Students' perceptions of vertical and horizontal integration in a discipline-based dental school.

INTRODUCTION: Integration is a key concern in discipline-based undergraduate dental curricula. Therefore, this study compared feedback on integration from students who participated in different instructional designs in a Comprehensive Patient Care course. METHODS: The study was conducted at the University of Pretoria (2009-2011). Third-year cohorts (Cohorts A, B and C) participated in pre-clinical case-based learning, whilst fourth-year cohorts (Cohorts D and E) received didactic teaching in Comprehensive Patient Care. Cohorts A, D and E practised clinical Comprehensive Patient Care in a discipline-based clinic. Cohort B conducted their Comprehensive Patient Care patient examinations in a dedicated facility supervised by dedicated faculty responsible to teach integration. Students had to indicate on visual analogue scales whether the way they were taught at the school helped them to integrate knowledge from the same (horizontal integration) and preceding (vertical integration) year of study. The end-points of the scales were defined as 'definitely' and 'not at all'. Analysis of variance (ANOVA) was employed to measure the differences between cohorts according to the year of study. RESULTS: Third-year case-based learning cohorts rated the horizontal integration close to 80/100 and vertical integration ranging from 64 to 71/100. In year four, Cohort B rated vertical and horizontal integration 9-15% higher (ANOVA, P < 0.05) than Cohorts A and D. In year five, Cohort A rated vertical and horizontal integration 11-18% higher (ANOVA, P < 0.05) than Cohorts D and E. CONCLUSION: Pre-clinical case-based learning and Comprehensive Patient Care supervised by dedicated faculty were associated with more favourable perceptions about integration in the discipline-based undergraduate dental curriculum.

Developing students' clinical reasoning skills: correlates of perceived relevance of two teaching and learning approaches.

INTRODUCTION: 'Relevance' is a key concept in adult learning. Hence, this study sought to examine students' perceptions of relevance of the teaching and learning in relation to different instructional designs employed in a Comprehensive Patient Care (CPC) course that aims to develop integrated clinical reasoning skills. METHODS: Third to fifth year students (2009-2011) were asked to anonymously rate the relevance of the instructional design (RELID) they participated in by means of visual analogue scales at the School of Dentistry, University of Pretoria. They were also asked to rate their perceptions of the alignment between teaching and learning and outcomes (ATLO), assessments' contribution to learning (ACL), course organisation (CO) and teacher competence (TC). RELID served as the outcome measure in stepwise linear regression analyses. ATLO, ACL, CO, TC and the instructional design (case-based learning (CBL = 1) and the combination of discipline-based and lecture-based teaching in CPC (DB-LBT = 0)) served as the co-variables for each of the years of study. RESULTS: The analyses showed positive correlations between RELID and ATLO and between RELID and ACL for all the years of study. RELID was associated with TC in year three and four and CO was associated with RELID in year four and five. CBL outperformed DB-LBT in terms of perceived relevance of the teaching and learning. CONCLUSION: The results suggest that students' perceptions of the relevance of the instructional design may be enhanced when outcomes, teaching, learning and assessment are constructively aligned during the development of clinical reasoning skills.

Socio-demographic and academic correlates of clinical reasoning in a dental school in South Africa.

INTRODUCTION: There are no empirical studies that describe factors that may influence the development of integrated clinical reasoning skills in dental education. Hence, this study examines the association between outcomes of clinical reasoning in relation with differences in instructional design and student factors. MATERIALS AND METHODS: Progress test scores, including diagnostic and treatment planning scores, of fourth and fifth year dental students (2009-2011) at the University of Pretoria, South Africa served as the outcome measures in stepwise linear regression analyses. These scores were correlated with the instructional design (lecture-based teaching and learning (LBTL = 0) or case-based teaching and learning (CBTL = 1), students' grades in Oral Biology, indicators of socio-economic status (SES) and gender. RESULTS: CBTL showed an independent association with progress test scores. Oral Biology scores correlated with diagnostic component scores. Diagnostic component scores correlated with treatment planning scores in the fourth year of study but not in the fifth year of study. 'SES' correlated with progress test scores in year five only, while gender showed no correlation. CONCLUSION: The empirical evidence gathered in this study provides support for scaffolded inductive teaching and learning methods to develop clinical reasoning skills. Knowledge in Oral Biology and reading skills may be important attributes to develop to ensure that students are able to reason accurately in a clinical setting.

Developing integrated clinical reasoning competencies in dental students using scaffolded case-based learning - empirical evidence.

INTRODUCTION: This study provides empirical evidence of the development of integrated clinical reasoning in the discipline-based School of Dentistry, University of Pretoria, South Africa. Students were exposed to case-based learning in comprehensive patient care (CPC) in the preclinical year of study, scaffolded by means of the four-component instructional design model for complex learning. METHODS: Progress test scores of third- to fifth-year dental students, who received case-based teaching and learning in the third year (2009-2011), were compared to the scores of preceding fourth- and fifth-year cohorts. These fourth- and fifth-year cohorts received content-based teaching concurrently with their clinical training in CPC. The progress test consisted of a complex case study and 32 MCQs on tracer conditions. Students had to gather the necessary information and had to make diagnostic and treatment-planning decisions. RESULTS: Preclinical students who participated in the case-based teaching and learning achieved similar scores compared to final-year students who received lecture-based teaching and learning. Final-year students who participated in the case-based learning made three more correct clinical decisions per student, compared to those who received content-based teaching. Students struggled more with treatment-planning than with diagnostic decisions. CONCLUSION: The scaffolded case-based learning appears to contribute to accurate clinical decisions when compared to lecture-based teaching. It is suggested that the development of integrated reasoning competencies starts as early as possible in a dental curriculum, perhaps even in the preclinical year of study. Treatment-planning should receive particular attention.

Developing clinical reasoning in the classroom - analysis of the 4C/ID-model.

OBJECTIVES: The purpose of this study is to provide a theoretical rationale for the implementation of the four-component instructional design model for complex learning (4C/ID-model) at the University of Pretoria with the aim of systematically developing the clinical reasoning of undergraduate dental students in a classroom setting. METHODS: Recent literature provides a rationale for the use of the 4C/ID-model to teach clinical reasoning in terms of four strategic teaching and learning needs: (i) the need for authenticity in the learning process; (ii) the need to manage cognitive load during the learning process; (iii) the need for repeated practice; (iv) a need for valid assessment, feedback and reflection. RESULTS AND DISCUSSION: The literature review indicated that the 4C/ID-model makes provision for teaching and learning in an authentic context and proposes systematically structured methods that could be practically applied to manage cognitive load during repetitive exercises. The model also makes provision for cognitive feedback following assessment in order to eliminate misconceptions about content and to develop the cognitive strategies of the learner. CONCLUSIONS: On the basis of the literature review above, it is recommended that the 4C/ID-model be considered as a basis for classroom teaching and learning to develop competence in clinical reasoning in undergraduate dental students, even at pre-clinical level. The model may also have an application in medical education.

Clinical correlates of oral malodour in a population of patients attending a preventive clinic in Pretoria, South Africa.

AIM: This study investigates the occurrence of oral malodour in an adult dental clinic population in Pretoria, South Africa, and the clinical parameters associated with the condition. METHODS: Data collected from new patients (n=896), examined by oral hygiene students under supervision of instructors, between January - October 2004, were retrospectively analysed. Subjects self-reported their medical history and smoking status. Caries experience, plaque index, pocket depths, bleeding on probing (BOP), tongue coating status, and oral hygiene practises were recorded. Malodour was diagnosed using the halimeter (> or = 120ppb) and an organoleptic measurement (0-5 point scale) of > or = 3. Data analysis included chi-square, t-tests and logistical regression. RESULTS: 15.1% presented with organoleptically-determined malodour and 20.9% presented with malodour detected by the use of the halimeter. Irrespective of the diagnostic tool used, tongue coating, increased plaque levels and BOP were associated with an increased likelihood for oral malodour, while regular flossing reduced the likelihood of presenting with the condition. Periodontitis was associated with oral malodour when applying organoleptic ratings, but not with the halimeter. CONCLUSIONS: Oral malodour prevalence corresponds with values reported in developed countries. Interdental flossing was the most effective self-care practise associated with a reduced likelihood of presenting with malodour. Halimeter performance should be further investigated in relation to varying degrees of severity of periodontal disease.

An analysis of complaints against oral health professionals charged with misconduct at the HPCSA: 2004-2009.

AIM: This study investigates the nature, frequency, and outcome of complaints relating to misconduct laid against oral healthcare professionals (OHPs), charged with misconduct in South Africa. METHODS: Records of the Health Professions Council of South Africa (2004-2009) were analysed and classified using the ethical rules as a reference. "Clinically-related complaints" and "fraud" were added as extra categories. The nature and outcome of the complaints and the penalties were quantified, and the detailed nature of the complaints was qualitatively reported. RESULTS: Two percent of the registered dentists and 5.5% of the registered dental therapists were charged with misconduct. Clinically related complaints (59%) and fraud (29%) were most prevalent amongst the accused dentists. Fraud (46%), clinically related complaints (19%), advertising (15%), infection control (8%), and creating expectations that could not be met (8%) were the most common complaints against dental therapists. CONCLUSIONS: Substandard dental treatment and fraud were the main reasons for patient dissatisfaction that led to OHPs being charged with misconduct. Both these undesirable practices may be financially motivated. OHPs should take cognisance of these statistics and should adjust their professional approach accordingly in order to reflect acceptable ethical behaviour.

Musculoskeletal disorders amongst practising South African oral hygienists.

OBJECTIVES: The study sought to determine the level of musculoskeletal disorders among working oral hygienists in South Africa and potential determinants that are associated with these disorders. METHODS: Oral hygienists registered with the HPCSA were requested to complete an anonymous questionnaire. Apart from demographic information they were asked to report on any musculoskeletal symptoms experienced in the hands, neck, shoulders and lower back as well as details of workload, types of scaling procedures, size of instruments, the mobility of the operator's chair and the adjustability of patient chairs. RESULTS: Of the 362 respondents, 61.3%, 66.5%, 56.6% and 59.6%, experienced hand, neck, shoulder and lower back symptoms respectively. Twenty-eight percent of the respondents performed hand-scaling for more than four hours per day. Twenty-six percent reported immobile operator chairs, while 12.6% reported patient chairs that were difficult to adjust. Employing multivariate analysis, excessive hand scaling was associated with hand and shoulder symptoms, while immobile operator's chairs and poorly adjustable patient chairs were respectively associated with neck and lower back problems. CONCLUSIONS: The prevalence of work-related musculoskeletal disorders in practising oral hygienists in South Africa appears to be similar to that in developed countries. Significant determinants of musculoskeletal disorders may be immobile operator stools, poorly adjustable patient chairs and excessive hand-scaling daily.

Empirical support for a fissure sealant placement timeframe protocol for black South Africans.

OBJECTIVES: It is recommended that fissure sealants should be placed within four years after eruption. Due to considerable variations in the eruption times of molar teeth, this recommendation is of limited value from a public health perspective. This study, therefore, sought to provide empirical support for a public health fissure sealant placement timeframe protocol. METHODS: The first and second molar eruption patterns of black South African children aged five to seven and 11 to 16 years were analysed in relation to caries experience using the 1999/2002 National Children's Oral Health Survey. RESULTS: By seven years of age, 90% of first molars had erupted with a caries experience of 3%. By 14 years of age the erupted first molars caries experience was 20%. The 13- and 14-year-olds presented with 86% and 98% erupted second molars with a caries experience of 11% and 20%, respectively. CONCLUSIONS: The study findings suggest that during school-based fissure sealant programmes involving black South African children, first molars should be targeted at age seven (Grade 1), or as soon as possible thereafter. However, caries protection may still be achieved until thirteen years of age (Grade 7). Furthermore, second molars should be sealed between the age of 11 and 13 years (grades 5-7).

Assessment of the anterior loop of the inferior alveolar nerve using reformatted computed tomography: a retrospective study.

The anterior loop of the inferior alveolar nerve (IAN) is an important landmark in the anterior mandible that must be considered during the placement of dental implants. We measured the length and prevalence of loops of the IAN in 188 consecutive, dentate patients using reformatted computed tomography (CT). A total of 158/188 (84%) had at least one anterior loop; 111/188 (59%) had bilateral loops. The mean (SD) length of the loops in the third quadrant was 1.4 (0.7)mm; 95% CI 1.3 to 1.6; (range 0.3 - 4.0mm). The mean (SD) length of the loops in the fourth quadrant was 1.5 (0.9)mm; 95% CI 1.4 to 1.6; range 0.3 - 5.5mm. In total 42/188 (22%) had loops that were longer than 2mm in quadrants three and four. CT images that have been reformatted with specialised software may be useful to identify loops in the IAN, particularly when recent cone-beam CT images are not freely available. The prevalence of these loops is high while their length varies, which makes meticulous assessment necessary before the placement of implants.

Is the human papillomavirus a mutual aetiological agent in oral and cervical squamous cell carcinoma?

BACKGROUND: Oncogenic HPV-types are the most important risk factor in cervical SSC and have also been implicated in the aetiology of OSSC. This evidence of infection at different anatomical sites suggests systemic susceptibility that implies that different expressions of disease should more or less correlate over long periods of time. MATERIALS AND METHODS: This was undertaken to establish whether any correlation could be found between the incidence of cervical SCC and OSCC in females and OSSC in males in South Africa, over a ten-year period, 1986 to 1995. RESULTS: Several moderate to strong correlations, which ranged from significant (p < 0.05) to highly significant (p < 0.01), between the incidence of cervical SSC and OSSC in the Black and Coloured populations, and OSSC in the White male population, were found. CONCLUSION: These results support the idea of systemic susceptibility, and infection through a common agent such as HPV, contributing to the cause of SSC.