A Three Delays theoretical framework to describe social determinants as barriers to dental care.

OBJECTIVES: The Three Delays model is a well-established global public health framework for the utilization of obstetric services where each delay represents a series of factors affecting utilization: (1) Delay #1-Deciding to seek care, (2) Delay #2-Reaching an appropriate facility and (3) Delay #3-Receiving adequate care. The aim of this qualitative study was to explore the application of the Three Delays model to dental service utilization and describe factors attributed to delayed utilization within this framework. METHODS: This study utilized a framework analysis, underpinned by the Three Delays model, to examine delays in dental care utilization. A criterion purposive sample of English-speaking adults (18+ years) in Massachusetts and Florida, USA with limited dental care access was recruited. Data were collected via semi-structured interviews conducted in two phases: 17 individual interviews, followed by interviews with a subset of five participants over 3 months (a total of 18 interviews). The analysis involved inductive thematic coding and systematic organization within the framework. RESULTS: Major themes and subthemes were constructed from the participants' narratives, identified and categorized as factors in the Three Delays framework. Each of the delays was interrelated to the other two, and Delay #1 was the most common delay based on the participants' interviews. The themes and subthemes contributing to one or more delays included interpersonal communication, prior dental experience, financial considerations, childcare costs, social connection, technology literacy, time constraints, competing priorities, stressors such as eviction and immigration status and microaggressions including racism and stigma. CONCLUSION: The Three Delays model was applicable to the study of dental care utilization and factors that impact the decision to seek dental care, reaching an appropriate dental facility and receiving adequate dental care in this study context.

Admissions data as predictors for student performance in restorative dentistry.

INTRODUCTION: The purpose of the study was to determine the relative predictive power of admissions criteria and predoctoral academic performance in the area of restorative dentistry in order to better understand and guide the dental school admissions process. METHODS: In addition to admissions criteria, student performance in restorative dentistry, such as the Final Restorative Treatment course, the didactic and preclinical examinations, and the objective structured clinical examinations (OSCE), was measured for the 172 predoctoral students representing the graduating classes of 2017-2021. RESULTS: The association between the didactic score in restorative dentistry and grade point average (GPA, p = 0.009) and Dental Admission Test (DAT, p = 0.002) score was statistically significant. Although no statistically significant association was found between preclinical scores and gender, GPA, or DAT, there was a statistically significant association between preclinical scores and the Perceptual Ability Test (PAT) score (p = 0.012). Preclinical scores included laboratory examinations for fixed prosthodontics, such as crown preparation and temporization, representing hand skills assessment. Finally, there was no statistically significant association found between the OSCE score and any of the admissions criteria. CONCLUSION: The dental admissions criteria could play a role in predicting academic performance in the didactic portion and preclinical component of restorative dentistry.

Predoctoral Student Performance in a Restorative Dentistry Course During the COVID-19 Pandemic.

PURPOSE: To compare predoctoral student performance in restorative dentistry related to curricular changes implemented in response to the COVID-19 pandemic and to evaluate the impact of remote education on performance in didactic and preclinical examinations and objective structured clinical examinations (OSCEs). MATERIALS AND METHODS: The study population consisted of 172 students, all members of the DMD graduating classes from 2017 to 2021. Scores in the Final Restorative Treatment (FRTx) course, subdivided into didactic and preclinical lab work, and the OSCEs were assessed and compared between pre-pandemic students and during-pandemic students. RESULTS: Performance in the preclinical lab exercises was statistically significantly higher in the during-pandemic cohort than in the pre-pandemic cohort after adjusting for students' gender and admission scores. Performance in restorative dentistry as measured by the OSCE was not statistically different among during-pandemic students compared to the pre-pandemic students. It was observed that students were more efficient and engaged during the more limited lab sessions with the increased student-to-faculty ratio that allowed for more feedback. CONCLUSION: Although virtual education cannot replace in-person experiences, this model served students satisfactorily during the COVID-19 pandemic, with added support structures such as flexible scheduling, interactive sessions, and additional small-group discussions to maintain academic performance in predoctoral education.