American Board of Dental Public Health diplomate survey, 2021: Competency domains and practice.

OBJECTIVE: To describe current Dental Public Health diplomates and list the competency domains that diplomates considered either essential or optional elements of their practice. METHODS: The American Board of Dental Public Health administered an electronic survey to active and life member diplomates during September 2021. The survey included 101 items in three sections: (1) Education and Work Experience; (2) Dental Public Health Tasks; and (3) Demographics. The Dental Public Health Tasks section asked individuals how essential work-related tasks were to their current practice. Descriptive analyses were conducted using SAS. RESULTS: The overall response rate was 82.6% (157 eligible of 190 returned). Most respondents were women, 35 to 54 years of age, and either non-Hispanic white or non-Hispanic Asian. Twice as many had DDS or DMD degrees than BDS degrees. The vast majority completed a Dental Public Health residency and received masters level training from an accredited program. About three-fourths worked in the United States and held a U.S. license. More than 37% reported a second doctoral degree and 70% worked in academia. Responses to questions about tasks closely aligned with working in academia and less so with positions related to advocacy, regulation, and program evaluation. CONCLUSIONS: Current diplomates are concentrated in academia. If this trend continues, it may be necessary to restructure the competencies, so training and skills acquisition remain timely and relevant. The specialty may also need to encourage future generations to consider non-academic positions so Dental Public Health remains an impactful component of the public health care system.

Characteristics of students in International Dentist Training Programs versus applicants who are not yet successful in matriculating.

PURPOSE/OBJECTIVES: For foreign-trained dentists who seek requalification in United States dental schools, the acceptance rate is half that of applicants to traditional 4-year DDS/DMD programs. Unsuccessful applicants also lack clarity on how to strengthen their re-application. This is a comparison of foreign-trained dentists who successfully matriculated into the University of Michigan's advanced standing program and prospective students who have yet to matriculate into any advanced standing program. METHODS: We collected data through a survey on the website of the University of Michigan program for foreign-trained dentists-the Synergy Program is tuition-free and helps International Dental Program (IDP) applicants navigate the application process. Secondly, we surveyed those enrolled in the University of Michigan's IDP. We compared various characteristics of these two groups. Thirdly, we convened focus groups among the University of Michigan IDP and had unstructured discussions about barriers faced by internationally trained dentists in entering an IDP. University of Michigan Medical School Committee on Human Studies determined this research is "not regulated". RESULTS: There were 2400 unique visitors to the Synergy website. Among respondents, 1490 were female (62.1%). A total of 10.1% reported spending over $30,000 on strengthening their application. There were 38 individuals (out of a possible 60) in the University of Michigan's IDP who responded to the survey and 28 were female (73.7%). A total of 31.6% reported spending more than $30,000 on strengthening their application. We had focus groups with 12 IDP students. Regarding perceived differences that led to acceptance, all participants described the advantage in having a greater familiarity with American culture. CONCLUSIONS: We found that those from wealthier households, those who are willing to spend more on their application process, and those who obtained an additional US degree were more likely to be matriculants in IDPs.

Oral health needs of U.S. children with developmental disorders: a population-based study.

BACKGROUND: Children with Special Health Care Needs (CSHCN) have higher rates of oral diseases and tooth decay compared with the general population. Children with developmental disorders/ disabilities (DD) are a subset of CSHCN whose oral health has not been specifically addressed. Therefore, this study had two objectives: to describe the oral health needs (OHN) of children with DD compared with children without DD; and to assess barriers to access to care, utilization of dental services, and their association with oral health needs for children with DD. METHODS: This cross-sectional study utilized a sample of 30,530 noninstitutionalized children from the 2018 National Survey of Children's Health (NSCH). Analysis was conducted using descriptive and inferential statistics. RESULTS: The analysis identified 6501 children with DD and 24,029 children without DD. Children with DD had significantly higher prevalence of OHN (20.3% vs. 12.2%, respectively), unmet dental needs (3.5% vs 1.2%), and utilization of any dental visits (86.1% vs 76.1%), (P-value < . 001). The adjusted logistic model identified four factors that contributed to the higher odds of OHN among children with DD: poverty (< 100% of the Federal Poverty Level (AOR = 2.27, CI: 1.46-3.51), being uninsured (AOR = 2.12, 95% CI: 1.14-3.95), a high level of disability (AOR = 1.89, CI: 1.23-2.78), and living in the western United States (AOR = 1.61, CI: 1.09-2.37. CONCLUSION: Despite higher utilization of dental services, children with DD had poorer oral health and more unmet dental needs than children without DD. Advocacy efforts and policy changes are needed to develop affordable access that assesses, as early as possible, children with DD whose conditions impact their ability a great deal so that their potential OHN may be alleviated more effectively.

Diversity, equity, and inclusion interventions to support admissions have had little benefit to Black students over past 20 years.

The United States has a history of systemic racism and violence toward minority communities. Unfortunately, the last year has demonstrated that systemic racism, and its consequences, persist. The dental profession has also failed to adequately resolve known issues of racial inequity and systemic racism, with persistent disparities in oral health outcomes for Black Americans compared to all other Americans, underrepresentation of minorities in the profession, and barriers to entry. However, dental education has the opportunity to address these issues. Current accreditation standards do not specifically address racial diversity among the student body, yet it is clear that representation of a population matters and the lack of representation may exacerbate race and racism as public health issues in dentistry. To explore the issue, we curated American Dental Education Association (ADEA) data on the race of students admitted and enrolled into dental programs across the United States. We used data visualization techniques to present the data and study trends. While the number of Black and African American (BAA) enrollees in dental schools has increased between 2000 and 2019, this population continues to make up a disproportionately small percentage of all enrollees, relative to the BAA percentage in the U.S. population. Much of the increase in BAA enrollment is attributable to increased places (due to the opening of new schools and increased class size in established schools) and the rate of acceptance of BAA students has had limited improvement. Very little progress has been accomplished in growing the enrollment of BAA applicants to dental school in 20 years. As a profession, we also fail to grow interest among our graduates in careers that may support historically underrepresented and marginalized racial groups-public health, rural practice, population research, academia, and health policy. This may be a contributing factor to the oral health disparities faced by Black Americans and have implications for dental education.

Reaching Vulnerable Populations through Portable and Mobile Dentistry-Current and Future Opportunities.

The Action for Dental Health Act of 2017 bill is intended to prevent dental disease and divert dental emergencies from high-cost centers (like hospital emergency rooms) to dental offices. Lines 15-17 of the bill include grant funding to support portable or mobile dental equipment, and this should lead to an expansion of opportunities to deliver and receive care through the use of portable dental equipment and mobile dental vans, i.e., portable and mobile dentistry (PMD). Historically, PMD has been valuable to bridge the access gap for those for whom transport can be a challenge, like children and the elderly. However, PMD could be valuable to large employers, allowing the employees to receive dental care with minimal disruption to their workday. Oral pain is known to affect work and school attendance, and improving access to dental care could benefit individuals, families, organizations, and communities.

Characteristics of Patients Discontinuing Care.

Objectives: Due to lower fees, dental school clinics (DSCs) may provide dental care for vulnerable populations. This study evaluates factors associated with patients deciding to discontinue care at a DSC. Methods: This is a retrospective analysis of a patient transfer form that was implemented to smooth transition of a patient when their student provider graduated. Forms provided deidentified information about characteristics and unmet dental needs. Descriptive and bivariate statistics were used to identify associations between patient characteristics and deciding to continue treatment in the student practice. Results: Of 1894 patients, 73.4% continued care. Financial limitations were most commonly reported as the reason for discontinuing care (30.1%). Patients speaking a language other than English or who had reported financial barriers were significantly less likely to continue care. Conclusions: Dental school patients from vulnerable groups are more likely to discontinue care. Dental schools should implement programs that will assist patients in maintaining a dental home.

Variability between credit units dedicated to dental and clinical sciences in dental schools across the USA.

PURPOSE: The Commission of Dental Accreditation (CODA) does not set minimum standards for clock hours of training in Dental and Clinical sciences. The purpose of this evaluation was to compare United States (US) dental schools for variability in clock hours. The current paper utilizes the American Dental Association's survey of clock hours of all US dental schools which is publicly available data. Clock hours survey from 2010 to 2011 was utilized and the analysis tool, JMP, was utilized to visualize and report variability. PERSPECTIVE: The current paper highlights the large variation in clock hours of training among core clinical subjects in accredited dental schools around the United States. For example, teaching Physical Evaluations; Oral and Maxillofacial; and Oral Diagnosis and Treatment Planning were 97.0; 126.6; and 74.4 h. Moreover, upper limit for hours of Operative Dentistry teaching was 1410 h and lower limit was 129 h. Various other fields of education do enforce strict requirements on educational clock hours. For instance, Massachusetts' General Law states that both private and public schools must have 900 and 990 h in a school year for elementary and secondary schools, respectively. However, no such stipulation exists in the field of Dental Education. CODA's mission is "to serve the oral health care needs of the public" and CODA must consider if the average dental patient would consider a dentist who attended the school delivering 1410 h of Operative Dentistry to be the same standard as a graduate of the school delivering 129 h.

Does a case completion curriculum influence dental students' clinical productivity?

The purpose of this study was to evaluate the effects of a new clinical curriculum on dental student productivity as measured by number of procedures performed in the student teaching practice. Harvard School of Dental Medicine adopted a new clinical education model for the predoctoral program in summer 2009 based upon a Case Completion Curriculum (CCC) rather than a discipline-based numeric threshold system. The two study groups (threshold group and case completion group) consisted of students who graduated in 2009 and 2010. Clinical performance was assessed by clinical productivity across five major discipline areas: periodontics, operative dentistry, removable prosthodontics, fixed prosthodontics, and endodontics. The relationships between the two study groups with regard to number of procedures performed by category revealed that the case completion group performed a significantly higher number of operative and removable prosthodontic procedures, but fewer periodontal and endodontic procedures (p≤0.03). No statistically significant difference in number of procedures was observed with fixed prosthodontic procedures between the two groups. Clinical productivity as a result of redesigning the clinical component of the curriculum varied in selected disciplines. The CCC, in which the comprehensive management of the patient was the priority, contributed to achieving a patient-based comprehensive care practice.

A case completion curriculum for clinical dental education: replacing numerical requirements with patient-based comprehensive care.

The aim of this article is to describe the development and implementation of a case completion curriculum as a new clinical education model for the predoctoral program at Harvard School of Dental Medicine. In this innovative model, students conduct patient-based comprehensive care and complete assigned patient cases on which their performance is assessed, in contrast with a traditional model based on procedural numerical requirements. In our new model, senior tutors, who are full-time faculty members, act as group leaders responsible for patient assignment, treatment planning, monitoring of student performance, and verification of patient care. The number of completed patient cases in this new comprehensive care system increased from a previous average of 12.8 cases per student prior to graduation to 22.8 cases. Additionally, the number of patients who had to be transferred due to outstanding or pending treatment when their student provider graduated or because of students' need to fulfill discipline requirements has decreased from an average of 16.4 to 4.6.

Integrating leadership into a practice management curriculum for dental students.

Curriculum evaluations by recent graduates of the Harvard School of Dental Medicine suggested the need for additional coursework in practice management. Given the complex challenges facing practitioners, the course design was expanded beyond the suggested practice management to include leadership theory and skills. Students were able to distinguish and assess their level of various leadership skills at the end of the course. The course received an overall rating of 4.23 on a scale of 1 (poor) to 5 (excellent), with 84 percent of responding students indicating that their interest-specifically in the areas of clinical efficiency, practice management, reducing medical errors, communication, business, team building, leadership, and access to care-was enhanced. The responding students assessed their current leadership skills overall at 3.84. They assessed themselves best at "Integrity" (4.48) and worst at "Managing Conflict" (3.12). They felt that "Ability to Build Trust with Others" is the most beneficial skill for a dentist, while "Ability to Influence" is the least beneficial. Eighty-eight percent of students responding indicated that it is "Very Likely" they will continue to practice developing their leadership skills. Qualitative feedback was overwhelmingly positive and indicated that students found the course life-altering and highly valued its breadth of topics.

A faculty group practice-driven credentialing and privileging infrastructure in a school of dental medicine.

Credentialing and assigning clinical privileges are well-established practices in institutions that need to verify a clinician's ability to provide direct patient care services. The credentialing process verifies a provider's credentials to practice his or her profession, while privileging authorizes the individual to perform enumerated procedures within a specific scope of practice. All clinical faculty members at Harvard School of Dental Medicine (HSDM) practice in the Faculty Group Practice (FGP). Because of the number of practitioners in the FGP, the organization instituted a more formal process of credentialing that verifies that practitioners are not only licensed to practice, but also are competent to provide direct patient care. In contrast to other dental schools that have established similar protocols, HSDM approached the process not from the academic side, but rather from the clinical practice side, explicitly taking into account whether the FGP could accommodate another practitioner when an academic department wished to appoint a new faculty member. In doing so, we had to be careful to reconcile our educational and research needs with those of the FGP. In this article, we describe how, within this framework, we established a credentialing and privileging program in which all full- and part-time faculty members, as well as advanced graduate students, were included.

Dental care use among pregnant women in the United States reported in 1999 and 2002.

INTRODUCTION: The purpose of this study was to determine national and state-specific estimates of dental care use among adult pregnant women in the United States using data from two 12-month periods. The study also determined person-level characteristics that may predict a lack of dental care use within this subgroup. METHODS: Responses were analyzed from 4619 pregnant women aged 18 to 44 years who participated in the 1999 and 2002 state-based Behavioral Risk Factor Surveillance System. Dental care use was defined as having a dental visit or a dental cleaning in the 12 months preceding the interview. State-specific estimates were adjusted to the 2000 U.S. population distribution. Multivariable regression analysis was used to evaluate person-level characteristics that may predict not obtaining dental care during this period. RESULTS: Overall, 70% of pregnant women in 1999 and 2002 had received dental care in the previous 12 months. Age-adjusted estimates ranged from 36% (Nevada) to 89% (Vermont) to 91% (Puerto Rico). In 19 states, 75% or more of pregnant women had obtained dental care in the previous 12 months (age-adjusted figure). Most pregnant women with dental care were non-Hispanic white and married, and they had a greater than high school education. Income and smoking status were significant predictors for not using dental care. CONCLUSION: In several states, more than 70% of pregnant women reported a dental visit or dental cleaning during the previous 12 months. Relative to the general population, pregnant women are as likely to receive dental care, but certain subgroups need to do much better. However, these estimates may be biased toward a population with a higher socioeconomic status and may not represent dental care use among pregnant women in the general U.S. population.

Clinical prevention and population health: curriculum framework for health professions.

The Clinical Prevention and Population Health Curriculum Framework is the initial product of the Healthy People Curriculum Task Force convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers. The Task Force includes representatives of allopathic and osteopathic medicine, nursing and nurse practitioners, dentistry, pharmacy, and physician assistants. The Task Force aims to accomplish the Healthy People 2010 goal of increasing the prevention content of clinical health professional education. The Curriculum Framework provides a structure for organizing curriculum, monitoring curriculum, and communicating within and among professions. The Framework contains four components: evidence base for practice, clinical preventive services-health promotion, health systems and health policy, and community aspects of practice. The full Framework includes 19 domains. The title "Clinical Prevention and Population Health" has been carefully chosen to include both individual- and population-oriented prevention efforts. It is recommended that all participating clinical health professions use this title when referring to this area of curriculum. The Task Force recommends that each profession systematically determine whether appropriate items in the Curriculum Framework are included in its standardized examinations for licensure and certification and for program accreditation.