Patient and clinician perspectives on implant dentistry decision aid content: Results from an enhanced Delphi study.

PURPOSE: To investigate patient and clinician perspectives on what is considered important to include in a decision aid for replacement of a missing tooth with an implant. METHODS: An online modified Delphi method with pair comparisons technique was used to survey participants (66 patients, 48 prosthodontists, 46 periodontists, and 31 oral surgeons) in Ontario, Canada from November 2020 to April 2021 regarding the importance of information provided during an implant consultation. Round one included 19 items derived from the literature and informed consent protocols. The decision to retain an item was based on group consensus, defined as at least 75% of participants identifying the item as "important" or "highly important." After analysis of round one results, a second-round survey was sent to all participants to rank the relative importance of the consensus items. Statistical testing was completed using the Kruskal-Wallis one-way analysis of variance test and post hoc Mann-Whitney U tests with a significance level set at p ≤ 0.05. RESULTS: The first and second surveys had response rates of 77.0% and 45.6%, respectively. In round one, all items except purpose of steps reached group consensus. In round two, the highest group ranked items were patient responsibilities for treatment success and follow-ups after treatment. The lowest group ranked items were cost factors and restorative steps. Significant differences between the stakeholder groups were found on several items, including diagnosis (p ≤ 0.00), non-implant options (p ≤ 0.00), and cost (p ≤ 0.01). In general, patients' opinions were significantly different than clinicians' opinions on the relative importance of items. CONCLUSIONS: Clinicians and patients feel that multiple items are important to include in a decision aid for implant therapy; however, differences exist between patients and clinicians on the relative importance of items.

The six-domain well-being framework in oral health sciences: A pathway from theory to practice.

OBJECTIVES: Well-being is a complex and multifaceted construct that has gained popularity in oral health sciences education. Maintaining students' well-being is essential for their academic performance and quality of life. While many definitions and frameworks of well-being exist, their applicability to oral health sciences education remains unknown. This study aimed to evaluate the applicability of the Feeney and Collins's framework of well-being to oral health sciences education by exploring students' perceptions and experiences in the University of British Columbia METHODS: An Interpretive Description approach was used to conduct semi-structured interviews with dental and dental hygiene students. Interviews were transcribed, and transcripts were coded and analyzed with guidance from Feeney and Collins's well-being and thriving framework using content analysis. Domains were inductively developed within and beyond the organizing categories of the chosen framework. RESULTS: Thirty-one oral health sciences students participated in the study. Study data can largely be explained by the five well-being domains suggested by Feeney and Collins: physical, psychological, eudaimonic, subjective, and social. Spirituality and gratitude emerged as an additional domain that contributes to students' well-being. Interdomain relationships were observed. The social domain seemed to contribute to all other well-being domains; while the subjective domain seemed to be shaped by all other domains CONCLUSIONS: Feeney and Collins's framework seemed to be useful to understand and conceptualize well-being in oral health sciences education but needed to be expanded to include spirituality and gratitude. Further evidence is needed to explore the applicability of this framework in other health professional education disciplines.

Thriving in foreign learning environments: The case of hands-on activities in early years of dental education.

OBJECTIVES: Hands-on learning environments can challenge learners' wellbeing in dental education, given their unfamiliarity with students. As today's learners are more aware about their wellbeing needs, it is important to explore the depth and complexity of the challenges they experience and provide them with the necessary support strategies. This study aims to identify the challenges and sources of cognitive overload of early years' dental students across two time-points: 2012 and 2022. We also aim to describe the students' recommendations for future program revision considerations to support students' wellbeing. METHODS: This study employs both qualitative and quantitative methods. Qualitatively, we utilized an Interpretive Description approach and conducted focus groups with first-year dental students in 2023. Quantitively, we utilized first-year dental students' responses to the Study Habits survey administered in 2012/2013. RESULTS: Five main concerns and sources of cognitive load emerged from the focus groups and survey data: steepness of the learning curve, inconsistent feedback, stigma around asking for support, structural and organizational challenges, and lack of resources. Students also identified several suggestions to support their wellbeing, including time, instructor support, non-graded exercises, additional resources, and re-organizing the curriculum. CONCLUSION: This study adopts a wellbeing lens to examine students' transition into hands-on learning activities. These findings were utilized to propose the TIPSS Support Framework (Time, Instructor Capacity Building, Peer Learning and Other Resources, Safe Learning Spaces, and Spiraling Curriculum). The proposed model can serve as a prototype for future studies to explore its applicability and effectiveness in other dental programs.

British Columbia Dentists' Perceptions and Practices Regarding HPV Vaccinations: A Cross-sectional Study.

INTRODUCTION: Human papillomavirus (HPV), as the most common form of sexually transmitted infection, has been implicated in almost one-third of oropharyngeal cancers. One way to prevent HPV infections is through vaccination. This study aimed to investigate whether dentists in British Columbia (BC) were willing to discuss, refer and administer the vaccine in a dental practice setting. METHODS: Our cross-sectional study used a survey consisting of 14 questions pertaining to demographics, scope of practice, barriers to discussing the HPV vaccine and willingness to engage in HPV vaccination. On 1 April 2021, the survey was distributed to all practising dentists in BC via a URL link; the link remained active for 30 days. Descriptive and inferential statistics were used to analyze results, and statistical significance was set at p < 0.05. RESULTS: Of the 201 respondent who completed a survey, 168 (84%) agreed that discussing the link between HPV and oropharyngeal cancer falls within their scope of practice. Fewer agreed that recommending (74%) and administering (39%) the HPV vaccine were within their scope of practice. Barriers that may contribute to this unwillingness included lack of professional policies and guidelines. Although a significant proportion of respondents were willing to educate patients on HPV, they were unwilling to discuss sexual history in a dental setting (p = 0.02). CONCLUSIONS: Despite a willingness to discuss and refer patients for HPV vaccination, most respondents were unwilling to administer the vaccine in a dental setting, as they perceived the act to fall outside their scope of practice. There remains a reluctance to engage in vaccination activities in dental settings in BC.

Exploring students' perspectives from two Canadian dental schools toward online learning experiences.

OBJECTIVES: The utilization of online teaching and learning in dental education has grown during the past two academic years. In addition to its numerous advantages, the modality also has its limitations. The objective of this qualitative study was to explore the perceptions of oral health sciences students at the University of British Columbia (UBC) and the University of Toronto (UofT) regarding their experiences with online learning over the course of 2 pandemic-impacted years. METHODS: Interpretive Description was used as a methodology to guide semi-structured data collection. Individual interviews and focus groups were conducted with graduate and undergraduate dental and dental hygiene students at UBC and UofT. Qualitative data were coded and analyzed using a thematic approach. RESULTS: A total of 31 interviews and 4 focus groups were conducted. Online teaching and learning demonstrated many advantages, including flexibility, sustainability of curricular content, and promoting inclusivity in the classroom. Students indicated that due to online learning, there were opportunities to gain resources in practicing self-care and additional time to connect with family. Reported limitations of online classrooms included the loss of attentiveness, challenging content, and logistical challenges. Isolation and physical symptoms experienced in online classrooms with prolonged screen times were described as potential threats. CONCLUSIONS: The results of this study call for developing a structured and sustainable blended approach that balances the limitations of online classrooms with the interaction and engagement of in-person classrooms and patient care experiences. Based on the students' perspectives toward online learning, a road map was provided to dental educators to consider when designing future dentistry curricula.

Multiple cases in case-based learning: A qualitative description study.

INTRODUCTION: Case-based learning is widely used in health professions education to improve clinical learning, but little is known about how best to approach multiple cases in this active learning strategy. Our study explored dental student views of multiple case-based learning in oral pathology. MATERIALS AND METHODS: Qualitative description informed the study design. Data were collected through semi-structured, individual interviews with twenty-one third- and fourth-year dental students who participated in multiple case-based learning seminars. Data were analysed using inductive, manifest thematic analysis. RESULTS: Themes were identified at approach and case levels. Approach-level themes included preparing students for clinical practice and board exams and maximising exposure (e.g., to lesions/conditions), knowledge application, and engagement within the time allotted for the learning session. Case-level themes included using challenging but manageable cases, linking cases to lecture content, providing the necessary clinical information to solve the cases, and ensuring that cases were authentic and common with non-typical presentations. Aspects of themes encompassed definitions of case characteristics, benefits, conditions of implementation, and recommendations for improvement. CONCLUSION: Cases should be considered individually, collectively, purposefully, and contextually in multiple case-based learning. Evaluations of learning and behavioural outcome are needed to further establish the effectiveness of approaches and case characteristics in multiple case-based learning.

Students' resilience and mental health in the dental curriculum.

OBJECTIVES: Dental education is perceived as a source of students' psychological and occupational stress. Resilience has been proposed as a protective factor that may support students' in managing that stress. The objectives of this study were twofold: to map the mental health and well-being content in the curriculum of the Faculty of Dentistry (FoD) at the University of British Columbia (UBC) and to investigate factors influencing resilience levels amongst dental students at UBC. METHODS: The curricular database and website of UBC's FoD were used to gather information on mental health content. A survey with the Connor-Davidson 10-Item Resilience Scale was distributed to dental students at UBC (N = 289). Students' de-identified demographic data were also collected. RESULTS: Two main mental health and well-being curricular components were identified: one didactic session on stress management and one interactive workshop on resilience. The response rate for the survey was 68.2%. Students who did not receive any mental health content (2020/21 year 1 students) had higher resilience scores (p = .043) when compared to students who received both components (2019/20 year 1 students and 2018/19 year 2 students). The multiple regression analysis highlighted North American/European ethnic origins as a predictor for higher resilience levels (p = .008). CONCLUSIONS: The results of this study showed that ethnic origins and major life events, such as the pandemic, influenced resilience. Curricular activities promoting resilience seemed to not necessarily impact students' resilience. Further longitudinal studies are needed to assess the curricular and non-curricular activities influence over dental students' well-being.

Theory-Guided Remote Cooperative Learning-Based Preventive Dental Education as Part of the School Curriculum.

BACKGROUND: Oral health is fundamental to overall well-being. As teens are at high risk for tooth decay, we require a unique approach to motivate them to maintain oral health. METHODS: Sixty-four adolescents (10-13 years) were recruited from 2 schools. Oral health education was based on cooperative learning guided by the social determination theory (SDT) principles. Students' oral health knowledge and oral self-care skills were assessed at baseline (before education), 3 weeks, and 6 months after the education. RESULTS: Complete data were available for 51 students (follow-up rate 79.7%). There were significant (p < 0.001) changes in the mean (SD) toothbrushing score from 10.1 (±6.3) (baseline) to 26.5 (±6.0) (follow-up 1) and to 28.1 (±5.3) (follow-up 2). The mean (SD) tooth brushing time significantly (p < 0.001) increased from the baseline of 84.0 (±43.5) to the first follow-up to 107.0 (±39.8) and to 102.3 (±33.1) at the second follow-up. The mean (SD) diet knowledge scores significantly (p < 0.001) increased from 8.2 (±2.1) at the baseline to 10.2 (±2.7) at the first follow-up and remained the same at the second follow-up. CONCLUSION: Social determination theory-guided cooperative learning was efficient in improving student oral health-related knowledge and oral self-care skills, and this improvement was maintained for 6 months after the discontinued education.

Professional identity formation: The key contributors and dental students' concerns.

OBJECTIVES: This study aimed to explore the components of professional identity formation (PIF) and understand dental students' concerns toward their professional identity development so that research-informed recommendations can be made to improve dental professional programs. METHODS: This is a qualitative study. A total of 18 students of the whole graduating class (class size: 46) were interviewed about their progress through a newly designed curriculum specific for the dental students at a large public research university in Canada. The audio files were recorded, transcribed, and corrected by a research assistant. Using QSR International's NVivo (Version 12), the researchers of this study conducted a thematic analysis to generate overarching themes and extract the relevant components of PIF. RESULTS: Five themes emerged from the study as follows: (i) domain-specific self-efficacy, (ii) role modeling and mentoring, (iii) professional socialization with peers, (iv) learning environment (LE), and (v) reflection. We considered these to be the five key contributors to dental students' PIF. CONCLUSIONS: Understanding the main concerns for students and improving the LE are critical in helping students form their professional identity. The findings of this qualitative study identified some important aspects of the dental curricula for educators to consider. These results can be used by future research studies to explore models for professional identity assessment tools that can aid in guiding students' professional identity development.

Mental health and wellness in Canadian dental schools: Findings from a national study.

OBJECTIVES: To survey the mental health and wellbeing content in the curricula, services, and activities of the 10 Canadian dental schools, and to explore the specifics of this area in the Faculty of Dentistry (FoD) at The University of British Columbia (UBC). METHODS: An electronic survey consisted of four major categories: curricular activities and services, structural approaches, infrastructural approaches, and evaluation methods, was distributed to all Canadian dental schools. A situational analysis was conducted at UBC's FoD via document appraisal and key informants' exploratory interviews. RESULTS: Eight dental schools responded to the survey showing that didactic sessions being the pedagogical method to deliver resilience content. None of the responding schools reported formally evaluating their mental health content. Through situational analysis, a relational map that identified four major areas contributing to students' mental health at UBC's FoD was generated which includes four major aspects: (1) curricular content on mental health, (2) informal wellbeing and mental health networks, (3) protective, and (4) risk factors influencing students' mental health. CONCLUSIONS: As this study described the mental health and wellbeing activities, services, and curricular content across multiple Canadian dental schools, the diverse approaches each school adopted and how personal and professional aspects of students' lives being attempted to be addressed are a critical starting point to engage educators in dentistry. The situational analysis outcome, where a detailed description of the mental health situation at UBC's FoD, can be used to guide in-depth studies of the area of wellbeing at other dental schools.

Micro-computed Tomographic Evaluation of the Quality of Root Canal Fillings in Mandibular Molars after Obturation for 54 Months.

INTRODUCTION: The present study evaluated the percentage volume of voids in root canals of mandibular molars that had been obturated for 54 months. METHODS: Thirty extracted human mandibular molars were instrumented and debrided. The teeth were assigned to 3 groups (n = 10) according to the filling technique and sealer used: the single-cone technique using AH Plus sealer (AHS; Dentsply Sirona Endodontics, Tulsa, OK) or EndoSequence BC sealer (BCS; Brasseler USA Dental LLC, Savannah, GA) and the warm vertical compaction technique using AH Plus sealer (AHW). The specimens were stored at 37°C and 100% humidity. Micro-computed tomographic imaging was used to scan each specimen 1 day 54 months after obturation. Data were analyzed using 1-way analysis of variance and the paired t test. RESULTS: The percentage volume of voids in the teeth 1 day after obturation in the AHS group was higher than in the BCS group and the AHW group (P < .05). After 54 months, the proportion of voids decreased in all groups (P < .05). No significant difference was observed between the AHS group and the BCS group after 54 months. Teeth in the AHW group contained fewer voids than the AHS group (P < .05). CONCLUSIONS: Voids in root canal filling were reduced 54 months after obturation. The warm vertical compaction technique achieved better root canal filling quality in mandibular molars than the single-cone technique when using AHS after long-term storage at 100% humidity.

Uncertainties around COVID-19 from the perspectives of oral health care workers during the first wave of SARS-CoV-2 infections in British Columbia, Canada.

BACKGROUND: The first wave of COVID-19 infections caused disturbances in all aspects of personal and professional lives. The aim of this study was to explore the ways in which that first wave of novel coronavirus infections resulted in uncertainties, as experienced by members of the oral health care workforce in British Columbia, Canada. METHODS: This qualitative inquiry purposefully recruited frontline oral health care workers, including dentists, dental hygienists, certified dental assistants, and administrative staff, via remote semi-structured interviews between April 20 and May 4, 2020. Coding, categories, and themes were inductively assigned. RESULTS: A total of 45 interviews, lasting between 39 and 74 minutes each, were conducted involving 18 dentists (6 females), 12 dental hygienists (11 females), 6 certified dental assistants (all females), and 9 administrators/front-desk staff (7 females). Fifty-one hours of audio recordings and more than 650 single-spaced pages of transcripts were produced. Five main themes emerged pertaining to uncertainties surrounding COVID-19, patient care, personal lives and infectiousness, concern for the future, and variations among different pandemics. Certitudes were less evident, but surfaced mostly when considering a potential new normal resulting from the pandemic. CONCLUSION: Participants indicated that the uncertainties they felt were dependent upon what is known, and unknown, about the pandemic and the provision of oral health care during the first wave of infections. Future studies are needed to include the viewpoints of oral health care workers from other provinces, as well the perceptions of patients who received oral health care during the height of the first wave of the pandemic.

A Pan-Canadian narrative review on the protocols for reopening dental services during the COVID-19 pandemic.

The current coronavirus disease 2019 (COVID-19) pandemic is impacting the way in which dental services are provided. The aim of this narrative review was twofold: to summarize key areas from the Canadian protocols available for the reopening and restructuring of dental services across the country and to critically review these protocols based on existing evidence. A narrative review of the existing Canadian protocols, written in English and French, was undertaken between April 15 and July 13, 2020. The protocols were obtained by searching through regulatory bodies and websites from professional organizations, and from personal contacts through academic institutions and policy leaders. The data extraction form focused only on protocols related to dentistry, and the information was compiled by a hired assistant. Content was categorized via group discussions with the research team on eight areas: office management and procedures, patient and staff screening, treatment procedures, office layout, risk reduction, personal protective equipment, supporting information, and length and readability. Thirteen protocols were identified and offered substantial variation in the level of details provided. All but two protocols specified proper donning/doffing of personal protective equipment, while all protocols recommended daily monitoring of COVID-19 related signs and symptoms in staff and patients. They varied in terms of recommended mask types, eye and face shield protection, and head coverings. While all protocols aimed at restructuring emergency dental services, their recommendations were often not based on the published evidence. This narrative review summarized key areas from 13 provincial and territorial protocols in Canada to help oral health care providers plan the reopening of their services. The information conveyed across all documents was clear, but variance highlights the need for a coordinated effort to develop an evidence-based document for dental practitioners.

Dental Hygiene Clinical Instructors' Pedagogical Beliefs and Described Practices About Student-Centered Education.

The aims of this study were to understand dental hygiene clinical instructors' teaching and learning perspectives regarding their described pedagogical beliefs, perceived roles in facilitating learning, and factors that influenced those perspectives and to assess how their espoused beliefs matched their instructional practice in relation to student-centered competency-based education. The Theory of Planned Behavior was used as a theoretical framework to guide the qualitative study design and analysis. Data were collected through semi-structured interviews with 15 dental hygiene clinical instructors at a Canadian university in 2014. Transcript data derived from the interviews were coded for thematic analysis. In the results, these dental hygiene clinical instructors reported a spectrum of pedagogical beliefs, with one end defined as student-centered and the other end teacher-centered. While the instructors tended to describe their teaching as student-centered, their responses in the simulated teaching scenarios of the interview were closer to teacher-centered practices. Interview-analysis results showed that the process by which the instructors developed their approaches to teaching was multifactorial. Factors included instructors' perceptions of their own learning experiences, experiences of inter-instructor collaboration, and methods of supporting students' self-efficacy in learning. Given the emergence of support for student-centered education ideology and the program's adoption of this ideology, this exploratory study suggests that uncovering the teaching and learning beliefs of instructors is crucial prior to designing faculty development programs.

The Culture of Certainty in Dentistry and Its Impact on Dental Education and Practice.

With this essay, the authors encourage all dental educators to look at a common characteristic in our dental profession: the culture of certainty. They also urge educators to look beyond this culture of certainty for its impact on educational activities and clinical care.

Designing and Implementing a Competency-Based Formative Progress Assessment System at a Canadian Dental School.

Progress testing is an innovative formative assessment practice that has been found successful in many educational programs. In progress testing, one exam is given to students at regular intervals as they progress through a curriculum, allowing them to benchmark their increase in knowledge over time. The aim of this study was to assess the first two years of results of a progress testing system implemented in a Canadian dental school. This was the first time in North America a dental school had introduced progress testing. Each test form contains 200 multiple-choice questions (MCQs) to assess the cognitive knowledge base that a competent dentist should have by the end of the program. All dental students are required to complete the test in three hours. In the first three administrations, three test forms with 86 common items were administered to all DMD students. The total of 383 MCQs spanning nine domains of cognitive knowledge in dentistry were distributed among these three test forms. Each student received a test form different from the previous one in the subsequent two semesters. In the fourth administration, 299 new questions were introduced to create two test forms sharing 101 questions. Each administration occurred at the beginning of a semester. All students received individualized reports comparing their performance with their class median in each of the domains. Aggregated results from each administration were provided to the faculty. Based on analysis of students' responses to the common items in the first two administrations, progression in all domains was observed. Comparing equated results across the four administrations also showed progress. This experience suggests that introducing a progress testing assessment system for competency-based dental education has many merits. Challenges and lessons learned with this assessment are discussed.

Creating a test blueprint for a progress testing program: A paired-comparisons approach.

CONTEXT: Creating a new testing program requires the development of a test blueprint that will determine how the items on each test form are distributed across possible content areas and practice domains. To achieve validity, categories of a blueprint are typically based on the judgments of content experts. How experts judgments are elicited and combined is important to the quality of resulting test blueprints. METHODS: Content experts in dentistry participated in a day-long faculty-wide workshop to discuss, refine, and confirm the categories and their relative weights. After reaching agreement on categories and their definitions, experts judged the relative importance between category pairs, registering their judgments anonymously using iClicker, an audience response system. Judgments were combined in two ways: a simple calculation that could be performed during the workshop and a multidimensional scaling of the judgments performed later. RESULTS: Content experts were able to produce a set of relative weights using this approach. The multidimensional scaling yielded a three-dimensional model with the potential to provide deeper insights into the basis of the experts' judgments. CONCLUSION: The approach developed and demonstrated in this study can be applied across academic disciplines to elicit and combine content experts judgments for the development of test blueprints.

Dental Faculty Members' Pedagogic Beliefs and Curriculum Aims in Problem-Based Learning: An Exploratory Study.

The aims of this exploratory study were to explore dental faculty members' views and beliefs regarding knowledge, the dental profession, and teaching and learning and to determine how these views related to their problem-based learning (PBL) instructional practices. Prior to a PBL in dental education conference held in 2011, all attendees were invited to complete a survey focused on their pedagogical beliefs and practices in PBL. Out of a possible 55 participants, 28 responded. Additionally, during the conference, a forum was held in which preliminary survey findings were shared and participants contributed to focus group data collection. The forum results served to validate and bring deeper understanding to the survey findings. The conference participants who joined the forum (N=32) likely included some or many of the anonymous respondents to the survey, along with additional participants interested in dental educators' beliefs. The findings of the survey and follow-up forum indicated a disconnect between dental educators' reported views of knowledge and their pedagogical practices in a PBL environment. The results suggested that the degree of participants' tolerance of uncertainty in knowledge and the discrepancy between their epistemological and ontological beliefs about PBL pedagogy influenced their pedagogical choices. These findings support the idea that learner-centered, inquiry-based pedagogical approaches such as PBL may create dissonance between beliefs about knowledge and pedagogical practice that require the building of a shared understanding of and commitment to curricular goals prior to implementation to ensure success. The methods used in this study can be useful tools for faculty development in PBL programs in dental education.