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Early Caries Intervention: A Collaborative ApproachA Peer-Reviewed Publication Written by Kimberly M. Parsons, EdD, CDA, EFDA, RDH, and Jennifer K. Bartek, LDH, MS, CDA, EFDA

Go Green, Go Online to take your course

Publication date: Apr. 2016Expiration date: Mar. 2019

This educational activity was made possible through an unrestricted educational grant by Dentsply.This course was written for dentists, dental hygienists and assistants, from novice to skilled. Educational Methods: This course is a self-instructional journal and web activity. Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or services discussed or shared in this educational activity nor with the commercial supporter. No manufacturer or third party has had any input into the development of course content.Requirements for Successful Completion: To obtain 2 CE credits for this educational activity you must pay the required fee, review the material, complete the course evaluation and obtain a score of at least 70%.CE Planner Disclosure: Heather Hodges, CE Coordinator does not have a leadership or commercial interest with products or services discussed in this educational activity. Heather can be reached at hhodges@pennwell.comEducational Disclaimer: Completing a single continuing education course does not provide enough information to result in the participant being an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise.Image Authenticity Statement: The images in this educational activity have not been altered.Scientific Integrity Statement: Information shared in this CE course is developed from clinical research and represents the most current information available from evidence based dentistry. Known Benefits and Limitations of the Data: The information presented in this educational activity is derived from the data and information contained in reference section. The research data is extensive and provides direct benefit to the patient and improvements in oral health. Registration: The cost of this CE course is $49.00 for 2 CE credits. Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.

Supplement to PennWell Publications

PennWell designates this activity for 2 Continuing Educational Credits

Dental Board of California: Provider 4527, course registration number CA# 02-4527-15075“This course meets the Dental Board of California’s requirements for 2 units of continuing education.”

The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from (11/1/2015) to (10/31/2019) Provider ID# 320452.

AbstractThe incidence of dental caries is increasing globally. It is essential that the dental team work together with the patient to manage dental caries throughout the various stages of the patient’s life. Using a risk assessment can assist the dental professional in addressing the disease process with the patient and in planning treatment. It is advantageous to use a completed risk assessment, along with various caries identification methods, to help guide the patient and dental team in management of early carious lesions. The use of minimal-intervention dentistry to address early carious lesions is an integral part of the caries management process and should be considered when devising a caries management plan.

Educational Objectives:At the conclusion of this course, participants should be able to:1. Recognize visual and radiographic

methods used for caries identification2. Describe how CAMBRA can assist with

caries management3. Identify seven methods used in minimal-

intervention dentistry that may aid in caries management

Author ProfilesKimberly M. Parsons, EdD, CDA, EFDA, RDH, is the Program Chair of the Dental Assisting and Dental Hygiene Programs and an Assistant Professor of Dental Assisting/Dental Hygiene at the University of Southern Indiana. Her scholarly activities include research in the areas of educational technology, treatment of special needs patients, and allied dental education. Dr. Parsons has been a dental hygienist for 15 years, practicing in Arizona, Indiana, Kentucky, and Michigan. She has also worked as a dental educator in Arizona and Indiana.

Jennifer K. Bartek, LDH, MS, CDA, EFDA, is the Dental Clinic Coordinator and a Clinical Assistant Professor of Dental Hygiene at the University of Southern Indiana. Her scholarly activities center on dental hygiene education, particularly methodology and peer assessment in the clinical setting. Mrs. Bartek has been a dental hygienist for 30 years, practicing in New Jersey, New York, Pennsylvania, and Indiana. Mrs. Bartek currently serves as a representative for the Indiana State Board of Dentistry.

Author Disclosures Kimberly M. Parsons, EdD, CDA, EFDA, RDH, and Jennifer K. Bartek, LDH, MS, CDA, EFDA, have no com-mercial ties with the sponsors or the providers of the unrestricted educational grant for this course.

1607DE_73 73 6/28/16 11:22 AM

Educational ObjectivesAt the conclusion of this course, participants should be able

to:

1. Recognize visual and radiographic methods used for

caries identification

2. Describe how CAMBRA can assist with caries

management

3. Identify seven methods used in minimal-intervention

dentistry that may aid in caries management

AbstractThe incidence of dental caries is increasing globally. It is

essential that the dental team work together with the pa-

tient to manage dental caries throughout the various stages

of the patient’s life. Using a risk assessment can assist the

dental professional in addressing the disease process with

the patient and in planning treatment. It is advantageous to

use a completed risk assessment, along with various caries

identification methods, to help guide the patient and dental

team in management of early carious lesions. The use of

minimal-intervention dentistry to address early carious

lesions is an integral part of the caries management process

and should be considered when devising a caries manage-

ment plan.

IntroductionCaries rates are rapidly increasing on a global level1 and

dental health professionals should be mindful of this dis-

ease process in their patients. In addition, this should be

an essential part of the process of care for practicing dental

hygienists.2 Dental caries should be managed through a

partnership between the patient and dental team through-

out the stages of the patient’s life.3 Using evidence-based

research, appropriate actions for caries assessment and

treatment is necessary to ensure successful outcomes with

incipient carious lesions.4

Methods for caries identificationVarious methods are available for the identification of cari-

ous lesions. The clinician should inspect the dentition for

areas on the tooth surface that appear gray in color, often

described as a “shadow” or “halo” on the tooth. The clini-

cian can also use visual inspection to assess the dentition

for dark stain in deep pits and/or fissures on the tooth

surface. Assessments such as the International Caries De-

tection Assessment System (ICDAS) are available to guide

clinicians and provide universal interpretation.5

Radiographs may be used in caries identification with

advancements in digital imaging and technology-based as-

sessment methods showing great promise.4–6

Bitewing radiographs specifically aid in the identifica-

tion of carious lesions on the interproximal tooth surface

(figure 1). In addition, radiographs provide value for the

dental team as an assessment tool, as past radiographs can

be used as a baseline to compare changes in the patient’s

dentition over time.6

Lasers and fluorescence based technologies are ad-

ditional assessment methods used in the identification of

carious lesions.4 Research has demonstrated a high sensi-

tivity for caries detection with the use of lasers.4,7 However,

it is currently recommended that dental professionals not

use lasers as a sole diagnostic methodology but rather in

conjunction with good visual and radiographic techniques

for caries detection.4

Figure 1: Bitewing radiograph showing incipient lesion

Risk assessmentA proficient dental health professional must serve as an

investigator to uncover those daily factors in the patient’s

life that allow for control of disease. Utilization of risk as-

sessment for dental caries allows the dental professional to

focus on the disease process instead of disease treatment.2

There are various tools commonly used to identify caries

risk, such as Caries Management by Risk Assessment

(CAMBRA).2,8

CAMBRA is an evidence-based approach to caries man-

agement that helps with assessment of the patient’s level of

risk and aids the dental health professional in care-planning

strategies.8 This tool places emphasis on the whole disease

process, provides ways to identify problems early, and uses

evidence-based strategies to provide the best oral health

outcomes for patients.1,8 CAMBRA can guide early inter-

vention for carious lesions, instead of traditional restorative

treatment. Consideration for disease indicators and patho-

genic factors are weighed against competing protective fac-

tors for each individual patient.8 Understanding nutrition,

products, and oral health educational goals are imperative

once the risk is identified for individual patients. The dental

hygienist should be actively involved in using the evidence

gathered through a risk assessment to determine an inter-

vention plan unique to the patient’s caries risk8 that includes

treatment and products.

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Minimal-intervention dentistryBy using evidence from a completed caries risk assessment,

the dental health team can guide the management of lesions

diagnosed early in their development. Strategies include

products that improve salivary flow, correct pH balance,

antimicrobials, sealants, xylitol, fluoride, and minimally

invasive restorative work.8 While some strategies may be

used alone, various minimal-intervention strategies can be

used together for optimal prevention and/or treatment of

incipient carious lesions.

• Saliva-stimulating products and pH-balancing

products: Saliva-stimulating products and those that

help balance the pH of the oral cavity can be useful in

the management of early carious lesions. Neutralizing

products, such as antacid tablets, may raise a low

intraoral pH to combat the progression of incipient

caries.9 pH-balancing products include desensitizing

toothpastes that contain calcium phosphate, sodium

bicarbonate rinses, and over-the-counter rinses aimed

specifically at neutralizing pH.8 Recent research has

described dental caries as a pH-specific disease, with a

low pH level being directly related to the demineraliza-

tion of teeth.1 Saliva-stimulating products, such as

sorbitol-containing gum, can also reduce the develop-

ment of dental caries.10

• Antimicrobials: Prescription-based antimicrobial

products may aid in caries management. Chlorhexi-

dine gluoconate, a broad-spectrum agent proven

effective against Streptococcus mutans and Lactobacilli

is a second-generation product with considerable

substantivity.11 This agent will reduce the bacterial

count but should be used in conjunction with fluoride

remineralization therapy. Essential-oil mouth rinses

have also been shown to be effective in reducing

bacterial plaque and the bacterial count in the mouth

as well as aiding in the arrest of incipient lesions.11

An additional benefit of rinsing with an antimicrobial

agent is that the rinse can reach areas of the mouth that

are rarely targeted, inaccessible, and often missed by

mechanical means.

• Sealants: Glass-ionomer sealants have fluoride-

releasing properties to aid in the remineralization of

incipient lesions.12 Research has shown that placing a

glass-ionomer sealant over an incipient carious lesion

reduces the level of bacteria in the carious lesion.8,12

Sealants can prevent caries progression by blocking

fermentable substrates that cause carious lesions to

advance; when the bacteria are not nourished due to

the placement of a sealant, the bacterial count of a cari-

ous lesion may decrease, thus inhibiting further growth

of the lesion.12 Reduction in bacterial count of sealed

lesions increases over time with sealant retention.12

• Xylitol: Studies suggest that xylitol, a five-carbon

sugar alcohol, reduces the incidence of caries and may

lead to anticariogenic results.13 Xylitol reduces plaque

formation and adherence of bacteria, inhibits enamel

demineralization, and has a direct inhibitory effect

on Streptococcus mutans, a decay-causing bacteria by

preventing adhesion to the tooth.11,13 There are numer-

ous forms available, including gum, mints, chewable

tablets, lozenges, toothpastes, mouthwashes, and oral

wipes.13 The American Academy of Pediatric Dentistry

supports the use of xylitol as part of a strategy for

long-term caries pathogen suppression.13

• Fluoride: Using fluoride for the prevention and

control of caries is proven to be both safe and highly

effective.14,16 Fluoride has three main mechanisms

of action: (1) to promote remineralization; (2) to

reduce demineralization; and (3) to inhibit bacterial

metabolism and acid production.16 In particular,

stannous fluoride is proven to have both antimicrobial

and anti-caries properties and may be an effective

choice in certain cases.15 The use of regular, low-dose

fluoride is a good home-care strategy for suppressing

dental caries. Forms of home fluoride delivery include

fluoridated toothpastes and mouth rinses (both of

which are available over the counter and in prescrip-

tion strength), fluoridated water and dietary fluoride

supplements (Table 1).14,16 A high-dosage, in-office

treatment is an additional option for patients with a

moderate or high risk of caries who may benefit from

professional topical fluoride application.17 In-office

fluoride delivery options for patients include fluoride

rinses, gels, foams, and varnishes (table 1).17

• Minimally invasive restorations- The philosophy

of minimally invasive restorative care centers on not

preparing access cavities in the tooth, thus protecting

and preserving the tissues surrounding the carious

lesion.3 This technique is virtually painless and is

gaining ground, particularly in pediatric dentistry.18

One example of a minimally invasive restorative

procedure uses a chemical etchant, (instead of a

mechanical high-speed handpiece), to access carious

tissue vis-a-vis penetration into the pores of the lesion.

A glass-ionomer sealant is then placed on the lesion,

allowing for the slow release of fluoride onto the cari-

ous surface, halting progression of the lesion.18 This

technique is increasing in popularity, as it preserves

healthy tissues and restores incipient lesions without

discomfort.

Table 1: Types of fluoride treatments

Home fluoride treatments In-office fluoride treatments

Toothpastes Rinses

Mouth rinses Gels

Fluoridated drinking water Foams

Dietary supplements Varnishes

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Conclusion

In conclusion, as the incidence of caries rises in the United

States, it is increasingly important that the dental team be

knowledgeable of the best practices in the early diagnosis

and treatment of incipient lesions.3,16 The dental team

should work with the patient to devise an action plan for

assessment, prevention, and treatment of dental caries.

This may include a thorough assessment of caries risk and

current patient status, staying abreast of the most recent

evidence-based recommendations for effective treatment

of lesions, and continual assessment of lesions over time.2

Whether caries intervention includes assessment of the

lesion at regular intervals while providing oral health

education, non-restorative intervention (fluoride, saliva

enhancers, antimicrobials, etc.), or minimally invasive re-

storative procedures, the dental team and patient must work

together to achieve optimal outcomes. The relationship

should be considered a lifelong process, with reassessment

and continual change so that the care provided is optimal for

the individual patient’s oral health needs.

References

1. Malterud MI, Kutsch VK. The evolution of dental caries treatment. Gen Dent. 2012;60(5):386–389.

2. Fransisco EM, Johnson TL, Freudenthal JJ, Louis G. Dental hygienists’ knowledge, attitudes and practice behaviors regarding caries risk assessment and management. J Dent Hyg. 2013;87(6):353–361.

3. Pitts NB. Are we ready to move from operative to non-operative/preventive treatment of dental caries in clinical practice? Caries Res. 2004;38:294–304. doi: 10.1159/000077769

4. Rochlen GK, Wolff MS. Technological advances in caries. Dent Clin N Am. 2011;55:441–452. doi: 10.1016/j.cden.2011.02.018

5. Braga MM, Mendes FM, Ekstrand KR. Detection activity assessment and diagnosis of dental caries lesions. Dent Clin A Am. 2010;54:479–493. doi: 10.1016/j.cden.2010.03.006

6. Shah N, Bansal N, Logani A. Recent advances in imaging technologies in dentistry. World J Radiol. 2014;6(10):794–807. doi: 10.4329/wjr.v6.i10.794

7. Zero DT, Fontana M, Martinez-Mier EA, et al. The biology, prevention, diagnosis and treatment of dental caries. JADA. 2009;140:25S–33S.

8. Young DA, Lyon L, Azevado S. The role of dental hygiene in caries management: A new paradigm. J Dent Hyg. 2010;84(3):121–129.

9. Lindquist B, Lingstrom P, Fandriks L, Birkhed D. Influence of five neutralizing products on intra-oral pH after rinsing with simulated gastric acid. Eur J Oral Sci. 2011;119(4):301–304. doi: 10.1111/j.1600-0722.2011.00841.x

10. Stookey GK. The effect of saliva on dental caries. JADA. 2008;139:11S–17S.

11. Darby JL, Walsh M. Dental Hygiene Theory and

Practice. 4th ed. St. Louis, MO: Elsevier; 2015.12. Oong EM, Griffin SO, Kohn WG, Gooch BF, Caufield

PW. The effect of dental sealants on bacteria levels in caries lesions: A review of the evidence. JADA. 2008;139:271–278.

13. Council on Clinical Affairs. Policy on the use of xylitol. Reference Manual: American Academy of Pediatric Dentistry. 2015;37(6):45–47.

14. Council on Clinical Affairs. Guideline for fluoride therapy. Reference Manual: American Academy of Pediatric Dentistry. 2015;37(6):176–179.

15. Sensabaugh C, Sagel ME. Stannous fluoride dentifrice with sodium hexametaphosphate: Review of laboratory, clinical and practice-based data. J Dent Hyg. 2009;83(2):70–78.

16. Clark MB, Slayton RL. Fluoride use in caries prevention in the primary care setting. Pediatr. 2014;134(3):626–633.

17. American Dental Association Council on Scientific Affairs. Professionally applied topical fluoride: evidence-based clinical recommendations. J Dent Ed. 2007;71(3):393–402.

18. Soviero VM, Sellos MC, Santos MG. Micro-invasive treatment of caries-expanding the therapy spectrum in modern pediatric dentistry. Int Dent SA. 2010;12(5):34–42.

Author Profiles

Kimberly M. Parsons, EdD, CDA, EFDA, RDH, is the

Program Chair of the Dental Assisting and Dental Hygiene

Programs and an Assistant Professor of Dental Assisting/

Dental Hygiene at the University of Southern Indiana. Her

scholarly activities include research in the areas of education-

al technology, treatment of special needs patients, and allied

dental education. Dr. Parsons has been a dental hygienist

for 15 years, practicing in Arizona, Indiana, Kentucky, and

Michigan. She has also worked as a dental educator in Ari-

zona and Indiana.

Jennifer K. Bartek, LDH, MS, CDA, EFDA, is the

Dental Clinic Coordinator and a Clinical Assistant Profes-

sor of Dental Hygiene at the University of Southern Indiana.

Her scholarly activities center on dental hygiene education,

particularly methodology and peer assessment in the clinical

setting. Mrs. Bartek has been a dental hygienist for 30 years,

practicing in New Jersey, New York, Pennsylvania, and Indi-

ana. Mrs. Bartek currently serves as a representative for the

Indiana State Board of Dentistry.

Author Disclosures

Kimberly M. Parsons, EdD, CDA, EFDA, RDH, and Jen-

nifer K. Bartek, LDH, MS, CDA, EFDA, have no commer-

cial ties with the sponsors or the providers of the unrestricted

educational grant for this course.

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Questions

Online CompletionUse this page to review the questions and answers. Return to www.ineedce.com and sign in. If you have not previously purchased the program select it from the “Online Courses” listing and complete the

online purchase. Once purchased the exam will be added to your Archives page where a Take Exam link will be provided. Click on the “Take Exam” link, complete all the program questions and submit your

answers. An immediate grade report will be provided and upon receiving a passing grade your “Verification Form” will be provided immediately for viewing and/or printing. Verification Forms can be viewed

and/or printed anytime in the future by returning to the site, sign in and return to your Archives Page.

1. Which of the following is not a delivery method for receiving a high-dose fluoride treatment in a dental office?a. Fluoridated toothpasteb. Gel/foamc. Rinsed. Varnish

2. Which method of inspection for dental caries includes the identification of halos and areas of distinct stain on the teeth?a. Radiographsb. Visual inspectionc. Use of an explorerd. Fluorescence

3. Who should be involved in the planning process for caries assessment and treat-ment?a. Patientb. Dentistc. Dental hygienistd. All of the above

4. During minimally invasive restorative work, what type of material is placed on the carious lesion that allows the slow release of fluoride onto the carious surface?a. Amalgamb. Chlorhexidine gluconatec. Sodium bicarbonated. Glass ionomer

5. Which of the following is not considered to be a pH-balancing product?a. Desensitizing toothpaste containing calcium

phosphateb. Sodium bicarbonate rinsec. Sealantd. Over-the-counter mouth rinse

6. What type of radiographs aid in the identification of carious lesions on the interproximal tooth surface?a. Bitewingsb. Panoramicc. Periapicald. Occlusal

7. Which of the following is true concerning Caries Management By Risk Assessment (CAMBRA)?a. Places emphasis on the whole disease processb. Provides ways to identify problems earlyc. Uses evidence-based strategies to provide best

outcomesd. All of the above

8. A form of home fluoride delivery includes:a. Over-the-counter toothpaste

b. Prescription toothpaste

c. Gum with xylitol

d. Both A and B

9. Which of the following can be described as a second-generation product with considerable substantivity that has been proven effective against Streptococcus mutans?a. Saliva stimulant

b. Chlorhexidine gluconate

c. Sealant

d. Antacid tablet

10. What type of preventive agent reduces plaque formation and adherence of Strep-tococcus mutans to the tooth?a. Xylitol

b. Minimally invasive restorations

c. Rinsing with water

d. All of the above

11. Which type of caries treatment protects and preserves tissue surrounding the carious lesion by not preparing access cavities?a. Xylitol-containing gum

b. pH-balancing rinse

c. Minimally invasive restorations

d. Saliva-stimulating product

12. Fluoride, saliva enhancers, and antimi-crobials are all examples of what?a. Non-restorative caries intervention

b. Minimally invasive restorations

c. Invasive restorations

d. Cariogenic agents

13. What agent does the American Academy of Pediatric Dentistry support as part of a strategy for long-term caries pathogen suppression?a. Amalgam restorations

b. Xylitol

c. Dental crowns

d. Dental implants

14. Demineralization of the tooth occurs with what type of pH level?a. Neutral

b. High

c. Low

d. pH does not effect demineralization

15. What effect does the placement of a

glass-ionomer sealant have on an incipi-

ent carious lesion?

a. Reduces bacteria level in the lesion

b. Increases bacteria level in the lesion

c. Has no effect on bacteria level in the lesion

d. Effect depends on the brand of sealant used

16. Current recommendations for the use of

lasers in caries detection include:

a. Use of lasers as a sole diagnostic technique

b. Use of lasers in conjunction with visual and

radiographic techniques

c. Use of lasers in conjunction with an explorer on the

occlusal surface

d. There are currently no recommendations for laser use

17. Which of the following can guide early

intervention strategies for carious lesions?

a. Saliva-stimulating products

b. CAMBRA

c. Antimicrobials

d. Use of an explorer on the occlusal surface of the tooth

18. With what type of caries risk can pa-

tients benefit from professional fluoride

application?

a. Low caries risk

b. Moderate caries risk

c. High caries risk

d. Both B and C

19. Xylitol is available in which of the

following forms?

a. Mints

b. Chewable tablets

c. Oral wipes

d. All of the above

20. Which of the following statements

is true regarding minimally invasive

restorative work?

a. This technique has not been well-received among

dental professionals

b. This technique includes making a smaller-than-

normal access cavity in the tooth

c. This technique is gaining popularity, particularly in

pediatric dentistry

d. This technique utilizes amalgam to cover carious

lesions for prevention of further growth

Notes

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INSTRUCTIONSAll questions should have only one answer. Grading of this examination is done manually. Participants will receive confirmation of passing by receipt of a verification form. Verification of Participation forms will be mailed within two weeks after taking an examination.

COURSE CREDITS/COSTAll participants scoring at least 70% on the examination will receive a verification form verifying 2 CE credits. The formal continuing education program of this sponsor is accepted by the AGD for Fellowship/Mastership credit. Please contact PennWell for current term of acceptance. Participants are urged to contact their state dental boards for continuing education requirements. PennWell is a California Provider. The California Provider number is 4527. The cost for courses ranges from $20.00 to $110.00.

PROVIDER INFORMATIONPennWell is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

Concerns or complaints about a CE Provider may be directed to the provider or to ADA CERP at www.ada.org/cotocerp/.

The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from (11/1/2011) to (10/31/2015) Provider ID# 320452.

RECORD KEEPINGPennWell maintains records of your successful completion of any exam for a minimum of six years. Please contact our offices for a copy of your continuing education credits report. This report, which will list all credits earned to date, will be generated and mailed to you within five business days of receipt.

Completing a single continuing education course does not provide enough information to give the participant the feeling that s/he is an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise.

CANCELLATION/REFUND POLICYAny participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.

© 2016 by the Academy of Dental Therapeutics and Stomatology, a division of PennWell

PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS.

Educational Objectives

1. Recognize visual and radiographic methods used for caries identification

2. Describe how CAMBRA can assist with caries management

3. Identify seven methods used in minimal-intervention dentistry that may aid in caries management

Course Evaluation

1. Were the individual course objectives met? Objective #1: Yes No Objective #2: Yes No

Objective #3: Yes No

Please evaluate this course by responding to the following statements, using a scale of Excellent = 5 to Poor = 0.

2. To what extent were the course objectives accomplished overall? 5 4 3 2 1 0

3. Please rate your personal mastery of the course objectives. 5 4 3 2 1 0

4. How would you rate the objectives and educational methods? 5 4 3 2 1 0

5. How do you rate the author’s grasp of the topic? 5 4 3 2 1 0

6. Please rate the instructor’s effectiveness. 5 4 3 2 1 0

7. Was the overall administration of the course effective? 5 4 3 2 1 0

8. Please rate the usefulness and clinical applicability of this course. 5 4 3 2 1 0

9. Please rate the usefulness of the supplemental webliography. 5 4 3 2 1 0

10. Do you feel that the references were adequate? Yes No

11. Would you participate in a similar program on a different topic? Yes No

12. If any of the continuing education questions were unclear or ambiguous, please list them.

___________________________________________________________________

13. Was there any subject matter you found confusing? Please describe.

___________________________________________________________________

___________________________________________________________________

14. How long did it take you to complete this course?

___________________________________________________________________

___________________________________________________________________

15. What additional continuing dental education topics would you like to see?

___________________________________________________________________

___________________________________________________________________

ANSWER SHEET

Early Caries Intervention: A Collaborative ApproachName: Title: Specialty:

Address: E-mail:

City: State: ZIP: Country:

Telephone: Home ( . Office ( .

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Requirements for successful completion of the course and to obtain dental continuing education credits: 1. Read the entire course. 2. Complete all information above. 3. Complete answer sheets in either pen or pencil. 4. Mark only one answer for each question. 5. A score of 70% on this test will earn you 2 CE credits. 6. Complete the Course Evaluation below. 7. Make check payable to PennWell Corp. For Questions Call 800-633-1681

CARIES0716DE

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