A Comparison of Recommendations from a Computer-Based Decision System and Tobacco Treatment Specialists: Insights and Lessons Learned.

This pilot study examines the similarities and differences between treatment recommendations offered by a decision system and trained tobacco treatment specialists. Using a sample of ten de-identified patient cases who used tobacco, we compared recommendations from the manual and preliminary review of cases by four tobacco specialists with the automated analysis of patient cases using both the first version of the rule-based system and the second version with improved and additional rules.

Addressing oral health barriers to care in head and neck cancer patients using a novel collaborative care approach.

With appropriate interprofessional collaboration, dental schools have the capacity to facilitate the dental management of patients with head and neck cancer who are facing multiple barriers to care.

Effect of Bone Graft on the Correlation between Clinical Bone Quality and CBCT-determined Bone Density: A Pilot Study.

AIM AND OBJECTIVE: The aim of this pilot study is to explore the possible correlation between radiographic bone density and clinical bone quality in edentulous implant sites with and without a history of bone grafting. MATERIALS AND METHODS: A retrospective evaluation of 273 surgically placed dental implants with adequate preoperative cone-beam computed tomography (CBCT) between 2017 and 2019. Misch classification was used to assess the bone quality, and CBCT grayscale values, utilizing Hounsfield units (HU), were used for radiographic bone density assessment. RESULTS: Sixty-six patients (mean age, 58 years; 43 [65%] female and 23 [35%] male) with 118 implant sites were included. A total of 38 sites with bone grafts were evaluated. Controlling for location, sites with previous bone graft had softer bone quality (p = 0.003) and greater bone density (p <0.001) compared to sites without previous bone grafts. A significant correlation existed between radiographic bone density and clinical bone quality (p ≤0.01). The magnitude of the relationship increased in the absence of bone graft (p <0.001) and became nonsignificant in sites with previous grafting. In sites with allograft, the relationship was not statistically different than those without bone graft (both p ≥0.07), while it was statistically different in sites with xenograft when sites assumed independent (p = 0.02). CONCLUSION: CBCT-determined radiographic bone density was correlated to clinical bone quality in the absence of previous bone grafting, while in the presence of previous bone graft, the radiographic bone density of the edentulous sites seemed to be not associated with the clinical bone density, especially in sites with history of xenograft bone grafting. CLINICAL SIGNIFICANCE: CBCT could be utilized to predict preoperative clinical bone quality in sites without previous bone grafting. When assessing sites with history of bone grafting, the CBCT should be interpreted with caution, especially if xenografts were used.

Dental Students' Knowledge and Attitudes about Human Papillomavirus Prevention.

The purpose of the current study was to assess knowledge and attitudes about human papillomavirus (HPV) and HPV vaccination for oropharyngeal cancer (OPC) prevention in first-year through fourth-year dental students. METHODS: In this cross-sectional quantitative study, surveys assessed knowledge and attitudes about HPV, HPV-related OPC, and HPV vaccination of incoming first-year dental students (D1), outgoing first- and second-year dental students (D1-D2), and outgoing third- and fourth-year dental students (D3-D4). After completing a 40-item pre-training knowledge and attitude assessment survey, a one-time, one-hour national HPV training session was conducted. An 8-item attitudinal post-survey was completed after training. RESULTS: Of 173 participants (75.9% response rate), over 85% did not know that the rate of HPV is not highest among women in their 30s, and only 11% to 28% knew that smoking-associated OPC is more deadly than HPV-associated OPC. While participants overall expressed willingness to administer the HPV vaccine, the willingness of dental students to do so in their future practice tapered off progressively through dental school year categories (p < 0.001). Among outgoing D1-D4 students, the one-hour HPV training increased participants' self-perceived ability to describe the burden of HPV disease, discuss the importance of HPV vaccination for cancer prevention, and provide needed HPV vaccination information to parents (all p ≤ 0.004). CONCLUSIONS: Understanding deficits in dental student knowledge and attitudes across the 4 years of dental school may help dental educators better understand the timing and content needed for effective HPV training in the dental school curriculum to reduce HPV-associated OPC prevalence.

Community partnerships within a novel dental school urgent care center: Student perceptions.

PURPOSE/OBJECTIVES: Oral health inequities and limited access to care cause patients to seek dental treatment in hospital emergency departments. In addition, conventional clinic models and curricular limitations may result in inadequate experiences for students learning urgent dental care. The aim of the current study was to investigate student perceptions of a novel dental school urgent care clinic model. METHODS: A mixed-methods, cross-sectional study design was used to survey third-year and fourth-year students at a Midwest dental school in spring 2020 about their experiences providing patient care in the school's internal urgent care center. Along with a structured curriculum, the urgent care clinic model incorporates an on-site partnership with a community health center and a hospital emergency department affiliation that serves as a referral base to provide students with their learning experiences. RESULTS: Of 81 students, 78 completed the survey (96% response rate). The majority of students treated 50 or more patients. From their urgent care experiences, a majority of students felt prepared to manage patients with acute dental pain and swelling (72/77, 94%), and reported a better understanding of interprofessional collaborations in dentistry (42/77, 55%) and the importance of providing urgent dental care to underserved patients (72/77, 94%). Most students (64/75, 85%) were more likely to offer urgent dental care services to underserved populations in future practice. CONCLUSION: This collaborative school-based urgent care clinic model incorporating community partnerships provided transformative learning experiences, positively impacted student perceptions of their learning, and influenced future practice behaviors related to urgent dental care.

Impact of experiential learning on dental students' training in nitrous oxide inhalation sedation.

PURPOSE/OBJECTIVES: Competence in nitrous oxide/oxygen (N2 O/O2 ) inhalation sedation is expected of dental graduates, but applying what is learned through didactic instruction to patient care can be challenging without firsthand experience. Therefore, the purpose of the current study was to evaluate the impact of experiential learning on dental students' confidence and sense of preparedness for administration of N2 O/O2 . METHODS: A biphasic, mixed methods study was conducted at a Midwestern dental school and included 2 cohorts of dental students. In Phase 1 (spring 2019), a cross-sectional study design was used to survey outgoing third-year and fourth-year students who received didactic N2 O/O2 instruction alone. In Phase 2 (summer 2019), a nonrandomized, preintervention-postintervention study design was used to survey incoming third-year students before and after a hands-on N2 O/O2 laboratory exercise. RESULTS: Of the 79 Phase 1 students (99% response rate), all believed a firsthand learning experience with N2 O/O2 during didactic learning would increase their confidence and preparedness when administering to a patient (both P < .001). Of the 41 Phase 2 students (100% response rate), after the lab exercise, all felt that firsthand experience enhanced classroom instruction and increased confidence and preparedness when administering N2 O to a patient (all P < .001). Fifty-six (71%) Phase 1 and 39 (80%) Phase 2 students believed classroom instruction alone was inadequate to prepare them to administer N2 O/O2 (both P < .001). CONCLUSIONS: Our results strongly suggest that experiential learning of N2 O/O2 inhalation sedation through a hands-on laboratory exercise should be incorporated into the predoctoral curricula of dental schools.

Predicted prevalence of oral human papillomavirus (HPV) by periodontitis status and HPV vaccination status.

OBJECTIVES: The purpose of the present study was to examine differences in oral human papillomavirus (HPV) prevalence among adults based on HPV vaccination status and periodontitis status. METHODS: Data from 2011 to 2012 and 2013 to2014 National Health and Nutrition Examination Surveys (n = 822) were retrieved in order to predict the prevalence of oral HPV in 24 separate demographic groups (age by sex by race) based on the following characteristics: HPV vaccination status and periodontitis status. A multiple logistic regression model, controlling for gender, age, race, smoking behavior, alcohol consumption, and sexual partners, was calculated in order to generate prevalence estimates. RESULTS: Median predicted oral HPV prevalence rates per 1,000 in 2011-2012 were highest among nonvaccinated individuals with periodontitis [median ( x˜ ) = 31.62, interquartile range (IQR) = 102.97], followed by nonvaccinated individuals without periodontitis ( x˜ = 24.63, IQR = 81.84), vaccinated individuals with periodontitis ( x˜ = 18.40, IQR = 62.27), and vaccinated individuals without periodontitis ( x˜ = 14.29, IQR = 48.96). Median predicted oral HPV prevalence rates per 1,000 in 2013-2014 were highest among nonvaccinated individuals with periodontitis ( x˜ = 9.50, IQR = 33.02), followed by nonvaccinated individuals without periodontitis ( x˜ = 7.37, IQR = 25.76), vaccinated individuals with periodontitis ( x˜ = 5.48, IQR = 19.27), and vaccinated individuals without periodontitis ( x˜ = 4.25, IQR = 14.98). CONCLUSIONS: Interventions that integrate primary care and dental care are needed, given increased risk for oral HPV among unvaccinated individuals with periodontitis.

Tobacco dependence education: A survey of US and Canadian dental schools.

BACKGROUND: Tobacco use is the leading preventable cause of morbidity and premature mortality and is a significant factor in the development of oral disease. Tobacco dependence education (TDE) has not, however, been consistently integrated into predoctoral education. The authors conducted a study assessing the content and extent of TDE and intervention skills in US and Canadian dental schools. METHODS: In 2013, the authors contacted the academic deans of the 74 accredited US and Canadian dental schools to identify the educator who would be most appropriately described as the tobacco-use cessation "champion" at their institution. The authors e-mailed an introductory letter to each school's champion with a hyperlink to a 45-item survey; 2 follow-up emails were sent with links to the survey. RESULTS: The response rate was 66% (N = 49). TDE was taught at 92% of dental schools; 90% of respondents indicated that faculty members were confident to extremely confident in teaching tobacco-related pathology. Only 49% reported this level of confidence in teaching students how to help patients quit tobacco. TDE is taught in periodontics (82%), oral pathology (77%), clinic (66%), oral diagnosis (59%), public health dentistry (55%), pharmacology (55%), oral medicine (52%), and other disciplines (less than 50%). CONCLUSIONS: The survey responses revealed that TDE is not a curricular component in all US and Canadian dental schools. Faculty members were most confident in teaching tobacco-related pathology but may lack the interest and skills needed to integrate TDE as part of patient care. PRACTICE IMPLICATIONS: Patients who use tobacco in any form are at an increased risk of developing periodontitis, developing oral cancer, and having poorer surgical outcomes, emphasizing the need for the dental team to be well-prepared through predoctoral dental education.

Tobacco dependence education in U.S. Dental assisting programs' curricula.

The aim of this study was to assess the level of tobacco dependence education (TDE) in the curricula of U.S. dental assisting programs and to compare the findings to those from a similar assessment of dental hygiene curricula. In the 2012-13 academic year, a 51-item survey was sent to directors of all 298 accredited dental assisting programs. Assessed were curricular TDE content, time spent on each topic, expected levels of clinical competence, and resources used. Of the 298 potential participants, 89 programs returned completed surveys, for a response rate of 30%. Of the 13 TDE-related content areas, those most often covered were oral disease related to tobacco use (100%) and general diseases related to tobacco use (93%); those least often covered were stages of (behavior) change (29%), how to develop a comprehensive tobacco intervention program in a private office setting (23%), and strategies for community-based tobacco control (22%). Responding program directors indicated the following levels of tobacco cessation intervention at which students should demonstrate competence: brief, 44%; moderate, 55%; intensive, 8%. Less than half of the reporting programs conducted a formal assessment of clinical competence in any TDE-related skills; however, skills in assessing patient tobacco use and associating head and neck findings to tobacco use were formally or informally assessed by 74% and 61%, respectively. Compared to dental hygiene programs, TDE appeared to play a smaller role in the curricula of dental assisting programs, and dental assisting programs were less likely to formally assess clinical competence in TDE.

Assessment of tobacco dependence curricula in Italian dental hygiene schools.

The aim of this study was to assess the level of tobacco dependence education offered by Italian dental hygiene programs. A fifty-question survey was mailed to the thirty-one active public and private dental hygiene programs in Italy during the 2008-09 academic year. The survey assessed faculty confidence in teaching tobacco treatment, which courses contained tobacco dependence content, the number of minutes spent on specific content areas, and the level of clinical competence that dental hygiene graduates should be able to demonstrate. Surveys were returned by sixteen programs for a response rate of 52 percent. Respondents indicated tobacco dependence education was included in clinic or clinic seminar (56 percent), periodontics (44 percent), oral pathology (31 percent), and prevention (19 percent). All programs reported including the effects of tobacco on general and oral diseases in courses. However, more in-depth topics received less curriculum time; these included tobacco treatment strategies (63 percent) and discussion of cessation medications (31 percent). Interestingly, 62 percent of the respondents indicated they expected dental hygiene graduates to demonstrate a tobacco treatment competency level of a moderate intervention or higher (counseling, discussion of medications, follow-up) rather than a brief intervention in which patients are advised to quit then referred to a quitline. The results of this study indicated that Italian dental hygiene students are not currently receiving adequate instruction in tobacco treatment techniques nor are they being adequately assessed. This unique overview of Italian dental hygiene tobacco dependence education provides a basis for further discussion towards a national competency-based curriculum.

A qualitative study of tobacco dependence treatment in 19 US dental hygiene programs.

INTRODUCTION: The US Public Health Service calls for health professionals to provide tobacco dependence counseling for patients. The purpose of this study was to understand how dental hygiene programs make decisions about and provide training for tobacco dependence counseling to help them graduate more fully competent hygienists. METHODS: We conducted interviews (N = 32) with mainly program and clinic directors from 19 US dental hygiene education programs for this qualitative case study. We explored fluoride therapy training and tooth whitening training for comparison. Two analysts summarized the transcripts into a case study for each program. RESULTS: All programs reported a similar process of learning about and choosing a method for teaching the topics explored. The programs used a common process, ADPIE (assess, diagnose, plan, implement, evaluate), to structure students'clinical encounters. Almost all programs train students to ask about tobacco use and to advise quitting, but few programs train students to effectively help patients to quit and only 2 programs evaluated the competence of all students to provide such training. ADPIE shows promise for integrating tobacco dependence treatment more fully into the clinical training of dental hygiene students. Comparison to tooth whitening and fluoride therapy training indicated that complexity of the treatment and alignment with dental hygiene's mission were themes related to training decisions. CONCLUSION: Full implementation of tobacco dependence counseling into dental hygiene education requires a commitment by dental hygiene educators to train students and faculty in counseling techniques and their evaluation. We identified an existing clinical structure as showing promise for facilitating improvement.

Assessing the current status of tobacco dependence education curricula in U.S. physician assistant programs.

PURPOSE: Tobacco use continues to be the single most preventable cause of death and disease in the United States. A paradigm shift is needed in physician assistant (PA) education to address tobacco dependence as a chronic, relapsing disease requiring patient education, counseling, treatment, and follow-up. METHODS: A national study was conducted to assess the existing tobacco dependence education currently offered in U.S. PA programs. An established tobacco dependence curriculum survey was revised and mailed to the 141 accredited PA programs in the United States during the 2008-2009 academic year. The survey asked respondents to report the following with regard to tobacco dependence education content in their PA program; (1) Perceived self-efficacy and barriers; (2) Medical topics covered and minutes spent; (3) Evaluation of students' competency level; (4) Tobacco courses, topics, and resources used; and (5) Level of tobacco-cessation competency expected upon graduation. RESULTS: A total of 79 surveys were returned (56% response rate). Though, on average, over 827 minutes (14 hours) were devoted to tobacco dependence education curriculum, most minutes (223 minutes) were spent on the health effects of tobacco use, with only 42 minutes spent on cessation counseling, 55 minutes on medications, and 13 minutes on integrating tobacco-cessation into clinical practice. CONCLUSIONS: PA educators have the unique opportunity to affect tobacco-related morbidity and mortality. The present study demonstrates that PA instructors are more than adequately teaching students about tobacco use. However, it is not clear if students are being adequately taught how to assist patients to quit using tobacco.

Effect of hormone replacement therapy (HRT) on periodontal status of postmenopausal women.

BACKGROUND: The risks/benefits balance of hormone replacement therapy (HRT) is controversial. The aim of this study was to assess the periodontal status of a postmenopausal women group receiving HRT and to determine the effects of HRT on clinical measures of periodontal disease. MATERIAL/METHODS: Ninety-one postmenopausal women, 52 taking HRT (HRT+) and 39 not taking HRT (HRT-), completed the study. Clinical parameters measured included visible supragingival plaque, probing pocket depth (PD) and clinical attachment level (CAL). Gingival status was recorded as gingival bleeding on probing (BOP). Previous oral contraceptive use and current and past smoking status were also assessed. RESULTS: Data indicated that PD and CAL were not significantly different between HRT+ patients and HRT- patients (P=0.8067 and P=0.1627, respectively). The HRT+ group exhibited significantly lower visible plaque levels compared to the control group (P<0.0001). The percentage of gingival sites with positive BOP was significantly lower in the HRT+ group compared to the HRT- group (34.85% vs. 65.15%; P=0.0007). Plaque accumulation was also tested in ANCOVA as a possible explanatory variable for the differences observed in gingival bleeding. The ANCOVA showed no significant differences in gingival bleeding between HRT+ and HRT- women (P=0.4677). No significant differences in past smoking status and oral contraceptive use were detected between HRT+ and HRT- women (P=0.9999 and P=0.0845, respectively). CONCLUSIONS: These findings indicated that long-term HRT was not associated with relevant effects on periodontal status and clinical measures of periodontal disease, thus suggesting that HRT may not confer protection against periodontitis in postmenopausal women.

Assessment of tobacco dependence curricula in U.S. dental hygiene programs.

Tobacco dependence education (TDE) continues to be a vital component of dental hygiene curricula-made even more important by the fact that tobacco cessation in adults in the United States has stagnated over the past ten years. This study was undertaken to assess the salient characteristics of TDE in U.S. dental hygiene programs. A fifty-one question survey was mailed to the program directors of all 283 accredited dental hygiene programs during the 2007-08 school year (this number does not include the programs in Illinois, which were excluded since they had participated in a previous study). A total of 187 schools returned the survey for a return rate of 66 percent. Curricular content, minutes spent on each topic, existing level of clinical competence measured, expected level of clinical competence, and resources used were assessed. Respondents reported an average of 6.7 hours spent on all identified components of tobacco education. While 77 percent of respondents reported formally assessing whether a student asked if a patient used tobacco, only 26 percent indicated having a formal competency utilizing all of the U.S. Public Health Service's Clinical Practice Guideline 5 As and 5 Rs. In contrast, 72 percent of program directors reported expecting their graduates to be competent in a moderate intervention that included all 5 As. Though there is a clear commitment to TDE among dental hygiene programs in the United States, we recommend training to a more intensive level of TDE in order to facilitate broader adoption of comprehensive, evidence-based guidelines.

Evaluation of a comprehensive tobacco cessation curriculum for dental hygiene programs.

Dental health care providers continue to offer inconsistent and limited tobacco use cessation (TUC) interventions even though smoking-related morbidity and mortality continue to be a substantial health concern. Our purpose was to conduct a comprehensive, three-year (2003-06) TUC curriculum evaluation that included assessment of existing TUC education offered; dental hygiene educators' readiness to incorporate TUC education into the curriculum; and development of a pre-test/post-test assessment instrument and faculty development program. This curriculum study was carried out alongside a research study to evaluate the effectiveness of a peer-reviewed tobacco curriculum (Tobacco Free! Curriculum). Faculty members (baseline n=97; third-year n=42) from the twelve dental hygiene associate degree programs in Illinois participated in the study, which included a pre-treatment survey, six hours of on-site TUC curriculum training, and a post-treatment survey to determine the attitudes, perceived barriers, and current practices in tobacco education. Results showed an average increase of eighty-five minutes spent on tobacco education in the dental hygiene curriculum, a large positive increase in the percentage of faculty members who formally assessed the use of 5As and 5Rs (21 percent to 88 percent), and a dramatic increase (+100) in the percentage of faculty members who taught or included most of the thirteen TUC content areas following the introduction of the curriculum and training program.

Education of tobacco use prevention and cessation for dental professionals--a paradigm shift.

The use of tobacco continues to be a substantial risk factor in the development and progression of oral cancer, periodontitis, implant failure and poor wound healing. Dental and dental hygiene education providers have made great advances towards the incorporation of tobacco education into their curricula in recent years. Unfortunately, however, both medical and dental education research has consistently reported schools providing only basic knowledge-based curricula that rarely incorporate more effective, behaviourally-based components affecting long-term change. The limited training of oral healthcare students, at least in part, is reflected in practising dental professionals continuing to report offering incomplete tobacco interventions. In order to prepare the next generation of oral healthcare providers, this paper proposes a paradigm shift in how tobacco use prevention and cessation (TUPAC) may be incorporated into existing curricula. It is suggested that schools should carefully consider: to what level of competency should TUPAC be trained in dental and dental hygiene schools; the importance of establishing rapport through good communication skills; the core knowledge level for TUPAC; suggested instructional and assessment strategies; the importance of continuing professional education for the enhancement of TUPAC.

Factors affecting adoption of tobacco education in dental hygiene programs.

BACKGROUND: Tobacco cessation interventions provided by health care professionals, including dental hygienists can significantly increase the rate of tobacco cessation, yet providers feel inadequately prepared to deliver such interventions. METHODS: 96 dental hygiene faculty completed a survey measuring attitudes, subjective norms, and perceived behavioral control to determine their influence on teaching and assessing tobacco cessation intervention competencies. RESULTS: Prior experience with providing tobacco cessation counseling, perceptions of internal confidence and control of barriers were significantly related to covering tobacco-related topics. CONCLUSION: Comprehensive, flexible tobacco education curriculum guides may help faculty overcome barriers to incorporating tobacco education in dental hygiene programs.

The need for tobacco education: studies of collegiate dental hygiene patients and faculty.

The need for inclusion of comprehensive tobacco control education/training for health care providers continues to be stressed in publications addressing cessation services. The dental appointment presents an excellent opportunity to provide tobacco interventions to basically healthy people on regular intervals. The purpose of this study was twofold: 1) to assess the need (stage of change and concomitant need for tobacco cessation intervention) of dental hygiene patients at a Midwest dental hygiene clinic, and 2) to assess and compare the level of tobacco intervention education currently being offered by dental hygiene educators in a Midwestern state. Patients (n=426) of a collegiate dental health clinic completed a survey that assessed the level and type of tobacco cessation intervention patients might require. A statewide sample of dental hygiene faculty (n=97) were surveyed to determine the attitudes, perceived barriers, and current practices in tobacco education offered in their programs. Of patients who currently smoked (34.5 percent), 24.7 percent indicated being in the Action stage of change; 14.2 percent were in Preparation; 22.2 percent were in Contemplation; and 29 percent were in Precontemplation. Although faculty indicated tobacco education was very important (5.03 on 1-6 scale), they felt only moderately confident delivering tobacco education (3.18 on a 1-5 scale). Only 16 percent to 35 percent of faculty reported that their curriculum included brief motivational interviewing, pharmacotherapies, or setting-up a private practice tobacco control program. The results strongly suggest the need for a comprehensive, competency-based tobacco curriculum to enhance and expand existing dental hygiene programs.

Tobacco cessation for the dental team: a practical guide part II: evidence-based interventions.

Dental professionals are strategically placed to be the leaders in tobacco prevention and cessation as they provide preventive and therapeutic services to a basically healthy population on a regular basis. By expanding the dental exam, diagnosis, and treatment to include tobacco cessation, a potentially life saving element of care is added to an established service. In addition periodontal disease and the potential for oral cancer mandate the inclusion of tobacco cessation services into dental care. Though dental professionals are aware of the health issues associated with tobacco use, they often feel ill prepared or uncomfortable presenting patients with a clear cessation message. In this, the second of a two-part article, the purpose is to provide dental professionals with the evidence-based strategies necessary to provide effective tobacco cessation as a normal part of patient care.

Tobacco cessation for the dental team: a practical guide part I: background & overview.

Dental professionals are strategically placed to be the leaders in tobacco prevention and cessation as they provide preventive and therapeutic services to a basically healthy population on a regular basis. By expanding the dental exam, diagnosis, and treatment to include tobacco cessation, a potentially life saving element of care is added to an established service. In addition periodontal disease and the potential for oral cancer mandate the inclusion of tobacco cessation services into dental care. Though dental professionals are aware of the health issues associated with tobacco use, they often feel ill prepared or uncomfortable presenting patients with a clear cessation message. In this, the first of a two-part article, the purpose is to provide dental professionals with the foundational knowledge necessary to provide effective tobacco cessation as a normal part of patient care.