Exploring preferences of older adults for dental services: A pilot multi-national discrete choice experiment.

OBJECTIVES: To pilot an exploration of older adults' future preferences using discrete choice experiments to understand who should provide dental examinations and treatment, where these services should be provided, and participants' willingness to pay and willingness to travel. BACKGROUND: The proportion of older adults in the general population is increasing and is recognised as a pressing public health challenge. MATERIALS AND METHODS: Older people aged 65 years and over were recruited into this study from the UK, Switzerland and Greece. Drawing on earlier stakeholder engagement, a set of choice experiments are developed to explore the future preferences of older people for dental examinations and dental treatment, as they anticipated losing their independence. These were presented to the participants using a range of platforms, because of the COVID pandemic. Data were analysed in STATA using a random-effects logit model. RESULTS: Two hundred and forty-six participants (median age 70 years) completed the pilot study. There was a strong preference across all countries for a dentist to undertake a dental examination (Greece: ß = 0.944, Switzerland: ß = 0.260, UK ß = 0.791), rather than a medical doctor (Greece: ß = -0.556, Switzerland: ß = -0.4690, UK: ß = -0.468). Participants in Switzerland and the UK preferred these examinations to be undertaken in a dental practice (Switzerland: ß = 0.220, UK: ß = 0.580) while participants in Greece preferred the dental examination to be undertaken in their homes (ß = 1.172). Greek participants preferred dental treatment to be undertaken by a specialist (ß = 0.365) in their home (ß = 0.862), while participants from the UK and Switzerland preferred to avoid any dental treatment at home (Switzerland: ß = -0.387; UK: ß = -0.444). Willingness to pay analyses highlighted that participants in Switzerland and the UK were willing to pay more to ensure the continuity of future service provision at a family dental practice (Switzerland: ß = 0.454, UK: ß = 0.695). CONCLUSION: Discrete choice experiments are valuable for exploring older people's preferences for dental service provision in different countries. Future larger studies should be conducted to further explore the potential of this approach, given the pressing need to design services that are fit for purpose for older people. Continuity of dental service provision is considered as important by most older people, as they anticipate losing their dependence.

Preliminary validation of the Dental Clinical Learning Environment Instrument in a Brazilian dental school.

INTRODUCTION: This study aimed to perform a preliminary validation of the Dental Clinical Learning Environment Instrument (DECLEI) in a Brazilian dental school. MATERIAL AND METHODS: Dental Clinical Learning Environment Instrument was translated into Brazilian-Portuguese, and Brazilian DECLEI's items relevance and content validity were assessed using the content validity index (CVI). DECLEI was then distributed to 155 Brazilian undergraduate dental students attending the 7th and 8th semester of dental studies. Principal Component Analysis (PCA) was used as an initial exploration of the Brazilian DECLEI's internal structure. Item-total correlations for the remaining items were calculated to identify items with poor discrimination coefficients. The internal consistency reliability for the final set of 17 items was calculated using Cronbach's alpha coefficient. The sensitivity of the instrument to measure differences between groups regarding year in dental school, race and sex was also assessed. RESULTS: The CVI was ≥0.80 for all 24 items of the Brazilian DECLEI indicating that all items were relevant to the local culture. Principal Components Analysis (PCA) provided evidence of a single dominant component containing 17 items (Cronbach's α = .86), and all 17 items met the benchmark of acceptable item-total correlation. Significant differences were found only when comparing 7th- and 8th-semester students. CONCLUSIONS: Dental Clinical Learning Environment Instrument has the potential to be used as a reliable instrument to measure clinical learning environments for Brazilian dental students.

Dual institution validation of an ageism scale for dental students.

PURPOSE/AIM: Ageism negatively affects health care. This paper presents an extended validation of a novel scale assessing ageism among dental students. METHOD AND MATERIALS: A previously pilot-tested 27-question scale applied to a larger sample (n = 315) from two U.S. dental schools with Principal Component Analysis used to assess internal structure of the measure. Questions whose deletion increased the overall α loading on >1 factor or those unexpectedly grouped in another factor were thoroughly examined. RESULTS: The scale resulted in five statements (grouped in two factors), which explained 63% of the overall variance with a substantially higher reliability value than other solutions (0.76). Two factors highly correlated were grouped together in a single scale. The five statements are "Elderly people do not take good care of their teeth" (0.62), "Elderly patients do not usually comply with dental advice" (0.93), "The Elderly patient does not live long enough to make it worthwhile to invest time and effort in complex dental treatment" (0.81), "The elderly patient does not live long enough to make it worthwhile to invest money in expensive dental treatment" (0.95), and "Dental treatment of elderly patients is too time-consuming" (0.57). CONCLUSIONS: Five items achieved high reliability toward the validity of this scale.

Preliminary Validation of an Instrument to Assess Students' Perceptions of Clinical Learning Environments at U.S. Dental Schools.

Research on dental students' perceptions of clinical learning environments is needed to identify strengths, weaknesses, and need for interventions to sustain high-quality dental education, but a primary challenge has been the absence of an instrument designed to assess these perceptions. The Dental Clinical Learning Environment Instrument (DECLEI) is a new instrument developed specifically for dental clinical learning environments according to psychometric standards and validated in Europe. The aim of this study was to perform a preliminary validation of DECLEI in a U.S. dental school, thus providing data for subsequent validation in a larger, multi-institution sample. After five experienced faculty members assessed DECLEI's item relevance and content validity, the instrument was distributed in 2016 to 144 third- and fourth-year dental students at the University of Iowa College of Dentistry & Dental Clinics. All 144 questionnaires were completed (100% response rate). The results were tabulated and submitted to principal component analysis with an orthogonal rotation to assess internal structure of the measure. Internal consistency reliability was assessed using Cronbach's alpha coefficient and corrected item-total correlations. The results showed that, of the initial 24 items, principal component analysis allowed 18 items grouped in five domains: student-faculty interaction, equipment and patient issues, didactic-clinical components interaction, negative perceptions, and self-assessment. The Cronbach's alpha coefficients for these five domains ranged from 0.52 to 0.80. These results suggest that DECLEI has the potential for use as a reliable instrument to assess students' perceptions of clinical learning environments at U.S. dental schools, thus supporting the need for a definitive validation analysis in a larger sample.

Variation in oral health parameters between older people with and without mental disorders.

This study investigated the variation in the oral examination findings and the subjective oral complaints between older people with and without mental disorders. An interview and an oral investigation were performed in a group of older patients with mental disorders with a mean age of 71.9 years and in a group of older people without mental disease with a mean age of 70.2 years. The analysis did not reveal any statistically significant differences in the dental status of the participants and in the prevalence of oral ulcers and stomatitis. However xerostomia, burning mouth, dysgeusia, and oral malodor complaints were more frequent in patients with mental disorders, whereas general chewing complaints were less frequent. The multiple logistic regression analysis revealed that psychiatric illness was significantly associated with more complaints of dysgeusia and fewer chewing complaints. The increased prevalence of specific oral complaints in the older patients with mental disorders revealed the significant psychopathological compound of these symptoms.