Working collaboratively across schools to promote oral health education through interprofessional education.

PURPOSE: The Association of American Medical Colleges and American Dental Education Association have identified oral health knowledge, skills, and attitudes shared by both medical and dental professionals. Although oral health was deemed an essential competency for medical practitioners, our state struggled to ensure learners received proper training. This training deficit resulted in conducting a needs assessment and implementing an oral health interprofessional module at our schools. METHODS: First-year medical students and clinical faculty were emailed surveys in 2016 to obtain baseline information. A team of faculty and students from the Schools of Medicine and Dentistry reviewed the curriculum to determine where to augment oral health content. An oral health module to teach a basic head, neck, and oral examination to first-year medical students during their patient-centered care small-group sessions was implemented and evaluated. RESULTS: Only 13.6% of faculty respondents were aware of national oral health competency recommendations, and <50% rated oral health important for primary care physicians (PCPs) to include in history, physical exam, or oral health counseling. On baseline, ≤25% of PCP respondents reported integrating the listed skills in their practice, and most indicated lacking expertise to teach oral health. Teaching sessions were rated helpful by students and faculty. After the teaching sessions, ratings on the importance of including oral health significantly increased from baseline. CONCLUSION: Collaboration between Schools of Dentistry and Medicine successfully integrated oral health into medical school curriculum and improved the tutors' attitudes of its importance.

Enhancing Allied Dental Health Students' Understanding of Poverty through Simulation.

Purpose: Poverty impacts the daily lives of over 40 million Americans. Allied dental health students need to be aware of the oral health barriers experienced by individuals with limited resources. The purpose of this exploratory descriptive study was to evaluate the impact of a poverty simulation exercise (PSE) on students' understanding of daily challenges faced by low-income families.Methods: A total of 34 second-year dental hygiene students and 23 dental assisting students (n=57) participated in a 3-hour Missouri Association for Community Action poverty simulation exercise (PSE). Participants completed a survey immediately following the PSE to determine the degree of change in understanding challenges faced by low-income families. Upon completion of all scheduled community practicum/rotations, participants completed a second survey exploring whether the PSE changed their levels of understanding of the challenges faced by actual low-income families and their impact on oral health.Results: Fifty-five dental hygiene and dental assisting students completed both surveys for a response rate of 96% (n=55). A majority of the respondents (87%, n=46) rated the PSE as extremely valuable in preparing them to understand challenges faced by low-income families and 85% (n=47) indicated encountering families living in situations similar to their role in the PSE. A majority of participants (89% n=48) indicated having a better understanding of how poverty effects oral health status and its impact on access to dental care. In addition, students indicated that they became less judgmental and more empathetic toward low-income families.Conclusions: Results from this study demonstrate that a PSE was effective in eliciting change in allied dental health students' affective perceptions regarding poverty and helped improve their understanding of challenges faced by low-income populations.

Assessing Dental Students' Knowledge, Attitudes, and Beliefs About Medicaid and Health Care Reform: A Mixed-Methods Study.

The aim of this study was to conduct a needs assessment of Medicaid and health care reform education in the current dental curriculum of one U.S. dental school. A mixed-methods approach was employed using focus groups and surveys. Three focus groups with dental students (nine first-and second-year students, eight third-year students, and seven fourth-year students) and one focus group with six external oral health stakeholders were conducted in 2018 to explore participants' attitudes and beliefs about Medicaid and health care reform. The focus groups used a semi-structured guide, and transcripts were analyzed using thematic content analysis. Following the focus groups, all first-and fourth-year dental students were invited to participate in a survey assessing their general and dental-specific Medicaid knowledge and attitudes about Medicaid. In both methods, participants made suggestions for future curricular experiences involving Medicaid. Surveys were returned from 81 first-year students (96% response rate) and 72 fourth-year students (86% response rate), for an overall response rate of 93%. Participating students and stakeholders agreed that Medicaid is confusing and challenging to incorporate into private practice. All participants viewed programs sponsored by organized dentistry as venues to learn about oral health policy. Nearly all participants agreed that private practice mentorship, improved practice management, and more experiential opportunities in the predoctoral curriculum would be effective strategies to increase knowledge about Medicaid and health reform. According to the survey responses, Medicaid and health reform knowledge is poor and scarcely covered in the current curriculum, and only 39% of participating students planned to participate in Medicaid after graduation. These findings suggest that curricular improvements are needed to incorporate more engaging and experiential learning using external resources.

Interprofessional Education: Oral Health in the Medical Curriculum.

Schools of medicine and dentistry on the same geographical campus have an opportunity to promote oral health by training physicians to become more skilled in screening for oral disease in addition to counseling and referring patients to dental health professionals.

Fluoridation advocacy in referenda where media coverage is balanced yet biased.

BACKGROUND: Despite supporting scientific evidence, community water fluoridation (CWF) often fails in public referenda. To understand why, the authors quantitatively analyzed text from news media coverage of CWF referenda. METHODS: The authors analyzed text from 234 articles covering 11 CWF referenda conducted in 3 US cities from 1956 through 2013. The authors used cluster analysis to identify each article's core rhetoric and classified it according to sentiment and tone. The authors used multilevel count regression models to measure the use of positive and negative words regarding CWF. RESULTS: Media coverage more closely resembled core rhetoric used by fluoridation opponents than the rhetoric used by fluoridation proponents. Despite the scientific evidence, the media reports were balanced in tone and sentiment for and against CWF. However, in articles emphasizing children, greater negative sentiment was associated with CWF rejection. CONCLUSIONS: Media coverage depicted an artificial balance of evidence and tone in favor of and against CWF. The focus on children was associated with more negative tone in cities where voters rejected CWF. PRACTICAL IMPLICATIONS: When speaking to the media, advocates for CWF should emphasize benefits for children and use positive terms about dental health rather than negative terms about dental disease.

Enhancing Dental Students' Understanding of Poverty Through Simulation.

Dental students should develop an understanding of the barriers to and frustrations with accessing dental care and maintaining optimal oral health experienced by persons with limited resources rather than blaming the patient or caregiver. Developing this understanding may be aided by helping students learn about the lives of underserved and vulnerable patients they will encounter not only in extramural rotations, but throughout their careers. The aim of this study was to determine if dental students' understanding of daily challenges faced by families with low income changed as a result of a poverty simulation. In 2015 and 2016, an experiential poverty simulation was used to prepare third-year dental students at one U.S. dental school for their upcoming required community-based rotations. In 2015, United Way staff conducted the simulation using the Missouri Community Action Poverty Simulation (CAPS); in 2016, faculty members trained in CAPS conducted the simulation using a modified version of the tool. In the simulation, students were assigned to family units experiencing various types of hardship and were given specific identities for role-playing. A retrospective pretest and a posttest were used to assess change in levels of student understanding after the simulation. Students assessed their level of understanding in five domains: financial pressures, difficult choices, difficulties in improving one's situation, emotional stressors, and impact of community resources for those living in poverty. The survey response rates in 2015 and 2016 were 86% and 74%, respectively. For each of the five domains, students' understanding increased from 58% to 74% per domain. The majority reported that the exercise was very valuable or somewhat valuable (74% in 2015, 88% in 2016). This study found that a poverty simulation was effective in raising dental students' understanding of the challenges faced by low-income families. It also discovered that framing the issues in the context of accessing dental care was important.

"They Told Me to Take Him Somewhere Else": Caregivers' Experiences Seeking Emergency Dental Care for Their Children.

PURPOSE: The purpose of this mixed-methods study was to examine pediatric emergency dental trends in two safety net clinics and care-seeking experiences of young children's caregivers. METHODS: Administrative data were used to describe and compare emergency first visits of children ages zero to six years in a community-based (CC) and a University-based (UC) safety net clinic from 2010 to 2014. In-person interviews were conducted with 11 caregivers of children ages zero to six presenting for nontrauma-related emergency visits at the UC from January to August 2016. Interviews were transcribed verbatim, coded, and analyzed inductively using Atlas. ti.7.5.9. RESULTS: The UC experienced significantly more emergency first visits (33 percent) than the CC (five percent, P<0.001), and the majority of these UC visits were referrals. Caregivers were dissatisfied with the experienced barriers of access to care and lack of child-centeredness, specifically the referral out of the dental home for emergency dental care. CONCLUSIONS: A considerable proportion of children's first visits at dental safety net clinics was emergency related. Children's caregivers voiced issues related to access to care and lack of child-centered care. Discordance was apparent between how professional organizations define the dental home and how caregivers experience it in the context of emergency care.

Preventing dental caries through school-based sealant programs: updated recommendations and reviews of evidence.

BACKGROUND: School-based sealant programs (SBSPs) increase sealant use and reduce caries. Programs target schools that serve children from low-income families and focus on sealing newly erupted permanent molars. In 2004 and 2005, the Centers for Disease Control and Prevention (CDC), Atlanta, sponsored meetings of an expert work group to update recommendations for sealant use in SBSPs on the basis of available evidence regarding the effectiveness of sealants on sound and carious pit and fissure surfaces, caries assessment and selected sealant placement techniques, and the risk of caries' developing in sealed teeth among children who might be lost to follow-up. The work group also identified topics for which additional evidence review was needed. TYPES OF STUDIES REVIEWED: The work group used systematic reviews when available. Since 2005, staff members at CDC and subject-matter experts conducted several independent analyses of topics for which no reviews existed. These reviews include a systematic review of the effectiveness of sealants in managing caries. RESULTS: The evidence supports recommendations to seal sound surfaces and noncavitated lesions, to use visual assessment to detect surface cavitation, to use a toothbrush or handpiece prophylaxis to clean tooth surfaces, and to provide sealants to children even if follow-up cannot be ensured. CLINICAL IMPLICATIONS: These recommendations are consistent with the current state of the science and provide appropriate guidance for sealant use in SBSPs. This report also may increase practitioners' awareness of the SBSP as an important and effective public health approach that complements clinical care.

Disaster response in Illinois: the role for dentists and dental hygienists.

Taking a leadership role, the Illinois Department of Public Health's Division of Oral Health has helped to successfully integrate oral health professionals into the emergency medical response system in Illinois by raising awareness, building needed partnerships, identifying and garnering resources, and facilitating training, policy development, surveillance, and evaluation. Applying the same principals and standards to the integration of oral health and disaster preparedness and response as it does to all facets of dental public health, the division has partnered with the Disaster Emergency Medicine Readiness Training Center at the University of Illinois at Chicago and many other key stakeholders to cement oral health as an integral component to the public health response system in Illinois.

Disaster medicine training survey results for dental health care providers in Illinois.

BACKGROUND: Ongoing vigilance by governments, public health agencies and health care professionals monitoring potential epidemic and pandemic outbreaks, terrorist threats and ever-present natural disasters requires the continuous evolution of comprehensive disaster response plans and teams, which include the integration of oral health care professionals. METHODS: The authors conducted a study in which oral health care professionals assessed their training in the American Medical Association's (AMA's) National Disaster Life Support (NDLS) courses. At the conclusion of each instructional session, the authors asked participants to complete an anonymous course evaluation form to report their impressions of the training activity. The authors included in the analysis those evaluations associated with sessions attended almost exclusively by dentists and hygienists. RESULTS: The authors derived descriptive statistics from the selected course evaluations. Overall, oral health care professionals believed that the Core Disaster Life Support (CDLS) and Basic Disaster Life Support (BDLS) courses were of great educational value, rating course impact at 9.50 and 9.29, respectively, on a scale from 1 to 10. CONCLUSIONS: Statistical evaluation instruments reveal satisfaction with the all-hazards awareness training received through the AMA's NDLS disaster medicine training curriculum. Licensed oral health care professionals in Illinois accepted the utility and merits of, and benefited from, the four-hour CDLS and eight-hour BDLS certification programs. Practice Implications. Dental professionals in Illinois require minimal additional training for dental emergency responder duties. The AMA's NDLS curriculum provides effective preparation for dental professionals.

Healthy Smiles Healthy Growth 2004--basic screening survey of migrant and seasonal farmworker children in Illinois.

OBJECTIVES: To obtain baseline data for caries prevalence, use of dental sealants, and dental treatment needs for children of migrant and seasonal farmworkers (MSFWs) enrolled in the Illinois Summer Migrant Education Program, 2004. METHODS: This study adapted the methodology of Healthy Smiles Healthy Growth 2003-2004, by Illinois Department of Public Health (IDPH), Division of Oral Health. Oral screenings were conducted for children of migrant and seasonal farmworkers at participating schools. RESULTS: Of the 840 eligible children 58% participated in the assessment. Overall caries experience was 64%. Untreated decay was observed in 42%, 8% urgently needed treatment, and sealant prevalence was 51%. Among those 6-9 years old (n = 254), 47% had cavitated lesions, 12% urgently needed treatment, and 45% had dental sealants. For children 10-15 years old (n = 198), 34% had cavitated lesions, 4% urgently needed treatment, and 65% had dental sealants. CONCLUSIONS: The population's mobility suggests need for more frequent surveillance for effective programmatic planning.

The dental emergency responder: Expanding the scope of dental practice.

BACKGROUND: Natural disasters, the potential for terrorism and weapons-of-mass-destruction events occurring within the continental United States necessitate that all licensed health care providers understand the National Incident Management System and be able to contribute to inoculation, mass casualty assistance and triage care of the populace. CONCLUSIONS: Health care and political leaders constantly revise "all hazard" response plans, using the available health care assets that local, state and federal agencies bring to emergency events. Illinois Public Act 49-409 modifies the scope of dental practice within Illinois to allow for a dental emergency responder (DER). PRACTICE IMPLICATIONS: The DER is a dentist or dental hygienist "acting within the bounds of his or her license when providing care during a declared local, state or national emergency."

Predictors of oral health counseling by WIC providers.

PURPOSE: The purpose of this study was to assess selected predictors for the inclusion of oral health counseling by Illinois Women, Infants, and Children (WIC) providers. METHODS: A questionnaire was developed and mailed to all 166 WIC sites to assess attitudes towards oral health counseling. Variables that revealed significant associations in bivariate analysis (P< or =.05) were considered as candidates for building a final logistic regression model in which frequency of oral health counseling was the outcome. RESULTS: A response rate of 76% was achieved after 1 mailing, with 27% of the WIC providers having some form of oral health training. There were no statistically significant differences in the frequency of WIC providers discussing oral health with their clients by age, gender, and level of education of the provider. In the final logistic regression analysis, variables significantly associated with the frequency of WIC providers' dicussing oral health with their clients were having: (1) oral health training; and (2) nursing training. CONCLUSIONS: The results suggest that Women, Infants, and Children (WIC) providers, who have had some oral health training, are more likely to provide counseling about dental disease and its prevention. This information was used to develop an educational tool for these nondental, health care providers.