Can self-assessment ability predict student performance in a dental anatomy course?

INTRODUCTION: The development of early self-assessment skills and determining its correlation with academic performance could provide evidence to alter dental curricula. The aim of this retrospective study was to examine the relationships between students' early self-assessment ability in waxing and three different evaluation methods (waxing assessment, written examinations, and tooth identification examination) in a dental anatomy course. MATERIALS AND METHODS: The dental anatomy scores during the academic years of 2018-2019 and 2019-2020 from two cohorts of second-year pre-doctoral dental students at the Harvard School of Dental Medicine were analyzed. Regression analyses were completed to assess the relationship between all evaluation methods. RESULTS: There was a statistically significant correlation between self-assessment ability and the waxing assessment but no significant correlation between self-assessment ability and the other evaluation methods. CONCLUSION: Our results showed that the introduction of self-assessments in dental anatomy waxing was correlated with successful waxing skills. Furthermore, a relevant finding is that students who received higher classifications were also capable of doing better self-assessments. These findings provide evidence that impacts dental curricula.

Treatment deferral for elevated blood pressure at a dental school clinic.

OBJECTIVES: Current guidelines by the American Dental Association (ADA) recommend deferral of elective dental care for elevated blood pressure. However, it is unknown how frequently this impacts dental treatment. The purpose of this study was to evaluate rates of asymptomatic hypertension and treatment deferral at a dental school clinic. METHODS: This was a retrospective study with data extracted from a chart review of all patients presenting for care at a dental school teaching practice. Differences in dental procedures, the time between visits, and the number of antihypertensive medications were calculated between patients with and without a blood pressure reading exceeding current guidelines for elective treatment. RESULTS: Among 26,821 individuals, 1265 had a visit with elevated blood pressure. Blood pressure readings at the next visit were significantly lower (systolic blood pressure 137 [95% confidence interval {CI} 135-138] mmHg, diastolic blood pressure 82 [95% CI 81-83 mmHg], p < 0.001), although only 24 patients reported taking a new medication. Only 4.1% of these patients had a procedure deferred; for those that did, the average intervisit time was 88.2 days (95% CI 77.7-98.7 days). CONCLUSIONS: The majority of patients with blood pressure readings exceeding current ADA recommendations for treatment were treated without evidence of harm. Patients were also unlikely to return to the clinic with new medications for blood pressure after a visit with an elevated blood pressure reading. Oral health providers must weigh the risks and benefits of care deferral and can consider an expanded role in hypertension management in dental settings when caring for patients with elevated blood pressure.

Behavioral Health Within Primary Care Postgraduate Dental Curricula: A Mixed Methods Study.

PURPOSE: This study evaluated the integration of behavioral health topics (anxiety disorder, depressive disorder, eating disorders, opioid use disorder, and intimate partner violence) into primary care postgraduate dental curricula. METHODS: We used a sequential mixed methods approach. We sent a 46-item online questionnaire to directors of 265 Advanced Education in Graduate Dentistry programs and General Practice Residency programs asking about inclusion of behavioral health content in their curriculum. Multivariate logistic regression analysis was used to identify factors associated with inclusion of this content. We also interviewed 13 of the program directors, conducted content analysis, and identified themes pertaining to inclusion. RESULTS: A total of 111 program directors completed the survey (42% response rate). Less than 50% of programs taught their residents to identify anxiety disorder, depressive disorder, eating disorders, and intimate partner violence (86% taught identification of opioid use disorder). From the interviews, we identified 8 main themes: influences on the inclusion of behavioral health in the curriculum; training strategies; reasons for incorporating the training strategies; training outcomes (ie, ways in which residents were evaluated); training outputs (ie, ways in which a program's success was quantified); barriers to inclusion; solutions to barriers; and reflections on how the current program can be made better. Programs housed in settings with no to minimal integration were 91% less likely (odds ratio = 0.09; 95% CI, 0.02-0.47) to include identifying depressive disorder in their curriculum compared with programs in settings with close to full integration. Other influences for including behavioral health content were organizational/government standards and patient populations. Barriers to including behavioral health training included organizational culture and lack of time. CONCLUSIONS: Advanced Education in General Dentistry and General Practice Residency programs need to make greater efforts to include in their curricula training on behavioral health conditions, particularly anxiety disorder, depressive disorder, eating disorders, and intimate partner violence.

Evaluation of the Oral Health Knowledge Network's Impact on Pediatric Clinicians and Patient Care.

PURPOSE: Oral disease has a major impact on the overall health of US children, with dental caries being the most prevalent chronic disease in this age group. Given nationwide shortages of dental professionals, interprofessional clinicians and staff with proper training can influence oral health access. The American Academy of Pediatrics created the Oral Health Knowledge Network (OHKN) in 2018 to bring together pediatric clinicians via monthly virtual sessions to learn from experts, share resources, and network. METHODS: The Center for Integration of Primary Care and Oral Health partnered with the American Academy of Pediatrics to evaluate the OHKN in 2021. The mixed method evaluation included an online survey and qualitative interviews among program participants. They were asked to provide information on their professional role and prior commitment to medical-dental integration as well as feedback on the OHKN learning sessions. RESULTS: Of the 72 program participants invited, 41 (57%) completed the survey questionnaire and 11 took part in the qualitative interviews. Analysis showed that OHKN participation supported both clinicians and nonclinicians in integrating oral health into primary care. The greatest clinical impact was incorporating oral health training for medical professionals (cited by 82% of respondents), while the greatest nonclinical impact was learning new information (cited by 85% of respondents). The qualitative interviews highlighted the participants' prior commitment to medical-dental integration as well as drivers for their current medical-dental integration work. CONCLUSIONS: Overall, the OHKN had a positive impact on pediatric clinicians and nonclinicians and, as a learning collaborative, successfully educated and motivated health care professionals to improve their patients' access to oral health through rapid resource sharing as well as clinical practice change.

Context matters: Integration of social determinants of health in AEGD and GPR curricula.

PURPOSE: To examine the integration of social determinants of health (SDH) in the US Advanced Education in General Dentistry (AEGD) and General Practice Residency (GPR) programs. METHODS: This study used an explanatory sequential mixed-methods approach. A 46-question survey was sent to all 265 AEGD and GPR programs in February 2019. Descriptive statistics and multivariate analyses were conducted to identify factors influencing SDH curricular inclusion. A convenience sample of program directors (PDs) was interviewed between June and December 2019. Through content analysis, themes and subthemes were identified. RESULTS: Of the 265 AEGD and GPR PDs, 111 completed the survey (42% response rate). Almost three-quarters of PDs (72%) agreed that it was important for residents to understand basic SDH concepts. However, programs lacked eight of the 10 surveyed SDH subtopics. The odds of teaching five or more SDH subtopics were 0.09 (95% CI: 0.02-0.41) for programs with none-to-minimal levels of SDH integration in their clinical settings compared to close-to-fully integrated ones. Coding of PD interviews (N = 13) identified five major themes: 1. influences to integrate SDH, 2. training strategies, outcomes, and outputs, 3. reasons for training strategies, 4. barriers and solutions, and 5. future integration goals. Most PDs cited delivering SDH content during patient care and reported time and organizational culture being barriers to more curricular inclusion. CONCLUSIONS: AEGD and GPR curricula are deficient in SDH content and risk underpreparing residents for caring for the underserved. PDs and organizational leaders must prioritize SDH inclusion in order to train dentists for integrated person-centered care.

An Assessment of Oral Health Training Among Geriatric Fellowship Programs: A National Survey.

Oral health (OH) has profound effects on the overall health of elderly people. While oral disease is prevalent in the geriatric population and access to care is a major issue, it is unclear the extent of OH training among US geriatric fellowship programs. A 19-item electronic survey was sent to all 148 accredited geriatric fellowship training programs via the Association of Directors of Geriatric Medicine. Directors were asked about hours of trainings, barriers, and evaluation of trainees among other topics. Univariate and bivariate analyses were performed. Seventy-five directors completed the survey (51% response rate). Sixty-three percent (46/73) report their fellows receive 1 to 2 hours of OH instruction (ie, lectures, workshops) during their training. Almost a quarter (23%; 17/73) reported 0 hours of OH content. Only 17% (13/75) have clinical experiences in a dental setting. Barriers to more OH education include competing priorities or lack of time (57%; 43/75), lack of faculty expertise (55%; 41/75), and no clear geriatric national educational competencies (44%; 33/75). Programs with an OH champion or dental school/residency affiliation had more hours of OH instruction. Geriatric fellowships appear to need more OH training, which could be achieved by creating OH champions and connecting fellowships with dental schools/residencies. Barriers could be overcome by exposing fellowships to existing resources and creating national competencies. J Am Geriatr Soc 67:1079-1084, 2019.