A case report of self-medication with over-the-counter fish antibiotic: Implications for pharmacists.

OBJECTIVE: The human use of over-the-counter antibiotics intended for the treatment of pet animals has been recognized as a potential barrier to antibiotic stewardship efforts. The objective of this report is to describe a case of self-medication with a fish antibiotic resulting in delayed medical treatment and provide recommendations for pharmacists practicing in outpatient settings on how to best identify and manage nonprescription antibiotic use. CASE SUMMARY: A 24-year-old man experienced dental pain and "flu-like" symptoms for which he attempted self-treatment with oral amoxicillin 250 mg daily purchased by a family member from a pet store. The amoxicillin was marketed for the treatment of bacterial infection in pet fish. After several days of increasing tooth pain despite the self-medication, the patient presented to an outpatient clinic where he was found to have a molar abscess requiring tooth extraction. The patient responded well to therapy and was counseled to discontinue antibiotic self-treatment. PRACTICE IMPLICATIONS: Undocumented use of nonprescription antibiotics represents a threat to patient safety. Potential deleterious outcomes include resistance, adverse drug events, and delays in definitive infection treatment. Pharmacists should screen patients for nonprescription antibiotic use, provide them counseling on appropriate antibiotic use, and educate other health care professionals on underrecognized sources of nonprescription antibiotics to increase awareness of this growing issue. Furthermore, antibiotic resistance should be considered when recommending an antibiotic agent for the treatment of infections.

Dental Bite-Sized Bits: A Module for Teaching Common Oral Health Conditions to Multidisciplinary Students.

The Surgeon General's report in the year 2000 highlighted the association between chronic diseases and oral health infections. Current healthcare education programs, regrettably, report only 1 to 3 h of oral health instruction within curricula. In the years 2020-2022, as part of their respective oral health curricula, 278 first-year physician assistant and 12 pre-clinical second-year pharmacy students were invited to participate in a voluntary survey examining the effectiveness of animated succinct, online video-based oral health units. Among all student responses for the post-use survey, respondents "strongly agreed" or "agreed" that learning objectives of the unit(s) were achieved after reviewing the videos. Of the participants, 97% "strongly agreed" or "agreed" that the videos helped them understand information of which they had no prior knowledge. Similarly, 98% "strongly agreed" or "agreed" the information was appropriate for their level of knowledge. Most students, 93%, "strongly agreed" or "agreed" the exercise was a valuable learning experience. Regarding the importance of future interprofessional collaboration pertaining to a mutual patient's oral health, 95% of participants "strongly agreed" or "agreed" that they would be likely to collaborate. This study demonstrates the importance of oral health as a critical area of focus in healthcare education. The study also confirms the hypothesis that Dental Bite-Sized Bits units deliver engaging, valuable oral health education for preclinical healthcare learners, incorporating interprofessional perspectives from the disciplines of dental, pharmacy, and physician assistant.

Single duplex DNA sequencing with CODEC detects mutations with high sensitivity.

Detecting mutations from single DNA molecules is crucial in many fields but challenging. Next-generation sequencing (NGS) affords tremendous throughput but cannot directly sequence double-stranded DNA molecules ('single duplexes') to discern the true mutations on both strands. Here we present Concatenating Original Duplex for Error Correction (CODEC), which confers single duplex resolution to NGS. CODEC affords 1,000-fold higher accuracy than NGS, using up to 100-fold fewer reads than duplex sequencing. CODEC revealed mutation frequencies of 2.72 × 10-8 in sperm of a 39-year-old individual, and somatic mutations acquired with age in blood cells. CODEC detected genome-wide, clonal hematopoiesis mutations from single DNA molecules, single mutated duplexes from tumor genomes and liquid biopsies, microsatellite instability with 10-fold greater sensitivity and mutational signatures, and specific tumor mutations with up to 100-fold fewer reads. CODEC enables more precise genetic testing and reveals biologically significant mutations, which are commonly obscured by NGS errors.

Case report of spongiotic gingivitis in an adult male treated with novel 9,300-nanometer carbon dioxide laser low-energy ablation.

BACKGROUND AND OVERVIEW: To date, only about 125 cases of juvenile or adult spongiotic gingivitis have been described in the literature, primarily from retrospective biopsy searches. Spongiotic gingivitis is a relatively new, often misdiagnosed, periodontal pathology that was originally attributed only to juveniles. This is the first case report to our knowledge on spongiotic gingivitis diagnosed in a middle-aged adult man and treated with a novel carbon dioxide (CO2) laser low-energy ablation therapy. CASE DESCRIPTION: A 56-year-old man sought treatment for a localized erythematous lesion on the facial gingiva of the maxillary left central incisor (tooth no. 9). Initial treatment was conventional excisional surgery and biopsy. Diagnosed as spongiotic gingivitis, it reoccurred in the same location within 4 months. It was then treated in 3 sessions using a novel 9,300-nm CO2 laser low-energy ablation set at 0.4 W and 1.25-mm cut width for an irradiance of 33.3 W/cm2 and energy density of 0.21 J/cm2. The lesion was significantly reduced and has shown no hyperplastic reoccurrence to date. CONCLUSIONS AND PRACTICAL IMPLICATIONS: This case report brings to dental professionals' attention that acute spongiotic gingivitis may occur in older adults, not just juveniles. As such, spongiotic gingivitis may be underreported in adults with localized gingivitis, possibly attributed to toothpastes containing sodium laurel sulfate. 9,300-nm CO2 laser therapy may successfully treat lesions such as acute spongiotic gingivitis without the need for anesthesia or additional medications. This report may also encourage further research on treatment modalities, biopsy of lesions resembling this entity, and improved reporting of adult spongiotic gingivitis to better understand this unique gingival pathology.

Practice management curricular changes may lead to enhanced preparedness for practice.

PURPOSE: The 2018 American Dental Education Association Survey of Dental School Seniors showed that 62.5% of graduates felt prepared in practice administration compared to 49.5% in 2013. The aim of this study was to survey and Internet search U.S. Dental Schools' Practice Management curriculum (PMC) to assess if and what changes, made in the past 5 years, may account for the continued increase in dental graduates' perception of preparedness for practice METHODS: An electronic survey was emailed to 64 dental schools querying factors for changes in PMC, updates in instructors, instructional methods, technology, topics, hours, and content enhancements. In addition, if a dual degree in business administration was developed or planned in the future. RESULTS: Twenty-three schools responded for a 36.0% response rate. All participants (100.0%) indicated PMC changes, 73.9% responded that changes were motivated by student interest, and 60.9% planned future PMC improvements. All respondents (100.0%) updated subject matter and 52.2% had added technology, including Web-based business model and simulation courses. Two schools added dual degree MBA programs in 2017 due to student interest in entrepreneurship and administrative goals. CONCLUSION: The study showed that upgrades in topics and teaching methods with Web-based technology, dual degrees, and additional focus on PMC hours, sequence, and number of practice administration courses in D1 and D2 years may be contributory factors for the development of enhanced skills and enhanced attitudes of graduates for practice readiness. Future study is needed to assess if these PMC improvements and advanced business courses have been successful in practicing dentists' careers.

Dental Faculty, Student, and Alumni Perceptions of Happiness and Life Satisfaction in Dental School: Foundations for Resilience and Well-Being.

This study examined happiness and satisfaction as possible foundations for long-term well-being and resilience in dental education. Psychological research has found that respect, camaraderie, and trust help define well-being and that resilience is built with these supportive influences. The aims of this study were to assess if happiness and life satisfaction reported by one U.S. dental school's faculty, students, and alumni also enhanced their perceived well-being and resilience and to determine the factor that most affected the participants' happiness. Email and hard copy surveys were distributed in 2018 and 2019 to all 71 full-time preclinical and clinical faculty members, 572 students in all four years, and 143 alumni who graduated in 2018 (total N = 786). Overall, 471 responded; response rates by group were as follows: faculty 87.3% (N = 62), students 65.9% (N = 377), and graduates 22.4% (N = 32). Of the three groups, responding faculty members reported having the highest levels of happiness in life (92.0%) and job satisfaction (90.3%). In the highest percentage reported, 90.2% of D4 students reported that the level of trust and respect they received from clinical faculty members contributed most to their happiness. The lowest level of happiness among the groups (71.0%) was reported by the D2 students. These results suggested that perceived well-being translated to happiness among the participants in our study. More research is needed to understand the relationship among positive environments, well-being, and provider resilience in dental education.

Prevalence and dental professional awareness of antibiotic self-medication among older adults: Implications for dental education.

OBJECTIVE: Antibiotic stewardship has been recognized as an essential component of dental education. A notable threat to stewardship is the growing trend toward self-medication with nonprescribed antibiotics (SMNPA), particularly among older adults who may be at increased risk for adverse outcomes. This study aimed to assess the need to incorporate SMNPA into dental education by researching (1) professional awareness and (2) self-medication behaviors among older adults. METHODS: A SMNPA awareness survey was administered to dentists in Arizona with 148 respondents including general dentists, dental school faculty, and public health clinicians. A second survey was distributed to 410 households in an independent and assisted living facility. RESULTS: The dentists were aware of sources of SMNPA such as friends/family, leftover prescriptions, as well as sources outside of the United States; however, most (>80%) were not aware that ornamental fish antibiotics could be obtained online or in pet stores. The survey response rate for the older adults was 46.3%, of which 68.3% reported antibiotic use within the past 2 years (several for dental premedication) and 6.4% (n = 12) admitted to SMNPA for treating cold symptoms or pain. The main reason given for self-treatment was the belief that antibiotics had resolved similar symptoms in the past. One-third of the older adult respondents were unaware that antibiotics only treat bacterial infections. CONCLUSION: Approximately 1 in 16 older adults surveyed reported SMNPA. Dental professionals reported some knowledge of SMNPA but were unaware of all sources. This study highlights the need for SMNPA education, awareness, and implementation within dental curricula.

Preclinical Competency Testing in North American Dental Schools and Opinions About Possible Standardization.

In the U.S., the Commission on Dental Accreditation (CODA) requires that dental schools use competency-based assessments and standardized levels of proficiency to ensure that students are prepared for patient care after graduation. No such comprehensive standardized preclinical testing is required in the CODA standards. The aim of this study was to determine the use of preclinical competency assessments for students transitioning from preclinical to clinical education in North American dental schools and respondents' perceptions of the need for standardization in preclinical testing. An electronic survey was sent to the academic deans of all 76 U.S. and Canadian dental schools in July 2018 asking if the school used competency exams to assess preclinical students prior to entering patient care and, if so, about the type of tests and disciplines tested, student remediation, and reasons for revisions. The survey also asked for the respondents' perspectives on potential preclinical assessment standardization. Respondents from 28 U.S. and two Canadian schools participated in the survey, for a 39.5% response rate. The majority (92.3%) of respondents said their school considered preclinical competency assessments to be good indicators of students' readiness for transitioning into patient care, yet 40.0% reported their schools had no comprehensive preclinical testing, and 13.8% had no preclinical testing in endodontics, periodontics, prosthetics, or restorative dentistry. Regarding type of comprehensive preclinical assessment used, 71.4% reported using typodont-based exams, 46.4% used written comprehensive exams, and 42.9% used objective structured clinical examinations (OSCEs); respondents could select all that applied on this item. Of the respondents whose schools had preclinical competency assessments, 72.4% had a review mechanism in place to evaluate its effectiveness. Overall, this study found that 60% of the participating schools had some form of preclinical testing, but there were no agreed-upon competencies to determine preclinical dental students' readiness for safe patient care in their clinical education.

Dental Students' Use of Student-Managed Google Docs and Other Technologies in Collaborative Learning.

Textbooks, once the standard of education, now have competition when students prefer the Internet and digital technology. The aim of this research study was to survey dental students at one dental school about their use of student-managed Google Docs and other online technologies in collaborative e-learning. All dental students in all four classes at Midwestern University College of Dental Medicine-Arizona were invited to participate in online surveys in 2015 and 2017. The average class size was 140 (n=560 for all four years) for each survey. The 2015 survey focused on the emerging use of Google Docs in collaborative learning. The 2017 study asked not only about Google Docs but how students were using other e-learning technologies and textbooks. In 2015, 282 students responded, for a 50.4% response rate; in 2017, 129 students responded, for a 23% response rate. The 2017 survey showed a 36% increase (p<0.0001) in the use of Google Docs in all dental classes over use in 2015, and a 67% increase (p<0.0001) in respondents' reporting they had used Google Docs during their undergraduate education. Google Docs, Blackboard, and collaboration with peers were the most popular study choices in 2017. The results showed a decline in respondents' reported use of hard copy textbooks from 24.5% in 2015 to 14.8% in 2017 (p=0.0405). Future studies are needed to increase dental educators' understanding of the ways their students are using collaborative technologies in learning and to define ways to overcome challenges posed by these technologies identified in our study.

Dentists' Perceptions of Their Peer Learning Experiences in Dental School and Effects on Practice.

Peer-assisted learning (PAL) has been found in medical, nursing, and dental education research to aid in preparing students to develop clinical judgment, leadership, and teamwork skills. This study sought to extend that research by assessing the effect of PAL on dentists in practice. The aim of this study was to ask practicing dentists who were clinically trained with PAL in dental school for their perceptions of the effects and value of that training for their patient care, team relations, and professional development. In addition, participants were asked for recommendations to improve pairing and the matching process. An electronic survey was sent in October 2017 to all 667 dentists who graduated from Midwestern University College of Dental Medicine-Arizona from 2012 to 2017, all of whom had been trained in a PAL-general practice model. A total 107 alumni responded, for a 16% overall response rate; the response rate averaged 16.7% for each class. The majority (83.6%) of responding dentists recommended peer learning in clinical dental education. Survey participants attributed their clinical judgment (72.3%) and teamwork (80.9%) skills to peer pairing in dental school. Among the respondents, 89.8% had taken leadership roles and were training team members, and 75.7% reported enjoying teaching others. Of the 65% who commented on peer pairing enhancements, 15% recommended rotation of peers for greater learning experiences, and 24% advised personality assessments for future pair matching. These results suggested that participating in PAL had helped prepare these alumni for practice.