Communication Management Processes of Dentists Providing Healthcare for Migrants with Limited Japanese Proficiency.

Low health literacy results in health inequity are linked with poor adherence to medical care. In the globalized Japanese context, the number of migrants with Japanese as a second language is increasing year after year. Since limited Japanese proficiency may pose a greater health risk, dentists are expected to manage cross-cultural communication and provide dental care to foreign patients. This study explored dentists' experiences of treating patients with limited Japanese proficiencies. Semi-structured interviews were conducted with 11 community dentists and the qualitative data were analyzed through a thematic analysis approach. Their major challenges were classified into three themes-linguistic aspect (e.g., complicated explanation regarding root canal treatment), sociolinguistic aspect (e.g., communication with foreign residents with limited dental knowledge), and sociocultural aspect (e.g., cultural differences in their dental aesthetics and insurance treatment system). Several management strategies were employed, including linguistic accommodation, avoidance of complexities, use of various communication tools, and getting help from others. However, they were unsatisfied with their practice because they could not understand the patients' psychosocial aspects due to incomplete communication. These findings provided insights into dentists' practice in the globalized context.

Broadening the Dental Hygiene Students' Perspectives on the Oral Health Professionals: A Text Mining Analysis.

Professional identity formation, an important component of education, is influenced by participation, social relationships, and culture in communities of practice. As a preliminary investigation of dental hygienists' professional identity formation, this study examined changes in the dental hygiene students' perceptions of oral health professionals over the three years of their undergraduate program. At a Japanese dental hygiene school, 40 students participated in surveys with open-ended questions about professional groups several times during their studies. The text data were analyzed through content analysis with text mining software. The themes that characterized their dental hygienist profession perceptions in their programs each year were identified as: "Supporters at the dental clinic"; "Engagement with interprofessional care" and "Improved problem-solving skills for clinical issues regarding the oral region"; and "Active contribution to general health" and "Recognition of the roles considering relationships" (in the first, second, and third years, respectively). The students acquired professional knowledge and recognized the significance and roles of oral health professionals in practice. They gained more learning experiences in their education, including clinical placements and interprofessional education. This study provides insight into curriculum development for professional identity formation in dental hygiene students.

Complexities of interprofessional identity formation in dental hygienists: an exploratory case study.

BACKGROUND: In a super-aging society, medical-dental collaboration is increasingly vital for comprehensive patient care. Particularly in dysphagia rehabilitation and perioperative oral functional management, dental hygienists' active involvement is pivotal to interprofessional collaborative practice. Despite this societal expectation, dental hygienists' experiences and perceptions of interprofessional collaboration have not been explored. This study aims to investigate dental hygienists' interprofessional identity formation and perceptions of interprofessional collaboration. Specifically, it was explored from the perspectives of dental hygiene students and hospital dental hygienists. METHODS: This study is underpinned by Wenger's social theory of learning, which focuses on identity as a component in the process of learning in communities. Semi-structured interviews were conducted with 11 dental hygiene students in their final year at a technical college and five dental hygienists engaging in interprofessional care at a university hospital in Japan. The narrative data were analysed using an inductive approach to thematic analysis to extract themes regarding the identification of self in interprofessional teams. RESULTS: Dental hygiene students found several barriers to the collaboration, including power relation and conceptual hierarchy, limited understanding of other professional roles, and differences in language and jargon. They viewed themselves as inferior in the interprofessional team. This resulted from their limited knowledge about general health and less responsibility for problems directly related to patient life and death. However, they could ultimately perceive the negative experiences positively as challenges for the future through reflection on learning in clinical placements. Contrarily, dental hygienists did not have such negative perceptions as the students did. Rather, they focused on fulfilling their roles as dental professionals in the interprofessional team. Their identities were formed through actively involving, coordinating their activity, and creating new images of the world and self in inter-professional communities of practice. CONCLUSIONS: Interprofessional identity is relational as well as experiential, which is developed in complex and socially dynamic processes across intra- and inter-professional communities of practice. Engagement, imagination, and alignment are essential aspects of their interprofessional identities, which inform conceptual foundations of interprofessional education and collaborative practice in health care.

Aggressive periodontitis and NOD2 variants.

Aggressive periodontitis (AgP) occurs at an early age and causes rapid periodontal tissue destruction. Nucleotide-binding oligomerization domain-containing protein 2 (NOD2) encodes a protein with two caspase recruitment domains and eleven leucine-rich repeats. This protein is expressed mainly in peripheral blood leukocytes and is involved in immune response. NOD2 variants have been associated with increased susceptibility to Crohn's disease, and recently, NOD2 was reported as a causative gene in AgP. The present study aimed to identify potential NOD2 variants in an AgP cohort (a total of 101 patiens: 37 patients with positive family histories and 64 sporadic patients). In the familial group, six patients from two families had a reported heterozygous missense variant (c.C931T, p.R311W). Four patients in the sporadic group had a heterozygous missense variant (c.C1411T, p.R471C), with no reported association to the disease. Overall, two NOD2 variants, were identified in 10% of our AgP cohort. These variants were different from the major variants reported in Crohn's disease. More cases need to be investigated to elucidate the role of NOD2 variants in AgP pathology.

Dental trainees reflect more critically on negative experiences: portfolio analysis using a pragmatic approach and a rubric in Japan.

BACKGROUND: Dental trainees have various clinical experiences during their internships and they grow by experiencing success and failure. When looking back on an event, it is not apparent which experiences result in more critical reflection. Therefore, we qualitatively analyzed the portfolios of dental trainees using Significant Event Analysis to investigate their depth of reflection. METHODS: We asked all Hiroshima University Hospital dental trainees who completed a 1-year training program between 2010 and 2016 to describe their most memorable event from the past year. We coded the text using a qualitative analysis method. Then, we classified the responses as positive or negative events. We evaluated the depth of reflection following a pragmatic approach to categorizing reflective material (Sandars method) and a reflective ability rubric and user guide (O'Sullivan method) and compared these results. The evaluation was performed separately by two researchers and a good rate of agreement was confirmed by the weighted kappa statistic. Comparison of the depth of reflection was performed by the Mann-Whitney U test. RESULTS: The assessments of the positive event group and negative event group were compared with the respective evaluation criteria of the Sandars and O'Sullivan methods, and reflection was found to be deeper in the negative event group. The Mann-Whitney U test revealed a significant difference (p < 0.05) in the median values of the two groups for both methods. CONCLUSIONS: Both positive and negative experiences are important for dental practitioners to grow, but negative experiences are associated with critical reflections. In promoting the growth of training dentists, it is considered important to encourage deep reflections on positive experiences that are likely to be shallow.

Dental hygienists' perceptions of professionalism are multidimensional and context-dependent: a qualitative study in Japan.

BACKGROUND: Due to the declining birth rate and aging of Japanese society, the roles and responsibilities of dental hygienists are continuously expanding. Medical professionalism needs to be pursued continuously throughout one's career in order to improve dental care and treatment. Although conceptualising professionalism is essential to the education of health professionals, professionalism in the field of dental hygiene has not been defined or adequately examined in Japan. The purposes of this study are to investigate dental hygienists' perceptions of the constituent elements of professionalism and the factors affecting their perceptions. METHODS: Semi-structured interviews were conducted with 18 dental hygienists in Japan. Drawing on the conceptualisation of professionalism in medicine described by Van de Camp et al., the transcribed data were thematically analysed. RESULTS: The dental hygienists in this study perceived 70 constituent elements that were categorised into eight core competencies related to professionalism. These competencies were further classified into three main themes: intrapersonal, interpersonal, and public professionalism. There were three sociohistorical factors that affected their perceptions of the constituent elements, namely academic background (university or technical school), the contexts of any previously provided dental care (university hospital or dental clinic), and their social interactions with their colleagues during their engagement in dental practice (dental team or interprofessional team). Moreover, according to their sociohistorical backgrounds, the dental hygienists saw themselves variously as scholars (university graduates), facilitators (university hospital), skillful artisans (dental clinic), or collaborators (interprofessional team). CONCLUSIONS: Dental hygienists' perceptions of professionalism are multidimensional and context-dependent, so culture- and professional-specific elements need to be included in educational curricula and continuing professional development programmes. In particular, the conceptualisation of professionalism in the field of dental hygiene as described in this study can be a springboard for enhancing undergraduate education and clinical training.

Five-year longitudinal study of dental caries risk associated with Streptococcus mutans and Streptococcus sobrinus in individuals with intellectual disabilities.

Streptococcus mutans (S. mutans) and Streptococcus sobrinus (S. sobrinus) are important etiologic agents in human dental caries. Using quantitative real-time polymerase chain reaction assays for the presence of those strains, we examined 145 outpatients with intellectual disability (ID), calculated the proportion of each of these strains to total bacteria, and compared dental caries incidence over 5 years. Plaque samples were collected from all erupted tooth sites, and dental examinations were performed annually to determine numbers of decayed, missing, and filled teeth (DMFT score; World Health Organization caries diagnostic criteria). Elevated DMFT scores were calculated as ∆DMFT, and sites of newly affected caries (∆SNAC) were identified. Sixty-six patients had both strains. The proportion of S. mutans to total bacteria was moderately correlated with DMFT in year 2, ∆DMFT in years 2 and 5, and ∆SNAC in years 2 and 5 (correlation coefficient = 0.470, P < 0.001), while the proportion of S. sobrinus to total bacteria was moderately correlated with DMFT in years 2 and 5, ∆DMFT in years 1, 2, and 5, and ∆SNAC in years 2 and 5 (correlation coefficient = 0.695, P < 0.001). Individuals with ID who harbored both bacterial strains had a higher risk of dental caries and a significantly higher proportion of S. sobrinus to total bacteria.