A university-wide seed grant program accelerates interprofessional education through faculty and staff engagement.

The University of Texas Health Science Center at San Antonio launched an annual university-wide seed grant program in 2019 to foster innovation in interprofessional education (IPE) and increase IPE opportunities for learners. Program objectives included leveraging hypothesis-driven research to identify sustainable IPE activities for integration into educational programs (i.e. mandated for at least one cohort of learners), increasing scholarly dissemination of IPE efforts, and using pilot data to secure extramural funding. Over the first four funding cycles (2019-2022), US$100,509.00 was awarded to support 22 IPE projects (10 curricular, 12 co-curricular) involving 80 faculty and staff collaborators and over 2,100 student participants. To date, funded projects have yielded nine sustained IPE activities (four of which have been integrated), produced 24 scholarly presentations and three peer-reviewed publications, and contributed to the success of one extramural grant. Barriers experienced are discussed in this report alongside lessons learned and unexpected positive outcomes, including identification of future IPE champions.

Health professions learners' evaluation of e-learning scenario-based case study design: Reinvigorating flipped classroom modalities.

OBJECTIVES: Interactive scenario-based learning (SBL) cases were developed using the SoftChalk platform to deliver content about patients' barriers to accessing healthcare and patient management strategies connecting oral to systemic health. The interactive cases were designed to engage the digital-savvy learners, meet them where they are by leveling up, and seek their feedback to determine flipped (FC) or modified flipped classroom (MFC) content delivery approaches. METHODS: Health professions students completed interactive SBL cases (Phase-I) using either FC as assigning content outside of class time preparation or MFC as allocating time at the beginning of the class deliveries, and a 12-item post-completion survey. The senior dental student cohort (Phase-II) completed an anonymous Qualtrics survey that assessed their confidence leading to clinical competence two years after the interactive SBL case deliveries. The final survey (Phase-III) of first-year dental students evaluated the improved interactive scenario-based cases post modifications. [Corrections added on 03 October 2023: After first online publication the first sentence of methods section has been updated.] RESULTS: No significant differences existed between the FC and MFC content delivery scores; however, learners preferred the structured time allotted in the MFC approach as a learning style for participants (N=989). The overall means percent score was 93.2% (n = 398) for FC and 96.5% (n = 591) for MFC. Thematic analysis of written responses indicated that learners felt the vignettes were relevant, thought-provoking, incorporated decision-making, and provided feedback. Four themes about strengths emerged as engaging, interactive, relevant, and critical. Design and technological challenges emerged as interactive SBL improvements. A follow-up report (74/103, 2021) revealed that 48% of senior dental students surveyed recollected the SBL cases when they delivered preventive, patient-centered dental services as juniors and seniors. They also recalled that the interactive cases prepared them for clinical success. The Final comments (2022) did not commend any significant improvements. CONCLUSION: Interactive scenario-based approaches nurture active learning and critical thinking. The educator can engage learners by incorporating teaching modalities as SBL cases to enhance their knowledge and create educational environments by meeting learners where they are. Learners can be valuable partners as educators define their instructional strategies to be equitable and student-centered. [Correction added on 04 October 2023: after first online publication, abstract section has been revised.].

Evaluation of a novel caries detecting oral rinse.

AIM: LumiCare™ Caries Detection Rinse (LC Rinse), a starch-based rinse, illuminates active initial caries (positive response) using dental curing light, thus augmenting the dentist's visual examination. This clinical study investigated if active caries as assessed by the International Caries Detection and Assessment System (ICDAS) were more likely to have positive LC Rinse response than sound surfaces and inactive caries. METHODS: 25 subjects participated in the study. Caries was assessed on selected teeth and the entire dentition, firstly using ICDAS and then by fluorescence evaluation after LC Rinse application. Data were statistically analyzed using Diagnostic Odds Ratio (OR) and Chi-square test X2 (α = 0.05). Sensitivity (Se), specificity (Sp), and Diagnostic accuracy (DA) were calculated. RESULTS: With selected teeth, active caries were 638.6 times (60.05 with full dentition) more likely to have positive LC Rinse response than sound surfaces and inactive caries combined (X2, p < 0.01) and 191.67 times (18.35 with full dentition) than inactive lesions only (X2, p < 0.01). With combined sound surfaces and inactive caries, Se, Sp, and DA of LC Rinse assessment were 0.94, 0.98, and 0.96 respectively. CONCLUSIONS: LC Rinse can distinguish between active caries, inactive caries and hypomineralization, and can augment caries detection with high sensitivity, specificity, and diagnostic accuracy.

Innovation in Collaborative Online Learning Yields Sustainable Model for University-wide Interprofessional Education.

BACKGROUND: Growing health professional accreditation mandates and expectations for interprofessional education (IPE) have led to heightened interest amongst health professions educators and administrators in the creation and development of effective and sustainable IPE programming. IPE ACTIVITY: At the University of Texas Health Science Center at San Antonio, an institution-wide initiative called Linking Interprofessional Networks for Collaboration (LINC) was initiated to strengthen IPE knowledge and skills, increase IPE offerings, and integrate IPE into curricula. In 2020, stakeholders developed, implemented, and evaluated a university-wide IPE activity called the LINC Common IPE Experience, which includes three collaborative online learning modules that students complete synchronously using a videoconference platform without direct faculty facilitation. Mini-lectures, interprofessional discussions, and authentic case studies using innovative media facilitated meaningful engagement of 977 students from 26 different educational programs. DISCUSSION: Quantitative and qualitative results from evaluations demonstrated significant student engagement, increased awareness and understanding of teamwork, progress towards interprofessional competency development, and benefits related to professional development. The LINC Common IPE Experience provides a valuable example of a robust, high-impact foundational IPE activity that can serve as a sustainable model for university-wide IPE.

The Case for Community-Based Global Oral Health Immersive Experiences.

We designed and implemented a collaborative immersion in Ethiopia as a service learning experience for a team of interprofessional (IP) learners. The IP team of four dental students, one dental faculty, nine medical students, two medical student leaders, and one global health faculty fully experienced this immersion. The setting was in rural Ethiopia, and the immersive experience included ecological accommodations by the Common River Non-Governmental Organization (CR-NGO).

Defining and classifying co-curricular interprofessional education in the health professions: a scoping review protocol.

OBJECTIVE: This scoping review will identify, characterize, and classify co-curricular interprofessional education activities and practices. INTRODUCTION: According to the World Health Organization, interprofessional education occurs when students from two or more professions learn about, from, and with one another to enable effective collaboration and improve health outcomes. As such, interprofessional education is imperative to health professions education. Globally, competency frameworks and guidelines have urged educators to reach consensus about interprofessional education terminology and to integrate this form of education into formal curricula. Voluntary interprofessional education that takes place outside formal curricula (ie, co-curricular) is frequently used to overcome well-documented barriers (eg, discordant academic calendars). We will explore the global literature to identify, characterize, and classify published examples of co-curricular interprofessional education activities. INCLUSION CRITERIA: This review will consider voluntary interprofessional education involving students from at least two different health professions. These education activities will take place outside the formal curriculum and will not result in transcript designation. METHODS: The search strategy will aim to locate primary studies from peer-reviewed journals indexed in MEDLINE, CINAHL, Scopus, ERIC, and Academic Search Complete. The results will be limited to English-language publications from 2009 until the present. Two independent reviewers will screen titles and abstracts, and potentially relevant papers will be assessed in detail. Data will be extracted using a tool developed by the reviewers. Descriptive statistics will be used to characterize the data, which will be presented in diagrammatic, tabular, or other relevant formats.

Clinical efficacy of a novel radiofrequency toothbrush for tooth stain reduction and tooth whitening: A randomized controlled trial.

BACKGROUND: The authors aimed to evaluate the effect of a novel radiofrequency (RF) toothbrush on tooth stains and shades compared with a sonic vibrating toothbrush (CVS Health SmileSonic Pro Advanced Clean Sonic Toothbrush, Ranir) that earned the American Dental Association Seal of Acceptance. METHODS: The authors conducted a single-blind prospective study over 6 weeks. Participants were randomized to 1 of 2 study groups to receive either an RF toothbrush (ToothWave, Home Skinovations [test]) or a sonic vibrating toothbrush (SmileSonic powered toothbrush, Ranir [control]) and performed twice-daily toothbrushing with fluoridated toothpaste (Crest Cavity Protection, Procter & Gamble) for 6 weeks. Tooth stains and shades were assessed using the Lobene Stain Index and VITA Bleachedguide 3D-MASTER shade guide (VITA North America) at baseline and after 4 and 6 weeks of toothbrushing. In addition, the VITA Easyshade Advance 4.0 spectrophotometer (VITA North America) was used for shade evaluation. Safety was evaluated by means of oral soft-tissue examinations at each visit. Percentage reduction from baseline was compared between the groups. Statistical analyses were conducted using Mann-Whitney nonparametric model. RESULTS: Eighty-six participants (43 in each group) completed the study with fully evaluable data. At baseline, the groups did not differ significantly in mean measurement scores. Percentage reductions of the measured scores were significantly greater (more extrinsic stain removal and whitening) in the test group than in the control group (P < .001). Both toothbrushes were well-tolerated, and no device-related adverse events were reported during the study. CONCLUSIONS: The RF toothbrush produced substantial benefits in the reduction of tooth stains and whitening of tooth shade compared with a powered toothbrush (CVS Health SmileSonic Pro Advanced Clean Sonic Toothbrush, Ranir) that earned the American Dental Association Seal of Acceptance. PRACTICAL IMPLICATIONS: The novel RF toothbrush is a safe and effective tool for stain removal and tooth whitening and can serve as an alternative to other whitening agents. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT03885609.

A Randomized Clinical Trial Preventive Outreach Targeting Dental Caries and Oral-Health-Related Quality of Life for Refugee Children.

Objective: The study assessed a preventive outreach educational intervention targeting improvements in dental caries and oral-health-related quality of life in the children of refugee families by comparing pre- and postintervention outcomes. Methods: This randomized controlled clinical trial assessed the outcomes at baseline and three times over six months using the WHO oral health assessment form (DMFT/dmft) and the parent version of the Michigan Oral-Health-Related Quality of Life scale. Children and at least one of their parents/caretakers were educated on oral health topics in two one-hour sessions. Results: Of the 66 enrolled families, 52 (72%) completed the six-month follow-up. DMFT/dmft scores increased significantly in both the control and intervention groups (p < 0.05); differences in the changes in the DMFT/dmft and MOHRQoL-P scores from baseline to the three- and six-month follow-up visits between groups were not significant (p > 0.05). Conclusions: Oral health education programs targeting a diverse group of refugee children and their parents/caregivers single-handedly did not reduce the increased number of caries lesions or improve oral-health-related quality of life.

Education intervention with respect to the oral health knowledge, attitude, and behaviors of refugee families: A randomized clinical trial of effectiveness.

OBJECTIVES: The study assessed the effectiveness of an oral health educational and behavioral intervention program in improving the knowledge, attitudes, and behaviors of refugee families. METHODS: This randomized 2-arms, controlled, single site, clinical trial assessed the dental knowledge, attitudes, and behaviors related to oral health at baseline and three times over the course of the 6 months of the intervention in recent refugee families. Participating families were educated on five topics in oral health in two 1-hour sessions utilizing existing oral health education materials adapted to be linguistically and culturally appropriate for demonstration and instruction. Culturally competent techniques and motivational interviewing styles were also implemented during sessions. Pre/post surveys were used to assess changes to knowledge, attitudes, and behavior among refugee family participants. RESULTS: Out of the 66 families enrolled in the program, 52 (72 percent) completed visits over the course of 6 months. Differences between the intervention and control groups were not significant between baseline and 3 to 6 months later (P > 0.05). CONCLUSIONS: A short-term, culturally informed oral health educational and behavioral intervention program did not improve oral health-related knowledge, attitudes, or behaviors in a diverse group of recent refugee families.

San Antonio refugees: Their demographics, healthcare profiles, and how to better serve them.

OBJECTIVE: The recent refugee crisis has resulted in the largest burden of displacement in history, with the US being the top resettlement country since 1975. Texas welcomed the second most US-bound refugees in 2016, with a large percentage arriving in San Antonio. Yet, the composition of the San Antonio refugees has not been described and their healthcare needs remain ill-defined. Through this study, we aim at elucidating their demographics and healthcare profiles, with the goal of devising recommendations to help guide refugee program development and guide other refugee resettlement programs. METHODS: Data from 731 charts belonging to 448 patients at the San Antonio Refugee Health Clinic (SARHC) were extracted and analyzed. Data included age, gender, country of origin, first language, interpretation need, health insurance status, medical history, vital signs, diagnoses, and prescribed medications. RESULTS: Women constituted the majority of patients (n = 267; 56.4%), and the median age of all patients was 39 (Q1:26, Q3:52). Nepali-speaking Bhutanese patients were the most represented group (n = 107, 43.1%), followed by Iraqi (n = 35, 14.1%), Burmese (n = 30, 12.1%), and Iranian (n = 19, 7.7%) refugees. Of those who responded, 200 (86.6%) did not have any form of health insurance. Additionally, 262 (50.9%) had a body-mass index (BMI) in the overweight or obese range. Further, 61.4% (n = 337) had blood pressures in the hypertensive range, while 9.3% (n = 51) had an elevated blood pressure. On average, each patient had 1.9 complaints, with abdominal pain, headaches, and cough being the predominant complaints. Allergic rhinitis, viral upper respiratory infections, and elevated blood pressure were the most common diagnoses. However, the list of common diagnoses differed per country of origin. CONCLUSION: The SARHC demographics were different from those of other Texas refugees. The rate of the uninsured and the burden of non-communicable diseases were high. Furthermore, each refugee subgroup had a different set of common problems. These findings reveal important considerations for refugee healthcare providers and the unique approach that may be required for different communities.

Using Interprofessional Education to Promote Oral Health Literacy in a Faculty-Student Collaborative Practice.

The aim of this study was to assess the oral health literacy knowledge gained by patients who are refugees, community members, and medical and nursing students after participating in an interprofessional education collaborative of students and faculty from the University of Texas Health San Antonio Schools of Dentistry, Medicine, and Nursing. In this faculty-student collaborative practice, all patients were triaged (including oral hygiene status and alcohol/tobacco use), and tailored treatment options were offered following assessment of their dental, medical, and social histories. The study was designed as a pre-post assessment of an educational intervention on oral health literacy. In the pretest, all groups were invited to respond to questionnaires assessing their knowledge of oral health. After participants engaged in oral hygiene instruction demonstrations and received information about an oral health literacy campaign, a posttest was conducted to assess knowledge gained. A total of 151 patients who were refugees, 38 medical students, 34 nursing students, and 17 community/parish members voluntarily participated in this initiative. Each group had a significant increase in mean oral health literacy score from pre- to posttest: patients 33.5%, community/parish members 22.3%, nursing students 20.8%, and medical students 13% (all p<0.0001). These results showed that the oral health literacy initiative helped increase all participants' oral health literacy and knowledge of preventive care.

A student operated, faculty mentored dental clinic service experience at the University of Texas Health Science Center at San Antonio for the underserved refugee community: an interprofessional approach.

BACKGROUND: As the number of refugees settling in San Antonio increases, so will their health care needs. Due to limited resources and stress, they suffer from acute and chronic diseases, reducing their potential for success in their new host country. The need for proper health education coupled with a stable holistic health care facility is essential for their future success. OBJECTIVES: In 2009, nursing students began serving the San Antonio refugee population. By 2011, dental and medical students joined to create the student-run San Antonio Refugee Health Clinic (SARHC). SARHC serves the refugees by providing free health care/education while connecting them to San Antonio's primary health care system. METHODS: Select dental, medical, and nursing students under the mentorship of their faculty operate the SARHC clinic. The students work in collaborative teams where select members of the refugee community and bilingual students provide translational assistance. The nursing students take vital signs and medical students perform physical exams after gathering a history of present illness. Dental students provide oral health/nutritional education and screenings inclusive of head and neck examination and oral cancer risk assessment. RESULTS: Thirty-two dental, 83 medical, and 118 nursing students rotated through the clinic last year, serving patients with the most common chief complaints of dental, musculoskeletal, dermatological, and gastrointestinal nature. The most common dental findings for this population have been dental caries, periodontal disease, and other dental diseases requiring urgent care. Sub-programs such as the student interpreter program, ladies' health education, and the Refugee Accompaniment Health Partnership have resulted from the SARHC initiative to meet the refugees' needs. Currently under development is a future collaboration with local San Antonio clinics such as the San Antonio Christian Dental Clinic to serve as their dental home. CONCLUSION: The use of this interprofessional model has resulted in holistic and accessible health care for the refugees in San Antonio. Patients receive complimentary comprehensive care while students benefit from development of cultural competence reinforcement of humanitarian values. It is difficult to conclude which group is the biggest beneficiary of attending SARHC. As the dental students reflected, "We started attending the clinic as a service learning project. We then became their advocates, treated them at our dental school, and became knowledgeable about our community's dental clinics while offering tailored referrals."

The effects of a dairy probiotic product, espar, on salivary calcium and mutans streptococci.

Background and aims. Espar is a dairy product of probiotic nature that contains useful bacteria and high calcium content. The aim of this study was to analyze effects of daily consumption of Espar on the number of salivary mutans streptococci and the level of calcium content in a population of 15 to 17 year-old female students. Materials and methods. A double-blind randomized crossover study (n = 50) of healthy female adolescents was implemented in four stage intervals. The first and third stages were 'run-in' and 'wash-out' intervals. For the second and fourth stages, two weeks long in duration, the participants consumed 100 grams of Espar or 200 grams of plain yogurt. At the end of each stage, the number of salivary mutans streptococci and the level of calcium content were documented. Results. There was a statistically significant decrease in the number of salivary mutans streptococci subsequent to Espar consumption when compared to ordinary yogurt (p < 0.01). Additionally, salivary calcium content increased significantly subsequent to the consumption of Espar and yogurt. However, Espar yielded a higher level of significant increase in salivary calcium when compared to plain yogurt (p < 0.01). Conclusion. This study found that daily consumption of Espar increased the salivary calcium level while decreasing mutans streptococci of the saliva.

Maternal acculturation: could it impact oral health practices of mexican-american mothers and their children?

A mother's cultural beliefs can affect her infant's health, but the influence of acculturation of Mexican-American women on their young children's oral health is unknown. The authors hypothesized that maternal acculturation impacts very young children's oral health practices favoring, in particular, the mothers who are more Anglo-oriented. A convenience sample of 204 predominantly Mexican-American women attending the Women, Infants, and Children Clinic in San Antonio, Texas, completed the Knowledge, Attitudes, Beliefs, Social Support, and Self-Efficacy of Oral Health (KASE-OH) and Acculturation Questionnaires. Results indicated that mothers with strong Anglo orientation were more likely educated in the United States, first visited a dentist while in elementary school, and breast-fed their children. Children belonging to Anglo-oriented Mexican-American mothers had stronger oral health practices, were more likely to breast-feed, were exposed to more sugary and acidic drinks, consumed higher levels of candy, had Medicaid coverage, and had stronger supervisions of tooth brushing practices.