Teacher feedback and student learning: A quantitative study.

INTRODUCTION: Feedback plays a significant role in informing students about the outcome of their assessments and contributes to their ongoing learning. The aim of this study was to investigate feedback currently given by clinical teachers to dental students throughout Europe. METHODS: This study used a piloted questionnaire, delivered on-line to members of the Association for Dental Education in Europe (ADEE). A largely quantitative approach was adopted with multiple-choice, single answer, open text boxes and Likert scale type questions. These data were collected via Google Forms, transferred to an excel spreadsheet and analysed using SPSS software Version 24. RESULTS: Data were collected from 223 questionnaires completed by respondents from 42 countries. Students received feedback following: (i) formative assessment (70%; n = 155), (ii) summative assessment (88%; n = 196) and iii) informally at any time (85%; n = 188). Feedback was delivered by different people including administrative staff (15%; n = 25). Several methods were used to deliver feedback, including written, oral/spoken, email and individually or as a group. 85% (n = 184) of teachers reported that their teaching had changed following feedback they had received from students. CONCLUSION: The study showed a strong ethos of delivering feedback from teachers to dental students following both assessment and non-assessment related activities. Teachers should understand/appreciate the individualistic nature of feedback and the importance of cultivating a congenial environment for feedback delivery. Challenges remain in delivering them to a high standard and in a timely manner.

Implementing a New Service Line Model to Support Growth and Serve Patients.

SUMMARY: Many healthcare organizations are reinvesting in clinical service lines to differentiate themselves, standardize evidence-based care, and add value. Typically, service line structures are built around hospital-based procedures and are accountable solely to local operations. That can be a blueprint for missed growth and lost value.Banner Health, based in Phoenix, Arizona, with operations in six southwestern states, has pivoted to a systemwide service line strategy to foster growth and support value-based care. Service lines are now organized to maximize both revenue and quality across the continuum of care, to the benefit of both the system and its patients. The new, team-based structure allows Banner Health to respond nimbly to changes in the healthcare environment because it is based on the ways patients access the system. In 2021, just two years into this complex transition, the results have demonstrated that this service line model can achieve measurable benefits that include growth; improved financial performance, safety, and clinical outcomes; and increased collaboration in value-based payment models-all helping the system to realize its mission of making healthcare easier so that life can be better for our patients.

The impact of confidence on clinical dental practice.

INTRODUCTION: Increasing confidence through learning has the potential to change General Dental Practitioners' (GDPs) perceptions of clinical practice. By examining how changes in confidence influence the clinical practice of two cohorts of GDPs, during and following an extended period of postgraduate training, we show the importance of confidence to GDPs and that a lack of confidence is a primary reason why GDPs attend postgraduate training courses. METHODS: A mixed-method approach was adopted for this study. Quantitative data were collected via a series of linked questionnaires; qualitative data were collected using focus group discussions, interviews and contemporaneous field notes. Analysis was undertaken using SPSS software and a phenomenological approach, respectively. FINDINGS: Participants indicated an increase in confidence in their ability to undertake dental procedures, which led to an increase in confidence in communication skills, and their ability to undertake complex restorative procedures. This led to greater treatment acceptance by patients resulting in better "job satisfaction." DISCUSSION: A sense of confidence is central to personal development and ongoing study, leading to first, an improved capability to perform tasks (competence); second, confidence is a product of the relationship and trust of those people associated with the individual/professional and third, the correct level of challenge is important to confidence. CONCLUSIONS: The issue of confidence has not been looked at in postgraduate dentistry, but it is well recognised in medical education fields.

Oral health and elite sport performance.

While the research base is limited, studies have consistently reported poor oral health in elite athletes since the first report from the 1968 Olympic Games. The finding is consistent both across selected samples attending dental clinics at major competitions and more representative sampling of teams and has led to calls from the International Olympic Committee for more accurate data on oral health. Poor oral health is an important issue directly as it can cause pain, negative effects on appearance and psychosocial effects on confidence and quality of life and may have long-term consequences for treatment burden. Self-reported evidence also suggests an impact on training and performance of athletes. There are many potential challenges to the oral health of athletes including nutritional, oral dehydration, exercise-induced immune suppression, lack of awareness, negative health behaviours and lack of prioritisation. However, in theory, oral diseases are preventable by simple interventions with good evidence of efficacy. The consensus statement aims to raise awareness of the issues of oral health in elite sport and recommends strategies for prevention and health promotion in addition to future research strategies.

Assessing dentists' awareness of the orthodontic-restorative interface.

OBJECTIVES: Awareness of the interface between restorative and orthodontic treatments is essential for dentists to facilitate a meaningful interdisciplinary approach by integrating the knowledge and skills of different dental disciplines into patients' treatment to enhance outcomes. The aim of this study was to investigate General Dental Practitioners' (GDPs) awareness of the orthodontic-restorative interface. METHODS: This was a mixed-method study involving the collection of a) quantitative data via a bespoke online questionnaire and b) qualitative data through open questions. A weblink was created to the questionnaire using Opinio®. The questionnaire was distributed to GDPs practising in the UK. Clinical vignette-based questions assessed GDPs awareness and the results were categorised into two groups: aware and unaware. Two months after the primary survey, respondents were sent an email with follow-up (reliability) survey. Reliability responses were compared against the primary responses to assess the repeatability using intraclass correlation coefficient. Data were analysed using independent t-test and X2 test. RESULTS: 118 complete responses were received. 63 GDPs (53.4 % [95 % CI 44 %-63 %]) demonstrated a good understanding of the orthodontic-restorative interface. These GDPs were characterised by greater age (t = 2.75, p = 0.007) and experience (t = 3.54, p < 0.001). Qualitative data showed that respondents perceived orthodontic-restorative treatments as minimally invasive and aesthetics enhancing. CONCLUSIONS: Orthodontic-restorative treatment aids in minimal invasive dentistry. GDPs lack adequate awareness of the orthodontic-restorative interface in relation to patient care and communication with patients. More quality and structured undergraduate and postgraduate training are imperative to facilitate GDPs to understand and utilise aspects of orthodontic-restorative treatments to raise the standard of patient care. Additionally, to support these patients, the educational pathway between GDPs and specialist orthodontists is crucial. CLINICAL SIGNIFICANCE: GDPs ability to assess and carry out orthodontic-restorative treatments would conserve natural teeth. Dependable access to orthodontic services would encourage GDPs to refer challenging cases to specialists or dentists with enhanced skills. When the circumstances call for it, patients should be given orthodontic-restorative alternatives, regardless of the potential consequences of their acceptance of the procedures.

Dental Teacher Feedback and Student Learning: A Qualitative Study.

INTRODUCTION: Feedback is essential to improve student learning and motivation and to encourage curriculum development by teachers. This study looked at feedback to and from dental students from a qualitative perspective. METHODS: Dental teachers were recruited exclusively to this study from the membership of the Association for Dental Education in Europe (ADEE). Delegates from each of the four annual ADEE conferences were invited to attend focus groups to discuss aspects of feedback. Focus groups established an individual theme for the respective conferences: (i) the role of the teacher in delivering feedback; (ii) feedback from the students' perspective; (iii) changes to feedback due to the COVID-19 pandemic; and (iv) integrating feedback with assessments. RESULTS: Qualitative data collected from the conference delegates were diverse and thought provoking. Delegates reported different styles of feedback varying from individual, personal feedback to no feedback at all. An enforced and mostly positive adaptation to online delivery during the COVID-19 pandemic was reported. A partial return to pre-pandemic practices was described. CONCLUSIONS: Feedback is well recognized by students and teachers as contributing to learning. A universal approach to delivering feedback as part of the student learning process can be challenging due to a multitude of variables. Many aspects of changes in dental education, teaching, and feedback practices adopted as a result of the COVID-19 pandemic have been retained post-pandemic, thereby accelerating the anticipated progression to online teaching.

Students' perceptions of tutor feedback: a pilot study.

BACKGROUND: Feedback offered to dental students by their tutors should aim to elicit ongoing learning and motivation. Previous studies looked at the impact on learning of feedback delivered by tutors from tutors' perspectives. However, what students know about feedback and its purposes and how they experience them during their study effect the impact of feedback on learning. The aim of this pilot study was to assess the proprieties of tutor feedback and its impact on future learning from the students' perspective. METHODS: A short questionnaire based cross sectional survey was designed and delivered electronically to 135 undergraduate and postgraduate students at Brescia Dental School, Italy. The questionnaire consisted of 16 questions which were divided into 3 sections. Quantitative data were collected via Google Forms, the analysis of the data was undertaken using SPSS software, Version 24. RESULTS: Sixty-one students (45.2%) responded to the questionnaire. Forty-one of respondents (67.2%) were undergraduate students and 20 (32.8%) were postgraduate students. The vast majority of students indicated that they received feedback, thirty (49.2%) indicated that it was delivered by tutors and eight (13.1%) by fellow students. Further, students reported that feedback was timely, delivered within two weeks of assessments and that constructive criticism was the favoured feedback style (N.=52, 85.2%). Most students felt that the feedback they received helped with ongoing learning (N.=54, 88.5%). CONCLUSIONS: Most of the respondents considered that feedback received at Brescia Dental school did have a positive impact on their learning. This is of course what tutors hope would be the case but nevertheless it is gratifying to receive this endorsement from the respondent students. A more comprehensive study involving multiple dental schools in different learning environments will now be undertaken, including the collection of qualitative data.

Longevity of Anterior Composite Restorations for Localized Tooth Wear: A Scoping Review.

(1) Objective: This scoping review evaluates composite restorations as a treatment modality for anterior tooth surface loss and investigates the longevity of the direct and indirect composites used herein. (2) Method: The search encompassed Medline, Embase, Web of Science, the Cochrane Library, and hand search utilizing the PICO framework. (3) Results: Eight studies were included in this review, comprising one randomized controlled trial, one retrospective, and six prospective studies. Some studies reported favorable outcomes for composite restorations in anterior teeth. Although not statistically significant, evidence supported the anterior composite as a viable short- to medium-term solution for managing tooth wear. Direct resin composites were deemed clinically and cost-effective when managing localized anterior tooth wear. However, limitations and inconsistencies in this scoping review limited definitive clinical recommendations. (4) Conclusions: Further research, including well-managed randomized controlled trials using standardized protocols and longer follow-up periods, is essential to reconfirm the long-term efficacies of anterior composite restorations when managing tooth wear. A robust research design and exacting protocols could facilitate more meaningful clinical conclusions.

Wealth Management and Retirement.

SUMMARY: The purpose of this publication is to introduce basic financial planning concepts and highlight their use in creating a retirement savings plan. These tools may help young surgeons set their financial targets and create a plan to meet them, whereas surgeons later in their careers may reflect on their choices and implement adjustments, or be inspired to pass on the lessons they learned to the next generation. This publication is limited by design and should be thought of as a primer, not a comprehensive treatise. The topic of personal financial management is as vague as it is broad, and there are many concepts and situations that are outside the scope of this publication. Unique goals, income and expense streams, and risk tolerances necessitate individualized solutions, but there are fundamental concepts listed below that are more universally applicable. The discussion is tailored to the high income stream that plastic surgeons can expect, albeit one that starts relatively late in their careers compared to nonphysician colleagues. There are three foundational principles the reader should take away: having a plan is crucial in achieving any financial goal; starting any savings/investment endeavors as early as possible is as or more important than the amount of capital committed to them; and lastly, individual investors (professional and amateur) have consistently demonstrated an inability to consistently do better than the market over the long run.

A Scoping Review of Marginal and Internal Fit Accuracy of Lithium Disilicate Restorations.

OBJECTIVE: To assess and compare the accuracy of the marginal and internal fit of lithium disilicate crowns and onlays fabricated by conventional and digital methods. SOURCES: An electronic search was carried out on MEDLINE, Embase, Web of Science and Cochrane Library between 2010 and 2021. STUDY SELECTION: Seventeen studies published between 2014 & 2021 were included, of which thirteen were in vitro laboratory-based studies; three were in vivo clinical studies and one randomised controlled trial. DATA: Twelve studies focused on the marginal fit, five focused on the marginal and internal fit. Five studies found that the marginal and internal fit of crowns were more accurate using digital techniques. Five studies noted that there was no difference using either technique and two noted that conventional methods had a more accurate marginal fit. CONCLUSION: Digital techniques were comparable to conventional methods in terms of accuracy although there was insufficient evidence to indicate that one technique was more accurate than the other with respect to Lithium Disilicate restorations. CLINICAL SIGNIFICANCE: Digital impressions are reliable and viable alternatives for clinicians compared to conventional impression techniques when restoring teeth with lithium disilicate restorations.

An investigation into the management of the deep carious lesion by general dental practitioners in the UK.

Objectives As techniques and dental materials have evolved, the management of deep carious lesions has also changed. This study investigated how UK-based general dental practitioners (GDPs) managed deep carious lesions in permanent, vital teeth and factors that influence their choices.Methods This mixed-method study employed an online questionnaire as its primary source of quantitative data collection. The questionnaire enquired about GDPs': a) demographics; b) working environment; and c) whether they had postgraduate training that covered caries management/minimally invasive dentistry (MID). Respondents were presented with a clinical case to elicit qualitative data. Relevant questions were asked in order to examine current practice and explore treatment among the respondents.Results In total, 239 responses were received. Overall, 168 (70% [95% CI 64%, 76%]) of the respondents chose a partial caries removal technique, 155 (69.3% [95% CI 60%, 72%]) used an adhesive restorative material and 205 (85.8% [95% CI 81%, 89%]) advised fluoride adjuncts. However, rubber dam (75; 31.4% [95% CI 26%, 38%]) and saliva testing (17; 7.1% [95% CI 4%, 11%]) were not routinely used. A significant relationship between those who had postgraduate training and those who chose partial caries removal as their treatment choice (χ2 = 6.27; p = 0.01) was noted. Respondents working in an NHS-based practice were significantly (χ2 = 34.98; p <0.001) more likely to restore teeth with amalgam.Conclusions There is an inconsistent management protocol when presented with a deep carious lesion, but partial caries removal is more widely adopted than previously reported. Rubber dam isolation was not routinely used when choosing to restore a deep carious lesion. Those who have had postgraduate training felt more confident in offering MID, so there is a clear need for further education to ensure its engagement.

Electronic medical records: a path forward.

Health systems are moving to implement comprehensive electronic medical record (EMR) systems, or significant pieces of them, in the belief that EMR can be integrated into clinical practice and lead to improved patient outcomes and enhanced safety. There are substantial roadblocks to implementing EMR, including significant cost, the competency needed to implement, the political environment, organization infrastructure and culture, and how organization leaders understand return on investment. Complicating factors include the drive to implement EMR to meet meaningful use standards to qualify for a federal incentive program and recently publicized studies that question the value equation of the EMR as it relates to patient care improvements. We offer our experiences on the successful implementation of the EMR across the large health systems we lead. We offer practical advice and tips on how to achieve successful implementation, evidence that successful implementations improve patient care and safety, and a glimpse of how EMR is a significant foundation in a future of collaborative models that provide continuum-based care.

'Injury prevention versus performance': has the time come to mandate the use of mouthguards in all contact sports?

Mouthguard use continues to be a hotly debated issue in the domain of contact sports. Regulations from sports governing bodies on wearing mouthguards and attitudes towards their use from athletes vary significantly across 'at-risk sports'. We explore how recent advances in sports dentistry have led to the widespread availability of new customisable mouthguards and whether their use may impact athletic performance, reduce orofacial trauma or sport related concussion. We also discuss whether 'no mouthguard, no play' policies designed to mandate their use may help to promote a culture of safe participation in contact sport.

Developing the role of the sports dentist.

Sports dentistry has traditionally focused on orofacial trauma. There is now increasing evidence that participation in sport, particularly at elite level, may significantly increase the risks to oral health. The negative impact of poor oral health on athlete-reported wellbeing and performance is clear. The risks to athlete oral health can and should be mitigated and the role of the sports dentist is evolving to meet these new challenges. Custom-made mouthguards provide protection against orofacial trauma and potentially, concussion. Oral health screening should be included in athlete pre-season preparation. As integrated members of the athlete support team, dentists and dental care professionals can provide sport-specific oral health advice, encouraging athletes to take ownership of their oral health. The potential for translational health and wellbeing benefits to the wider population is also substantial, particularly with youth groups and recreational athletes. Sports dentistry requires distinctive skills. A UK-wide network of dentists and other oral health professionals with an interest in sport is important, to ensure that both appropriate advice and treatment is evidence-based and to further develop the research and clinical foundations.

Investigating the effect of mouth guard use on aerobic performance in amateur boxers.

OBJECTIVES: To assess if wearing a mouth guard impacts maximal aerobic capacity in amateur boxers. MATERIALS AND METHODS: A prospective crossover cohort (pilot) study was conducted to assess maximal aerobic capacity in amateur boxers using the 20 m multi stage fitness test (MSFT). Two primary outcomes measures were recorded: (1) the maximum oxygen uptake (peak VO2 -mL/kg/min) and (2) distance run (meters-m). Thirteen amateur boxers completed the MSFT 7 days apart under control (no mouth guard-C) and intervention conditions (mouth guard-MG). Participants also submitted data on height, weight, type of mouth guard and Rate of Perceived Exertion (RPE) during the test. STATISTICS: Paired T-test. RESULTS: Mouth guard use was shown to reduce peak VO2 and distance run during the 20 m MSFT from 56.31 to 54.12 mL/kg/min and 2572 to 2380 m respectively (p < 0.05). Twelve out of 13 participants wore a Boil & Bite mouthguard and recorded lower peak VO2 scores (-4.38%) when wearing a mouth guard compared to control conditions, (Mean = -2.46 mL/kg/min, Range of decrease = 4.2-0.9 mL/kg/min; p < 0.05). Ten participants submitted data on RPE-One participant with a custom made mouthguard reported no change in RPE in mouthguard conditions, while nine participants reported an average (+30.5%) increase in mean RPE in Boil & Bite mouthguard conditions compared to control conditions. CONCLUSIONS: Boil & Bite mouth guard use was shown to significantly reduce aerobic performance in amateur boxers and increase the perceived rate of exertion during the 20 m MSFT.

General dental practitioners' knowledge and opinions of snoring and sleep-related breathing disorders.

Aims There is increasing recognition that sleep disturbances can affect lifestyle, economy and health. General dental practitioners (GDPs) can play a vital role in helping to identify at-risk patients through screening as well as aid in the management of these conditions. The aim of this study was to assess the knowledge of UK-based GDPs in relation to sleep-related breathing disorders (SRBDs).Material and methods A questionnaire was developed to assess GDPs' knowledge of SRBDs and their current practice in relation to the management of SRBDs, and identify the factors associated with improved knowledge and management. A volunteer sample was recruited from social media platforms and conference attendees.Results In total, 152 GDPs completed the questionnaire; 101 (66% [95% CI 59%,74%]) agreed that GDPs should ask their patients about sleep disorders, while only 82 (54% [95% CI 46%,62%]) confirmed that they actually asked their patients about the problem. On a 22-point knowledge scale, the mean score was 12.93 (95%CI 12.23, 13.63). Postgraduate education (F = 5.47; p = 0.001), increasing age (r = 0.23; p = 0.005) and GDP workplace (F = 4.98; p = 0.008) contributed to a higher knowledge score. GDPs were strongly in favour of having more information (N = 141; 93% [95% CI 87%,97%]).Conclusion Although GDPs' knowledge of SRBDs was better than anticipated, they clearly felt a need for further information and training. There is a compelling case to include this subject in the undergraduate dental curriculum.