2015 American College of Rheumatology Workforce Study and Demand Projections of Pediatric Rheumatology Workforce, 2015-2030.

OBJECTIVE: To describe the character and composition of the 2015 pediatric rheumatology workforce in the US, evaluate current workforce trends, and project future supply and demand of the pediatric rheumatology workforce through 2030. METHODS: The American College of Rheumatology created the workforce study group to study the rheumatology workforce. The workforce study group used primary and secondary data to create a representative workforce model. Pediatric rheumatology supply and demand was projected through 2030 using an integrated data-driven framework to capture a more realistic clinical full-time equivalent (FTE) and produce a better picture of access to care issues in pediatric rheumatology. RESULTS: The 2015 pediatric rheumatology workforce was estimated at 287 FTEs (300 providers), while the estimated excess demand was 95 (33%). The projected demand will continue to increase to almost 100% (n = 230) by 2030 if no changes occur in succession planning, new graduate entrants into the profession, and other factors associated with the workforce. CONCLUSION: This study projects that the pediatric rheumatology workforce gap will continue to worsen significantly from the 2015 baseline, and by 2030 the demand for pediatric rheumatologists will be twice the supply. Innovative strategies are needed to increase the workforce supply and to improve access to care.

Reflections of psychomotor skill development in preclinical simulation: A qualitative analysis.

INTRODUCTION: Reflection on competency helps students become more proficient in performing skills, with the ultimate goal of better retention of knowledge and skill. Competency progression involves a complex interplay of factors, and not having the insight of such multiple perspectives of the same experience, we will not be able to understand students as learners fully and consequently may rely on assumption and may not be able to provide the necessary interventions for growth and progress towards competency. This study aims to investigate students' insight of their own progression during psychomotor skill development. MATERIALS AND METHODS: Data were obtained from scanned reflective dialogue log document portfolios from the preclinical fixed dental prosthodontics section, which is part of a comprehensive dental care course during the second year. Data were coded using NVivo software version 12 plus (QSR International Pty Ltd, Vic, Australia), and subsequent thematic analyses identified emerging themes. RESULTS: Three themes emerged and these were (a) challenges to overcome, (b) feed-back and self-appraisal, and (c) progress and growth. The qualitative data generated did not reveal considerable variation in the students' reflections, and the three themes seem to interrelate. CONCLUSIONS: The main challenge was the concept of the single path of insertion and the perception that it was a source of frustration during this course. Self-appraisal identified time management issues and the transformation from preconceived or learned concepts. As the semester progressed, students reflected progress and growth.

Leadership Development in Dental Education: Report on the ADEA Leadership Institute, 2000-14.

The American Dental Education Association's Leadership Institute (ADEA LI) is the association's flagship development program for those aspiring to leadership in dental and higher education. As with previous studies of the ADEA LI, ADEA will use information from the survey described in this report to improve the ADEA LI curriculum and to guide other leadership development efforts. In 2014-15, ADEA distributed a 50-item online survey via email to all ADEA LI alumni from the classes of 2000 through 2014. The survey included selected-response questions, closed-ended questions, and open-response questions. The survey had an overall response rate of 47% (133/285); response rates to individual items varied. The mean age of the respondents when they participated in the Institute was 48.5 years. Men and women were almost equally represented among the respondents. Nearly half reported their ultimate career goal as department chair, associate dean, or assistant dean, while 20 (15.8%) indicated a goal of becoming dean and 15 (11.8%) aspired to administrative roles higher than dean. Areas the respondents recommended for improvement included more programming in budgeting and financial management, fundraising, and personnel management. Almost 100% of the respondents indicated they would recommend the ADEA LI to others. Overall, the survey respondents confirmed the value of the ADEA LI in their assessment of their fellowship and its subsequent application to their careers. Comparison of elements from this study to previous studies of ADEA LI alumni demonstrates the effectiveness of past changes made to the Institute and the creation of additional ADEA leadership initiatives.

Use of High-Definition Audiovisual Technology in a Gross Anatomy Laboratory: Effect on Dental Students' Learning Outcomes and Satisfaction.

Laboratory cadaver dissection is essential for three-dimensional understanding of anatomical structures and variability, but there are many challenges to teaching gross anatomy in medical and dental schools, including a lack of available space and qualified anatomy faculty. The aim of this study was to determine the efficacy of high-definition audiovisual educational technology in the gross anatomy laboratory in improving dental students' learning outcomes and satisfaction. Exam scores were compared for two classes of first-year students at one U.S. dental school: 2012-13 (no audiovisual technology) and 2013-14 (audiovisual technology), and section exams were used to compare differences between semesters. Additionally, an online survey was used to assess the satisfaction of students who used the technology. All 284 first-year students in the two years (2012-13 N=144; 2013-14 N=140) participated in the exams. Of the 140 students in the 2013-14 class, 63 completed the survey (45% response rate). The results showed that those students who used the technology had higher scores on the laboratory exams than those who did not use it, and students in the winter semester scored higher (90.17±0.56) than in the fall semester (82.10±0.68). More than 87% of those surveyed strongly agreed or agreed that the audiovisual devices represented anatomical structures clearly in the gross anatomy laboratory. These students reported an improved experience in learning and understanding anatomical structures, found the laboratory to be less overwhelming, and said they were better able to follow dissection instructions and understand details of anatomical structures with the new technology. Based on these results, the study concluded that the ability to provide the students a clear view of anatomical structures and high-quality imaging had improved their learning experience.

A Profile of Dental School Deans, 2014.

To develop a profile of current U.S. dental school deans and report their perceptions, challenges, and opportunities that should be addressed in the leadership development programs of the American Dental Education Association (ADEA), data were gathered using a web-based survey organized into seven content areas. In 2014, the deans of all accredited dental schools in the U.S. including Puerto Rico were invited to participate in the survey. The response rate was 86% (56/65). A majority of the deans were male (N=44; 79%) and white/non-Hispanic (N=49; 88%); all reporting degrees held a DDS/DMD (N=54; 100%). Just over half were between the ages of 46 and 55 (N=31; 55%) when they first became a dean. The mean age of these deans was 61.4 years, with a range of 48-72. The respondents reported that school administration/management, fundraising, students, the academic environment, leadership development, and faculty had a high level of influence on their job satisfaction. Communication, conflict resolution, and finance were reported as the most important knowledge areas. A majority reported being better prepared for clinical education and student relations than fundraising and research when they took their positions. They responded that finances and faculty recruitment and retention were their greatest challenges as a dean. Among these respondents, 98% (N=55) reported being satisfied to very satisfied with their job overall. The survey results will inform ADEA's leadership development programs for the next five to seven years.

Evaluation of an integrative model for professional development and research in a dental curriculum.

The purpose of this project was to evaluate a Research, Professional Development, and Critical Thinking Integrative Model developed for use in a dental curriculum. This article outlines strategies used in developing a competency-based pedagogical model designed to provide a tailored student learning environment with objective, measurable, and calibrated assessment outcomes. The theoretical model integrated elements of critical thinking, professionalism, and evidence-based dentistry across dental school disciplines; implementation was based on consensus of dental faculty and student representatives about course content, faculty allocation, and curriculum alignment. Changes introduced included the following: 1) conversion and integration of previously siloed course content taught in Years 1 and 2 to sequential two-year combined courses; 2) reduction of course and content redundancies; 3) delivery of courses by teams of faculty members in biomedical, behavioral, and clinical sciences; and 4) reduction of total curriculum credit/contact hours from 13.5 (201 contact hours) to 5.0 (60 contact hours), allowing the Curriculum Committee to accommodate additional courses. These changes resulted in improvement in student satisfaction.

Distance from source and fluoride concentrations in municipal water supply.

AIM: The purpose of this study was to evaluate the concentrations of fluoride in community water at the point of source, compared to the concentration delivered to various locations within the Las Vegas Valley, to determine if the levels of fluoride change over distance. METHODS: Ten samples per week over an 8-week period were taken from four locations, totaling 320 samples. The first location included the water treatment facility where fluoride is added to the municipal water to bring the concentrations to the desired amount. The other locations included three residences at an increasing distance from the source of fluoridation. The 320 samples were submitted for fluoride analysis. Repeated-measure anova was used to compare the means between the four data points. RESULTS: The fluoride concentration data for the four test locations ranged from 0.73 to 0.89 mg/L. Mauchly's test of sphericity revealed no significant difference in the fluoride concentrations in Las Vegas from the point of source to distant locations. CONCLUSIONS: The analysis of the collected data revealed that there was no statistical difference in the fluoride concentration in the Las Vegas municipal water supply from the source to the remote locations, and that distance does not affect fluoride concentration in the Las Vegas Valley municipal water supply.

Evaluation of the spatter-reduction effectiveness of two dry-field isolation techniques.

BACKGROUND: The authors conducted a study to compare the effectiveness of two dry-field isolation techniques with that of a control technique (no isolation) in reducing spatter from a dental operative site. METHODS: The authors designed a benchtop experiment to evaluate spatter patterns after performing simulated occlusal surface preparations on three typodont teeth in a dental manikin. Fluorescein dye served as the marker to enable visualization of the spatter distribution. The authors compared the effectiveness of a nonisolated control consisting of high-volume evacuation (HVE) alone with that of two dry-field isolation techniques: a dental dam with HVE and the Isolite system (Isolite Systems, Santa Barbara, Calif). RESULTS: The authors performed a two-way analysis of variance. Both the Isolite device and the dental dam with HVE exhibited a significant decrease in the number of contaminated squares (P < .001) compared with that for the nonisolated control. In addition, overall, the results showed no statistically significant difference between the Isolite system and the dental dam with HVE (P = .126). CONCLUSIONS: The study results showed that use of a dental dam with HVE or the Isolite system significantly reduced spatter overall compared with use of HVE alone. CLINICAL IMPLICATIONS: Isolation with a dental dam and HVE or with the Isolite system appears to aid in the reduction of spatter during operative dental procedures, potentially reducing exposure to oral pathogens.

Electronic vs. traditional textbook use: dental students' perceptions and study habits.

This descriptive study assessed dental students' attitudes about computer use as it relates to study habits and use of e-textbook technology. Academic deans and student leaders at all accredited dental education programs in the United States, Puerto Rico, and Canada were asked to forward an e-mail to students explaining the purpose of the study and asking them to participate. The e-mail included an embedded URL link to the survey. A total of 703 complete responses from twenty-four dental schools were received and used in the final analysis. Because the number of students contacted could not be determined, the overall response rate cannot be calculated. Over 65 percent of the respondents reported spending >11 hours per week studying although over 75 percent said they spent little time studying from their textbooks. Over 55 percent were from schools that use e-textbooks exclusively, with 25 percent from schools that exclusively use print textbooks. One-fourth indicated they purchased a traditional printed textbook even when an e-textbook was provided; more than one-third printed information from the e-textbooks rather than reading on the computer. A majority (59 percent) preferred traditional textbook resources over e-textbooks, with over 50 percent reporting not using the required e-textbooks at all. E-textbooks were used by students in this study less frequently than materials/notes provided by dental school faculty. The majority preferred to use traditional resources as references and for augmenting lecture material.

Southern Nevada assisted living residents' perception of their oral health status and access to dental care.

OBJECTIVE: Oral health is an integral component of general health, and quality of life. The purpose of this study was to determine the perceptions of oral health status and acces\s to dental care by Southern Nevada Assisted Living Facilities Residents. METHODS: A cross-sectional questionnaire study design was used to survey residents between 34 and 99 years old residing in Assisted Living Facilities. Seventy respondents (42 males and 28 females) completed a survey that included personal oral hygiene, access to care, and demographic information. Data analyses included descriptive statistics and chi-square. RESULTS: Mean age was 75.78 years, and the majority had a college education (n = 41). Four currently smoked cigarettes. Twenty-nine (males = 14; females = 15) reported having dental insurance. Eleven respondents had seen a dentist twice a year, while 33 reported a visit less than 6 months. Forty-one reported the facility did not provide oral health care with majority (n = 64) indicating that accessing oral health care was difficult. Self-rated response to oral hygiene, a majority (n = 64) reported their oral hygiene as fair and five reported their oral hygiene as poor. CONCLUSIONS: Assisted living residents in Southern Nevada reported difficulty accessing dental services within and outside of the facility. Oral care models to address this unique population should be explored.

Ninth-grade students' perceived attitudes and behaviors in a tobacco cessation program delivered by dental educators.

This study measured whether a tobacco cessation program in Nevada's Clark County School District (CCSD) delivered by dental educators affected ninth-grade students' short-term perceived knowledge, attitudes, behaviors, and intentions (KABI) toward tobacco use and whether the CCSD's immersion approach led to positive changes in students' KABI. A quantitative research methodology with a descriptive research design was used. Data were collected from 617 students using pre- and post-program surveys self-administered by the participants. The surveys were based on those used previously in national and other large-scale epidemiologic studies assessing tobacco intervention program effectiveness. The survey data revealed that, after the program, more students had an increased awareness of tobacco use dangers to their health and significantly increased awareness of the negative consequences of tobacco use. The number of students who did or did not use tobacco changed very little as a result of the program, but the tobacco users on the post-program survey did report statistically significant decreases in overall use. Significant reduction in tobacco usage by the tobacco users indicates some desire on the part of smoking students to quit or reduce their tobacco usage. Little evidence of major changes in student attitudes was found.

Validation of a multifactorial risk factor model used for predicting future caries risk with Nevada adolescents.

BACKGROUND: The objective of this study was to measure the validity and reliability of a multifactorial Risk Factor Model developed for use in predicting future caries risk in Nevada adolescents in a public health setting. METHODS: This study examined retrospective data from an oral health surveillance initiative that screened over 51,000 students 13-18 years of age, attending public/private schools in Nevada across six academic years (2002/2003-2007/2008). The Risk Factor Model included ten demographic variables: exposure to fluoridation in the municipal water supply, environmental smoke exposure, race, age, locale (metropolitan vs. rural), tobacco use, Body Mass Index, insurance status, sex, and sealant application. Multiple regression was used in a previous study to establish which significantly contributed to caries risk. Follow-up logistic regression ascertained the weight of contribution and odds ratios of the ten variables. Researchers in this study computed sensitivity, specificity, positive predictive value (PVP), negative predictive value (PVN), and prevalence across all six years of screening to assess the validity of the Risk Factor Model. RESULTS: Subjects' overall mean caries prevalence across all six years was 66%. Average sensitivity across all six years was 79%; average specificity was 81%; average PVP was 89% and average PVN was 67%. CONCLUSIONS: Overall, the Risk Factor Model provided a relatively constant, valid measure of caries that could be used in conjunction with a comprehensive risk assessment in population-based screenings by school nurses/nurse practitioners, health educators, and physicians to guide them in assessing potential future caries risk for use in prevention and referral practices.

Preparing the dental workforce for oral disease prevention in an aging population.

The growing proportion of older adults in the U.S. population, as well as escalating dental expenditures, is leading to major changes in the demands on oral health care delivery. Researchers over the years have clearly demonstrated the shortcomings of traditional restorative treatment and the cycle of repeat interventional care. Oral health care professionals are constantly seeking advances in technology, protocols, methodologies, and materials to meet the needs of the growing, diverse older population. Early stages of oral diseases such as caries and periodontal disease are vigorous, preventable, and reversible. Assessment of social, systemic, and oral risk factors that emphasize patient counseling to facilitate risk reduction, along with individualized evidence-based disease prevention planning, is more cost-effective than traditional restorative treatment and will improve overall outcome. The purposes of this article are to briefly describe current issues and challenges related to oral health promotion for older adults and to examine strategies for disease prevention and health promotion in health and dental care settings.

Accuracy of successive casts for full-arch fixed prostheses.

This clinically simulated study examined the accuracy of full-arch impression materials using successive casts reproduced from single impressions. Materials tested included a polyether polyvinyl siloxane, medium viscosity material, and putty wash. Maxillary full-arch Dentoform models were created with four abutments prepared for complete crowns. Six impressions of each material produced successive first and second generation casts. Individual cast copings were then fabricated and assembled into full-arch fixed dental prostheses. Marginal discrepancies were measured on both the casts and Dentoform. Data analysis suggests insignificant differences between successive casts. However, among second generation casts, clinically similar marginal discrepancies were exhibited. Outcomes demonstrated that second generation casts enabled fabrication and assembly of full-arch restorations that were clinically equivalent to first generation casts obtained.

Predental students' attitudes toward and perceptions of the dental profession.

The purpose of this study was to assess reasons students seek a career in dentistry, their perceptions of the dental school admissions process, and their expectations of the profession. Of 155 predental students participating in a dental school simulation course offered at a Nevada dental school, 152 participated in this study (68.4 percent [n=104] male, and 31.6 percent [n=48] female). When asked when they made the decision to pursue a career in dentistry, 52 percent (n=79) said they decided in college, while 33.6 percent (n=51) made the decision in high school. A slight majority of the respondents (52.6 percent; n=80) identified their family dentist as having the greatest influence in their decision. Nearly half (47.8 percent; n=64) expected to pursue a career in general dentistry, while the next largest subgroup expected to pursue orthodontics (16.4 percent; n=22). A significant majority of the respondents (72.8 percent; n=110) perceived the dental school admissions process to be fair. Males were significantly more likely to identify themselves as competitive applicants than did females (chi(2)=9.644; p<.01). Approximately half (47.4 percent; n=72) anticipate earning between $100,000 and $199,999 within five years after graduation, with 50.7 percent (n=77) anticipating working between thirty-five and forty hours a week. By understanding the applicant pool and their perceptions, admissions committees can better prepare to attract the applicants they desire.

Development of a theoretical screening tool to assess caries risk in Nevada youth.

OBJECTIVES: One objective of this study was to determine the prevalence and severity of caries among Nevada youth, subsequently comparing these data with national statistics. A second objective was to identify the risk factors associated with caries prevalence and severity in order to develop and tailor a theoretical screening tool for this cohort for future validation. METHODS: Researchers computed the prevalence rates of dental caries (D-score) and severity rates of decayed, missing, and filled teeth indices in a cohort of 9202 students, 13 to 18 years of age, attending public/private schools in the 2005/2006 academic year. Multiple regression established which of the 13 variables significantly contributed to caries risk, subsequently using logistic regression to ascertain the weight of contribution and odds ratios of significant variables. RESULTS: Living in counties with no municipal water fluoridation, increased exposure to environmental smoke, minority race, living in rural communities, and increasing age were the largest significant contributors (respectively). Exposure to tobacco, being female, lack of dental insurance, increased body mass index risk, and lack of dental sealants were also significant, but to a lesser extent. Nonsignificant factors included socioeconomic status, ethnicity, and family history of diabetes. CONCLUSIONS: This study confirmed high caries prevalence and severity and identified significant risk factors for inclusion in a theoretical risk screening tool for future validation and translation for use in the early detection of caries risk in Nevada youth.

Clinical outcomes for primary anterior teeth treated with preveneered stainless steel crowns.

PURPOSE: The purpose of this retrospective study was to explore clinical outcomes for NuSmile anterior preveneered stainless steel crowns. METHODS: A convenience sample of healthy children treated with anterior crowns was selected from a teaching clinic and private office. Crowns were placed by either a private practice dentist or pediatric dental resident. Clearly defined clinical outcomes were assessed by 3 calibrated examiners at recall, including: (1) presence; (2) chipping; (3) wear; (4) crazing; and (5) marginal location by clinical and radiographic examination. Factors affecting placement--such as operator experience and behavior--were also assessed. RESULTS: In 46 subjects (21 females, 25 males; mean age at placement=4 years, 2 months), 226 crowns with a mean post-placement time of 12.9 months were evaluated. Only 2 crowns matched natural teeth, with NuSmile crowns lighter in 83% of subjects. Most crowns (86%) were normal in size. Eighty-eight percent resisted fracture for 6 months. All but 3 crowns resisted color change for 6 months. Canine crowns were the least successful, but overall 91% of crowns retained good to excellent clinical appearance. CONCLUSIONS: NuSmile anterior preveneered crowns are a clinically successful restoration for primary incisors with early childhood caries.

Pediatricians' perceptions and practices regarding prevention and treatment of type 2 diabetes mellitus in children and adolescents.

OBJECTIVE: To assess pediatricians' perceptions and practices regarding the prevention and treatment of type 2 diabetes mellitus in children and adolescents in a cross-sectional study. DESIGN: A 3-wave mailing of a questionnaire to 550 pediatricians. Descriptive statistics, analysis of variance, and logistic regression were used for data analyses. SETTING: A national random sample of pediatricians who work in private practice, hospital settings, and/or clinics. RESULTS: Every 1 in 9 respondents referred their patients with type 2 diabetes mellitus for exercise, while most pediatricians referred their patients for dietary interventions (62.3%) and educational services (62.6%). Pediatricians who were confident during counseling and follow-up were significantly (P =.02) more likely than pediatricians who were less confident to refer their patients for exercise, dietary interventions, and educational services. Of the respondents, 15.3% perceived they were well prepared to counsel and provide follow-up to patients with type 2 diabetes mellitus. The leading perceived barriers to counseling and follow-up were inadequate time for counseling, poor adherence of patients, lack of family support, lack of familiarity of clinical practice recommendations, and lack of health care insurance coverage. CONCLUSIONS: Pediatricians who had a higher perceived confidence level and who perceived they were better prepared for the counseling and follow-up of patients with type 2 diabetes mellitus had a greater potential to positively affect their diabetic patients. Improving continuing medical education and residency-based programs is imperative to adequately address the emerging epidemic of type 2 diabetes mellitus in children and adolescents.

Prehabilitation in preparation for orthopaedic surgery.

By improving an individual's functional capacity through increased physical activity before an anticipated orthopaedic procedure, it seems reasonable to assume that the individual will maintain a higher level of functional ability and rebound more rapidly in the rehabilitation process. Prehabilitation is the process of enhancing functional capacity of the individual to enable him or her to withstand the stressor of inactivity associated with an orthopaedic procedure. A generic prehabilitation program incorporates the components of warm-up, a cardiovascular component, resistance training, flexibility training, and practicing functional tasks.