Empathy levels among health professional students at a large midwestern public university - a cross-sectional study.

BACKGROUND: Empathic care is considered extremely important by patients and providers alike but there is still an ample need for assessing empathy among healthcare students and professionals and identifying appropriate educational interventions to improve it. This study aims to assess empathy levels and associated factors among students at different healthcare colleges at the University of Iowa. METHODS: An online survey was delivered to healthcare students, including nursing, pharmacy, dental, and medical colleges (IRB ID #202,003,636). The cross-sectional survey included background questions, probing questions, college-specific questions, and the Jefferson Scale of Empathy-Health Professionals Student version (JSPE-HPS). To examine bivariate associations, Kruskal Wallis and Wilcoxon rank sum tests were used. A linear model with no transformation was used in the multivariable analysis. RESULTS: Three hundred students responded to the survey. Overall JSPE-HPS score was 116 (± 11.7), consistent with other healthcare professional samples. There was no significant difference in JSPE-HPS score among the different colleges (P = 0.532). CONCLUSION: Controlling for other variables in the linear model, healthcare students' view of their faculty's empathy toward patients and students' self-reported empathy levels were significantly associated with students' JSPE-HPS scores.

Training in radiographic caries detection and staging using an interactive tool.

INTRODUCTION: The objective of the study was to compare a dental student's practical ability to detect and stage radiographic caries per International Caries Detection and Assessment System (ICDAS), following a traditional lecture and a lecture containing an interactive session using an audience response system (ARS). Associations between the order of instructions and student performance were also evaluated. MATERIALS AND METHODS: Eighty-three dental students were randomly assigned to groups A and B. On the first day, group A received a traditional lecture and group B received content using the ARS. All students then took an electronic quiz (T1) identifying and staging caries on radiographs per ICDAS. For the second day, group A received the content using the ARS system and group B received a traditional lecture. All students subsequently took a second electronic quiz (T2). Two survey questions about the learning experience were also included. RESULTS: Wilcoxon rank-sum analysis of scores from consenting students (81) showed no difference between the quiz 1 scores of two groups (p=.61). Whilst not statistically significant (p = .07), the group that had the ARS initially scored marginally higher on quiz 2. Survey results showed that most participants preferred either the ARS alone (49.38%) or a combination of the ARS and a traditional lecture (40.74%). A majority of them (80%) found the ARS helpful. CONCLUSION: When training students in practical skills of detection and staging radiographic presence of dental caries per ICDAS, hands-on learning tools, such as an ARS, complement traditional lectures.

Data Collection in Dental Research: A Practitioner's Guide.

Data collection is a fundamental process in any scientific investigation. This article outlines best practices for three general elements of the data-collection process: (1) determining the specific aim, (2) design, and (3) documentation. We discuss these elements in the style of a tutorial, using extended examples specific to dental research. Each section of the tutorial concludes with a bullet-point summary for ease of reference to the readers. The supplemental material for this article includes templates designed to assist dental researchers in initiating the data-collection process in their respective research efforts, and selected references are organized by topic. Although written for an audience of clinical scientists in dentistry, the principles outlined here could be generalized to other health science research contexts.

Predictors of survival of large non-occlusal non-incisal glass-ionomer restorations in older adults.

PURPOSE: This study aimed to investigate the predictors of survival of non-occlusal non-incisal glass-ionomer restorations as a surrogate for root surface restorations among older adults. METHODS: In a retrospective cohort analysis using the University of Iowa College of Dentistry electronic dental records, we included 721 patients aged 65+ who received 2+ surface non-occlusal non-incisal glass ionomer restorations placed from January 2005 - December 2011. Restorations were followed until September 2017 or until they were deemed to have failed. RESULTS: At baseline, participants' mean age was 77.6 ± 8.2 years, and 45.8% were females. Most patients were self-pay (65.2%). Most restorations were placed by residents and dental students (82.7%) and included only two surfaces (95.6%). About half (49.1%) failed during follow-up, with a median survival time of 3.7 years. The time ratio for lower incisors compared to other teeth was 0.6 (p = .006), for three-and-four-surface restorations compared to two was 0.7 (p = .007), for faculty as providers compared to residents and students was 1.4 (p = .039), and for the Geriatric & Special Needs Clinic compared to others was 0.8 (p = .013). Time ratios less than one indicate association with shorter durations for restorations, and time ratios greater than one indicate association with longer durations for restorations. CONCLUSION: Tooth type, number of restored surfaces, provider type, and clinic were all significant factors associated with survival of these restorations.

The Dental Researcher's Guide to Data Analysis: Part 1.

One of the most important parts of any research project is the statistical analysis through which results are described and deemed significant or otherwise. Given this role of statistical analyses, it is imperative to understand what statistical tests are available and, most importantly, when they are appropriate. This is because choosing an improper statistical test can lead to inaccurate results and meaningless conclusions. We have written this data analysis guide to assist dental researchers with carrying out a proper analysis plan in consultation with a statistician. In this first part, we detail common types of outcome and predictor variables and include some common tests that can be used for each scenario. Using different simulated datasets, we also provide examples of common data visualization techniques and how a proper statistical test can be applied. We hope this guide provides some general background knowledge on common statistical techniques and allows for easier and more effective conversations with your statistician.

Correlation in Dental Studies: Why It Matters and What to Do About It.

In dental research, it is particularly common for studies to collect data that are fundamentally correlated. Some common dental situations in which correlation arises include patients being observed across multiple teeth and/or across multiple time points, such as before and after treatment, or groups of patients being clustered (ie, familial units). For a number of traditional statistical tests and modeling techniques, the assumption of independence between observations is imperative in order to receive valid results and make accurate conclusions. This article describes how ignoring inherent correlations in data can lead to erroneous results when using traditional methods as well as the types of modeling techniques that are available to handle correlated data. Furthermore, two simulation studies are performed to further illustrate and prove the advantages of adequately handling correlated data in statistical analyses. Int J Oral Maxillofac Implants 2023;38:417-421. doi: 10.11607/jomi.10285.

The Dental Researcher's Guide to Data Analysis - Part 2.

It is important for dental researchers to have a general idea of the different types of data that can be collected from a study and the available statistical tools that can be used with such data. By knowing about what is available, researchers will have an informed idea of the types of studies that should be conducted, the data that should be collected, and the proper statistical methods for analyzing collected data. In the first part of this general overview of statistical methods, we walked through the various types of data that traditional statistical techniques, such as t tests and linear regression, can handle. In this second part, we explore more complex types of data that traditional statistical techniques are unable to handle. Specifically, we discuss longitudinal and time-to-event data because both occur frequently in dental studies and require special modeling techniques in order to analyze correctly. Using two different simulated dental datasets, the proper application of techniques such as repeated measures ANOVA, linear mixed modeling, generalized estimating equations, log-rank test, and Cox proportional hazards models are discussed and illustrated in depth.

Are adults with autism receiving regular preventive dental services?

PURPOSE/AIM: To investigate the frequency of preventive dental care among adults with autism and explore factors associated with receiving regular preventive care. MATERIALS AND METHODS: De-identified data was collected from electronic health records of 18-year-old or older patients with autism that had at least one preventive dental procedure recorded. The data was then analyzed to describe the frequency of preventive dental procedures provided for this population and investigate what variables are associated with regular care. RESULTS: Sample size was 119, 67% were males, average age was 30.8 years, and 58% had Medicaid. Average BMI was 42.8, the prevalence of diabetes and heart disease were 16% and 34%, respectively, and 86% reported mental health problems. Recreational drug use was 6.8%, alcohol use was 19%, and tobacco use 16%. Xerostomia was reported by 32%, and the average number of medications was 7.2 ± 5.5. The average number of preventive dental visits was 7.9 ± 10.6, and 35% of the patients had at least one preventive dental visit per year. Only number of medications had a statistically significant association with number of preventive dental visits. CONCLUSIONS: Only one in every three adults with autism had at least one preventive dental visit per year.

Bayesian Statistics: A Walkthrough with a Simulated Dental Dataset.

When a clinician sees a patient with a complication, they often go through a Bayesian style of logic, most likely without even knowing it. They assess whether they have seen the complication before, provide an intervention based on historical knowledge of what leads to improvement, and then later assess how the intervention is performed. This process, which is routine in clinical practice, can be mathematically extended into an alternative way of performing statistical analyses to assess clinical research. However, this process is contrary to the most common statistical methods used in dental research: frequentist statistics. Though powerful, frequentist methods come with advantages and disadvantages. Bayesian statistics are an alternative method, one that mirrors how we as researchers think and process new information. In this primer, a walkthrough of Bayesian statistics is performed by constructing priors, defining the likelihood, and using the posterior result to draw conclusions on parameters of interest. The motivating example for this walkthrough was a Bayesian analog to logistic regression, fit using a simulated dental-related dataset of 50 patients who received a dental implant-classified as either within or outside normal limits-from practitioners who did or did not receive a training course in implant placement. The results of the Bayesian and traditional frequentist logistic regression models were compared, resulting in very similar conclusions regarding which parameters seemed to be strongly associated with the outcome.

Prevalence of non-cavitated lesions and progression, regression, and no change from age 9 to 23 years.

OBJECTIVES: Some non-cavitated caries lesions (D1 ), the initial stage of caries, progress to cavitation. This article reports participant-level and surface-level D1 prevalence and changes in status of D1 lesions through different periods from age 9 to 23. METHODS: The Iowa Fluoride Study (IFS) participants were followed longitudinally; all permanent tooth surfaces were examined clinically for caries at ages 9, 13, 17, and 23 using standardized criteria for sound (S), questionable (D0 ), non-cavitated (D1 ), cavitated (D2+ ), filled (F), or missing due to decay (M). D1 lesions at the beginning of each interval were reassessed at each follow-up age to determine transitions (to the 5 categories or no transition). RESULTS: The sample had relatively high socioeconomic status (SES), with about 52%-55% high SES, 32-35% middle SES, and 12-13% low SES. Person-level prevalences of D1 lesions were 23%, 38%, 60%, and 45% at ages 9, 13, 17, and 23, respectively. Surface-level prevalences were less than 1% at ages 9 and 13, 3% at 17, and 2% at 23. Thirteen percent of D1 s at age 9 progressed at 13, 18% progressed from 13 to 17, and 11% progressed from 17 to 23. The percentages regressing (to sound or D0 ) were 72%, 54%, and 72%, respectively. CONCLUSION: Non-cavitated lesions were more prevalent at age 17 than at ages 9, 13, and 23. The high rates of regression compared to progression or no change suggest that many non-cavitated lesions do not progress to cavitated lesions and could be reversed; therefore, surgical intervention should not be the treatment of choice for incipient lesions.

Systematic review and meta-analysis of oral squamous cell carcinoma associated oral microbiome.

The intersection between the human oral microbiome and oral health is an emerging area of study which has gained momentum over the last decade. This momentum has motivated a search for associations between the oral microbiome and oral cancer, in hopes of identifying possible biomarkers that facilitate earlier diagnosis and improved prognosis for patients with that disease. The present study examined the relationship between the microbiome in the human oral cavity and oral squamous cell carcinoma (OSCC). We searched the literature for case-control studies which focused on the relationship between the human oral microbiome and OSCC. We aggregated three types of data from these studies: bacteriome data at the genus level, predicted functional pathway data, and gene abundance data. From these data, we noted several microbial genera which may be associated with oral cancer status, including Fusobacterium. We also identified functional pathways which merit further investigation, including RNA degradation (ko03018) and primary immunodeficiency (ko05340). In addition, our analysis of gene abundance data identified the gene K06147 (ATP-binding cassette, subfamily B, bacterial) as being over abundant in OSCC samples. Our results are generalizations which identified some currents that we believe could guide further research. Our work faced several limitations related to the heterogeneity of the available data. Wide variation in methods for sample collection, methods for controlling for known behavioral risk factors, computing platform choice, and methods for case-control design all posed confounding factors in this work. We examined the current methods of data collection, data processing, and data reporting in order to offer suggestions toward the establishment of best practices within this field. We propose that these limitations should be addressed through the implementation of standardized data analytic practices that will conform to the rigor and reproducibility standards required of publicly funded research.

Tooth Agenesis Patterns in Orofacial Clefting Using Tooth Agenesis Code: A Meta-Analysis.

Individuals with orofacial clefting (OFC) have a higher prevalence of tooth agenesis (TA) overall. Neither the precise etiology of TA, nor whether TA occurs in patterns that differ by gender or cleft type is yet known. This meta-analysis aims to identify the spectrum of tooth agenesis patterns in subjects with non-syndromic OFC and controls using the Tooth Agenesis Code (TAC) program. An indexed search of databases (PubMed, EMBASE, and CINAHL) along with cross-referencing and hand searches were completed from May to June 2019 and re-run in February 2022. Additionally, unpublished TAC data from 914 individuals with OFC and 932 controls were included. TAC pattern frequencies per study were analyzed using a random effects meta-analysis model. A thorough review of 45 records retrieved resulted in 4 articles meeting eligibility criteria, comprising 2182 subjects with OFC and 3171 controls. No TA (0.0.0.0) was seen in 51% of OFC cases and 97% of controls. TAC patterns 0.2.0.0, 2.0.0.0, and 2.2.0.0 indicating uni- or bi-lateral missing upper laterals, and 16.0.0.0 indicating missing upper right second premolar, were more common in subjects with OFC. Subjects with OFC have unique TA patterns and defining these patterns will help increase our understanding of the complex etiology underlying TA.

Chairside risk assessment for first-onset temporomandibular disorders: Result from the Orofacial Pain: Prospective Evaluation and Risk Assessment data set.

BACKGROUND: Temporomandibular disorders (TMD) risk assessment is difficult in general dentistry owing to the complexity of multifactorial risk contributions and the lack of standardized education. The authors explored a health history-based chairside risk assessment. METHODS: Secondary data analysis was performed on the Orofacial Pain: Prospective Evaluation and Risk Assessment data set. Potential demographic, systemic, and local risk contributors were conceptualized into 10 risk categories. Multivariate Cox proportional hazards modeling with backward selection was applied. Variables with P values < .05 were kept in each successive model. RESULTS: The analysis included data from 2,737 participants. The final model indicated that people with any psychological conditions, pain disorders, sleep disorders, or orofacial symptoms were at elevated risks of developing first-onset TMD. Results of post hoc analysis showed the coexistence of conditions from multiple body systems conferred greater risk of developing TMD. CONCLUSIONS: Coexisting conditions and symptoms from multiple body systems substantially increase the risk of developing TMD pain. Therefore, multisystem risk assessment and interprofessional collaborations are important for the prevention of TMD. PRACTICAL IMPLICATIONS: Dentists should include psychological conditions, pain disorders, sleep disorders, and orofacial symptoms when assessing patients' risk of developing TMD pain.

Factors associated with the counts of selected oral microorganisms in nursing home residents.

PURPOSE/AIM: To analyze potential factors associated with levels of selected oral pathogens, as well as total aerobic bacterial species, among nursing home residents. MATERIALS AND METHODS: Nursing home residents were divided into three groups (G1 included people with teeth but no dentures, G2 included people with teeth and dentures, and G3 included people with no teeth and with dentures). All participants had microbiological samples collected from their oral cavity and dentures. Counts of total aerobic bacterial species, Porphyromonas gingivalis, Fusobacterium nucleatum, Actinomyces viscosus, Aggregatibacter actinomycetemcomitans, and Candida albicans were compared among groups using the Wilcoxon rank sum test. A multivariate analysis was also performed to control other available covariates. RESULTS: Bivariate analysis revealed significant differences among the groups, and multivariate analysis showed that sex, the presence of natural teeth, denture wearing, oral hygiene indices, and systemic health conditions were associated with bacterial and Candida albicans log counts. CONCLUSIONS: Presence of natural teeth and denture wearing, as well as oral hygiene, sex and systemic health conditions were associated with bacterial and Candida albicans log counts among nursing home residents.

Oral Health in Adult Patients Receiving Palliative Care: A Mixed Method Study.

BACKGROUND: Oral disease is highly prevalent in persons receiving palliative care (PRPC). Yet, little is known about how PRPC perceive their oral health status and related treatment needs. METHODS: This mixed-method study included 49 English-speaking PRPC (age≥18) recruited from the University of Iowa Palliative Care Clinic. Participants first completed a structured review of oral symptoms, followed by an oral exam. A nested sample of 11 participants also completed a semi-structured, in-depth interview querying their perceived oral health concerns and related treatment needs. Quantitative and qualitative data was analyzed and integrated for interpretation. RESULTS: Participants averaged 58.4 years. Nearly 70% had terminal cancer and 25% had advanced organ failure. Eighty-six percent of participants reported at least one oral symptom, including dry mouth (83.7%), a pain-related symptom (40.8%), or oral function difficulties (51.0%). Among the 31 dentate participants, 52% had untreated decayed/broken teeth and 33.3% had oral soft tissue lesions. Ill-fitting dentures and denture sores were common among denture users. About 40% of participants reported compromised health and/or quality of life due to oral conditions; however, the perceived impacts were modest. With the exception of painful conditions, oral treatment was not a priority for most of the participants. CONCLUSION: Oral disease was highly prevalent in PRPC, yet its overall impact was modest. In the absence of painful symptoms, most participants reported limited desire to seek treatment for oral health conditions. However, given the serious impacts of untreated oral diseases, oral healthcare decision should not be based solely on self-reported symptoms or distress.

Factors attracting Pediatric Dentists to Associateship Agreements.

Purpose: To evaluate the satisfaction of pediatric dentists in associateship agreements. Associateship agreements were deemed satisfactory if a dentist would recommend the employment experience to a colleague.
Methods: A web-based survey was administered to 6,587 pediatric dentists and pediatric dental residents in the United States in 2018. Attributes of associateships that affected dentists' decisions to join or leave a practice were examined with descriptive statistics. Logistic regression was used to identify significant associations between demographic characteristics and satisfaction with previous associateship agreements.
Results: The survey had an adjusted response rate of 13.2 percent. A total of 405 respondents reported previous experience as an associate in a pediatric dental practice; 62.0 percent of these individuals recommended their previous associateship to a colleague. Males were significantly more likely to recommend their previous associateship than females (odds ratio=1.85, 95 percent confidence interval=1.16 to 2.95). Income was the most frequently selected attribute that attracted dentists to an associateship (51.1 percent); 34.6 percent identified practice treatment philosophy as a primary reason for leaving an associateship agreement.
Conclusion: Nearly two-thirds of pediatric dentists who worked as an associate would recommend the experience to a colleague. Many dentists viewed these as positive career opportunities, even if the associateship did not culminate in buy-in or buy-out.

Teaching rapid oral health deterioration risk assessment: A 5-year report.

PURPOSE/OBJECTIVES: The purpose of this study was to present a 5-year report about the outcomes of using a teaching tool that guides dental students through the thought process of the expert about how to assess the risk of rapid oral health deterioration (ROHD) among older adults and provide viable treatment alternatives. METHODS: A teaching tool was previously developed using ROHD risk factors identified in the literature and the steps that experts apply in their treatment decision making, summarized in 10 questions. During 5 years, 188 senior dental students were introduced to the teaching tool and asked to use the 10-question set to present a case they have treated during their Geriatric and Special Needs Program. Two evaluators were asked to grade the students on each question. Students were graded "G" if they answered the question and grasped the principles behind it, "A" if they only answered the question, or "M" if they missed the question. Additionally, the students were given a form to grade the importance of and comment on the exercise. RESULTS: More than 75% of the students had an A or G for most questions, agreement between the 2 evaluators was above 85%, and students' performances improved during the 5-year period. Additionally, 94.4% of the students considered the teaching tool as important or very important for the general dentist. CONCLUSION: The vast majority of the students had an A or G grade, examiner agreement was high, and the students appreciated the importance of this teaching tool for the general dentist.

PD-L1 correlates with chemokines and cytokines in gingival crevicular fluid from healthy and diseased sites in subjects with periodontitis.

OBJECTIVE: PD-L1 is an immune checkpoint molecule that regulates immune and inflammatory responses. While cells of periodontal tissues express PD-L1, its presence in GCF is not known. The purpose of this study was to measure the PD-L1 values in GCF and correlate values with the presence of chemokine and cytokine values from periodontally diseased subjects and periodontally healthy subjects. RESULTS: PD-L1 values (pg/30 s), determined in triplicate using a fluorescent microparticle-based immunoassay ranged from 0.04-31.65 pg/30 s. PD-L1 correlated with 15 out of 22 chemokine and cytokine responses. In 85 healthy sites in 31 subjects, PD-L1 values were negatively correlated with IL6, CXCL8, IL10, and CCL3 values. In 53 diseased sites in 20 subjects, PD-L1 values were positively correlated with CCL11, CSF2, IFNG, IL1A, IL1B, IL2, IL7, IL15, and CCL5 values and negatively correlated with IL12A and IL5 values. Gene ontology (GO) annotations identified roles of PD-L1 in Th1 and Th2 activation and T-cell exhaustion signaling canonical pathways. PD-L1 values were correlated with the expression of chemokines and cytokines, which likely regulates immune cell trafficking and protects the periodontium from uncontrolled immune responses to pathogens and inflammation-induced tissue damage.