Evaluación de teóricos on-line en la Cátedra de Odontología Integral Niños / Evaluation of online theoreticals at the Department of Comprehensive Dentistry for Children

Los objetivos de este trabajo fueron conocer la percepción de estudiantes y docentes sobre la implementación de la modalidad de clases expositivas on-line, estimar la frecuencia y oportunidad de acceso por parte de los alumnos y comparar los resultados obtenidos en las calificaciones finales obtenidas con la modalidad teórico presencial y la on-line. El recurso resultó positivo para el 80,62% y 73,33% de alumnos y docentes respectivamente. Los primeros ingresaron cada uno un promedio de 2,75±1,45 veces a cada uno de los 15 módulos y el 60.45% lo hizo 15 días antes del examen. No hubo diferencias entre las calificaciones obtenidas entre dos cohortes que utilizaron las diferentes modalidades. Se concluyó que la modalidad on-line con clase de repaso presencial fue percibida como apropiada y con contenidos relevantes. Fue utilizada por los estudiantes como una herramienta de consulta, con amplia flexibilidad horaria y en reiteradas oportunidades, sin restarle horas a la atención de pacientes (AU)

The effect of viewing video clips of paediatric local anaesthetic administration on the confidence of undergraduate dental students.

INTRODUCTION: Dental treatment for children requires not only technical skills, but also the knowledge and confidence to provide behaviour management to support children of differing ages and stages of development. It is not surprising then that dental students find treating children especially stressful. Paediatric dentistry training is therefore a vital element of the undergraduate dental curriculum. MATERIALS AND METHODS: Eighty-six fourth-year undergraduate dental students received standard lectures and seminars about behaviour management techniques for children having local anaesthetic. The students were then randomly divided into groups using cluster randomisation. The intervention group received an intervention-based around video clips (VCs) demonstrating behaviour management techniques (BMTs) for children receiving local anaesthetic The intervention and control groups completed self-administered questionnaires to determine their level of confidence in managing local anaesthetic for children. RESULTS: There was a statistically significant difference in the level of confidence between the groups immediately after the teaching intervention (P=.003) and at 4 months (P=.001) in favour of the video group. DISCUSSION: Previous studies on the use of video as a teaching aid have reported favourable results in terms of both student attitudes and learning outcomes. The results from this study confirm the benefits of this style of teaching paediatric behaviour skills in the undergraduate dental curriculum, and the benefits were maintained at 4 months. CONCLUSION: This study has demonstrated that VCs as an additional teaching aid are an effective method in improving students' confidence for BMTs when delivering local anaesthetic.

Creating a new generation of pediatric dentists: a paradigm shift in training.

The University of California, Los Angeles (UCLA) School of Dentistry has implemented a Health Resources and Services Administration-funded program to prepare dentists for the complex and comprehensive needs of pediatric patients within rapidly changing demographics and a paradigm shift in dentistry. Traditional dental education has focused on how to respond to oral disease, whereas UCLA's program shifts the paradigm to emphasize early assessment, risk-based prevention, and disease management. A holistic approach to dental care that considers social and environmental determinants is used with minimally invasive techniques for restorative care. To support this change, pediatric dental residents receive traditional training combined with new didactics, advocacy opportunities, and applied learning experiences at community-based organizations. These new elements teach residents to recognize the causal factors of disease and to identify interventions that promote oral health at the individual, family, community, and policy level. Consequently, they are better prepared to treat a diverse group of patients who historically have faced the greatest burden of disease as well as an increased number of barriers to accessing oral health care; these consist of low-income, minority, and/or pediatric populations including children with special health needs. The program's ultimate goal is for residents to deploy these skills in treating vulnerable populations and to demonstrate greater interest in collaborating with non-dental health providers and community organizations to increase access to dental services in private or public health practice settings.

Pediatric dentistry for the general practitioner: satisfying the need for additional education and training opportunities.

The Pediatric Oral Health Access Program is a joint project of the California Dental Association and the California Society of Pediatric Dentistry. The results have been remarkable in terms of the number of underserved children who have received oral health services. What is less certain is the number of general dentists who, as a result of the training, have been able and willing to provide comprehensive care to more and younger children.

Ohio dentists' awareness and incorporation of the dental home concept.

BACKGROUND: The authors measured the awareness of the dental home concept among pediatric dentists (PDs) and general practice dentists (GPs) in Ohio and determined whether they included dental home characteristics for children 5 years and younger into their practices. METHODS: The authors sent a pretested 20-question survey to all Ohio PDs and to a random sample of approximately 20 percent of GPs in Ohio. The authors designed the survey to elicit information about dental home awareness and the extent to which dental home characteristics were incorporated into dental practices. RESULTS: More than 90 percent of both GPs and PDs incorporated or intended to incorporate into their dental practices the specific dental home characteristics mentioned in 20 of 41 items related to dental home characteristics. Of the respondents who did not already incorporate dental home characteristics into their practices, however, most did not intend to do so. Less than 50 percent of respondents in both groups responded positively to some items in the culturally effective group, and GPs were less likely than were PDs to provide a range of behavior management services and to provide treatment for patients with complex medical and dental treatment needs. PDs were more likely than were GPs to accept Ohio Medicaid (64 versus 33 percent). PDs were more likely than were GPs (78 versus 18 percent) to be familiar with the term "dental home." More recent dental school graduates were more familiar with the term. CONCLUSIONS: Most Ohio PDs' and GPs' practices included characteristics found in the definition of dental home, despite a general lack of concept awareness on the part of GPs. Research is needed to provide an evidence base for the dental home. Practical Implications. Once an evidence base is developed for the important aspects of the dental home and the definition is revised, efforts should be made to incorporate these aspects more broadly into dental practice.

Acompanhamento de consulta de crescimento e desenvolvimento infantil (CD) com abordagem multiprofissional ­ relato de experiência / Follow up of growth and development consultation (CD) with multidisciplinary team approach - an experience report

A consulta de acompanhamento do crescimento e desenvolvimento infantil ou puericultura, quando realizada no âmbito da Estratégia de Saúde da Família (ESF), funciona como uma ferramenta indispensável na construção do Sistema Único de Saúde, além de propor novas formas de relacionamento entre profissionais de saúde e as crianças. Ela tem como objetivo acompanhar a progressão das crianças de forma global, contemplando todas as áreas do saber no campo da saúde, a fim de possibilitar uma assistência integral e promover qualidade de vida. No entanto há poucos relatos na literatura à respeito da realização do CD de forma multiprofissional, com a inserção do cirurgião-dentista na puericultura. Nesse sentido, o objetivo desse trabalho é realizar um relato de experiência de caráter descritivo acerca de consultas multiprofissionais das consultas de CD realizadas na Unidade de Estratégia Saúde da Família Cintra, situada em Montes Claros, ao norte do Estado de Minas Gerais, Brasil (AU).

The follow-up of child growth and development (CD) or childcare, when performed under the Family Health Strategy (FHS) works as an indispensable tool in the construction of the Health System, also proposing new forms of relationships between health professionals and children. It aims to follow the progression of children globally, covering all areas of knowledge in the health field to enable comprehensive care and promote quality of life. However, there are few reports in the literature regarding the completion of the CD in a multidisciplinary perspective, with the insertion of the dentist in child care. Thereby, the aim of this paper is to perform an descriptive experience report about multidisciplinary CD held in the Family Health Strategy Unit Cintra, located in Montes Claros, in the northern state of Minas Gerais, Brazil (AU).

A preliminary analysis of the US dental health care system's capacity to treat children with special health care needs.

PURPOSE: The purpose of this study was to use existing data to determine capacity of the US dental care system to treat children with special health care needs (CSHCN). METHODS: A deductive analysis using recent existing data was used to determine the: possible available appointments for CSHCN in hospitals and educational programs/institutions; and the ratio of CSHCN to potential available and able providers in the United States sorted by 6 American Academy of Pediatric Dentistry (AAPD) districts. RESULTS: Using existing data sets, this analysis found 57 dental schools, 61 advanced education in general dentistry programs, 174 general practice residencies, and 87 children's hospital dental clinics in the United States. Nationally, the number of CSHCN was determined to be 10,221,436. The distribution, on average, of CSHCN per care source/provider ranged from 1,327 to 2,357 in the 6 AAPD districts. Children's hospital dental clinics had fewer than 1 clinic appointment or 1 operating room appointment available per CSHCN. The mean number of CSHCN patients per provider, if distributed equally, was 1,792. CONCLUSIONS: The current US dental care system has extremely limited capacity to care for children with special health care needs.

Management of carious primary molar teeth by UK postgraduates in paediatric dentistry.

AIM: To assess the treatment preferences amongst UK postgraduates (PG) in Paediatric Dentistry for a symbolic child with sample case history of differing caries severity in a primary molar tooth. METHODS: All Paediatric Dentistry PG were contacted by e-mail and asked to participate in an on-line structured questionnaire. The survey described four different case scenarios of a 5-year-old child, presenting with a mesio-occlusal cavity in tooth 85 with varying symptoms and signs. Treatment options were listed and participants asked to select the single most preferred treatment for each case. The same scenarios were also presented for both non-anxious and dentally-anxious children and differences were analysed by Chi2 analysis. RESULTS: Responses were received from 38/59 (F: 31; M: 7) PGs. The preformed metal crown (PMC) with Hall technique was selected as the option for patients with no indication of pulpal involvement by 4/38 and 20/38 for non-anxious and dentally-anxious patients respectively (Chi2=27.56, P=0.001, 1 dof). For a tooth with signs of pulpal involvement or symptoms the options selected were (non-anxious, dentally-anxious): zinc-oxide eugenol pulpecotomy and PMC 8/38, 2/38 (Chi2=9.85, P=0.002, 1 dof); local analgesia extraction 15/38, 2/38 (Chi2=27.22, P=0.001, 1 dof) and extraction under a general anaesthetic 0/38, 16/38 (Chi2=42.00, P=0.001, 1dof). CONCLUSION: There was no consistency of response by PGs in Paediatric Dentistry within the UK. The Hall technique appeared to be a favoured option for treatment of an asymptomatic carious primary molar tooth in dentally-anxious child patients. Extraction was preferred for those with pulpal involvement for both non-anxious and dentally-anxious patients, although the suggested mode of extraction differed.

Alternative careers in pediatric dentistry: a survey of pediatric dental residents.

Pediatric dentistry has enjoyed growing popularity in recent years, yet there remains a need for leadership in academe, research, and public health. In November 2008, the first Maternal and Child Health Bureau-sponsored regional Leadership in Pediatric Dentistry convocation was held at the Columbia University College of Dental Medicine. Seventy-two pediatric dentistry trainees from thirteen programs in the New York City area participated in interactive presentations and exercises. Of the sixty- seven participants who completed a pre-event survey, 93 percent stated they would likely or very likely pursue careers that involved, at least in part, private practice, 55 percent in care of children in Medicaid, 51 percent academics, 36 percent dental public health, and 12 percent research. Barriers related to finances, competence, or work environment/location were perceived by 83 percent for careers involving research, 73 percent for dental public health, 66 percent for providing care to children in Medicaid, 46 percent for academics, and 9 percent for private practice. Results of a pair of pre-event and post-event surveys completed by sixty-three attendees showed no change in reported likelihood to pursue a career alternative except for an increase in the likelihood of working in a practice that accepts Medicaid. The challenge before dental educators is to provide consistent and meaningful opportunities throughout training that encourage residents to consider all career options and to discover how their individual interests mesh with their clinical learning.

Differences in the perception of seven behaviour-modifying techniques in paediatric dentistry by undergraduate students using lecturing and video sequences for teaching.

Whilst preparing undergraduate students for a clinical course in paediatric dentistry, four consecutive classes (n = 107) were divided into two groups. Seven behaviour-modifying techniques were introduced: systematic desensitization, operant conditioning, modelling, Tell, Show, Do-principle, substitution, change of roles and the active involvement of the patient. The behaviour-modifying techniques that had been taught to group one (n = 57) through lecturing were taught to group two (n = 50) through video sequences and vice versa in the following semester. Immediately after the presentations, students were asked by means of a questionnaire about their perceptions of ease of using the different techniques and their intention for clinical application of each technique. After completion of the clinical course, they were asked about which behaviour-modifying techniques they had actually used when dealing with patients. Concerning the perception of ease of using the different techniques, there were considerable differences for six of the seven techniques (P < 0.05). Whilst some techniques seemed more difficult to apply clinically after lecturing, others seemed more difficult after video-based teaching. Concerning the intention for clinical application and the actual clinical application, there were higher percentages for all techniques taught after video-based teaching. However, the differences were significant only for two techniques in each case (P < 0.05). It is concluded that the use of video based teaching enhances the intention for application and the actual clinical application only for a limited number of behaviour-modifying techniques.

Evaluating the need for alternative didactic learning options in pediatric dental residency training.

The need for an alternative means of delivery of a didactic curriculum to pediatric dental residents is described. It is our hope with this project to encourage a much-needed didactic curriculum for programs lacking faculty and to endorse other programs in which academicians exist but cannot cover all the material with which a resident needs to become familiar in the two years of postgraduate residency training. A decrease in faculty number due to retirement, debt burden, or marginal recruitment techniques along with an increase in positions in pediatric dentistry residency programs poses a unique educational dilemma. Using a mixed-method research methodology, we sent a twelve-question survey to 105 pediatric dentistry residency program directors and department chairs, followed by eight telephone interviews. Results from a 55 percent return rate show that the debt burden of most pediatric dental residents is well over $100,000 and that this affects a resident's decision to enter academia, as does the relative lack of positive recruitment techniques and poor faculty remuneration. The survey results affirm the need for improvement in the didactic curriculum of pediatric dentistry residents and show that program directors and department chairs also feel that an alternative delivery method using DVD or online/web-based programs would be welcomed. Despite their extremely heavy workloads, educators are willing to contribute by providing lectures or reading lists in their area of expertise.

The American Academy of Pediatric Dentistry and the specialty of pediatric dentistry.

Founded in 1947, the American Academy of Pediatric Dentistry (AAPD) is a not-for-profit membership association representing the specialty of pediatric dentistry. The AAPD's 7,500 members are primary oral health care providers who offer comprehensive specialty treatment for millions of infants, children, adolescents, and individuals with special healthcare needs. The AAPD also represents general dentists who treat a significant number of children in their practices. As advocates for children's oral health, the AAPD develops and promotes evidence-based policies and guidelines, fosters research, contributes to scholarly work concerning pediatric oral health, and educates healthcare providers, policymakers, and the public on ways to improve children's oral health. The academy's philanthropic arm, Healthy Smiles, Healthy Children: The Foundation of the AAPD, advances the AAPD mission through the support and promotion of education, research, service, and policy development.

El estudio de casos como estrategia de enseñanza de la odontología para niños y adolescentes / Cases study as an strategy for teaching dentistry for children and adolescents

Objetivos: el objetivo de este trabajo es analizar la estrategia de enseñanza del estudio de casos en un grupo de estudiantes; conocer su punto de vista de la vivencia de la experiencia. Materiales y métodos: en el año 2002 fueron seleccionados aleatoriamente diez alumnos cursantes de la material Odontología Integral Niños y Adolescentes del último año de la crrera de la Universidad Maimónides. Se les aplicó un pretest en el que se les formularon 7 preguntas, cada una de las cuales se categorizó de 0 a 3. El total de puntaje máximo esperado del pre y post test fue de 21. Se utilizó la estrategia de enseñanza del estudio de casos. Se realizaron 3 sesiones de una hora y cinco minutos cada una, durante 3 semanas consecutivas. A los 15 días de finalizada la tercera sesión, se les aplicó a los esutidantes el post test, igual al pretest. Al mismo tiempo se realizó una encuesta con el fin de conocer su opinión respecto de la estrategia de enseñanza utilizada. Resultados del pre y post test: etre el pre y post test se registraron diferencias significativas en las preguntas 1, 2, 3, 6 y 7. Las preguntas 1 y 2 con una P < 0.05 y las preguntas 3, 6 y 7 con una P < 0.01. Las preguntas 4 y 5 no registraron diferencias significativas. Según el índice de mejoría, el 70 por ciento de los estudiantes presentó un índice entre el 30 y 60 por ciento. El aprendizaje mayor al 60 por ciento se registró en el 30 por ciento de los estudiantes. Entre el post y el pretest se observó una diferencia de 3.90 puntos como promedio de las diferencias alcanzadas en el total de preguntas. Las diferencias en cada una de las preguntas resultaron como 0 punto (pregunta 5) hasta 0.90 (preguntas 3 y 7). De la encuesta el 90 por ciento de los estudiantes contestó que les resultó provechoso el trabajo y el 10 por ciento contestó en forma negativa. Conclusiones: la estrategia empleada mostró un aprendizaje significativo en los estudiantes que se evidenció en el post test. La vivencia que tienen los cursantes de la estrategia de enseñanza del estudio de casos es positiva, esto se evidenció en la encuesta realizada (AU)

El estudio de casos como estrategia de enseñanza de la odontología para niños y adolescentes / Cases study as an strategy for teaching dentistry for children and adolescents

Objetivos: el objetivo de este trabajo es analizar la estrategia de enseñanza del estudio de casos en un grupo de estudiantes; conocer su punto de vista de la vivencia de la experiencia. Materiales y métodos: en el año 2002 fueron seleccionados aleatoriamente diez alumnos cursantes de la material Odontología Integral Niños y Adolescentes del último año de la crrera de la Universidad Maimónides. Se les aplicó un pretest en el que se les formularon 7 preguntas, cada una de las cuales se categorizó de 0 a 3. El total de puntaje máximo esperado del pre y post test fue de 21. Se utilizó la estrategia de enseñanza del estudio de casos. Se realizaron 3 sesiones de una hora y cinco minutos cada una, durante 3 semanas consecutivas. A los 15 días de finalizada la tercera sesión, se les aplicó a los esutidantes el post test, igual al pretest. Al mismo tiempo se realizó una encuesta con el fin de conocer su opinión respecto de la estrategia de enseñanza utilizada. Resultados del pre y post test: etre el pre y post test se registraron diferencias significativas en las preguntas 1, 2, 3, 6 y 7. Las preguntas 1 y 2 con una P < 0.05 y las preguntas 3, 6 y 7 con una P < 0.01. Las preguntas 4 y 5 no registraron diferencias significativas. Según el índice de mejoría, el 70 por ciento de los estudiantes presentó un índice entre el 30 y 60 por ciento. El aprendizaje mayor al 60 por ciento se registró en el 30 por ciento de los estudiantes. Entre el post y el pretest se observó una diferencia de 3.90 puntos como promedio de las diferencias alcanzadas en el total de preguntas. Las diferencias en cada una de las preguntas resultaron como 0 punto (pregunta 5) hasta 0.90 (preguntas 3 y 7). De la encuesta el 90 por ciento de los estudiantes contestó que les resultó provechoso el trabajo y el 10 por ciento contestó en forma negativa. Conclusiones: la estrategia empleada mostró un aprendizaje significativo en los estudiantes que se evidenció en el post test. La vivencia que tienen los cursantes de la estrategia de enseñanza del estudio de casos es positiva, esto se evidenció en la encuesta realizada

Students' perceptions of the acceptability of behaviour management techniques.

The aim of the present study was to determine the perceptions of dental students of the acceptability of different forms of behaviour management for children. The effect of client characteristics (typically developing or learning disabled), intervention method (relaxation training and reinforcement or physical restraint) and treatment outcome (good or poor) on acceptability ratings made by fourth year dental students was determined. Students rated the acceptability of treatments on the basis of written vignettes using a standardized measure of the acceptability of behavioural treatments (the Treatment Evaluation Inventory, TEI, Kazdin, French and Sherick 1981). The study had a full factorial design; all possible combinations of variables were represented in the vignettes. The results were analysed using ANOVA models. There were significant main effects of intervention method and treatment outcome, indicating that less restrictive methods and good intervention outcome were rated as more acceptable. Significant two- and three-way interactions were found, which suggested that the use of restrictive methods may be perceived as more acceptable for a child with learning disabilities even when the outcome was poor. The second order interactions revealed that the acceptability of restrictive techniques was improved less markedly by a good outcome. This study highlights the importance of empirically evaluating outcome and treatment restrictiveness when engaging in behaviour management during dental procedures.

Stress management for dental students performing their first pediatric restorative procedure.

Research has demonstrated that dental students experience considerable stress during their training. Students' anxiety is likely to be especially high when they perform their first pediatric restorative procedure. The aims of this study were to provide a description of dental students' level of anxiety and typical coping strategies and to evaluate the use of a distress management intervention for reducing anxiety around their first pediatric restorative procedure. Dental students were randomly assigned to either an Anxiety Management or an Attention Control group. The management group received training on relaxation strategies (i.e., deep breathing, progressive muscle relaxation). The control group attended a lecture on the relation among stress, anxiety, and health. No significant differences were found between group levels of anxiety related to their first pediatric restorative procedure. Information is provided on students' reported level of anxiety and general coping strategies. Limitations of the current study and suggestions for future research are provided.

Children's oral health in the medical curriculum: a collaborative intervention at a university-affiliated hospital.

The purpose of this study was to 1) describe the structure of the oral health program in a university-affiliated hospital; 2) evaluate staff's knowledge and attitudes toward oral health; and 3) propose ways to strengthen the incorporation of oral health prevention for children into clinical medical education. Qualitative methods were used to evaluate the program. Structured interviews with seventeen medical center personnel were conducted, and clinic utilization reports provided ICD-9 diagnostic frequency and visits. Clinic staff, pediatric residents, dental and pediatric faculty, hospital administrators, and clinic directors were interviewed. The themes identified during these interviews were motivation, roles, operational and organizational issues, and integration into the larger medical care system. Integration of an early childhood caries prevention program into the clinical medical education curriculum can be accomplished. After implementation of the oral health program described in this paper, dental caries became the eleventh most common diagnosis seen in the clinic when previously it did not appear in the top forty. However, institutional and organizational barriers are significant. Barriers identified were 1) lack of clarity in defining leadership and roles regarding oral health, 2) time and work overload in a busy pediatric clinic, 3) a tracking system was not available to quickly determine which children needed caries prevention procedures and education, and 4) billing and medical record form changes could not be fully established prior to starting the program.

Dental care considerations for young children.

Although the majority of America's children enjoy remarkably good oral health, a significant subset of low-income, minority, medically and developmentally compromised, and socially vulnerable children continue to suffer significant and consequential dental and oral disease. Most of this inequitably distributed disease burden is preventable through early and individualized preventive care. Yet the primary-care medical and dental workforce is ill-prepared to manage the oral health needs of young children. Demographic trends suggest that the problem of disparities in both oral health status and access to competent dental services will continue to worsen for young children. Impediments to improving the oral health of young children include barriers between medical and dental systems of care, paucity of private and safety-net facilities and providers in many areas where vulnerable children reside, and dysfunctional Medicaid insurance programs. Barriers are generated by parents, providers, payers, and systems of care as well as by the age-appropriate behaviors of young children. Vulnerable families often do not access the case management services and disease control information needed to effectively address their young children's needs. Approaches to improving the oral health of young children therefore include enhancing public education about oral health, the appropriateness of early and periodic dental care, and primary prevention. Improvements in workforce numbers, distribution, diversity, and competency are needed. Attention to delivery systems and public insurance capacities are also necessary to effectuate improvements. HRSA's Title VII and VIII health professions training programs could potentially address may of these barriers and shortcomings. Training enhancements for predoctoral, postdoctoral, and graduate dentists and hygienists as well as for primary-care medical providers hold the key to marked improvements in the oral health of young children. Enhanced training of health care providers is the necessary if not sufficient condition to children whose daily life experiences are compromised by dental and oral diseases that are overwhelmingly preventable.