Visual interpretation of clinical images among dental students using eye-tracking technology.

BACKGROUND: Tele-consultations are increasingly used for screening and diagnosis. Only a few studies have assessed dental students' visual attention to clinical images. AIM: To (i) determine dental students' gaze behavior, visual fixations, and diagnostic competence while viewing clinical images, and (ii) explore potential opportunities to strengthen the teaching-learning approaches. DESIGN: Tobii Pro Nano-device captured the eye-tracking data for 65 dental undergraduate students in this cross-sectional study. The predetermined areas of interest (AOI) for all five clinical photographs were uploaded onto Tobii software. All participants used a think-aloud protocol with no restrictions to view time. RESULTS: A total of 325 clinical pictures were analyzed, and the average view time was 189.25 ± 76.90 s. Most participants started at the center of the image (three frontal photos), spent a significant share of their view time on prominent findings, did not follow a systematic pattern, and exhibited diagnostic incompetence. Also, most participants followed a "Z" viewing pattern (oscillating movement from left to right) for the remaining two pictures. CONCLUSIONS: Subjects frequently fixated on the prominent AOI, however, failed to make the correct diagnosis. Their view patterns revealed no sequential viewing. Therefore, emphasizing knowledge about common dental abnormalities and focusing on full coverage of clinical pictures can improve dental students' diagnostic competence and view patterns.

Association of exposures to environmental chemicals estimated through primary teeth biomatrix and health outcomes in children and adolescents - A systematic review.

Children's heightened susceptibility to environmental exposure arises from their underdeveloped detoxification mechanisms and augmented per-unit body-weight absorption capacity for chemical compounds. Primary teeth are an emerging biomatrix, which aid in storing crucial data on early exposure to harmful substances and developmental illnesses. This systematic review aimed to evaluate the association between environmental chemical exposure and health outcomes in children and adolescents using primary teeth as a matrix. The study protocol was registered with PROSPERO (CRD42023428013). The review spanned studies published between 1974 and 2023, identified through an extensive literature search on databases like MEDLINE, EMBASE, LILACS, CINAHL, the Cochrane Oral Health Group Specialized Register, Scopus, and Web of Science. Distiller SR software was used to assess study quality and extract the outcome data. The NTP-OHAT scale assessed evidence quality, and case-control, cross-sectional, and cohort studies in English were included. Comprehensively reviewing 5287 articles resulted in 29 studies being included in the final analysis, comprising 15 cross-sectional, seven case-control, and seven cohort studies. All 29 studies qualified for qualitative analysis. Eleven studies analyzed lead (Pb) effects on health outcomes, four analyzed manganese (Mn), and 14 investigated other element groups. Primary teeth biomatrix assessed various health outcomes: neurobehavior, childhood behaviour, ADHD, birth outcomes, fetal alcohol syndrome disease, inflammatory bowel disease, and dental caries. This study contributes to existing evidence, reinforcing a link between environmental metal exposure and health consequences. The evidence extends to prenatal and postnatal periods, substantiated by primary teeth biomatrix analysis. Lead level fluctuations can influence neuropsychological functioning, potentially causing cognitive impairments. Altered manganese levels correlate with behavioral issues, adverse effects on visuospatial development, and birth weight changes. Primary teeth biomatrices aid fetal alcohol spectrum disorders diagnosis, and correlations between organo-chemical exposure and autism were observed.

Visual interpretation of panoramic radiographs in dental students using eye-tracking technology.

PURPOSE: While eye-tracking technology is a validated tool in the field of education it is still in its infancy in the field of Pediatric Dentistry. The primary aim of this study was to determine dental undergraduates' search patterns and visual fixations while viewing panoramic radiographs (PR) using an eye-tracker. The secondary aim was to decide on the potential opportunities to enhance teaching-learning strategies when studying these radiographs. METHODS: Sixty-five dental undergraduates in the final year of their dental education consented to and participated in this study. A Tobii Pro Nano screen-based eye-tracking camera was mounted to the lower edge of a laptop with five different PR uploaded onto the Tobii Studio software. Regions of Interest (ROIs) were pre-determined for the five PR. The participants (17 males and 48 females) viewed all the PR images with no time restrictions and a "think-aloud" protocol was exercised. RESULTS: The average view time for the PR was 245.58 ± 106.7 s. Participants spent significantly less time examining the surrounding structures (14.85 s) than the dentitions (primary: 97.58 s and permanent: 37.58 s). Males demonstrated a slightly higher view time (290.88 ± 97.7 s) than females (229.53 ± 106.05 s). CONCLUSIONS: The results revealed that though the participants focused on the ROI, most of them failed to make the correct diagnosis. In addition, the search patterns of the participants unveiled no sequential viewing of PR. Hence the need to revise the teaching-learning strategies for the systematic interpretation of PR images in the dental curriculum is warranted.

Crown dimensions of primary teeth-A systematic review and meta-analysis.

Odontometrics, also known as metric traits, includes mesiodistal, buccolingual dimensions, and crown height. The purpose of this study was to assess pancontinental odontometric variations in the crown dimensions of primary teeth. Ten electronic databases were searched to identify studies that measured crown dimensions of primary teeth, published in English language, without year restriction up to July 2020. Studies included cross-sectional research measuring on casts, subjects, and on radiographs of healthy children. Meta-analysis was performed, and risk of bias was assessed using modified Newcastle-Ottawa Scale. Eighty-seven observational studies were included, with 24,634 participants (9487 males, 11,083 females; 19 studies lacked gender information). Only one study showed a low bias risk, whereas 81 and 5 studies had moderate and high risk, respectively. Sixty-five studies included for meta-analysis revealed heterogeneity in mean mesiodistal dimensions of maxillary first molars from Asia (I2 -99.7%), buccolingual measurements of mandibular first molars from Europe (I2 -99.9%), crown height of mandibular second molars from Africa and Europe (I2 -79.8%). Among mesiodistal and buccolingual dimensions, Australians have larger while Asians have smaller teeth. Pertaining to crown height, very few studies could be found in the literature. This review highlights the variations in crown dimensions of primary teeth among populations.

Embracing Psychological Ownership in Dental Education: A Potential Game Changer.

Psychological ownership (PO) is conceptually defined as the state in which individuals feel as though the target of ownership or a piece of it is "theirs" (i.e., "It is MINE!"). Theoretical dimensions of PO are promotion oriented (self-efficacy, self-identity, belongingness, accountability, autonomy, and responsibility) and prevention oriented (territoriality). This paper describes the application of PO in dental education and assists us to establish or master numerous aforementioned skills during the learning process in dental school. This PO system will facilitate a gradual transition of students from the dental school environment to private practice smoothly without any apprehensions.

Development of a Competency-Based Curriculum for undergraduate education in Pediatric Dentistry: A systematic approach.

The changing paradigm of dental education in India has led its way to the development of Competency-Based Curriculum (CBC). This article describes the process of developing CBC in the specialty of Pediatric Dentistry under the initiative of Dental Council of India. Rationale behind CBC development is to bring uniform system of education for improving oral health outcomes of the society in long term. The process of CBC development was a collaborative teamwork, planned meticulously with predefined outline, tasks and timelines. Workflow involved identification of curricular content, defining program goals, outlining competencies, assigning them domains / levels of clinical competence, priority, educational strategies, assessment practices, integration and numbers needed for certification in selected competencies. Early clinical exposure was introduced in CBC. The final content was validated and submitted to the Council. CBC output can be summarized as competencies with fair share of all domains, levels, prioritization and integration. It is characterized by flexibility for choosing educational strategies and assessment practices. It opens up ways for global competition. However, it still has some inherent weaknesses like diverging learning paths, time constraints and number chasing. CBC can further have more academic flexibility and develop toward an outcome-based approach. Faculty preparedness and acceptability shall be the biggest challenges in CBC implementation besides resources' availability, support from leadership and acceptability from our primary stakeholders, our learners. CBC is the beginning of evidence-based delivery of education in dentistry. An effective implementation of CBC in current form would result in increased numbers of competent oral healthcare professionals for the society.

Management of oral mucosal lesions in salicylate sensitive stevens-Johnson syndrome - A case report.

In the present era, the use of drugs is an important paradigm of health care. Reactions to drugs range from minor cutaneous reactions to potentially lethal conditions like Stevens-Johnson syndrome. A 13-year-old, male patient, known case of Stevens-Johnson Syndrome was referred from the pediatric ward for the management of oral mucosal lesions, post consumption of the antibiotic combination of sulfamethoxazole and trimethoprim. Failure of lesion regression led to the change in the treatment plan, speculating an allergic reaction to one of the components of the initial treatment medication (choline salicylate) as well. Identification and withdrawal of the offending medication and rendering supportive care along with treatment of the lesions with topical corticosteroids form the outline of management. This case report demonstrates the approach undertaken by the pediatric dentist to cure the oral mucosal lesions in symbiosis with pediatricians, ophthalmologists and nutritionists to cure this life-threatening condition.

Prevalence of the Cusp of Carabelli: a systematic review and meta-analysis.

CONTEXT: The Cusp of Carabelli (CoC) is the most commonly occurring dental morphological trait. OBJECTIVE: To provide a pancontinental overview on the prevalence of the CoC in primary maxillary second molars and permanent maxillary molars. METHODS: An electronic search was conducted on ten databases without year restrictions up to July 2020. All cross-sectional studies published in the English language reporting prevalence estimate of CoC were included. A modified version of the Newcastle-Ottawa scale was used to assess study quality. Meta-analyses were conducted for studies that reported data using Dahlberg and ASUDAS classification across continents. RESULTS: For qualitative synthesis, 142 studies (45,327 participants) were included, of which 130 studies had moderate risk of bias. Random effects meta-analysis was performed for 41 studies. For prevalence of CoC in primary maxillary second molars, the estimate was 72% (2,829 participants). The overall percentage attained for permanent maxillary molars was 59% (16,607 participants) for first molars; 8% (2,277 participants) for second molars; and 10% (89 participants) for third molars. Subgroup analysis revealed the European continent reported the highest prevalence in permanent maxillary first and second molars. CONCLUSION: Primary maxillary second molars recorded highest prevalence of CoC followed by permanent maxillary first, third and second molars. Pancontinental studies with regard to primary maxillary second molars are warranted.

Use of Puzzles as an Effective Teaching-Learning Method for Dental Undergraduates.

INTRODUCTION: Passive teaching in the form of didactic lecture is the usual mode of disseminating knowledge in dental colleges in India. An innovative way to address the diverse learners learning style at the undergraduate level is much sought after in dental education. Puzzles in the form of crossword and word search are structural, self-learning educational tools that review and reinforce knowledge and concepts acquired during the lecture. OBJECTIVES: To evaluate the effectiveness of crossword and word search puzzles as an active teaching learning method for dental undergraduates. MATERIALS AND METHODS: This is an open, randomized parallel group interventional study conducted with the final BDS students in the Department of Pediatric and Preventive Dentistry of Sri Ramachandra Institute of Higher Education and Research. Two modules of the "must know" category of the curriculum were selected. The class was divided into two groups (interventional and control) using computerized random generator. Learners in both the groups were exposed to didactic lectures, but the activity of solving the puzzles was undertaken only by the interventional group learners. Questionnaire in the form of MCQ was given at the end of the activity to both the groups, and results were evaluated. RESULTS: Mann-Whitney U test between interventional (Group I) learners revealed an average mean score of 4.2, 6.1, 9.3, and 6 out of 10 in the post-activity test when compared to 2.9, 6.6, 4.6, and 5.1 of the control (Group II) students and was statistically significant in three of four sessions. CONCLUSION: Our study revealed that puzzles can be used as an effective active learning tool to reinforce lecture material for dental undergraduates. HOW TO CITE THIS ARTICLE: Nirmal L, MS Muthu, Prasad M. Use of Puzzles as an Effective Teaching-Learning Method for Dental Undergraduates. Int J Clin Pediatr Dent 2020;13(6):606-610.