Social Justice Education in Dentistry: A Qualitative Analysis and Conceptual Framework.

BACKGROUND: Social justice, empathy, and social responsibility are emerging themes in dentistry. Many dental faculties have started incorporating these concepts into their curriculum, but our knowledge of the effectiveness of these initiatives remains limited. PURPOSE: The objective of this study was to understand how students and educators perceive the role of social justice education, if any, in the undergraduate dentistry program. METHODS: This qualitative study was performed by using semistructured interviews with students, professors, and clinical faculty at the Université de Montréal dental school from January to May 2020. Eighteen participants were recruited through purposeful sampling until saturation. The interviews were recorded and transcribed integrally. They were coded with QDA Miner 5.0 (Provalis). Thematic analysis was undertaken to elucidate emerging themes via qualitative methodology. RESULTS: Five themes emerged from the results. Certain students were more inclined to be interested in social justice and participate in voluntary community-based activities. There were gaps in current teaching methods, including a lack of exposure to alternative treatment plans (e.g., extractions vs. endodontic treatments) better suited to patients' financial or social situations. Some barriers to teaching were identified, the most important being a lack of time. Desired teaching of social justice would include increased awareness and active student participation and taking responsibility to motivate action to produce social change. The application of social justice in dentistry involves care that is accessible and adapted to a patient's individual needs. CONCLUSION: The results of this study provide valuable insight for the development of a social justice education curriculum in dentistry that can be evaluated and validated to train socially competent dentists who can provide patient-centered care to the community. KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by dental educators and administrators who are looking to incorporate social justice education into their dental school undergraduate curriculum. The findings serve as a starting point to foster discussions and inspire change to reduce inequalities within the dental health care system.

Single-Implant Overdentures Retained by a Novel Attachment: A Mixed Methods Crossover Randomized Clinical Trial.

INTRODUCTION: Single-implant mandibular overdentures (SIMOs) are one of the least invasive implant treatments for edentulism. The new Novaloc attachment system can improve the clinical performance of implant-retained overdentures but has not been tested for SIMOs. OBJECTIVES: To compare Novaloc and a gold standard system (Locator) for SIMOs in an edentate elderly population in terms of patient-reported outcomes and device- and treatment-related complications. METHODS: In this single-center crossover randomized clinical trial (RCT), 10 edentulous participants received an implant in the lower midline and had their lower complete dentures converted to SIMOs. The participants received each attachment system for 3 mo in a randomized order, followed by measurement of patient satisfaction and oral health-related quality of life via the McGill Denture Satisfaction Questionnaire and the Oral Health Impact Profile for Edentulous People questionnaire, respectively. Complications were registered throughout the RCT. Patients were interviewed for their experiences with SIMOs and preference for one of the attachment systems. Quantitative analysis employed mixed linear models and chi-square tests (α = 0.05), whereas interview data underwent thematic analysis and, in turn, integration into quantitative data (mixed methods explanatory design). RESULTS: All 10 randomized participants completed the trial. Mean ± SD general satisfaction was 92% ± 8% with Novaloc versus 85% ± 13% with Locator (mean difference, 9%; 95% CI, 1% to 17%). For specific McGill Denture Satisfaction Questionnaire items, only denture stability was significantly increased for Novaloc. Seven participants preferred Novaloc over Locator at the end of the RCT (chi-square, P = 0.045). No difference was found between the attachments in terms of oral health-related quality of life based on the Oral Health Impact Profile for Edentulous People and complications. Thematic analysis revealed high patient satisfaction with SIMOs, with denture stability the main criterion for their satisfaction and attachment preference. CONCLUSION: Among elderly edentulous patients wearing SIMOs, Novaloc led to increased patient satisfaction and preference. Better patient-perceived denture stability may explain this result. The attachment systems exhibited similar short-term maintenance needs. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03126942 (first registered on April 13, 2017). Secondary identifiers: A03-M07-17A (McGill University, Institutional Review Board) and 2018-3873 (McGill University Health Centre, Research Ethics Board). KNOWLEDGE TRANSFER STATEMENT: The results of this mixed methods study can be used by clinicians when choosing which attachment system to use for SIMOs. Results suggest that edentulous patients prefer attachments with a better-defined seating position, such as that of the Novaloc system, as opposed to the nylon matrix on metallic abutment of the Locator system.

Willingness to Pay for Mandibular Overdentures: A Societal Perspective.

OBJECTIVES: Dental services in many countries are funded out-of-pocket by patients whose acceptance of a dental treatment depends on their valuation of it. Using a willingness-to-pay (WTP) strategy, this study aimed to determine how people who do not wear dentures value the benefits of dentures retained by implants and what factors explain variations in WTP among subjects. METHODS: Telephone numbers of a representative Canadian sample were obtained from a consumer database provider. Respondents completed either an internet-based or telephone survey with 3 payment scenarios: paying oneself (out-of-pocket), coverage with private health insurance, and publicly financed through additional taxes. Personal information data (e.g., age, income) were used as independent variables in regression models to assess the determinants of WTP amounts. RESULTS: Among 1,096 respondents, 317 participated in the survey (response rate, 28.9%). The mean WTP of participants (mean ± SD age: 41.2 ± 0.6 y; 54.3% male) who were dentate/partially edentate was $5,347 for implant overdentures. Considering a 1 in 5 chance of becoming edentate, they were willing to pay $26.93 as monthly payments for private insurance. They were also willing to pay an additional yearly tax of $103.63 to support a public program. WTP private payments increased substantially with increase in household income and dental needs. CONCLUSION: This preference study provides information to dentists, insurance companies, and policy makers on what dentate people are willing to pay for implant overdentures, whether directly or with insurance/government coverage. KNOWLEDGE TRANSFER STATEMENT: This study provides results of interest to many stakeholders. For clinicians, the results reveal what people are willing to pay for implant overdentures for themselves. It also provides information to employers and insurance companies on how people value having coverage for this kind of service. Furthermore, it provides public policy makers the value that people place on public funding of such treatments and how they would support a decision to publicly fund such a treatment.

Have Women Broken the Glass Ceiling in North American Dental Leadership?

In the last few decades, the number of women graduating from North American (NA) dental schools has increased significantly. Thus, we aimed to determine women's representation in leadership positions in NA dental and specialty associations/organizations, dental education, and dental journals, as well as the proportion of men/women researcher members of the American Association for Dental Research (AADR). We contacted NA dental associations to provide us with the total number and the men/women distribution of their members. Men/women distributions in leadership positions were accessible from the internet, as were data on the sex of deans of NA dental schools. Data on the editors in chief of NA dental journals were gathered from their websites, and the AADR provided the number and sex of its researcher members. Collected data underwent descriptive statistics and binomial tests (α = 0.05). Our findings suggest that women are underrepresented in leadership positions within the major NA dental professional associations. While the median ratio of women leaders to women members in professional associations is 0.91 in Canada, it is only 0.67 in the United States. The same underrepresentation of women is evident in the leadership of the Canadian Dental Association and the American Dental Association. We found that women are underrepresented as deans and editors in chief for NA oral health journals. Only 16 of 77 NA dental school deans are women, while 3 of 38 dental journals have women editors in chief. The probability of finding these ratios by chance is low. However, the number of women dental researcher AADR members underwent an overall increase in the past decade, while the number of men declined. These results suggest that, despite the increase in women dentists, it will take time and effort to ensure that they move through the pipeline to senior leadership positions in the same manner as their male colleagues.

A Survey of the Barriers Affecting the Career Practice and Promotions of Female Dentists in Saudi Arabia.

INTRODUCTION: Over the last 40 y, the proportion of women in the profession of dentistry has been growing steadily. The extant literature, although limited, demonstrates that gender differences exist in choice of specialization, practice pattern, and professional attitudes, revealing that women are more likely to work in primary dental care and are less prominent in other dental specialties. Female Saudi dentists, working in the government sector, tend to occupy lower positions in the occupational hierarchy, are paid less, and are less likely to hold consultant positions as compared with men. OBJECTIVES: The objectives of this study were to identify barriers faced by female dentists practicing in Saudi Arabia in seeking professional advancement and to determine the variables that influenced respondents' promotions. METHODS: In February 2017, a web-based cross-sectional survey was emailed to all female dentists registered with the Saudi Dental Society ( N = 2,651). Completed questionnaires ( N = 130, response rate = 7.1%) were analyzed with simple summary statistics and a logistic regression analysis to evaluate the association between the dependent variable (promotion) and independent variables (family, environmental, interpersonal, and cultural factors). RESULTS: Most female dentists believed that family, environmental, and cultural factors are challenges to their career practice and progression. Other factors included interpersonal challenges, such as gender discrimination and male dominance in the field of dentistry. Results of the regression analysis revealed that family and environmental factors were significant predictors of whether female dentists would be promoted. CONCLUSION: Saudi female dentists continue to face significant obstacles in their career practice and advancement. Their role in the workplace needs to be recognized. Factors that obstruct their career advancement should be well understood by dental institutions and efforts should be made to move more female dentists into leadership positions. KNOWLEDGE TRANSFER STATEMENT: Policy makers can use the results of this study to develop strategies to overcome the barriers faced by female dentists in Saudi Arabia with respect to their professional and personal (family) needs. This study could lead to the development of employment incentives and a supportive workplace for female dentists.

A qualitative study on the oral health of humanitarian migrants in Canada.

OBJECTIVES: There is limited evidence to guide oral health policy and services for the 25,000 refugees and asylum seekers who arrive in Canada yearly. The purpose of this study was to explore and understand the pre-migration use of dental services, oral health knowledge, and the effects of oral disease among newly arrived humanitarian migrants in order to inform policy and practice for the population. METHODS: Using focused ethnography and the public health model of the dental care process, we conducted face-to-face interviews (50-60 minutes) with a purposive sample of humanitarian migrants who had indicated the need for dental care. We observed mobile dental clinics that provided care to underserved communities in Montreal. Data were analyzed using a thematic and contextual approach that combined inductive and deductive frameworks. RESULTS: Participants included 25 humanitarian migrants from four global geographical regions. Five major thematic categories were explored: problem-based dental consultation, self-assessed oral health status, causes of oral diseases, personal oral hygiene, and good oral health for wellbeing. In their countries of origin, participants consulted a dentist when oral symptoms persisted. They cited excessive sugar consumption and inadequate oral hygiene as causes of oral diseases, and reported significant oral diseases impacts that limited their daily functions and wellbeing once in Canada. CONCLUSIONS: Humanitarian migrants were knowledgeable about causes of oral disease and the importance of good oral health, yet poor oral health continued to affect their lives in Canada in important ways.

Are There Barriers for Professional Development of Women Dentists? A Qualitative Study in Saudi Arabia.

Globally, there is an upward trend in the number of women applying to dental schools and entering the profession of dentistry. Women dentists aim to advance their careers; however, differences exist between men and women dentists regarding leadership positions and work titles. For example, in Saudi Arabia, women usually occupy lower ranked positions than men in the Saudi public sector, and they are, therefore, paid less than their male counterparts. This study aimed to explore the possible barriers to Saudi women dentists' professional advancement using a qualitative descriptive study design. Specifically, semistructured in-depth interviews were conducted with 13 women practicing dentistry in the Makkah region of Saudi Arabia. The interviews were audio-recorded and transcribed verbatim, and the data were interpreted using qualitative content analysis (NVivo 11; QRS International). The results revealed 4 challenges that might delay the participants' career development. These include family-related challenges, sociocultural challenges, workplace challenges, and transportation issues. From this perspective, some perceived barriers to the professional development of women dentists were found that might not be unique to Saudi Arabia, and the article's suggestions and recommendations aim to minimize the effects of these barriers impeding women's advancement in dentistry in Saudi Arabia. Knowledge Transfer Statement: This study makes an important contribution to knowledge on this topic. These results will aid policy makers' efforts to create supportive work environments through gender-specific incentives that meet the current professional and family needs of women dentists, particularly those in Saudi Arabia.

Screw- vs. Cement-retained Implant-supported Prosthesis in Partially Edentulous Patients: An Oral Health Technology Assessment Report.

Understanding the morbidity events, incidence, and cost associated with each type of retention system used for implant supported prosthesis will help the clinician in better decision making. This study assessed the clinical and cost-effectiveness of the screw- and cement-retained implant-supported single crown and fixed partial denture for the replacement of teeth in partially edentulous jaws, from a health services perspective. A systematic literature search conducted in 10 databases, complemented by 4 journal databases and International Association for Dental Research abstracts, identified 92 studies on the single crown and 40 studies on the fixed partial denture. Minor and major technical complication events, as well as failure events, were extracted from strong- and medium-quality studies. Studies based on similar designs were pooled with a random-effects Poisson regression model. A decision tree was developed to estimate the cost-effectiveness over a 15-y period posttreatment. The initial and maintenance costs to treat technical complication events were based on an American Dental Association survey of 2011 to 2012. Probabilistic sensitivity analysis was used to examine the uncertainty in the data input parameters. Clinical evidence generated from the meta-analysis suggested no statistical difference between the 2 retention systems. The cost-effectiveness is presented as an incremental cost-effectiveness ratio. The evidence from this report suggests that cement retention is the more cost-effective strategy as compared with screw retention prosthesis. Knowledge Transfer Statement: Evidence generated by this study will help clinicians make an appropriate cost-effective treatment decision in choosing the retention system for partially edentulous patients.

The Effect of Phentolamine on Reversing Soft Tissue Anesthesia: An Oral Health Technology Assessment Report.

Long-lasting numbness of soft tissues such as lips, tongue, and cheeks after dental anesthesia is not only unpleasant but has the potential to cause self-inflicted damage to the numb tissue. Phentolamine mesylate, when injected in vicinity to the site of local anesthesia, accelerates the absorption of local anesthesia. Dental use of this drug was approved in the United States and Canada in 2008 and 2014, respectively. The rapidly increasing popularity of this novel technology (intraoral phentolamine injections) warrants a health technology assessment for clinicians. A medical librarian conducted a systematic literature search (up to March 1, 2016) for any clinical study involving intraoral phentolamine injection. Meta-analysis of the efficacy data from 4 clinical studies supports the role of intraoral phentolamine injections in shortening the duration of numbness after local anesthesia. No publication bias was found in the selected studies. The selected studies identified no serious adverse events other than pain at the site of injection and some postprocedural pain. Our cost-effectiveness analysis shows phentolamine mesylate to be an effective treatment modality when compared with no treatment, sham, or placebo injection. Phentolamine mesylate incurs an additional cost (in US dollars) of $0.13 to $0.16 per minute of reversing the soft tissue local anesthesia and $0.38 to $0.46, when compared with sham or placebo injection, after a noninvasive dental procedure. The literature lacked substantial evidence in favor of clinical benefits, such as a decrease in self-inflicted injuries. Only a subgroup of the dental patient population undergoing specific dental procedures would benefit from accelerated recovery from numbness. Knowledge Transfer Statement: Intraoral phentolamine to reverse numbness is a new intervention with ambiguous utility. With consideration of cost and patient preference, evidence generated by this report may be used in clinical decision making and case selection for this intervention.

Reductions with lithium in low molecular weight amines and ethylenediamine

Reductions of several types of compounds with lithium and ethylenediamine using low molecular weight amines as solvent are described. In all cases 1 mol of ethylenediamine or N, N'-dimethylethylenediamine per gram-atom of lithium was used. In some cases it was beneficial to add an alcohol as a proton donor. These reaction conditions were applied to the debenzylation of N-benzylamide and lactams which are refractory to hydrogenolysis with hydrogen and a catalyst. N-Benzylpilolactam 2, synthesized from pilocarpine hydrochloride in refluxing benzylamine, was debenzylated in good yield using 10 gram-atoms of lithium per mole (10 Li/mol) of 2 in n-propylamine. The debenzylation of N-benzyl-N-methyldecanoic acid amide, 4 (6 Li/mol), in t-butylamine/N, N'-dimethylethylenediamine gave N-methyldecanoic acid amide 6 in 70% yield. Alternatively, reduction of 4 (7 Li/mol) in t-butanol/n-propylamine/ethylenediamine gave n-decanal 12 in 36% yield. Using the same conditions, thioanisole, 1-adamantane-p-toluenesulfonamide, and 1-adamantane methyl p-toluenesulfonate were reduced with 3, 7, and 7.2 Li/mol of compound to give thiophenol (74%), adamantamine (91%), and 1-adamantane methanol (75%), respectively. In this solvent system naphthalene and 3-methyl-2-cyclohexene-1-one were reduced to isotetralin (74%) and 3-methyl cyclohexanone (quantitative) with 5 and 2.2 Li/mol of starting compound, respectively. Oximes and O-methyloximes were reduced to their corresponding amines using 5 and 8 Li/mol of compound, respectively. Anisole was also reduced to 1-methoxy-1,4-cyclohexadiene with 2.5 Li/mol of anisole. Undecanenitrile was reduced to undecylamine with 8.6 Li/mol. Additionally, a base-catalyzed formation of imidazolines from a nitrile and ethylenediamine was also explored.

Epidural analgesia for total hip replacement in a patient with dilated cardiomyopathy.

A 69-year-old patient with severe impairment of left ventricular function secondary to dilated cardiomyopathy underwent a successful total hip replacement under epidural analgesia. Perioperative heart rate and mean arterial pressure were stable at an analgesic level up to the seventh thoracic dermatome, achieved with mepivacaine two per cent with epinephrine. Asymptomatic pulmonary hypertension, occurring during the insertion of the femoral prosthesis, subsided spontaneously over the next twelve hours. The circulatory effects of epidural analgesia and their significance in a patient with dilated cardiomyopathy are discussed.

Reye syndrome: a predictably curable disease.

Seventeen years after the initial description of this syndrome of hepatic failure and encephalopathy, the etiology and pathophysiology are still not well defined. Clinical staging of the disease proposed by Lovejoy and colleagues is helpful and is recommended as a standard to be followed by referring physicians and hospital-based pediatricians and intensivists. A new classification based on the status of intracranial pressure and unrelated to clinical, laboratory, or EEG staging is presented.