Changing the education paradigm in pediatric dentistry.

Traditional curricula of pediatric dental residency programs have overemphasized restorative dentistry while failing to give adequate attention to early diagnosis, preventive disease management, risk assessment, cultural competency, advocacy, community partnerships and interprofessional education. The University of California, Los Angeles, Community Health and Advocacy Training Program in Pediatric Dentistry emphasizes these lesser-taught areas, integrating them within a structured education in classical restorative techniques and Commission on Dental Accreditation-approved standards, providing a diverse curriculum and preparing residents for practice in increasingly diverse communities.

Evaluation of the Oral Health Education Programme for Nurses using an Oral Lesion Simulator.

PURPOSE: This study aimed to investigate the usefulness of a newly developed oral simulator for nursing students' oral assessment education on oral diseases and symptoms. MATERIALS AND METHODS: The participants were first-year students (n=105) at a nursing school in Japan. Ten identical oral simulators with angular cheilitis, missing teeth, dental caries, calculus, periodontitis, hypoglossal induration, food debris, and crust formation were created by a team of dentists. After a 45-minute lecture programme for oral assessment performance with the Oral Health Assessment Tool (OHAT), the ability test with the simulators and the OHAT as well as test feedback were conducted in a 30-minute practical programme. To evaluate the effectiveness of the programmes, questionnaires and ability tests with slides of oral images were conducted at baseline and after the programme. RESULTS: Ninety-nine students (94.3%) participated in this study. The results of the ability test with the simulators and the OHAT in the practical programme showed that the correct answer rates of assessing tongue, gingiva, present teeth, and oral pain were less than 40%. Their levels of confidence, perception, and oral assessment performance were statistically significantly higher after the programmes than they were at baseline. Their level of confidence in assessing the need for dental referral had the largest increase in scores compared to the lowest scores at baseline in the nine post-programme assessment categories. CONCLUSIONS: This study identified several problems with nursing students' oral assessment skills and improvements of their oral assessment confidence, perceptions and performance.

Feasibility of implementing rapid oral fluid HIV testing in an urban University Dental Clinic: a qualitative study.

BACKGROUND: More than 1 million individuals in the U.S. are infected with HIV; approximately 20% of whom do not know they are infected. Early diagnosis of HIV infection results in earlier access to treatment and reductions in HIV transmission. In 2006, the CDC recommended that health care providers offer routine HIV screening to all adolescent and adult patients, regardless of community seroprevalence or patient lifestyle. Dental providers are uniquely positioned to implement these recommendations using rapid oral fluid HIV screening technology. However, thus far, uptake into dental practice has been very limited. METHODS: The study utilized a qualitative descriptive approach with convenience samples of dental faculty and students. Six in-depth one-on-one interviews were conducted with dental faculty and three focus groups were conducted with fifteen dental students. RESULTS: Results were fairly consistent and indicated relatively high levels of acceptability. Barriers and facilitators of oral fluid HIV screening were identified in four primary areas: scope of practice/practice enhancement, skills/knowledge/training, patient service/patient reactions and logistical issues. CONCLUSIONS: Oral fluid HIV screening was described as having benefits for patients, dental practitioners and the public good. Many of the barriers to implementation that were identified in the study could be addressed through training and interdisciplinary collaborations.

A service-learning project to eliminate barriers to oral care for children with special health care needs.

Children with special health care needs face many barriers to oral care and are at high risk for oral disease. School nurses are in a unique position to promote oral wellness in this vulnerable population. Collaboration between school nurses and dental hygiene faculty resulted in the formation of a partnership between a university-based dental hygiene program and two special education districts in rural southern Illinois. Senior dental hygiene students participated in a school-based service-learning project that provided dental examinations, preventive services, and education to children with special health care needs. Evidence-based behavioral interventions were used to teach children to comply with oral procedures. School nurses mentored dental hygiene students in behavior management of children. Dental exams were provided to 234 children from four special education schools with the majority receiving cleanings and fluoride.

A comparative study of student vs supervisor diagnoses of anatomical abnormalities affecting the TMJ.

INTRODUCTION: The use of modern teaching methods and learning tools by educators to ensure competent graduates has been encouraged. At the Department of Odontology, University of Pretoria, School of Dentistry, four diagnostic screening tests were tested as learning tools and their efficacy in teaching undergraduate dental students to diagnose abnormalities affecting the osseous components and associated muscles of mastication of the temporomandibular joint (TMJ). These screening tests are known as joint play, end feel, static pain and dynamic pain. OBJECTIVES: The aim of this study was to determine if dental students would be able to diagnose abnormalities affecting the osseous components and associated muscles of mastication of the TMJ using these four screening tests, as well as to compare their diagnoses with the diagnosis of a prosthodontist. METHODS: One hundred joints were randomly examined for abnormalities by 50 dental students and a prosthodontist. The diagnoses were recorded on a diagnostic form and entered into an electronic Microsoft Excel database. RESULTS: Of the 100 joints examined, 78 of the diagnoses made by the students were in agreement with that of the prosthodontist, which is highly significant (p < 0.001). CONCLUSION: The tests were used successfully by the majority of the students to make a correct diagnosis.

An international survey in postgraduate training in Oral Medicine.

OBJECTIVES: The aim of this preliminary study was to investigate postgraduate Oral Medicine training worldwide and to begin to identify minimum requirements and/or core content for an International Oral Medicine curriculum. MATERIALS AND METHODS: Countries where there was believed to be postgraduate training in Oral Medicine were identified by the working group. Standardized emails were sent inviting participants to complete an online survey regarding the scope of postgraduate training in Oral Medicine in their respective countries. RESULTS: We received 69 total responses from 37 countries. Of these, 22 countries self-identified as having postgraduate Oral Medicine as a distinct field of study, and they served as the study group. While there is currently considerable variation among Oral Medicine postgraduate training parameters, there is considerable congruency in clinical content of the Oral Medicine syllabi. For example, all of the training programs responded that they did evaluate competence in diagnosis and management of oral mucosal disease. CONCLUSIONS: This preliminary study provides the first evidence regarding international Oral Medicine postgraduate training, from which recommendations for an international core curriculum could be initiated. It is through such an initiative that a universal clinical core syllabus in postgraduate Oral Medicine training may be more feasible.

Impact of Oral Health Educational Interventions on Oral Hygiene Status of Children with Hearing Loss: A Randomized Controlled Trial.

INTRODUCTION: Oral health is considered as one of the essential components of the overall health of every individual. Maintaining oral health is a gradual process that requires commitment. Children who require special care such as hearing impairment experience difficulty in maintaining oral health primarily due to communication difficulties. This study is aimed at using different interventions to evaluate the improvement of oral hygiene in hearing impaired children. MATERIALS AND METHODS: Fifty-nine children were recruited in this study that were allocated randomly into each group with twenty children as follows: group 1: pictorial, group 2: video, and group 3: control. Mean plaque and gingival scores were noted before and after the use of different interventions. Oral hygiene was categorized as "excellent," "good," and "fair." Gingival health was categorized as "healthy," "mild gingivitis," and "moderate gingivitis." RESULTS: Thirty-four children (57.6%) were from 12-13 years of age bracket, and 25 (42.4%) belonged to 14-16 years of age. Regarding gender, there were 37 (62.7%) males and 22 (37.3%) females. About comparison of mean gingival and plaque scores before and after interventions in each group, a significant difference was found in group 1 (p < 0.001) and group 2 (p < 0.001), as compared to group 3 where the difference in scores was not significant (p > 0.05). CONCLUSION: Maintaining oral health requires the compliance of individuals to perform different methods of preventive dentistry, such as tooth brushing and use of dental floss. The use of different oral hygiene educational interventions such as pictorial and video methods have been proven and useful for hearing impaired children in improving oral health.

Benefits of mock oral examinations in a multi-institutional consortium for board certification in general surgery training.

The Southeast Michigan Center for Medical Education (SEMCME) is a consortium of teaching hospitals in the Greater Detroit metropolitan area. SEMCME pools its resources for several educational means, including mock oral board examinations. The educational and cost benefits to mock oral examinations on a multi-institutional basis in preparation for the American Board of Surgery (ABS) certifying examination were analyzed. Ten-year multi-institution data from the mock oral examinations were correlated with ABS certifying examination pass rates. Mock oral examination scores were available for 107 of 147 graduates, which included 12 candidates who failed their certifying examination on the first attempt (pass rate = 89%). Four of 31 examinees who had a low score (4.9 or less) in their mock oral exams failed their certifying examination in their first attempt. The cost of running the mock examination was low (approximately $35/resident for 50 residents). When graduates from the last 10 years were surveyed, the majority of respondents believed that the mock oral examination helped in their success and with their preparation for the certifying examination. Thus, the many benefits of administering the examination with the resources of a consortium of hospitals result in the accurate reproduction of real-life testing conditions with reasonable overall costs per resident.

Student versus faculty performance using a new visual criteria for the detection of caries on occlusal surfaces: an in vitro examination with histological validation.

The current study compared three groups of participants with different levels of clinical experience in using the International Caries and Detection System (ICDAS) on occlusal surfaces. Thirty participants (faculty, graduate and undergraduate students), after a lecture and hands-on training session on two occasions, examined 60 occlusal surfaces previously examined by two criteria expert examiners. There were no significant differences between the groups for intra- and inter-examiner agreement for ICDAS severity or activity on occlusal surfaces as measured by kappa. Previous clinical dental experience does not seem to play a significant role in learning ICDAS.

A model for critical thinking measurement of dental student performance.

The educational application of critical thinking has increased in the last twenty years with programs like problem-based learning. Performance measurement related to the dental student's capacity for critical thinking remains elusive, however. This article offers a model now in use to measure critical thinking applied to patient assessment and treatment planning across the four years of the dental school curriculum and across clinical disciplines. Two elements of the model are described: 1) a critical thinking measurement "cell," and 2) a list of minimally essential steps in critical thinking for patient assessment and treatment planning. Issues pertaining to this model are discussed: adaptations on the path from novice to expert, the role of subjective measurement, variations supportive of the model, and the correlation of individual and institutional assessment. The critical thinking measurement cell consists of interacting performance tasks and measures. The student identifies the step in the process (for example, chief complaint) with objective measurement; the student then applies the step to a patient or case with subjective measurement; the faculty member then combines the objective and subjective measurements into an evaluation on progress toward competence. The activities in the cell are then repeated until all the steps in the process have been addressed. A next task is to determine consistency across the four years and across clinical disciplines.

Web-based virtual patients in dentistry: factors influencing the use of cases in the Web-SP system.

We studied the students' acceptance and utilization of virtual patients (VPs) authored by faculty using the Web-SP system over two consecutive years. We also studied factors of importance for the utilization of VPs for self-assessment. Both year-groups studied found the Web-SP system easy to use and their overall opinion of Web-SP was positive (Median: 5, p25-p75: 4-5). They found the VPs engaging, realistic, fun to use, instructive and relevant to their course. Students used, on average, 9.68 VPs per course, which constitutes 43 percent of the available VPs. The number of VPs available seemed to be sufficient for the target course, even if some of the students preferred a higher number of VPs. Of the VPs encountered, 71% (CI: 68-75%) were VPs with feedback, and correspondingly 29% of the VPs chosen were without feedback. The difference in utilization between both types of VPs was significant, at p < 0.001. Thus, the students clearly favoured VPs with feedback compared to VPs without feedback. There were three modes of engagement in which the VP was utilized. Mode 1 was the preferred mode for VPs without feedback, while mode 3 was dominant for VPs with feedback.. Whether or not a VP was selected for review during a teacher led seminar or not, did not affect student behaviour, at least on the surface. Teacher led seminars may still be of importance to provide credibility to the VPs by integrating them into the curriculum.

Oral cancer and dentists: knowledge, attitudes, and practices in Italy.

The purpose of the survey was to assess through a mailed questionnaire the knowledge, attitudes, and behaviors regarding oral cancer and their relationship with different indicators in a random sample of 1000 dentists in Italy. Respondents know the major risk factors and only half identify the diagnostic procedures. One-third indicated the most common form and the early lesions and this knowledge was more likely in those graduated from dental school and attended a course on oral cancer in the previous year. Approximately two-thirds (64.8%) believed that they were prepared to perform an oral cancer examination and to palpate lymph nodes in patients' necks. Multiple logistic regression revealed that this positive attitude was significantly higher for those who graduated from medical school and for those who have attended a course on oral cancer in the previous year. Half of the dentists routinely perform an oral cancer examination on all patients and it was more likely by those graduated from dental school, those who know that squamous cell is the most common form of oral cancer and that an early oral cancer lesion usually is a small, painless red area, those who believed that they are prepared to perform an oral cancer examination and to palpate lymph nodes in patients' necks, those who have attended a course on oral cancer in the previous year, and those who claim they need information. The importance of health care professionals as communicators of public health messages should be emphasized.

Influence of years of professional experience in relation to the diagnostic skill of general dental practitioners (GDPs) in identifying oral cancer and precancerous lesions.

OBJECTIVE: To evaluate skill in diagnosing cancer and oral precancerous lesions among general dentists in the Autonomous Community of Murcia (Spain). MATERIAL AND METHOD: Twenty randomly distributed clinical images were used, of which 45% corresponded to benign lesions, 35% to oral precancerous lesions, and 20% to oral cancer. Each case was accompanied by a summarised clinical history. The study sample comprised 150 general dentists divided into two groups: group I (60 recently graduated dentists without professional experience) and group II (90 dentists with established professional activity). RESULTS: In group I, the sensitivity of oral cancer diagnosis was 61.3% versus 85.5% in group II (p < 0.001), while the sensitivity of precancerous lesion diagnosis was 71.7% in group I versus 80.7% in group II (p = 0.004). CONCLUSIONS: The results obtained show that junior dentists and general dentists with public or private practice need more training and more experience in diagnosing cancer and oral precancerous lesions.

On the reliability of a dental OSCE, using SEM: effect of different days.

AIM: The first aim was to study the reliability of a dental objective structured clinical examination (OSCE) administered over multiple days, and the second was to assess the number of test stations required for a sufficiently reliable decision in three score interpretation perspectives of a dental OSCE administered over multiple days. MATERIALS AND METHODS: In four OSCE administrations, 463 students of the year 2005 and 2006 took the summative OSCE after a dental course in comprehensive dentistry. The OSCE had 16-18 5-min stations (scores 1-10), and was administered per OSCE on four different days of 1 week. ANOVA was used to test for examinee performance variation across days. Generalizability theory was used for reliability analyses. Reliability was studied from three interpretation perspectives: for relative (norm) decisions, for absolute (domain) and pass-fail (mastery) decisions. As an indicator of reproducibility of test scores in this dental OSCE, the standard error of measurement (SEM) was used. The benchmark of SEM was set at <0.51. This is corresponding to a 95% confidence interval (CI) of <1 on the original scoring scale that ranged from 1 to 10. RESULTS: The mean weighted total OSCE score was 7.14 on a 10-point scale. With the pass-fail score set at 6.2 for the four OSCE, 90% of the 463 students passed. There was no significant increase in scores over the different days the OSCE was administered. 'Wished' variance owing to students was 6.3%. Variance owing to interaction between student and stations and residual error was 66.3%, more than two times larger than variance owing to stations' difficulty (27.4%). The SEM norm was 0.42 with a CI of +/-0.83 and the SEM domain was 0.50, with a CI of +/-0.98. In order to make reliable relative decisions (SEM <0.51), the use of minimal 12 stations is necessary, and for reliable absolute and pass-fail decisions, the use of minimal 17 stations is necessary in this dental OSCE. CONCLUSIONS: It appeared reliable, when testing large numbers of students, to administer the OSCE on different days. In order to make reliable decisions for this dental OSCE, minimum 17 stations are needed. Clearly, wide sampling of stations is at the heart of obtaining reliable scores in OSCE, also in dental education.

A Computer-Assisted Training Approach for Performing and Charting Periodontal Examinations: A Retrospective Study.

The aim of this study was to retrospectively investigate the development of a model-based, computer-assisted training approach for performing and charting periodontal examinations in a dental clinic in Germany. The study was initiated in summer semester 2013 and repeated in two consecutive semesters (S1: 44 students, S2: 48 students, and S3: 61 students) because technical features were introduced (S2: feedback and time control; S3: input control). In each semester, new dental students who had never performed periodontal examinations participated. Students were divided into two groups and received intense training at different time points. Agreement levels were calculated at baseline, after the first group received training, and after the second group received training. Comparisons were also made among the semesters. All 153 enrolled students in the three semesters participated. The results showed that probing depth accuracy significantly decreased in S1 from baseline to training completion (79.9% to 74.5%), and the probing depth accuracy significantly increased in S2 (76.1% to 78.9%) and S3 (77.2% to 82.3%). The students who received intense training at a late stage of the tutorial showed greater improvement, especially in the case of S3. Small changes in accuracy were observed for recession (S1: 94.5% to 96.1%; S2: 93.8% to 93.9%; S3: 95.4% to 96.6%). Accuracy for furcation involvement improved significantly in S1 (46.1% to 52.0%), S2 (46.8% to 59.7%), and S3 (44.2% to 58.3%); the improvements occurred when the students received intense training. The time taken for periodontal examination decreased significantly for S2 (23.6 to 14.2 min) and S3 (25.7 to 13.9 min). This study found that when feedback was provided, the students' periodontal examinations improved in accuracy and duration.

Epidemiology of primary oral cancer diagnostics in Kaunas.

INTRODUCTION: Ability for general practitioners and dentists to successfully identify oral cancer (OC) and knowledge about it has a huge influence in further primary diagnosis and good specialized treatment and care. It is very important to realize what obstacles appear in medical care professionals (dentists and general medical practitioners(GPs)) way for primary oral cancer diagnostics. PURPOSE: To find out the insight of primary oral cancer diagnostics in Kaunas city. GOALS: to analise knowledge of society about oral cancer and its primary symptoms; to evaluate and compare the insight of POCD for general medical practitioners and dentists; to appraise the oncological awareness and evaluate the experience in oral oncology for mentioned medical care proffesionals. MATERIALS AND METHODS: Questionnaires were prepared for patients and medical professionals. Permission for investigation was confirmed by LUHS Bioethical centre. Questioning was done in Kaunas city (Lithuania) and its districts. RESULTS: 100 questionnaires were collected from random people, questioned at health care centers and 106 questionnaires were given to medical staff (64 for dentists and 42 for general medical practitioners); 81% of GPs and 75% of dentists claims to have low insight on POCD; 83,3% of GPs and 46.9% of dentists claims that they have not enough learning experience on POCD from graduated university. Although, only 4,8% of GPs and 6,2% of dentists updated their knowledge on POCD after graduation. CONCLUSIONS: Society agrees having a poor knowledge on POCD; GPs and dentists are not educated enough for POCD; GPs pay too little attention for oral cavity examinations and are in shortage collaborating with dentists about POCD.

Children's oral health in Italy: training and clinical calibration of examiners for the National Pathfinder about caries disease.

PURPOSE: To evaluate the dental status of 12-year-old children in 2004, an epidemiological survey called 'National pathfinder about children's oral health in Italy' was planned. The present paper describes the clinical calibration method. MATERIALS AND METHODS: Thirty children (20 caries-affected and 10 caries-free) were selected. Seven examiners received 35 hours of training and calibration in making clinical measurements by a single trainer. The trainer's diagnosis was the benchmark validity reference. Increase in sensitivity was tested using paired Student's t-test. Inter-examiner reliability for DMFS was evaluated using Pearson's correlation coefficients and ANOVA. Percent agreement and Kappa statistics were calculated for dichotomous judgments (tooth-by-tooth analysis and caries prevalence). RESULTS: The raters' sensitivity increased from calibration I to calibration II (p < 0.05). For DMFS a good agreement between raters was found without significant differences among them at both calibration exercises. The Pearson's correlation coefficients between all pairs of raters were significant (p < 0.001) after both calibration exercises. Tooth-by-tooth reliability was high: the strength of agreement was substantial or almost perfect in calibration I (Kappa statistics from 0.81 to 0.95) and almost perfect in calibration II (Kappa statistics from 0.92 to 0.97). Regarding caries prevalence, sensitivity, specificity, percent agreement and Kappa statistics results were high but without significant differences between individual pairs of observations in the two calibration sessions (p > 0.05). CONCLUSIONS: The results suggest that sensitivity measurements should be used for agreement assessments in addition to the other World Health Organization-recommended reliability measurements. Kappa statistics are the eligible measurement of reliability for dichotomous judgments.

Use of the OSCE to evaluate brief communication skills training for dental students.

Although communications competency is recommended by the American Dental Education Association, only a few (n=5) dental schools report evaluating students' skills using a competency examination for communication. This study used an objective structured clinical examination (OSCE) to evaluate dental students' competency in interpersonal and tobacco cessation communication skills. All students were evaluated on their interpersonal communication skills at baseline and at six months post-OSCE by standardized patients and on their tobacco cessation communication skills by two independent raters. First- and second-year dental students (n=104) were randomized to a control or intervention group. One month after the baseline OSCE, students in the intervention group participated in a two-hour training session in which faculty members communicated with a standardized patient during a head and neck examination and counseled the patient about tobacco cessation. There were no statistically significant differences from baseline to post-test between the intervention and control group students as measured by the OSCE. However, among first-year students, both the intervention (n=23) and control (n=21) groups significantly increased in tobacco cessation communication scores. Second-year students in both intervention (n=24) and control (n=28) groups declined in interpersonal communication skills from baseline to post-test. Overall, this one-shot intervention was not successful, and results suggest that a comprehensive communication skills training course may be more beneficial than a single, brief training session for improving dental students' communication skills.