Brief and Telehealth Acceptance and Commitment Therapy (ACT) Interventions for Stress in Inflammatory Bowel Disease (IBD): A Series of Single Case Experimental Design (SCED) Studies.

Psychological intervention targeting distress is now considered an integral component of inflammatory bowel disease (IBD) management. However, significant barriers to access exist which necessitate the development of effective, economic, and accessible brief and remote interventions. Acceptance and commitment therapy (ACT) is a therapy with demonstrated acceptability and a growing evidence base for the treatment of distress in IBD populations. The present paper trialled two brief ACT interventions via randomized multiple baseline designs. Study 1 trialled a single-session ACT intervention (delivered face-to-face and lasting approximately two hours) targeting stress and experiential avoidance, respectively. Participants were seven people with an IBD diagnosis who presented with moderate to extremely severe stress (five females, two males; M age = 39.57, SD = 5.74). The findings of study 1 indicate that a single-session ACT intervention represented an insufficient dosage to reduce stress and experiential avoidance. Study 2 investigated a brief telehealth ACT intervention (delivered via a video conferencing platform and lasting approximately four hours) targeting stress and increased psychological flexibility. Participants (N = 12 people with an IBD diagnosis and mild to extremely severe stress) completed baselines lasting from 21 to 66 days before receiving a two-session ACT telehealth intervention supplemented by a workbook and phone consultation. Approximately half of participants experienced reduced stress, increased engagement in valued action, and increased functioning. Despite shortcomings such as missing data and the context of COVID-19, the present findings suggest that brief ACT interventions in this population may be effective and economic, though further research and replications are necessary.

Application of Practice Oriented-Peer Review for Prosthodontics (PRO-PReP)-A Qualitative Study.

OBJECTIVE: Communication skills diminish with time and must be applied and updated frequently. Due to various professional constraints, the dentists may not be able to attend training programs to sharpen their skills. During patient interactions, dentists may face difficult situations which they may be unable to handle and, consequently, make them overreact. Therefore, there is a need to provide a platform to freely discuss their feelings, ideas, and take opinion from peers. METHODS: Training in communication skills customized for dealing with complete denture patients was conducted for the prosthodontic postgraduates. Based on feedback obtained, it was decided to have periodic meetings and the concept of Practice-Oriented-Peer Review for Prosthodontics (PrO-PReP) was introduced. This novel concept is a combination of the Relationship building, exploring Reactions, exploring Content, and Coaching (R2C2) model of residency education and the Balint method. The meetings were scheduled every one or two months based on the available caseload of the patients treated by the postgraduates. RESULTS: The thematic analysis of the postgraduates' self-reflection during the sessions and the video recorded observations (assessed using the Kalamazoo scale) revealed that these sessions were effective in positively engaging the postgraduates to discuss their experiences, reflect on their performances, practice their newly gained skills, and learn from peer sharing. CONCLUSION: The postgraduates felt that they have changed in their working style and were more confident to manage patients. They found such sessions very useful for being updated with the already-learned skills.

A cross-sectional virtual survey to evaluate the outcome of online dental education system among undergraduate dental students across India amid COVID-19 pandemic.

PURPOSE: A questionnaire-based study was conducted to understand the pros and cons of online education among undergraduate dental students across India. The study was also proposed to assess the mental and physical well-being of the students amid the COVID-19 pandemic lockdown. METHODS: A total of 533 undergraduate dental students across India participated in a cross-sectional study by means of virtual survey. A self-designed questionnaire was created using google forms. The questionnaire consisted of 25 questions and was divided into two parts, first, regarding the academic outcome of online dental education and second, psychological and physical well-being of the students in reference to online dental education. A descriptive statistical analysis was done using IBM SPSS statistics software. RESULTS: In the present study, 91.6% students reported that the format of dental education was shifted to online lectures due to the COVID-19 pandemic. 86.4% students suggested that they preferred offline lectures rather than online lectures. Psychological and physical well-being were affected in both male and female students; however, male students were affected more significantly than females. CONCLUSION: The study concluded that the education of dental students was adversely affected as a result of COVID-19 pandemic. The physical and psychological well-being of the students has also been affected, with males being affected in a higher proportion. The study concluded that the quality of online education should be enhanced and must be student centred to meet their education requirements. Also, there is a need of regular counselling and other measures to alleviate the students from the psychological stresses.

Barriers to cancer care for people with significant mental health difficulties: What healthcare staff say?

OBJECTIVES: Despite similar rates in cancer morbidity, patients with comorbid significant mental health difficulties (SMHD) experience higher mortality rates. This population has largely been neglected in cancer care research. Little is known about how to improve cancer outcomes for patients with SMHD. The aim of this research is to explore the views of healthcare professionals concerning the provision of cancer care to individuals with SMHD in an Irish context. METHODS: Semi-structured interviews were conducted with healthcare professionals (n = 28) providing care to people with SMHD and cancer. This included oncology and psychiatry consultants (n = 10); clinical nurse specialists (n = 8); clinical psychologists (n = 6); and medical social workers (n = 4). Data were analysed using thematic analysis. RESULTS: Four overarching themes were generated from the data highlighting the challenges associated with healthcare provision for this cohort. The themes were: Fragmentation of Care, Healthcare Providers' Understanding of SMHD, Complex Nature of Presentation, and Specialised Care Needs. CONCLUSIONS: The findings contribute to advancing our understanding of cancer care provision for patients with SMHD. They identify important barriers and facilitators to cancer care provision for this population from the perspective of healthcare professionals in Ireland. These findings will help to shape future research and contribute to improving the quality-of-care for people with SMHD and cancer.

Predicting denture satisfaction and quality of life in completely edentulous: A mixed-mode study.

Aim: The aim of the study was to evaluate the effect of dentist's communication skills and patient's psychological factors in predicting denture satisfaction and quality of life. Settings and Design: Cohort study. Materials and Methods: Patient-related variables were obtained using questionnaires in both pre- and post-intervention phases. In addition to this, in preintervention phase, lacunae in doctor-patient communication were obtained. Based on this, the postgraduates were trained in relevant communication skills required during complete denture treatment. In postintervention phase, the postgraduates were again followed up for continuation or decay of skills. Statistical Analysis: Mixed-mode approach - quantitative and qualitative analysis. Results: Both groups were similar in psychological parameters, personality domains, denture quality and quality of life at baseline. However, there was significant difference in denture satisfaction (P < 0.001) in both the groups. In the experimental group, denture satisfaction was more (80.4%) and quality of life had improved from baseline to 3 months (P = 0.000). Denture satisfaction was associated with self-efficacy (P = 0.002) and the communication skills of the dentist (P = 0.000). Quality of life was associated with the conscientiousness domain of personality (P = 0.049) and the communication skills of the dentist (P < 0.05). Conclusion: Satisfaction and quality of life with dentures were associated with self-efficacy, conscientiousness domain and the communication skills of the dentist. Denture satisfaction can be predicted by dentist communication skills. Therefore, training in communication skills for complete denture patient management and assessment of the psychological profile of the patient could contribute to the effective patient-centered practice to avoid patient dissatisfaction.

COVID-19 pandemic and its impact on dental students: A multi-institutional survey.

PURPOSE/OBJECTIVES: To investigate dental students' perceptions and concerns regarding the COVID-19 pandemic, their coping strategies and support resources, and their perceived stress levels. METHODS: A customized 19-item survey and the perceived stress scale (PSS) were applied to undergraduate dental students from the US, Spain, Ireland, Chile, India, and Brazil between April 10 and July 5, 2020. Linear modeling and mediation analysis were used to explore the relationships among demographics, stressors, coping mechanisms, social support, and stress RESULTS: A total of 4475 students responded to the survey. The majority (72.4%) were women, and 52.3% had no COVID-19 training at the time of the survey. The students reported that they had to accommodate to changes in patient care (96.6%) and didactic learning (95.2%) activities, while 88.5% of the respondents indicated at least one of their courses moved online. Transition to online courses went "smoothly with some troubles" for 51.8% of the respondents, and 48.3% perceived the faculty as prepared for the online transition; however, 45.9% reported feeling extremely concerned about the impact of COVID-19 on their education. The average PSS score was 21.9 of 40 (moderate stress). Multivariate models were built for participants with full data (n = 3899). Being male, having completed more dental coursework, and perceiving a smoother transition were associated with lower PSS scores; more concern about academic progress was associated with higher PSS. Faculty support mediated the relationship between a smoothness of transition and concern about academic progress and PSS scores CONCLUSION: Stress caused by the pandemic may be alleviated by smoother transition and good faculty support.

Current status of gerodontology curriculum in India and other parts of the world: A narrative review.

BACKGROUND: The current rise in the world's geriatric population has placed additional demands on dental professionals, as the management of geriatric patients requires distinct competencies. AIM: To review and perform a content analysis of the gerodontology undergraduate curriculum worldwide. DATA SOURCES: A search was carried out in PubMed, Web of Science, ERIC and EMBASE databases for the period-July 2008 till May 2019, using MeSH terms. A search for websites of Indian universities was also done, and undergraduate curricula were screened. STUDY ELIGIBILITY CRITERIA: The study included articles related to the undergraduate curriculum, which contained training in geriatric dentistry. Articles in foreign languages and those related to dental hygienists were excluded. RESULTS: A total of 218 articles were obtained, of which 19 met the inclusion criteria. A total of 301 colleges taught gerodontology. Amongst them, 50 colleges had a gerodontology department. Clinical training and outreach experience were provided in 175 and 73 colleges, respectively. There are no reports on the status of gerodontology in Asian countries (excluding Japan). In India, gerodontology is not taught as a separate subject. However, few gerodontology-related topics are covered in clinical subjects. CONCLUSIONS: There seems to be a wide variation in the content of gerodontology curriculum taught worldwide. Other than the European and American regions, gerodontology is yet to develop in other parts of the world. In India, a robust training programme is required to address the lack of dental care providers for the geriatric population using guidelines established by ECG and ADEA.

Developing Prosthodontic Residents' Communication Strategies with Edentulous Patients: A Pilot Study.

The aim of this study was to investigate whether prosthodontic residents' attitudes toward provider-client communication would be shaped by a tailor-made communications skills course. In 2016, the pre-intervention attitudes of all six second- and third-year prosthodontic residents in a three-year residency at an academic dental institution in India were assessed using the Communication Skills Attitude Scale (CSAS). The residents' performance was then video-recorded while they treated complete denture patients and was analyzed using the Kalamazoo scale, a validated scale for communication skills assessment. The residents' weaknesses were identified, and a custom-made generic module was designed along with individual guidance counseling for addressing aspects relevant to complete denture patients. The residents' attitudes were again assessed immediately after they completed the training using CSAS, as well as after two and four months using Balint sessions. Analysis of the recordings showed that few of the deficiencies during intraoral procedures were contextual, and the Kalamazoo scale did not address them: these were noted as being "beyond Kalamazoo." After the training, the residents reported awareness of their weaknesses and feeling motivated to practice their newly acquired skills. The Balint sessions showed that they had started valuing patients' agendas and the rapport-building process, and they reported transfer of skills when treating other types of prosthodontic patients. In this study, a customized communication skills module brought about a positive change in residents' attitudes, which was sustained over four months. Similar training could be implemented in other dental specialties.

A Self-Retaining Lingual Flap Guarding Device During Surgical Removal of Impacted Mandibular Third Molar.

INTRODUCTION: Lingual nerve damage is one of the common complications following mandibular third molar surgery. On considering the impact of lingual nerve damage on the patient's quality of life, it is necessary to exercise caution to minimize its occurrence. MATERIAL AND METHODS: Although many lingual retractors are available, in this article we describe an indigenously designed lingual retractor for use in mandibular third molar surgery. CONCLUSION: The indigenous lingual retractor described in this article provides advantages like clear access and excellent retention unlike conventional retractors.

Are we Training Enough of Communication Skills and Patient Psychology Required in Dental Practice.

The aim of this review is to discuss about lacunae in the areas of Communication skills and Patient psychology teaching in the dental set up in India. A literature search was performed using various databases and other resources. Data obtained was reviewed to obtain the work done in this field. It was found that there is currently no clear data in literature as to how much and how well students are taught about communication and behavioural skills and patient personality in dental curriculum in India. Pinpointing such lacunae can help dental colleges and universities to focus on the emphasis of their approaches to teaching about communication skills and psychology of the patient. Identification of future research area in this field is the need of the time for future discovery and progress in this overlooked field.

Comparative clinical efficacy evaluation of three gingival displacement systems.

AIM: We compared the clinical efficacy of three gingival displacement systems to accurately record intra-crevicular margins of tooth preparation. MATERIALS AND METHODS: One mechanical (magic foam cord) and two chemico-mechanical (expasyl paste and retraction cord impregnated with 15% aluminum chloride) gingival displacement systems were used. This study was conducted on the maxillary central incisors of 20 patients (20-60 years old) requiring full coverage restoration. All the three gingival displacement systems were tested in three sessions at an interval of 14 days in same order. The casts were sectioned and viewed under an optical microscope, followed by quantitative measurements of the width of the pre and postretracted sulci. RESULTS: All the three displacement systems produced highly significant horizontal gingival displacement. Retraction cord soaked in 15% aluminum chloride produced maximum displacement (0.74 mm), followed by expasyl paste (0.48 mm) whereas magic foam cord produced the least displacement (0.41 mm). CONCLUSIONS: Gingival displacement shown by each displacement system was found to be more than the accepted value necessary for elastomeric impression accuracy (0.2 mm) to record intra-crevicular margins of tooth preparation.

Double frenum weds fusion: a rare wedlock?

Morphological variation of normal oral structures such as double frenum and fusion together in a patient is rare. Sometimes such scenarios may mislead the diagnosis, affecting treatment planning and prognosis. Hence a thorough evaluation of patients with such morphological defects is necessary. This case report describes a case of double frenum and fusion, and the multiple challenges the clinician faces.

Prosthodontic rehabilitation of a patient with aggressive periodontitis.

Aggressive periodontitis previously termed as juvenile periodontitis is characterised by rapid destruction of the periodontium at a relatively young age. Rehabilitation of these patients is often challenging and difficult. Controlling the disease and restoring periodontal health is essential for successful prosthodontic rehabilitation. This clinical report describes an interdisciplinary approach in the rehabilitation of a young adult patient with generalised aggressive periodontitis. Treatment objectives included plaque control, prevention of further attachment loss, reduction/elimination of pockets, and prosthetic rehabilitation to enhance aesthetics and restore masticatory function. One year recall evaluation revealed stable periodontal support with no further loss of attachment and no other complications.

Does periodical department audit really works to make things fall in place: A Geriatric/General Oral Health Assessment Index based audit in prosthodontics.

PURPOSE: The purpose was to assess the outcome of improved staff supervision on the efficiency and quality of complete dentures delivered by clinical students. MATERIALS AND METHODS: The audit was performed in two parts. In the first cycle, retrospective analysis for complete dentures delivered by clinical students was undertaken, and patient's satisfaction was graded using Geriatric/General Oral Health Assessment Index (GOHAI). All the impeding factors encountered in the first cycle were identified, and corrective measures were implemented. Subsequently, a prospective analysis for the dentures delivered under strict staff supervision was undertaken in the second cycle. Patient satisfaction was graded again using GOHAI. RESULTS: Improved staff supervision increased the patient satisfaction significantly. CONCLUSIONS: The quality of care had improved in leaps and bounds compared to the first cycle due to increased level of supervision and strict adherence to the recommendations made at the end of the first cycle.

Evaluation of Crestal Bone Loss Around Implants Placed at Equicrestal and Subcrestal Levels Before Loading: A Prospective Clinical Study.

INTRODUCTION: Depth of placement of implant shoulder in relation to the crestal bone positively influence bone remodelling and preservation but the role of placement depth on bone loss before loading is not very clear. AIM: To assess the effect of placement depth alone on the crestal bone loss around implant placed at subcrestal and equicrestal level before prosthetic loading. MATERIALS AND METHODS: Patients reporting to the Department of Prosthodontics with the complaint of missing teeth were enrolled in the study after analysing inclusion and exclusion criteria. A total of 24 implants were planned to be placed into two groups as Group E (n=12) and Group S (n=12). Follow up radiographs after implant placement and after six months were analysed for the amount of bone loss. RESULTS: On six months follow up crestal bone levels of Group E were apical to Group S. Bone loss comparison between groups after six months follow up, revealed almost same mean bone loss. CONCLUSION: The implants placed at subcrestal and equicrestal level did not show difference in crestal bone loss before prosthetic loading.

Effect of four surface treatment methods on the shear bond strength of resin cement to zirconia ceramics- a comparative in vitro study.

BACKGROUND: Improving the retention of zirconia-based ceramics is desirable in order to avoid the failure of crowns and fixed partial dentures .This can be achieved by creating micromechanical retention using surface treatments. Therefore, it becomes necessary to constantly compare and re-evaluate the influence of different surface treatment methods on the bond strength . AIM: To evaluate the effect of four different surface treatments on shear bond strength between zirconia surface and resin cements. SETTINGS AND DESIGN: Observational study. MATERIALS AND METHODS: Twenty five zirconia plate samples were prepared based on ISO standards and were divided into five groups and each group was subjected to following five different surface treatments : no treatment, sandblasting with 110 µm alumina, sandblasting with 250 µm alumina, acid etching with 9.6% hydrofluoric acid and laser radiation on the surface. All the samples were surface disinfected and were embedded in blocks of autopolymerising resin to check shear bond strength on the universal testing machine. Statistical analysis used-data was analyzed using one-way ANOVA and a Post Hoc Bonferroni test. RESULTS: Analysis of the data showed that the highest shear bond strength values were obtained with laser treatment (18.120 ± 0.8159 Mpa). The lowest values were obtained with control group (9.166 ± 0.569 Mpa). Laser treatment increased the shear bond strength values significantly (p<0.05). CONCLUSION: Surface treatments increased the bond strength between zirconia and resin cement and carbon dioxide laser could be an effective surface treatment for increasing bond strength.

Prosthetic rehabilitation of palatal perforation in a patient with 'syphilis: the great imitator'.

Syphilis is a sexually transmissible disease caused by treponema palladium, a microaerophilic spirochete. Syphilis may progress from primary to tertiary stage if left unnoticed and untreated. Dentists should be vigilant and suspect sexually transmitted infections such as syphilis in the differential diagnosis of oral inflammatory or ulcerative lesions with palatal perforation. Moreover, it is imperative that dentists should have knowledge about its stages, characteristic features, oral presentation and prosthetic rehabilitation. This case report describes a case of tertiary syphilis with palatal perforation and the prosthetic rehabilitation of the defect with a prosthetic obturator.

Prosthodontic management of an albinism patient-dental implications and management.

Albinism is a congenital hypopigmentary disorder. Albinism is due to the dysfunction of the melanin-producing cells (melanocytes) resulting in defective production of melanin from tyrosine through a complex pathway of metabolic reactions. Little is known about the varied dental features that albinism presents with. This case report summarises the features encountered in albinism, the different oral findings available in the literature and also presents a case of an albinism patient treated with fixed partial denture and the precautions to be exercised for such patients.