Program Director Attitudes Toward Acceptance of Pediatric Dentistry Entrustable Professional Activities (EPAs).

Purpose: To acquire comments on pediatric dentistry entrustable professional activities (EPAs) from pediatric dentistry residency program directors (PDs). Methods: An electronic survey invited PDs to evaluate 16 previously developed EPAs on whether they were critical to patient safety, resident education, or both. PDs were asked to evaluate a fully developed EPA to assess structure and clarity and describe barriers to EPA. Descriptive statistics were completed. Results: Forty-one of 103 PDs completed the entire survey. Eighty-five percent (36 of 42) of PDs believed EPAs are critical to pediatric dentistry education, and 81 percent (34 of 42) believed EPAs are critical to patient safety. Eighty-one percent of PDs would likely use EPAs when available. Seventy-five percent (31 of 41) of PDs reported that they have had a resident who would have benefited from a longer duration of training. Conclusions: The majority of pediatric dentistry residency program director participants surveyed reported that entrustable professional activities are critical to patient safety and resident education. EPAs may be a valuable option for assessing residents' readiness for graduation.

Development of entrustable professional activities for post-doctorate pediatric dentistry education.

PURPOSE: To identify the core components of pediatric dentistry defining entrustable professional activities (EPAs) representing the profession. METHODS: Potential core components of pediatric dentistry and corresponding domains were identified through review of literature and existing pediatric dentistry standards. A modified Delphi technique was utilized to rate these candidate EPAs to achieve consensus around prioritized EPAs. RESULTS: Eleven participants participated in all three rounds of the Delphi. After three rounds, 16 candidate EPAs reached consensus for pediatric dentistry. Each EPA fell into one of four domains: "assessment and planning," "provision of care," "behavior guidance," and "professional development." An original candidate EPA focused on non-pharmacological behavior guidance was deemed too broad by the Delphi. This EPA was subsequently developed into three separate components on nitrous oxide analgesia, moderate sedation, and general anesthesia. CONCLUSIONS: Prioritized EPAs will help define the essential activities of the profession and provide a framework for creating assessments to ensure that graduating pediatric residents are ready for unsupervised practice.

LGBTQ+ and dental education: Analyzing the present and recommendations for the future.

LGBTQ+ populations constitute increasing proportions of children, adolescents, and adults in the United States. Compared to their heterosexual counterparts, this group suffers from health inequities, including oral health. The report "Oral Health: Advances and Challenges" identified the LGBTQ+ community as an underserved population which faces significant barriers in accessing oral health care. Coverage of LGBTQ+ topics in formal education settings in both dental schools and dental hygiene programs is scarce, which contributes to inequities within this group. Increasing curriculum content related to LGBTQ+ populations is of utmost importance to promote optimal patient-provider interactions while improving oral health outcomes. Ensuring equity in oral health care provision will require deliberate, consistent efforts on the part of all stakeholders. Dental and allied dental education programs have made important strides in enhancing equity and inclusion in their institutions by engaging campus groups that support LGBTQ+ populations, creating mentorship programs, and collaborating with non-profit advocacy groups. Such efforts have successfully empowered LGBTQ+ patients, providers, and allies who are committed to further closing the knowledge gap. Most of the research regarding LGBTQ+ inclusion efforts have been done in the medical arena and there is a void in the data available from the dental profession. To fill this void, recommendations are offered that institutions can easily implement to expand LGBTQ+ diversity and inclusion visibility.

Pediatric Dentistry Program Directors' Resident Assessment Techniques.

Purpose: The purpose of this study was to determine how pediatric dentistry residency program directors evaluate residents and determine graduation readiness. Methods: A questionnaire containing demographic, multiple answer, and yes/no questions was developed by investigators and piloted to former program directors. An updated survey was distributed electronically to program directors in the United States. Subjects were asked to respond to current resident evaluation strategies and future opportunities. Results: Fifty-seven program directors responded to the survey, for a response rate of 55.9 percent. Most relied on daily observation to determine competence and ability to move to more complex procedures. Most were interested in standardized parameters to determine competence but had concerns about cost and time to implement. Most were not aware of entrustable professional activities as a method to evaluate for competence. Conclusion: Program directors rely primarily on daily observation and formal assessments to evaluate residents and determine readiness for graduation.

Understanding and Caring for LGBTQ+ Youth by the Oral Health Care Provider.

With growing visibility, there is an increasing prevalence of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth who feel empowered to own their true identity. Members of the oral health team frequently do not receive sufficient education in their training to recognize the nuance that treating this population may require. Although the tooth-level treatment does not materially change, a deeper appreciation of development of sexuality and gender identity, transgender medicine, and the health disparities LGBTQ+ youth face can promote more meaningful, trusting clinical relationships with this vulnerable population. This article aims to provide members of the oral health team with the requisite knowledge to deliver culturally competent care to LGBTQ+ youth.

Caregiver acceptance of an anticipated COVID-19 vaccination.

BACKGROUND: The world is hopeful a vaccine will help mitigate the COVID-19 pandemic. The authors conducted a hospital-based study using a questionnaire to examine parental acceptance of an anticipated COVID-19 vaccination. METHODS: A 41-item questionnaire using the Health Belief Model was administered to caregivers of children receiving oral health care in a dental clinic in an urban pediatric teaching hospital. Demographic, health-seeking, and health-behavior questions were assessed. RESULTS: A total of 39.2% of caregivers would not allow their child to receive a COVID-19 vaccination. Whereas 27.8% of caregivers agreed that if their physician recommends a COVID-19 vaccination, they will allow their child to receive it, 52.2% said that a health care professional could influence this decision. CONCLUSIONS: Dentists, intimately aware of the suggested risks of aerosol-generating procedures, can play a critical role in educating the public about the importance of accepting a COVID-19 vaccine. PRACTICAL IMPLICATIONS: Dentists are in a unique position to discuss and advocate for vaccine acceptance. If a COVID-19 vaccine is not widely accepted, risks associated with performing aerosol-generating procedures will remain.

Preferential Use of Stainless Steel Crowns as a Strategy to Minimize Retreatment of Primary Molars under General Anesthesia.

Purpose: The purpose of this study was to investigate whether primary molars treated with composite resins (CRs) and stainless steel crowns (SSCs) during an oral rehabilitation under general anesthesia (GA1) required retreatment at a second oral rehabilitation under GA (GA2). Methods: Records were examined from 296 healthy patients with more than one dental rehabilitation under general anesthesia from June 2012 to January 2019. Data included treatment details and demographic information. Frequencies and means were recorded. An analysis was completed using logistic regression and chi-square for categorical variables. Results: For primary first molars, 43 percent of CRs placed at GA1 were treated with SSCs at GA2. For primary second molars, 35 percent of CRs placed at GA1 were treated with SSCs at GA2. There was no statistically significant difference in retreatment rates by molar type (P equals 0.27). Eight percent of SSCs placed on any molar at GA1 required retreatment at GA2. Conclusions: Primary molars treated with stainless steel crowns using general anesthesia had the lowest percentage of retreatment compared to those treated with composite resins. Strong consideration should be given to the placement of SSCs on primary molars in patients with early childhood caries under general anesthesia. Placement of primary molar SSCs during initial treatment under general anesthesia may reduce the need for additional treatment in the future.

Oral Sex Knowledge and Experience of Transgender Youth: An Opportunity for Dental Education.

Recent evidence suggests that, when compared to their cisgender counterparts, transgender youth exhibit more unsafe sexual behavior that may elevate their risk for sexually transmitted infections. The aim of this study was to better understand what transgender youth know about oral sex, related consequences, and mechanisms of protection and where they obtained this information. The findings can be helpful in preparing oral health providers to play a role in meeting this public health need. The study took place at a U.S. academic pediatric medical center in 2017. Participants were recruited at a Transgender Research Day and during Transgender Clinic sessions. English-speaking transgender adolescents ages 14 to 24 were invited to participate in a previously validated survey about their knowledge and behaviors related to oral sex. Of the 138 transgender youth invited to participate, 57 completed the surveys, for a 41% response rate. Most respondents reported feeling they understood the necessity of protection and consequences of oral sex but did not use protection. Over half of the participants (58%) said they had not had a physician, dentist, or parent speak to them about oral sex. Given the lack of standardized, evidence-based sex education, it is imperative that adolescents, particularly in highly vulnerable populations like transgender youth, receive accurate information about oral sexual contact. Dental schools should prepare future practitioners to address these issues with youth using a culturally competent, evidence-based approach.

ADEA Faculty Diversity Toolkit: A Comprehensive Approach to Improving Diversity and Inclusion in Dental Education.

Population demographic shifts in the United States and Canada have led to an increasingly diverse postsecondary student population. However, the largely homogenous dental faculty in the United States and Canada does not reflect the rapidly changing student body and the diverse patient population academic dentistry has been called to serve. Therefore, recruitment and retention of diverse dental faculty in dental education must be a priority. Substantial evidence also indicates improved outcomes for faculty, students, and institutions when faculty diversity on campus is increased. Beyond the positive impact faculty diversity can deliver to the learning and working environments of an academic institution, a variety of regulatory bodies mandate good faith efforts to maintain a diverse faculty, including the Commission on Dental Accreditation (CODA) standards for dental schools and dental therapy education programs. To assist its member institutions with answering the call for improved faculty diversity, the American Dental Education Association (ADEA) worked with its members to develop the ADEA Faculty Diversity Toolkit (ADEA FDT), a landmark evidence-based resource designed to assist dental education with the design and implementation of faculty recruitment and retention initiatives that can be tailored to their unique needs. This article provides an overview of the changing landscape of the United States and Canadian populations, shares the historic homogeneity of dental education faculty, provides an overview of some of the benefits associated with faculty diversity and highlights the challenges and barriers related to recruiting and retaining diverse faculty. Most importantly, it introduces the ADEA FDT and the need for dental schools and allied dental programs to use the Toolkit as a proactive resource in increasing and maintaining faculty diversity. Furthermore, it provides an overview of how to utilize and adapt the highlighted best practices and model programs to improve faculty diversity on their campuses.

Supporting and Caring for Transgender and Gender-Expansive Individuals in the Dental Practice.

Transgender and gender nonconforming youth are rapidly gaining visibility and acceptance. Nevertheless, this group still experiences a variety of health disparities and is often at high risk for negative health outcomes. To improve cultural competence and provide the best possible care to this vulnerable population, health care professionals, including dentists, need to have a broader understanding of their issues. The purposes of this paper are to (1) summarize the prevalence, etiology, treatment, and common health risks associated with a transgender or gender nonconforming identity; and (2) discuss strategies to create a safe and welcoming environment for this population in the dental practice. (J Dent Child 2019;86(3):173-9).

"I just want to be treated like a normal person": Oral health care experiences of transgender adolescents and young adults.

BACKGROUND: Transgender and gender nonconforming (TGNC) people continue to experience health care disparities despite increasing visibility and acceptance. As far as is known, no information exists regarding their experiences with oral health care providers. In this study, the authors intended to understand how TGNC adolescents and young adults interface with their oral health care providers. METHODS: A total of 36 participants, including patients 14 through 24 years of age and their caregivers, were recruited from the Transgender Health Clinic at the Cincinnati Children's Hospital, Cincinnati, Ohio. Interviews were conducted using a semistructured interview guide. All interviews were transcribed verbatim, coded, and analyzed for major themes using grounded theory methodology. RESULTS: Overall, participants reported positive experiences with their oral health care providers. Those with negative experiences reported that the problems were corrected rapidly. Some participants reported issues processing insurance. Several indicated that stress and anxiety related to gender identity could be reduced via use of certain strategies. CONCLUSIONS: TGNC adolescents and young adults have minimal difficulty receiving oral health care. Oral health care providers can make minor modifications to intake forms and office design to improve patient experience and reduce stress and anxiety related to gender identity in the health care setting. PRACTICAL IMPLICATIONS: Although TGNC adolescents and young adults may not need oral health care specific to their identity, taking steps to provide a safe and comfortable treatment setting can improve patient experience for this vulnerable population.

Sexual orientation-related oral health disparities in the United States.

OBJECTIVE: Recent reports have documented health disparities according to sexual orientation and used the minority stress model as a framework for understanding their origins. To date, however, sexual orientation-related disparities in the oral health domain have not been evaluated. Accordingly, this study sought to investigate potential health disparities in objectively-assessed and subjective reports of oral heath among lesbian, gay, and bisexual adults relative to the heterosexual community-dwelling US population. METHODS: We used three consecutive cycles (2009-2014) of National Health and Nutrition Examination Survey (NHANES) data for men and women aged 18-59 years. We examined clinical measures of dental caries, tooth loss, chronic periodontitis, and oral human papillomavirus (HPV) as well as subjective reports of oral health status and use of dental services. RESULTS: Clinical measures of oral disease did not differ according to sexual orientation; however, bisexual adults were more likely to rate their oral health unfavorably (41%) than heterosexual adults (27%). Gay men reported "bone loss around teeth" more frequently (35%) than heterosexual (11%) and bisexual (10%) men. Bisexual individuals were more likely to confront barriers to accessing dental care (30%) versus heterosexual adults (19%). CONCLUSIONS: While clinical measures of oral health did not substantially differ between sexual orientation strata, subjective measures of oral health were worse among gay, lesbian, and bisexual adults versus heterosexual adults. Further study of the psychosocial construction of oral health among sexual minorities is warranted.

Pediatric Dentists' Attitudes, Perceptions, and Experience with the Affordable Care Act.

PURPOSE: Pediatric oral health benefits were designated as one of 10 Essential Health Benefits (EHB) in the Affordable Care Act. Although it provided coverage for many children, several issues prevent its success. The purpose of this study was to document experience with, attitudes toward, and perceptions of the Affordable Care Act (ACA) among pediatric dentists. METHODS: The study was conducted using a survey consisting of nine multiple choice questions and one open-ended item and was distributed electronically in November 2015 to active and life members of the American Academy of Pediatric Dentistry. RESULTS: Respondents reported patients deferring treatment due to high out-of-pocket costs. Providers perceive that patients do not have enough information to understand their benefits. Providers reported not having enough information to understand how these benefits affect their practices. CONCLUSIONS: Pediatric dentists report deferral of both preventive and restorative care due to high out-of-pocket costs. Pediatric dentists do not feel they have adequate information regarding the Affordable Care Act and its effect on their practices. The majority of pediatric dentists believe that parents have difficulty understanding their children's benefits.