Children's Perceptions of Dental Experiences and Ways to Improve Them.

This qualitative study explored children's perceptions of their dental experiences and their acceptability of the CARD™ (Comfort, Ask, Relax, Distract) system, adapted for the dental setting as a means to mitigate dental fear and anxiety (DFA). A purposive sample of 12 participants (7 males) aged 8-12 years receiving dental care at the Paediatric Dental Clinic, University of Toronto, was recruited. Virtual one-on-one interviews were augmented with visual aids. Participants were oriented to and asked about their perceptions of various dental procedures. Data were deductively analyzed, according to the Person-Centered Care framework (PCC). Four themes were identified: establishing a therapeutic relationship, shared power and responsibility, getting to know the person and empowering the person. Children emphasized the importance of clinic staff attributes and communication skills. They expressed a desire to engage more actively in their own care and highlighted the positive influence of pre-operative education and preparation. Participants found the CARD™ system to facilitate opportunities for self-advocacy in their dental care.

What influences attitudes toward professionalism in dental students?

OBJECTIVES: To explore dental students' attitudes toward professionalism and the environmental, institutional, and student-related factors that may be associated with these attitudes. METHODS: A cross-sectional online survey, conducted in 2020, analyzed data from a convenience sample of undergraduate dental students at the Faculty of Dentistry, University of Toronto. Attitudes toward professionalism were assessed using Likert scale statements related to the American Dental Education Association professionalism values of "Fairness," "Responsibility," "Respect," and "Service-mindedness." Codes ranging from 1 to 5 were assigned for the different levels of agreement and an "attitudes toward professionalism score" (ATPS) was computed by summing the codes for all the statements. Greater agreement with the statements or a higher ATPS indicated more positive attitudes toward professionalism. Association of the ATPS with environmental, institutional, and student-related factors was investigated using non-parametric tests and linear regression. RESULTS: The survey yielded a response rate of 51.4% (n = 221). The majority of respondents agreed with all professionalism statements. Results showed that the ATPS was significantly associated with and decreased for students who viewed their future patients as consumers (ß = -3.41, 95% confidence interval [CI]: -5.21, -1.60), experienced unprofessional faculty behavior (ß = -2.45, 95% CI: -4.88, -0.01), and chose to pursue dentistry for financial benefit (ß = -2.55, 95% CI: -4.63, -0.47). CONCLUSION: This sample of dental students generally had positive attitudes toward professionalism and numerous factors were associated with these attitudes. Enhancing the instruction and reinforcement of professional attitudes may be important to students' application of professionalism in decisions regarding clinical practice.

Ontario Dentists' Practice of Sedation and General Anesthesia: Barriers to Access and Use.

BACKGROUND: To investigate, among Ontario dentists, (1) self-reported barriers to access to sedation and general anesthesia (GA) services and (2) their current use of sedation and GA. METHODS: Of Ontario dentists practising, 3001 were randomly selected to complete a 16-question survey by mail or online in 2011. Mixed analysis of variance (ANOVA) followed by independent-sample t tests or 1-way ANOVA evaluated the relation between dentists' views and demographic variables including sex, clinical experience and size of primary practice. RESULTS: Of the participants (n = 1076; 37.9% response rate), 69.7% were male, 84.4% were general practitioners, mean time in practice was 20.6 years (0.5-42 years) and 42.2% were in cities of over 500 000 people. Most dentists (60.2%) provided anesthesia services, although 38.2% indicated lack of training and the belief that there is no patient demand (25.3%) as reasons not to use anesthesia in their offices. Nitrous oxide was used 17.5% of the time for all dental procedures except implants. Barriers to referral of patients for anesthesia services included high costs associated with sedation/GA (72.2%) and patient fear of anesthesia (33.5%). CONCLUSION: This study identified a perceived lack of patient demand, lack of dentist training, high costs of sedation/GA and patient fear of sedation/GA as primary barriers to use of sedation/GA in Ontario dental practices. The use of various anesthesia modalities is diverse, with 60.2% of dentists providing sedation/GA.

Ontario Dentists' Estimation of Patient Interest in Anesthesia.

Objective: To investigate Ontario dentists' perceptions of patient interest in sedation and general anesthesia (GA) during treatment and patient fear and avoidance of dental treatment. Methods: Using the Royal College of Dental Surgeons of Ontario roster, we randomly selected 3001 practising Ontario dentists, from among those who listed an email address, to complete a 16-question survey by mail or online. Demographic information (e.g., gender, size and type of primary practice, and years of experience) was collected as well as dentist reports of patient interest in sedation/GA and level of fear regarding treatment. Analysis included sample t-tests to compare Ontario dentist responses with patient responses to a 2002 national survey. Results: 1076 dentists participated (37.9% response rate), comprised of 69.7% males, 84.4% general practitioners, 0.5­42 years of practice (mean 20.6 years), and 40.6% from cities with a population larger than 500,000. Dentists underestimated patients' interest in sedation/GA, with dentists and patients reporting patients "Not interested" as 66.8% and 43.9%, respectively, and "Interested depending on cost," 19.8% v. 42.3%. Dentists also underestimated patient interest in sedation/GA for specific dental procedures including scaling, fillings/crowns, root canal therapy and periodontal surgery (p < 0.01). Dentists overestimated patient fear levels ("Somewhat afraid," 19.9% v. 9.8%; "Very afraid," 10.6% v. 2.0%; "Terrified," 6.0% v. 3.5%) and the proportion of patients avoiding dental care (13.3% v. 7.6%). Conclusion: Dentists underestimate patients' preference for sedation/GA and overestimate their fear and avoidance of dental care. The significant disparities between the views of dentists and patients may affect the availability and provision of sedation and general anesthesia in Ontario dental practices.

Dental Students' Clinical Expectations and Experiences Treating Persons with Disabilities.

Persons with disabilities (PWDs) have a disproportionate level of dental disease relative to the general population. Access to care is a cause along with dentists' willingness to treat PWDs. The aim of this study was to investigate the expectations and experiences of dental students in providing treatment to these patients in a hospital-based dental clinic for PWDs. Senior dental students at the Faculty of Dentistry, University of Toronto (n=92) were surveyed prior to (Phase I) and at the end of (Phase II) mandatory clinical rotations at the Mount Sinai Hospital's Dentistry Clinic for Persons with Special Needs. Response rates were 88% for Phase I and 58% for Phase II. Before the rotations, 70% of the respondents reported little or no experience with PWDs, and 46% said they did not feel comfortable providing basic dental treatment to PWDs. However, in Phase II, significantly more students reported being comfortable than in Phase I (p=0.001). Overall, the majority of respondents (Phase I 95%; Phase II 98%) indicated they would at least attempt to provide basic dental care to PWDs after graduation. The majority also identified the opportunity to provide care and interact with PWDs as the most enjoyable aspect of their experience at the clinic. They reported that the experience helped reduce their concerns about treating PWDs including being more realistic about the time required and ideal quality of the treatment they could provide. These results suggest that their experience in the clinic significantly increased students' comfort in treating PWDs. The respondents expressed a willingness to treat PWDs once graduated and generally identified their experience as being more positive than their expectations.

A systematic review of computer-assisted learning in endodontics education.

Results of the efficacy and time efficiency of computer-assisted learning (CAL) in endodontics education are mixed in the literature. The objectives of this study were to compare the efficacy and time efficiency of CAL with traditional learning methods or no instruction. The search strategy included electronic and manual searches of randomized controlled trials (RCTs) completed in English up to June 2009. The intervention comprised any method of CAL, while the control group consisted of all traditional methods of instruction including no further instructions. Various outcome measures of CAL efficacy were considered and were categorized using Kirkpatrick's four-level model of evaluation: reaction, learning, behavior, results, with the addition of return on investment as a fifth level. The time efficiency of CAL was measured by the time spent on the learning material and the number of cases covered in a unit period. Seven RCTs met the inclusion criteria. Overall, students' attitudes were varied towards CAL. Results from the knowledge gain outcome were mixed. No conclusions can be made about students' performance on clinical procedures or cost-effectiveness of CAL. Better time efficiency was achieved using CAL compared to traditional methods. CAL is as efficacious as traditional methods in improving knowledge. There is some evidence to suggest that CAL is time efficient compared to traditional methods. Overall, the number of studies included in this review was small, thus warranting the need for more studies in this area and the exploration of various CAL techniques.