Statement of the American Association of Dental Schools submitted for the record to the Centers for Disease Control.
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Acquired Immunodeficiency Syndrome↗
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Marketing American Dental Association-accredited dental assisting education part II.
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Accreditation↗
Prevention of bacterial endocarditis: recommendations by the American Heart Association.
OBJECTIVE: To update recommendations issued by the American Heart Association last published in 1990 for the prevention of bacterial endocarditis in individuals at risk for this disease. PARTICIPANTS: An ad hoc writing group appointed by the American Heart Association for their expertise in endocarditis and treatment with liaison members representing the American Dental Association, the infectious Diseases Society of America, the American Academy of Pediatrics and the American Society for Gastrointestinal Endoscopy. EVIDENCE: The recommendations in this article reflect analyses of relevant literature regarding procedure-related endocarditis, in vitro susceptibility data of pathogens causing endocarditis, results of prophylactic studies in animal models of endocarditis and retrospective analyses of human endocarditis cases in terms of antibiotic prophylaxis usage patterns and apparent prophylaxis failures. MEDLINE database searches from 1936 through 1996 were done using root words endocarditis, bacteremia and antibiotic prophylaxis. Recommendations in this document fall into evidence level III of the U.S. Preventive Services Task Force categories of evidence. CONSENSUS PROCESS: The recommendations were formulated by the writing group after specific therapeutic regimens were discussed. The consensus statement was subsequently reviewed by outside experts not affiliated with the writing group and by the Science Advisory and Coordinating Committee of the American Heart Association. These guidelines are meant to aid practitioners but are not intended as the standard of care or as a substitute for clinical judgment. CONCLUSIONS: Major changes in the updated recommendations include the following: (1) emphasis that most cases of endocarditis are not attributable to an invasive procedure; (2) cardiac conditions are stratified into high-, moderate- and negligible-risk categories based on potential outcome if endocarditis develops; (3) procedures that may cause bacteremia and for which prophylaxis is recommended are more clearly specified; (4) an algorithm was developed to more clearly define when prophylaxis is recommended for patients with mitral valve prolapse; (5) for oral or dental procedures the initial amoxicillin dose is reduced to 2 g, a follow-up antibiotic dose is no longer recommended, erythromycin is no longer recommended for penicillin-allergic individuals, but clindamycin and other alternatives are offered.
Algorithms↗
Overview of efficacy outcome variables for the evaluation of periodontal disease treatment.
Since the late 1980s, numerous new products for the prevention, diagnosis, and treatment of periodontal disease have been developed. These products have required randomized clinical trials to provide proof of efficacy and safety prior to marketing. Originally, no consensus existed in the scientific community, regulatory agencies, or industry as to the appropriate design, conduct, and methods of analyses of clinical trials in periodontics. However, in 1967, the Task Force on Design and Analysis in Dental and Oral Research was formed. This task force held three conferences to address specific issues in clinical oral health research; these meetings provided the foundation for the development of guidelines for clinical trials by the Subcommittee on Clinical Trials in Periodontics of the American Academy of Periodontology. Members of the subcommittee held an international symposium in 1996. Following this meeting, 4 working groups were convened and charged with the development of guidelines for the design and conduct of clinical trials in periodontics. These working groups developed guidelines for periodontal clinical trials in the areas of chemotherapeutic agents to slow or arrest periodontitis, products and methods for diagnosis and/or management of periodontitis, products designed to regenerate periodontal tissues, and clinical trials on endosseous dental implants. These guidelines have been published and approved or accepted by the American Academy of Periodontology and the Council on Scientific Affairs of the American Dental Association.
American Dental Association↗
ADA members weigh in on critical issues.
BACKGROUND: Science, new technology, patient care, dental reimbursement and government regulations all affect today's dental practitioners. To find out more about how such challenges may affect current private practitioners, the American Dental Association conducted the 2000 Membership Needs and Opinions Survey. METHODS: A questionnaire was sent to 6,310 ADA members in January 2000 with follow-up mailings in February, March and April 2000. Data collection was completed in July 2000. The survey included questions on critical professional issues, and on perceptions of the ADA and ADA priorities. A total of 3,558 completed surveys were received for an adjusted response rate of 59.5 percent. RESULTS: Members rated the identified issues' level of importance to them. The top three issues included "maintaining my ability to recommend the treatment option I feel is most appropriate for my patients," "receiving fair reimbursement for the dental services I provide," and "protecting myself, my staff and my patients from communicable diseases." New dentists found other items to be more significant to them compared with members overall. CONCLUSIONS: Although ADA members as a whole had similar views on critical issues facing dentistry and ADA priorities, there were significant differences regarding some issues. New dentists were far more concerned about securing funds for their practice and paying off debt than were all ADA members. Minority dentists expressed greater levels of concern about certain issues than did all ADA members. PRACTICE IMPLICATIONS: When planning and implementing ADA activities, the Association should continue to take into account members' relative rankings of professional issues and note issues of special interest to selected membership subgroups.
American Dental Association↗
Noble metal alloys for metal-ceramic restorations.
A review of the comparative characteristics and properties of noble metal alloys used for metal-ceramic restorations has been presented. Selection of an alloy for one's practice should be based on long-term clinical data, physical properties, esthetic potential, and laboratory data on metal-ceramic bond strength and thermal compatibility with commercial dental porcelains. Although gold-based alloys, such as the Au-Pt-Pd, Au-Pd-Ag, and Au-Pd classes, may appear to be costly compared with the palladium-based alloys, they have clearly established their clinical integrity and acceptability over an extended period of time. Other than the relatively low sag resistance of the high gold-low silver content alloys and the potential thermal incompatibility with some commercial porcelain products, few clinical failures have been observed. The palladium-based alloys are less costly than the gold-based alloys. Palladium-silver alloys require extra precautions to minimize porcelain discoloration. Palladium-copper and palladium-cobalt alloys may also cause porcelain discoloration, as copper and cobalt are used as colorants in glasses. The palladium-cobalt alloys are least susceptible to high-temperature creep compared with all classes of noble metals. Nevertheless, insufficient clinical data exist to advocate the general use of the palladium-copper and palladium-cobalt alloys at the present time. One should base the selection and use of these alloys in part on their ability to meet the requirements of the ADA Acceptance Program. A list of acceptable or provisionally acceptable alloys is available from the American Dental Association and is published annually in the Journal of the American Dental Association. Dentists have the legal and ethical responsibility for selection of alloys used for cast restorations. This responsibility should not be delegated to the dental laboratory technician. It is advisable to discuss the criteria for selection of an alloy with the technician and the thermal manufacturer or supplier. Once an alloy is selected, the specific alloy name should be written on all laboratory prescriptions as well as in patients' charts. Maintenance of accurate dental records is necessary from a legal point of view, and it also allows the clinician to determine the longevity of specific metal-porcelain systems.
Cobalt↗
Dental premedication protocols for patients with knee and hip prostheses.
In 1997, the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) published an advisory statement regarding antibiotic prophylaxis for patients with total joint replacements undergoing dental treatment. The first periodic update of these guidelines was published in 2003. Nevertheless, confusion exists among dentists and physicians as to the clinical indications for premedication in this patient population. This article serves as an overview of current recommendations for use of chemoprophylaxis in the dental treatment of patients with prosthetic joints.
American Dental Association↗
The Future of Dentistry: a synopsis.
The American Dental Association commissioned the Future of Dentistry report in 1999. A sixteen-member oversight committee and six expert panels developed the report. It was presented to the American Dental Association's House of Delegates in October 2001. The Future of Dentistry report was intended to describe the current status of the U. S. dental profession, observe trends that will influence the profession, envision challenges that the profession will confront in the next five to fifteen years, and make recommendations regarding how to meet those challenges. The report concludes that the profession is strong and healthy. Revolutionary changes are not necessary. However concerted effort to address the areas of concern is important to assure the American people access to the finest dental health care possible. This effort will require the cooperation of all involved in the dental care--the profession, industry, policy-makers and the public.
Adult↗
The future of dentistry: an overview of a new report.
BACKGROUND AND OVERVIEW: The 2001 Future of Dentistry, or FOD, report was commissioned by the American Dental Association in 1999, developed by an oversight committee, and presented to the ADA House of Delegates in October 2001. The FOD report was intended to describe the current status of the U.S. dental profession, observe the recent trends that have guided the profession, envision challenges that the profession will face in the next five to 15 years and, finally, make recommendations about how to meet those challenges. This article presents a digest of some of the issues that are perceived to be of greatest interest and concern to the country's practicing dentists. CONCLUSIONS: The analyses in the FOD report lead to the conclusion that the profession is strong and healthy and that revolutionary changes are not necessary. Rather, a concerted effort to address the areas of concern is important to assure the American people of access to the finest dental health care possible. This will require the cooperation of all those involved in the delivery of dental care--not only the profession itself, but also industry, policy-makers and the public. CLINICAL IMPLICATIONS: The FOD report is a road map that will give every practitioner in his or her office more tools to provide the best care to the public. All of the recommendations--whether they involve education, research, finance or clinical practice--are meant to stimulate thoughts and actions that will help dentists and their patients in the pursuit of optimal oral health.
American Dental Association↗
Comparison of the efficacies of disinfectants to control microbial contamination in dental unit water systems in general dental practices across the European Union.
Water delivered by dental unit water systems (DUWS) in general dental practices can harbor high numbers of bacteria, including opportunistic pathogens. Biofilms on tubing within DUWS provide a reservoir for microorganisms and should be controlled. This study compared disinfection products for their ability to meet the American Dental Association's guideline of <200 CFU x ml(-1) for DUWS water. Alpron, BioBlue, Dentosept, Oxygenal, Sanosil, Sterilex Ultra, and Ster4Spray were tested in DUWS (n = 134) in Denmark, Germany, Greece, Ireland, The Netherlands, Spain, and the United Kingdom. Weekly water samples were tested for total viable counts (TVCs) on yeast extract agar, and, where possible, the effects of products on established biofilm (TVCs) were measured. A 4- to 5-week baseline measurement period was followed by 6 to 8 weeks of disinfection (intermittent or continuous product application). DUWS water TVCs before disinfection ranged from 0 to 5.41 log CFU x ml(-1). Disinfectants achieved reductions in the median water TVC ranging from 0.69 (Ster4Spray) to 3.11 (Dentosept) log CFU x ml(-1), although occasional high values (up to 4.88 log CFU x ml(-1)) occurred with all products. Before treatment, 64% of all baseline samples exceeded American Dental Association guidelines, compared to only 17% following commencement of treatment; where tested, biofilm TVCs were reduced to below detectable levels. The antimicrobial efficacies of products varied (e.g., 91% of water samples from DUWS treated with Dentosept or Oxygenal met American Dental Association guidelines, compared to 60% of those treated with Ster4Spray). Overall, the continuously applied products performed better than those applied intermittently. The most effective products were Dentosept and Oxygenal, although Dentosept gave the most consistent and sustained antimicrobial effect over time.
Biofilms↗
Nursing habits and dental decay in infants: "nursing bottle caries".
The decay-producing capabilities of certain foods can be influenced by eating habits. When a habit of frequent nocturnal bottle or breast feeding is maintained beyond a year of age, the potential for gross dental decay in very young children is established. Bovine milk, milk formulas and human breast milk have all been implicated in the condition of "nursing bottle caries," because of their lactose content. Additional sweeteners in the nursing bottle, the use of fruit juices or the use of honey-dipped pacifiers can also cause "nursing bottle caries." "Nursing bottle caries" can be prevented through a timely educational program to new parents. Prevention is particularly applicable in young children, since a healthy oral condition promotes good nutrition, a healthy state and normal growth. Both the American Dental Association and the American Society of Dentistry for Children have pamphlets explaining "nursing bottle caries," which are available for distribution to the public.
Animals↗
Special report. Controls for AIDS-infected health care workers: an update.
In the wake of public concern and increased litigation about infected health care workers transmitting the AIDS virus to their patients, professional and government agencies--including the American Medical Association (AMA), the Centers for Disease Control (CDC), and the American Dental Association (ADA)--have recently issued guidelines on self-policing and safety procedures to their members, and threatened strict sanctions to those who disregard them. Even tougher is the bill which was overwhelmingly approved by the United States Senate in July. Sponsored by Senator Jesse Helms (R-NC), the bill formally makes it a crime carrying a 10-year prison sentence and a fine for AIDS-infected doctors, nurses, and dentists to treat patients without first warning them that they have an infectious disease. In this report, we'll review the new guidelines and how they are expected to impact the health care industry. We'll also present recent developments in AIDS-related litigation that could affect safety and security directors, risk managers, or anyone with managerial responsibility for hospital safety.
Acquired Immunodeficiency Syndrome↗
Dental education summits: the challenges ahead.
BACKGROUND: The authors present the major findings from ADA-sponsored education summit meetings in 2001 and 2002 that addressed the issues of dental education costs, dental student debt levels at graduation and budgeted unfilled dental school faculty positions. OVERVIEW: The meetings included representation from the ADA, the American Dental Education Association, the American Student Dental Association, the National Institute of Dental and Craniofacial Research and ADA-recognized dental specialty organizations. National experts on the three issue areas made formal presentations. State funds for dental education declined 22 percent from 1991 to 1998, after adjusting for inflation. Reductions in state budgets for 2002 and 2003 suggest further declines in state support. To cope with declining revenues, schools increased student tuition and fees 10 percent annually from 1991 to 1998, contributing to increasing levels of student educational debt, which in 2000 averaged dollar 87,600. Dental schools also have decreased their investment in physical plant and faculty numbers. Annual faculty salaries have increased 3 percent, while practitioner income has increased 7 percent. Academic income disparities with private practice have contributed to dental schools having almost 400 unfilled faculty positions. CONCLUSIONS AND PRACTICE IMPLICATIONS: Dental education is facing severe financial challenges that likely will increase. While there are no easy solutions, schools must make greater efforts to reduce operating expenses and seek more state and federal support for dental education. The ADA approved the summit reports, and the ADA House of Delegates adopted six resolutions that support the summits' recommendations.
American Dental Association↗
The dental profession's commitment to quality assurance.
Although the phrase quality assurance has only recently been used in the health care field, it is clear that the concept is far from new. As has been described, early efforts by the American Dental Association in licensure and accreditation of professional educational programs were directed toward providing the consumer of health care services confidence in the quality of care being rendered. Such programs serve as a strong foundation upon which current work can build ongoing and future efforts. This current effort is a logical step along the path that was defined many years ago by the dental profession. Although current projects in dental quality assurance are exciting and new, the commitment to assuring the American public of the highest possible quality of dental care is not new. The goal of the American Dental Association remains unchanged: patients entering the dental health care system must be able to do so with confidence that they will receive quality care.
American Dental Association↗
Amalgam--Resurrection and redemption. Part 1: the clinical and legal mythology of anti-amalgam.
Dental amalgam has come under attack for its allegedly poor physical properties and clinical performance in addition to its poor appearance. It has been claimed that the American Dental Association has a hidden agenda to protect amalgam and that other countries have banned its use. A literature search revealed that the vast majority of amalgam restorations do not cause fractured cusps or have recurrent caries. Most amalgam restorations have been shown to last longer than resin composite restorations. In addition, the materials and techniques involved in amalgam restorations have vastly improved in recent years. Like resin composite restorations, amalgam restorations can often be repaired. The American Dental Association has no vested interest in protecting amalgam. The use of amalgam has not been banned in any country in the European Union. According to the latest scientific information available, dental amalgam is a remarkably durable and long-lasting restorative material. Although its appearance is unesthetic, its clinical performance and effectiveness are unsurpassed by those of resin composite.
American Dental Association↗
Assessment of periodontal status with PSR and traditional clinical periodontal examination.
The system of peridontal screening and recording was developed by the American Dental Association and the American Academy of Periodontology to simplify early detection of periodontal pathology. The authors evaluated the results of PSR against those of a conventional periodontal examination in 24 subjects, each of whom had a minimum of 18 natural teeth. The results of this study suggest that the PSR examination, while a useful screening tool, could be improved to further enhance its identification of patients with peridontal diseases.
Adolescent↗
Current issues in prevention of infective endocarditis.
Prevention of infective endocarditis continues to concern health care providers in many specialties. The well-known lack of primary clinical trials in this area is not expected to change. Therefore, the evolution of recommendations and practice must be based on theoretic considerations and continuing assessment of secondary sources of information. Recent developments include a report of 52 cases in which antibiotic prophylaxis for infective endocarditis was attempted but appeared to fail. Most of these patients had undergone dental procedures after oral penicillin prophylaxis, with subsequent development of streptococcal endocarditis. In two thirds, the organism was sensitive to the antibiotic used. Notably, the most common underlying cardiac lesion among these patients was mitral valve prolapse. However, two recent independent analyses have concluded that providing endocarditis prophylaxis for all patients with mitral valve prolapse during procedures that might cause bacteremia would not be cost-effective. This is primarily because mitral valve prolapse is common and endocarditis is relatively rare, resulting in an adverse risk-benefit ratio. Parenteral prophylaxis for mitral valve prolapse might even cause a net loss of life from anaphylaxis. On the other hand, for the individual patient or physician, the reassurance provided by attempted prophylaxis with oral penicillin can be purchased at low cost and low risk. Very few cases of infective endocarditis have been reported after gastrointestinal and other endoscopic procedures; most of these do not need antibiotic coverage. Prophylactic antibiotics should be restricted to those situations in which both the procedure and the underlying cardiac condition seem to pose significant risk, for example, endoscopic sclerotherapy of esophageal varices in patients with prosthetic heart valves. Newly revised recommendations have been issued by the Medical Letter, the American Heart Association, and the American Dental Association. These regimens are shorter and simpler than earlier versions.
Anti-Bacterial Agents↗
Luting cement-metal surface physicochemical interactions on film thickness.
Low film thickness is critical to the clinical success of cemented castings. This study investigated the effect of luting agent-metal physico-chemical surface interactions on film thicknesses of representative luting agents. Control group luting agents were placed between two glass plates, as described by American Dental Association specifications 8, 61, and 66, and test group luting agents were positioned between glass and metal plates. The materials selected were zinc phosphate cement, polycarboxylate cement, glass ionomer cement, glass ionomer-composite resin hybrid cement and a resinous cement, with a type III gold alloy, a noble metal ceramic alloy, and a base metal ceramic alloy. A two-way analysis of variance and follow-up tests were done. The effects of the type of metal surface, type of cement, and their statistical interaction significantly affected film thickness (p < 0.0001). The type of cement had a greater affect on film thickness than the type of metal. A glass ionomer cement produced lower overall film thicknesses than other cement types, and a noble metal ceramic alloy created lower overall film thicknesses than other types of metal. American Dental Association specifications for cement film thickness did not accurately reflect normal cement use.
American Dental Association↗