Perceived sources and levels of stress, general self-efficacy and coping strategies in preclinical dental students.

Dental education programs are known to be highly stressful and stress can affect general health. The aims were to identify sources of stress among preclinical students and to evaluate their perceived levels of stress, self-efficacy and effective coping strategies in a private dental school. One hundred preclinical students in a Turkish private dental school were surveyed using dental environment stress (DES), perceived stress (PSS), general self-efficacy (G-SES) and brief coping scales (Brief-COPE). Age, gender, history of psychiatric treatment, factors that affected the choice of dentistry, choice rank of dental school, scholarship and income was recorded. 'Exams and grades' followed by 'Fear of failing course or year' were found to be the most stressprovoking factors. The most and the least stressprovoking DES domains were 'Workload' and 'Social stressors', respectively. 'Social stressors' affected male more than female (p < .05). The most and the least common coping strategies were found to be 'Planning', and 'Drug', respectively. Female used 'Instrumental support' more than male (p < .05). Demographic factors had impact on the perceived stress factors and levels, as well as coping strategies. Unlike previous studies establishing high stress levels in dental students, preclinical students displayed moderate level of stress. Clinical dental education might be more responsible for creating stress.

Percentage and severity of periodontal diseases in Turkish adults aged 35+ years, 2009-10.

OBJECTIVE: This article presents data on the burden of periodontal diseases in Turkish adults aged 35 years or older. METHODS: Within each region of Turkey, a rural and an urban area or city were selected in 2009-10 using a probability proportional to size method. In the selected towns, local officials who were familiar with their communities assisted in recruiting subjects. Loss of Attachment (LOA) was measured at six sites around each tooth present in the mouth, excluding third molars. Additionally, the Community Periodontal Index was used to assess the severity of periodontal diseases around 12 index teeth. Self-reported data on key risk factors were also collected. Weights were computed using a raking ratio adjustment procedure and used in all analyses. RESULTS: Almost all examined adults had some loss of periodontal attachment. The proportion of those with more than 3 mm LOA ranged from 43 percent in 35-44 year olds to 91 percent in those aged 65+ years. Among females, older age, low education status, smoking 11-40+ cigarettes a day, being employed, and presence of high number of missing tooth surfaces were associated with LOA > 3 mm. Among males LOA >3 mm was associated with older age, use of alcohol, and unemployment. The CPI data did not yield the same associations with periodontal diseases and risk factors. CONCLUSIONS: Periodontal diseases in Turkish adults are highly prevalent. A tailored common risk factor health promotion program is recommended to reduce the burden of periodontal infection in Turkey.

Perceived sources and levels of stress, general self-efficacy and coping strategies in clinical dental students.

The aims of this study were to identify sources of stress among clinical students and to evaluate the students' perceived levels of stress, general self-efficacy and effective coping strategies in a private dental school environment. The study group consisted of 130 undergraduate clinical dental students in a Turkish private dental school, during the academic year 2014-2015. The students were surveyed using modified version of the dental environment stress (DES) survey, the perceived stress scale, the general self-efficacy scale (G-SES) and the brief coping scale. Age, sex, year of study, history of psychiatric treatment and factors that affected the choice of dentistry were also recorded. Final year and female clinical dental students, who were found to be the most stressful students, had moderate to high perceived stress scores. Total and 'Faculty and administration' related DES scores increased with the year of study. Stressors related to 'Workload' and 'Clinical training' affected females more than males. G-SES scores were higher in male students and students, who had no history of psychiatric treatment. The most and the least common coping strategies were 'Planning' and 'Substance abuse', respectively. 'Religion' was found to be one of the main coping strategies. Stress factors affecting Turkish clinical dental students studying at private dental school differed from the previously reported stress factors affecting students studying at a governmental dental school. Advanced year and female students experienced more stress than the other students.

Ethical decision making in dental education: a preliminary study.

BACKGROUND: In terms of ethical decision making, every clinical case, when seen as an ethical problem, may be analyzed by means of four topics: medical indications, patient preferences, quality of life, contextual features. The aim of this study was to compare the performance of 4th year dental students on Ethical Decision Making before and after a course on ethics. METHODS: Fourth year dental students (n = 37) from academic year 2013-2014 participated in the study. A 3-h lecture, which was about four topics approach to clinical ethical case analysis, was given to the students. The lecture was based on case scenarios related with dental ethics. After the completion of lectures,a case scenario was presented to the students to assess their ethical decision making abilities. At the end of the exam, four topics and ethical judgment were evaluated. Their performances on this examination were evaluated before and after lectures. Statistical evaluation was performed with the significance level set at p < 0.05. RESULTS: A statistically significant difference was found between the means of four topics (p < 0.05). There was no statistically significant difference between the mean scores of judgment of ethical decision (p > 0.05). The mean total score of the students after the course was significantly higher than before course (67.5 and 54.4, respectively; p < 0.05). CONCLUSION: More lectures should be implemented to the curriculum to increase the student awareness of ethical issues and to reach the ultimate goals of dental education.

Toothbrushing: A Link Between Noncommunicable and Communicable Diseases?

PURPOSE: To assess the correlation between toothbrushing (TB) and the common biological (HDL) and quality-of-life-related risk factors for noncommunicable diseases (NCDs) and communicable diseases among patients with diabetes mellitus type 2 (DM2). MATERIALS AND METHODS: The present study is part of a prospective intervention study among DM2 patients (n=200), randomly selected from the outpatient clinics, Istanbul, Turkey. The assessed variables were: TB, self-reported gingival bleeding (SRGB), HDL, BMI, body-fat proportion, modified quality of life scale (WHOQOL-BrefPhPs). Descriptive statistics, frequency distributions, Spearman rank correlation, the chi-square test and factor analysis were applied. RESULTS: A minority of the patients brushed their teeth twice a day or more (27%) and reported no gingival bleeding (37%). Favourable HDL and high WHOQOL-BrefPhPs were 77% and 57%, respectively. A majority of patients had unhealthy BMI (83%) and body-fat proportions (63%). SRGB was negatively correlated with WHOQOL-BrefPhPs (rs=-0.24, p<0.05) and TB (rs=-0.25, p<0.01). The patients who reported less than daily TB were more likely to have unfavourable HDL and low WHOQOL-BrefPhPs (32% vs 54%) than those brushing their teeth daily (17% vs 35%, p<0.05). Principal component analysis revealed two clusters: 'healthy weight' (WHOQOL-BrefPhPs, TB, BMI) and 'oral health' (SRGB, HDL). CONCLUSION: The present results demonstrate a correlation between TB and biological and quality-of-life-related risk markers of NCDs and communicable diseases. There seems to be a need to increase the awareness of the significance TB's potential intermediatory role between NCDs and communicable diseases.

Comparison of case-based and lecture-based learning in dental education using the SOLO taxonomy.

The aim of this study was to compare the impact of case-based learning (CBL) and lecture-based learning (LBL) on fourth-year dental students' clinical decision making by using the Structure of Observed Learning Outcome (SOLO) taxonomy. Participants in the study were fourth-year dental students (n=55) in academic year 2012-13 taught in a large-group LBL context and fourth-year dental students (n=54) in academic year 2013-14 taught with the CBL methodology; both took place in the oral diseases course at Yeditepe University Faculty of Dentistry, Istanbul, Turkey. All eligible students participated, for a 100 percent response rate. A real case was presented to the students in both groups to assess their clinical decision making on the topic of oral diseases. Their performance was evaluated with the SOLO taxonomy. Student t-test was used for statistical evaluation, and significance was set at the p<0.05 level. A statistically significant difference was found between the mean scores of the relational and extended abstract categories of the CBL and LBL groups (p<0.05). Students who were taught with CBL had higher scores at the top two levels of the SOLO taxonomy than students taught with LBL. These findings suggest that an integrated case-based curriculum may be effective in promoting students' deep learning and it holds promise for better integration of clinical cases likely to be encountered during independent practice.

"Smile healthy to your diabetes": health coaching-based intervention for oral health and diabetes management.

OBJECTIVES: This study is the first to our knowledge that aims to evaluate the impact of Health Coaching (HC) compared to Health Education (HE) on oral health and diabetes management among patients with diabetes type II (DM2). MATERIAL AND METHODS: The study is part of a prospective intervention among randomly selected DM2 patients (n = 186), Istanbul, Turkey. The data analyzed were Community Periodontal Need Index (CPI) and HbA1c (glycated hemoglobin percentage). Data was collected initially and at the end of the intervention. The participants, both attending oral examinations and filing out questionnaires (n = 179), were allocated to HC (n = 77) and HE (n = 102) groups by means of a block table of random numbers. RESULTS: At baseline, there was no statistical difference between HC and HE groups in terms of CPI and HbA1c (p > 0.05). At postintervention, the HC group had significantly lower CPI and HbA1C than the HE group (p < 0.01). There was a significant reduction at HbA1c (0.8 %) and CPI (74 %) in HC group (p < 0.05). The impact of HE on CPI was less significant (21 % reduction) (p = 0.001); however, it was not significant on HbA1c (p = 0.68). The improvement at CPI from baseline to postintervention had significant impact on reduced HbA1c in the HC group (p < 0.05). CONCLUSIONS AND CLINICAL RELEVANCE: The present findings imply that HC has a significantly higher impact on better management of diabetes and oral health when compared to formal HE. This calls for the use of HC by dentists, physicians, and diabetes educators in order to improve quality of life of DM2 patients by facilitating better oral health and diabetes self-management.

A survey of local anesthesia education in Turkish dental schools.

The aim of this study was to evaluate differences with regard to local anesthesia education in Turkish dental schools. Questionnaires designed to collect information about local anesthesia education were sent to the heads of the Departments of Oral and Maxillofacial Surgery of seventeen Turkish dental schools. Eleven returned the completed survey for a response rate of 64 percent. It was determined that dental schools begin the theoretical part of their local anesthesia (LA) curricula during the first half of the third year. Most dental schools start teaching the practical aspects during the second half of the third year on average--half a year after the beginning of the theoretical background. The first injection in humans, usually a fellow student (82 percent), is mostly supervised by an oral and maxillofacial surgeon. The number of injections under supervision usually depends upon the individual capabilities of the student. None of the schools said they required permission of a medical ethics committee for injections on fellow students. Seventy-three percent of the schools said they were satisfied with their current LA teaching and were not planning to make any changes. Overall, LA teaching programs showed minor variations across the surveyed Turkish dental schools.

Relationship between oral health, diabetes management and sleep apnea.

OBJECTIVES: The aim of this study was to assess the relationship between tooth loss, toothbrushing behaviour, diabetes type 2 (DM2), obesity and sleep apnea among diabetics. MATERIAL AND METHODS: DM2 patients (n = 165) in Istanbul, Turkey, were randomly selected from the outpatient clinics of two hospitals. Baseline clinical measurements (HbA1c, fasting blood glucose, high-density lipoprotein (HDL), low-density lipoprotein (LDL), body mass index (BMI), body-fat proportion, tooth loss) and self-administered questionnaires (toothbrushing, gingival bleeding, sleep apnea) provided data for factor and principal component analysis with Varimax rotation. Univariate statistics and chi-square tests were derived. RESULTS: Mean maxillary tooth loss (4.49 ± 3.69 teeth) was higher than in the mandible (3.43 ± 3.12 teeth, p< 0.001). Favourable HDL was measured among most patients (77%); other favourable clinical measures occurred only in a minority of participants (HbA1c, 28%; fasting blood glucose, 17%; LDL, 30%). Twice daily toothbrushing was reported by 33% (17%) for healthy BMI; 37% when healthy body-fat proportions. There was risk of sleep apnea in 37 %. The higher number of lost teeth in the maxilla was linked with obesity and sleep apnea. Non-daily toothbrushers were more likely to have high LDL and low HDL cholesterol and a higher risk of sleep apnea. When "at least occasionally" bleeding on toothbrushing occurred, higher HbA1c levels and sleep apnea were more likely. CONCLUSION: Oral care with early diagnosis and monitoring of glycaemic level can help prevent complications of DM2. CLINICAL RELEVANCE: Dentists may play a key role in better managing and diagnosing sleep apnea early by referring the patients with severe tooth loss and periodontal disease for general medical examination.

Evaluation of dental students' perception and self-confidence levels regarding endodontic treatment.

OBJECTIVES: The aim of this study was to obtain information about senior dental students' perceptions and self-confidence levels regarding endodontic practice. MATERIALS AND METHODS: Anonymous survey forms were handed out to senior students at Yeditepe University, Faculty of Dentistry. The students were asked to score their level of confidence using a 5-point scale and comment about future practices. RESULTS: The response rate of the survey was 88%. 11.9% expressed endodontics as the first branch in terms of difficulty. The majority (90.5%) indicated they would perform root canal treatments within their expertise limit in the future but refer difficult cases to an endodontist. Bleaching of endodontically treated teeth, managing flare-ups, placement of a rubber dam were procedures in which students reported the lowest confidence (2.55 ± 1.17, 3.24 ± 0.96, 3.24 ± 1.19, respectively). On the other hand, students felt the lowest confidence in the treatment of maxillary molars followed by mandibular molars (3.43 ± 1.02 and 3.93 ± 0.97, respectively). Students also reported the lowest confidence in root resorptions, endo-perio lesions, traumas, retreatments and apexifications (2.93 ± 1.16, 3.07 ± 0.89, 3.24 ± 0.85, 3.33 ± 1.7 and 3.36 ± 1.1, respectively). CONCLUSIONS: The results showing students' lower confidence in more challenging aspects of dentistry may be related with the attitude of dental schools to refer these cases to post graduate students and instilling information about these cases on a theoretical basis only. Though there seems to be a tendency for students to refer challenging cases to a specialist in future, authorities should give priority to enhance the way information and experience is conveyed regarding various aspects of endodontic treatment.

Demographic profile and future expectations of students enrolled in a Turkish private dental school.

The purposes of this study were to obtain information about the social and demographic profile of students enrolled in the first private Turkish dental school, to gather information regarding the reasons for their preferences, and to obtain data about their career expectations. Questionnaires were distributed to 278 students; 229 returned the survey for an overall response rate of 82 percent. Of the respondents, 145 (65.5 percent) were females and seventy-five (34.5 percent) were males; they had an average age of 21.62±1.58. First degree relative (mother, father, sibling) had the greatest influence on the students in choosing dentistry as a career. Fathers and mothers had similar impact on the students' choice of dental profession (45.9 percent and 46.6 percent, respectively). Humanistic feelings, desire to serve others, and reasonable working hours were the predominant reasons that motivated females to become a dentist (p<0.05). Also, academic interest and interest in a medical field were significantly influencing factors for female students (p<0.05 and p=0.001, respectively). One-hundred and ninety-seven students (86 percent) expressed a goal of specializing in a specific branch of dentistry; orthodontics and oral and maxillofacial surgery were the top-ranked specialties. Although only 41 percent of the students were of Istanbul origin, 82.5 percent reported that they wish to practice in Istanbul.

Self-efficacy perspective on oral health behaviour and diabetes management.

PURPOSE: To assess the role of toothbrushing self-efficacy (TBSE) in toothbrushing (TB) behaviour and diabetes management, measured in terms of HbA1c knowledge, quality of life, BMI, self-reported health and physical activity among Turkish type-II-diabetes (DM2) patients. MATERIALS AND METHODS: A pilot study using self-administered health questionnaires was conducted among a random sample of 60 patients (aged 40 to 70 years) in Istanbul, Turkey. The assessed variables were: TBSE, TB, glycated haemoglobin (HbA1c) knowledge, quality of life, BMI, self-reported health and physical activity. Descriptive statistics, frequency distributions, Pearson's correlation, the chi-square test and MANOVA were applied. RESULTS: Almost half of the patients reported low TBSE (mean >= 53%). and TB once a day (54%). Most (77%) did not know their HA1C level and they were overweight (42%) and obese (32%). Almost half of the patients reported good quality of life (> mean, 55%), being physically active (51%) and in good health (mean < 46%). The patients reporting high levels of TBSE were more likely to know their HbA1c (OR= 10.5: 95%CI= 1.01-103.24) and to report better health (OR= 10.0: 95%CI = 1.80-55.63) and were less likely to be obese (OR= 0.16: 95%CI= 0.02-1.00) (P < 0.05). There was a strong correlation between TBSE and TB (rs = 0.61, P < 0.01). CONCLUSION: The present study underlines the need for TBSE-integrated common health promotion for oral health and DM2, considering the relation of TBSE, HbA1c, BMI and toothbrushing.