( SDCC). METHODS: A questionnaire was sent to the parents of 852 children for whom complete dental records were available. Treatment was completed for 111 children (study 1) and 170 children were recently referred and had just started treatment (study 2). RESULTS/STATISTIC: In total 281 questionnaires were returned and filled out. Parents of children who returned to their general dental practitioner (GDP) were more satisfied with their GDP treatment than parents of children who did not return to their GDP (study 1: Z=- 3.65, p<0.001; study 2: Z=-2.86, p=0.004). CONCLUSION: The decision to return to the family dentist or not after treatment at a SDCC centre was based on their satisfaction with their treatment.

Attitude to Health↗

PubMed2002

Radiographic prevalence of approximal enamel lesions and relationship with dentine lesions and restorations in Dutch adolescents.

AIM: The aim of this study was to assess the prevalence of approximal enamel lesions from radiographs in groups of 14, 17, 20 and 23 years old, and to determine the relation with dentine lesions and restorations present. METHOD: Per age group, the bitewings of 120 persons were randomly selected and assessed for enamel lesions from the distal surface of the first premolar to the mesial surface of the second molar. A second examiner assessed 20% of the material for enamel lesions to determine the interexaminer agreement (Cohen's kappa = 0.63). RESULTS: An enamel lesion was found in 12-15% of the unfilled surfaces. The mean number of surfaces with enamel lesions was almost three per person. For all age groups it was found that about 20% of the persons had at least four enamel lesions and the number of enamel lesions was significantly correlated with the number of dentine lesions. Of all enamel lesions 20% were found in persons without any dentinal lesions or restorations. CONCLUSION: The bitewing radiographs showed a considerable number of enamel lesions for these age groups. This seems to justify its use on a routine base as a diagnostic tool at the age of 14-16 years.

Adolescent↗

PubMed2002

[Clinical underestimation of the prevalence of approximal dentin lesions and inadequate restorations].

The aim of this study was to determine the additional diagnostic value of bitewing radiographs compared to clinical examination, with respect to the presence of dentine lesions and inadequate restorations for different age groups. Subjects were 14-, 17-, 20-, 23-years-old, or were in the age groups of 25-34 and 35-54 years, who participated in 2 clinical epidemiological surveys. After obtaining informed consent, bitewing radiographs were made of approximately 25% of the participants (n = 663). The extra diagnostic yield of the bitewing radiographs varied between a factor 1.6 and 7.2 for approximal dentine caries diagnosis of untreated surfaces, and between 2.3 and 5.9 for inadequate restorations. In conclusion, a considerable increase in the numbers of approximal dentinal lesions and inadequate restorations for all age groups was found.

Adolescent↗