Maintenance of health and preservation of tooth structure through risk-based prevention and patient-centered, evidencebased disease management, reassessed at regular intervals over time, are the cornerstones of present-day caries management. Yet management of caries based on risk assessment that goes beyond restorative care has not had a strong place in curriculum development and competency assessment in U.S. dental schools. The aim of this study was to develop a competency-based core cariology curriculum framework for use in U.S. dental schools. The Section on Cariology of the American Dental Education Association (ADEA) organized a one-day consensus workshop, followed by a meeting program, to adapt the European Core Cariology Curriculum to the needs of U.S. dental education. Participants in the workshop were 73 faculty members from 35 U.S., three Canadian, and four international dental schools. Representatives from all 65 U.S. dental schools were then invited to review and provide feedback on a draft document. A recommended competency statement on caries management was also developed: "Upon graduation, a dentist must be competent in evidence-based detection, diagnosis, risk assessment, prevention, and nonsurgical and surgical management of dental caries, both at the individual and community levels, and be able to reassess the outcomes of interventions over time." This competency statement supports a curriculum framework built around five domains: 1) knowledge base; 2) risk assessment, diagnosis, and synthesis; 3) treatment decision making: preventive strategies and nonsurgical management; 4) treatment decision making: surgical therapy; and 5) evidence-based cariology in clinical and public health practice. Each domain includes objectives and learning outcomes.

PurposeThe purpose of this article is to empirically investigate the relationship between communities of practice and performance.Design/methodology/approachInterviews, surveys, and company records from a case study of several communities of practice within a multi‐billion dollar construction project are investigated. Using the concept of learning curves, the authors look at the relationship between four communities of practice and their performance as well as taking an in‐depth look at the communication patterns within each community of practice.FindingsThree communities of practice that operated under stable conditions were found to exhibit improved performance. However, the one community of practice that experienced changes in its communication channels due to a physical move was never able to regain its previous ability to continuously improve, indicating a strong relationship between communication channels and performance.Research limitations/implicationsThe research presented here focuses only on communities of practice within one organization and one industry, thus limiting the degree to which the results can be generalized.Practical implicationsThe results provide support for the recent efforts by managers to sponsor and even “formally define” communities of practice within organizations. This article also illustrates how sensitive communities of practice are to changes in communication channels, thus alerting managers to the importance of understanding the impact of their actions on a community's cognitive processes and structural dimensions.Originality/valueThis paper offers empirical support for a positive relationship between communities of practice and performance, thus filling a research gap that has been difficult to fill due to the ethereal nature of communities of practice.

Dental caries remains a world-wide disease despite the global distribution of fluoride. It has become apparent that the introduction of significant levels of sugar (fermentable carbohydrate) into the diet has resulted in a change in the biofilm, encouraging acid formation. Further, there has been a shift in the microbiota in the biofilm to a flora that produces acid, and thrives and reproduces in an acidic environment. The management of caries activity under these conditions has focused on brushing to remove the biofilm with fluoride pastes, and high-dose fluoride treatments. Kleinberg, in the 1970s, identified an arginine-containing compound in saliva that several oral biofilm bacterial species metabolize to produce base. Multiple in situ and in vivo studies have been conducted, and have discussed the ability of multiple bacteria to increase the resting pH of the biofilm and even reduce the decrease in pH when the biofilm is challenged with glucose. This shift in resting pH can shift the level of caries formation by the biofilm. Here, we present 8 clinical studies, with different clinical designs, measuring different clinical outcomes, for a diverse, world-wide population. Each of these studies demonstrates reductions in caries formation beyond that seen with fluoride alone and several demonstrate the reversal of early caries lesions. Significant clinical research has been shown that 1.5% arginine combined with fluoride toothpaste has superior anti-caries efficacy to toothpaste containing fluoride alone.

Eight studies, with over 700 participants, were included. Two studies were conducted in the USA, two in Thailand, two in Germany and one each in Saudi Arabia and Turkey. The studies compared the use of liners under tooth-colored resin fillings (RBC) in permanent teeth at the back of the mouth to no liners for Class I and Class II fillings. One of the two studies in the USA took place in dental practices, the others in university-based dental schools. All participants were over 15 years of age. Key results Very little evidence was found to show that a liner under Class I and II RBC fillings in permanent teeth in the back of the mouth reduced sensitivity in adults or children 15 years or older. No evidence was found to show that there was any di erence in the length of time fillings lasted when placed with or without a cavity liner. No adverse events were reported in any of the included studies. Quality of evidence The body of evidence identified in this review does not allow for robust conclusions about the e ects of dental cavity liners. The quality of the evidence identified in this review is low and there is a lack of confidence in the e ect estimates. Furthermore, no evidence was found to demonstrate a di erence in how long restorations last when placed with or without dental cavity liners.

In 2006, the Centers for Disease Control and Prevention (CDC) recommended routine HIV screening in health care settings regardless of the patient's level of risk. This pilot study was developed in response to the suggestion by some health care professionals that dental settings would be appropriate for expansion of HIV testing. This project consisted of two parts: oral fluid HIV testing of patients in the clinic of a dental school and a survey of the clinical dental faculty members’ attitudes about acceptability of routine HIV testing in the dental clinic. When patients’ agreement to participate in oral fluid HIV testing was examined, 8.2 percent of the patients contacted by the clinic administration staff completed testing. When approached by a faculty member or student during the dental visit admission and tested during the dental visit, however, 88.2 percent completed testing. Of the faculty members who took the survey, 27.4 percent were neutral, 26.4 percent were somewhat in agreement, and 32.1 percent were willing to incorporate HIV testing into routine dental care. In this pilot study, HIV testing of dental patients was most successful when a dental care provider approached patients about testing. If consent was given, the testing was performed during the visit. For the faculty members, the major barrier to testing was a lack of protocol familiarity.

This study tested the feasibility of using information technology to improve dentists' adherence to the Treating Tobacco Use and Dependence Clinical Practice Guidelines by offering a web-based computer-mediated clinical decision support system (CDSS) for tobacco use treatment in dental clinics. The authors developed a CDSS tool, deployed the software in one of New York University College of Dentistry's general practice clinics, interviewed associate student dentists, and reviewed a random selection of patients' charts to determine if, after implementation, there were changes in tobacco use screening and referral to treatment. Students reported that the CDSS was easy to use, increased their eficiency, and provided better quality of evidence than was available prior to the intervention. Chart reviews demonstrated that, after CDSS implementation, patients in the target clinic were signiicantly more likely to be screened for tobacco use (<0.001), and tobacco-using patients were more likely to be advised (<0.001), referred to the state's Quit Line (<0.001), and prescribed nicotine replacement therapy (0.035). This study concludes that it is feasible to implement a CDSS for tobacco use treatment in dental clinics. The CDSS is a promising method for improving adherence to tobacco use treatment guidelines and warrants further study.

Delivering the evidence -skill mix and education for elder careObjectives: To review the current status of dental curricula on elder care, and the current curricula regarding elder care, and it's effect on altering practitioner behaviors while addressing the needs of a growing North American elder population. Background: An impending crisis is looming over the oral healthcare of our aging population. At the same moment that life expectancy is being extended through increasingly complex healthcare improvements, the numbers of trained dental providers capable and interested in delivering the needed care is failing to grow at an adequate rate. Discussion: The skills necessary to manage these increasingly complex patients require an interprofessional approach capable of delivering care to sicker patients, in a variety of living accommodations, while managing a variety of care givers. The dental skills necessary to treat these elderly are modifications of skills students routinely learn in dental school. As a matter of fact, the skills students acquire to treat an adult patient population may be contrary to the basic skills necessary to manage the elderly dependent adult patient. Teaching students the nuance differences needed to properly diagnose and care for this population is a difficult task that must be taught in a contextual environment. Conclusion: Significant changes in the teaching of dental management of the elderly are critical within much of the education community. Just as teaching students to care for the pediatric population as general dentists, the clinical education must involve a sufficient number of quality experiences to address issues of both competency, that of the graduate to perform care independently, and attitudes, the actually willingness to treat the elderly.

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