Development and integration of a clinical dashboard within a dental school setting.

PURPOSE: To describe the development and integration of an electronic health record-driven, student dashboard that displays real-time data relative to the students' patient management and clinic experiences at the University of Illinois Chicago, College of Dentistry. MATERIALS AND METHODS: Following development and implementation of the student dashboard, various objective metrics were evaluated to identify any improvements in the clinical patient management. A cross-sectional retrospective chart review was completed of the electronic health record (axiUm, Exan, Coquitlam, BC, Canada) from January 2019 to April 2022 evaluating four performance metrics: student lockouts, note/code violations, overdue active patients, and overdue recall patients. Descriptive statistics were analyzed. The Kolmogorov-Smirnov test was applied to assess the normal distribution of data. Data were analyzed by the Kruskal-Wallis tests for potential differences between pre-dashboard and post-dashboard implementation years with the mean overdue active/recall patient to student ratio variables. Mann-Whitney U-tests for between-groups comparisons with Bonferroni correction for multiple comparisons were performed (α = 0.05). Descriptive statistics were performed to analyze the student utilization frequency of the dashboard. RESULTS: Post-implementation analysis indicated a slight decrease in the number of lockouts and note/code violation; and a statistically significant decrease in overdue active patients post-dashboard (P < 0.001). On average, students accessed their dashboards 3.3 times a week. CONCLUSIONS: Implementation of a student dashboard through the electronic health record platform within an academic dental practice has the potential to assist students with patient management and is utilized regularly by the students.

Patterns of complementary and alternative medicine (CAM) use among dental patients.

OBJECTIVES: Complementary and alternative medicine (CAM) is a diverse collection of approaches used to prevent or treat diseases. The goal of this study was to examine relationships between dental patient characteristics and current usage of CAM therapies. METHODS: The CAM definition encompassed 24 therapies excluding prayer. Associations and trends in usage were assessed for gender, income, education, and age. Multivariable logistic and negative binomial models were used to identify factors impacting the use and number of CAM therapies used. RESULTS: In dental patients (n = 402), nearly 67 percent of subjects reported at least one CAM treatment. Gender was significantly associated with recent utilization of CAM, biological, manipulative (all P < 0.01), and mind-body (P = 0.04) therapies, as well as the number (P < 0.01) of therapies used. Higher education levels were significant in usage of any CAM, biological, and mind-body therapies (P < 0.01). CONCLUSION: A large proportion of dental patients reported use of CAM therapies. While CAM therapies and those who use them are diverse, given their widespread use, they clearly have potential impacts on the oral health of the public. Knowledge of the characteristics of dental patients who use CAM therapies is a first step in developing a broader understanding how CAM therapies and associated beliefs may affect oral health and public health programs.

Complementary and alternative medicine in predoctoral dental curricula: an exploratory survey of U.S. dental schools.

The purpose of this study was to identify the prevalence of complementary and alternative medicine (CAM) education in U.S. dental schools. A survey was administered via e-mail to each U.S. dental school's academic dean, and data were collected from respondents in a fillable PDF form submitted electronically to the study investigators. The survey asked respondents whether CAM was taught at the institution; if the response was yes, information was requested regarding the CAM therapies included, credentials of the instructor, number of hours taught, reason for teaching CAM, and format in which CAM was taught. Of the sixty dental schools contacted, twenty-two responded to the survey (37 percent response rate). Of these respondents, ten (45.5 percent) reported offering instruction in CAM as part of their predoctoral curricula. Herb/drug interactions were found to be taught with more frequency than any other CAM topic (in six out of the ten institutions). Limitations of the study are discussed, and suggestions for future studies are made.

Complementary and alternative medicine usage by patients of a dental school clinic.

This pilot study investigated the prevalence and specific reasons for usage of complementary and alternative medicine (CAM) among patients of a dental school clinic. Four hundred and two patients completed a 30-page survey on CAM usage. A higher rate of CAM usage was found in this dental school clinic population than rates previously reported in a general population. More than three-quarters (76.1%) of the respondents reported using at least one CAM treatment in the past 12 months; 93.3% reported using at least one CAM treatment at some time in their lives. High rates of chiropractic use were found in this population. Tooth pain was the most frequently reported dental condition motivating CAM use. About 10% of dental school clinic patients use topical oral herbal and/or natural products to treat dental conditions, most frequently for preventive/oral health reasons or for tooth pain.

The use of a respiratory rate biofeedback device to reduce dental anxiety: an exploratory investigation.

Anxiety experienced by individuals visiting the dental office to receive treatment is common. Evidence has shown biofeedback to be a useful modality of treatment for numerous maladies associated with anxiety. The purpose of the current pilot study was to investigate the use of a novel biofeedback device (RESPeRATE™) to reduce patients' pre-operative general anxiety levels and consequently reduce the pain associated with dental injections. Eighty-one subjects participated in this study, forty in the experimental group and forty-one in the control group. Subjects in the experimental group used the biofeedback technique, while those in the control group were not exposed to any biofeedback. All subjects filled out a pre-injection anxiety survey, then received an inferior alveolar injection of local anesthetic. Post-injection, both groups were given an anxiety survey and asked to respond to four questions regarding the injection experience using a Visual Analog Scale (VAS). With the use of the respiratory rate biofeedback device, there was a significant reduction of negative feelings regarding the overall injection experience, as measured by a VAS. Our findings demonstrate that this novel biofeedback technique may be helpful in the amelioration of dental anxiety, and may help produce a more pleasant overall experience for the patient.

Prenatal diagnosis of ventriculocoronary arterial communication in fetuses with hypoplastic left heart syndrome.

OBJECTIVE: The purpose of this series was to describe the fetal echocardiographic findings in hypoplastic left heart syndrome with aortic atresia and ventriculocoronary arterial communication and implications of these findings. METHODS: We describe 2 fetuses with hypoplastic left heart syndrome with ventriculocoronary arterial communication diagnosed at 29 and 20 weeks' gestation, respectively. The underlying cardiac anatomy consisted of a hypoplastic left heart and mitral stenosis with aortic atresia. We used color Doppler and pulsed Doppler sonography on the surface of the myocardium to specifically look for coronary arterial flow. RESULTS: By color Doppler sonography, ventriculocoronary arterial communication was shown between the left ventricular cavity and the left coronary artery with characteristic bidirectional flow on pulsed Doppler examination. There was no mitral regurgitation. The left ventricular myocardium was substantially hypertrophied. The first patient underwent surgical Norwood palliation and died after a prolonged postoperative course. The second patient underwent stenting of the arterial duct and bilateral pulmonary artery banding in the catheterization laboratory but died after a few weeks. Implications of ventriculocoronary arterial communication in association with hypoplastic left heart syndrome are discussed. CONCLUSIONS: It is possible to accurately diagnose ventriculocoronary arterial communication on fetal echocardiography. The presence of ventriculocoronary arterial communication is seen exclusively in a subgroup of patients with an aortic atresia and mitral stenosis variant of hypoplastic left heart syndrome. The prognosis is poor in this subgroup of patients.

Fetal echocardiographic diagnosis of vascular rings.

OBJECTIVE: The purpose of this series is to describe the prenatal echocardiographic findings of vascular rings. METHODS: The 3-vessel and trachea view consists of the axial view of the upper mediastinum. The normal left aortic arch appears as a V-shaped confluence of the ductus arteriosus and aortic arch, with the trachea situated posterior and to the right. No vessel should encircle the trachea. The diagnoses of vascular rings were made prenatally and were confirmed in all patients postnatally. RESULTS: Six fetuses had diagnoses of vascular rings. The mean gestational age at diagnosis was 23.3 weeks (range, 18-31 weeks). The indications for fetal echocardiography were family history of congenital heart disease, echogenic focus in the left ventricle, and abnormal 4-chamber view. There were 2 fetuses with a double aortic arch; 3 fetuses with a right aortic arch, an aberrant left subclavian artery, and a left ductus arteriosus; and 1 with a right circumflex aortic arch with a left ductus arteriosus and an aberrant left subclavian artery. Two fetuses had associated structural cardiac defects, 1 with an unbalanced atrioventricular septal defect and trisomy 21 and the other with a double-outlet right ventricle, pulmonary atresia, and multiple other congenital anomalies. CONCLUSIONS: Vascular rings can be accurately diagnosed prenatally with recognition of a vascular structure that courses around the trachea and absence of the usual V-shaped relationship of the aortic and ductal arches. The color Doppler findings and the presence of a ductus arteriosus aid in identifying various components of the vascular ring.

Totally anomalous pulmonary venous connection and complex congenital heart disease: prenatal echocardiographic diagnosis and prognosis.

OBJECTIVE: The purpose of this study was to determine the accuracy of prenatal cardiac diagnosis, prognosis, and outcome of totally anomalous pulmonary venous connection (TAPVC) and to determine echocardiographic clues in the prenatal diagnosis of isolated TAPVC or TAPVC in association with other complex congenital heart disease (CHD). METHODS: We reviewed our 13-year experience of prenatal diagnosis of TAPVC. Thirteen fetuses were identified with the diagnoses of TAPVC. We systematically analyzed the individual pulmonary veins by color and pulsed Doppler imaging, the presence of a pulmonary venous confluence, the pulsed and color Doppler evaluation of the vertical vein, and sites of connections. Prenatal diagnosis was confirmed by postnatal echocardiography, cardiac catheterization, surgery, or autopsy. RESULTS: The mean gestational age at diagnosis of TAPVC was 26.3 weeks (range, 20-33 weeks). There were 8 fetuses with TAPVC and right isomerism, 3 fetuses with other associated CHD, and 2 with isolated TAPVC. There were 7 fetuses with supracardiac TAPVC, 4 with infracardiac TAPVC, and 2 with mixed TAPVC. Pulmonary vein color and pulsed Doppler data were available in 10 of 13 fetuses. The pulmonary venous confluence was visualized in all fetuses except 1. The vertical vein was visualized in all fetuses. Five fetuses had suspected signs of obstruction. The diagnosis was confirmed postnatally or at autopsy in 12 cases. Eight patients underwent surgery; 6 died, and 2 were alive. Two patients had compassionate care and died; 3 pregnancies were terminated. CONCLUSIONS: It is possible to diagnose accurately complex CHD, including the pulmonary venous connections. When diagnosed prenatally, TAPVC carries a poor prognosis.