Demographic disparities in dental school selection: An analysis of current UK practices.

INTRODUCTION: Specific social groups remain under-represented within dentistry. While the University Clinical Aptitude Test (UCAT) aims to widen participation in under-represented social groups, there is no evidence in dental education that this aim is being met. MATERIALS AND METHODS: Data over two admission cycles (2012 and 2013), including 3246 applicants to 10 UK dental schools, were analysed. Applicant and selected pools were compared to the UK population. Multiple logistic regression was used to investigate the association between demographic variables and UCAT and receiving an offer of a place at dental school. RESULTS: Over-representation of Female, Asian, least deprived and grammar school groups were found in applicant and selected pools compared with the UK population. White ethnic applicants were significantly more selected than Black (OR 0.25), Asian (OR 0.57) and Mixed (OR 0.80) ethnicities, while least deprived applicants were significantly more selected than most deprived (OR 0.59). Grammar school education increased odds of selection by 1.8 when compared to state school. The addition of UCAT to the model for applicants reduced ethnic disparities but led to disparities between other groups. CONCLUSION: Current widening participation practices focus on attracting applicants from lower socio-economic groups. However, this study showed that ethnicity, sex and educational background biases also affect demographic diversity in dentistry. The UCAT shows promise in levelling the playing field; however, widening access measures will only succeed if selection committees radically change selection processes to address the systemic biases, enabling the dentists of tomorrow to represent the society they serve.

Insights on selection of undergraduate dental students.

INTRODUCTION: The goal of selection to dental education was to find those with the greatest aptitude for dentistry. Recently, schools have introduced a variety of tools; however, these have often been adopted without appropriate evaluation regarding existing evidence for fairness, reliability or validity. We explore dental admissions staff beliefs about the quality of different selection tools, with the objective of exploring their decision-making in implementing selection practices. METHODS: This qualitative study is underpinned by a social constructionist epistemology, in which our principal concern is "explicating the processes by which people come to describe, explain or otherwise account for the world (including themselves) in which they live." We conducted individual interviews with 15 of the 16 UK dental admission leads to elicit their views around admissions processes and aims. Data coding and analysis were initially inductive, using thematic analysis. After the themes emerged, we applied a deductive framework of affordances to group themes and then examined these for heuristics. RESULTS AND DISCUSSION: We identified three main themes; "Selection Tool Use," "Widening Participation Practices," and "Professionalising the Admission Lead Role." Admission leads spoke favourably of tools that allowed a "holistic" view of the applicants "potential". Selection tools were favoured if they enabled "Gut feeling". Leads spoke of evaluating candidates, making sure they were "rounded", and "know what dentistry is all about." In justifying the use of elements of their procedure, the use of heuristics was prominent. CONCLUSION: In order to minimise the potential consequences of poor selection decisions, it is important to acknowledge that dental admission leads are at risk of depending on sub-optimal heuristics to make judgements about effective selection (shaped by previous practices) rather than using more rational decision-making processes based on the extant evidence (regarding the quality of different selection tools). Future research may be usefully informed by the knowledge translation literature to offer solutions for improving selection practices in dental education.

A literature review of the predictive validity of European dental school selection methods.

INTRODUCTION: Selection to dental school is the point at which there is the potential to assess a wide range of candidate attributes and select those most likely to learn, train and work within the profession. Despite this, little is known in terms of what works and what does not work in dental selection in terms of predicting future performance accurately and fairly. Given this, our aim was to synthesise the last 30 years of research investigating the predictive validity of dental school selection methods. METHODS: A search of the electronic databases SCOPUS, Pubmed and Embase was conducted. Results were limited to English language studies published between January 1987 and January 2017. RESULTS: Twenty-one studies were included. Selection tools fell into five broad categories: tests of personal qualities; cognitive ability; academic attainment; psychomotor skills and combined ability tests. Most were retrospective, single-site studies limited to early years of dental school. Weak correlations were reported, but in most cases, these were between small sections of the selection tool and/or the outcome measure. DISCUSSION: There was a notable dearth of published research examining dental schools selection processes across Europe over the last 30 years. Current literature was limited by weak study design and lack of long-term follow-up. CONCLUSION: There is insufficient high-quality evidence from which to draw any conclusions as to the best selection methods to use in dental school selection. Without this, designing selection frameworks for dentistry which are appropriately weighted, reliable and valid remains a challenge.

Cone beam computed tomography in pre-surgical assessment of mandibular third molars.

DesignMulticentre, randomised controlled clinical trial.InterventionPatients referred for third molar removal received a digital panoramic radiograph(PR). Adults with one or more lower third molars in a close relationship with the mandibular canal were eligible for the study. Patients randomised to the cone beam computed tomography (CBCT) group received a high resolution CBCT scan in addition to the PR. All lower third molar extractions were performed under local anaesthesia without sedation and without antibiotic prophylaxis. Information on variables such as experience of the surgeon, duration of surgery and technique for third molar removal were recorded.Outcome measureThe primary outcome measure was the number of patient-reported altered sensations one week after surgery. Secondary outcomes included the number of patients with an objective IAN injury; permanent IAN injury (>6 months); occurrence of other postoperative complications (wound infection, alveolar osteitis); Oral Health Related Quality of Life-14, questionnaire responses; pain (VAS score); duration of surgery; number of emergency visits; and number of missed days of work or study.ResultsThree hundred and forty-one patients with 477 lower third molars were randomised from three centres. Two hundred and sixty-eight patients with 320 mandibular third molars were analysed according to the intention-to-treat principle for the primary and secondary outcomes. The overall incidence of patient-reported altered sensations one week after surgery was 6.3%. At one week there was no difference in subjective IAN injury between the CBCT and PR group. No significant differences were noted between the two groups for any of the secondary outcomes recorded.ConclusionsAlthough CBCT is a valuable diagnostic adjunct for identification of an increased risk for IAN injury, the use of CBCT does not translate into a reduction of IAN injury and other postoperative complications, after removal of the complete mandibular third molar. In these selected cases with a high risk for IAN injury, an alternative strategy, such as monitoring or a coronectomy, might be more appropriate.

What is the Risk of Having Offspring with Cleft Lip/Palate in Pre-Maternal Obese/Overweight Women When Compared to Pre-Maternal Normal Weight Women? A Systematic Review and Meta-Analysis.

OBJECTIVES: The purpose of the study was to identify the risk of orofacial cleft in the offspring of women with pre-maternal obesity/overweight when compared with pre-maternal normal weight women. MATERIAL AND METHODS: MEDLINE and EMBASE were searched from 1980 to July 2014 for cohort, case control and cross sectional studies. BMI were categorized according to WHO recommendation: normal weight (BMI 18.5 - 24.9), overweight (BMI 25 - 29.9) and obese (BMI ≥ 30). RESULTS: Six studies were identified; three case control studies which were used for the meta-analysis and two cross sectional studies and one cohort study. Compared with women of recommended BMI, obese women were at increased odds of pregnancy affected by CLP (OR = 1.16; 95% CI 1, 1.34) and CP (OR = 1.14; 95% CI 0.95, 1.37). Overweight women were also at increased odds of pregnancy affected by CLP (OR = 1.06; 95% CI 0.93, 1.21) but not CP (OR = 0.89; 95% CI 0.75, 1.06). The results of the risk ratios reported in the cross sectional and cohort studies were similar to the results of the meta-analysis. CONCLUSIONS: The results of this study reveal that there is an increased risk of having offspring with orofacial cleft in obese/overweight women. The reason for this association is not known. Although, the risk is small, it is important because of the increasing incidence of obesity.

Can Alcohol Intake from Mouthwash be Measured in Epidemiological Studies? Development and Validation of Mouthwash Use Questionnaire with Particular Attention to Measuring Alcohol Intake from Mouthwash.

OBJECTIVES: The purpose of this study was to develop and validate the mouthwash use questionnaire to determine the lifetime exposure to alcohol from mouthwash and verify that it was suitable for use in general population. MATERIAL AND METHODS: Data were available from three consecutive studies, all collecting information on mouthwash use. In addition, supermarkets and online stores were screened for the brands of mouthwash they sold. Alcohol content of mouthwash was identified from various sources, including laboratory measurements. Alcohol-containing mouthwash use was converted to glasses of wine equivalent. RESULTS: Mouthwash was used by 62% of the participants, and the main benefits reported were refreshment of bad breath (75%), elimination of bacteria (68%) and reduction of plaque formation (47%). Majority mouthwashes used by the participants contained alcohol (61%). Life-time exposure from alcohol in mouthwash was relatively small for most of the study participants: 79% had rinsed for less than one year with alcohol equivalent of one glass of wine per day. There was substantial agreement in mouthwash reporting between different occasions (Kappa > 0.62). CONCLUSIONS: The questionnaire can be used to investigate mouthwash use in the general population and to measure alcohol intake from mouthwash.

Mouthwash use in general population: results from adult dental health survey in grampian, Scotland.

OBJECTIVES: The purpose of this study was to determine the pattern of mouthwash use and to investigate the associated factors in general population. MATERIAL AND METHODS: An Adult Dental Health Survey was conducted on 3,022 residents of Grampian region of Scotland (adjusted participation rate 58.2%). Participants received a questionnaire consisting of questions on oral health and behavioural factors. RESULTS: The majority of participants (38.1%) have never used mouthwash, 17.5% used mouthwash less than once a month, 19.4% used mouthwash once every few days and 25.1% used mouthwash daily. Prevalence of use decreased with age (P < 0.001). Woman were more likely to use mouthwash than men (P = 0.004). Mouthwash use decreased with decrease in the level of deprivation (P < 0.001). Never-smokers were less likely to use mouthwash (40.3%) compared to smokers (53.1%) or those who stopped smoking (46.5%) (P < 0.001). Mouthwash was used by smaller proportion of people drinking alcohol on daily basis (36.6%), than by abstainers (42.2%) (P = 0.012). There was a positive relationship between flossing or brushing pattern and mouthwash use (P < 0.001). There was statistically significant relationship between mouthwash use and reasons for the last dental visit (P = 0.009). When compared to healthy individuals, mouthwash was used by higher proportion of people reporting that they had gum disease (P = 0.001), ulcers (P = 0.001), oral infections or swelling (P = 0.002) or other problems (P = 0.025). CONCLUSIONS: Mouthwash use in general population is associated with socio-demographic, health and behavioural factors.