Regulatory barriers to dental anesthesia services for special populations.

AIMS: Sedation and general anesthesia are necessities for the treatment of many individuals within special populations such as those with physical and intellectual disabilities, fear/anxiety, or individuals requiring extensive procedures. This study aims to discover regulatory factors that may be contributing to the limited access to anesthesia services provided by dentist anesthesiologists. METHODS AND RESULTS: The study included an online survey completed by self-reported dentist anesthesiologists with 2 or more years of formal anesthesia training. The survey was distributed at the April 2019 American Society of Dentist Anesthesiologists national meeting in Chicago. Participants responded to questions regarding the effect of specific state regulations on decisions to practice in a particular state and how such regulations influenced patient safety and barriers to care. Rules and regulatory restrictions on the mobility of dentist anesthesiologist equipment/supplies and additional state narcotic transportation regulations were deemed statistically significant in failing to improve safety. Requiring airway and sedation training for a facility's provider and staff were not barriers to care. Rules and regulations were not a factor to establishing clinical practice in one state over another state. CONCLUSION: Individuals and organizations responsible for influencing the regulatory environment of anesthesia services should improve regulations to facilitate the mobility of dentist anesthesiologists.

Feasibility and usability study of a pilot immersive virtual reality-based empathy training for dental providers.

PURPOSE: Social determinants of health (SDOH) significantly impact individuals' engagement with the healthcare system. To address SDOH-related oral health disparities, providers must be equipped with knowledge, skills, and attitudes (KSAs) to understand how SDOH affect patients and how to mitigate these effects. Traditional dental school curricula provide limited training on recognizing SDOH or developing empathy for those with SDOH-related access barriers. This study describes the design and evaluation of such a virtual reality (VR)-based simulation in dental training. We hypothesize the simulation will increase post-training KSAs. METHODS: We developed "MPATHI" (Making Professionals Able THrough Immersion), a scripted VR simulation where participants take the role of an English-speaking caregiver with limited socioeconomic resources seeking dental care for a child in a Spanish-speaking country. The simulation is a combination of 360° video recording and virtual scenes delivered via VR headsets. A pilot was conducted with 29 dental residents/faculty, utilizing a pre-post design to evaluate effectiveness in improving immediate and retention of KSAs toward care delivery for families facing barriers. RESULTS: MPATHI led to increased mean scores for cognitive (pre = 3.48 ± 0.80, post = 4.56 ± 0.51, p < 0.001), affective (pre = 4.20 ± 0.4, post = 4.47 ± 0.44, p < 0.001), and skill-based learning (pre = 4.00 ± 0.47, post = 4.52 ± 0.37, p < 0.001) immediately post-training. There was not a significant difference between skills measured immediately post-training and in the 1-month post-training survey (p = 0.41). Participants reported high satisfaction with the content and methods used in this training. CONCLUSIONS: This pilot study supports using VR SDOH training in dental education. VR technology provides new opportunities for innovative content design.

Outcome evaluation of the Dental Health Outreach Mobile Experience (HOME) Coach Program.

BACKGROUND: The Ohio Department of Health identified dental care as the number one unmet health need for Ohio's children. The Dental Health Outreach Mobile Experience (HOME) Coach is a pediatric mobile dental unit that seeks to meet the dental needs of underserved children in the Columbus City Schools. PURPOSE: The purpose was to conduct an outcome evaluation of the Dental HOME Coach Program and to compare the outcomes before (2010-2014) and after (2015-2019) the incorporation of the new Dental HOME Coach. METHODS: Using a longitudinal outcome evaluation research design, the data were analyzed from 10 years of the Dental HOME Coach Program at the Ohio State University (OSU) College of Dentistry during the academic years ending in 2010-2019. RESULTS: A total of 1063 dental students provided dental care to 26469 children in the Columbus City Schools. The top 3 performed procedures were sealants, prophylaxis, and resin composite fillings. Despite significant increases in the number of dental students providing oral health care, there were significant decreases in the number of amalgam fillings and stainless-steel crowns from before to after the incorporation of the new Dental HOME Coach. CONCLUSION: The outcome evaluation revealed the Dental HOME Coach Program has been providing underserved children with oral health care that offers them a dental "home," giving dental students an array of hands-on learning experiences that include pediatric dentistry treatments performed under the supervision of OSU faculty members, and positively impacting the problems of access to oral health care for Ohio's families.

Process, outcome, and impact evaluation of the ohio state university DentPath postbaccalaurate program.

Despite the progress in increasing racial and ethnic diversity in dental school programs in the United States, minority dental students still remain underrepresented when compared with the total population. As a result, dental education programs have been attempting to increase the number of students from underrepresented and underserved communities in their programs. PURPOSE: The purpose of this study was to conduct process, outcome, and impact evaluations of the Ohio State University (OSU) College of Dentistry's (CoDs) DentPath Program. METHODS: Upon Institutional Review Board approval, this study utilized a computer-assisted telephone interview research design of graduates from the OSU CoD DentPath Program. Forty closed and open-ended questions were asked during the structured interview. Descriptive and thematic analyses were used to analyze the data. RESULTS: The data from 25 eligible graduates were analyzed, which represented a 100% response rate. Process evaluation revealed 100% (n = 25) of the participants expressed satisfaction with their DentPath experiences and recommendations for improvement were provided. Outcome evaluation revealed the participants treated patients using Medicaid (range: 20%-90%, n = 5) or a sliding scale (range: 5%-85%, n = 3) for payment and 36% (n = 9) of the participants regularly treated underserved populations outside of their regular practice settings. Impact evaluation revealed 68% (n = 17) participants reported the DentPath Program had no impact on their practice location. CONCLUSIONS: Future research is needed to determine methods to promote the transition of DentPath students through dental school and into underserved communities.

Process and outcome evaluation of the Oral Health Improvement through Outreach (OHIO) Project.

Academic dental institutions serve a foundational role in meeting the oral health needs of Americans through community-based learning experiences. PURPOSE: The purpose of this study was to longitudinally evaluate an ongoing primary objective of the Oral Health Improvement through Outreach (OHIO) Project Program, which is to build strong partnerships between The Ohio State University (OSU) College of Dentistry (CoD) and community-based dental facilities and increase access to dental care for underserved populations. METHODS: Upon exempt Institutional Review Board approval (2004H0067), a longitudinal evaluation study was conducted of 15 years of the OHIO Project during the 2004-2019 academic years. Descriptive statistics were used to evaluate the OHIO Project using process and outcome evaluation methods. RESULTS: The data from 107,510 patients were analyzed. Process evaluation revealed the OHIO Project has been reaching the target population of communities with dental care needs and limited access, as evidenced by the main methods of patient payment/non-payment and the quantity of completed restorative/oral surgery procedures. Outcome evaluation revealed the OHIO Project has been building strong partnerships between the CoD and communities to address dental care needs and improve access, as evidenced by the increased number and distribution of the community-based facilities throughout Ohio. CONCLUSION: Process and outcome evaluation revealed the OHIO Project has been meeting its primary goal of building strong partnerships between the CoD and OHIO Project community-based facilities to address the basic dental needs and increase access for Ohio residents. Future research is needed to evaluate the dental student impact of providing community-based care.

Campus-Based, Community-Based, and Philanthropic Contributions to Predoctoral Pediatric Dental Clinical Education: Two Years of Experiences at One Dental College.

The aim of this study was to investigate the contribution of a tiered predoctoral pediatric dentistry clinical education model to competency achievement by dental students over a two-year clinical education. Retrospective data were obtained for academic years 2012-13 and 2013-14 from three sources: a campus-based, dental school-housed clinic; division-directed clinics in community-based pediatric and special needs clinics (DDC); and clinics affiliated with the dental college's community-based dental education (CBDE) program, the OHIO Project (OP). A fourth dataset was obtained for the same two-year period from a biannual clinic event held at the college in conjunction with Give Kids a Smile Day (GKAS). Procedures considered essential to the care of children were sorted by 12 dental codes from all services for patients 18 years of age and younger. The dental school clinic provided 11,060 procedures; the DDC, 28,462; the OP, 17,863; and GKAS, 2,028. The two-year total was 59,433 procedures. Numbers of diagnostic and preventive procedures were 19,441, restorative procedures were 13,958, and pulp and surgical procedures were 7,392. Site contribution ranged from 52.2 to 144.9 procedures per attending student, with the DDC yielding the highest per student average for each year (126.4 and 144.9) and the dental school clinic the lowest (52.2 and 53.1). This study found that a combination of school-based, community-based, and philanthropic pediatric dental experiences offered a large number of essential pediatric dentistry experiences for predoctoral dental students, with CBDE opportunities offering the largest contribution.

Community-based dental education at the Ohio State University: the OHIO Project.

In the late 1990s, Ohio's citizens expressed to the state leadership that access to dental care was their greatest unmet health need. State-sponsored surveys continued to report that certain populations-the poor, disabled, and minorities-experience higher-than-average rates of dental disease and cannot access care. The Ohio State University College of Dentistry sought to respond to this need by securing a $1.5 million grant from the Robert Wood Johnson Foundation in 2002 and began an experiment in engagement with community partners unprecedented in its history. As the state's flagship dental institution, the college committed to a fundamental change in its clinical education of students and began a process of making dental education relevant to our citizens, exposing students to populations they were being trained to help, and bolstering the fragile statewide network of safety-net clinics with providers. This case history offers an operational overview, including some challenges and successes, of one school's journey in community-based dental education.

Academic integrity in dental school: a call to action.

Recently there has been much discussion in the media and literature pertaining to academic misconduct in higher education. Dentistry has not been immune to this discussion. Recent "scandals" involving student misconduct in U.S. dental schools have sparked dialogue within dentistry's premier professional organizations. The authors of this position paper recognize that academic misconduct can be a serious threat to dental education and the profession of dentistry as a whole. This paper addresses academic misconduct in dental school, the impact it may have on our profession, and how educators can begin to develop strategies to curtail cheating in their institutions.

Rethinking the role of community-based clinical education in pediatric dentistry.

The early childhood caries epidemic has prompted a look at predoctoral clinical dental education in pediatric dentistry. The purpose of this study was to examine the contribution of community-based clinical education (CBE) to procedural and patient diversity in predoctoral pediatric dental education. Using procedural and demographic data from pediatric clinical experiences of the dental class of 2007 at The Ohio State University College of Dentistry, profiles of patient diversity, clinical pediatric dental procedures, and student efficiency were developed for both CBE sites and the campus-based clinic. Ninety-two students performed 16,523 procedures on children in the fourth year in CBE sites in the community compared to 4,268 on campus in their third year. Pediatric-dedicated CBE sites accounted for almost 12,000 pediatric dental procedures. Approximately 56 percent of children treated at CBE sites were minorities. CBE sites accounted for most of the dental student restorative experience for pediatric patients for the Class of 2007, giving each student on average multiple restorative procedures. The campus-based clinic provided largely diagnostic and preventive procedures but few restorative opportunities. We conclude that community-based dental clinical education presents an opportunity to enhance pediatric predoctoral student clinical experiences in both quantity and diversity.

Comparing fourth-year dental student productivity and experiences in a dental school with community-based clinical education.

Reports and articles by the Institute of Medicine, the American Dental Education Association (ADEA) Commission on Change and Innovation in Dental Education (CCI), and the Macy Foundation have examined the challenges confronting dental education and reached the conclusion that U.S. dental education is on the brink of major change. A recent "case for change" article by the CCI makes the argument that dental education, as currently structured, is quickly becoming obsolete, overpriced, and lacking in its ability to provide the education that future practitioners will need. The Ohio State University College of Dentistry (OSUCOD) began a major reorganization of its clinical education program upon receipt of a Robert Wood Johnson Foundation-sponsored Pipeline, Profession, and Practice grant. In our fourth year of the five-year grant program, known as the OHIO Project (Oral Health Improvement through Outreach), our fourth-year dental students approached the sixty-day target of time spent in community-based clinical education. The purpose of this report is to describe the productivity of students and the characteristics of the patient pool they care for in community-based sites as compared to our school-based clinics during that final year. This report reflects the activity of 102 students in the graduating class of 2006. Attendance (clinic utilization) was estimated to be 94 percent at OSUCOD and 99 percent at OHIO Project sites. In the aggregate, the OHIO Project-based students treated a total of 11,808 unique patients and completed 26,882 procedures in the community during their 41.9-day community experience. This translates into 116 unduplicated patients and 264 procedures per student in the community-based sites for the period studied. In comparison, the same students treated 19,344 unique patients and completed 28,680 procedures during ninety-three clinic days at the school. Each student treated 190 patients and completed 281 procedures. Fourth-year dental students completed as many procedures and generated similar revenue-equivalents in community sites as they did in a dental school clinic in half the time.

A snapshot of cultural competency education in US dental schools.

During the last decade, cultural competency has received a great deal of attention in health care and the literature of many fields, including education, social services, law, and health care. The dental education literature provides little information regarding status, strategies, or guiding principles of cultural competency education in U.S. dental schools. This study was an attempt to describe the status of cultural competency education in U.S. dental schools. A web-based thirty-question survey regarding cultural competency education coursework, teaching, course materials, and content was sent in 2005 to the assistant/associate deans for academic affairs at fifty-six U.S. dental schools, followed up by subsequent email messages. Thirty-four (61 percent) dental school officials responded to the survey. The majority of respondents (twenty-eight; 82 percent) did not have a specific stand-alone cultural competency course, but indicated it was integrated into the curriculum. Recognition of local and national community diversity needs prompted course creation in most schools. Respondents at almost two-thirds of schools indicated that their impression of students' acceptance was positive. Teachers of cultural competency were primarily white female dentists. Few schools required faculty to have similar cultural competency or diversity training. Thirty-three of the thirty-four U.S. dental schools responding to this survey offer some form of coursework in cultural competency with little standardization and a variety of methods and strategies to teach dental students.