Salivary microbiome changes distinguish response to chemoradiotherapy in patients with oral cancer.

BACKGROUND: Oral squamous cell carcinoma (SCC) is associated with oral microbial dysbiosis. In this unique study, we compared pre- to post-treatment salivary microbiome in patients with SCC by 16S rRNA gene sequencing and examined how microbiome changes correlated with the expression of an anti-microbial protein. RESULTS: Treatment of SCC was associated with a reduction in overall bacterial richness and diversity. There were significant changes in the microbial community structure, including a decrease in the abundance of Porphyromonaceae and Prevotellaceae and an increase in Lactobacillaceae. There were also significant changes in the microbial community structure before and after treatment with chemoradiotherapy, but not with surgery alone. In patients treated with chemoradiotherapy alone, several bacterial populations were differentially abundant between responders and non-responders before and after therapy. Microbiome changes were associated with a change in the expression of DMBT1, an anti-microbial protein in human saliva. Additionally, we found that salivary DMBT1, which increases after treatment, could serve as a post-treatment salivary biomarker that links to microbial changes. Specifically, post-treatment increases in human salivary DMBT1 correlated with increased abundance of Gemella spp., Pasteurellaceae spp., Lactobacillus spp., and Oribacterium spp. This is the first longitudinal study to investigate treatment-associated changes (chemoradiotherapy and surgery) in the oral microbiome in patients with SCC along with changes in expression of an anti-microbial protein in saliva. CONCLUSIONS: The composition of the oral microbiota may predict treatment responses; salivary DMBT1 may have a role in modulating the oral microbiome in patients with SCC. After completion of treatment, 6 months after diagnosis, patients had a less diverse and less rich oral microbiome. Leptotrichia was a highly prevalent bacteria genus associated with disease. Expression of DMBT1 was higher after treatment and associated with microbiome changes, the most prominent genus being Gemella Video Abstract.

Entrustable professional activities framework for assessment in predoctoral dental education, developed using a modified Delphi process.

PURPOSE/OBJECTIVES: The purpose of this study was to define and develop a set of Entrustable Professional Activities (EPAs) for dental education using a modified Delphi consensus approach. EPAs define the core tasks that a graduating dentist needs to perform independently in practice. The EPA framework facilitates assessment of competencies as they manifest in the tasks and independence needed to be ready for practice. METHODS: Feedback was obtained from participants about a list of EPAs, with modifications made after each of the 3 rounds, using a modified Delphi approach. Phase 1 included attendees at the ADEA Fall 2017 meeting (n = 35) who participated in an EPA workshop primarily composed of academic deans. The Phase 2 "reactor panel" consisted of 10 dental schools' academic deans and other individuals with expertise and interest in dental curriculum and assessment (n = 31). Phase 3 participants were attendees at the ADEA CCI 2019 meeting (n = 91) who also participated in a 2-day EPA workshop. RESULTS: In phase 1, overall ratings for acceptability of the EPAs were satisfactory. In phase 2, the next iteration of EPAs was judged as satisfactory for inclusion in curriculum, match well with clinical practice and clarity. In phase 3, the EPAs were judged as satisfactory for being an "entrustable, essential, and important task of the profession." Qualitative feedback suggested wording, measurability, and specific focus of EPA statements is important. CONCLUSIONS: A preliminary set of EPAs was designed for predoctoral dental education through a systematic, careful consensus building approach involving a diverse set of participants.

Contemporary appraisal of factors influencing pediatric dental program directors' selection of residents.

PURPOSE: With the increasing number of applicants and changes to information available in applications, pediatric dentistry program directors must adapt the resident selection process. The evaluation approach was significantly impacted when the National Board Dental Examination (NBDE) changed to a pass/fail grading system. The purposes of this are study to examine what criteria pediatric dentistry program directors now use to select residents, and to evaluate current criteria against those used in the past. METHODS: A 30-item survey was structured similar to a previous questionnaire used in 2005. An invitation to participate was sent via email to all pediatric dentistry program directors for the 82 Commission on Dental Accreditation (CODA)-accredited programs located in the United States and Canada. Anonymous responses were analyzed. RESULTS: There were 58 responses (70.7% response rate). The overall most important factors were clinical grades, dental school class rank, dental school grade point average (GPA), and applicant's essay. The least important factors were the applicant being a graduate of the program's dental school, Advanced Dental Admission Test (ADAT) score, and applicant's fluency in a second language. The factor that had the most significant increase in importance from 2005 is the applicant's essay, followed by dental school reputation and the dental school's pediatric program reputation. CONCLUSIONS: The most important factors to program directors are clinical grades, dental school class rank, dental school GPA, and applicant's essay. The applicant's essay has increased in importance since 2005.

Dental Students' Evaluations of Practice Management Education and Interest in Business-Related Training: Exploring Attitudes Towards DDS/DMD-MBA Programs.

Being well prepared for a competitive business environment is crucial for future dentists. The aims of this study were to assess dental students' satisfaction with their practice management education, their current and future interest in business-related education and attending a DDS/DMD-MBA program, and the relationship between their demographic and other characteristics and their business education-related responses. The study, conducted in 2016 and 2017, surveyed students in all four years at the authors' home school and at other schools that did not have a DDS/DMD-MBA program. At the home school, 273 students responded (response rate 63%); and 341 students from 11 of the 51 U.S. dental schools without a DDS/DMD-MBA program responded (respondents were from 21% of schools invited; the response rate of those students could not be calculated). The responding students disagreed that their school adequately prepared them for the business aspects of dentistry (mean=2.42 on a scale from 1=disagree strongly to 5=agree strongly). Large majorities agreed/strongly agreed that dentistry is a career that requires a certain amount of business acumen (95%) and that they were very interested in learning about business (85%). A total of 68% agreed/strongly agreed that their school should offer a dual DDS/DMD-MBA degree and 63% that they would consider enrolling in such a program. The more advanced the respondents were, the less satisfied they were with their practice management education (r=-0.20; p<0.001). Female respondents were less interested in business-related education (r=-0.20; p<0.001) and less likely to consider a DDS/DMD-MBA program than the males. Respondents planning to own a dental practice were more interested in additional current business education (r=0.22; p<0.001) and in future business education (r=0.15; p<0.001) than those without that plan. These results showed that a significant percentage of these dental students were interested in a DDS/DMD-MBA program. The male students and students who planned to own a practice were more interested in business education than the female students and students who did not plan to own their own practice.

General Dentists' Perceptions of Dental Hygienists' Professional Role: A Survey.

Purpose: Changes in dental hygienists' scope of practice in the United States (U.S.) are not independent of general dentists' attitudes and behavior related to dental hygienists' professional roles. The purpose of this study was to assess perceptions and knowledge of general dentists concerning the legally allowable duties of dental hygienists in their state versus the services they provide in their individual practices; the importance of dental hygienists' contributions to the practice; and how well dental hygienists interact with dentists and patients. The relationships between dentists' attitudes, and dental hygienists' actual behavior, the age of the dentist and the number of dental hygienists and dental assistants employed in the practice were also explored.Methods: Survey data were collected from 292 general dentists in the state of Michigan concerning their attitudes and behavior related to dental hygienists' scope of practice.Results: The average number of services dental hygienists provided in the practices surveyed were lower than the average number of services that dental hygienists are legally permitted to provide in the state of Michigan. The higher the importance dentists placed on dental hygienists' clinical and overall contributions to their practice and their patient management skills, the more diagnostic services and therapies the dental hygienists performed. The older the dentists were, the higher they rated the importance of dental hygienists' clinical contributions, their contributions for the provision of patient care, and the more often dental hygienists performed diagnostic and additional procedures.Conclusions: While dentists did not indicate delegating all of the legally allowable dental hygiene duties in their practices, they did indicate having a very high appreciation of the contributions of dental hygienists to their practice. The perceived value of dental hygienists' contributions correlated positively with the number of diagnostic and adjunctive services dentists delegated dental hygienists to perform in their practices.

Educating Dental Students About Eating Disorders: Perceptions and Practice of Interprofessional Care.

Providing care for patients with eating disorders (EDs) requires an interprofessional care (IPC) approach. The aims of this study were to assess dental students' ED- and IPC-related educational experiences, perceptions of preparedness for ED-related communication with patients and providers, and attitudes related to an IPC approach to ED. Relationships among perceptions of education, preparedness, attitudes, and characteristics (e.g., year in program and family members in other health care fields) were also explored. Of the 440 University of Michigan students invited to participate, 339 completed the survey (77% response rate). A total of 257 students from another 21 dental schools completed the web-based survey, but their response rates could not be computed because it is unknown how many academic deans at the other 65 schools forwarded the recruitment email to their students. In the combined results, the students did not evaluate their ED- and IPC-related clinical education positively (mean=1.33 on scale from 1=least to 3=most education), with first-year students (D1) reporting the least and fourth-year students (D4) the most educational experiences (D1: 1.08, D2: 1.16, D3: 1.42, D4: 1.59; p<0.001). While the students did not perceive themselves well prepared to talk with patients about mental health/ED, they reported feeling better prepared for IPC-related communication: on scale from 1=least to 5=most prepared, mean (patient)=2.94 vs. mean (IPC/provider)=3.61; p<0.001. All the students had mean positive attitudes towards dental professionals' ED-related responsibilities and related IPC considerations. The more education these students reported, the more prepared they perceived being and the more positive their attitudes. The more family members in health professions the students had, the better prepared they reported feeling to communicate with patients and providers from other disciplines about EDs. However, the finding that even the fourth-year students did not evaluate their ED- and IPC-related clinical education positively deserves attention. Educating students about EDs with an IPC approach could ensure better professional preparedness in this context.

Cytokines in saliva increase in head and neck cancer patients after treatment.

OBJECTIVE: Approximately one-third of advanced head and neck squamous cell carcinomas (HNSCCs) recur within 2 years of treatment. Due to ease of collection, saliva is of interest to monitor changes that correlate with treatment. Previously this was a challenge due to xerostomia after conventional radiation. The emergence of gland-sparing radiation has made it possible to collect saliva post-treatment. This study investigated changes in cytokines in saliva pre- and post-treatment to provide foundational knowledge for future studies exploring the use of saliva to monitor treatment response. STUDY DESIGN: Pre- and post-treatment saliva was evaluated for 8 cytokines by multiplex assay and enzyme-linked immunosorbent assay. RESULTS: In oropharyngeal HNSCC, secretion of epidermal growth factor (EGF), GROα (Growth-regulated protein alpha), interleukin (IL)-1α, IL-ß, IL-6, IL-8, tumor necrosis factor-α, and vascular endothelial growth factor increased significantly post-treatment. In additional patients, significant increases of GR-α and IL-6 were validated, but EGF showed no change. CONCLUSIONS: The uniqueness of this study is its comparison of salivary cytokines from HNSCC patients pre- and post-treatment.

Student Evaluations of Teaching: Dental and Dental Hygiene Students' and Faculty Members' Perspectives.

The aim of this study was to explore dental and dental hygiene students' and faculty members' perceptions of student evaluations of teaching (SET) and determine whether dental vs. dental hygiene student, beginning vs. advanced student, and faculty vs. student responses differed. Perceived benefits, challenges, and suggestions for conducting SETs optimally were also assessed. Survey data were collected from 329 dental students (D1: 108; D2: 91; D3&4: 130) and 68 dental hygiene students (DH2: 26; DH3: 19; DH4: 23) (overall response rates 76%/92%) and 56 dental and eight dental hygiene faculty members (response rates 41%/100%). Faculty respondents were more positive about SETs than students (five-point scale with 1=disagree: 3.85 vs. 3.39; p<0.001), with seniors being the least positive (mean 2.42). Respondents agreed that all students should complete SETs (3.87 vs. 3.61; p=0.068), with faculty agreeing more strongly than students that all courses should be evaluated (4.32/4.04; p=0.046). Students agreed more strongly than faculty that SETs should occur during regular class time (3.97/3.44; p<0.001) and are too long (3.47/3.09; p=0.010) and that results should be shared with students (4.03/3.57; p=0.002). Open-ended responses showed that students perceived more benefits of SETs for faculty members than for students and that the most frequently mentioned problem was that SETs do not result in changes. Faculty members were generally more positive than students (especially seniors) about SETs. These findings suggest that, according to these respondents, SETs should be completed by all students for all courses, be short, provide opportunities for open-ended comments, and be administered in class to improve response rate. In addition, SET results and how SETs are used to improve courses should be shared with students.

Grand rounds for dental students: an exploration.

Grand Rounds are widely used in medicine for educating students comprehensively about clinical issues. The aim of this study was to explore the value of Grand Rounds for introducing first- (D1) and second-year (D2) dental students to an interdisciplinary approach to dental care. The objectives were to explore how interested students were in various topics, which topics they would like to see addressed in future sessions, which aspects they liked/disliked, how they evaluated the program components, and how they evaluated the outcomes. Data were collected from D1s at the end of the Year 1 fall term and from D1s and D2s at the beginning and end of the Year 1 winter term and at the end of Year 2. Response rates for most of the groups ranged from 88% to 100%, but response rates for surveys at the end of the study period fell to 40% and 32%. The results showed that the students were most interested in clinical topics that were presented in an interdisciplinary way. Their suggested topics ranged from specialty-specific issues to treatment-related topics such as implants and cosmetic dentistry. The open-ended responses showed that students liked learning differing perspectives on these topics, but disliked the course-related assignments and the preparation work in small groups. The closed-ended responses showed that the students appreciated the in-class presentations by experts and evaluated the course as helpful in informing them about the complexity of issues and the importance of the interplay between basic and clinical sciences. Educating future dentists in a way in which they embrace interdisciplinary approaches is challenging. Using the Grand Rounds concept could be one approach to increasing students' awareness of the importance of interdisciplinary work.

Dental and dental hygiene students' perceptions of a standardized patient instructor conflict resolution program.

The aim of this study was to examine students' perceptions of the value of a standardized patient instructor conflict resolution program designed to strengthen their communication and confidence during difficult patient conversations. Three cohorts of students at one dental school were part of the study: the dental class of 2013, the dental class of 2014, and the dental hygiene class of 2013. The same groups of students completed surveys immediately following the program and one, two, or three years afterwards. Response rates for the survey immediately after the program were 98 percent (n=99) of the dental class of 2013, 97 percent (n=103) of the dental class of 2014, and 100 percent (n=25) of the dental hygiene class of 2013. Response rates for the subsequent survey were 41.5 percent (n=42) of the dental class of 2013, 74.5 percent (n=79) of the dental class of 2014, and 100 percent (n=25) of the dental hygiene class of 2013. In the results, all students reported a high level of satisfaction in their immediate assessment of the program and its ability to prepare them for conflict situations. They also reported a high level of satisfaction in their retrospective self-assessment of conflict resolution skills. However, their assessment of the program's value and applicability appeared to have diminished over time. This study suggests that the program should continue being a part of both dental and dental hygiene curricula, with more training and guided experiences in self-assessment and perhaps supplemental experiences added.

Toxicities affecting quality of life after chemo-IMRT of oropharyngeal cancer: prospective study of patient-reported, observer-rated, and objective outcomes.

PURPOSE: To test the hypothesis that intensity modulated radiation therapy (IMRT) aiming to spare the salivary glands and swallowing structures would reduce or eliminate the effects of xerostomia and dysphagia on quality of life (QOL). METHODS AND MATERIALS: In this prospective, longitudinal study, 72 patients with stage III-IV oropharyngeal cancer were treated uniformly with definitive chemo-IMRT sparing the salivary glands and swallowing structures. Overall QOL was assessed by summary scores of the Head Neck QOL (HNQOL) and University of Washington QOL (UWQOL) questionnaires, as well as the HNQOL "Overall Bother" question. Quality of life, observer-rated toxicities (Common Toxicity Criteria Adverse Effects scale, version 2), and objective evaluations (videofluoroscopy assessing dysphagia and saliva flow rates assessing xerostomia) were recorded from before therapy through 2 years after therapy. Correlations between toxicities/objective evaluations and overall QOL were assessed using longitudinal repeated measures of analysis and Pearson correlations. RESULTS: All observer-rated toxicities and QOL scores worsened 1-3 months after therapy and improved through 12 months, with minor further improvements through 24 months. At 12 months, dysphagia grades 0-1, 2, and 3, were observed in 95%, 4%, and 1% of patients, respectively. Using all posttherapy observations, observer-rated dysphagia was highly correlated with all overall QOL measures (P<.0001), whereas xerostomia and mucosal and voice toxicities were significantly correlated with some, but not all, overall QOL measures, with lower correlation coefficients than dysphagia. Late overall QOL (≥6 or ≥12 months after therapy) was primarily associated with observer-rated dysphagia, and to a lesser extent with xerostomia. Videofluoroscopy scores, but not salivary flows, were significantly correlated with some of the overall QOL measures. CONCLUSION: After chemo-IMRT, although late dysphagia was on average mild, it was still the major correlate of QOL. Further efforts to reduce swallowing dysfunction are likely to yield additional gains in QOL.

Survey of Michigan dentists and radiation oncologists on oral care of patients undergoing head and neck radiation therapy.

BACKGROUND: Oral complications of radiation therapy for head and neck cancer (HNC) are associated with a significant decline in oral health-related quality of life (OHQOL). The dentist, working with the radiation oncologist and the rest of the health care team, plays an important role in the prevention and management of these complications, but patients do not always receive care consistent with current guidelines. This study investigated barriers to recommended care. HYPOTHESES: There is variability in knowledge and practice among dentists and radiation oncologists regarding the dental management of patients treated with head and neck radiotherapy (HNRT), and inadequate communication and collaboration between members of the patient's health care team contribute to inconsistencies in application of clinical care guidelines. There is on interest and need for continuing dental (CDE) and medical education (CME) on this topic. MATERIALS/METHODS: A questionnaire was developed to assess dentists' knowledge and practice of dental management of HNC patients and their interest in CDE on this topic. All members of the Michigan Dental Association (MDA) with email addresses were asked to complete the survey online, and a random sample of MDA members without email addresses was invited to complete a paper version of the same survey. All Michigan members of the American Society for Radiation Oncology (ASTRO) were invited to complete an online version of the survey modified for radiation oncologists. RESULTS: The response rate for dentists was 47.9% and radiation oncologists was 22.3%. Of the dentists who responded, 81% reported that a major barrier to providing dental treatment before radiotherapy was a lack of time between initial dental consultation and the start of radiation; inadequate communication between health care providers was blamed most frequently for this. Ten percent of the dentists and 25% of the radiation oncologists reported that they did not treat HNC patients because they lacked adequate training, and 55% of dental respondents said that they did not feel adequately trained in dental school to treat patients who have had head and neck radiation therapy. Most respondents (radiation oncologists 67%; dentists 72%) were interested in CDE and CME on this topic. CONCLUSIONS: These results suggest a need for CDE and CME for Michigan dentists and radiation oncologists on the oral management of HNC patients. Improved training and communication between health professionals could improve patient outcomes and more consistent application of clinical care guidelines.