Dental students' perceptions of standardized patient experiences using Zoom: Dyadic factors.

PURPOSE: The COVID-19 pandemic required a rapid transition to online education, including simulations. The current study identified students' perceptions of communicating with standardized patients in a virtual setting. METHODS: This qualitative study thematically analyzed 485 reflections submitted by 248 students between Spring 2020 and Spring 2022. Statements describing both the virtual medium and dyadic interactions between students and patients were coded for emergent themes and also coded as positive (facilitative) or negative (critical). RESULTS: Four themes emerged from the data related to the virtual medium: impact on nonverbal communication, patient engagement/rapport, presentation aids, and listening. Within these broad themes, 13 subthemes were identified, nine of which were negative/critical. Technology problems were specifically identified as compromising both engagement and listening. Even when technology worked well, students noted that it reduced the number of message cues received from the patient and complicated the process of sending cues (e.g., by requiring students to look away from a patient's face to make "eye contact" through a camera). CONCLUSIONS: Overall, students were critical of Zoom's impact on dyadic factors with standardized patients. However, they did acknowledge some positive aspects regarding the technology. These findings provide a foundation to consider when teaching students how to communicate effectively via teledentistry.

The interactive effects of oral health literacy and acculturation on dental care use among Hispanic adults.

OBJECTIVE: Assess whether there is an interactive effect between oral health literacy and acculturation on dental care use for Hispanic adults. METHODS: Self-identifying Hispanic adults participated in this observational study (N = 338). Oral health literacy (low vs. high) was measured using the Comprehensive Measure of Oral Health Knowledge (CMOHK). Acculturation (low vs. high) was measured using the Short Acculturation Scale for Hispanics (SASH) and operationalized a second way by the language in which the survey was completed (English or Spanish). The outcome was dental care use in the past year (yes/no). Confounder-adjusted modified Poisson regression models were run to generate risk ratios (RR) and to test the hypothesis that participants with high oral health literacy and high acculturation would be more likely to have used dental care in the past year than participants with low oral health literacy and low acculturation. RESULTS: About 65% of participants used dental care in the past year. The final models failed to show that participants with high oral health literacy and high acculturation were more likely to have used dental care than other participants. However, in the language proxy interaction model, participants with high oral health literacy and low acculturation were significantly more likely to have used dental care than participants with low oral health literacy and low acculturation. CONCLUSION: There may be an interaction between oral health literacy and acculturation when modeling dental care use for Hispanic adults that should be further explored.

Repair versus replacement of defective direct restorations: A cross-sectional study among US dentists.

BACKGROUND: Repair increases the longevity of restorations and is well-accepted by patients. In this study, the authors assessed the acceptance of dental restoration repair by dentists and determined the main variables of repair versus replacement of defective restorations. METHODS: A 15-item questionnaire was developed and distributed electronically to the American Dental Association Clinical Evaluators panel members (n = 785) during a 2-week period in 2019. Descriptive, bivariate, and multivariable analyses were conducted. RESULTS: Of the 387 respondents, 83.7% stated that they repair defective restorations, and 16% stated that they always replace them. Reasons to forego a restoration repair among dentists who perform repairs included defect size and carious lesion extension (42%) and negative personal experience or lack of success (37.9%). However, the latter was considerably higher for dentists who do not perform repairs (60.7%). The most commonly cited patient-related reason and tooth condition to repair restorations were limited patient finances (67%) and noncarious marginal defects (86%), respectively. Neither sex nor age group was significantly associated with the practice of restoration repair (P = .925 and P = .369, respectively). However, sole proprietors were more likely to perform repairs than those in an employee, associate, or contractor practice setting (P = .008). The most significant reason to forego restoration was negative experience or lack of success (P = .002). CONCLUSIONS: Restoration repair is considered a treatment option for managing defective restorations. Negative personal experience or lack of success and practice setting influenced the dentists' decision to repair or replace a defective restoration. PRACTICAL IMPLICATIONS: Understanding dentists' clinical challenges and practice environment is necessary when advocating for this approach.

An evaluation of the geriatric dental curricula within Advanced Education in General Dentistry and General Practice Residency programs in the United States.

AIM: To compare the geriatric dentistry curricula between Advanced Education in General Dentistry (AEGD) and General Practice Residency (GPR) programs. METHODS: A 108-item survey was developed to assess residents' didactic and clinical experiences pertaining to geriatric patients. Surveys were mailed in 2018 to all AEGD (N = 89) and GPR (N = 180) program directors. Statistical analysis consisted of descriptive and bivariate analyses with the chi-square test, Fisher's exact test, and the Wilcoxon rank sum test (alpha = .05). RESULTS: Twenty-four AEGD and fifty-eight GPR directors completed surveys (response rate = 30%). Seventy-one percent of responding programs reported mandatory didactic training pertaining to frail and functionally dependent geriatric adults. Ninety-nine percent of respondents reported that residents provided treatment to geriatric patients; however, they were less likely to perform procedures on frail and functionally dependent patients. Only 15% of respondents provided nursing home care. Considering all patient encounters, responding GPR programs were more likely than AEGD programs to treat patients using IV bisphosphonates (63% vs 25%; P < .01), undergoing chemotherapy (48% vs 16%; P = .02), and undergoing head and neck radiation therapy (55% vs 25%; P = .02). CONCLUSION: A majority of responding AEGD and GPR programs reported providing educational experiences pertaining to geriatric patients; however, GPR programs reported treating more medically complex patients than AEGD programs.

Prescribing practices for antibiotic prophylaxis in patients with prosthetic joints.

AIMS: With the increasing number of patients with prosthetic joints, recommendations for antibiotic prophylaxis (AP) prior to dental procedures to prevent prosthetic joint infections (PJI) have changed. METHODS AND RESULTS: This survey evaluated dentists' AP practices for patients with prosthetic joints undergoing dental procedures and their familiarity with the American Dental Association Guidelines (ADA CPG) and American Academy of Orthopaedic Surgeons Appropriate Use Criteria (AAOS AUC). Dentists' attitudes about antibiotic resistance, medical-legal aspects, and adverse effects to using AP were examined. Dentists (n = 574) were familiar (51.2%) with ADA CPG and with the AAOS AUC (25.8%). Familiarity varied according to years since graduation. Female dentists (63.5%) were more likely to be very familiar with the ADA CPG than male dentists (49.5%). Overall, 65.4% of respondents believed that AP is not effective in the prevention of PJI, and 19.4% believed there is enough evidence to support AP. For a healthy patient, 28.9% of dentists would never recommend AP, 44.9% would recommend AP within the first two years since prosthetic joint replacement. CONCLUSIONS: Dentists' recommendations for the use of AP varied depending on different factors, including health status of the patient, dental procedure, time elapsed since joint surgery, suggesting that adherence to the ADA CPG and AUC is still challenging.

Predictors of Dental Students' Anticipated Willingness to Treat Underserved Populations Five Years After Graduation.

The aim of this study was to assess which variables were associated with dental students' anticipated willingness to treat 13 underserved populations as dentists five years after graduation. A questionnaire was distributed from 2008 to 2014 to all 240 first- through fourth-year dental students at the University of Iowa College of Dentistry & Dental Clinics. Only participants who completed surveys in each of their four years (n=132) were included in data analysis. The results showed that professional and personal interactions with each population, along with feeling comfortable and competent in treating a population, were most often associated with the students' anticipated willingness to treat underserved populations. In contrast, the participants' personal and demographic variables were less frequently associated with an anticipated willingness to treat underserved populations. In addition, shadowing a dentist before dental school and volunteering, either before or during dental school, were rarely associated with participants' anticipated willingness to treat underserved populations. These findings suggest that providing dental students with multiple positive opportunities to treat underserved populations may help them become more willing to treat underserved populations after they graduate.

Oral health knowledge levels of Hispanics in Iowa.

BACKGROUND: Hispanics disproportionately experience preventable oral health conditions in the United States. This study aimed to determine the oral health knowledge (OHK) of Hispanic adults in Iowa to identify potential gaps in knowledge. METHODS: This cross-sectional study included a convenience sample of self-identifying Hispanic adults. Data pertaining to oral health literacy and demographic, cultural, and dental characteristics were collected. OHK was assessed with the Conceptual Measure of Oral Health Knowledge, and it was categorized as low or high. Bivariate analyses and multiple logistic regression models were conducted to identify the variables related to OHK (P < .05). Institutional review board approval was obtained. RESULTS: Three hundred thirty-eight participants completed the questionnaire, 68% of participants completed the questionnaire in Spanish, and 51% of all participants had low OHK. Participants were less likely to correctly answer questions pertaining to children's oral health, periodontal disease, and oral cancer. Low OHK was associated with having less than 12th grade education, lack of dental insurance, and preference for a Spanish-speaking oral health care provider. CONCLUSIONS AND PRACTICAL IMPLICATIONS: OHK appears to be low in this population. Increasing OHK may help decrease oral health disparities and improve oral health outcomes. Furthermore, it is important that oral health care providers have an understanding of barriers that can impede patients' understanding of the health care system. Specifically, minority populations, such as Hispanics, may have a harder time because of certain cultural differences that exist among this ethnic group.

Preferences Related to the Use of Mobile Apps as Dental Patient Educational Aids: A Pilot Study.

PURPOSE: Numerous patient education apps have been developed to explain dental treatment. The purpose of this study was to assess perceptions and preferences regarding the use of apps in dental settings. MATERIALS AND METHODS: Four patient education apps describing fixed partial dentures were demonstrated to participants (N = 25). Questions about each app were asked using a semi-structured interview format to assess participants' opinions about each app's content, images, features, and use. Sessions were analyzed via note-based methods for thematic coding. RESULTS: Participants believed that apps should be used in conjunction with a dentist's explanation about a procedure. They desired an app that could be tailored for scope of content. Participants favored esthetic images of teeth that did not show structural anatomy, such as tooth roots, and preferred interactive features. CONCLUSIONS: Patient education apps may be a valuable tool to enhance patient-provider communication in dental settings. Participants exhibited varying preferences for different features among the apps and expressed the desire for an app that could be personalized to each patient. Additional research is needed to assess whether the use of apps improves oral health literacy and informed consent among patients.

Poor Oral Health Literacy May Lead to Missed Dental Appointments.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: The association between oral health literacy and missed dental appointments. Baskaradoss JK. JADA 2016;147(11):867-74. SOURCE OF FUNDING: Information not available TYPE OF STUDY/DESIGN: Unmatched case-control study that used a convenience nonprobability sampling method.

Should PGY-1 Be Mandatory in Dental Education? Two Viewpoints: Viewpoint 1: PGY-1 Provides Benefits That Support Making It Mandatory and Viewpoint 2: PGY-1 Should Be Available for Dental Graduates But Not Mandatory.

This Point/Counterpoint considers whether a general dentistry postgraduate year one (PGY-1) residency should be required for all new graduates who do not pursue specialty training. Currently, New York and Delaware require PGY-1 for dental licensure, while other states offer it as an alternative to a clinical examination for obtaining licensure. Viewpoint 1 supports the position that PGY-1 should be mandatory by presenting evidence that PGY-1 residencies fulfill new graduates' need for additional clinical training, enhance their professionalism and practice management skills, and improve access to care. The authors also discuss two barriers-the limited number of postdoctoral positions and the high cost-and suggest ways to overcome them. In contrast, Viewpoint 2 opposes mandatory PGY-1 training. While these authors consider the same core concepts as Viewpoint 1 (education and access to care), they present alternative methods for addressing perceived educational shortcomings in predoctoral curricula. They also examine the competing needs of underserved populations and residents and the resulting impact on access to care, and they discuss the potential conflict of interest associated with asking PGY-1 program directors to assess their residents' competence for licensure.

Changes in Dental Students' Attitudes About Treating Underserved Populations: A Longitudinal Study.

The aim of this study was to assess changes in a group of dental students' feelings about, willingness to treat, and perceived responsibility in treating underserved populations as they progressed through their predoctoral education. A questionnaire was developed to assess the first- through fourth-year (D1-D4) students' attitudes about treating 13 underserved populations after graduation. Surveys were distributed from 2008 to 2014, resulting in longitudinal data from three graduating classes (D1 year: N=240; eligible D4 participants: N=221). A total of 132 students from the three classes (Class of 2012 N=41; 2013 N=46; 2014 N=45; adjusted response rate 60%) completed all surveys (D1-D4). The results showed that changes in students' feelings about treating and willingness to treat underserved populations were population-specific rather than universal. Compared to the D1 year, the students in later years anticipated feeling more negatively towards treating low-income, frail elderly, homebound, homeless, other ethnic groups, and non-English-speaking patients, while their feelings were more positive towards treating known drug users and HIV/AIDS populations. Across the four years, students' willingness to treat low-income, frail elderly, homebound, and non-English-speaking populations after graduation became more negative, while their willingness to treat medically complex populations, known drug users, and HIV/AIDS populations became more positive. The students also became less likely to strongly agree that it is their responsibility as dentists to treat underserved populations as they progressed through school. These respondents reported that clinical and faculty interactions had impacted their likelihood to treat underserved populations. These findings may point to specific types of interventions and faculty mentoring to bring about change.

An Exploration of Dental Students' Assumptions About Community-Based Clinical Experiences.

The aim of this study was to ascertain which assumptions dental students recalled feeling prior to beginning community-based clinical experiences and whether those assumptions were fulfilled or challenged. All fourth-year students at the University of Iowa College of Dentistry & Dental Clinics participate in community-based clinical experiences. At the completion of their rotations, they write a guided reflection paper detailing the assumptions they had prior to beginning their rotations and assessing the accuracy of their assumptions. For this qualitative descriptive study, the 218 papers from three classes (2011-13) were analyzed for common themes. The results showed that the students had a variety of assumptions about their rotations. They were apprehensive about working with challenging patients, performing procedures for which they had minimal experience, and working too slowly. In contrast, they looked forward to improving their clinical and patient management skills and knowledge. Other assumptions involved the site (e.g., the equipment/facility would be outdated; protocols/procedures would be similar to the dental school's). Upon reflection, students reported experiences that both fulfilled and challenged their assumptions. Some continued to feel apprehensive about treating certain patient populations, while others found it easier than anticipated. Students were able to treat multiple patients per day, which led to increased speed and patient management skills. However, some reported challenges with time management. Similarly, students were surprised to discover some clinics were new/updated although some had limited instruments and materials. Based on this study's findings about students' recalled assumptions and reflective experiences, educators should consider assessing and addressing their students' assumptions prior to beginning community-based dental education experiences.

Neighborhood and family social capital and parent-reported oral health of children in Iowa.

OBJECTIVES: A growing body of evidence supports the impact of social factors on oral health disparities in children in the United States. The goal of this study was to examine the relationship between two types of social capital-family and neighborhood-and the parent-reported oral health of Iowa's children. METHODS: We analyzed results from a 2010 cross-sectional statewide health survey. The outcome was parent-reported child oral health status, and the five primary independent variables were neighborhood social capital and four separate indicators of family social capital. Data were analyzed using a mixed-effects linear regression with a random effect for zip code. RESULTS: Significant positive associations were found between child oral health status and neighborhood social capital (P = 0.005) and one indicator of family social capital, family frequency of eating meals together (P = 0.02), after adjusting for covariates. CONCLUSIONS: This study adds to the growing body of literature around the social determinants of oral health. Our findings indicate that the oral health of children may be influenced by broad social factors such as neighborhood and family social capital.

Geographic variation of dental utilization among low income children.

Spatial accessibility of dental care is mediated by dentist workforce availability and travel costs. In this study, we generated dental service areas through small area analysis of Medicaid administrative data and claims. Service areas were then used to assess dimensions of spatial accessibility, including dentist-to-population ratios, and examine relationships in geographic variation of routine dental care among Medicaid-enrolled children. Our findings indicate significant geographic differences in accessibility for Hispanic children compared to other children, even after controlling for individual and service area characteristics.

Oral health knowledge among elderly patients.

BACKGROUND: The purpose of this study was to determine the level of oral health knowledge among patients 65 years or older to identify areas in which knowledge gaps exist. METHODS: The authors administered the Comprehensive Measure of Oral Health Knowledge questionnaire to patients 65 years or older at a university-based dental clinic and examined associations between oral health knowledge scores and participants' demographic and dental characteristics. RESULTS: Most participants were familiar with basic dental disease prevention and treatment; however, many participants were unfamiliar with concepts pertaining to periodontal disease, oral cancer, and children's oral health. CONCLUSIONS: Advocates for geriatric oral health should educate elderly populations about the risk factors associated with periodontal disease and oral cancer, especially as they become more at risk of experiencing these diseases. PRACTICAL IMPLICATIONS: Educational messages aimed at both routine and nonroutine users of dental care should be developed on the basis of universal health literacy principles to facilitate understanding among elderly adults, who have varying literacy levels.

Association of community-based dental education components with fourth-year dental students' clinical performance.

The purpose of this study was to assess which components of a community-based dental education (CBDE) program at The University of Iowa College of Dentistry & Dental Clinics were associated with overall student performance. This retrospective study analyzed data for 444 fourth-year students who graduated in 2006 through 2011. Information pertaining to students' CBDE rotations and their final grades from the comprehensive clinic (in two areas: Production and Competence) were used for statistical analysis. Bivariate analyses indicated that students who completed CBDE in the fall were more likely to receive an A or B in Production compared to students who completed CBDE in the spring. However, students who completed CBDE in the beginning or end of the academic year were more likely to receive an A or B in Competence compared to those who completed CBDE in the middle of the year. Students who treated a variety of patient types during CBDE experiences (comprehensive and emergency care vs. mainly comprehensive care) were more likely to receive better grades in Production, while CBDE clinic type was not associated with grades. Dental schools should consider how CBDE may impact students' performance in their institutional clinics when developing and evaluating CBDE programs.

Association between dentists' participation in charitable care and community-based dental education.

The Institute of Medicine and the Commission on Dental Accreditation (CODA) have recommended that dental schools incorporate community-based dental education (CBDE) programs into their curricula. The expectation is that CBDE participation will help dental students gain the skills and motivation to treat vulnerable populations after graduation. The purpose of this study was to determine whether dentists' involvement with charitable dental care is associated with participation in CBDE as dental students. A questionnaire was mailed to private practice Iowa dentists (N=1,312); the response rate was 41.2 percent (n=541). Logistic regression analyses, controlling for age, gender, number of hours worked per week, graduation year, and alma mater, were conducted. A majority of the respondents provided charitable care: 85 percent in their offices, and 70 percent in the community. Seventy-nine percent had participated in CBDE as dental students. Respondents who reported being very satisfied/satisfied with their charitable care experiences were more likely to provide charitable care in their offices and the community than respondents who were not satisfied with their experiences. Respondents who participated in CBDE as dental students were more likely to provide charitable care in the community than respondents who did not participate in CBDE. The type of sites where dentists completed their CBDE experiences was associated with where they provide charitable care. This study suggests that participation in CBDE may be associated with dental students' providing charitable dental care after graduation.

Influence of minor children and contribution to household income on work hours of female dentists.

OBJECTIVE: To study the association of having minor children and contribution to household income on weekly work hours of Iowa female dentists. METHODS: A 28-question survey was mailed to all active Iowa dentists. This study represents female dentists who responded to the survey (n = 192; response rate = 63 percent). The dependent variable was whether dentists currently worked full- or part-time (≥ 32 versus <32 hours/week). The associations of having minor children and the percent women contributed toward their household income were then analyzed using stepwise logistic regression, controlling for covariates (alpha = 0.05). RESULTS: Of the respondents, 14.6 percent worked part-time. Females who had no minor children (40.1 percent) were 3.1 times as likely to work full-time (P = 0.0353), and those who contributed >60 percent to household income (57.8 percent) were 3.0 times as likely to work full-time (P = 0.0129). The final regression model indicated that those who contributed >60 percent to household income (P = 0.0096) and had no leave of absence longer than 45 consecutive days within the prior 2 years (P = 0.0483) were more likely to work full-time compared with their counterparts. CONCLUSION: Iowa female dentists who provided more than 60 percent to household income and had not taken a leave of absence during the past 2 years were more likely to work full-time. The inclusion of leave of absence as a predictor variable negates any additional influence of the presence or absence of minor children in the regression model, indicating that these variables are highly correlated for this population.

Geographic accessibility and utilization of orthodontic services among Medicaid children and adolescents.

OBJECTIVES: To describe rates of Medicaid-funded services provided by orthodontists in Iowa to children and adolescents, identify factors associated with utilization, and describe geographic barriers to care. METHODS: We analyzed enrollment and claims data from the Iowa Medicaid program for a 3-year period, January 2008 through December 2010. Descriptive, bivariate, and multivariable logistic regression analyses were performed with utilization of orthodontic services as the main outcome variable. Service areas were identified by small area analysis in order to examine regional variability in utilization. RESULTS: The overall rate of orthodontic utilization was 3.1 percent. Medicaid enrollees living in small towns and rural areas were more likely to utilize orthodontic services than those living in urban areas. Children who had an oral evaluation by a primary care provider in the year prior to the study period were more likely to receive orthodontic services. Service areas with lower population density and greater mean travel distance to participating orthodontists had higher utilization rates than smaller, more densely populated areas. CONCLUSIONS: Rural residency and increased travel distances do not appear to act as barriers to orthodontic care for this population. The wide variability of utilization rates seen across service areas may be related to workforce supply in the form of orthodontists who accept Medicaid-insured patients. Referrals to orthodontists from primary care dentists may improve access to specialty care for Medicaid enrollees.