Bridging the health gap: Measuring the unmet social needs of patients within a dental school clinic.

OBJECTIVES: As safety-net clinics, dental school clinics are uniquely positioned to evaluate the unmet social need. There is evidence that patients treated in a safety-net type clinic, such as dental schools, report experiencing one or more of the determinants of health. However, there is limited evidence describing screening for Social Determinants of Health (SDOH) in dental clinics. The purpose of this study is to gain knowledge of the types of social determinants of health that exist in a dental school clinic and how it is reflected in the geographic region of the school. METHODS: This cross-sectional prospective study used a 20-item questionnaire assessed unmet social needs in a predoctoral clinic. The questionnaire contained multiple choice and binary yes/no questions, organized under SDOH domains: housing, food, transportation, utilities, childcare, employment, education, finances, and personal safety. Socioeconomic and demographic information was captured. The questionnaire was administered via iPad using Qualtrics XM. The data were descriptively and quantitatively analyzed at a significance level of p ≤ 0.05. RESULTS: There were 175 respondents with a 93.6% response rate, males (49.7%), females (49.1%), and 1.1% nonbinary. Overall, 135 (77.1%) respondents reported having at least one unmet social need. The greatest number of unmet needs was in the domains of employment and finances, with 44% and 41.7% respectively. Respondents who were unable to work stated they often or sometimes worried about running out of food before getting money to buy more, (p = 0.0002), and or the food didn't last before there was money to get more (p = 0.00007). A comparison of annual incomes of respondents earning less than $40K with those earning $40K or more, demonstrated statistically significant differences in unmet social needs for housing (p < 0.0001), food (p = 0.0003, p < 0.0001), utilities (p = 0.0484), employment (p = 0.0016), education (p < 0.0001), and finances (p < 0.0001). CONCLUSION: Screening patients in the dental clinic was an efficient way to uncover the level of unmet social needs. Annual household income was a predominant driver of unmet social needs: with the greatest number of unmet needs existing in the domains of employment and finances. The results suggest that screening for social determinants of health dental school clinics could be incorporated into routine patient data collection.

Incorporation of podcast as an adjunctive study material for national board examination: A preliminary study.

BACKGROUND: In 2020, higher education embraced alternative content delivery to provide academic instruction to accommodate for the pandemic. Although this adaptation of content delivery was temporary for some, the uses of YouTube videos, Podcast, and distance learning have been an increasingly desired format for students. The transition of the traditionally two-part National Board Dental Examination into a one-part, integrating biomedical, behavioral, and clinical sciences initiated in 2018 started with limited study resources. This study hypothesized that podcast would be a useful format for Integrated National Board Dental Examination (INBDE) review. The study's purpose was to evaluate the students' perspective of podcasts as INBDE supplemental review resource. METHODS: Seven episodes, 10-15 min long, case-based clinical scenario podcasts were recorded. Students and faculty reviewed academic content and accuracy. Episodes were recorded and published on Spotify, Apple Podcasts, and Google Podcasts under the channel "Dental Study Bites" as INBDE review material. Listeners were invited to complete a 16-item Google form questionnaire. Respondents were deidentified, and descriptive analysis was performed. RESULTS: Podcast episodes were played 256 times with 31 survey respondents. Listeners on Spotify represented seven different countries with 61.3% females and 38.4% males. Ninety percent of respondents found cases useful and helpful. Eighty-six percent found cases promoted learning and 90% believed podcasts could be useful in the dental curriculum. CONCLUSION: The Dental Study Bites Podcast served as a helpful and useful method to deliver instructional content. The use of podcast offers flexible means for students to review instructional materials and can be created inexpensively.

Establishing an antiracism framework for dental education through critical assessment of accreditation standards.

PURPOSE: The purpose of this manuscript is to establish an antiracism framework for dental education. Since the accreditation process is an influential driver of institutional culture and policy in dental education, the focus of the framework is the Commission on Dental Accreditation (CODA) standards for predoctoral education. METHODS: The authors of this manuscript reviewed each CODA predoctoral standard for opportunities to incorporate antiracism strategies. Eight standards were identified under themes of diversity (Standards 1-3, 1-4, 4-4), curriculum development (Standards 2-17, 2-26), and faculty recruitment and promotion (Standards 3-1, 3-4, 3-5). Guided primarily by National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, a logic model approach was used to critically assess those standards for opportunities to establish antiracism strategies, with anticipated outcomes and impacts. RESULTS: Strategies highlighted a need to improve recruitment, admissions, and accountability among dental schools to address the low numbers of historically underrepresented racial and ethnic (HURE) students and faculty. They emphasized the inclusion of racism in curricula geared toward training dental students to provide care to HURE populations. Finally, there are opportunities to improve accountability that dental schools are providing equitable opportunities for career advancement among HURE faculty, with consideration of conflicting demands for scholarship with HURE student mentoring, role modeling, teaching, and/or service. CONCLUSIONS: The framework identifies gaps in CODA standards where racism may be allowed to fester, provides specific antiracism strategies to strengthen antiracism through the accreditation process, and offers dental education programs, a process for evaluating and establishing their own antiracism strategies.

Development and implementation of a COVID-19 Vaccine and Pandemic Planning course: An interprofessional education approach.

We developed an online interprofessional COVID-19 Vaccine and Pandemic Planning course at the height of the pandemic to prepare health science students for future vaccine delivery. Faculty from nursing, pharmacy, medical, and dentistry developed a six-week online co-curricular interprofessional education activity open to all health science students across seven schools on three campuses within the same University system. Total enrollment included 303, with 228 completing the course from 16 programs. The majority of students were from the Doctorate in Dental Surgery (DDS) program (26.2%) and the Midwestern urban campus (90.3%). Successful rapid course development and implementation was attributed to several factors. The broad range of students across health science programs and differing years in respective programs provides insight to plan future co-curricular activities. The rapid development of a system-wide health science IPE course has implications for continuously changing professional health education needs.

Dental hygienists' use of motivational interviewing and perceptions of effectiveness in changing patient behaviors.

BACKGROUND: The University of Minnesota (UMN) Dental Hygiene (DH) program devotes considerable time developing students' competency using motivational interviewing (MI). However, the extent to which graduates use MI in clinical practice and their perceptions of MI effectiveness in changing behavior is unknown. METHODS: A cross-section of UMN dental hygiene classes from 2010-2019 were emailed an electronic survey using Qualtricsxm software (n = 208). The survey instrument collected demographic information and queried respondents' current MI use and perceptions of its effectiveness in changing patients' behavior. Survey questions were aligned with the constructs of the Theory of Planned Behavior (TPB): attitudes, subjective norms, and perceived behavioral control. Data analyses included descriptive statistics, cross-tabulations, and one-way ANOVA tests. RESULTS: There were 73 responses for a 35% response rate and 58 surveys (28%) included in data analysis. Respondents (95%) used MI, held positive attitudes toward MI and perceived MI to be an effective behavior counseling method (98%). However, respondents expressed concerns about patients' abilities to change behaviors. The three TPB constructs were found to be predictors of MI use in the clinical environment. A significant association was found between age and the TPB construct: behavioral control (p = 0.02). CONCLUSION: The majority of respondents reported using MI in clinical practice. According to the TPB, respondents exhibited strong behavioral intentions to use MI. Respondents held favorable attitudes toward MI and believed it to be effective in motivating positive behavior change. Respondents were confident in their MI skills and felt supported to use MI in their work environments.

Junior faculty perspectives on the academic environment: A call for development and onboarding.

BACKGROUND: One challenge in dental education is new faculty members can be hired with limited teaching experience or understanding of pedagogy. Recent publications document increasing initiatives of faculty development in US and Canadian dental schools. This study evaluates full-time faculty perspectives of their develop and academic environment. METHODS: A 33-item questionnaire distributed to senior administrators and forwarded to faculty, collected data on demographics and satisfaction, utilizing a 5-item Likert scale, multiple choice, and binary yes/no questions. Responses were descriptively and statistically analyzed utilizing an analysis of variance, chi-square, and two-sample t-test. RESULTS: There were 183 faculty respondents (37.7% male/62.3% female), age ranges were 20-29 (2.2%), 30-39 (53.5%), and 41-49(44.3). Respondents reported race/ethnicity: Caucasian (60.7%), Asian (19.1%), Hispanic (12.6%), Black/African American (5.5%), two or more races (2.2%), and Native American 0%. Length of employment was significantly associated with primary responsibility (p = 0.0023), recent publications (p < 0.0011), and short-term intent to remain in academia (p = 0.046). There was a statistically significant difference between age and satisfaction with professional development (p = 0.0411), achieving career objectives (p = 0.0151), well-being (p = 0.0492), access to resources for scholarly interests (p = 0.0114), communication (p = 0.0058), and assessment training (p = 0.0249). Non-Caucasian faculty reported greater dissatisfaction with being treated respectfully (p = 0.0302), departmental commitment to diversity and inclusion (p = 0.0075), and departmental cooperation/teamwork (p = 0.0323). CONCLUSIONS: A significant number of junior faculty have interest in academic dental careers. Institutions should invest in improving onboarding and professional development. Improve the early experiences of faculty, and foster diversity and inclusion and faculty well-being.

Mathematical Tooth Proportions: A Systematic Review.

PURPOSE: The aim of this systematic review was to evaluate and compare three commonly used proportions that include the golden proportion, golden percentage, and Recurring Esthetic Dental (RED) proportion to identify which of the mathematical formulas, if any, can be used to provide predictable and repeatable esthetic clinical outcomes. METHODS: A comprehensive search of electronic databases that included EBSCO, ProQuest, SCOPUS, Science Direct, Wiley, Google Scholar and PubMed was conducted using the terms: "golden proportion," "golden percentage," and "Recurring Esthetic Dental (RED) proportions" alone or in concurrence with one or both ensuing terms: "tooth proportions" and "esthetic tooth proportions." In addition, the following journals were hand searched for relevant articles: Journal of Prosthodontics, Journal of Prosthetic Dentistry and Journal of Esthetic and Restorative Dentistry. Related citations were also considered. RESULTS: Tooth proportions varied substantially in the natural dentition. No studies revealed findings that supported the use of one mathematical formula to predict esthetic success. The golden proportion is present between the central to lateral incisor in some cases, but rarely between the lateral incisor and the canine. When compared to the other proportions, the golden percentage provided better starting points for tooth shape and size, but only when values were adjusted to consider other factors such as ethnicity and/or facial proportions. CONCLUSION: Mathematical formulas did not provide consistent results that would allow for their use as a standardized guide for esthetically pleasing smiles. Although the golden percentage may be a good starting point if the percentages are adjusted on a case-by-case basis, generalized esthetic ideals cannot be determined by a mathematical formula and are open to interpretation by both the clinician and the patient.

The ability of oral health professionals to significantly influence improving overall health.

In 2000, David Satcher wrote, Oral Health in America: A Report of the Surgeon General, and stated that "oral health means much more than healthy teeth," and he challenged all health providers to step up and be a part of the improvement of the nation's oral health status. Over the past few decades, the heightened awareness of these oral health inequities within the United States has resulted in public policy stakeholders and scholars, similarly calling for the improvement of the nation's oral health status. Satcher also suggested that saliva may provide clues to a patient's overall health and a possible predictor of systemic disease. There have been several articles that have demonstrated an increased risk of systemic diseases with circulating inflammatory mediators, a reduction in treatment cost for pregnant women who received treatment for their clinically diagnosed periodontal disease. Health profession education has responded to the call for transforming the health system by developing graduates who are capable for working in an environment designed to improve the overall health of patients. Therefore, this article examines why oral health professionals have a significant opportunity to contribute to the improvement overall health of patients and participate in healthcare transformation.

YouTube use among dental students for learning clinical procedures: A multi-institutional study.

INTRODUCTION: The objective of this study was to evaluate the use of YouTube as a learning tool for clinical procedures among third- and fourth-year dental students. METHODS: A multiple choice survey was distributed through Qualtrics to third- and fourth-year dental students at 5 United States dental schools. Questions pertaining to YouTube use were asked related to the following categories: demographic information, general YouTube use, YouTube use as a tool to learn clinical procedures, YouTube video sharing, and validity. Descriptive and quantitative analyses were performed. RESULTS: Data were collected in 2019 and 2020 from 479 third- and fourth-year dental students (overall response rate 28.3%). Respondents ranged in age from under 23 to over age 50. Ninety-five percent of respondents considered YouTube videos on clinical procedures to be a helpful learning tool, and 89% would like for their dental school to post tutorials to YouTube/social media. No statistically significant differences were found between dental institutions; however, a statistically significant difference between third- and fourth-year students did exist regarding the frequency of YouTube use. While the use of YouTube as a learning tool for clinical procedures is high, 36% of students are uncertain about the evidence-base of the videos. CONCLUSIONS: As dental students use publicly available resources as adjuncts to the dental curriculum, it is important to analyze the quality of the material accessed. These findings may suggest a need for dental institutions to increase the development of evidence-based instructional videos as a part of their clinical educational curriculums.

Dental Students' Intent to Practice in Rural Communities Before and After Community-Based Rotations in a Rural Area.

Community-based dental education (CBDE) has the potential to positively impact the educational process in a manner that both contributes to educational outcomes and shapes the learner's behavior. The aim of this study was to determine the correlation between dental students' intended practice location and the size of their hometown and to assess any impact their CBDE rotation in a rural location had on practice location intention. From March 7, 2016, to August 12, 2018, fourth-year students at one U.S. dental school were invited to complete a ten-item questionnaire prior to and after their four-week clinical rotations at a rural clinic. Of the 123 dental students on rotation at the clinic during this time, 106 completed the pre-rotation survey and 112 the post-rotation survey, for response rates of 86% and 91%, respectively. Prior to the rotation, 58.6% selected one of the rural locations as an ideal practice location, and that percentage increased slightly to 61.4% after the rotation; the difference was not statistically significant (p=0.984). The results did show a significant increase from pre to post rotation for women intending to practice in rural communities (p=0.0413). This study found that students' intent to practice in a rural location was not significantly affected by a clinical rotation in a rural clinic; however, there was strong evidence that students from rural communities intended to practice in rural communities after graduation.

Dental Students' Non-Clinical Learning During Community-Based Experiences: A Survey of U.S. Dental Schools.

Dental schools use community-based dental education (CBDE) to ensure students gain experience in treating diverse and underserved patient populations. However, it is unclear to what extent schools utilize CBDE experiences to increase students' knowledge of structural factors impacting access to care. The aim of this study was to determine the level and types of non- clinical learning included in CBDE experiences and how that learning is being assessed across U.S. dental schools. This cross- sectional analysis used an 18-item questionnaire distributed to associate deans and CBDE directors at all 66 U.S. dental schools. The questions focused on rotation structure, CBDE objectives, and didactic content for CBDE programs. Representatives from 31 schools-public (71%) and private (29%)-responded, for a 44% response rate. The primary objectives for the community-based rotations were reported to be demonstrating cultural competence in diverse clinical settings (93.1%), addressing access to care (86.2%), and diagnosing and treating oral diseases (75.9%). Of the respondents, 73% reported that their schools supported clinical experiences with non-clinical didactic course work, which addressed access to care (95%), professional responsibility (91%), social determinants of health (86%), the U.S. health care system (77%), health policy (73%), practice management (73%), motivational interviewing (50%), and public presentation training (32%). The results suggest that U.S. dental schools are using CBDE rotations to provide didactic content and assessing students on their knowledge of access to care, social determinants of health, interprofessional practice, and oral health policy. These important aspects of students' education provide additional evidence of the value of CBDE in dental education.

A Retrospective Analysis of a Cross-Year Peer Tutoring Program for Oral Health Students.

Health professions education is extremely challenging for students, requiring high performance in fast-paced learning environments. In addition, the challenge of instructing students at many performance levels and the lack of teaching assistants can create a knowledge gap between educators and students. Using cross-year peer tutors is one potential method to close this gap and improve student performance. The aims of this study were to retrospectively evaluate the impact of a cross-year peer tutoring program on successful course completion of oral health students and to assess student and tutor perceptions of the experience. First- and second-year dental and dental therapy students were assigned to cross-year tutors as a result of progression committee recommendations and self-identification. Potential tutors were vetted by the course directors. The collected data included number of courses in which students were assigned a tutor, the type of course (lecture vs. lab), and students' success in the courses. These data were collected for a four-year period (2013-14 to 2016-17), and student and tutor perceptions were assessed in one year. The results showed that 94% of the students who received tutoring passed their courses. Students who had been tutored had a significantly lower failure rate than those who were not tutored (20% vs. 80%, respectively). These results suggest that the cross-year peer tutoring program was useful in closing the learning gap between instructors' expert level and novice learners. Participating students and tutors also perceived the program as a positive and beneficial experience.

Should Live Patient Licensing Examinations in Dentistry Be Discontinued? Two Viewpoints: Viewpoint 1: Alternative Assessment Models Are Not Yet Viable Replacements for Live Patients in Clinical Licensure Exams and Viewpoint 2: Ethical and Patient Care Concerns About Live Patient Exams Require Full Acceptance of Justifiable Alternatives.

This Point/Counterpoint article addresses a long-standing but still-unresolved debate on the advantages and disadvantages of using live patients in dental licensure exams. Two contrasting viewpoints are presented. Viewpoint 1 supports the traditional use of live patients, arguing that other assessment models have not yet been demonstrated to be viable alternatives to the actual treatment of patients in the clinical licensure process. This viewpoint also contends that the use of live patients and inherent variances in live patient treatment represent the realities of daily private practice. Viewpoint 2 argues that the use of live patients in licensure exams needs to be discontinued considering those exams' ethical dilemmas of exposing patients to potential harm, as well as their lack of reliability and validity and limited scope. According to this viewpoint, the current presence of viable alternatives means that the risk of harm inherent in live patient exams can finally be eliminated and those exams replaced with other means to confirm that candidates are qualified for licensure to practice.

Care Provided by Students in Community-Based Dental Education: Helping Meet Oral Health Needs in Underserved Communities.

Since 2000, reports have documented the challenges faced by many Americans in receiving oral health care and the consequences of inadequate care such as high levels of dental caries among many U.S. children. To help address this problem, many dental schools now include community-based dental education (CBDE) in their curricula, placing students in extramural clinics where they provide care in underserved communities. CBDE is intended to both broaden the education of future oral health professionals and expand care for patients in community clinics. The aim of this study was to develop a three-year profile of the patients seen and the care provided by students at extramural clinics associated with one U.S. dental school. Three student cohorts participated in the rotations: final-year students in the Doctor of Dental Surgery, Bachelor of Science in Dental Hygiene, and Master of Dental Therapy programs. The study was a retrospective analysis of data retrieved from the school's database for three consecutive academic years. The data included patients' demographics and special health care needs status (based on information collected by students from their patients) and procedures students performed while on rotations. For the three-year period, the results showed a total of 43,128 patients were treated by 418 student providers. Approximately 25% of all encounters were with pediatric patients. Students completed 5,908 child prophylaxis, 5,386 topical fluoride varnish, and 7,678 sealant procedures on pediatric patients. Annually, 7% of the total patients treated had special health care needs. The results show that these students in CBDE rotations provided a substantial amount of oral health care at extramural sites and gained additional experience in caring for a diverse population of patients and performing a wide range of procedures.

Community-Based Dental Education Models: An Analysis of Current Practices at U.S. Dental Schools.

Community-based dental education (CBDE) enhances students' clinical expertise, improves their cultural competence, increases access to care, and fosters community engagement. As emphasis on CBDE has increased over the last decades, the aim of this survey study was to determine how CBDE is currently being implemented in U.S. dental schools. The study used a 20-item, author-designed survey emailed in April to August 2015 to 60 of the 65 U.S. dental schools, excluding those that had been recently established. Of the 60 schools, representatives of 33 responded, resulting in a 55% response rate: 70% public and 30% private. These respondents reported that the extramural sites being used the most were community clinics (90.9%), Federally Qualified Health Clinics (66.7%), public health clinics (54.5%), and Indian Health Service clinics (42.4%). The majority of responding schools (63.6%) had ten or more sites available for rotations, and the rotation lengths were 1-2 weeks (29%), 2-4 weeks (25%), 4-6 weeks (29%), 6-8 weeks (3.2%), and 8-10 weeks (12.9%). Most of the respondents (78.8%) reported that their students were unable to be assessed for clinical competencies at external clinical sites, but roughly half allowed students to receive clinical credit. After students completed their rotations, the majority of the respondents (81.8%) reported that students were required to produce a reflection, and 87.9% reported that students completed a post-rotation survey. Considering the benefits of CBDE for students' education and for improving access to oral health care, it is encouraging that over 45% of the responding schools required their students to spend four weeks or longer on external rotations.

A Systematic Review of the Use of Self-Assessment in Preclinical and Clinical Dental Education.

A desired outcome of dental and dental hygiene programs is the development of students' self-assessment skills. To that end, the Commission on Dental Accreditation states that "graduates must demonstrate the ability to self-assess." However, it is unclear that merely providing opportunity for self-assessment actually leads to the desired outcome. The aim of this study was to systematically review the literature on self-assessment in dental education. A search of English-language articles for the past 25 years (January 1, 1990, to June 30, 2015) was performed using MEDLINE Medical Subject Heading terms. Each abstract and/or article was validated for inclusion. The data collected included student classification, self-assessment environment, faculty assessment, training, faculty calibration, predictive value, and student perceptions. A qualitative analysis was also performed. From an initial list of 258 articles, 19 were selected for inclusion; exclusion criteria included studies that evaluated a non-preclinical or non-clinical exercise or whose subjects were not predoctoral dental or dental hygiene students. The results showed limited information regarding any kind of systematic training of students on how to perform a self-assessment. The majority of the studies also did not specify the impact of self-assessment on student performance. Self-assessment was primarily performed in the second year and in the preclinical environment. Students received feedback through a correlated faculty assessment in 73% of the studies, but 64% did not provide information regarding students' perceptions of self-assessment. There was a trend for students to be better self-assessors in studies in which a grade was connected to the process. In addition, there was a trend for better performing students to underrate themselves and for poorer performing students to overrate themselves and, overall, for students to score themselves higher than did their faculty evaluators. These findings suggest the need for greater attention to systematically teaching self-assessment in dental and dental hygiene curricula and for further research on the impact of self-assessment on desired outcomes.