Impact of COVID-19 on dental education in Europe: The students' perspective.

INTRODUCTION: COVID-19 pandemic impacted dental students and postgraduate residents world-wide, forcing them to rapidly adapt to new forms of teaching and learning. Dental school leaderships needed to ensure the academic continuity, therefore the majority of the in-person actives were transitioned into a virtual setting. The aim of this study was to identify students' perception regarding the measures taken to adapt during the pandemic by different dental schools in the European Region. MATERIALS AND METHODS: This cross-sectional study utilised a validated 37 questions survey. Ethical approval was obtained from the Trinity College Dublin, Ireland. Using this instrument, the perceptions of the European dental students regarding the impact of COVID-19 on their education and mental health were identified. The questions were divided into categories: standard demographic information; models of education during the COVID-19 pandemic (types of teaching, examination and other educational activities) and support received. The survey was administered through electronic online tools, and all responses remained confidential. The data were processed through quantitative and qualitative analysis. RESULTS: A total of 879 student responses to the survey from 34 countries in the European Region were included in this study. When asked about the time spent on their education, 50% of the participants (n = 435) reported spending less time on their education and 30% (n = 265) reported spending more time. The types of teaching included showed a heterogeneous approach, varying from online simulations to problem solving for the didactic setting, or a hybrid model with group activities for the clinical setting. There were broad splits in satisfaction with the education delivered, with 44% (n = 382) being either satisfied or very satisfied and 31% (n = 279) being either unsatisfied or very unsatisfied. Students were most concerned with their clinical experience and skills. CONCLUSIONS: The qualitative and quantitative data compiled in this cross-sectional study enable a direct comparison between different approaches to adapt dental education during the COVID-19 in the European Region. Future studies are recommended that will include compiling perceptions from the staff, faculty and administrators on the transition as well.

A global perspective on implant education: Cluster analysis of the "first dental implant experience" of dentists from 84 nationalities.

OBJECTIVES: The aim of this cross-sectional study was to explore the demographic and educational patterns related to the dentists' first implant dental experience. MATERIAL AND METHODS: Participants of a Massive Open Online Course in implant dentistry who have placed and restored implants completed a 25-item online questionnaire investigating their pathway of education and assessing their experience with the "first implant placement." Exploratory analysis included hierarchical clustering using 9 demographic categorical factors. RESULTS: A total of 1015 respondents from 84 countries formed 5 distinct clusters. Age and work experience were dominant clustering traits, decreasing from Cluster 1 to Cluster 5. Clusters 1 and 3 represented "senior" and "younger" general dental practitioners, respectively, whilst Clusters 2 and 4 represented post-graduate educated clinicians. Cluster 5 represented recent graduates. Asia, South America and Africa were over-represented in "younger" clusters. Time in practice was a significant determinant of attitudes, followed by completion of post-graduate education. There were significant differences in reported patterns of challenges and complications depending on dentists' time in practice, age and post-graduate education. Challenge in implant positioning was more frequently identified by "young post-graduate" educated dentists. Recent graduates reported having the fewest complications of all clusters. Obtaining implant education in University settings was most frequently recommended by clusters of dentists with post-graduate education. CONCLUSIONS: Time in practice is a parameter to be considered when designing implant education. The absence of structured education and mentorship might lead to inability to properly assess treatment outcomes and identify complications. Quality-assured and practice-directed education is needed at a global level, to support in particular, recent graduates who now seem to engage with implant dentistry early in their career.

The Effect of the Bass Intrasulcular Toothbrushing Technique on the Reduction of Gingival Inflammation: A Randomized Clinical Trial.

OBJECTIVES: The primary objective of this randomized controlled clinical trial was to investigate the effect of the Bass Intrasulcular Technique (BIT) on reducing gingival inflammation at 4 and 12 weeks compared with the toothbrushing techniques commonly used. METHODS AND MATERIALS: After receiving ethical approval from the Tufts Health Sciences Institutional Review Board, 55 subjects were invited to participate in the study. Only the subjects who presented with bleeding on probing (BoP) were enrolled. The test group (BT) was instructed on how to use the BIT, and the control group (NI) received no brushing technique instructions. Clinical measurements (probing depth, plaque score, BoP) of each tooth were recorded at 4 and 12 weeks. The toothbrushes of all participants were photographed and assessed by two blinded examiners using the ImageJ software. The statistical significance between the cohorts' BoP and their plaque score results was assessed via hierarchical logistic regression. The analyses were performed using the SAS software (version 9.4; SAS Institute, Cary, NC). RESULTS: Forty-eight participants were eligible to participate and were randomly assigned to one of the two groups (N = 24). The BT group showed significantly smaller percentages of BoP than the NI group at 4 (BT = 12.4% and NI = 31.4%) and 12 (BT = 11.6% and NI = 43.8%) weeks. The difference in plaque scores at 12 weeks was statistically significant (P = .0003) between the two groups. At 12 weeks, the Mann-Whitney U Test indicated that the difference between the groups in terms of toothbrush area was statistically significant (P = .043). CONCLUSIONS: Within the limitations of this randomized controlled clinical trial, the BIT used by participants in the BT group was significantly more effective in reducing gingival inflammation as determined by BoP than the techniques used by participants who had no instructions on brushing techniques; at 12 weeks, the BT group experienced less toothbrush deformation than the control group. CLINICAL RELEVANCE: BIT should be recommended particularly to patients exhibiting BoP and periodontal diseases.

Integrating student feedback during "Dental Curriculum Hack-A-thon".

BACKGROUND: The future of dental education is at crossroads. This study used the parameter of the 2016 Dental Curriculum Hack-a-Thon to assess intra- and inter-institutional agreement between student and faculty views regarding dental curriculums to determine if there is an impact in student perceptions towards dental education from before and after the event. METHODS: This exploratory, cross-sectional study involved two surveys, with Survey 1 being distributed among four faculty-student pairs of the four participating dental schools answering 14 questions. Survey 2 assessed the views of 20 participating dental students through 26 questions in a pre- and post- event survey design. Descriptive statistics were used to explore differences in perceptions towards dental education across both instrument surveys. RESULTS: The results revealed valuable student insights regarding intra- and inter-institutional agreement relevant for the change in dental curriculum that needs to occur. Survey 2 revealed that mandatory attendance in didactic courses, electronic based examination preferences, and the preference of preclinical courses being held in the first and second years of a four-year dental curriculum were of particular importance to student participants. CONCLUSIONS: The results of this study indicate that exposure and participation in subjects pertaining to dental education can be influential on student preferences and opinions on how dental education should be delivered in a four-year curriculum.

Clinical Outcomes of Comparing Soft Tissue Alternatives to Free Gingival Graft: A Systematic Review and Meta-Analysis.

OBJECTIVES: This systematic review and meta-analysis aimed to compare clinical outcomes and width of keratinized tissue (KT) around teeth, following the soft tissue alter- natives and free gingival graft (FGG) procedures. The specific graft materials that were explored were extracellular matrix membrane, bilayer collagen membrane, living cellular construct, and acellular dermal matrix. METHODS: Four different databases were queried to identify human controlled clinical trials and randomized controlled clinical trials that fulfilled the eligibility criteria. Relevant studies were identified by 3 independent reviewers, compiling the results of the electronic and handsearches. Studies identified through electronic and handsearches were reviewed by title, abstract, and full text using Covidence Software. Primary outcome in the present study was change in the width of KT. Results of the included studies were pooled to estimate the effect size, expressed as weighted mean differences and 95% confidence interval. A random-effects model was used to perform the meta-analyses. RESULTS: Six hundred thirty-eight articles were screened by title, 55 articles were screened by abstracts, and 34 full-text articles were reviewed. Data on quantitative changes in width of KT were provided in 7 studies. Quantitative analyses revealed a significant difference in changes in width of KT between patients treated with soft tissue alternatives and patients treated with FGGs (P < .001). The weighted mean difference of changes in the width of KT was 21.39 (95% confidence interval: 21.82 to 20.96; heterogeneity I 5 70.89%), indicating patients who were treated with soft tissue alternatives gained 1.39 mm less KT width compared with the patients who received free gingival graft. CONCLUSIONS: Based on the clinical outcomes, the results of this systematic review and meta-analysis showed that soft tissue alternatives result in an increased width of KT. Patients in the soft tissue alternatives group obtained 1.39 mm less KT compared with those in the FGGs group.

The Synergy of Periodontic and Orthodontic Collaboration in Contemporary Oral Health Practice.

Orthodontic treatment (OT) has become a means of improving psychosocial well-being secondarily to enhanced occlusal function and can help patients obtain normal oral physiologic function, coordinated facial profiles, and healthy dentomaxillofacial development. With more adult patients undergoing OT, the need for interdisciplinary treatment and collaboration is vital to ensure periodontal health. This article highlights the importance of combined efforts between periodontics and orthodontics in adult patients with a history of periodontitis who are interested in OT. Furthermore, the article discusses the technological and surgical advances within these specialties, as well as timing of synchronization of treatment. A clinical case demonstrates the results of a collaborative periodontics and orthodontics approach to treat an adult patient with a history of advanced periodontal disease.

Correcting mucogingival deformities for pescatarian patients: A clinical case study.

AIM: This clinical case study is to highlight the improvement of periodontal health of mandibular canines using a soft tissue alternative of fish origin, a piscine graft. METHODS: A 37-year-old female patient was referred to a periodontal practice for evaluation of mucogingival deformities around teeth #22 and #27 that were also diagnosed with recession, lack of keratinized tissue (KT), and bilateral high frenum attachment. Multiple soft tissue treatment options were presented to the patient, including autogenous, allograft, or xenograftporcine or piscine. RESULTS: Given the patient's dietary preference, piscine option was preferred. The procedures were completed one at a time, first #22 and later #27, using the standard of care procedures for correcting mucogingival deformities using soft tissue alternatives. Post-surgical visits were scheduled at regular intervals (2, 4, 12, 24, 52 weeks) to evaluate the clinical outcomes. Healing was uneventful and clinical outcomes reveal correction of the mucogingival deformities. The amount of KT at the 52 weeks healing time, measured using an intraoral scanner was 2.12 mm on #22 and 1.78 mm on #27. CONCLUSION: Within this clinical case's scope, piscine xenograft demonstrates to be a safe and effective soft tissue alternative to correct mucogingival deformities, increasing the KT width and achieving recession coverage. In addition, integration of patient's preference may lead to increased case acceptance and patient compliance. KEY POINTS: What new information is this case providing? The use of a soft tissue alternative of piscine origin that was selected based on the patient's preference to correct bilateral combined mucogingival deformities (recession, lack of KT, and aberrant frenum attachment) around teeth. What is a key step to integrating this soft tissue alternative in clinical practice? The pre-hydration of the soft tissue alternative is preferred, compared to other soft tissue alternatives that might not require hydration (xenograft bovine origin). What are the limitations to success in this case? Confirming with the patient no pre-existing fish allergies.

Are Simulators Paving a New Way for Continuing Education?

Simulated learning has been practiced for decades and was a key element in remote learning during the midst of the COVID-19 pandemic. Continuing healthcare education courses for clinicians have incorporated surgical simulators to enable relief from the time constraints encountered in the operating room and provide a more relaxed environment in which to practice complex surgical procedures. Educational research studies show that the implementation of such applications in pedagogy have improved knowledge retention, increased clinician confidence, provided easier access to educational materials, and reduced levels of anxiety about learning. This review highlights the benefits and limitations of surgical simulators. Based on the evidence and current trends, simulated learning signifies a fundamental shift in higher education that is transforming healthcare academic institutions and offering significant potential for continuing dental education.

Faculty perception on clinical shadowing: A concurrent mixed methods study.

PURPOSE: This mixed methods study aims to investigate faculty members' perceptions of early clinical exposure through clinical shadowing program (CSP) at one academic dental institution. METHODS: After ethical approval was received, concurrent data collection using quantitative and qualitative methods was integrated for this study design. For the quantitative data, a validated instrument (Likert scale) was distributed to all basic and clinical science faculty members regarding the CSP. Qualitative semi-structured interviews of basic and clinical science faculty members were conducted to explore their perceptions of the CSP. Descriptive statistics were completed for the quantitative data, and thematic analysis was carried out for the transcribed interviews. RESULTS: Faculty members from basic and clinical sciences participated in this mixed methods study, 97% (n = 74) participants in the quantitative and 12 participants in the qualitative. The majority of faculty (67%; n = 44) strongly agreed that CSP helps predoctoral students in the application of basic science knowledge to clinical practice. All basic science respondents (n = 10; 100%) and many clinical science faculty (60%; n = 35) strongly agreed that CSP requires coordination between basic and clinical science educators (p = 0.042). Some faculty suggested the inclusion of training for educators on the program and regular periodic student assessments of the program's effectiveness. CONCLUSION: The current study reported positive faculty perception toward the proposed method of integration. Furthermore, opportunities to foster coordination between basic and clinical science educators may be provided by administrators to strengthen the existing CSP framework.

Minimally Invasive Coronally Advanced Flap Techniques for Correction of Gingival Recession Defects: A Review.

For treatment of patients with isolated and/or multiple adjacent gingival recession defects, debate exists as to whether minimally invasive coronally advanced flap-based surgical techniques achieve improved root coverage compared with traditional evidence-based techniques. Correction of gingival recession defects requires mucogingival surgery utilizing tissue grafting and/or soft-tissue alternatives. Traditional mucogingival techniques for root coverage using autogenous tissue are associated with patient morbidity and discomfort. Considering the philosophical shift in daily practice from "patient-centered" to "person-centered," minimally invasive surgical procedures are warranted that provide esthetic results with reduced morbidity. This review article evaluates five minimally invasive mucogingival techniques: semilunar, tunneling, modified tunneling, vestibular incision subperiosteal tunnel access, and pinhole. These surgical procedures and their clinical application are compared and contrasted.

Evaluating a dental sleep apnea mini-residency program using the Kirkpatrick model.

OBJECTIVE: The aim of this retrospective study was to evaluate a Dental Sleep Medicine Mini-Residency (DSMMR) continuing education (CE) program using the Kirkpatrick model. METHODS: After receiving ethical approval, data from participants in the 2019-2020 DSMMR CE course were included for the Kirkpatrick evaluation. The analysis was stratified and all the Kirkpatrick levels were integrated: level 1 (satisfaction) was assessed via Likert scale and open-ended questions; level 2 (learning) was evaluated using pretest and posttest knowledge data following Module 1 (M1) and an assessment of multiple-choice questions (MCQs) developed by participants; level 3 (behavior) was evaluated using Likert scale questions; and level 4 (results) was assessed via the percentage of participants who passed the American Board of Dental Sleep Medicine (ABDSM) examination on their first attempt. RESULTS: A total of 90 participants were included in the study. At least 83.1% of participants agreed/strongly agreed with positively worded statements about satisfaction. Knowledge scores significantly increased from pre-M1 to post-M1 (p < 0.001); however, only 15.2% of MCQs were evaluated as well-formulated. At least 88.6% of participants agreed/strongly agreed with positively worded statements about transfer of knowledge/skills to their practice. 91.1% passed the ABDSM examination on their first attempt. CONCLUSION: The evaluation of the 2019-2020 DSMMR using the Kirkpatrick model suggests its overall positive impact as a training program. The Kirkpatrick model provided information that can be used to improve the quality of a program. Future studies should assess other dental CE programs using the Kirkpatrick model or another evaluation model.

The Effect of Dental Flossing Instructions and Technique on Interproximal Bleeding: A randomized control trial.

Purpose Dental floss has been promoted reduce the effects from interdental microbial biofilm, however its efficacy has been questioned in the literature. The purpose of this study was to compare daily flossing instructions using an adapted horizontal vertical flossing technique (AHVFT) and routine oral hygiene on gingival inflammation as indicated by bleeding on probing (BoP).Methods This randomized single-blinded controlled clinical trial was conducted with non-smoking adults presenting with gingivitis and no other systemic diseases. Eligible participants were recruited from a dental school patient population and were randomly assigned to one of two groups. Group A (experimental group) was instructed in how to use the AHVFT once daily and Group B (control group) was asked to continue with their regular oral hygiene practices. Clinical evaluations (interproximal BoP measurements) were performed by blinded, calibrated examiners at two, four, and eight-week intervals; the percentage of sites with interproximal BoP was recorded. Descriptive and inferential statistics were used to analyze the data.Results A total of 36 eligible participants were enrolled in the study: Group A (n=18), Group B (n=18). The mean (±SD) percentage of interproximal sites with BoP was 26.3 (±4.7), 8.6 (±7.3), 7.2 (±5.2), and 7.9 (±5.8) for Group A at baseline, two weeks, four weeks, and eight weeks, respectively. The corresponding values for Group B were 25.8 (±9.9), 15.6 (±12.4), 12.3 (±12.2), and 18.0 (±13.1), respectively. The percentage of sites with BoP was significantly lower for Group A than for Group B (p=.015 at two weeks, p=.009 at four weeks, and p<.001 at eight weeks). Within each group, the percentage of sites with BoP was significantly lower when compared with baseline (p<.008). At the final visit, the percent reduction in BoP for Group A was 70% and 30% for Group B compared with baseline. Most (88.2%) of Group A participants demonstrated mastery of the AHVFT at eight weeks.Conclusion Participants who received Instruction with the daily use of the AHVFT were shown to have reductions in interproximal BoP as compared to participants who had not received instructions in the AHVFT. Positive gingival health outcomes with dental flossing may be technique sensitive.

Using Project Management Principles to Facilitate Interdisciplinary Collaboration.

The impact of interdisciplinary collaboration should always be evaluated from the perspectives of different stakeholders, including patients (and their families/caregivers), healthcare providers, third-party insurance providers, researchers, and companies that provide materials/supplies, to name a few. In an educational environment, the healthcare provider team consists of a dental student/resident and a faculty member. The assessment of outcomes for interdisciplinary collaborations can be multilayered from patient care to education and research. The aim of this article is to review the different layers of assessment (ie, patient care, education, and research) and provide an overview of the benefits and limitations of interdisciplinary care. In addition, the authors compare the varied processes involved in the synergistic care of a patient to a project delivery in an agile environment.

Integrating digital scholarship in dental education: Why, what, and how?

The aim of this perspective paper is to highlight the potential role and value digital scholarship can have in dental education. The use of digital scholarship and alternative metrics for academic assessment, promotion, and tenure is growing rapidly among healthcare scholars and can complement traditional frameworks. The US dental academic institutions might consider expanding the scope of their promotion and tenure guidelines from reliance on publications and grants to a greater appreciation of the impact of the scholar's work in the digital sphere by integrating newer citation indices and altmetrics.

Teledentistry at the Crossroads: Benefits, Barriers, and Beginnings.

Since the start of COVID-19 shelter-in-place orders given as early as March 16, 2020, routine dental care has experienced a sharp interruption. This challenging time has provided an opportunity for healthcare professionals to use and collaborate with available technologies in a meaningful way. One of the silver linings for dental professionals during this time has been the use of teledentistry. While it is not a replacement for a clinical examination, studies show that teledentistry can be utilized to triage cases, maintain contact with patients, and successfully identify abnormal oral lesions. This article explains both the benefits and barriers of teledentistry that specifically apply to pandemic conditions, providing examples of how this modality can be used by different specialties in dentistry. Additionally, the article proposes models of how teledentistry can be effectively integrated in two different settings: the private practice model and dental schools.

Evaluation of Omega-3 piscine acellular dermal matrix membrane as a soft tissue alternative for the treatment of mucogingival defects.

BACKGROUND: The natural Omega-3 lipids in the OADM serve to reduce inflammation. Preliminary results in a human model reported no adverse events and favorable healing and esthetic outcomes. OBJECTIVE: The primary objective of this animal model study was to histologically evaluate the use of Omega-3 piscine acellular dermal matrix (OADM) as a soft tissue alternative in surgically created mucogingival defects. METHODS: Bilateral maxillary canines in 6 adult beagle dogs were randomly assigned to the test (OADM) and control sub-epithelial connective tissue graft (SCTG) groups. Dehiscence defects 4 × 6 mm were created surgically on the buccal surfaces. The OADM/SCTG were placed to completely cover the root surface to the level of the cemento-enamel junction and sutured with resorbable sling sutures. The gingival flap was repositioned to cover the grafts. At two months follow-up, the dogs were sacrificed, and block samples were retrieved, including the whole canine and periodontium. The histological outcomes were evaluated using qualitative analysis. RESULTS: The qualitative histological analysis revealed the oral, sulcular and junctional epithelium had healed with normal appearance on both test and control sites. None of the test (OADM) samples presented with any foreign body reaction. CONCLUSION: The use of this new piscine xenograft resulted in minimal complications and the attachment apparatus healed normally.

Entrustable professional activities framework for assessment of patient handoffs in dentistry.

PURPOSE/OBJECTIVES: The aim of this study is to report data on the lack of a proper patient handoff system in dentistry and dental education and to present a possible solution to integrate this into curriculum using the "entrustable professional activities" (EPAs) framework. METHODS: Delphi participants from seven US dental schools provided feedback on a preliminary definition of handoff, a mnemonic and an assessment rubric. 2019 American Dental Education Association Commission on Change and Innovation in Dental Education (ADEA CCI) participants further evaluated the handoff EPA using the EQual rubric for EPA quality and structure. RESULTS: Delphi participants identified points of transition in dentistry, selected the D-PASS as a mnemonic, and agreed with the evaluation rubric. The ADEA CCI participants agreed the handoff EPA describes work that is essential for the profession and suitable for entrustment. CONCLUSION: The D-PASS rubric is an effective way to assess patient handoffs.

Harvard-Tufts Dental Education Collaborative: Stronger Together.

The authors, with Dr. Sahni representing Harvard School of Dental Medicine (HSDM) and Dr. Dragan from Tufts University School of Dental Medicine (TUSDM), have joined together in a collaborative effort to examine differences and similarities in their respective dental education residency programs. This cooperative work is aimed at exchanging views on various topics related to dental training and amplifying dental education by providing enrichment opportunities to participants in each of the programs. Its primary purpose is to promote improvement in dental education and foster the professional development of leaders in academic dentistry by a novel method of collaboration through a shared model of teaching and learning.

Unexpected: Managing Oral Health in a Complicated Pregnancy

While most pregnancies are healthy and uncomplicated, adverse pregnancy outcomes and pregnancy complications do occur and may frequently present in the dental office. Management of patients with high-risk pregnancies and/or established pregnancy complications within the dental office should be undertaken to establish and maintain optimal oral health and an integrated approach to overall health. The dental team's understanding of potential pregnancy complications, their implications for oral health, and standards for management of patients with a complicated pregnancy within the dental office is critical to the overall well-being of all pregnant patients. Recognizing and differentiating between normal pregnancy sequelae and more serious complications, as well as proper referral to and adequate communication with the perinatal team, are critical to promoting wellness for patients experiencing pregnancy complications.

Types and roles of reviews of the literature in dental education.

Systematic reviews have consistently grown in popularity and reputation. On behalf of the Dental Caucus of the Medical Library Association and with insight from the Director of Faculty Education & Instructional Development at Tufts University School of Dental Medicine, we offer guidance on the wide variety of reviews of the literature available to aid researchers in dental education in selecting the best review to suit their question, team size, time, and needs of the profession.