Assessment of Mass Fatality Preparedness and Response Content in Dental Hygiene Education.

When mass fatality incidents (MFIs) occur, they can quickly overwhelm local, state, and government agencies, resources, and personnel. It is important to have a rapid and effective response with skilled, multidisciplinary victim identification teams since specific skill sets are necessary to participate in mass fatality preparedness and response. The aims of this study were to determine the extent of formal education related to mass fatality preparedness and response training in U.S. dental hygiene programs and to assess program directors' perceptions of the need for such training. A 23-item cross-sectional survey was emailed to 319 U.S. dental hygiene programs in 2015. Survey questions addressed if the program offered mass fatality preparedness and response training to its students and how much training was given, as well as collecting respondents' demographics and opinions regarding education and training. An overall response rate of 36% was obtained, with 111 program chairs completing the survey. The results showed that only a small percentage of responding programs incorporated coursework related to mass fatality and preparedness in their curricula. Of the responding programs, 84% had no formal instruction on the role of a dental hygienist in MFIs; however, 53 of 69 program directors agreed or strongly agreed that the role of dental hygienists in MFIs should be covered in dental hygiene curricula. The top three barriers to incorporating such training reported by respondents were time requirements, lack of faculty expertise, and lack of equipment. Future research is needed to establish standardized competencies for mass fatality preparedness and response in dental hygiene education.

Preventive care delivered within Public Dental Service after caries risk assessment of young adults.

OBJECTIVES: To study preventive care provided to young adults in relation to their estimated risk category over a 3-year period. METHODS: The amount and type of preventive treatment during 3 years was extracted from the digital dental records of 982 patients attending eight public dental clinics. The baseline caries risk assessment was carried out by the patient's regular team in four classes according to a predetermined model, and the team was responsible for all treatment decisions. Based on the variables 'oral health information', 'additional fluoride' and 'professional tooth cleaning', a cumulative score was constructed and dichotomized to 'basic prevention' and 'additional prevention'. RESULTS: More additional preventive care was provided to the patients in the 'low-risk' and 'some risk' categories than to those classified as 'high' or 'very high' risk (OR = 2.0, 95% CI 1.4-3.0; P < 0.05). Professional tooth cleaning and additional fluorides were most frequently employed in the 'low-risk' and 'some risk' categories, respectively. Around 15% of the patients in the high-risk categories did not receive additional preventive measures over the 3-year period. There was an insignificant tendency that patients with additional prevention developed less caries than those that received basic prevention in all risk categories except for the 'very high-risk' group. CONCLUSION: The caries risk assessment process was not accompanied by a corresponding targeted individual preventive care in a cohort of young adults attending public dental service. Further research is needed how to reach those with the greatest need of primary and secondary prevention.

Assessment of the oral health knowledge of healthcare providers in geriatric nursing homes: additional training needs required.

OBJECTIVES: This study was aimed at assessing the knowledge of oral health and training needs of health workers in geriatric nursing homes. BACKGROUND: Providing daily oral care to dependent elderly people is the best way to prevent oral disorders. Because there are no dental hygienists in France, health workers play an important role in providing oral care in nursing homes and should have correct and adequate knowledge. MATERIALS AND METHODS: Health workers from 8 geriatric nursing homes in Puy de Dôme (France) completed a 58-item questionnaire. Oral health knowledge regarding dental decay, periodontal diseases, oral hygiene and denture care was assessed. Univariate and bivariate analyses were performed. RESULTS: A total of 99 health workers took part in the study. The total mean score was significantly different if health workers had received training in oral disorders (49.3 ± 11.7 vs. 43.9 ± 10; p < 0.05) or in the maintenance of oral health (50.5 ± 10.5 vs. 42.9 ± 10; p < 0.01). The mean scores obtained in the 'dental decay' subsection and in the 'oral and denture hygiene' subsection were the lowest. CONCLUSION: Geriatric nursing home staff need training in understanding the impact of oral health on general health. Theoretical knowledge of oral diseases has to be improved in order for health workers to understand oral hygiene procedures and to help them identify early oral disorders.

Preparedness of Entering Pediatric Dentistry Residents: Advanced Pediatric Program Directors' and First-Year Residents' Perspectives.

For children to receive needed oral health care, adequate training at both the predoctoral and postdoctoral levels of dental education is required, but previous studies have found inadequacies in predoctoral education that lead to general dentists' unwillingness to treat certain young populations. As another way of assessing predoctoral preparation, the aim of this study was to determine the perspectives of first-year residents and pediatric program directors about residents' preparedness to enter advanced education programs in pediatric dentistry. Surveys were sent to all 74 U.S. program directors and 360 first-year residents. The survey focused on procedures related to prevention, behavior management, restorative procedures, pulp therapy, sedation, and surgery, as well as treating patients funded by Medicaid and with special health care needs. Among the first-year residents, 173 surveys were returned for a 48% response rate; 61 directors returned surveys for an 82% response rate. Only half of the residents (55%) reported feeling adequately prepared for their first year in residency; less than half cited adequate preparation to place stainless steel crowns (SSCs) (42%) and perform pulpotomies (45%). Far fewer felt adequately prepared to provide treatment for children six months to three years of age, including examinations (29%), infant oral exams (27%), and children with severe caries (37%). The program directors were even less positive about the adequacy of residents' preparation. Only 17% deemed them adequately prepared to place SSCs and 13% to perform pulpotomies. Approximately half reported their first-year residents were inadequately prepared to treat very young children and children with severe caries (55% each). This study found that the perceived inadequacy of predoctoral education in pediatric dentistry was consistent at both the learner and educator levels, supporting previous studies identifying inadequacies in this area.

Dental student perception and assessment of their clinical knowledge in educating patients about preventive dentistry.

In today's dental school curricula, an increasing amount of time is dedicated to technological advances, and preventive dentistry topics may not be adequately addressed. Freshman (D1) students participated in a new Introduction to Preventive Dentistry course, which consisted of didactic lectures, active learning breakout sessions and case-based studies. The goal of this study was to determine if D1 dental students completing the course had a better knowledge and comfort level with basic preventive dentistry concepts and caries risk assessment than the upcoming graduating senior dental students. Following the completion of the course, D1 students were administered a survey that assessed their comfort level describing preventive dentistry topics to patients. This was immediately followed by an unannounced examination over the same topics. Senior (D4) students, who had not taken a formal course, reported statistically significant higher comfort levels than D1 students. However, the D4s scored significantly lower in all of the examination areas than the D1 students. Higher scores in D1s may have been due to recent exposure to the course material. However, the basic nature of the content-specific questions should be easily answered by novice practitioners educating their patients on oral disease prevention. As the current data shows lower content-specific scores of basic preventive dentistry knowledge amongst graduating D4 students, this may indicate a need for more guidance and education of students during the patient care. This study showed that implementation of a formalised course for D1 students can successfully ameliorate deficiencies in knowledge of preventive dentistry topics.

Assessment of tobacco dependence curricula in Italian dental hygiene schools.

The aim of this study was to assess the level of tobacco dependence education offered by Italian dental hygiene programs. A fifty-question survey was mailed to the thirty-one active public and private dental hygiene programs in Italy during the 2008-09 academic year. The survey assessed faculty confidence in teaching tobacco treatment, which courses contained tobacco dependence content, the number of minutes spent on specific content areas, and the level of clinical competence that dental hygiene graduates should be able to demonstrate. Surveys were returned by sixteen programs for a response rate of 52 percent. Respondents indicated tobacco dependence education was included in clinic or clinic seminar (56 percent), periodontics (44 percent), oral pathology (31 percent), and prevention (19 percent). All programs reported including the effects of tobacco on general and oral diseases in courses. However, more in-depth topics received less curriculum time; these included tobacco treatment strategies (63 percent) and discussion of cessation medications (31 percent). Interestingly, 62 percent of the respondents indicated they expected dental hygiene graduates to demonstrate a tobacco treatment competency level of a moderate intervention or higher (counseling, discussion of medications, follow-up) rather than a brief intervention in which patients are advised to quit then referred to a quitline. The results of this study indicated that Italian dental hygiene students are not currently receiving adequate instruction in tobacco treatment techniques nor are they being adequately assessed. This unique overview of Italian dental hygiene tobacco dependence education provides a basis for further discussion towards a national competency-based curriculum.

Odontología, Universidad y Sociedad / Dentistry, University and Society

Las reformas en salud en Latinoamérica han fomentado la privatización de los tratamientos en salud, estando asíel acceso a los servicios acorde al poder adquisitivo del individuo. Actualmente, las patologías bucales representan un problema prioritario en salud pública. Comunidades desfavorecidas económicamente tienden a acumular niveles de salud bucal deteriorados. Para reducir las desigualdades en salud bucal, las estrategias y recursos deben considerar las diferencias entre comunidades, promoviendo la odontología preventiva primaria desde una perspectiva comunitaria; teniendo en cuenta aspectos biológicos, contexto social, cultural, económico, ambiental y acceso a los sistemas de atención en salud. Para ello la educación y el cambio de conducta tienen un papel preponderante. La Universidad como componente de la sociedad, tiene como misión participar en la cultura y aportar soluciones a los problemas sociales, articulando la formación en salud bucal comunitaria con la docencia, investigación y extensión, de manera a formar profesionales orientados en la atención de necesidades de la población. La metodología de la investigación científica debe facilitar y contribuir en la generación de nuevos conocimientos que aporten soluciones concretas al mejoramiento en salud bucal comunitaria. Es preciso emprender nuevos esfuerzos en la formación odontológica a nivel nacional. En tal sentido, se presenta una revisión de los aspectos fundamentales que conciernen a la desigualdad en salud, a la educación como punto de partida para la prevención, a la motivación humana y al cambio de conducta del individuo, incluyendo al rol de la Universidad en la propuesta de soluciones a problemas sociales. Palabras clave: Odontología Comunitaria -Educación en Salud Dental - Odontología Preventiva

Health reforms in Latin America have encouraged the privatization of treatments, thus, access to services are dependent of the individual's purchasing power. Oral pathologies currently represent a public health priority. Economically disadvantaged communities tend to present high levels of impaired oral health. In order to reduce inequalities in oral health, both strategies and resources should consider the differences between communities, promoting primary preventive dentistry from a community perspective, while taking into account biological, social, cultural, economic, and environmental aspects, as well as the access to health care systems. In this regard, education and behavioral changes have a major role. The University, as a component of society, has the mission to participate in culture and provide solutions to social problems, articulating community oral health education with teaching, research and extension, in order to form professionals focused on caring for the needs of the population. Scientific research methodology should facilitate and contribute to the generation of new knowledge that provides concrete solutions for the improvement of community oral health. New efforts on dental training nationwide need to be applied. In this regard, fundamental aspects of health inequality, education as a starting point for prevention, human motivation and individual behavioral change, including the role of the University role in the solution of social problems. Keywords: Community Dentistry -Health Education, Dental - Preventive Dentistry

Assessment of implementation of a CAMBRA-based program in a dental school environment.

Caries development is determined by a balance of protective and pathological factors, so the clinician should be able to identify and document those factors, understand their relative weight in disease development or reversal, and make recommendations to patients that will lead to risk reduction. The caries management by risk assessment (CAMBRA) protocol frames these factors into an easy-to-follow template that also guides the clinician in making recommendations. The purposes of this study were to examine implementation of the CAMBRA-based risk assessment program in a predoctoral clinic at one dental school, assess the accuracy of caries risk evaluation by the students, and evaluate the utilization of professionally applied fluoride varnish in a moderate- and high-risk patient cohort. After dental clinic patients were screened for previous caries risk status, sixty-eight moderate- or high-risk patients were invited to participate in the study. At the study visit that included four bite-wing radiographs, a new caries risk assessment (CRA) form was completed. Our results showed that students underestimated the risk in 25 percent of the cases; the underestimation occurred especially when visible cavitation or caries into dentin by radiograph was the only risk factor or when caries were not identified at the initial visit when the CRA form was completed for the first time despite the presence of other high-risk factors. Students also underestimated both risk and protective factors at the initial evaluation visit compared with the study visit. The results show that students were not rigorous enough in documenting these factors and determining the patient's risk. In order to increase the sensitivity of risk assessment, training and recalibration for students and faculty members should be an ongoing process.

Risk Assessment-Based Individualized Treatment (RABIT): a comprehensive approach to dental patient recall.

Patient recall should be a tool to support prevention, allow early intervention, and ensure long-term dental health. Although the concept of patient-customized recall intervals has increased in popularity, recommendations vary significantly. Concepts of risk assessment-derived recalls are described in the literature separately for caries, periodontal disease, and edentulism, but no published guidelines exist for creating patient-centered recall systems that integrate all risks. Further, no recommendations exist regarding oral cancer risk assessment and recall intervals. The evidence shows that recall intervals of less than twelve months do not impact stage and tumor size at diagnosis although increasing this interval may significantly affect the outcome. The typical approach to recall scheduling is that the interval before the next oral health review should be chosen when no further treatment is indicated or on completion of a specific treatment journey. This article advocates a modified approach that supports individualized risk-based recall schedules not only after active therapy is completed but also during the course of treatment. The design of individualized recall schedules would address a patient's risk for caries and periodontal disease and the need to perform periodic oral cancer screenings. Evidence is also presented regarding the timing of recalls for edentulous patients. This article describes design principles for a Risk Assessment-Based Individualized Treatment (RABIT) system, presents an example of an electronic health record (EHR) recall module implemented at one dental school, and identifies barriers to implementation. As EHRs become more prevalent in dental practice, it is expected that the software industry and the profession will collaborate to include RABIT-like concepts in software management packages.

Revolutionising the dental curriculum--delivering better oral health.

There is a paradigm shift taking place in healthcare with the recognition that every consultation should count for health - not merely the treatment of disease - drawing on the principles of health promotion and underpinned by a strong evidence-base for clinical prevention. Institutions such as King's Health Partners [KHP], an academic health science centre in London, recognise that its responsibilities extend beyond the clinical environment to the local community and beyond and that there should be greater emphasis on promoting health. This paper outlines recent proposals by Dental Institute as a clinical academic group within KHP to promote health, the underlying philosophy, actions taken and the evidence-based resources available, as well as the challenges to be overcome.

Saúde pública: auto-avaliação e revisão / Public health: self-evaluation and review

Aborda questões do tipo teste de múltipla escolha, que cobrem o largo espectro formado por subespecialidades da maior relevância na saúde pública, distribuídas em: epidemiologia, estatística vital e demográfica, bioestatística, administração preventiva e social, administração hospitalar, economia da saúde, economia em saúde, saúde materno-infantil, nutrição em saúde pública, odontologia preventiva e social, saúde ocupacional e saúde ambiental e saúde da família. Para cada questão existe resposta comentada que explica e/ou justifica a opção certa e indica as referências bibliográficas onde o assunto pode ser verificado e estudado...

Dentists' opinion and knowledge about preventive dental care in Saudi Arabia: a nationwide cross-sectional study.

AIM: The aim of this study was to determine the dentists' opinions on causes for high prevalence of dental caries in the country and to assess their level of knowledge about preventive dental care. MATERIALS AND METHODS: A questionnaire based national crosssectional survey among 500 dentists was conducted under the auspices of Directorate of Dentistry, Ministry of Health. The data was analyzed using SPSS software version 11.0 and descriptive statistics were obtained. RESULTS: The response rate was 87.8% (n = 439). 83% of dentists identified poor oral hygiene as the major reason for high prevalence of caries, only 39% of patients reportedly brushed teeth at least once a day, oral prophylaxis (83%) is the most common preventive practice followed, social factors (62.5%) are the most challenging barriers in preventive dental programs, 71.3% always give chair side dental health education, school based programs (66.6%) are most effective tools for dental health education. CONCLUSION: Majority of dentists in Saudi Arabia are adequately informed and motivated toward preventive dental care but they are in need of further support from policy makers to enhance preventive dental programs in the Kingdom. CLINICAL SIGNIFICANCE: Oral hygiene should be improved in the country by reaching out to the entire community through extensive and continued education programs.

Assessment of pediatricians dental knowledge, attitude and behavior in Jeddah, Saudi Arabia.

UNLABELLED: Early assessment of the oral health status of children has the potential to reduce or even eliminate oral diseases. Parents rarely take their children to dentist early enough to control dental diseases. However, parents contact pediatricians several times even before the child is born and during the child's early life. Accordingly, pediatricians are considered a perfect and reliable source for oral health control and prevention. AIM: To measure the dental knowledge, attitude and behavior (KAB) of pediatricians in the City of Jeddah regarding oral health status and methods for prevention of dental diseases in children. MATERIALS AND METHOD: Questionnaires consisting of 40 demographic and KAB's questions were distributed to all pediatricians in Jeddah city (605 pediatricians). The KABs' questions consisted of general dental knowledge, preventive dental measures, timing for referral, diet counseling, parafunctional habits and handling of traumatized teeth. A score was given for each question. Percentages of total scores of KABs were compared. RESULTS: The response rate of pediatricians in Jeddah city (363) was 60%. Their mean age was 39.57 years. Pediatricians' KABs were found to be unsatisfactory. The most important observation was that the concept of oral health prevention was deficient. Pediatricians' awareness of fissure sealants, fluoride, dietary counseling, time of first dental visits and thumb sucking were quite limited Pediatricians' knowledge was significantly lower than their attitude and behavior's scores. CONCLUSION: In general, pediatricians' knowledge, attitudes and behavior regarding oral health were not satisfactory.

Interface with a community feeding team to address oral health of special needs children: a pilot project.

PURPOSE: Children with special health care needs (CSHCN) are most in need of anticipatory guidance and prevention. Achieving and maintaining optimal oral health is challenging, due to the many challenges this group faces both in medical and dental care. The purpose of this pilot project was to identify the educational needs of health professionals on a feeding team to prepare them to provide anticipatory guidance to special needs children, along with preliminary investigation into the role of the dental hygienist in improving the oral health of the CSHCN served by the feeding team. METHODS: Small focus groups were used to determine educational needs of the feeding team and provide initial identification of the role of the dental hygienist on the feeding team. RESULTS: The needs assessment indicated interest in an in-service to address connections between oral health and feeding issues, i.e.problems related to tube feeding and oral hypo- and hypersensitivities of the CSHCN. CONCLUSION: This project suggests there is a role for the dental hygienist on the feeding team to provide preventive dental care and referral as well as education for caregivers and therapists. Future research is needed to further delineate the role of the dental hygienist on the feeding team as well as implementation of a model for integrating them into this multidisciplinary team.

Caries risk assessment/treatment programs in U.S. dental schools: an eleven-year follow-up.

The purpose of this survey was to identify the number and characteristics of caries risk assessment/treatment (CRA/ Tx) programs in U.S. dental schools in 2009 and compare the results to those of the 1998 survey. A survey of U.S. dental schools was conducted in 2009 using the same eleven-question survey instrument as in 1998. Results were analyzed using stratified random sampling and chi-square tests for six of the questions. Additionally, data from the other questions were directly compared. Two questions showed a statistically significant difference: an increase in programs supervised by one school department and the number of schools using CRA as a graduation requirement. Positive changes are occurring in the development of CRA/Tx programs in U.S. dental schools. A wide variety of approaches to teaching this subject, including use of terminology and treatment philosophies, is evident. The evolution of this subject has been slow and varied over the past eleven years. Changing from a mainly surgical approach model to a medical model is occurring, but a more integrated method is needed to clarify terminology, diagnosis, treatment, and communications with researchers, clinicians, teachers, patients, and third-party payers.

The University of Newcastle's first cohort of Bachelor of Oral Health students: a social profile.

BACKGROUND: This paper reports on the socio-demographic characteristics of the first year cohort of 52 students enrolled in the Bachelor of Oral Health programme at the University of Newcastle, New South Wales. METHODS: Forty students completed paper-based questionnaires. RESULTS: Results show that the cohort is predominantly female (94%), the mean age of students was 26.3 years and 72.5% of students had worked as dental chairside assistants prior to enrolment as mature-entry students. CONCLUSIONS: This study provided a unique opportunity to compare and contrast the socio-demographic profile of first year BOH students with similar research on first year dentistry students at the University of Sydney. Aspects of the study included age, gender, type of school attended, post-secondary qualifications and work experience, ethnicity, parents' level of education and occupation, and career choice motivation.

La importancia de la inclusión del niño desde su nacimiento en los proyectos de salud bucal de los servicios de salud del Minsa / The importance of including the child from his birth in the oral health projects of the Minsa health services

La salud del niño es compromiso de todos que hay que preservar para prevenir y educar, teniendo en cuenta que la odontología del futuro se basa en una fiel y exacta compresión del niño de hoy. Este trabajo quiere demostrar cómo funciona la odontología educativa, preventiva y motivadora en el Centro de Salud José Olaya del Servicio de Odontología perteneciente a la red Chiclayo, Dirección Regional de Salud de Lambayeque, trabajando en forma coordinada con los servicios de PAI, CRED, Nutrición y Obstetricia, atendiendo a niños, Wawawasis, pronoies y Centros Educativos Primarios y mujeres del Servicio de Ginecología y Obstetricia de José Olaya.

Designing a dental curriculum for the twenty-first century.

A healthcare curriculum must be up-to-date, fit for purpose and relevant to the population it serves wherever that population might be, worldwide. In this paper we describe the rationale for the design and implementation of a curriculum in a new dental school in UK. We assessed the general and dental health needs of our local population and proposed a set of core skills our dentists will need on graduation and in the future. This core learning falls into three domains of learning. The psychomotor domain covers the learning of technical skills for which we use the shorthand 'hands'. The affective domain covers empathy and behaviour management, that is the 'heart'; and the cognitive domain including critical thinking, the 'head'. The three domains require different ways of learning but all are delivered in context in an integrated, case-based spiralling curriculum building in complexity year on year. Students treat patients from half way through year 1, which helps them appreciate the relevance of the 'hands', 'heart' and 'head' of dentistry as they begin to build their knowledge and experience.