Evaluation of a Near-Infrared Light Transillumination Device for Caries Detection in Interproximal Primary Molar Surfaces.

Purpose: To evaluate the sensitivity and specificity of the near-infrared light transillumination caries detection method by using DEXIS CariVu (DCV) for imaging of interproximal primary molar surfaces (IPMS).
Methods: A retrospective evaluation of patient records at a university pediatric dentistry (PD) clinic identified 22 patients with unrestored IPMS, which had images of both bitewing radiography (BW) and DCV. A scoring system (no caries, incipient caries, dentinal caries) was developed for the study. Two investigators (pediatric dental faculty) identically scored 90 IPMS in both BW and DCV images, establishing benchmark IPMS scores. The 180 images were then compiled in a randomized order in a questionnaire, which was answered by 24 raters (PD residents and faculty) using the study caries scoring system. Data analysis included raters and experts' percent agreement, Vassar Stats for sensitivity and specificity, and Kendall's correlation coefficient for interrater reliability.
Results: The overall agreement between raters and experts for DCV images was 48 percent (54 percent for no caries, 23 percent for incipient caries, and 68 percent for dentinal caries). The DCV's sensitivity and specificity to detect any caries were, respectively, 0.72 and 0.54, 0.60 and 0.53 for incipient caries, and 0.82 and 0.53 for dentinal caries. The BW's sensitivity and specificity to detect any caries were respectively, 0.82 and 0.87, 0.98 and 0.86 for incipient caries, and 0.99 and 0.87 for dentinal caries. The overall interrater reliability was 0.48 (95 percent confidence interval equals 0.46 to 0.50).
Conclusion: The use of DCV as a stand-alone caries detection method for IPMS is limited.

A qualitative analysis of caregiver perceptions of pediatric dental surgery under general anesthesia.

BACKGROUND: Dental surgery under general anesthesia (GA) is a common treatment for severe childhood caries and thus may serve as an event to motivate behavior change. The frequency of recurrent caries, however, indicates opportunities within current practice to change a child's oral health behaviors. AIM: To assess caregiver experiences related to their child's dental surgery to inform development of a behavioral intervention. DESIGN: Semi-structured interviews with caregivers of children receiving GA for dental surgery. Transcripts (n = 19) were analyzed using qualitative thematic methods. RESULTS: Children were 2-5 years of age, mean 3.8 years. Limited access to GA services was a source of caregiver frustration and a barrier to caries treatment. Surgical events elicited emotional reactions including guilt, anxiety, and a sense of caregiver accountability for development of severe caries. There was variation in caregiver awareness and/or motivation to change oral health behaviors. CONCLUSIONS: A child's dental surgery under GA is an emotionally challenging event yet may inspire hope and expectations for improvement. Surgery offers an opportunity to implement interventions at a time when caregivers may be open to assistance with behavior change, though stress and anxiety may create barriers. Behavioral interventions should be tailored to individual caregiver needs/barriers and stage of developmental readiness.

Comparing Case-Based with Team-Based Learning: Dental Students' Satisfaction, Level of Learning, and Resources Needed.

The aims of this study were to compare third-year dental students' satisfaction and level of learning in case-based learning (CBL) versus team-based learning (TBL) and the resources required in those two methodologies. Level of learning was assessed for both knowledge and application, and resources were defined as student and faculty time and rooms. In academic year 2018-19, all 68 third-year dental students in one U.S. dental school were enrolled in two sequential semester-long courses; the first used CBL, and the second used TBL. After each course, students and faculty facilitators completed surveys, and data from students' knowledge and application exams were collected. The student surveys asked students to report their satisfaction with the learning methodology (CBL or TBL); the faculty surveys asked the faculty facilitators to report the resources used for each methodology. Forty-five of 68 students (66%) consented to participate; however, a larger number of students completed surveys in the two semesters (69% for CBL and 87% for TBL). Fourteen of 16 (88%) faculty facilitators completed the CBL survey, and five of the six (83%) completed the TBL survey. Overall, the results showed that students' satisfaction was higher with CBL than TBL (Mann-Whitney U = 882.0; p<0.001), and students reported having a better understanding of concepts after CBL than TBL (U = 899.0; p<0.001). The students performed better on knowledge exam items in TBL than CBL (86% vs. 82%) but the same on application items (both 86%). Resource requirements for both methods were extensive, with TBL requiring fewer facilitators and rooms than CBL but requiring more time from both students (2.6 vs. 2.3 hours weekly) and faculty members (2.3 vs. 1.4 hours weekly). In this study, students preferred CBL to TBL but had higher knowledge scores in the TBL course. The resources needed for both CBL and TBL were said to be extensive, with infrastructure use higher for CBL but time for students and faculty higher for TBL.

Understanding Oral Health Behaviors Among Children Treated for Caries Under General Anesthesia.

Purpose: To identify factors that influence oral health behaviors in the pediatric population treated for caries under general anesthesia (GA).
Methods: Nineteen semi-structured key informant interviews were conducted with caregivers while their children received comprehensive dental care under GA. Interviews were recorded on audio and professionally transcribed. Transcripts were coded using an inductive approach, with codes categorized and themes identified in an iterative process among four investigators.
Results: Data from 14 English and five Spanish interviews were reported. Factors that impacted accessing dental services, toothbrushing, and sugar intake were related to experiences living with severe caries and family dynamics. Many caregivers found the process of accessing care challenging, with barriers ranging from a caregiver's denial of disease severity to insurance status and provider availability. Discordant dynamics between parents and their children hindered efforts to change oral health behaviors. Stress of daily life impacted the ability for some caregivers to prioritize oral health.
Conclusion: Our findings provide a better understanding of how a family's experiences and dynamics prior to dental care under GA can serve as barriers to changing oral health behaviors within an urban, Medicaid-enrolled population. Future work should address the complexity and context of familial interactions in efforts to improve surgical outcomes.

Benefits and Challenges of Partner Site Engagement with Community-Based Dental Education Programs: The Partner Sites' Perspectives.

The aim of this qualitative study was to examine the perspectives of key personnel at partner sites providing community learning experiences to dental students to gain more understanding of the effects that community-based programs have on the sites themselves. Fourteen semi-structured interviews were conducted in 2015 with individuals from nine extramural sites. Interviewees had a range of roles from clinicians to CEOs, with six also reporting they were faculty preceptors. Three of the researchers developed a coding scheme focused on the benefits and challenges that community sites experience from participating in a community-based dental education (CBDE) program. Each coder then reviewed the interview transcripts independently before final group discussions and recoding to agreement. The main themes related to benefits were recruiting future dentists, staying current with clinical developments, sites' indirectly improving their missions by exposing students to broader roles of oral health providers, raising awareness regarding the need for dentistry in community settings, and nurturing a positive workplace environment. The main themes related to challenges were balancing education and training for students with clinical demands, communication with the university, and managing distinctive clinical and professional characteristics of students. This study's participants reported that the main benefit of CBDE for partner sites was dentist recruitment. The study also provided insights for both partner sites and dental schools to consider when developing and maintaining these partnerships.

Timing of Case-Based Discussions and Educational Outcomes for Dental Students.

The aim of this study was to determine if the timing of a case-based discussion affected dental students' assessment scores. The study specifically investigated whether the timing of a 60-minute case-based discussion before or after a 90-minute lecture affected students' performance on a quiz on topics in pediatric dentistry. In addition, students' preferences for the timing of the case discussion and confidence in the material with different timings were assessed in a survey. In a crossover design, all 52 second-year students in fall 2016 at one U.S. dental school participated in a case-based discussion either before or after lectures on stainless steel crowns and pulp therapy, compared to a control unit on space maintenance with no case-based discussion. The students took quizzes and responded to questionnaires a week after the lectures. A total of 45 (87%) of the 52 students consented to have their scores used. The results showed that the students performed better on the quiz when participating in a case-based discussion after the lecture compared to the discussion before the lecture (after mean=6.1±0.8 vs. before mean=5.5±1.3). The students' control quiz mean following a lecture with no associated case discussion was 6.3±0.8. Students also expressed more confidence when the case was held after the lecture (12.7 vs. 11.6, p=0.02) and preferred the case after (p=0.01). This study found that higher quiz and confidence scores resulted when a case discussion was held after (vs. before) a lecture. When dental educators consider adding a case discussion to a lecture format as a method of increasing students' active learning, these results suggest that having the case discussion after the lecture may be more effective for learners new to the material.

Association Between Childhood Traumatic Stress and Behavior in the Pediatric Dental Clinic.

PURPOSE: The purpose of this study was to examine the relationship between a history of potentially traumatic events (PTE) and a child's behavior during dental treatment. METHODS: Parents of healthy children, age four years and older and attending their initial dental appointment at a university pediatric dental clinic, were asked to complete the Traumatic Events Screening Inventory-Parent Report Revised and a demographic survey. Following the dental appointment, a pediatric dental resident reported the child's behavior using the Frankl scale. RESULTS: A total of 170 parent-child pairs participated; 53 percent of parents indicated their child had experienced at least one PTE; 44 percent reported their child had a prior negative experience at the dentist. Adjusted multivariable logistic regression analysis showed no significant association between PTE history and poor dental behavior (P=0.994), but a significant association was observed between a previous negative dental experience and poor dental behavior (P=0.000) as well as between age (younger than five years old) and poor behavior (P=0.006). CONCLUSIONS: Children with a history of potentially traumatic events did not exhibit uncooperative behavior more often than those who did not. A previous negative dental experience and the child's young age were significantly associated with uncooperative behavior.

Randomized trial of two e-learning programs for oral health students on secondary prevention of eating disorders.

The purpose of this study was to test whether an interactive, web-based training program is more effective than an existing, flat-text, e-learning program at improving oral health students' knowledge, motivation, and self-efficacy to address signs of disordered eating behaviors with patients. Eighteen oral health classes of dental and dental hygiene students were randomized to either the Intervention (interactive program; n=259) or Alternative (existing program; n=58) conditions. Hierarchical linear modeling assessed for posttest differences between groups while controlling for baseline measures. Improvement among Intervention participants was superior to those who completed the Alternative program for three of the six outcomes: benefits/barriers, self-efficacy, and skills-based knowledge (effect sizes ranging from 0.43 to 0.87). This study thus suggests that interactive training programs may be better than flat-text e-learning programs for improving the skills-based knowledge and self-efficacy necessary for behavior change.

The effects of beverages on plaque acidogenicity after a sugary challenge.

BACKGROUND: Caries prevention traditionally has emphasized the restriction of cariogenic foods and beverages, but it has placed less emphasis on how the choice, combination and sequence of consumed foods and beverages may help reduce plaque acidogenicity. The authors conducted a study to examine whether whole milk, 100 percent apple juice or tap water affect dental plaque acidity in people after a sugary challenge. METHODS: Twenty adults participated in a randomized controlled crossover study. Participants consumed four combinations of foods: 20 grams of dry sugary Froot Loops (FL) (Kellogg's, Battle Creek, Mich.) cereal, 20 g of FL followed by 50 milliliters of milk (FL/milk), 20 g of FL followed by 50 mL of juice (FL/juice) and 20 g of FL followed by 50 mL of water (FL/water). The authors used a touch microelectrode to take plaque pH readings at the interproximal space just below the contact area between the maxillary premolars on both left and right sides at two and five minutes after FL consumption and at two to 30 minutes after milk, juice or water consumption. RESULTS: Consumption of FL plaque pH (standard deviation [SD]) was 5.83 (0.68) at 30 minutes, whereas plaque pH (SD) in the FL/milk group was 6.48 (0.30), which was significantly higher than that for FL/juice (5.83 [0.49]) or FL/water (6.02 [0.41]) (P < .005) at 35 minutes. CONCLUSION: Drinking milk after a sugary cereal challenge significantly reduced plaque pH drop due to the sugary challenge. PRACTICAL IMPLICATIONS: When discussing the cariogenicity of foods and beverages with patients, dentists and other health care professionals should emphasize that the order of ingesting sugary and nonsugary foods is important and may affect their oral health.

Evaluation of a theory-driven e-learning intervention for future oral healthcare providers on secondary prevention of disordered eating behaviors.

Oral healthcare providers have a clinical opportunity for early detection of disordered eating behaviors because they are often the first health professionals to observe overt oral and physical signs. Curricula regarding early recognition of this oral/systemic medical condition are limited in oral health educational programs. Web-based learning can supplement and reinforce traditional learning and has the potential to develop skills. The study purpose was to determine the efficacy of a theory-driven Web-based training program to increase the capacity of oral health students to perform behaviors related to the secondary prevention of disordered eating behaviors. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance evaluation framework, a longitudinal group-randomized controlled trial involving 27 oral health classes from 12 oral health education programs in the United States was implemented to assess the efficacy of the Web-based training on attitudes, knowledge, self-efficacy and skills related to the secondary prevention of disordered eating behaviors. Mixed-model analysis of covariance indicated substantial improvements among students in the intervention group (effect sizes: 0.51-0.83) on all six outcomes of interest. Results suggest that the Web-based training program may increase the capacity of oral healthcare providers to deliver secondary prevention of disordered eating behaviors. Implications and value of using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework are discussed.

Parental attitudes regarding pediatric dentists' counseling on tobacco use: a survey of five private practices.

PURPOSE: To evaluate parental acceptance of provision of tobacco cessation and prevention education to children and parents by private practice pediatric dentists. METHODS: Receptionists gave confidential questionnaires to parents of child dental patients in five private pediatric dentistry practices. Demographic information and questions about dentist interventions were asked, with the most intrusive questions concerning parental tobacco use. RESULTS: Ninety-four percent (234) of parents responded. Over 90 percent of parents favored dentists speaking to 1) the child on the dangers of tobacco use and the benefits of avoiding tobacco, 2) parents about the effects of tobacco use on their children, and 3) parents about cessation. Among tobacco-using parents, 76 percent favored interventions directed at child tobacco use and warnings about adult smoking and children, dropping to 59 percent favoring dentist provisions of cessation education to parents. Users were less approving than nonusers on both parental interventions (P=.001). CONCLUSIONS: Parents showed high acceptance of various levels of tobacco interventions by pediatric dentists in private practice. Tobacco users, however, were less accepting than nonusers. Pediatric dentists may be more willing to provide such messages with this information, but they may also need training to prepare themselves to handle negative reactions.

Factors affecting the internal brain drain of Saudi healthcare professionals.

OBJECTIVE: To investigate factors affecting the internal brain drain of healthcare professionals in the Kingdom of Saudi Arabia. METHODS: A cross-sectional study was conducted using an anonymous self-administered online questionnaire sent to all Saudi students enrolled in healthcare profession programs in North America. The data was collected between January and March 2008 at the University of Illinois at Chicago, Chicago, Illinois, United States of America. Results were analyzed using logistic regression analyses. RESULTS: A total of 377 completed questionnaires were returned. Results revealed that 71% of respondents intended to return to work within the 2 major urban cities Riyadh and Jeddah. Respondents who completed their undergraduate studies in a large city were more likely to work in the same city (odds ratio [OR]=3.2; p=0.000; 95% confidence interval [CI] = 2.0-5.2). Furthermore, 51% of the students were willing to work in a rural area for a 50% or more increase in their salary. Finally, men were more willing to work in a rural area for a financial incentive (OR=2.3; p=0.006, 95% CI = 1.3-4.3). CONCLUSION: This study suggests that realistic financial incentives would probably not suffice to attract Saudi healthcare providers to rural areas. The provision of medical schools in smaller cities and rural areas is predicted to be a more effective method for improving the current maldistribution of healthcare providers.

A qualitative study of tobacco dependence treatment in 19 US dental hygiene programs.

INTRODUCTION: The US Public Health Service calls for health professionals to provide tobacco dependence counseling for patients. The purpose of this study was to understand how dental hygiene programs make decisions about and provide training for tobacco dependence counseling to help them graduate more fully competent hygienists. METHODS: We conducted interviews (N = 32) with mainly program and clinic directors from 19 US dental hygiene education programs for this qualitative case study. We explored fluoride therapy training and tooth whitening training for comparison. Two analysts summarized the transcripts into a case study for each program. RESULTS: All programs reported a similar process of learning about and choosing a method for teaching the topics explored. The programs used a common process, ADPIE (assess, diagnose, plan, implement, evaluate), to structure students'clinical encounters. Almost all programs train students to ask about tobacco use and to advise quitting, but few programs train students to effectively help patients to quit and only 2 programs evaluated the competence of all students to provide such training. ADPIE shows promise for integrating tobacco dependence treatment more fully into the clinical training of dental hygiene students. Comparison to tooth whitening and fluoride therapy training indicated that complexity of the treatment and alignment with dental hygiene's mission were themes related to training decisions. CONCLUSION: Full implementation of tobacco dependence counseling into dental hygiene education requires a commitment by dental hygiene educators to train students and faculty in counseling techniques and their evaluation. We identified an existing clinical structure as showing promise for facilitating improvement.

An association of premature loss of primary maxillary incisors with speech production of bilingual children.

PURPOSE: Early childhood caries is prevalent in the United States, especially among Hispanic children. One consequence may be premature loss of primary teeth, raising concern about developmental challenges. This study examined speech sound articulation errors association with premature loss of the primary maxillary incisors of bilingual children (Spanish/English). METHODS: Hispanic children were assessed with a speech sound articulation test at 7 to 10 years of age against their history of primary maxillary anterior incisor loss. The exposed group (N =25) experienced premature extraction of these incisors, and the unexposed group (N =8) had normal dental exfoliation. RESULTS: The groups were similar regarding: age at speech assessment; gender; language spoken at home; socioeconomic status; caries prevalence; mean number of decayed, missing, filled and sealed teeth. Higher values for the dental articulation errors (P=.04) were revealed among exposed vs unexposed. Exposed boys had more total speech articulation errors (P=.03), dental-related errors (P=.048), and other errors (P=.04) than the unexposed boys, although of small sample size. DISCUSSION: Bilingual children who experienced early primary tooth loss exhibited differences in speech sound production vs those who did not. Further research is warranted to determine the extent early tooth loss in bilingual children predicts speech problems.

Oral intubation in premature infants with and without stabilizing devices.

PURPOSE: This study evaluated the effects of palatal stabilizing devices (PSDs) on accidental extubations (AEs) and other intubation complications in infants with breathing tubes at a neonatal intensive care unit (NICU) of a university hospital. PSDs are individually crafted acrylic oral devices for stabilizing breathing tubes in neonates. METHODS: Charts of all first admission NICU neonates weighing less than 1,500 g were reviewed (N =733); 548 were intubated and had information available on birth weight, gender, transfer status, gestational age, length of admission, ventilator type, sedation, dates of intubations and extubations, number of accidental extubations, dates of PSD placement, and complications. RESULTS: 153 subjects received PSDs, with 19 AEs; 395 received no PSDs, with 31 AEs. Non-PSD neonates were intubated for a median of 3 and PSD neonates for 26 days. PSDs were associated with sedation, male gender, longer admissions, longer intubation periods, being on a high-frequency ventilator, and low birth weight (P<.05). 0.4 accidental extubations over 100 intubated patient days were recorded for the PSD vs 0.79 for the non-PSD group. CONCLUSIONS: Palatal stabilizing devices were not related to other complications of breathing tubes. The PSD group had fewer accidental extubations per days of intubation vs the non-PSD group.

Developing and pretesting case studies in dental and dental hygiene education: using the diffusion of innovations model.

Case-based learning offers exposure to clinical situations that health professions students may not encounter in their training. The purposes of this study were to apply the Diffusion of Innovations conceptual framework to 1) identify characteristics of case studies that would increase their adoption among dental and dental hygiene faculty members and 2) develop and pretest interactive web-based case studies on sensitive oral-systemic health issues. The formative study spanned two phases using mixed methods (Phase 1: eight focus groups and four interviews; Phase 2: ten interviews and satisfaction surveys). Triangulation of quantitative and qualitative data revealed the following positive attributes of the developed case studies: relative advantage of active learning and modeling; compatibility with a variety of courses; observability of case-related knowledge and skills; independent learning; and modifiability for use with other oral-systemic health issues. These positive attributes are expected to increase the likelihood that dental and dental hygiene faculty members will adopt the developed case study once it is available for use. The themes identified in this study could be applied to the development of future case studies and may provide broader insight that might prove useful for exploring differences in case study use across dental and dental hygiene curricula.

A case of collegial communication and a patient who does not pay.

Four individuals who teach ethics in dental schools comment on a case in which negative financial information is revealed by one dentist when transferring records of a potential patient to another dentist. All commentators find varying degrees of ethical problem with disclosing such information. Professional codes discourage this practice. All commentators stress the importance of the potential new dentist developing a relationship based on professional standards, with the greatest emphasis placed on the patient's health needs. Several of the commentators discuss positive ways of conducting a patient interview, including specific useful language.

Assessment of willingness to provide diabetes education and counseling in a dental school clinic.

Diabetes mellitus is a major public health concern for the U.S. population because of its high prevalence and long-term health implications. The purpose of this study was to apply the Theory of Planned Behavior (TPB) to assess dental faculty member and student willingness to provide diabetes education and counseling to patients in a dental school. A survey was administered to dental students (n=101 respondents) and faculty members (n=39 respondents), and summary scores for seven diabetic educational activities and TPB constructs were calculated and analyzed. Participants were most willing to refer a patient to a physician for treatment and provide basic information about diabetes and oral health, and they were least willing to provide basic information about diabetic medications. Importance, self-efficacy, and barriers constructs predicted willingness to perform diabetic educational or counseling activities. Our findings suggest that, when developing innovative approaches to expand diabetic education and counseling in our dental education environment, programs should demonstrate how diabetic counseling can improve patients' health and should include diabetic management skills-building in the curriculum.

Factors for increasing adoption of e-courses among dental and dental hygiene faculty members.

The incorporation of web-based learning into the dental curriculum has been consistently recommended in the literature on reform in dental education. There has been growing support for web-based learning in dental and dental hygiene education as demonstrated by deans' identifying this as a planned curricular innovation. The purpose of our study was to explore characteristics of e-courses that may serve to increase adoption among dental and dental hygiene faculty members. Eight ninety-minute focus groups (three dental; five dental hygiene) were conducted with dental (n=27) and dental hygiene (n=23) faculty members from six academic institutions. The resulting data were analyzed to identify two overarching themes and associated subthemes with regard to benefits and barriers influencing adoption of e-courses. A working conceptual framework, based on the Diffusion of Innovations, was developed from these themes to understand the characteristics that may influence the rate of adoption of e-courses among dental and dental hygiene faculty members. Analysis of the data revealed four main adoption barriers: 1) low perceived relative advantage to faculty members; 2) low compatibility with current curriculum; 3) high perceived time commitment; and 4) complexity of e-course development. This exploratory assessment identifies leverage points for facilitating the adoption and sustainability of e-courses in dental and dental hygiene education.

Assessment of tobacco dependence curricula in U.S. dental hygiene programs.

Tobacco dependence education (TDE) continues to be a vital component of dental hygiene curricula-made even more important by the fact that tobacco cessation in adults in the United States has stagnated over the past ten years. This study was undertaken to assess the salient characteristics of TDE in U.S. dental hygiene programs. A fifty-one question survey was mailed to the program directors of all 283 accredited dental hygiene programs during the 2007-08 school year (this number does not include the programs in Illinois, which were excluded since they had participated in a previous study). A total of 187 schools returned the survey for a return rate of 66 percent. Curricular content, minutes spent on each topic, existing level of clinical competence measured, expected level of clinical competence, and resources used were assessed. Respondents reported an average of 6.7 hours spent on all identified components of tobacco education. While 77 percent of respondents reported formally assessing whether a student asked if a patient used tobacco, only 26 percent indicated having a formal competency utilizing all of the U.S. Public Health Service's Clinical Practice Guideline 5 As and 5 Rs. In contrast, 72 percent of program directors reported expecting their graduates to be competent in a moderate intervention that included all 5 As. Though there is a clear commitment to TDE among dental hygiene programs in the United States, we recommend training to a more intensive level of TDE in order to facilitate broader adoption of comprehensive, evidence-based guidelines.