Preferences Related to the Use of Mobile Apps as Dental Patient Educational Aids: A Pilot Study.

PURPOSE: Numerous patient education apps have been developed to explain dental treatment. The purpose of this study was to assess perceptions and preferences regarding the use of apps in dental settings. MATERIALS AND METHODS: Four patient education apps describing fixed partial dentures were demonstrated to participants (N = 25). Questions about each app were asked using a semi-structured interview format to assess participants' opinions about each app's content, images, features, and use. Sessions were analyzed via note-based methods for thematic coding. RESULTS: Participants believed that apps should be used in conjunction with a dentist's explanation about a procedure. They desired an app that could be tailored for scope of content. Participants favored esthetic images of teeth that did not show structural anatomy, such as tooth roots, and preferred interactive features. CONCLUSIONS: Patient education apps may be a valuable tool to enhance patient-provider communication in dental settings. Participants exhibited varying preferences for different features among the apps and expressed the desire for an app that could be personalized to each patient. Additional research is needed to assess whether the use of apps improves oral health literacy and informed consent among patients.

Poor Oral Health Literacy May Lead to Missed Dental Appointments.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: The association between oral health literacy and missed dental appointments. Baskaradoss JK. JADA 2016;147(11):867-74. SOURCE OF FUNDING: Information not available TYPE OF STUDY/DESIGN: Unmatched case-control study that used a convenience nonprobability sampling method.

Dental students' perceptions of standardized patient experiences using Zoom: Dyadic factors.

PURPOSE: The COVID-19 pandemic required a rapid transition to online education, including simulations. The current study identified students' perceptions of communicating with standardized patients in a virtual setting. METHODS: This qualitative study thematically analyzed 485 reflections submitted by 248 students between Spring 2020 and Spring 2022. Statements describing both the virtual medium and dyadic interactions between students and patients were coded for emergent themes and also coded as positive (facilitative) or negative (critical). RESULTS: Four themes emerged from the data related to the virtual medium: impact on nonverbal communication, patient engagement/rapport, presentation aids, and listening. Within these broad themes, 13 subthemes were identified, nine of which were negative/critical. Technology problems were specifically identified as compromising both engagement and listening. Even when technology worked well, students noted that it reduced the number of message cues received from the patient and complicated the process of sending cues (e.g., by requiring students to look away from a patient's face to make "eye contact" through a camera). CONCLUSIONS: Overall, students were critical of Zoom's impact on dyadic factors with standardized patients. However, they did acknowledge some positive aspects regarding the technology. These findings provide a foundation to consider when teaching students how to communicate effectively via teledentistry.

The interactive effects of oral health literacy and acculturation on dental care use among Hispanic adults.

OBJECTIVE: Assess whether there is an interactive effect between oral health literacy and acculturation on dental care use for Hispanic adults. METHODS: Self-identifying Hispanic adults participated in this observational study (N = 338). Oral health literacy (low vs. high) was measured using the Comprehensive Measure of Oral Health Knowledge (CMOHK). Acculturation (low vs. high) was measured using the Short Acculturation Scale for Hispanics (SASH) and operationalized a second way by the language in which the survey was completed (English or Spanish). The outcome was dental care use in the past year (yes/no). Confounder-adjusted modified Poisson regression models were run to generate risk ratios (RR) and to test the hypothesis that participants with high oral health literacy and high acculturation would be more likely to have used dental care in the past year than participants with low oral health literacy and low acculturation. RESULTS: About 65% of participants used dental care in the past year. The final models failed to show that participants with high oral health literacy and high acculturation were more likely to have used dental care than other participants. However, in the language proxy interaction model, participants with high oral health literacy and low acculturation were significantly more likely to have used dental care than participants with low oral health literacy and low acculturation. CONCLUSION: There may be an interaction between oral health literacy and acculturation when modeling dental care use for Hispanic adults that should be further explored.

Significant indicators of intent to leave among Army Dental Corps junior officers.

OBJECTIVE: To identify the significant predictors associated with Army Dental Corps junior officers' intent to leave (ITL) the military. METHODS: A secondary data analysis of the 2009 Army Dental Officer Retention Survey was conducted. Frequencies, bivariate, linear, and logistic regression analyses were calculated. RESULTS: Forty-six percent of junior officers completed the survey (N = 577; n = 267). Fifty-eight percent of respondents reported an ITL the military before retirement. The following variables were positively associated (p < 0.05) with ITL: unit of assignment, specialty training status or area of concentration, military lifestyle, and residency training. Age and benefits were negatively associated with ITL. CONCLUSION: This study suggests that ITL is a multifactorial issue.

An evaluation of the geriatric dental curricula within Advanced Education in General Dentistry and General Practice Residency programs in the United States.

AIM: To compare the geriatric dentistry curricula between Advanced Education in General Dentistry (AEGD) and General Practice Residency (GPR) programs. METHODS: A 108-item survey was developed to assess residents' didactic and clinical experiences pertaining to geriatric patients. Surveys were mailed in 2018 to all AEGD (N = 89) and GPR (N = 180) program directors. Statistical analysis consisted of descriptive and bivariate analyses with the chi-square test, Fisher's exact test, and the Wilcoxon rank sum test (alpha = .05). RESULTS: Twenty-four AEGD and fifty-eight GPR directors completed surveys (response rate = 30%). Seventy-one percent of responding programs reported mandatory didactic training pertaining to frail and functionally dependent geriatric adults. Ninety-nine percent of respondents reported that residents provided treatment to geriatric patients; however, they were less likely to perform procedures on frail and functionally dependent patients. Only 15% of respondents provided nursing home care. Considering all patient encounters, responding GPR programs were more likely than AEGD programs to treat patients using IV bisphosphonates (63% vs 25%; P < .01), undergoing chemotherapy (48% vs 16%; P = .02), and undergoing head and neck radiation therapy (55% vs 25%; P = .02). CONCLUSION: A majority of responding AEGD and GPR programs reported providing educational experiences pertaining to geriatric patients; however, GPR programs reported treating more medically complex patients than AEGD programs.

Repair versus replacement of defective direct restorations: A cross-sectional study among US dentists.

BACKGROUND: Repair increases the longevity of restorations and is well-accepted by patients. In this study, the authors assessed the acceptance of dental restoration repair by dentists and determined the main variables of repair versus replacement of defective restorations. METHODS: A 15-item questionnaire was developed and distributed electronically to the American Dental Association Clinical Evaluators panel members (n = 785) during a 2-week period in 2019. Descriptive, bivariate, and multivariable analyses were conducted. RESULTS: Of the 387 respondents, 83.7% stated that they repair defective restorations, and 16% stated that they always replace them. Reasons to forego a restoration repair among dentists who perform repairs included defect size and carious lesion extension (42%) and negative personal experience or lack of success (37.9%). However, the latter was considerably higher for dentists who do not perform repairs (60.7%). The most commonly cited patient-related reason and tooth condition to repair restorations were limited patient finances (67%) and noncarious marginal defects (86%), respectively. Neither sex nor age group was significantly associated with the practice of restoration repair (P = .925 and P = .369, respectively). However, sole proprietors were more likely to perform repairs than those in an employee, associate, or contractor practice setting (P = .008). The most significant reason to forego restoration was negative experience or lack of success (P = .002). CONCLUSIONS: Restoration repair is considered a treatment option for managing defective restorations. Negative personal experience or lack of success and practice setting influenced the dentists' decision to repair or replace a defective restoration. PRACTICAL IMPLICATIONS: Understanding dentists' clinical challenges and practice environment is necessary when advocating for this approach.

Dentists' treatment of underserved populations following participation in community-based clinical rotations as dental students.

OBJECTIVE: The purpose of this study was to identify which underserved populations are being treated by dentists after participation in community-based clinical rotations as dental students and to determine which predictor variables are associated with dentists' treatment of these populations. METHODS: A 25-item written survey was developed and mailed to University of Iowa College of Dentistry alumni (1992-2002; N = 745) to assess what percentage of their current total patient population was composed of each of the twelve identified populations. Separate statistical analyses (descriptive, bivariate, and generalized logistic regression) were performed for each underserved population. RESULTS: Three-hundred seventy-two dentists responded for an adjusted response rate of 50 percent. Respondents were most likely to treat "other ethnic groups" and low income populations. In contrast, 70 percent or more of all respondents said they never treat the homebound, homeless, and incarcerated. Additionally, over 40 percent of respondents said they never treat HIV+/AIDS patients and Medicaid patients. Logistic regression models showed that comfort in treating a population, treating more than seven populations, and having the total percentage of underserved populations treated within a practice total more than 50 percent were the most frequently associated (P < 0.05) and strongest predictors of treating the listed underserved populations. CONCLUSIONS: Although respondents reported treating most populations, community leaders and dentists should identify at-risk populations and develop protocols to help ensure that these populations are able to obtain, at a minimum, emergency care. Additionally, dental schools should develop educational curricula to help increase students' comfort in treating underserved populations.

Prescribing practices for antibiotic prophylaxis in patients with prosthetic joints.

AIMS: With the increasing number of patients with prosthetic joints, recommendations for antibiotic prophylaxis (AP) prior to dental procedures to prevent prosthetic joint infections (PJI) have changed. METHODS AND RESULTS: This survey evaluated dentists' AP practices for patients with prosthetic joints undergoing dental procedures and their familiarity with the American Dental Association Guidelines (ADA CPG) and American Academy of Orthopaedic Surgeons Appropriate Use Criteria (AAOS AUC). Dentists' attitudes about antibiotic resistance, medical-legal aspects, and adverse effects to using AP were examined. Dentists (n = 574) were familiar (51.2%) with ADA CPG and with the AAOS AUC (25.8%). Familiarity varied according to years since graduation. Female dentists (63.5%) were more likely to be very familiar with the ADA CPG than male dentists (49.5%). Overall, 65.4% of respondents believed that AP is not effective in the prevention of PJI, and 19.4% believed there is enough evidence to support AP. For a healthy patient, 28.9% of dentists would never recommend AP, 44.9% would recommend AP within the first two years since prosthetic joint replacement. CONCLUSIONS: Dentists' recommendations for the use of AP varied depending on different factors, including health status of the patient, dental procedure, time elapsed since joint surgery, suggesting that adherence to the ADA CPG and AUC is still challenging.

Predictors of Dental Students' Anticipated Willingness to Treat Underserved Populations Five Years After Graduation.

The aim of this study was to assess which variables were associated with dental students' anticipated willingness to treat 13 underserved populations as dentists five years after graduation. A questionnaire was distributed from 2008 to 2014 to all 240 first- through fourth-year dental students at the University of Iowa College of Dentistry & Dental Clinics. Only participants who completed surveys in each of their four years (n=132) were included in data analysis. The results showed that professional and personal interactions with each population, along with feeling comfortable and competent in treating a population, were most often associated with the students' anticipated willingness to treat underserved populations. In contrast, the participants' personal and demographic variables were less frequently associated with an anticipated willingness to treat underserved populations. In addition, shadowing a dentist before dental school and volunteering, either before or during dental school, were rarely associated with participants' anticipated willingness to treat underserved populations. These findings suggest that providing dental students with multiple positive opportunities to treat underserved populations may help them become more willing to treat underserved populations after they graduate.

Dentists' comfort in treating underserved populations after participating in community-based clinical experiences as a student.

The purpose of this project was to determine new dentists' comfort levels in treating traditionally underserved populations after participating in two consecutive five-week community-based clinical experiences while in dental school. A written survey was mailed to all known University of Iowa alumni (1992-2002; N=745). Respondents were asked to rank their comfort levels in treating twelve underserved populations on a five-point Likert type scale (5=no problem; 1=will not). Bivariate and logistic regression model analyses were performed to examine associations (p<0.05) among comfort and six predictor variables. Alumni (n=372) were most comfortable treating other ethnic, low-income, non-English-speaking, and HIV+/AIDS populations and least comfortable treating incarcerated and homebound populations. The following variables were significantly associated with comfort: 1) perception that the community experiences had great/much value; 2) practice located in larger communities; 3) non-solo practitioners; and 4) dentist's gender. As more dental schools utilize community-based clinical experiences to increase students' exposure to underserved populations, it is important that these experiences provide exposure to a variety of populations. Additionally, dental schools should continuously monitor the short- and long-term value of these programs for their students and recent graduates.

Oral health knowledge levels of Hispanics in Iowa.

BACKGROUND: Hispanics disproportionately experience preventable oral health conditions in the United States. This study aimed to determine the oral health knowledge (OHK) of Hispanic adults in Iowa to identify potential gaps in knowledge. METHODS: This cross-sectional study included a convenience sample of self-identifying Hispanic adults. Data pertaining to oral health literacy and demographic, cultural, and dental characteristics were collected. OHK was assessed with the Conceptual Measure of Oral Health Knowledge, and it was categorized as low or high. Bivariate analyses and multiple logistic regression models were conducted to identify the variables related to OHK (P < .05). Institutional review board approval was obtained. RESULTS: Three hundred thirty-eight participants completed the questionnaire, 68% of participants completed the questionnaire in Spanish, and 51% of all participants had low OHK. Participants were less likely to correctly answer questions pertaining to children's oral health, periodontal disease, and oral cancer. Low OHK was associated with having less than 12th grade education, lack of dental insurance, and preference for a Spanish-speaking oral health care provider. CONCLUSIONS AND PRACTICAL IMPLICATIONS: OHK appears to be low in this population. Increasing OHK may help decrease oral health disparities and improve oral health outcomes. Furthermore, it is important that oral health care providers have an understanding of barriers that can impede patients' understanding of the health care system. Specifically, minority populations, such as Hispanics, may have a harder time because of certain cultural differences that exist among this ethnic group.

Students' opinions about treating vulnerable populations immediately after completing community-based clinical experiences.

The purpose of this study was to analyze students' perceptions of comfort and anticipated willingness to treat selected special needs and traditionally underserved populations immediately upon completion of community-based clinical assignments. The sample consisted of University of Iowa senior dental students who completed a questionnaire that asked, in part, about student comfort with and future willingness to treat twelve vulnerable population groups. With student comfort and future willingness to treat each group as dependent variables, logistic models were developed to determine whether there were significant associations between dependent variables and gender, graduation year, and students' prior experience with these groups. Regression models indicate students' prior experience is most often associated with comfort in treating the associated population group. Likewise, experience and comfort add different dimensions to perceived future willingness to treat almost all of the twelve groups. Student gender, graduation year from dental school, and community assignments influence only a few of these targeted population groups. This study provides empirical evidence concerning students' perceptions about comfort with various vulnerable populations after completing their extramural rotations. Students were more comfortable treating certain population groups as well as more willing to consider including these groups in their future practices.

General dentists' referrals of 3- to 5-year-old children to pediatric dentists.

BACKGROUND: Little is known about general dentists' referral patterns. The authors explored the practice, dentist and patient characteristics associated with general dentists' likelihood of referring children aged 3 to 5 years to pediatric dentists. METHODS: The authors sent all Iowa general dentists (N = 1,089) a 25-item questionnaire regarding the referral of children in their practices. The authors merged the resulting information with an existing database (Iowa Dentist Tracking System) to create the dataset. A total of 65.4 percent of the dentists (712) participated. RESULTS: Logistic regression analysis demonstrated that an increase in the percentage of children in the practice decreased the likelihood of the dentist's referring the children (odds ratio [OR] = 0.93, 95 percent confidence interval [CI] = 0.90 to 0.96). Practices with more than 5 percent of patients with public insurance were more likely to refer children (OR = 1.96, 95 percent CI = 1.26 to 3.06), as were dentists with additional training beyond dental school (OR = 1.69, 95 percent CI = 1.06 to 2.69). CONCLUSION: These data indicate that both practice and dentist characteristics are associated with the likelihood of making referals; however, there needs to be further study on general dentists' referral decisions. PRACTICE IMPLICATIONS: As the characteristics of the dental work force evolve, there is a need to study referral patterns and the influence they have on work force policy, patient accessibility and educational curriculum.

An Exploration of Dental Students' Assumptions About Community-Based Clinical Experiences.

The aim of this study was to ascertain which assumptions dental students recalled feeling prior to beginning community-based clinical experiences and whether those assumptions were fulfilled or challenged. All fourth-year students at the University of Iowa College of Dentistry & Dental Clinics participate in community-based clinical experiences. At the completion of their rotations, they write a guided reflection paper detailing the assumptions they had prior to beginning their rotations and assessing the accuracy of their assumptions. For this qualitative descriptive study, the 218 papers from three classes (2011-13) were analyzed for common themes. The results showed that the students had a variety of assumptions about their rotations. They were apprehensive about working with challenging patients, performing procedures for which they had minimal experience, and working too slowly. In contrast, they looked forward to improving their clinical and patient management skills and knowledge. Other assumptions involved the site (e.g., the equipment/facility would be outdated; protocols/procedures would be similar to the dental school's). Upon reflection, students reported experiences that both fulfilled and challenged their assumptions. Some continued to feel apprehensive about treating certain patient populations, while others found it easier than anticipated. Students were able to treat multiple patients per day, which led to increased speed and patient management skills. However, some reported challenges with time management. Similarly, students were surprised to discover some clinics were new/updated although some had limited instruments and materials. Based on this study's findings about students' recalled assumptions and reflective experiences, educators should consider assessing and addressing their students' assumptions prior to beginning community-based dental education experiences.

Changes in Dental Students' Attitudes About Treating Underserved Populations: A Longitudinal Study.

The aim of this study was to assess changes in a group of dental students' feelings about, willingness to treat, and perceived responsibility in treating underserved populations as they progressed through their predoctoral education. A questionnaire was developed to assess the first- through fourth-year (D1-D4) students' attitudes about treating 13 underserved populations after graduation. Surveys were distributed from 2008 to 2014, resulting in longitudinal data from three graduating classes (D1 year: N=240; eligible D4 participants: N=221). A total of 132 students from the three classes (Class of 2012 N=41; 2013 N=46; 2014 N=45; adjusted response rate 60%) completed all surveys (D1-D4). The results showed that changes in students' feelings about treating and willingness to treat underserved populations were population-specific rather than universal. Compared to the D1 year, the students in later years anticipated feeling more negatively towards treating low-income, frail elderly, homebound, homeless, other ethnic groups, and non-English-speaking patients, while their feelings were more positive towards treating known drug users and HIV/AIDS populations. Across the four years, students' willingness to treat low-income, frail elderly, homebound, and non-English-speaking populations after graduation became more negative, while their willingness to treat medically complex populations, known drug users, and HIV/AIDS populations became more positive. The students also became less likely to strongly agree that it is their responsibility as dentists to treat underserved populations as they progressed through school. These respondents reported that clinical and faculty interactions had impacted their likelihood to treat underserved populations. These findings may point to specific types of interventions and faculty mentoring to bring about change.

Should PGY-1 Be Mandatory in Dental Education? Two Viewpoints: Viewpoint 1: PGY-1 Provides Benefits That Support Making It Mandatory and Viewpoint 2: PGY-1 Should Be Available for Dental Graduates But Not Mandatory.

This Point/Counterpoint considers whether a general dentistry postgraduate year one (PGY-1) residency should be required for all new graduates who do not pursue specialty training. Currently, New York and Delaware require PGY-1 for dental licensure, while other states offer it as an alternative to a clinical examination for obtaining licensure. Viewpoint 1 supports the position that PGY-1 should be mandatory by presenting evidence that PGY-1 residencies fulfill new graduates' need for additional clinical training, enhance their professionalism and practice management skills, and improve access to care. The authors also discuss two barriers-the limited number of postdoctoral positions and the high cost-and suggest ways to overcome them. In contrast, Viewpoint 2 opposes mandatory PGY-1 training. While these authors consider the same core concepts as Viewpoint 1 (education and access to care), they present alternative methods for addressing perceived educational shortcomings in predoctoral curricula. They also examine the competing needs of underserved populations and residents and the resulting impact on access to care, and they discuss the potential conflict of interest associated with asking PGY-1 program directors to assess their residents' competence for licensure.

General dentists' referral of children younger than age 3 to pediatric dentists.

PURPOSE: The purpose of this study was to assess which variables are associated with Iowa general dentists' referral of children younger than age 3 to pediatric dentists. METHODS: A survey was mailed to all Iowa general dentists (N=1,089). Respondents were asked how likely (never, sometimes, often, always) they were to refer children younger than age 3 to pediatric dentists in the past 12 months. Associations between referral patterns with practice, dentists,' and patients' characteristics were determined. RESULTS: The adjusted response rate was 65%. Nearly 50% of all dentists reported often or always referring children younger than age 3. Dentists who referred were more likely to be males and to have been in practice longer. Dentists who perceived that they had not received adequate exposure to preschool children younger than age 3 in dental school were more likely to refer. Dentists with smaller percentages of children within their practices were more likely to refer. Dentists most often referred children who were uncooperative, had severe decay, or had special needs. CONCLUSIONS: About one half of Iowa's general dentists refer children younger than age 3 to a pediatric dentist. Initiatives need to be undertaken to address dentists' reluctance to care for young children.

Students' comfort level in treating vulnerable populations and future willingness to treat: results prior to extramural participation.

This study analyzed senior dental students' perceptions prior to extramural rotations for comfort and future willingness to treat patients with special needs and other vulnerable groups. The sample included 690 University of Iowa senior dental students who graduated from 1992 through 2004. These students completed a questionnaire concerning twelve vulnerable population groups. Logistic regression models were performed, using student comfort and future willingness to treat each group as the dependent variable. There was a wide percentage of range of comfort with these groups, yet there was no individual group that more than 60 percent of these students were willing to treat in their future practices. Generally, prior experience with the group had a positive impact on comfort level. When gender was included in the regression models, male students were more likely to express comfort. In all instances except one, experience had a positive influence on perceived future willingness to treat the associated group. However, younger graduates had a greater willingness to treat. When controlling for other variables within the future willingness to treat models, comfort was statistically significant only for HIV+/AIDS and non-English speaking groups. This study provides insight about comfort with and perceived future willingness to treat special needs and other vulnerable patient groups.