The evidence-based dentistry initiative at Baylor College of Dentistry.

This report describes the impact of an R25 Oral Health Research Education Grant awarded to the Texas A&M Health Science Center-Baylor College of Dentistry (BCD) to promote the application of basic and clinical research findings to clinical training and encourage students to pursue careers in oral health research. At Baylor, the R25 grant supports a multi-pronged initiative that employs clinical research as a vehicle for acquainting both students and faculty with the tools of evidence-based dentistry (EBD). New coursework and experiences in all 4 years of the curriculum plus a variety of faculty development offerings are being used to achieve this goal. Progress on these fronts is reflected in a nascent "EBD culture" characterized by increasing participation and buy-in by students and faculty. The production of a new generation of dental graduates equipped with the EBD skill set as well as a growing nucleus of faculty who can model the importance of evidence-based practice is of paramount importance for the future of dentistry.

Retention of underrepresented minority students in dental school: one dental schools story.

There is a large disparity between the proportions of African-Americans, Hispanics, and Native Americans in the general population and in the dental profession. While these underrepresented minorities (URMs) as a group make up almost 30% of the United States population, they constitute only about 6% of the nation's dentists. Eliminating this disparity is important in addressing access to care for underrepresented groups. Texas A&M Health Science Center Baylor College of Dentistry (TAMHSC-BCD) enrolled greater numbers and proportions of URM students than any other non-minority school from 2006-2010. Strategies used to achieve this level of diversity include a Whole File Review process; career awareness activities for elementary, junior high and high school students; and academic enrichment programs for college students and college graduates. Retaining and graduating URM students is just as important as enrolling them. TAMHSC-BCD's retention rate over the last five years is 95.7% for all students and 92.5% for URM students. A wide range of services aids in the retention process. These services are available to all students and include monitoring of students' academic performance followed up with academic advisement as appropriate, peer tutoring, an alternative five-year curriculum, professional psychological counseling, professional learning assessments, social support; and mentoring through student organizations. The retention program at TAMHSC-BCD can serve as a model for other dental and other health professions schools seeking ways to ensure the academic success of their URM students. The more of these students we enroll and graduate, the more the problem of access to dental care is addressed.

Creating a Supportive Educational Research Culture at a Dental School by Identifying Obstacles and Solutions.

The aim of this study was to identify the extent of educational research conducted at one U.S. dental school and to assess faculty needs for engaging in it more fully. A task force developed and administered a survey to all the school's full-time faculty members in January 2014. The response rate was 73.6% (n=106/144). The majority of the respondents were clinicians (73%), had a primary responsibility for teaching (80%), and were non-tenure track (62%). Thirty-six percent (n=24) of the non-tenure-track respondents reported being expected to engage in scholarship as well as the 38% (n=40) who were on the tenure track, for a total of 60% (n=64/106). Overall, 51% of respondents reported they had a half-day or less for scholarship. Clinical faculty respondents had significantly less time for scholarship than non-clinical (p<0.001). Two-thirds (n=72, 68%) said they had not received research training, and over half (n=56, 53%) had never conducted educational research. The most common answers for why respondents did not conduct educational research were "do not know how" (n=32%) and "not required" (n=23%). Help with statistical analysis was reported as the most important support factor, followed by having collaborators, help with research design, time, funding, and travel. While overall interest in conducting educational research was moderate (median=5 on a 1-10 scale, IQR=3,8), a highly interested group (n=45) had produced more research than others (p≤0.041). This group desired more small grants (91%) and training opportunities (89%, p≤0.001). In response to one of the findings of this study, a small-grant program of $15,000 annually for educational research was implemented in May 2014. Funded by this program, 11 projects have been initiated with both scholarship and learning improvement outcomes.

Does the Texas First Dental Home Program Improve Parental Oral Care Knowledge and Practices?

PURPOSE: This study evaluated the effectiveness of the Texas Medicaid First Dental Home (FDH) by comparing the oral health knowledge, practices, and opinions of participating vs. non-participating parents. METHODS: A 29-question survey (English & Spanish) was developed and administered to 165 parents of children under three years old (FDH=49, Non-FDH=116) who visited qualifying Medicaid clinics in Texas. RESULTS: Mann Whitney U tests showed that FDH parents scored higher on overall knowledge (P=0.001) and practice scores (P<0.001). FDH parents responded correctly more often than non-FDH about the recommended amount of toothpaste for toddlers (P<0.001). More FDH parents knew tap water was a potential source of fluoride (P<0.001). The FDH parents scored marginally higher about when a child should have the first dental visit (P=0.051). More Non-FDH parents let their child go to sleep with a bottle, sippy cup or pacifier (P<0.001). CONCLUSIONS: FDH visits are having a positive impact on Texas parents by increasing their oral healthcare knowledge and practices. This is the first step towards improving the oral health of children.

The Impact of Community Rotations on the Cultural Competence of Dental Hygiene Students in the State of Texas.

Purpose: Culturally competent health care providers understand cultural attitudes, values, beliefs and practices and are able to use this knowledge to guide patient care. Rising oral health disparities among racial and ethnic minorities require that dental educators emphasize the attainment of cultural competence in order to prepare students to effectively care for patients with backgrounds different from their own. This study investigated the role of community rotations on the cultural competence of second-year Texas dental hygiene students.Methods: A modified version of the validated self-assessing Clinical Cultural Competency Questionnaire (CCCQ) was given to students at twelve Texas dental hygiene programs with a 100% response rate (239/239). Data analysis was performed using the Kendall tau correlation for associations and Kruskal-Wallis and Mann-Whitney U tests for differences among and between groups.Results: Students scored highest in attitude (86th percentile). Time spent in community rotations (p=0.009), number of community rotations (p=0.028), racial/ethnic diversity of program clinic patients (p=0.042), and training hours (p=0.044) were associated with increased cultural competence scores. Students with over 50 community rotation hours (p=0.006) scored significantly higher than students with less than 50 hours. Generally, those with four rotations (p=0.002) scored highest. Those with public clinic (p=0.049) and school (p=0.044) rotations scored significantly higher than those without these experiences. Those with nursing home (p=0.009) and hospital (p=0.026) experience scored lower than those without these experiences. Students seeing the most racially/ethnically diverse patients in program clinics scored higher (p=0.014) than students seeing less diverse patients. Those with 6-10 training hours scored higher (p=0.013) than those with other training levels. Hispanics scored significantly higher than whites in skill and overall cultural competence (p≤ 0.005).Conclusion: Dental hygiene programs should invest time in cultural competence training and choose a robust program of community rotations, while considering the diversity of the student body and clinic patient pool to enhance graduates' cultural competence.

The winds of change revisited: progress towards building a culture of evidence-based dentistry.

In 2008, Texas A&M University Baylor College of Dentistry launched a comprehensive four-year curriculum in evidence-based dentistry (EBD) along with a series of faculty development initiatives to create an EBD culture. The aim of this study was to determine the institution's success in achieving this goal. The assessment tool used was the PEAK instrument, which measures respondents' EBD Practices, Experience, Attitudes, and Knowledge. Two EBD-trained classes of students and one class untrained in EBD (approximately 100 students in each class) were assessed annually. The faculty were assessed before and after completion of the initiative. Nearly all students responded, with samples ranging from 87 to 102; the faculty response rates were 53% (62/117) in 2009 and 66% in 2013 (81/123). In the results, the trained students scored significantly higher in knowledge than the untrained students at each of the first three PEAK administrations (p≤0.001). Regarding confidence in appraising a research report, the first trained group significantly gained in appropriate use of statistical tests (p<0.001), while the second trained group significantly gained in this aspect and five others (p≤0.032). At the final PEAK administration, the second trained group agreed more than the untrained group that EBD was important for the practice of dentistry (p<0.001). Faculty comfort level with reading peer-reviewed articles increased significantly from 2009 to 2013 (p=0.039). Faculty members who participated in the summer EBD Fundamentals course (n=28) had significantly higher EBD knowledge scores than those who did not participate (p=0.013), and their EBD attitudes and practices were more positive (p<0.05). Students and faculty trained in EBD were more knowledgeable and exhibited more positive attitudes, supporting a conclusion that the college has made substantial progress towards achieving an EBD culture.

How well prepared are Texas dental hygienists to recognize and report elderly abuse?

The elderly are the nation's fastest-growing population, and the number of elder abuse victims has reached epidemic proportions. In Texas, dentists and dental hygienists are mandated by law to report suspected abuse. This study surveyed Texas dental hygienists regarding elder abuse education received in dental hygiene school and post-graduation. Respondents were also asked to self-assess their knowledge level in recognizing the six types of elder abuse and to answer questions regarding Texas law and mandatory reporting of abuse. A survey designed for this study was mailed to 780 Texas licensed dental hygienists, representing 10 percent of the Texas dental hygiene population. Respondents were selected using a computer-generated random sample. A second mailing was sent to nonrespondents to prevent response bias. Results were analyzed using Statistical Programs for Social Scientists (SPSS). Over one-half of the respondents (56 percent) stated that abuse education was not part of their dental hygiene school curriculum. Only 46 percent of the respondents who replied that abuse education had been included in the curriculum were educated on elder abuse. A majority of respondents stated they lacked knowledge in recognizing the six types of elder abuse, and 81 percent of respondents reported being unknowledgeable about reporting elder abuse. The current status of elder abuse education in dental hygiene programs and post-graduation is insufficient. Dental hygienists have an obligation to become knowledgeable in recognizing and reporting elder abuse in order to provide complete care for their patients.

Using research for clinical decision-making: evaluating a research report.

Oral healthcare professionals need to ascertain the quality of journals and to read articles critically, distinguishing good from poor research. The oral health practitioner must continually review dental research articles to learn about new options for therapy and oral health products. How does the practitioner know when he/she should incorporate these new procedures into their practice? This continuing education course will present guidelines for critically evaluating the research and for making decisions about how to apply the research findings to clinical practice.

Bridge to dentistry: one dental school's approach to improving its enrollment of underrepresented minorities.

Presently, 25.7% of the U.S. population is comprised of Blacks/African Americans, Hispanics, and Native Americans. The dental school enrollment of underrepresented minorities (URM) does not reflect this demographic distribution. In 1994, URM students comprised 12.68% of enrolled dental students, but in 1999, enrollment decreased to 10.53%. This trend is evident at Baylor College of Dentistry (BCD). Bridge to Dentistry involves formal linkages with local school districts, Texas colleges and universities, community organizations, dental clinics, community dentists, and BCD. The program is unique in that it targets students from kindergarten through dental school. The key components are awareness, attraction, preliminary education, facilitated-entry, admissions, financial aid, and retention. Some important features of the program are visits to area schools, visits to colleges and universities, summer enrichment programs, and academic advising. Preliminary results indicate the effectiveness of the program. BCD has increased its enrollment of URM students 325% over that of 1998. In 1998, 4.7% of the college's first-year student enrollment was URMs. In 2001, 14.6% of Baylor's first-year student enrollment was URMs. Since 1995, BCD has retained 90.6% of its URM students.

Underrepresented minority students' experiences at Baylor College of Dentistry: perceptions of cultural climate and reasons for choosing to attend.

A study was conducted at Texas A&M University Baylor College of Dentistry (TAMBCD) in fall 2011 to identify the reasons underrepresented minority (URM) students chose to attend TAMBCD, the factors that supported their success as enrolled students, and their perceptions of the institution's cultural climate. A survey distributed online to all URM students received a 79 percent response rate (129/164). The respondents were primarily Hispanic (62 percent Mexican American and other Hispanic) and African American (33 percent) and had attended a college pipeline program (53 percent). The top reasons these students chose TAMBCD were reputation, location, and automatic acceptance or familiarity from being in a predental program. Alumni had most influenced them to attend. Regarding support services, the largest percentage reported not using any (44 percent); personal advising and tutoring were reported to be the most commonly used. In terms of climate, discrimination was reported by 22 percent (n=29), mostly from classmates and clinical faculty. The majority (87 percent) reported their cultural competence program was "effective" and agreed that faculty (83 percent), staff (85 percent), and students (75 percent) were culturally competent. Overall, the students were "satisfied" with how they were treated (88 percent), their education (91 percent), and the services/resources (92 percent). This information is being used to continue to improve the school's cultural climate and to conduct a broader assessment of all students.

Achieving student diversity in dental schools: a model that works.

It is well known that there is a large disparity between the proportions of African Americans, Hispanics, and American Indians in the general U.S. population and in the nation's dental profession. While these underrepresented minorities (URMs) together make up almost 30 percent of the population, they comprise only about 6 percent of U.S. dentists. For years, the American Dental Education Association has been diligently working with U.S. dental schools to reduce this disparity by increasing the diversity of their student bodies. However, with approximately 13 percent of first-year dental students coming from URM groups, the proportion of URM students entering dental school continues to remain significantly below that of the general population. Diversifying the dental profession is important for improving access to care for underrepresented groups, and student diversity provides better educational experiences for all students. Texas A&M Health Science Center Baylor College of Dentistry's strategy for increasing the number of URM dentists was to create a series of initiatives that together form a successful comprehensive program addressing students' awareness of and attraction to a dental career, academic enrichment, admissions, and graduation. The cumulative impact of this program is that the college enrolled greater numbers and proportions of URM students than any other non-minority U.S. dental school from 2006 to 2009. This article describes the program that led to these successes.

Dimensions of oral care management in Texas hospitals.

PURPOSE: There is a growing body of evidence that suggests improved oral health can help patient outcomes in hospitals. Yet there are indicators that oral care in hospitals is less than ideal. This study was conducted to quantify and qualify the dimensions of oral care in Texas hospitals with a focus on the dental knowledge, attitudes and practices of nurses and barriers to providing such care. METHODS: A random sample of 582 registered nurses, licensed and employed in Texas, was surveyed about oral care attitudes, practices and knowledge. Frequencies and Spearman correlations were used to describe and analyze the data with SPSS. RESULTS: Ninety-eight respondents returned surveys for a 16.8% response rate. Of these, 52% reported their nursing education did not ("minimally/not at all") prepare them for oral care management. However, they felt oral health was important (95%), felt responsible for oral care (79%) and assessed the oral cavity of their patients (78.6%). Although they reported being "knowledgeable" or "very knowledgeable" about oral health management (67%), their score on the knowledge questions was low (mean=51%, sd=0.132). There was not a significant correlation between the knowledge scores and education levels (ρ=0.136, p>0.05) or knowledge scores and work areas (ρ=-0.080, p>0.05). They also reported such barriers as low priority for oral care, lack of time, no mandate and the need for more resources. CONCLUSION: This study revealed that nurses experienced a disconnect between feeling responsible yet somewhat incapable and/or ill-prepared to provide adequate oral care for their patients. This suggests a possible need for revising nurse education, hospital requirements and protocols for performing oral care and employing dental professionals in hospitals.

Creating an evidence-based dentistry culture at Baylor College of Dentistry: the winds of change.

In the early years of the new millennium, the National Institute of Dental and Craniofacial Research of the National Institutes of Health began funding Oral Health Research Education Grants using the R25 mechanism to promote the application of basic and clinical research findings to clinical training and to encourage students to pursue careers in oral health research. This report describes the impact of an R25 grant awarded to the Texas A&M Health Science Center's Baylor College of Dentistry (BCD) on its curriculum and faculty development efforts. At BCD, the R25 grant supports a multipronged initiative that employs clinical research as a vehicle for acquainting both students and faculty with the tools of evidence-based dentistry (EBD). New coursework and experiences in all four years of the curriculum plus a variety of faculty development offerings are being used to achieve this goal. Progress on these fronts is reflected in a nascent EBD culture characterized by increasing participation and buy-in by students and faculty. The production of a new generation of dental graduates equipped with the EBD skill set as well as a growing nucleus of faculty members who can model the importance of evidence-based practice is of paramount importance for the future of dentistry.

The nonmedical use of prescription stimulants among dental and dental hygiene students.

The purpose of this study was to determine the nonmedical use of prescription attention deficit disorder (ADD) stimulant medication among dental and dental hygiene students. A questionnaire was used to examine demographic information, student experiences, and perceptions of prescription stimulant medication and to determine if students used a prescription stimulant nonmedically. In 2008, 401 surveys were mailed to dental education institutions in the south-central region of the United States, and 243 surveys (61 percent) were returned. The survey found that 12.4 percent of these students used a prescription stimulant nonmedically and, of those, 70 percent took it to improve attention and/or concentration. The most commonly reported stimulant medication used nonmedically was Adderall (77 percent). The majority (87 percent) of the students obtained the medication through friends, and 90 percent began using the drug in college. Even though 74 percent of the students reported being stressed, chi-square analysis found no significant association between nonmedical use of ADD stimulant medication and stress level (p=0.585). Sixteen percent of the students surveyed felt it was easy to obtain stimulant medication for nonmedical use at their school, and 17 percent thought it was a problem within their institution. These results may help administrators and faculty members become aware of potential problems with the misuse of ADD stimulant medication.

Factors affecting the performance of oral cancer screenings by Texas dental hygienists.

PURPOSE: The 5 year survival rates for oral cancer have not changed in the last 50 years. A simple intra- and extra-oral examination provided by health care professionals could help to reduce morbidity and mortality of oral cancer. This study focused on Texas dental hygienists' performance of oral cancer screenings (OCS) and factors that influenced their performance of this examination. METHODS: A 33 question survey of 608 randomly selected Texas dental hygienists was conducted. Frequency, chi-square and Spearman correlation tests were performed. RESULTS: Three hundred and six hygienists replied and provided the data for this study. The data indicated that 45.8% "always" performed OCS, 23.5% performed OCS at the initial appointment and 47.4% at the recall appointment. Experience and comfort level were the greatest influences on OCS performance. Dental hygienists practicing for 16 or more years performed OCS 51.2% of the time, while those with only 0 to 5 years of experience performed OCS 25.5% of the time. A statistically significant correlation (ρ=0.15, p<0.007) was found be tween years of experience and performance of OCS. A significant correlation (ρ=0.18, p<0.001) was found between the identification of a suspicious lesion and the performance of OCS. Forty-nine percent of dental hygienists reported feeling "very comfortable" with intra-oral examinations, but only 26.5% felt "very comfortable" with extra-oral examinations. A statistically significant correlation (ρ=0.16, p<0.001) was found between comfort level in the performance of an OCS and reported frequency of OCS. The majority of subjects performed poorly on the knowledge portion of the survey (mean=53%). There was a significant correlation (ρ=0.22, p<0.001) between attendance at OCS continuing education courses and the performance of OCS. CONCLUSION: Dental hygienists' knowledge about oral cancer was not current and comfort levels with performing OCS were low. These indicate a need for a stronger emphasis on the importance of OCS for students during dental hygiene education and a more thorough continuing education for practicing dental hygienists.

E-teaching and learning preferences of dental and dental hygiene students.

This project was conducted to identify student preferences for e-teaching and learning. An online Student Preferences for Learning with E-Technology Survey was developed to assess computer experiences, the use and effectiveness of e-resources, preferences for various environments, need for standardization, and preferred modes of communication. The survey was administered in May 2008 to all dental and dental hygiene students at Baylor College of Dentistry. There was an 85 percent response rate (n=366/432). About two-thirds of the students found college e-resources effective for learning. They preferred printed text over digital (64 percent) and wanted e-materials to supplement but not replace lectures (74 percent). They reported e-materials would "extensively" enhance learning, such as e-lectures (59 percent), clinical videos (54 percent), and podcasts (45 percent). They reported the need for a central location for e-resources (98 percent) and an e-syllabus for every course (86 percent) in a standard format (77 percent). One difficulty reported was accessing e-materials from external locations (33 percent). Students commented on the need for faculty training and standardization of grade posting. A qualitative theme was that e-resources should not replace interactions with faculty. Some infrastructure problems have been corrected. Planning has begun for standardization and expansion of e-resources. These improvements should enhance learning and increase the options for individualizing instruction, study strategies, and course remediation.

Application of basic science to clinical problems: traditional vs. hybrid problem-based learning.

It is widely acknowledged that clinical problem-solving is a key skill for dental practitioners. The aim of this study was to determine if students in a hybrid problem-based learning curriculum (h-PBL) were better at integrating basic science knowledge with clinical cases than students in a traditional, lecture-based curriculum (TC). The performance of TC students (n=40) was compared to that of h-PBL students (n=31). Participants read two clinical scenarios and answered a series of questions regarding each. To control for differences in ability, Dental Admission Test (DAT) Academic Average scores and predental grade point averages (GPAs) were compared, and an ANCOVA was used to adjust for the significant differences in DAT (t-test, p=0.002). Results showed that h-PBL students were better at applying basic science knowledge to a clinical case (ANCOVA, p=0.022) based on overall scores on one case. TC students' overall scores were better than h-PBL students on a separate case; however, it was not statistically significant (p=0.107). The h-PBL students also demonstrated greater skills in the areas of hypothesis generation (Mann-Whitney U, p=0.016) and communication (p=0.006). Basic science comprehension (p=0.01) and neurology (p<0.001) were two areas in which the TC students did score significantly higher than h-PBL students.