How do we teach simulation-based dental education? Time for an evidence-based, best-practice framework.

Historically, simulation-based dental education was taught using practical skills and the action of doing. An increased awareness of the importance of patient safety in healthcare education and delivery has seen considerable advances in the application of simulation-based education across several healthcare disciplines including medicine, nursing and anaesthetics. Dental simulation-based education requires improved standards of best-practice, and evidence-based, curriculum design that is based on theoretical frameworks, conceptual frameworks and educational theories. In this commentary, we explore the educational theory and the development of healthcare simulation, including internationally recognised standards of best practice and the simulation-based activity cycle. Given simulation-based education should be fit-for purpose, the components of these standards are examined within the specific context of dental education. We propose an evidence-based, best-practice framework that can be applied in the design and delivery of contemporary simulation-based dental curriculum.

Undergraduate Students Experience of Nutrition Education Using the Flipped Classroom Approach: A Descriptive Cohort Study.

OBJECTIVE: To explore undergraduate students self-reported learning experience in a foundation nutrition education course/unit delivered using a flipped classroom approach (FCA), which requires students to complete independent learning before and after interactive in-class learning experiences. METHODS: A descriptive cohort study design used selected items from a self-report flipped classroom student engagement questionnaire to assess Australian undergraduate student (n = 105) engagement in the course/unit and compared with nonflipped courses, preference for FCA, academic achievement, learning behaviors for 3 FCA learning phases, and more or less engaging aspects of the course/unit. RESULTS: Most (66.5%) students were engaged or very engaged, with half (55%) more engaged in this course/unit compared with other nonflipped courses/units with a preference for the FCA (53%). Almost half of the students agreed the FCA improved their academic performance (grade) (45%) and other academic skills (ie, teamwork) (48.5%). Most student comments related to the value of participate phase activities. CONCLUSIONS AND IMPLICATIONS: The FCA engaged most students in learning and is an emerging learning and teaching approach appropriate for undergraduate nutrition dietetic education.

Dental age estimation using radiographs: Towards the best method for Sri Lankan children.

Research supports the need for regionally and ethnically specific validated data as the reference base for age estimation techniques. This retrospective study evaluated the accuracy of three dental age estimation methods; Demirjian et al. (1973), Willems et al. (2001), and Blenkin and Evans (2010), for use in Sri Lanka for medico-legal purposes. Panoramic radiographs of 688 Sri Lankan children ranging in age from 8.00 to 16.99 years were used to determine their appropriateness to a Sri Lankan population. The mean age and standard deviations (±SD) were calculated separately for males and females of each age group. Paired t-test and mean absolute errors (MAE) were calculated to compare the calculated dental age (DA) with the chronological age (CA) across the nine age groups. The results revealed the mean CA of the entire sample was 12.38 ± 2.68 years, while the mean DA calculated using the Blenkin and Evans method was 11.83 ± 2.20 years, using the Demirjian et al. method was 12.57 ± 2.53 years, and using the Willems et al. method was 11.99 ± 2.43 years. The Demirjian et al. method consistently overestimated the age of males except in the 2 groups aged over 15 years, whereas the Blenkin and Evans method consistently underestimated the age except for the 11.00-12.99 age range. The method of Willems et al. produced DA quite close to CA up until 12.99 years of age, and then underestimated the age for all higher age groups. In females, the Demirjian et al. method consistently overestimated the age up until 13.99 years and then underestimated the higher age groups, while the Willems et al. method underestimated the age in all age groups except 10.00-10.99 years. The Blenkin and Evans method also consistently underestimated the age except in the 10.00-10.99 and 12.00-12.99-year age groups. The percentages of either overestimation or underestimation calculated for ±0.5 years of the true age were 41.0% for the Blenkin and Evans method, 42.8% for the Demirjian et al. method and 49.1% for the Willems et al. method. In conclusion, while all three methods could be applicable in the estimation of dental age for medico-legal purposes, the Willems et al. method appears to be more appropriate in overall measures for the Sri Lankan reference sample, up to the age of 12.99 years.

Cultural Competency Education in Academic Dental Institutions in Australia and New Zealand: A Survey Study.

The aim of this study was to assess the status of cultural competency education in Australian and New Zealand dental, dental hygiene, and oral health therapy programs. The study sought to explore the extent to which cultural competence is included in these programs' curricula, building on similar studies conducted in the United States and thus contributing to the international body of knowledge on this topic. A 12-item instrument was designed with questions in four areas (demographics, content of cultural competency education, organization of overall program curriculum, and educational methods used to teach cultural competence) and was sent to all Australian and New Zealand dental, dental hygiene, and oral health therapy educational programs. Of the total 24 programs, 15 responded for a response rate of 62.5%. The results showed that lectures were the most frequent teaching method used in cultural competency education; however, the variation in responses indicated inconsistencies across study participants, as discussions and self-directed learning also featured prominently in the responses. The majority of respondents reported that cultural competence was not taught as a specific course but rather integrated into their programs' existing curricula. The variations in methods may indicate the need for a standardized framework for cultural competency education in these countries. In addition, the notion of cultural competency education in academic dental institutions demands additional evaluation, and further research is required to develop a solid evidence base on which to develop cultural competency education, specifically regarding content, most effective pedagogies, and assessment of student preparedness.

The effect of loupes on neck pain and disability among dental hygienists.

BACKGROUND: Musculoskeletal disorders represent a significant occupational health issue in dental hygiene, with high prevalence rates documented. Despite this fact, there have been few advancements in the application of ergonomic principles in the dental hygiene profession. While the use of loupes is often promoted as an ergonomic solution, there is little published research to support this claim. OBJECTIVES: The aim of the present study, therefore, was to investigate the effect of the use of loupes on neck pain and disability in dental hygienists. METHODS: The study was conducted using an exploratory pre-test post-test design, comparing musculoskeletal measures in dental hygienists wearing loupes with final year dental hygiene students who do not wear loupes. Pre- and post-test measures included the Neck Pain and Disability Scale and a standardised physical assessment using previously validated measures. Statistical analysis was conducted as a series of mixed ANOVAs with time and treatment as the independent variables. RESULTS: While the analyses revealed no significant interactions between time and treatment (p <  0.05), there were general trends of improvement or deterioration for outcome measures. Improvements over time were noted in the treatment group for cervical range of motion and deep neck muscle endurance; however deteriorations were noted for forward head posture and cervical kinaesthetic sense. CONCLUSIONS: Overall, despite no statistically significant differences being detected, this study suggests that wearing loupes appears to have both positive and negative outcomes with regards to physical well-being. As such, further studies are required to more precisely determine the effects of loupes on MSD among dental hygienists, particularly long-term. Dental hygienists with existing neck pain exploring ergonomic equipment may reflect on the findings and consider the potential benefits and risks of wearing loupes.

The Frequency of Dietary Advice Provision in a Dental Hygiene Clinic: A Retrospective Cross-Sectional Study.

PURPOSE: The aim of this retrospective, cross-sectional study was to assess the frequency of dietary advice provision by dental hygiene students. METHODS: Data was obtained from clinical records of third-year Bachelor of Oral Health students at the University of Newcastle. Frequency of dietary advice was recorded by students over a 12-month period. The study investigated associations between demographics, treatment provided and frequency of dietary advice. RESULTS: The results indicated dietary advice was provided infrequently by dental hygiene students, with only 6.48% of all patients seen during the 12-month period receiving dietary advice. A statistically significant correlation was observed between dietary advice and age, with children under the age of 18 being 2.5 times more likely than adults to receive dietary advice. Additionally, patients who received oral hygiene instruction were 2.5 times as likely to receive dietary advice. Strong correlations were also observed between topical and concentrated fluoride application and dietary advice. CONCLUSION: The findings indicate dietary advice is provided infrequently by dental hygiene students. Further research is required to strengthen the findings and to investigate barriers to dietary advice provision, as well as perceptions of dental practitioners regarding dietary advice.

Musculoskeletal disorders in a 3 year longitudinal cohort of dental hygiene students.

PURPOSE: Musculoskeletal disorders (MSDs) are a significant occupational health issue for the dental hygiene profession. There is increasing evidence that these problems commence during undergraduate training; however, there is a surprising lack of studies investigating how MSD develops in student groups over the course of their study. The aim of this study was to determine the longitudinal MSD trends among a cohort of undergraduate dental hygiene students at an Australian university. METHODS: A previously validated self-reporting questionnaire was distributed to dental hygiene students in 3 consecutive years from 2008 to 2010. RESULTS: MSDs were most commonly reported in the neck (ranging from 66 to 68%) and lower back (ranging from 61 to 68%), with a marked increase in reported lower back pain by the final year of study. CONCLUSION: This study not only supports mounting evidence that MSDs are a common problem for dental hygiene students, but further demonstrates the magnitude of this occupational health issue across the training program. These findings are concerning for a group yet to embark on their professional careers, given that it raises some serious questions about career longevity and the efficacy of preventive measures.

Odontometric sex variation in Malaysians with application to sex prediction.

Information about the sex of individuals is important for human identification. This study was conducted to quantify classification rates of sex prediction models for Malaysians using odontometric profiles. Mesiodistal (MD) and buccolingual (BL) crown dimensions of the permanent dentition were studied in 400 young adult Malaysians, giving a total of 28 tooth size variables. The sample consisted of three major ethnic groups, the Malays, Chinese and Tamils, since the aim was to assess sex dimorphism in Malaysians as a whole. Results showed that the mesiodistal diameter of the lower canine was the most sexually dimorphic dimension in Malaysian Malays and Tamils. Univariate analyses showed that the magnitude and pattern of sex dimorphism varies between these three ethnic groups, with Malaysian Chinese and Tamils being more dimorphic than the Malaysian Malays. Stepwise discriminant functions were generated bearing in mind their application in practical forensic situations. The range of classification rates was from 70.2% to 78.5% for the composite Malaysian group, and 83.8%, 77.9%, 72.4% for Malaysian Chinese, Malays and Tamils, respectively. The 'Area Under the Receiver Operating Characteristic Curve statistics' indicated good classification rates for three prediction models obtained using a combination of all tooth size variables, mandibular teeth, and mesiodistal dimensions in the composite Malaysian group, and for all tooth size variables in each ethnic group. The present study provides strong support for the value of odontometry as an adjunct scientific method for sex prediction in human identification.

Musculoskeletal disorders and symptom severity among Australian dental hygienists.

BACKGROUND: Recent literature has identified that musculoskeletal disorders (MSD) are a significant occupational health issue for both dentists and dental hygienists. Research on the occupational health of dental hygienists is lacking in Australia, which is of particular concern given that it is a rapidly growing field in this country. The aims of this research are to investigate the prevalence of MSD and correlating regions of pain among Australian dental hygienists. A self-reporting questionnaire was distributed to all registered dental hygienists in Australia. The questionnaire was a modified version of a validated tool, used previously among health practitioners and students. RESULTS: A total of 624 dental hygienists responded to the questionnaire, achieving a response rate of 42%. MSD were frequently reported by dental hygienists in the neck (85%), shoulder (70%), and lower back (68%). Of those reporting pain, over two thirds reported that the pain lasted for longer than two days, for all body regions. Logistic regression analysis revealed that there is a correlation between reports of MSD in the neck, shoulder and lower back regions. CONCLUSIONS: Overall, this study suggests that MSD are a reasonably common problem for Australian dental hygienists, and that they often need to seek medical treatment for these problems. It is concerning that there is a correlation between reports of MSD in the neck, shoulder and lower back regions; further studies are needed to establish the epidemiological patterns of MSD in this profession.

Dental hygiene student experiences in external placements in Australia.

While placements in external locations are being increasingly used in dental education globally, few studies have explored the student learning experience at such placements. The purpose of this study was to investigate student experiences while on external placement in a baccalaureate dental hygiene program. A self-reporting questionnaire was distributed to final-year dental hygiene students (n=77) at the University of Newcastle, Australia, in 2010. The questionnaire included questions regarding the type of placement, experiences offered, supervision, resources available, and lasting impressions. Responding students were generally positive about their external placement experience and indicated that the majority of facilities provided them with the opportunity to provide direct patient care and perform clinical tasks typical of a practicing hygienist. However, there was a statistically significant difference in their opinions about discipline-focused and community placements. Students indicated that their external placement experience provided opportunities to learn more about time and patient management, including hands-on experience with specific clinical tasks. Ongoing evaluations are necessary to ensure that external placements meet both student needs and intended learning outcomes within dental hygiene programs.

Effect of loading time on the success of complete mandibular titanium implant retained overdentures: a systematic review.

OBJECTIVES: The aim of this review was to compare conventional against early/immediate loading protocols of implant-retained overdentures (IOD) in the edentulous mandible. MATERIAL AND METHODS: Medline search via Ovid to extract prospective comparative studies on trials comparing the effect of timing of loading initiation on the success of mandibular IOD. The outcome of major interest was marginal bone loss. Probing depth, plaque, bleeding index and mobility were also assessed. Indices at 12 and 24 months were compared and changes assessed. Outcomes were entered into RevMan (version 4.2.5) for meta-analysis. RESULTS: Of 239 articles, only nine trials fulfilled the criteria and involved 30 immediate, 71 early, 77 one-stage conventional, and 66 two-stage conventional subjects. Three immediate loading trials showed an increase in the amount of marginal bone loss over time, while the majority of early and conventionally loaded implants exhibited a decrease in the amount of bone loss in the second year compared with the first 12-month period. Probing depth at 24 months showed a significant difference between early and conventional loading; SMD 0.5 (95% confidence interval 0.03, 0.97). No other statistically significant differences were found between either immediate or early and conventional loading for any indices. CONCLUSIONS: No deleterious effects up to 24 months have been shown from immediate or early loading. Conventional loading after a 3-month healing period has not been proven to be the only acceptable protocol for mandibular IOD, but further long-term studies are needed to confirm this.

New growth references for assessment of stature and skeletal maturation in Australians.

BACKGROUND: We have provided evidence of secular increases in stature and acceleration of skeletal maturation in Australian male children and young adults in recent decades, and relatively less prominent secular increases in stature in females. AIMS: Our aims were to construct new references for stature and skeletal age in Australians. METHODS: We conducted a cross-sectional study of 2,497 South Australians, comprising 1,255 males and 1,242 females aged between 9 and 18 years. Clinical records obtained from 1995 to 2005 comprised stature, chronological and skeletal ages of these individuals. Means and standard deviations for stature and skeletal age were visually smoothed for each sex to construct growth charts depicting the 97th, 90th, 75th, 50th, 25th, 10th and 3rd centiles. RESULTS: Comparisons of the new stature references with the NHMRC (1975) charts indicated an upward shift of stature centiles across all age groups in both sexes by around 4-5 cm. Generally, skeletally advanced individuals tended to be taller, and skeletally delayed individuals tended to be shorter compared with the total sample in younger age groups, but this was less apparent in older age groups. Males aged 9 years in our study were skeletally advanced, on average, by 0.4 years, whereas males aged 17 years were skeletally delayed, on average, by 0.3 years compared with the Greulich and Pyle (1959) standards. In contrast, skeletal and chronological ages were concordant in females. CONCLUSION: Our new references for stature and skeletal age provide up-to-date information for orthodontists, paedodontists and paediatricians requiring growth data for young Australians.

Stature and skeletal maturation of two cohorts of Australian children and young adults over the past two decades.

BACKGROUND: Assessment of growth and maturation in humans has implications in the diagnosis and treatment of growth disorders and in determining timing of orthopaedic interventions. AIMS: Our aims were to investigate whether there was evidence of recent secular changes in stature and skeletal maturation in Australians, and to report any association between these parameters. METHODS: The cross-sectional study sample comprised 5,122 South Australian children and young adults, including 2,601 males and 2,521 females aged between 9 and 18 years. Records obtained from 1987 to 2005 included chronological age, stature and skeletal age in these individuals. Centiles for stature were calculated using the National Health and Medical Research Council of Australia (NHMRC) growth references published in 1975. Stature was measured to the nearest 0.1 cm and the developmental stages of strategic ossification centres on hand-wrist radiographs were evaluated using the Greulich and Pyle (1959) atlas method. RESULTS: Average values for stature were consistently greater in the 1995-2005 cohort compared with the 1987-94 cohort for both sexes, although secular increases in females were less prominent compared with males. Males in the 1995-2005 cohort were also skeletally advanced when compared with their counterparts in the 1987-94 cohort, but this trend was not evident in females. There were significant associations between stature and skeletal maturation, with the strongest associations being noted around puberty in both sexes and progressively weaker associations in older age groups. CONCLUSION: Our findings indicate secular increases in stature in Australian children and young adults of both sexes over the past few decades, and acceleration of skeletal maturation in males.