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PubMed1999

Dental unit waterlines: approaching the year 2000. ADA Council on Scientific Affairs.

BACKGROUND: This article discusses biofilm formation in dental unit waterlines and its resulting potential health effects. It also provides a review of ongoing research and available means to reduce microbial contamination in dental unit water. METHODS: An expert panel was convened by the American Dental Association Board of Trustees to discuss the implications of biofilms in dentistry. This report summarizes the panel's conclusions. CONCLUSIONS: The dental profession must continue its awareness of the presence of high levels of opportunistic microorganisms in dental unit water. Despite the lack of evidence of adverse health effects related to these microorganisms, they have the potential to overload the defense systems of immunocompromised patients and occupationally exposed dental staff members. Steps should be taken to improve dental unit water quality; contact of a patient's open wound, mucous membrane or body cavity with water of poor microbiological quality simply is inconsistent with patient expectations of modern dentistry. Efforts should continue to evaluate the health implications of biofilms in dentistry as new technology, research and data become available.

American Dental Association↗

PubMed1992

How the FDA and the ADA affect development of prescription drugs for oral care.

The patient-consumer, the health professional, and the producer are all essential in the world of prescription drugs for oral care. Also essential are the Food and Drug Administration (FDA) and the American Dental Association (ADA). The FDA is charged with reviewing new-drug applications in the United States and approving those drugs that are proved safe and effective. The FDA also controls prescription-drug advertising and promotion. The ADA applies professional standards in judging all submitted dental drugs. Those drugs accepted by ADA's Council on Dental Therapeutics may display the ADA seal in labeling and advertising. All advertising for accepted products must be cleared by the ADA. An example of a prescription drug approved by the FDA and accepted by the ADA is 0.12 percent chlorhexidine gluconate oral rinse (Peridex). This drug followed the FDA's investigational-drug (IND) regulations before final approval as a treatment for gingivitis.

American Dental Association↗

PubMed2002

Dentistry's response to bioterrorism: a report of a consensus workshop.

BACKGROUND AND OVERVIEW: The possibility of a significant bioterrorist attack on the civilian population of the United States has become a focus of local, state and national attention since the fall of 2001. An appropriate role for dentistry in the response to a massive bioterrorist attack has not yet been established, even though dentistry's role in other disasters has been developed and proven to be effective. To develop a consensus on a potential role for dentistry in dealing with bioterrorism, experts in bioterrorism issues and representatives of key organizations that could play a role in dentistry's response met at the American Dental Association's Workshop on the Role of Dentistry in Bioterrorism in June. CONCLUSIONS: In the event of a bioterrorist attack, dentists may be called on to fulfill several functions: education, risk communication, diagnosis, surveillance and notification, treatment, distribution of medications, decontamination, sample collection and forensic dentistry. Local dental societies should develop a plan for the dental response to potential bioterrorist attacks that can be integrated into each community's mass disaster response plan. Educational programs for dentists should be developed to prepare them for providing services they may be recruited to perform in an emergency. PRACTICE IMPLICATIONS: Dentistry has assets in personnel and facilities that can be of great value in responding to a major bioterrorist attack on the United States.

American Dental Association↗

PubMed2004

Lasers in dentistry: separating science from hype.

BACKGROUND: During the last two decades, much has been written in both the scientific literature and the popular press about lasers and their use in the dental office. Both soft- and hard-tissue applications have been discussed, including frenectomy, gingival contouring, caries removal and bleaching. OVERVIEW: Almost one-third of patients surveyed by the American Dental Association in the late 1990s thought it was very important that their dentists have lasers, which could put pressure on dentists to invest in this tool to attract patients. The authors describe the different types of dental lasers and examine the science behind their applications in dentistry. CONCLUSION AND CLINICAL IMPLICATIONS: Although lasers do have legitimate uses in dentistry, they do not take the place of any of the more conventional tools in the dentist's armamentarium. Before investing in a laser, dentists should fully understand the differences between the various types, including what the scientific literature says about their applications.

Dental Caries↗

PubMed2005

A look at allied dental education in the United States.

BACKGROUND: The American Dental Association conducts surveys of educational programs in dental assisting, dental hygiene and dental laboratory technology. The 2002-2003 survey included questions about enrollment, graduates, program information and trends. METHODS: The ADA Survey Center mailed the Survey of Allied Dental Education to 548 program directors of dental assisting, dental hygiene and dental laboratory technology educational programs. They also sent several follow-up notices as a reminder to complete the survey. A 100 percent response rate is mandatory for continued accreditation by the Commission on Dental Accreditation. Association staff members resolved inconsistencies in the data and analyzed them before producing a final report. RESULTS: The number of applications to, first-year enrollment in and number of graduates in dental hygiene and dental assisting educational programs have increased during the last five years. During the same period, the number of applications to, and graduates of, dental laboratory technology educational programs decreased, but first-year enrollment increased slightly. CONCLUSIONS: Results from these surveys help address the concerns of the public and the profession regarding allied dental manpower levels. They also provide information for those interested in applying to individual allied dental educational programs. PRACTICE IMPLICATIONS: Private dental practices employ the majority of graduates of allied dental educational programs. Recent graduates of dental assisting and hygiene programs continue to supply the office staff members needed to support the delivery of dental care.

American Dental Association↗

PubMed1994

Antimicrobial mouthrinses: overview and update.

The Seal of Acceptance of the American Dental Association's Council on Dental Therapeutics has been awarded to Listerine and chlorhexidine gluconate (Peridex). The mechanism of action of Listerine involves bacterial cell wall destruction, bacterial enzymatic inhibition, and extraction of bacterial lipopolysaccharides. Chlorhexidine has the property of substantivity, i.e. the ability to bind to hard and soft tissue with slow release. Antibacterial mouthrinses/dentifrices containing triclosan hold promise for the reduction of plaque and gingivitis but are not yet available in the United States. The quaternary ammonium compounds and sanguinarine compounds (Viadent) have some merit, but studies of their efficacy in plaque and gingivitis reduction are mixed. New products containing various fluorides and oxygenating agents may have potential for the future as antiplaque and antigingivitis agents.

Alkaloids↗

PubMed2005

Applying DICOM to dentistry.

There are more than 160,000 dentists licensed in the United States. For the dental patient, the dentist is both radiologist and treating clinician. The American Dental Association (ADA) has been a member of the Digital Imaging and Communication in Medicine (DICOM) Standard Committee since 1996. DICOM v.3 provides image object definitions for digital transmission radiography (Dx) with special categorization for intraoral projections (Io), and it also provides for color photography used in dentistry. Digital dental radiographs include transmission images of the head and jaws, pantomography, tomography and cone-beam computed tomography. In 2000, the ADA resolved to strive for interoperability of digital dental images, using the DICOM Standard as the backbone of the effort. ADA Working Group 12.1 was tasked with development of specifications and also with educating the dental profession concerning digital image interoperability. DICOM-related interoperability demonstrations are now a part of the ADA Annual Congress, in the form of seminar and as a noncommercial exhibit.

American Dental Association↗

PubMed1998

Compliance with infection-control procedures among Illinois orthodontists.

The authors of previous studies have reported an increasing percentage of orthodontists complying with infection-control procedures in their offices, yet compliance was found to be less than ideal. In this study we surveyed Illinois orthodontists to evaluate their compliance with the infection-control guidelines established by the American Dental Association and the Centers for Disease Control and Prevention. This study is an addition to a small number of studies in the field of orthodontics on infection-control procedures. The study population was taken from the World Directory of Orthodontists, which contains 374 listings for the state of Illinois. Responses were received from 140 orthodontists, for a response rate of 37%. Thirty-two percent of the responding orthodontists stated that they always wear masks; 13% said they never do. Almost 97% of the orthodontists said they always wear gloves, and no orthodontist reported never wearing gloves. Nearly 64% of the orthodontists reported always using eyewear, and 34% said they wear gowns, whereas only 5% do not wear eye protection and 35% never wear gowns. With regard to instruments and pliers, most of the orthodontists reported using dry-heat ovens (72% and 80%, respectively), whereas nearly 58% said they use chemical disinfection to some extent on instruments and 39% said they use chemical disinfection on pliers. Only 51% of the orthodontists surveyed in our study reported using a steam autoclave to sterilize handpieces, whereas 27% said they use dry-heat ovens, 11% reported using chemical vapor, and 37% said they use chemical disinfection. In conclusion, compliance with infection control procedures among orthodontists has improved from recent studies but is still less than full compliance.

Adolescent↗

PubMed1993

Attitudes of Maryland dentists toward AIDS and hepatitis patients.

A survey of dentists practicing in the state of Maryland found differences between general dentists (n = 905), oral surgeons (n = 88), and periodontists (n = 89). Oral surgeons were more willing to treat and had actually treated more AIDS patients. Also, almost twice as many oral surgeons agreed with the American Dental Association opinion that all dentists have a professional responsibility to treat AIDS patients. General dentists and oral surgeons were more willing to permit an AIDS infected dentist to continue to practice than were periodontists. There was more agreement concerning hepatitis patients between all three groups. Also, both specialty groups had been tested for the hepatitis antigen significantly more frequently than had general dentists.

Acquired Immunodeficiency Syndrome↗

PubMed1985

Does dentistry as we know it have a future?

The American Dental Association's Strategic Plan for the Future of Dentistry is primarily a self-serving document in that it attempts to protect the dentist regardless of the changing oral health needs of the population. Marketing, even if initially successful, will not increase the absolute demand for dental services, because persons on maintenance care require less care per year than sporadic users. Higher use will be balanced by less need. Excess supply creates incentive to overtreat. Today's dentist, as the dominant provider, does not have major motivation toward prevention, either by training or economic self-interest. The paper proposes that a modified hygienist, with more diagnostic training, should become the primary dental provider, with a better trained dentist as a secondary provider, combining problem solving and "surgical" skills. These changes would function best under a system combining group practice with a national health service.

American Dental Association↗

PubMed2002

Trends in dental specialty education and practice, 1990-99.

Policy issues related to dental specialty education and practice have been the responsibility of the American Dental Association's Council on Dental Education and Licensure. In 2001, the council concluded a comprehensive study of the ADA-recognized dental specialties that included a review of specialty practice and the practice environment, membership in specialty organizations, requirements and trends in board certification, advances in research and technology related to each specialty, and trends in advanced specialty education. This paper provides an overview of the results of this study and the council's analysis of data and information provided by the dental specialty organizations and the ADA Survey Center with an emphasis on dental specialty education. The council concluded that none of the dental specialties should be considered for rerecognition, but identified concerns regarding the shortage of qualified faculty and educational program directors. As a result of the council's study, recommendations have been made to the dental specialty organizations and ADA-recognized dental specialty certifying boards that they continue to monitor the number of board-certified specialists and identify ways to increase the number of board-certified specialists.

American Dental Association↗

PubMed2006

An audit improves the quality of water within the dental unit water lines of three separate facilities of a United Kingdom NHS Trust.

OBJECTIVE: To improve the quality of water emanating from dental unit waterlines (DUWLs). DESIGN: A prospective clinical audit. SETTING: Three geographically separate district dental facilities of a United Kingdom NHS Trust, involving two community clinics and one hospital orthodontic department, which were evaluated between 2002 and 2004. METHODS: Samples of water discharged from the DUWLs were collected prior to the start and midway through a morning session. These were tested microbiologically at a United Kingdom Accreditation Service testing laboratory within six hours of sampling. INTERVENTIONS: One of the clinics followed the contemporaneous BDA advice of flushing water through its DUWLs while the other two clinics used separate intermittent disinfection purging regimes instead. One of them used a two stage protocol of Ethylene Diamine Tetra-Acetic acid followed by hydrogen peroxide, while the other used Bio 2000 as a single agent, which was subsequently superseded by the continuous use of super-oxidised water (Sterilox). MAIN OUTCOME MEASURE: To assess whether the samples either met the American Dental Association's guideline on the quality of DUWL water, or the more stringent European Union standards for potable (drinking) water. RESULTS: The two units which used a disinfection regime both complied with the ADA guideline and the EU potable water standard. However, the unit which only flushed through its DUWLs without using a disinfectant failed to comply with either of them. After all three dental facilities subsequently standardised their DUWL disinfection regimes by using Bio 2000, the colony counts from all of the water samples thereafter remained well below the EU recommended level. The unit which progressed to using Sterilox as a continuous disinfectant achieved and maintained zero readings from its water samples. CONCLUSIONS: Clinical audit can result in the improvement of the quality of water that is discharged through DUWLs, thereby minimising both the risk of cross infection to vulnerable patients, as well as to dental staff chronically exposed to contaminated aerosols.

American Dental Association↗

PubMed1997

Career changers: dentists who choose to leave private practice.

Some dentists have voluntarily chosen to leave the dental profession despite the considerable time, effort, and financial expenditures involved in their educations. The purpose of this study was to survey the entire population of dentists who had identified themselves as being principally employed in a career outside of clinical practice in the American Dental Association's 1991 Census. A four-page survey was mailed to 654 former dentists, with a total of 237 usable responses (36%). Analysis of major demographic variables showed no significant difference between the survey respondents and the 1992 ADA Survey of Dentists. Major reasons cited by respondents for entering dentistry included professional, financial, and independence factors. Respondents as a group rated their dental school experience as average in degree of difficulty. Clinical dental experience was varied, with a substantially smaller percentage (37%) choosing solo clinical positions than the 1992 ADA Survey of Dentists reported (69%). Reasons for leaving practice included financial, stress, and external regulation concerns. Current careers varied widely, with business, teaching, medicine, and investing being the most common. Respondents ranked their current careers as considerably more favorable on measures of perceived creativity, freedom, belonging, and whether they would choose the same career again. These findings indicate that there was a difference between the perception of a dental career and the reality of clinical practice for the study sample.

Adult↗

PubMed2006

Using mouthguards to reduce the incidence and severity of sports-related oral injuries.

BACKGROUND: This report reviews the available literature on the types and properties of athletic mouthguards, current fabrication methods and the role of mouth protectors in reducing the incidence and severity of sports-related oral injuries. OVERVIEW: For more than 50 years, the American Dental Association has promoted the protective value of wearing properly fitted mouthguards while participating in athletic or recreational activities that carry a risk of dental injury. Safety is essential to maintaining oral health, and a properly fitted mouthguard can minimize the risks of sustaining oral injuries during participation in sports. CONCLUSIONS: The dental literature supports the use and protective value of mouthguards in reducing sports-related injuries to the teeth and soft tissues. Dentists are encouraged to educate patients regarding the risks of oral injury in sports, fabricate properly fitted mouthguards, and provide appropriate guidance on mouthguard types and their protective properties, costs and benefits. Further studies addressing the effectiveness of currently available mouthguard types and population-based interventions for reducing oral injuries are recommended. CLINICAL IMPLICATIONS: Participants in sporting and recreational activities are often susceptible to oral injury. To reduce the incidence and severity of sports-related oral trauma, the use of a properly fitted mouthguard is recommended in any athletic or recreational activity that carries a risk of injury.

American Dental Association↗

PubMed2004

Evidence-based dentistry in clinical practice.

BACKGROUND: Evidence-based dentistry, or EBD, is not a new concept for the dental profession in the United States. The American Dental Association has long relied on credible scientific evidence in setting policy and communicating with dentists and the general public. EBD provides an approach to oral health care that follows a process of systematically collecting and analyzing scientific evidence to answer a specific clinical question. OVERVIEW: The authors discuss applications of systematic review findings to everyday clinical practice and explore the implications of EBD for dental education, clinical research and the provision of care to patients. CONCLUSIONS AND PRACTICE IMPLICATIONS: In developing appropriate treatment plans, dentists should combine the patient's treatment needs and preferences with the best available scientific evidence, in conjunction with the dentist's clinical expertise. To keep pace with other health professions in building a strong evidence-based foundation, dentistry will require significant investments in clinical research and education to evaluate the best currently available evidence in dentistry and to identify new information needed to help dentists provide optimal care to patients.

Cariostatic Agents↗

PubMed2003

Infection control: its evolution to the current standard precautions.

BACKGROUND: The use of appropriate infection control precautions to protect against transmission of bloodborne and other occupational microbial pathogens has become a routine component of health care provision. Evolution and revision of recommendations continues to be based on updated scientific information, as well as documented and inferred clinical applications of new knowledge. In addition, surveillance of occupational risks in medical treatment settings often has served as a basis for subsequent disease prevention recommendations for dental care. TYPES OF STUDIES REVIEWED: Guidelines designed to protect dental professionals and their patients have focused on bloodborne pathogens since the first published American Dental Association recommendations in the 1970s. Subsequent statements developed by the Centers for Disease Control and Prevention, the ADA and other organizations during the past 30 years also have addressed prevention of other infections, transmitted by either direct or indirect contact with a variety of potentially infectious body fluids. RESULTS: Review of the major features of these recommendations provides an appropriate framework to consider current guideline revisions. The success of long-standing universal precautions, or UP, against bloodborne infection has been augmented with the incorporation of body substance isolation, or BSI, practices into the infection control protocol designated "standard precautions." Combination of the major tenets of UP with the BSI systems routinely employed in acute care facilities affords all health care professionals the means of preventing a spectrum of bloodborne, respiratory, contact and other potential exposures during provision of patient care. CLINICAL IMPLICATIONS: As infection control recommendations for dentistry are updated this year, they undoubtedly will include guidelines expanding previous UP to provide expanded protection for dental professionals in the multiple types of nonacute treatment settings in which routine treatment is provided.

American Dental Association↗

PubMed2006

Reaction to universal patient acceptance: The perspective of a private practice dentist.

The purpose of this article is to respond to the theories of Acceptance and Universal Patient Acceptance and their relationship to the American Dental Association's Principles of Ethics and Code of Professional Conduct (ADA Code). Universal Patient Acceptance (UPA) requires the dentist to communicate in some fashion with each patient who attempts to enter his or her practice to determine needs, desires, and financial ability to access dental care. The dentist must then help the patient gain entry into his or her practice or make appropriate referrals based on the patient's desires, needs, and financial status. The theory of UPA proposes that this action will alleviate some portion of the access problem. This article explores the notion of access as articulated in the ADA Code. The theory of UPA is explored from the view of the practicing dentist, noting the difficulties encountered when incorporating this theory into private practice. The conclusion is that the ADA Code offers appropriate guidance for ADA members regarding the ethical treatment of the underserved. Without further study, the inclusion of UPA in the ADA Code is not desirable. The author also concludes that support systems for the practicing dentist are necessary before UPA could be considered a reasonable way to practice dentistry.

American Dental Association↗

PubMed2000

Adequacy of dental records in clinical practice: a survey of dentists.

PURPOSE: The purposes of the study were to determine Minnesota dentists' perception of the adequacy of their dental record documentation, assess the general format and contents of dental records they used, and compare the self-reported contents of dental records with guidelines established by the American Dental Association (ADA). METHOD: Using ADA's published recommendations for structure and guidelines of the dental record from 1987, a 20-item questionnaire was developed, pretested, and used to survey a random sample of 750 Minnesota dentists. Reminder postcards were sent two weeks after the initial survey mailing. A third mailing to nonrespondents, including cover letter and duplicate questionnaire, was conducted three weeks later. Of the surveys returned, 63% (N = 475) were analyzed. Data analyses, including frequencies and tests of chi-square, were conducted using Statview and SPSS. RESULTS: While 15% (N = 69) of respondents used a single-page record format, 44% (N = 209) used multiple forms filed in a specific location within the record. Of the dentists responding, 403 (85%) felt their record documentation was adequate without comparison to any specified criteria. However, statistically significant differences occurred between dentists' perception of record adequacy and the actual presence or absence of ADA criteria for all record components. Data analysis revealed that information was absent 9.4% to 87.1% of the time. CONCLUSION: A discrepancy exists between dentists' perception of dental record adequacy and the ADA recommendations for structure and guidelines. Inadequate dental record components should be targeted for improvement.

American Dental Association↗