Incorporating Experiential Learning Techniques to Improve Self-Efficacy in Clinical Special Care Dentistry Education.

The New York University College of Dentistry has introduced a clinical rotation for fourth-year dental students that focuses on treating people with special health care needs (PSN). The aim of this study was to investigate the hypothesis that clinical experience in treating patients with special health care needs during predoctoral education is associated with increased self-assessed student ability and comfort and therefore self-efficacy. The study also investigated whether other characteristics, such as prior personal or volunteer experience with this population, service-mindedness, and/or the inclination to treat underserved populations, were associated with comfort in treating PSN. A survey was used to assess changes in students' perceived knowledge, beliefs, and attitudes regarding treating PSN before and after the clinical experience for July 2012-June 2013. The survey included questions about students' service-mindedness, comfort, perceptions of abilities of PSN and educational importance of learning to treat PSN, desire for clinical experience, and future intent or interest in treating PSN. Out of 364 students invited to participate, 127 surveys were returned, for a response rate of 34.9%. The results showed statistically significant increases on six items following training: impressions about the importance of oral health among PSN, comfort in treating people with cognitive disabilities and with medical complexities, intent to treat PSN in future practice, interest in including PSN in postgraduate training, and belief that PSN could be treated in the private practice setting. These students reported preferring to learn in the clinical setting over didactic instruction. This clinical experience was associated with improved self-efficacy in treating PSN and increased intentions to treat this population in future practice. Improvements were particularly evident among those with the least prior experience with PSN and were independent of other aspects of the students' past experience, future goals, or personality characteristics.

Knowledge of and attitudes towards HIV/AIDS: a survey among dental students in Ajman, UAE.

AIM: Encounters between dentists and patients with HIV/AIDS are bound to rise due to increased prevalence and emerging new treatments. This study assessed dental students' knowledge about transmission and oral manifestations of HIV/AIDS, and their attitudes towards patients regarding obligations to treat. METHODS: Out of 109 students in 4 years of a 6-year dental undergraduate program, 106 responded to a questionnaire on knowledge of and attitudes towards HIV/AIDS. Knowledge and attitude scores were analyzed with Kruskal-Wallis one-way anova and the gender differences with the Wilcoxon signed-rank test. RESULTS: The median score for students' overall knowledge was 39.5 (67%; maximum possible 59). The median knowledge scores for males and females were 38 and 40 respectively, although the difference was not statistically significant. The knowledge levels in Year 4 (42.5 ± 4.7), Year 3 (44 ± 6.5), and Year 2 (42 ± 5.8), were similar but significantly higher than in Year 1 (33 ± 7.9; P < 0.01). The median attitude score was 14 out of 24, with no significant differences within genders and years of study. Although the level of knowledge of the senior students was higher than that of the first years, the negative attitudes remained largely unchanged. CONCLUSIONS: Appropriate educational programs may alter the misconceptions and the negative attitudes.

Anxiety and pain during dental treatment among children with haemophilia.

AIM: Dental interventions are potentially overwhelming for children with hemophilia; the study was designed to assess the levels of dental anxiety related to the first dental intervention for these children. MATERIALS AND METHODS: Fifty-six boys with severe haemophilia A and B and 56 healthy peers between the ages of 7-12 in need of primary dental extraction were chosen for this study. Facial Analog Scale and Visual Analog Scale were applied to all participants. RESULTS: No significant differences among the groups were detected by means of the dental anxiety scores (FIS) and pain scores (VAS). The FIS scores of children who had experienced dental pain before the treatment were significantly higher regardless of the group they were part of (p=0.001). CONCLUSION: Children with haemophilia are not at an increased risk of dental anxiety using special precautions and with the help of adequate treatment regimens. Pain is a predictor for dental fear and anxiety on dental chair both for children with haemophilia and healthy ones.

Thai dental practitioners' knowledge and attitudes regarding patients with HIV.

To investigate the knowledge and attitudes of Thai dental practitioners regarding patients with HIV, a cross-sectional study using self-administered questionnaires was conducted. The questionnaires requested demographic information and included questions evaluating the knowledge and attitude of dental practitioners towards HIV. The results were analyzed using Scheffe method for multiple comparisons at the 95 percent confidence level. Out of 1,200 questionnaires sent, 446 questionnaires were returned (response rate 37.2 percent). The subjects included final (sixth)-year dental students (11.9 percent), general dentists (29.1 percent), specialist dentists (15.5 percent), dental hygienists (30.5 percent), and dental assistants (13 percent). More than 80 percent of the dental practitioners correctly answered the questions testing their basic knowledge of HIV such as routes of transmission and common opportunistic infections. However, knowledge about HIV pathogenesis, complications, and advances in HIV management was lacking. Dental hygienists and dental assistants had statistically significant lower scores in knowledge about HIV than other groups. Sixty-seven percent of dental practitioners said they feel worried when treating patients with HIV, and 20.4 percent said they would deny treatment for patients with HIV if possible. While knowledge about HIV may be adequate among dental practitioners in Thailand, greater effort should be put into emphasizing positive attitudes towards patients with HIV.

Knowledge, attitude, and behavior in managing patients with HIV/AIDS among a group of Indian dental students.

With increasing numbers of people with HIV/AIDS receiving oral dental care, dentists should have sufficient knowledge of the disease, and their attitude should meet professional expectations. HIV and AIDS-related knowledge among dental students provides a crucial foundation for efforts aimed at developing appropriate education on these topics. Accordingly, the aim of this study was to assess the HIV/AIDS-related knowledge and attitudes amongst the 460 dental students of the Institute of Dental Sciences, Bareilly (UP), India. A self-administered survey consisting of fifty-three structured questions was conducted with the students. Overall, the response rate was 79.7 percent. The total mean knowledge and attitudes scores were 78.8 percent (excellent) and 77.7 percent (positive). There was no statistically significant difference between the knowledge and attitude scores of males and females. Regarding oral manifestations, Kaposi's sarcoma and candidiasis were the most identified. The results indicated that the students' knowledge on HIV/AIDS generally increased as they progressed through the curriculum, but their utilization of all barrier techniques for infection control and clinical protocol lacked consistency and compliance. Hence, there is a need to address, more clearly, the students' misconceptions and attitudes towards the disease.

Knowledge and attitudes about HIV/AIDS of students in H.P. Government Dental College and Hospital, Shimla, India.

The purpose of this cross-sectional survey was to assess the knowledge and attitudes towards patients with HIV/AIDS among dental students in H.P. Government Dental College, Shimla, India. In November 2011, a survey was conducted of all the dental students of the college using a forty-five-item, self-administered questionnaire. The total mean knowledge score was 68.3 percent (good knowledge). The mean knowledge score was statistically higher in the clinical group than in the preclinical group. A majority of the students were aware of the association between HIV and oral candidiasis (89.1 percent), major aphthous (83.2 percent), and Kaposi's sarcoma (68.9 percent). Only 4.9 percent had professional attitudes about treating patients with HIV/AIDS. Male students had significantly fewer negative attitudes and higher positive attitudes than female students. The overall attitude score was significantly higher in the clinical group than in the preclinical group. Although a majority of the students had good knowledge, there were some inadequacies in their knowledge; those were more frequently seen in the preclinical students. It is important that dental students, as future dentists, develop not only the necessary practical skills but also knowledge and attitudes that will prepare them to treat patients with HIV/AIDS.

Parental acceptance of pediatric behavior management techniques: a comparative study.

OBJECTIVES: To evaluate and compare the attitude toward behavior techniques among parents of healthy and special children in Indian subpopulation. MATERIALS AND METHODS: Parents of healthy (Group A) and special children (Group B) watched videotape vignette of 10 behavior management techniques (BMTs) in groups and rated them using Visual Analog Scale (VAS). Group B parents were subgrouped as: Group B 1 (34 parents of medically compromised children), Group B 2 (34 parents of physically compromised children), and Group B 3 (34 parents of children with neuropathological disorders). RESULTS: Both Group A and Group B subjects judged all techniques as "acceptable." Group B parents were less accepting to techniques than Group A parents, except live modeling. Contingent escape and live modeling were the first ranked techniques in Group A and Group B parents, respectively. Voice control (VC) and hand-over-mouth exercise (HOM) were the least accepted techniques in both groups. Parents with low income and less education were more receptive to the techniques studied. A total of 25.49% of parents in each group did not consent to the use of HOM. CONCLUSION: Factors such as having a disabled child, low income, and less education influenced parental acceptability. HOM should be used with great caution and clinicians should approach the issue of informed consent on an individual basis.

A new approach to ensuring oral health care for people living with HIV/AIDS: the dental case manager.

INTRODUCTION: The American Dental Association has identified several barriers to adequate dental care for vulnerable populations, including appropriate case management. The objective of this study was to examine the perceptions, attitudes, and beliefs of dental patients living with HIV/AIDS on the role and value of the dental case manager (DCM) and the effect of DCM services on their oral or overall health. METHODS: We used a qualitative descriptive study design and focus groups. Twenty-five people who had received DCM services on Cape Cod, Massachusetts, attended 1 of 5 focus groups in 2009 and 2010. Digital recordings of the groups were transcribed verbatim. Textual data were categorized using directed qualitative content analysis techniques. We identified major themes and representative quotes. RESULTS: The following themes emerged from discussions on the DCM's role: being available, knowledgeable about clients and insurance, and empathetic; increasing access; and providing comfort. Most participants credited their oral and overall health improvements to the DCM. All participants believed that the DCM was a valuable addition to the clinic and noted that other at-risk populations, including the elderly and developmentally disabled, likely would benefit from working with a DCM. CONCLUSION: The addition of a DCM facilitated access to dental care among this sample of people living with HIV/AIDS, providing them with an advocate and resulting in self-reported improvements to oral and overall health.

Effect of an educational course at an Iranian dental school on students' knowledge of and attitudes about HIV/AIDS.

This study investigated the effects of an educational program designed to improve the knowledge and attitudes of senior dental students in an Iranian dental school about caring for patients with HIV/AIDS. As part of an extramural program in community dentistry, a new educational program about HIV/AIDS was developed at Tehran University of Medical Sciences in 2009. The program consisted of two days' observation at the Consultation Center for Behavioral Diseases and a one-day workshop on infection control. A control group was selected from dental students at Shahid Beheshti University of Medical Sciences. Before and after the intervention, students in both the intervention and control groups completed a questionnaire concerning their knowledge of and attitudes about HIV/AIDS. Students in the intervention group also expressed their opinions in a post-test questionnaire. An independent sample t-test was used for statistical analysis. In the control group, the means of students' knowledge and attitude scores did not differ significantly from pre-test to post-test. In the intervention group, however, the means of both knowledge and attitude scores on the post-test were significantly higher than on the pre-test (p=0.001 and p=0.009, respectively). In the intervention group, more than 96 percent of the students reported that they would completely follow infection control principles in future practice. This study concludes that the educational program improved the students' knowledge of and attitudes about HIV/AIDS and will have a positive effect on their future practice.

Dental students' regard for patients from often-stigmatized populations: findings from an Indian dental school.

The aim of this study was to evaluate and compare a group of Indian dental students' attitudes toward HIV-positive status, substance misuse, intellectual disability, acute mental illness, and lesbian, gay, bisexual, transgender (LGBT) orientation. Two hundred and twelve students at various stages in the dental curriculum anonymously completed the Medical Condition Regard Scale (MCRS) for these conditions. Friedman and Kruskal-Wallis tests were used, respectively, to analyze the intrastage and interstage differences in MCRS scores. The results revealed that the regard of dental students was considerably positive for all the conditions except LGBT, for which it was just borderline positive. Intellectual disability received the highest regard among all the conditions and LGBT the least. An intermediary and comparable regard was noted for acute mental illness and HIV-positive status followed by substance misuse. While the regard for LGBT remained consistent throughout the curriculum, those for other conditions showed a marginal decrease at the completion of the clinical training. Active curricular reforms are required to ensure a more inclusive and nondiscriminatory dental care environment for patients from such often-stigmatized populations, especially those with LGBT orientation and substance misuse.

Iranian dental students' knowledge of hepatitis B virus infection and its control practices.

With more than two billion infected people, from whom 350 to 400 million suffer from chronic infection, hepatitis B virus (HBV) is still a major health problem worldwide. As dental treatment puts both dentists and patients at a higher risk of HBV infection, dentists can play an important role in preventing HBV transmission in dental settings. This study was performed to evaluate dental students' awareness and practice regarding HBV-related issues and to compare the results obtained from different academic years. One hundred and forty-two questionnaires consisting of questions on students' knowledge of HBV and preventive measures against this virus were completed by third- to sixth-year dental students of Tehran University of Medical Sciences (TUMS), Tehran, Iran. Overall, a relatively good level of knowledge was observed amongst this population. However, students' answers to practice questions were less satisfying. It is noteworthy that in some cases students of higher academic years showed less awareness. This finding highlights the necessity of continued infection control education. TUMS students must complete an infection control workshop before they start their clinical education. The authors propose that such training at the beginning of each academic year would be worthwhile.

Orthodontic care for underserved patients: professional attitudes and behavior of orthodontic residents and orthodontists.

OBJECTIVES: To explore whether orthodontic residents and orthodontists differ in their attitudes and behavior concerning the treatment of underserved patients and to investigate how background factors such as the providers' gender, ethnicity/race, and age affect these attitudes and behavior. MATERIALS AND METHODS: Survey data were collected from 135 residents in US and Canadian graduate orthodontic programs and from 568 active members of the American Association of Orthodontists. Attitudes toward various aspects of treating underserved patients were rated on a five-point scale, with 1 indicating the most negative attitude and 5 indicating the most positive. RESULTS: Orthodontic residents had more positive attitudes about treating poor patients (3.02 vs 1.99; P < .001), pro bono cases (3.87 vs. 3.45; P < .001), and patients with craniofacial anomalies (3.64 vs 3.01; P < .001) or mental retardation (3.13 vs 2.72; P < .001) than orthodontists. However, compared to orthodontists, lower percentages of residents intended to treat pro bono cases (73.5% vs 83%; P = .009) and patients with craniofacial anomalies (63.6% vs 82.9%; P < .001) or mental retardation (55% vs 81.5%; P < .001). The providers' gender did not have an effect on these attitudes and related behavior, while ethnicity/race and age of the providers were relevant. CONCLUSIONS: Residents had more positive attitudes concerning the treatment of underserved patients than orthodontists. However, their behavioral intentions did not indicate an increased willingness to provide care for these patients.

Treating patients with HIV and Hepatitis B and C infections: Croatian dental students' knowledge, attitudes, and risk perceptions.

Dentists and dental students can be exposed to the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) during routine work. The aims of this study were to assess a group of dental students' knowledge about HIV, HBV, and HCV infections; assess their attitudes and risk perceptions about the treatment of patients with HIV, HBV, and HCV; and identify factors associated with their knowledge and willingness to treat these patients. An anonymous survey was administered to 534 predoctoral students at the School of Dental Medicine, University of Zagreb, Croatia. The response rate was 71.9 percent. Students' knowledge increased with each year of study. Senior students (in their third, fourth, and fifth years) had more professional attitudes and were significantly more positive about dentists' professional obligation to treat patients who are HIV-positive than were junior students (in their first and second years; p=0.0002). Senior students also expressed significantly more willingness to treat intravenous drug users and patients with hepatitis (p=0.016 and p=0.033, respectively). Female students were significantly more convinced than male students that routine dental treatment carried a significant risk of HIV and hepatitis infection (p=0.025). These students' knowledge negatively correlated with the lack of willingness to treat intravenous drug users and patients with hepatitis, and they expressed their willingness to receive further theoretical and practical education on this topic.

Survey of acceptance of the 2007 American Heart Association guidelines for the prevention of infective endocarditis: a pilot study.

OBJECTIVE: To evaluate the acceptance rate of the 2007 American Heart Association (AHA) prophylactic protocol by the patients for whom the need for prophylaxis for infective endocarditis was downgraded. METHOD AND MATERIALS: A survey among patients was conducted. Patients were included if they had to receive antibiotic prophylaxis prior to dental treatment according to the 1997 AHA protocol and did not require antibiotic prophylaxis prior to dental treatment according to the 2007 AHA guidelines. The perception of the patients and their physicians to the change was analyzed. Possible contributing parameters were assessed. RESULTS: The slight decrease in the rate of acceptance with an increase in time since the AHA publication demonstrated by the logistic regression (odds ratio, 0.93; 95% CI, 0.79 to 1.10) was not statistically significant (P=.41). Parameters related to lower patient acceptance rates were invasiveness of dental treatment and the type of dental setting (P=.046 and .001, respectively). Parameters that were found not to affect the patient acceptance rate were the severity of cardiac condition and a durable history of dental treatments in the same institute (P=.06 and .26, respectively). CONCLUSIONS: Sixteen months after publication of the 2007 AHA guidelines, the acceptance rate of the protocol is moderate to high. Reasons for this partial acceptance are discussed.

Treating patients with autism spectrum disorder--SCDA members' attitudes and behavior.

The goal of this study was to explore (a) the attitudes and behavior of members of the Special Care Dentistry Association (SCDA) who self-identified as treating patients with Autism Spectrum Disorders (ASD) and (b) the relationship between their professional attitudes and behaviors concerning these patients. Data were collected from 75 SCDA members who responded to an anonymous web-based survey on the SCDA website. The majority of respondents liked to treat children and adults with ASD (57%/56.9%). They treated approximately nine patients with ASD in an average week. The more they liked to treat children with ASD, the more patients with ASD they treated (r = .313; p = .018), and the more accommodations to overcome problems with communication, social interactions and aversion to change they made (r = .404; p < .001). Providers' attitudes concerning patients with ASD were quite positive and correlated with professional behavior concerning these patients. Future research should explore whether improving attitudes towards providing care for special needs patients could increase professional behavior and thus contribute to reducing the access to care problems these patients face.

The oral health of children considered very high risk for infective endocarditis.

BACKGROUND: Children with previous experience of infective endocarditis or with prosthetic heart valve are considered at very high risk for infective endocarditis. AIM: The aim of this study was to compare the dental health of a group of these children with a group of healthy controls and to determine parental awareness of the importance of good oral health. DESIGN: Oral examination was carried out in 28 children with previous infective endocarditis or a prosthetic heart valve to assess oral health. Findings were compared to a healthy control group of 28. Questionnaires were distributed to the parents to assess awareness of oral health. RESULTS: There was no significant difference in DMFT scores of study and control group (2.43 +/- 3.72 and 1.36 +/- 2.5 respectively) or in DMFT scores of study and control group (1.5 +/- 1.73 and 1.15 +/- 1.42 respectively), 36% of the study group had untreated caries. Parental knowledge of the link between oral health and infective endocarditis was excellent. CONCLUSIONS: There were no significant differences between the oral health of cardiac children and healthy children although the dmft and DMFT scores of the study group were high. Of concern was the proportion of children with untreated caries in spite of good dental awareness and attendance.

Nigerian dental students' willingness to treat HIV-positive patients.

Dental care of HIV-positive individuals plays a vital role in improving their nutritional intake, medication tolerance and effectiveness, treatment success rate, and quality of life. It is therefore important to ensure optimal dental care of this group of people, especially since more of them, with or without knowledge of their serologic status, are now utilizing dental services. The objective of this study was to assess Nigerian dental students' willingness to treat HIV-positive individuals. A descriptive cross-sectional survey of all seventy-six final-year dental students of the University of Benin, Nigeria, was conducted in December 2007 using a self-administered questionnaire that elicited information on the students' demography, self-rated knowledge on HIV/AIDS, attitude towards homosexuals, infection control practices, occupational risk perception, and willingness to provide care for HIV-positive individuals. The response rate was 76.3 percent. Over 77 percent of the respondents were in the twenty-five to thirty years age group. The male-female ratio was approximately 1.6:1. HIV-related knowledge was reported as high by only 31 percent of the respondents. Eighty-one percent showed great interest in HIV-related information, while about half (53.4 percent) exhibited significant worry about occupational contagion. Forty-eight (82.7 percent) desired more knowledge about safety precautions during treatment of HIV patients. Fifty respondents (86.2 percent) reported good infection control practices. About three-fourths (74.2 percent) rated the risk of HIV contagion from patients high, while only one-fourth (25.8 percent) reported having an unsympathetic attitude towards homosexuals. Almost all respondents (98.3 percent) agreed that oral care for HIV-positive individuals improves their quality of life, but only 58.8 percent expressed a willingness to treat HIV-positive patients and only 46.5 percent said they will render volunteer dental services in HIV centers. HIV prevalence will determine the location of practice of 41.4 percent of the respondents. The result suggests the need to have a comprehensive educational/motivational program for the next generation of dentists in Nigeria in order to ensure adequate care of HIV-positive individuals. The perceived deficiency revealed in this study can also serve as a vital guide for curriculum change on HIV-related issues.

The educational challenge of dental geriatrics.

Education in dentistry as in medicine is guided principally by the ontology and theory of science, which provides definitions of health and disease, legitimizes research methods, and influences the role of the clinician. The challenge of managing chronic oral disease and disability prompts interest in social theory as much as science. Therefore, dental geriatrics requires a solid foundation in the humanities from the belief that the determinants of health and the cause of chronic diseases lie within an intermingling of biology, economics, sociocultural structure, and human behavior. The dental curriculum in many places is reorganizing from the horizontal foundation of basic sciences to an integration of foundational and clinical knowledge focused on clinical competencies and integrated care. The impact of this integration on dental geriatrics necessitates a more humanistic and naturalistic perspective in dental education to balance and challenge the current evidence for best clinical practice, which at present is based almost exclusively on science. Consequently, dental students should be exposed to a consilience of the science and the humanities if dentists are to address effectively the needs of an aging population.

Satisfaction with dental case management among people living with HIV/AIDS.

We evaluated access to and satisfaction with dental services for people living with HIV/AIDS receiving services from a dental case manager (DCM). People living with HIV/AIDS who had received dental services at two Community Dental Centers on Cape Cod, Massachusetts were eligible to participate in a mailed, anonymous return, Dental Satisfaction Survey (N = 160). Overall, respondents were satisfied with the dental care they had received. Most patients (58%) were new to the practice and were more likely to report that they had not been seen by a dental provider for more than 12 months (OR 3.0, P = 0.044). The majority of respondents reported that they heard about the clinic from local agencies. Of respondents recognizing they had a DCM, almost all answered that their DCM had helped them receive the care they needed. Respondents who agreed that they sometimes avoided going to the dentist due to pain were significantly more likely to report that they had a dental case manager than patients who disagreed (OR 3.42, P = 0.027). When patients were asked how their DCM had helped them, themes identified included: assisting with access to dental care, conducting a needs assessment, and providing comfort. People living with HIV/AIDS often have unmet needs regarding dental care. The addition of the DCM to the dental facility appears to facilitate access to dental care for those connected to medical care through community outreach/partnerships and provides some respondents with an identified dental advocate.

Oral health-related quality of life and periodontal health status in patients undergoing hemodialysis.

BACKGROUND: Health-related quality of life (HRQOL) is a multidimensional concept regarding quality of life (QOL) as it relates specifically to health and disease. The effect of ongoing hemodialysis on a person's oral health can be determined by clinical variables, but these do not reflect the person's perception of health versus illness. The authors conducted a study to determine the periodontal status, attitude toward oral health and self-perceived oral health in patients undergoing hemodialysis, as well as to evaluate the effect of oral health on QOL within this group. METHODS: Patients undergoing hemodialysis were evaluated for socio-demographic and periodontal variables. The authors evaluated oral health-related quality of life (OHRQOL) by means of the short-form Oral Health Impact Profile (OHIP-14) and the General Oral Health Assessment Index (GOHAI). They measured perceived oral health by asking a single question. RESULTS: The study involved 47 patients undergoing hemodialysis. Plaque index score, gingival index score, probing depth and bleeding-on-probing status were 2.21 +/- 0.66, 1.24 +/- 0.77, 2.17 millimeters +/- 0.53 mm and 33.51 percent +/- 24.58 percent, respectively. Participants reported being uncomfortable when eating or swallowing. Participants reported being sensitive to hot or cold (69.8 percent), having a worse sense of taste (90.8 percent) and having painful aching in the mouth (72.1 percent). The mean OHIP-14 and GOHAI scores were 19.40 +/- 7.74 and 15.72 +/- 8.68, respectively. CONCLUSIONS: The self-perceived health of 72.7 percent of participants undergoing hemodialysis was fair or poor, and the impact of OHRQOL was moderate, which means that oral health was not a major concern. These results underscore the importance of using subjective and self-reported oral assessments to determine more convenient and satisfying treatment approaches for each patient. CLINICAL IMPLICATIONS: Clinicians should use oral health assessment tools to determine individual treatment and approaches to promote the oral health of patients undergoing hemodialysis and improve their QOL.