General dentists and periodontal referrals.

Questionnaire data were collected from 160 MDA members. The data showed that 16 percent of the respondents had not made a periodontal referral during the last month, 67 percent had made one to five referrals, 7 percent between six and 10 referrals, and 10 percent referred more than 10 patients. The number of referrals did not differ as a function of patients' disease characteristics or dentists' periodontal treatment patterns. They were affected by considerations of practice characteristics and patient's oral hygiene efforts. In conclusion, general dentists differ greatly in the number of periodontal referrals they make. Referral frequencies were not affected by diagnostic considerations or treatment patterns.

Periodontal referral patterns of general dentists: lessons for dental education.

The objectives of this study were to investigate periodontal treatment and referral patterns and the considerations used in the process of dentists who make no periodontal referrals, relatively few referrals, or more referrals. Specifically, the role of disease characteristics, patient- and provider-related factors, attitudes towards periodontal referrals, and perceptions of dental education were explored. The relationships between the perceived quality of dental education concerning periodontal diagnosis and treatment and the considerations used in this process were evaluated as well. Data were collected from 160 members of the Michigan Dental Association using a mailed questionnaire. The respondents were predominantly male (77 percent) and white (96 percent) and had practiced for an average of twenty-three years (SD=10.7). While 13 percent of the respondents had not made any periodontal referrals during the past month, 69 percent had referred between one and five patients, and 18 percent more than five patients. Dentists who referred more than three patients per month considered the patients' oral hygiene as more important, had fewer patients from lower socioeconomic backgrounds and more patients with private insurance, and felt less well prepared by their dental education compared to general dentists who referred fewer than three patients per month to a periodontist. The more positively dentists evaluated their dental education in periodontics, the more conservative they were when considering percentage of bone loss as a basis for referral (r=.228; p=.014), the more frequently they used systemic antibiotics in their treatment of periodontal disease (r=.180; p=.036), and the more they considered whether their patients would return after the periodontal treatment (r=.185; p=.028) as a factor in their referral decisions. General dentists' perceptions of the quality of their dental school education in periodontics decreased their willingness to refer patients and increased their desire to treat these patients in their own practices. Future research should analyze the ways in which dental school curricula could prepare students to make timely and necessary periodontal referrals.

Periodontal health, quality of life, and smiling patterns--an exploration.

BACKGROUND: This study explored whether periodontal health/disease affects psychosocial outcomes in smiling patterns of particular subjects and their smile-related quality of life. METHODS: We collected data from 21 regularly scheduled patients in a periodontal graduate student clinic (four males and 17 females; average age: 50.38 years; age range: 24 to 82 years). The subjects were videotaped while watching a funny television (TV) program. Two independent raters rated each videotape at 31 predetermined time points to assess four aspects of the objective smiling patterns of the subjects. In addition, the subjects responded to a questionnaire to assess their smile-related quality of life. Provider ratings and chart review data were used to assess the clinically assessed oral health status of the subjects. RESULTS: The smile-related quality of life of the subjects correlated significantly with indicators of the periodontal health of the subjects, such as the number of mobile teeth (r = 0.681; P =0.000), missing teeth (r = 0.784; P = 0.001), and gingival recession in the esthetic zone (r = 0.718; P = 0.001). Periodontal health and smiling patterns also were correlated. The more teeth with probing depths between 4 and 6 mm the subjects had, the less widely they opened their mouths when they smiled (r = -0.468; P = 0.032); the more hypermobile teeth the subjects had, the less open their smiles were (r = -0.442; P = 0.045) and the more likely they were to cover their mouths when they smiled (r = 0.517; P = 0.017); and the more sites of gingival recession in the esthetic zone the subjects had, the fewer teeth they showed when they smiled (r = -0.491; P = 0.028). CONCLUSIONS: The periodontal health of the subjects affects their smiling patterns and their smile-related quality of life. Poor periodontal health may prevent adults from expressing positive emotions which, in turn, can impact their self-concept as well as their social interactions.

Dental Hygiene Students' Perceptions of Importance and Confidence in Applying Motivational Interviewing During Patient Care.

Purpose: Motivational Interviewing (MI) is an evidence-based, patient-centered counseling approach for eliciting behavior change. In 2012, the University of Michigan (U-M) Dental Hygiene Program significantly enhanced their behavior change curriculum by reinforcing and building upon the Motivational Interviewing segment. The purpose of this study was to examine students' perceptions of the importance of MI and their confidence in applying it during patient care.Methods: A convenience sample of 22 U-M Class of 2015 dental hygiene students who had received an enhanced curriculum participated in this study, utilizing a retrospective, pre-test/post-test design.Results: A Wilcoxon signed rank test was used to compare the differences in average ranks between T1 (Retrospective Pre-Test) and T4 (Post-Test 3) for the importance and confidence questions at each time point for the Class of 2015. Students' perceptions of importance increased with statistical significance in five out of eight MI strategies. Perceptions in confidence increased in seven out of eight strategies. Effect size ranged from .00 to .55. Assessment of qualitative data provided additional insight on student experiences.Conclusion: Student perceptions of importance of using MI and their confidence in applying MI increased in a majority of the strategy categories. Successes with patient health behavior change and challenges with time to integrate this in practice were noted. Research on the longitudinal impact and faculty feedback calibration is recommended.

Effect of Faculty Development Activities on Dental Hygiene Faculty Perceptions of and Teaching About Motivational Interviewing: A Pilot Study.

The aims of this pilot study were to assess dental hygiene faculty members' perceptions of the importance of motivational interviewing (MI) and their confidence in teaching students about MI and to determine the effect of MI training sessions on those perceptions. Participants were a convenience sample of all 16 dental hygiene faculty members who teach in the clinic at the University of Michigan School of Dentistry. Participants' perceptions were assessed prior to a workshop in MI (pretest), immediately after the workshop (posttest 1), and eight months after the workshop, at the end of the academic year (posttest 2). During the same period, some of the workshop participants took part in team grading sessions of audio recordings of student-patient MI interactions. The results showed that the majority of the faculty members perceived it was important to personally embrace the overall spirit of MI during patient care, and they were confident supporting students as well. Their ratings for embracing the spirit of MI increased from pretest to posttest 1, but slightly decreased at posttest 2. This trend was also seen in their assessment of the importance of and their confidence in teaching the eight MI strategies over time. Among the workshop participants, 56% were part of team grading; they reported the most helpful professional development activities overall were team grading (58%) and the workshop (25%). These results suggest the importance of making use of a variety of faculty development activities and of introducing appropriate follow-up to training sessions over time to ensure long-lasting effects. Future research using carefully designed, multi-institution, longitudinal studies is needed to determine the most effective ways to prepare dental hygiene faculty members to educate their students about MI.

Surgical or non-surgical periodontal treatment: factors affecting patient decision making.

BACKGROUND: This study explored which factors affected patients' decisions to pursue either surgical or non-surgical periodontal treatment. METHODS: Data were collected from 74 patients at a regularly scheduled periodontal appointment, at which each patient was told that periodontal treatment was needed, and 2 weeks following the actual treatment. The surveys assessed the patients' decisions and potential determinants of these decisions. The dental anxiety scale-revised, the state-trait anxiety inventory, and the Iowa dental control index were used to measure psychosocial factors. RESULTS: Patients who decided to have surgery did not differ from patients who decided against surgery in sociodemographic variables such as gender, age, education, and socioeconomic status, nor in their desire for control over the treatment decision. However, they had less dental fear and less general anxiety than the non-surgery patients. Although the two patient groups did not differ in their responses concerning how well the dentists had informed them about the procedure, they differed in the degree of trust and rapport with their dentists. CONCLUSIONS: The less dentally fearful and anxious patients were in general and the more they trusted their provider and felt they had good rapport, the more likely they were to accept surgical periodontal treatment. These results stress the importance of good patient-provider communication.

An interdisciplinary approach to case-based teaching: does it create patient-centered and culturally sensitive providers?

This investigation explored whether teaching a case-based seminar influenced dental students' perceptions of the importance of various factors for diagnosis and treatment planning. In addition, the effects of an interdisciplinary approach to case-based teaching were analyzed. During the winter semesters 2004 and 2005, 204 second-year dental students participated in a case-based comprehensive care seminar. The students were randomly assigned either to a section with a behavioral science instructor present or to a section without a behavioral science instructor. At the beginning and end of each semester, the students evaluated the importance of various factors for diagnosis and treatment planning in self-administered questionnaires. This seminar increased students' importance ratings of subjective oral health-related factors (such as dental fear) and diversity-related factors (such as the patient's ethnicity/race) from the beginning to the end of the semester. Students in the section with a behavioral science instructor rated the importance of behavioral and diversity-related factors higher than students in the section without the behavioral science instructor. These findings suggest that interdisciplinary, case-based teaching increased students' appreciation of the complexity of patient care and of a patient-centered, culturally sensitive approach to diagnosis and treatment planning.

Accuracy and consistency of radiographic interpretation among clinical instructors in conjunction with a training program.

There are inaccuracies and inconsistencies of radiographic interpretation among clinical instructors. The purpose of this investigation was to determine if a training program could improve the accuracy and consistency of instructors' ratings of bone loss. A total of thirty-five clinical instructors consisting of periodontal faculty (periodontists and general dentists), dental hygiene faculty, and periodontal graduate students viewed projected digitized radiographic images and quantified bone loss for twenty-five teeth into four descriptive categories. Ratings of bone loss were made immediately before (pretest) and after (post-test 1) initiation of the training program and then again three months later (post-test 2). Ratings were compared to the correct choice categories as determined by direct measurement using the Schei ruler. Overall agreement with the correct choice improved over time (from 64.5 percent to 85.2 percent) with the greatest change from pretest (64.5 percent) to post-test 1 (76.5 percent). Mean and absolute differences improved in three of the four categories, but worsened in one from pretest to post-test 1. This category returned to its original high value at post-test 2. The greatest improvement in consistency among instructors' ratings was seen in one of the four categories, which was "none" (no bone loss). Extension of the training program may further enhance the accuracy and consistency of instructors' radiographic interpretation.

Accuracy and consistency of radiographic interpretation among clinical instructors using two viewing systems.

Accurate and consistent radiographic interpretation among clinical instructors is needed for assessment of teaching, student performance, and patient care. The purpose of this investigation was to determine if the method of radiographic viewing affects accuracy and consistency of instructors' determinations of bone loss. Forty-one clinicians who provide instruction in a dental school clinical teaching program (including periodontists, general dentists, periodontal graduate students, and dental hygienists) quantified bone loss for up to twenty-five teeth into four descriptive categories using a view box for plain film viewing or a projection system for digitized image viewing. Ratings were compared to the correct category as determined by direct measurement using the Schei ruler. Agreement with the correct choice for the view box and projection system was 70.2 percent and 64.5 percent, respectively. The mean difference was better for a projection system due to small rater error by graduate students. Projection system ratings were slightly less consistent than view box ratings. Dental hygiene faculty ratings were the most consistent but least accurate. Although the projection system resulted in slightly reduced accuracy and consistency among instructors, training sessions utilizing a single method for projecting digitized radiographic images have their advantages and may positively influence dental education and patient care by enhancing accuracy and consistency of radiographic interpretation among instructors.

Variation in periodontal diagnosis and treatment planning among clinical instructors.

Consistency in clinical decision making may be necessary for reliable assessment of student performance and teaching effectiveness, yet little has been done to examine variation in periodontal diagnosis and treatment planning among dental school faculty. The purpose of this investigation was to examine variation among faculty in diagnosis and management of common periodontal diseases. Twenty-seven clinical instructors (periodontists, general dentists, dental hygienists, and first- and second-year periodontal graduate students) reviewed three web-based cases and answered a brief questionnaire focusing on radiographic interpretation, periodontal diagnosis, and treatment planning. Response rates for the three cases ranged from 62 percent to 70 percent. Clinical instructors' rating of percent bone loss in the majority of cases varied between three descriptive categories for the same tooth. Greater consistency in periodontal diagnosis was noted within the graduate student group as compared to periodontal and dental hygiene faculty groups. Diagnoses offered for one of the three patients varied between gingivitis and chronic and aggressive periodontitis. Six to nineteen different treatment plans (many with subtle differences) were submitted for each of the three cases. Inter-rater variation was qualitatively more prevalent than intra-rater variation. To our knowledge, this is the first study to document substantial variation among instructors in radiographic interpretation, diagnosis, and treatment planning for common periodontal diseases. Qualitative judgments speculating on the impact of variability among dental school faculty on student performance and patient care can be made but as yet remain unknown. Consistent use of accepted practice guidelines and greater consensus-building opportunities may decrease variation among faculty and enhance dental education.

Providing care for underserved patients: periodontists' and periodontal residents' educational experiences, attitudes, and behaviors.

BACKGROUND: Patients with special health care needs (SHCNs) and patients from underrepresented minority and/or low socioeconomic backgrounds are more likely to have problems accessing oral health care services. The objectives of this study are: 1) to explore how well the dental education of periodontists prepared them to treat these underserved patients, 2) to assess related professional attitudes and confidence when treating these patients as well as professional behaviors, and 3) whether educational experiences are related with attitudes, confidence, and behaviors in this context. METHODS: Survey data were collected from a randomly selected sample of 291 members of the American Academy of Periodontology (AAP) and 64 periodontal residents. RESULTS: Overall, large percentages of residents agreed that their predoctoral and graduate dental educations had prepared them well to treat patients with special needs (predoctoral education: 58%; clinical graduate education: 45%; and classroom-based graduate education: 37%), from different ethnic/racial backgrounds (predoctoral education: 74%; clinical graduate education: 74%; and classroom-based graduate education: 60%), and on Medicaid (predoctoral education: 60%; clinical graduate education: 61%; and classroom-based graduate education: 42%). Practicing clinicians were least positive about their educations. Students were more positive about treating patients on Medicaid and pro bono cases than practicing clinicians. However, the two groups did not differ in their confidence when treating underserved patients. The quality of predoctoral and graduate educations regarding underserved patients correlates with the attitudes, confidence, and behaviors of providers concerning providing care for these patients. CONCLUSIONS: The findings of this study stress the importance of preparing future periodontists in their predoctoral and graduate programs for providing care for underserved patients such as patients with SHCNs. The better that dental education prepares future periodontists to provide care for underserved patients, the more confident periodontists will be when encountering these patients in their own practices and the more likely they will be to contribute to reducing disparities in oral health care access in the United States by treating these patients.