Curriculum Forum III. Cost and future of Dental Education. Introduction.
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Biomedical subjects
Publications and source records attributed to L A Tedesco.
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Lessons from other places present several diverse suggestions for the dental curriculum's continuing improvement. Models from other professional education venues (medical schools), conceptual frameworks for self-reflection (ethos), and the scientific bases for learning and teaching (cognitive psychology) demonstrate that an interplay of factors must be addressed to advance the curriculum.
Adolescents with commonly occurring forms of malocclusion often are presumed to be at risk for negative self-esteem and social maladjustment. A randomized control group design was used to assess the psychosocial effects of orthodontic treatment for esthetic impairment. Ninety-three participants, 11 to 14 years old, with mild to moderate malocclusions, were randomly assigned to receive orthodontic treatment immediately or after serving as delayed controls. A battery of psychological and social measures was administered before treatment, during treatment, and three times after completion of treatment, the last occurring one year after termination. Repeated measures analyses of variance assessed group differences at the five time points. Parent-, peer-, and self-evaluations of dental-facial attractiveness significantly improved after treatment, but treatment did not affect parent- and self-reported social competency or social goals, nor subjects' self-esteem. In summary, dental-specific evaluations appear to be influenced by treatment, while more general psychosocial responses are not.
Prosthodontics represents a highly developed body of knowledge and skill that spans multiple disciplines. Numerous studies can be cited that address biologic, mechanical, or materials science factors that influence decisions about patient care. On a daily basis as clinicians, teachers, or patients, we experience an interplay of social, economic, and psychologic conditions that similarly influence treatment decisions. This article explored a rationale for including a clear, explicit emphasis on knowledge and skill development for prosthodontic practice and education related to social, psychologic, and economic factors.
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An intervention designed to test the influence of cognitive restructuring on protective oral health behaviors was conducted with 108 patients with mild to moderate gingivitis. Subjects in the experimental group viewed slides of active, mobile bacteria taken from their mouths on 5 occasions: before and after prophylaxis and at 3 appointments, one month apart. A specially trained hygienist discussed with these participants the process of periodontal disease, the role of bacteria, and self-efficacy (self-control) for oral hygiene self-care. Both experimental and control group subjects received instruction in oral self-care procedures. Assessments of oral health using Löe and Silness' plaque and gingival indices (PI and GI) were taken throughout the study and at 3- and 6-month follow-up visits. Self-efficacy, oral hygiene intentions, attitudes, and values comprised the set of cognition variables. Plaque and gingival indices mean differences between groups approached significance at visit 6. Analyses were also performed using percent of gingival surfaces scored at "0" (no visible bleeding on probing). A trend occurred for group differences in percent "0" scores at visit 6, with the experimental group maintaining higher percent zeros (better health) at this 3-month follow-up. At visit 7 (9-month follow-up), PI and GI differences disappeared. No significant differences were found between groups for oral health cognitions or behavior reports over time. The data suggest that the cognitive-behavioral intervention produced a delayed relapse in protective oral self-care behaviors, and by extension, oral health status. Such a delay could be clinically relevant in promoting adherence to oral hygiene behavior between professional visits.
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Cooperation of 39 adolescents with orthodontic treatment was examined 8-10 months into treatment and again at completion. Early in treatment, parental attitudes served as the best predictors of cooperation. By the end of active treatment, however, the adolescent patients' own cognitions were the most salient predictors of cooperation. Prior to beginning orthodontic treatment, subjects and their parents completed a battery of psychosocial and orthodontic-specific measures. Results of stepwise multiple regression analyses showed that only the Parent Positive Attitude Toward Braces measure significantly predicted orthodontic cooperation early in treatment, while External-Powerful Others (Professionals) attributions of control, External-Chance attributions of control, and the initial assessment of cooperation significantly predicted cooperation over longer periods of time.
The usefulness of a social cognitive approach to compliance with brushing and flossing behavior recommendations was tested with 39 patients recruited from the State University of New York at Buffalo Periodontal Disease Clinical Research Center. Participants completed mailed study instruments assessing Fishbein and Ajzen's theory of reasoned action variables, Bandura's self-efficacy variables, and frequency of brushing and flossing behavior. Results indicated positive attitudes, beliefs, and norms for brushing and flossing and positive intentions to brush but less intention to floss. Hierarchical regression analyses supported the basic usefulness of the theory of reasoned action for oral health behavior reports. Addition of self-efficacy variables to theory of reasoned action variables significantly increased the explained variance of brushing and flossing behavior reports. These results establish a strong basis for future clinical studies investigating social cognitions and the prediction of oral health behavior.
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Educators, including those involved with dental curriculum, now understand that the way knowledge is delivered is critical to its assimilation. At SUNY Buffalo, School of Dental Medicine, more and more they are looking to technology to help them in the delivery process.
Precementation refinements of porcelain-fused-to-metal crowns often require reglazing or polishing of the porcelain surface. This study was done to determine whether visual inspection differences exist between glazed and polished porcelain surfaces. Prosthodontists, general dentists, and students (six in each group) rated esthetic properties of 12 porcelain-fused-to-metal crowns. All crowns were initially autoglazed. For phase 1 observations, six crowns were air abraded and polished and six retained their glazed surface. For phase 2 observations, the surface treatments were reversed. At both observations, crowns were rated on 5-point Likert scales for outline form, porosity, smoothness, reflectance, texture, dullness, defects, and general esthetic appearances. Phase 1 polished and glazed crowns had different means for outline form sharpness, porosity, reflectance, dullness, and general esthetic appearance. Phase 2 crowns were different for dullness. Polished and glazed crowns alike were more dull at phase 1 than at phase 2. Glazed crowns were different between phases for reflectance and general esthetic appearance. All reported differences were significant at p less than .01. Significant differences occurred among raters with polished and glazed crowns for several variables.
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