Challenges of Incivility in Dental Practice and Education.

Professional collaboration is a key component of patient care and a source of fulfilment for oral health care providers. However, reports of incivility in employment as well as education are increasing impacting individuals in all settings including patients. Uncivil behavior implies a disregard for others and creates an atmosphere of disrespect, conflict, and stress. In contrast, civility towards others implies polite, respectful behavior towards others. This short report presents case studies in dental hygiene clinical practice and in dental hygiene education with strategies for approaching uncivil behavior.

Faculty diversity, equity, and inclusion in academic dentistry: Has dental education missed the call of #MeToo?

Faculty, students, and staff experience sexual harassment in the workplace and educational environment. Frequently, the victim takes no action either due to a lack of understanding of their rights or concern about retaliation or adverse outcomes if an incident is reported. The #MeToo movement has enhanced awareness of sexual harassment and its impact on victims. However, dental institutions vary in their approach to creating an environment free from harassment and supportive of individuals subject to inappropriate or illegal behaviors. In this article, four vignettes provide examples of harassment, mistreatment, or bias. Common themes and critical issues within the vignettes are then identified, discussing the potentially illegal, unethical, inappropriate, and unprofessional behaviors and comments. Strategies to address the issues identified are described. Recommendations are also provided to assist dental institutions and educators in evaluating their current practices and policies and implementing change.

Legal and Ethical Issues in Treating Adolescent Patients.

Adolescent patients may present with unique and challenging ethical dilemmas and legal considerations during dental treatment. From the moment the patient registers with the practice, the issues of medical history, informed consent, treatment decisions, and role of the patient and parent affect the dynamic of the doctor-patient relationship. Providers are challenged with balancing the physical, psychological, and social changes occurring in these patients and the changing relationships between the patients and their parents/guardians. State laws, practice standards, and consumerism in dental practice all affect the relationship between the practice, the adolescent, and the parent/guardian.

Complexities of Providing Dental Hygiene Services in Community Care Settings.

UNLABELLED: Direct access care provided by dental hygienists can reduce oral health disparities for the underserved, yet legal, regulatory, and ethical considerations create complexities and limits. BACKGROUND AND PURPOSE: Individual state dental practice acts regulate the scope of practice and level of supervision required when dental hygienists deliver care. Yet, inconsistent state practice act regulations contribute to ethical and legal limitations and dilemmas for practitioners. The dental hygienist is positioned to assume an increasingly larger role in the management of oral health disparities. However, there are several legal and ethical considerations that impact both dental hygienists and dentists providing care in complex community settings. This article informs dental hygienists and other related constituencies about conundrums that are encountered when providing care 'beyond the operatory.' METHODS: An evidence-based view of ways in which dental hygienists are reducing oral health disparities illustrates the complex issues involved in providing such care. Potential scenarios that can occur during care provision in underserved settings provide the basis for a discussion of legal and other associated issues impacting dental hygiene practice.

Social Media in the Dental School Environment, Part A: Benefits, Challenges, and Recommendations for Use.

Social media consist of powerful tools that impact not only communication but relationships among people, thus posing an inherent challenge to the traditional standards of who we are as dental educators and what we can expect of each other. This article examines how the world of social media has changed dental education. Its goal is to outline the complex issues that social media use presents for academic dental institutions and to examine these issues from personal, professional, and legal perspectives. After providing an update on social media, the article considers the advantages and risks associated with the use of social media at the interpersonal, professional, and institutional levels. Policies and legal issues of which academic dental institutions need to be aware from a compliance perspective are examined, along with considerations and resources needed to develop effective social media policies. The challenge facing dental educators is how to capitalize on the benefits that social media offer, while minimizing risks and complying with the various forms of legal constraint.

Social Media in the Dental School Environment, Part B: Curricular Considerations.

The goal of this article is to describe the broad curricular constructs surrounding teaching and learning about social media in dental education. This analysis takes into account timing, development, and assessment of the knowledge, skills, attitudes, and behaviors needed to effectively use social media tools as a contemporary dentist. Three developmental stages in a student's path to becoming a competent professional are described: from undergraduate to dental student, from the classroom and preclinical simulation laboratory to the clinical setting, and from dental student to licensed practitioner. Considerations for developing the dental curriculum and suggestions for effective instruction at each stage are offered. In all three stages in the future dentist's evolution, faculty members need to educate students about appropriate professional uses of social media. Faculty members should provide instruction on the beneficial aspects of this communication medium and help students recognize the potential pitfalls associated with its use. The authors provide guidelines for customizing instruction to complement each stage of development, recognizing that careful timing is not only important for optimal learning but can prevent inappropriate use of social media as students are introduced to novel situations.

Faculty development for underrepresented minority dental faculty and residents.

This report describes the implementation and evaluation of the Bronx-Lebanon Hospital Center Dental Faculty Development Program (DFDP) for fifteen participants: five advanced dental education faculty members and ten residents. The 100-hour DFDP, designed in the longitudinal immersion model for faculty development, was conducted in four phases at the Bronx-Lebanon Department of Dentistry in the Bronx, New York, in 2010-11. The DFDP was implemented to help underrepresented minority (URM) dental residents and clinical faculty members develop skills necessary for academic careers and enhanced teaching effectiveness. The program's curriculum had four themes: teaching and learning, scholarship, academic leadership, and career planning. For each phase, the participants completed pre- and post-training assessments of their knowledge, attitudes, and confidence, as well as qualitative evaluation of DFDP organization, content, activities, and value. The participants' pre-instruction mean knowledge score for all phases combined was 48.3 percent, and the post-test score was 81.1 percent (p=0.01). The participants showed minimal change in their attitudes about educational issues, but they reported enhanced confidence for twenty-five skills addressed in the DFDP. The total confidence score was 77.5 (25 skills × 3.1 group mean) on all pre-tests combined and 100.2 (25 × 4.0 group mean) on the post-tests (p=0.01). The participant ratings for overall DFDP implementation and for twenty-four topical sessions were uniformly positive. The faculty and resident participants in this year-long faculty development initiative at an advanced dental education program with a high URM representation demonstrated enhanced knowledge and confidence and provided positive program evaluations. This report also describes curricular and assessment enhancements for subsequent years of the DFDP based on the first-year outcomes.

Ethical obliqations and the dental office team.

A hypothetical case of alleged sexual misconduct in a practice with high employee turnover and stress is analyzed by three experts. This case commentary examines the ethical role expectations of an office manager who is not directly involved but becomes aware of the activities. The commentators bring the perspectives of a dental hygienist, academic administrator, and attorney; a teacher of behavioral sciences in a dental school; and a general dentist with many years of practice experience.

The status of ethics teaching and learning in U.S. dental schools.

The purpose of this study was to gather and analyze information about the status of ethics teaching and learning in U.S. dental schools and to recommend a curriculum development and research agenda for professional ethics in dental education. A survey to collect this information was developed by the authors and administered by the American Society for Dental Ethics. The results suggest that dental schools have adopted many of the recommendations for curricular content and learning strategies proposed in the 1989 American Association of Dental Schools (now American Dental Education Association) Curriculum Guidelines on Ethics and Professionalism in Dentistry. The survey was sent to the individual who directs the ethics curriculum at the fifty-six U.S. dental schools that had a full complement of enrolled predoctoral classes as of January 2008. All fifty-six schools responded to the survey. The data suggest that, in general, little time is devoted to ethics instruction in the formal curriculum. The mean number of contact hours of ethics instruction is 26.5 hours, which represents about 0.5 percent of the mean clock hours of instruction for dental education programs reported in the most recent American Dental Association survey of dental education. While the amount of time devoted to ethics instruction appears not to have changed much over the past thirty years, what has changed are what qualifies as ethics instruction, the pedagogies used, and the development and availability of norm-referenced learning outcomes assessments, which are currently used by a number of schools. We found that dental schools address a substantial list of topics in their ethics instruction and that there is general agreement as to the appropriateness of the topics and the ethics competencies that need to be developed and assessed. This study also identified the respondents' perceptions of unmet needs in ethics education. Four general themes emerged: the need for ethics to be more fully integrated across the curriculum, including carryover into the clinical years; the need to assess and ensure competence; the need for faculty development; and the need for more attention to method of instruction. Recommendations based on the study findings are offered for a curriculum development and research agenda for professional ethics in dental education.

The case of the pregnant adolescent.

In this case an adolescent, minor female presents herself for routine dental care, but is pregnant without parental knowledge. She asks the dentist not to reveal the pregnancy to her parents. Three experts including one attorney, one dental educator with 25 years of private practice experience, and one member of a state psychological association's ethics committee comment on the difficult ethical and legal issues found in this actual case.

Professional promises: Summary and next steps.

A summary of the key themes discussed during the sessions is provided highlighting the participants' recommendations for addressing the ethics of access. Areas reviewed included strategies utilizing ethics as an educational tool. The need for professional associations and accrediting and licensing bodies to address access to care in their guidelines is an additional recommendation. Networking, sharing resources, and continuing the dialogue about ethics and access to care are identified as important strategies following the workshop. The summary also highlights promises made to continue the dialogue about the issue in various forums.