Inclusion of gerodontology in dental curriculum: An urgent case for India.

The proportion of older adults is on the rise. Management of dental problems in this group is different from the general population, and hence requires special training. Gerodontology is yet to find its place in the Indian dental curriculum. A lack of training would result in inadequate care delivery. In this article, we share our views on the need for inclusion of the subject, potential challenges, and a guide for incorporation of gerodontology in undergraduate and postgraduate curriculum in the Indian dental institutes. We propose a framework based on the salient features of Kern's 6-step approach for curriculum development and Kotter's 8-step change management model. Some features are common to both the models. A combination of these models includes the following salient features: Problem identification and general needs assessment, beginning with a sense of urgency and targeted needs assessment, communication of the vision for change, working in guided coalitions and defining clear goals and objectives, adopting the relevant educational strategies, implementation strategies to enable change and generating short-term wins, evaluating the effectiveness of the curricular reform and sustaining and anchoring the change. The proposed framework may also be useful for countries where gerodontology is yet to be implemented.

COVID-19 pandemic and its impact on dental students: A multi-institutional survey.

PURPOSE/OBJECTIVES: To investigate dental students' perceptions and concerns regarding the COVID-19 pandemic, their coping strategies and support resources, and their perceived stress levels. METHODS: A customized 19-item survey and the perceived stress scale (PSS) were applied to undergraduate dental students from the US, Spain, Ireland, Chile, India, and Brazil between April 10 and July 5, 2020. Linear modeling and mediation analysis were used to explore the relationships among demographics, stressors, coping mechanisms, social support, and stress RESULTS: A total of 4475 students responded to the survey. The majority (72.4%) were women, and 52.3% had no COVID-19 training at the time of the survey. The students reported that they had to accommodate to changes in patient care (96.6%) and didactic learning (95.2%) activities, while 88.5% of the respondents indicated at least one of their courses moved online. Transition to online courses went "smoothly with some troubles" for 51.8% of the respondents, and 48.3% perceived the faculty as prepared for the online transition; however, 45.9% reported feeling extremely concerned about the impact of COVID-19 on their education. The average PSS score was 21.9 of 40 (moderate stress). Multivariate models were built for participants with full data (n = 3899). Being male, having completed more dental coursework, and perceiving a smoother transition were associated with lower PSS scores; more concern about academic progress was associated with higher PSS. Faculty support mediated the relationship between a smoothness of transition and concern about academic progress and PSS scores CONCLUSION: Stress caused by the pandemic may be alleviated by smoother transition and good faculty support.

Interprofessional education - a case for Gerodontology training.

Increasing life expectancy, concepts of patient well-being, and the multiplicity of needs of the geriatric population, demand contribution, and collaboration of physicians, dentists, psychologists, pharmacists, and other allied health disciplines, to provide quality care to patients. Interprofessional education (IPE) is an approach to education that improves collaboration among health professionals and it can aid in better management of geriatric patients. Communication and cooperation affect health care performance and hence, influence patient outcomes. Currently, each of the disciplines mentioned has customized undergraduate and/or postgraduate training in geriatric care. Though a uni-disciplinary educational approach increases knowledge and skills of individual professions separately, IPE offers significant advantages. IPE seeks to have students learning together, as well as from each other to develop exemplary collaborative practice. The World Health Organization (WHO) has proposed that IPE will ensure optimum health care. However, IPE is yet to find its proper place in dental education. It would help dental students to develop a positive attitude toward geriatric patients and increase their empathy and efficiency in the management of these patients. This manuscript seeks to highlight the concept of interprofessional education (IPE) in gerodontology and develop recommendations for implementation of IPE in India.

Current status of gerodontology curriculum in India and other parts of the world: A narrative review.

BACKGROUND: The current rise in the world's geriatric population has placed additional demands on dental professionals, as the management of geriatric patients requires distinct competencies. AIM: To review and perform a content analysis of the gerodontology undergraduate curriculum worldwide. DATA SOURCES: A search was carried out in PubMed, Web of Science, ERIC and EMBASE databases for the period-July 2008 till May 2019, using MeSH terms. A search for websites of Indian universities was also done, and undergraduate curricula were screened. STUDY ELIGIBILITY CRITERIA: The study included articles related to the undergraduate curriculum, which contained training in geriatric dentistry. Articles in foreign languages and those related to dental hygienists were excluded. RESULTS: A total of 218 articles were obtained, of which 19 met the inclusion criteria. A total of 301 colleges taught gerodontology. Amongst them, 50 colleges had a gerodontology department. Clinical training and outreach experience were provided in 175 and 73 colleges, respectively. There are no reports on the status of gerodontology in Asian countries (excluding Japan). In India, gerodontology is not taught as a separate subject. However, few gerodontology-related topics are covered in clinical subjects. CONCLUSIONS: There seems to be a wide variation in the content of gerodontology curriculum taught worldwide. Other than the European and American regions, gerodontology is yet to develop in other parts of the world. In India, a robust training programme is required to address the lack of dental care providers for the geriatric population using guidelines established by ECG and ADEA.

Are Multiple Choice Questions for Post Graduate Dental Entrance Examinations Spot On?-Item Analysis of MCQs in Prosthodontics in India.

BACKGROUND: Construction of appropriate test items is a challenge in preparing quality multiple choice questions. Item analysis provides valuable feedback data on validity of multiple choice questions. The present study was conducted to evaluate the difficulty index, discrimination index and distracter efficiency of the items present in the multiple choice questions of post graduate dental entrance examinations. METHODS: A list consisting of 20 MCQs was taken from the entrance exam books of MCQs on an introductory topic and administered to 104 undergraduate students. RESULTS: In the present study 15% of the MCQs related to impression making procedure were difficult with difficulty index (p) less than 30%, 15% were poor discriminators and 55% had at least one non-functional distracter. CONCLUSION: Item analysis of MCQs in post graduate entrance examinations demonstrated low difficulty index, discrimination index and distracter efficiency. Hence, we propose a strong need for faculty training in test constructors and their post validation.

Assessing the Feasibility and Effectiveness of an App in Improving Knowledge on Oral Cancer-an Interventional Study.

Although current oral health care initiatives have proved to be quite successful, a great number of individuals are unaware of how their choice of daily activities compromises their oral health. That is why newer technologies like WhatsApp can definitely serve as a platform to communicate dental advice, thereby strengthening the bridge between health and technology. The objective of the study was to assess the effectiveness of WhatsApp as a tool for providing health education on tobacco and oral cancer as compared to the conventional health education via PowerPoint. The study was a cluster randomized controlled trial, single-center study. The students of 18-24 years of age with WhatsApp application active in their mobile phones were included. Four classes with 182 students were randomly divided into intervention and control groups. Control group received health education on oral cancer using a PowerPoint presentation weekly, for a total of 4 weeks. Intervention group received health education through WhatsApp messaging thrice a week for 4 weeks. Pre- and post-health education knowledge scores were assessed using a questionnaire and compared using unpaired and paired two-sample t tests. Statistically significant increase in knowledge scores was seen in both groups, with highly significant improvement in the intervention group (p value = 0.00). Intergroup comparison showed no significant difference in knowledge scores at baseline, but a significant difference in post intervention knowledge scores (t = -15.05 p<0.001) WhatsApp can be a more effective tool for providing dental education on tobacco and oral cancer as compared to conventional audio-visual aids.

Challenges in Learning Preclinical Prosthodontics: A Survey of Perceptions of Dental Undergraduates and Teaching Faculty at an Indian Dental School.

INTRODUCTION: Preclinical dental education promotes development of competency and expertise before students work on patients, but this phase is devoid of exposure to real patients leading to challenges in teaching-learning. AIM: The aim of this study was to explore the challenges faced by students during the process of learning preclinical prosthodontics. MATERIALS AND METHODS: Two Focus Group Discussions (FGDs) were conducted with two different groups of students and one FGD was held with prosthodontics faculty. The FGDs explored the student's and faculty perceptions on the topics which were difficult for the students to understand and their suggestions on how these topics can be made easier to understand. The discussions were audio taped with prior consent and transcribed. RESULTS: The students and the faculty felt that the subject of prosthodontics is vast, difficult to visualize and also difficult to correlate theory with practical aspects. Lack of clinical exposure coupled with use of conventional methods of teaching were identified as reasons for difficulty in understanding the subject. Both students and faculty members suggested that use of simulation, demonstrations, and videos could augment the learning process for the students. Early clinical exposure will help solve many problems encountered during learning and contribute to a better understanding. CONCLUSION: The students and faculty expressed a "need" for early clinical exposure to enhance the learner's understanding of the preclinical aspects of the subject. The present study highlights the need for change in instruction methods to enhance the learning experiences in preclinical prosthodontics of dental undergraduate students in India.

Ethical Conventions: A Study on Dental Practitioner's Knowledge and Practice of Ethics in their Line of Work in Bangalore, India.

INTRODUCTION: Dentistry, being one of the healing professions, has an obligation to society that its members will stick on to high ethical standards of conduct. In India, studies done to assess whether the dental practitioners adhere to ethics in their line of work are very meager. AIM: The present study was conducted to assess the knowledge and practice of ethics in their line of work among practicing dentists from various dental colleges in Bangalore, India. MATERIALS AND METHODS: A descriptive cross-sectional survey was conducted among 258 practicing dentists attached to various dental colleges in Bangalore city of Karnataka, India. Independent sample t-test was used to compare the knowledge and practice scores according to gender and qualification. One way ANOVA was used to compare knowledge and practice score according to practice type and practice period. RESULTS: Mean knowledge score among males is 8.9 as compared to 9.43 among females and mean practice scores among males was 8.25 as compared to 8.29 in females. Statistically significant differences were found in the mean knowledge and practice scores among graduate dentists and specialists. Mean knowledge score among graduate dentists was 8.44 as compared to 9.36 among specialists and mean practice scores among graduate dentists was 7.7 as compared to 8.53 in specialists. CONCLUSION: A significant association between the knowledge and practice scores was observed, implying that with an increase in knowledge, there was also an increase in the practices of ethics among study population.

An in vitro study to determine the effect of Terminalia chebula extract and its formulation on Streptococcus mutans.

AIM: Many weapons are available in the arsenal of a dental professional to combat dental caries, which is almost ubiquitously present. From a public health perspective, most of these weapons are far from being an ideal drug. Hence, there is a demand for better and effective antibacterial agents. This factor stimulated the process of the present study. The aim of the study was to determine the effect of ethanol extract of Terminalia chebula on Streptococcus mutans. MATERIALS AND METHODS: Dried ripe fruits of Terminalia chebula were procured and powdered. Physical tests were done to estimate purity of the fruit powder. Hydroethanolic and aqueous extracts were prepared according to standard procedures. Minimum inhibitory concentration of the extracts was determined by tube dilution method and confirmed by agar dilution method. The effect of the hydroethanolic extract on sucrose induced adhesion, glucan-induced aggregation and on glycolysis of Streptococcus mutans was also assessed. Preservative, gelling agent and sweetener were added in suitable quantities to the ethanol extract, and mouthrinse was formulated. Minimum inhibitory concentration of the formulation was also determined. RESULTS: Yield was better in case of aqueous extract. The Minimum inhibitory concentration of hydroethanolic extract was determined to be 2.5%. Minimum inhibitory concentration of the aqueous extract was determined to be 10%. Hydroethanolic extract of Terminalia chebula (2.5%) inhibited sucrose induced adherence and aggregation of Streptococcus mutans in vitro. CONCLUSION: The mouthrinse formulated from ethanol extract of Terminalia chebula demonstrated substantial antibacterial activity and could be used as an effective anticaries agent. CLINICAL SIGNIFICANCE: Terminalia chebula mouthrinse can be effectively used in clinical practice as an anticaries mouthrinse with additional benefit being that it is safe and economical.

Traumatic dental injuries in primary school children of South India--a report from district-wide oral health survey.

AIM: The aim of this study was to investigate the prevalence of dental trauma among primary school children aged 6-11 years in Belgaum, India. MATERIALS AND METHODS: A sample of 13,200 children from primary schools of Belgaum district was examined for dental trauma. WHO classification of dental trauma was used. RESULTS: Total number of children suffering from dental trauma was found to be 1946 (14.74%). A significant gender influence on the occurrence of dental trauma was observed, with more boys (17.26%) experiencing dental trauma than girls (12.29%). More than 3 mm overjet and incompetent lips were also significantly associated with dental trauma in children. CONCLUSION: The findings of this study show that dental trauma has a moderately high prevalence among Indian primary school children. Community, especially parents and school teachers, should be educated about prevention and early management of dental trauma in children.

Association of erosion with dietary factors among 5-year-old children in India.

PURPOSE: The purpose of this study was to determine the association of dental erosion with dietary factors and oral hygiene practices among 5-year-old schoolchildren in Belgaum, Karnataka, India. METHODS: A random sample of 1,002 5-year-old children was drawn from Belgaum schools. Erosion was assessed using the modified Smith and Knight index. A self-designed questionnaire was used to probe into the details of the children's dietary practices. RESULTS: Frequency of consumption of beverages, canned juices, tamarind, and honey, a mixed diet, and frequency of teeth cleaning were significant predictors of dental erosion. Oral hygiene practices like timing of cleaning teeth and materials used did not show significant association with dental erosion. CONCLUSION: Certain dietary factors like canned juice, raw mango, gooseberry, tamarind, honey, buttermilk, and beverages showed significant correlation with dental erosion. Dietary counseling must take this into consideration.

The efficacy of Terminalia chebula rinse on Streptococcus mutans count in saliva and its effect on salivary pH.

PURPOSE: The aim of the present study was to assess the effectiveness of Terminalia chebula aqueous extract rinse on salivary pH and Streptococcus mutans. Mouthrinses have been in use from time immemorial as a supplement for routine oral hygiene practice. Although a large number of mouthrinses are currently available, many of them possess certain drawbacks, which has necessitated the search for alternate agents. MATERIALS AND METHODS: Ten per cent of T. chebula extract was prepared. A purposive sample of 30 subjects was selected and randomly divided into extract and control groups. Baseline salivary sample was collected. The freshly prepared extract rinse and control were given to the respective groups. Distilled water was used as a negative control. Salivary samples were collected at 5 and 60 min after rinsing and were subjected to pH and microbiological analyses. An acceptability questionnaire was given to all of the participants. Statistical analysis was done using paired and unpaired t tests. RESULTS: There was a significant reduction in the S. mutans count at 5 and 60 min after rinsing the extract. Salivary pH remained alkaline for a period of 1 h after rinsing the extract. Results of the acceptability questionnaire indicated that the mouthrinse was acceptable to 80% of the subjects. CONCLUSIONS: The results of the present study indicate that T. chebula may prove to be an effective anticaries mouthwash owing to its ability to increase salivary pH and inhibit S. mutans. This may also be a valuable public health intervention as it is economical and has multiple health benefits.

Gender and glaucoma: what we know and what we need to know.

PURPOSE OF REVIEW: With growing aging populations and an increase in cases of glaucoma and glaucoma blindness worldwide, aging populations are particularly at higher risk of glaucoma and glaucoma blindness. Awareness of the gender differences might increase attention toward populations at risk. RECENT FINDINGS: Women not only outlive men, but also outnumber men in glaucoma cases worldwide. Women are at higher risks for angle closure glaucoma, but there is no clear gender predilection for open angle glaucoma. Of interest, there is some evidence suggesting that female sex hormones might be protective of the optic nerve. In addition, it is hypothesized that decreased estrogen exposure is associated with increased risk for open angle glaucoma, yet population-based studies present inconsistent results. Presently, there is insufficient evidence to support hormonal replacement therapy use in glaucoma prevention. In addition, it appears that women carry a larger burden of glaucoma blindness due to longevity and disadvantages in socioeconomic/health beliefs. SUMMARY: Current evidence suggests that older women are at risk for glaucoma and glaucoma blindness. Further interdisciplinary research involving investigators, specialized in glaucoma, women's health and health disparities, will lead to better understanding of gender health disparities in glaucoma and better targeting populations at risk.

Distribution and severity of erosion among 5-year-old children in a city in India.

PURPOSE: The purpose of this descriptive, cross-sectional study was to determine the prevalence and distribution of dental erosion among 5-year-old schoolchildren in Belgaum, North Karnataka, India. METHODS: A random sample of 1,100 5-year-old schoolchildren who met the inclusion criteria were included in the study, of whom 1,002 actively participated. The questionnaire given to parents pertained to sociodemographic factors, and the parents were instructed to maintain their child's 3-day diary to assess his/her existing dietary habits. Later, the questionnaire was collected and a clinical examination for dental erosion was performed. A modified Smith and Knight index was used to assess the extent of dental erosion. The child's socioeconomic status was assessed using Kuppuswamy's classification. Statistical analysis was performed using the chi-square test, Spearman's rank correlation coefficient tests and multiple logistic regression analysis. RESULTS: The prevalence of dental erosion was approximately 29% (with a higher prevalence observed in females). CONCLUSION: A statistically significant association was found between diet type, type and time of exposure to acidic diet and dental erosion.

A novel accelerated in vitro release method for biodegradable coating of drug eluting stents: Insight to the drug release mechanisms.

The major objective of the present study was to develop an accelerated in vitro release method for everolimus/poly(lactic-co-glycolic acid) (PLGA) biodegradable DES that reflects and discriminates between many different sources of variations in the manufacturing process by introducing organic solvents in the release medium. To get further insight into the underlying drug release mechanisms, alongside release studies, the surface changes of the coated stents and the molecular weight changes of the polymer upon immersion in the selected release media were examined by scanning electron microscopy and size exclusion chromatography. The incorporation of acetonitrile in the release medium resulted in an increase in the drug release rate due to an increment in total porosity of the matrices. The developed method reflected and discriminated between different sources of variations in the manufacturing process and correlated with the real-time release. Over 80% of everolimus release occurred within 24h. The molecular and gravimetric weights of PLGA remained unchanged throughout the dissolution period, suggesting that the polymer does not undergo degradation through cleavage of its backbone ester linkages. It is likely that the drug release occurred mainly through its diffusion. The method can be employed as a rapid quality control test during development or commercial manufacturing.