To assess the knowledge, attitudes, and confidence of caregivers and administrators towards the oral health of nursing home residents in San Antonio, Texas.

OBJECTIVE: The primary objective of this research was to use qualitative methods to assess the knowledge, attitudes, and confidence of caregivers in their ability to provide oral hygiene assistance to residents. The secondary objective was to assess the knowledge and attitude of administrators on the provision of oral hygiene assistance for residents, and their confidence in caregivers' ability to provide oral hygiene assistance to nursing home residents in San Antonio, Texas. METHODS: A semi-structured interview guide was used to conduct face-to-face interviews with seven caregivers and twelve administrative staff from ten nursing homes in San Antonio, Texas. Employees in nursing homes who are caring for residents are referred to as caregivers and those whom they care for are referred to as nursing home residents. One survey instrument was developed for the caregiver's knowledge, attitude, and confidence toward providing oral health care, and another to assess the administrator's knowledge, attitude, and confidence in caregivers providing oral care for nursing home residents. The interviews were recorded, transcribed, and coded for thematic content. RESULTS: The findings revealed that caregivers and administrators had adequate knowledge of the connection between oral and systemic health. The administrators were confident that caregivers were adequately trained to provide oral hygiene care for residents. Caregivers had a positive attitude toward the importance of good oral health. They regularly assessed the residents' oral health, but due to time constraints, staffing shortages, and other competing tasks providing oral health care to the residents was challenging. Most caregivers were confident in their skills in providing oral care for the residents since 85.6% agreed. On the contrary, almost half of the administrators were confident that caregivers have the necessary skills to provide oral care for residents, while 41.7% were unsure. CONCLUSIONS: The study gave a broader insight into the provision of oral care in nursing home residents from the perspectives of caregivers and administrative staff. Administrators must provide caregivers with adequate training and time so they can provide adequate oral health care for the residents.

Effectiveness of silver diamine fluoride in arresting dental caries in residents living in nursing homes: A randomized controlled trial.

OBJECTIVE: The primary objective of this randomized controlled trial was to determine the effectiveness of a single application of 38% silver diamine fluoride (SDF) solution in arresting and controlling active accessible caries compared to no treatment among adults aged 18 years and older residing in nursing homes or long-term care facilities. Many patients cannot receive standard-of-care dental treatment due to their medical conditions and inability to undergo anesthesia. All teeth in the control group will be treated with SDF at the conclusion of the study. METHODS: This study enrolled 39 adults aged 18 or older with 188 active lesions from nine San Antonio, Texas, nursing home facilities. Teeth were randomized and divided into two treatment and control groups. Each treatment tooth was paired with a control in the same oral cavity. Accessible carious lesions were treated with a single application of 38% SDF solution. Teeth were re-evaluated at 3 weeks where control groups also received SDF treatment. RESULTS: The treatment group demonstrated caries arrest in 77 (81.9%) teeth compared to 0 in the control group (0%). Notably, within the treatment group 14 of the 17 teeth with no caries arrest were posterior teeth (82.4%). CONCLUSIONS: Our results suggest that a single application of 38% SDF solution is an effective measure for arresting and controlling caries compared to standard oral hygiene maintenance. Our research team recommends the regular use of a single application of SDF solution in marginalized populations given the possible public health, oral health, social, and economic benefits.

An interprofessional education initiative: Introducing a local anesthesia dental course for nurse practitioner and physician assistant students.

PURPOSE/OBJECTIVE: To assess the impact of local anesthesia (LA) course for physician assistant (PA) and adult gerontology-acute care nurse practitioner (NP) program students on knowledge, attitudes, confidence, and intention to incorporate skills in clinical practice. METHODS: The course was conducted by dental faculty for forty-eight PA and seven NP students and consisted of two lecture hours on anatomy of the oral cavity, anesthesia and pain management, 2 hours of preclinic lab where participants practiced injection technique on mannikins, and a clinical practicum conducted by dental school faculty and residents where students observed dental treatment including administration of LA, and discussed symptom triage by NPs and PAs for patients with dental problems including orofacial pain, initial management including LA, and patient referral to dentists. An online survey was administered to all students before and after the course to assess changes in knowledge, attitudes, confidence, and intention to incorporate LA administration skills into clinical practice and elicit students' perception of program quality. Pre- to post-changes were analyzed by two-tailed t-tests and analysis of variance (ANOVA) with significance at 0.05. RESULTS: The response rate for pre- and post-course assessment was 96.4% and 87.3% respectively. Students' overall scale score for self-assessment of dental knowledge increased significantly from pre- (2.34) to post-assessment (4.19). An increase was seen in students' attitudes regarding management of dental emergencies (t = 2.181; p < 0.05). Furthermore, overall confidence of students related to managing patients with dental problems increased significantly (2.00 to 3.85) after taking the course. CONCLUSION: The LA course was well received by PA and NP students and resulted in increased knowledge and confidence in recognizing common oral health conditions, understanding dental pain management including administration of LA, and making referrals to dentists to optimize patient care.

Impact of Prenatal Health Conditions and Health Behaviors in Pregnant Women on Infant Birth Defects in the United States Using CDC-PRAMS 2018 Survey.

OBJECTIVE: To assess both individual and interactive effects of prenatal medical conditions depression and diabetes, and health behaviors including smoking during pregnancy on infant birth defects. METHODS: The data for this research study were collected by the Pregnancy Risk Assessment Monitoring System (PRAMS) in 2018. Birth certificate records were used in each participating jurisdiction to select a sample representative of all women who delivered a live-born infant. Complex sampling weights were used to analyze the data with a weighted sample size of 4,536,867. Descriptive statistics were performed to explore frequencies of the independent and dependent variables. Bivariate and multivariable analyses were conducted to examine associations among the independent and dependent variables. RESULTS: The results indicate significant interaction between the variables smoking and depression and depression and diabetes (OR = 3.17; p-value < 0.001 and OR = 3.13; p-value < 0.001, respectively). Depression during pregnancy was found to be strongly associated with delivering an infant with a birth defect (OR = 1.31, p-value < 0.001). CONCLUSION: Depression during pregnancy and its interaction with smoking and diabetes are vital in determining birth defects in infants. The results indicate that birth defects in the United States can be reduced by lowering depression in pregnant women.

Role of Patient's Ethnicity in Seeking Preventive Dental Services at the Community Health Centers of South-Central Texas: A Cross-Sectional Study.

BACKGROUND: This study was conducted to determine the impact of a patient's ethnicity on seeking preventive dental services at the Community Health Centers (CHCs) in South-Central Texas. METHODS: Primary electronic health records (EHR) data were collected regarding each patient's medical and dental history, and comprehensive treatment planning. The researchers retrieved EHR from January 2016 to 2022. Bivariate analysis was completed to test the outcome with the predictor variable and covariates using the appropriate statistical tests. A multiple linear regression model was used to understand the association between the predictor and outcome variable while controlling for confounders. RESULTS: The study findings revealed significantly higher dental visits (2.26 ± 2.88) for Hispanic patients. The results from the multiple regression model indicated that non-Hispanic patients had a smaller chance of visiting CHC for preventive dental services, by eight percent, compared to the Hispanic population (p-value < 0.001) when all other variables were held constant. However, the study results were not significant, as the effect size was too small to conclude the effect of ethnicity on the patients visiting the dental clinic at the CHC for preventive services. CONCLUSION: The study concluded that there is no difference in the preventive dental services completed by Hispanics and non-Hispanics when all other variables are controlled.

Malpractice allegations among US dentists: association of malpractice allegation with the severity of the alleged malpractice injury.

The objective of this study was to explore associations between allegations of malpractice and the severity of the alleged malpractice injury. The public-use data file of the National Practitioner Data Bank was used to identify 34,042 dentist malpractice reports from January 1, 2010, through December 31, 2020. Univariate descriptive analysis was conducted to identify frequencies of malpractice allegations when classified by the severity of the alleged malpractice injury, practitioner graduation year, and year of original report processing. Ordinal logistic regression analyses were conducted to explore associations between the malpractice allegation type and the severity of the alleged malpractice injury. A total of 15,183 valid reports were used in the analysis. Compared with treatment-related allegations, a surgery related allegation proved 5.3 times more likely to result in minor permanent injury; a diagnosis-related allegation was 6.5 times more likely to result in significant permanent injury and 10.4 times more likely to result in major permanent injury; and an anesthesia-related allegation was 6.2 times more likely to result in major permanent injury. The confounding variable of graduation year proved significant with respect to major temporary and minor permanent injury. As the allegation group advanced from diagnosis-related to anesthesia-, treatment-, and surgery-related allegations, the odds of a higher severity of injury did not increase. Establishing a proper diagnosis and developing a treatment plan to manage the anticipated complications of the procedure to be performed are critical to a successful outcome.

Dental care for pregnant patients: a survey to assess the current practices of Alabama dentists.

A commitment on the part of dentists to provide dental care to pregnant patients may contribute to alleviating the burden of oral disease experienced in this population. To assess barriers to providing dental care for pregnant patients, a survey instrument was developed and distributed to 472 Alabama Academy of General Dentistry members. Descriptive analyses were conducted to assess dental care practices, self-reported competence, and barriers to providing dental care. Bivariate analyses were conducted to determine whether dentists with and without residency training displayed differences in self-reported competence and dental care practice models. A total of 82 dentists completed the survey, yielding a response rate of 17.3%. Of the respondents, 93.9% reported providing dental care to pregnant patients in the past year. Lack of education and/or training was the most frequently identified barrier (41.5%) to the provision of care. Statistically significant associations were found between self-reported competence and residency training (χ2 = 4; P = 0.034; Φ = 0.235). Residency training may influence dentists' self-reported competence in providing care to pregnant patients. Dentists who did not receive residency training appeared more likely to report competence in their ability to provide such care. Most respondents reported providing dental care to pregnant patients, but only 40.6% of the respondents to the 2015 Alabama Pregnancy Risk Assessment Monitoring System (PRAMS) survey reported receiving a dental cleaning during pregnancy. Implementing systems to connect these patients with dentists may increase the receipt of care among this group.

Pilot test of an emerging leaders program for dental school faculty.

PURPOSE/OBJECTIVES: The School of Dentistry at The University of Texas Health Science Center at San Antonio (UTHSA-SoD) implemented an SoD Emerging Leaders Program (SoDELP) in 2020-2021. This case report describes the leadership training needs of junior faculty that stimulated SoDELP development, the inter-institutional collaboration that facilitated program implementation, SoDELP curriculum content, and outcomes of formative assessment for two pilot cohorts of the SoDELP. METHODS: The 32-h curriculum was comprised of readings, reflection exercises, seminars by the Center for Professional Excellence at the University of Texas at San Antonio, case discussion, analysis of leadership dilemmas, and self-assessments. For a capstone project, participants created a case depicting a challenging leadership situation they experienced as a team leader or member. The SoDELP commenced in a face-to-face format but was completed online due to COVID 19. Formative evaluation included participants' pre- and post-training perceptions elicited by the Leadership Attitudes, Confidence and Concerns Inventory (LACCI) and qualitative appraisal of program components obtained by surveys and focus groups. RESULTS: All 18 participants completed SoDELP and provided positive evaluations of program content, organization, teaching quality, and value. Analysis of pre- and post-assessments indicated that participants' confidence in performing an array of leadership tasks was significantly enhanced, and participants' concerns about assuming leadership roles, such as not being ready for the job, impact on friendships, or concerns about ethical challenges, were significantly reduced. The LACCI displayed promising reliability in assessing participants' confidence, attitudes and concerns, demonstrating the potential to serve as a measurement tool to appraise outcomes of leadership training in the health professions. CONCLUSION: Outcomes suggest that SoDELP enhances faculty members' sense of readiness for leadership roles, and the LACCI may be a useful assessment tool for leadership training.

Multifaceted impact of COVID-19 on dental practice: American dental care professionals prepared and ready during unprecedented challenges.

BACKGROUND: The purpose of this study was to evaluate the multifaceted impact of the COVID-19 pandemic on dental practices and their readiness to resume dental practice during arduous circumstances. METHODS: The authors distributed an observational survey study approved by The University of Texas Health Science Center at San Antonio Institutional Review Board to dental care practitioners and their office staff members using Qualtrics XM software. The survey was completed anonymously. The authors analyzed the data using R statistical computing software, χ2 test, and Wilcoxon rank sum test. RESULTS: Nearly all participants (98%) felt prepared to resume dental practice and were confident of the safety precautions (96%). Only 21% of dentists felt the COVID-19 pandemic changed their dental treatment protocols, with at least two-thirds agreeing that precautions would influence their efficiency adversely. Although most participants were satisfied with the resources their dental practice provided for support during the pandemic (95%), most were concerned about the impact on their general health and safety (77%) and to their dental practice (90%), found working during the pandemic difficult (≈ 60%), and agreed there are challenges and long-term impacts on the dental profession (> 75%). CONCLUSIONS: Dental care professionals, although affected by the COVID-19 pandemic and at high risk of developing COVID-19, were prepared to resume dental practice during most challenging circumstances. PRACTICAL IMPLICATIONS: The pandemic has affected dental care practitioners substantially; thus, there is need to formulate psychological interventions and safety precautions to mitigate its impact. Further research should evaluate the long-term effects on dentistry and oral health and interceptive measures for better communication and programming around future challenges.

Relationship between General Health Behaviors and Oral Health Behaviors in 2015-2016 NHANES Adult Population.

OBJECTIVES: The aim of this study was to examine the relationship between general health behaviors and oral health behaviors in adults who participated in the interview component of the National Health and Nutrition Examination Survey (NHANES) of 2015 to 2016. MATERIALS AND METHODS: This was a cross-sectional study design of a national data set that included 5,992 adults who represented a sample of civilian, noninstitutionalized US population. STATISTICAL ANALYSIS: Chi-squared test of independence was used to describe the relationship of demographic information with oral health behaviors of participants. Multivariate logistic regression was used to determine the association between general and oral health behaviors. RESULTS: More than half (53.6%) of the participants had seen a dentist in the past 12 months and the main reason for that visit was for a regular checkup, cleaning, or examination. More than one-quarter (28.7%) reported visiting a dentist because something was hurting or bothering them. Most respondents (63.4%) reported being hardly ever or never having been embarrassed by their mouth condition. Age at one's first sexual encounter, having a new sexual partner, mental health counseling, moderate- intensity sports, and computer use were significantly associated with positive oral health behaviors. CONCLUSIONS: For maximum effectiveness, health promotion efforts should target risk behaviors common to both oral and general health.

Marginal Gap of Milled versus Cast Gold Restorations.

PURPOSE: This in vitro study evaluated and compared the vertical marginal gap of cast and milled full coverage gold copings using two margin designs (chamfer and chamfer bevel) before and after fitting adjustments. MATERIALS AND METHODS: Ten impressions were made of two metal master dies (one chamfer margin, one chamfer-bevel margin) and poured twice in Type IV stone. The 20 subsequent casts with 40 dies were split into four groups (n = 10); cast gold bevel, cast gold chamfer, milled gold bevel, and milled gold chamfer groups. The cast specimens received approximately 40 µm die relief no closer than 1 mm from the finish line. Cast copings were hand waxed, cast in a high noble gold alloy, chemically divested, and the sprues were removed. For milled gold copings, casts were scanned and copings designed using 3shape D900 scanner and software. Parameters were set to approximate analog fabrication (cement gap = 0.01 mm; extra cement gap = 0.04 mm, drill radius = 0.65 mm). Copings were milled from the same high noble alloy. All copings were seated on their respective master die in a custom scanning jig and measured using a measuring microscope at 90× (60 measurements per specimen, 15 per surface). Following initial measurements, all copings were adjusted on stone dies. The number of adjustment cycles was recorded and post-adjustment measurements were made using the same method. Data were analyzed using independent and paired t-tests. RESULTS: Milled gold copings with a beveled margin (11.7 ± 20.4 µm) had a significantly (p < 0.05) smaller marginal gap than cast gold copings with a beveled margin (43.6 ± 46.8 µm) after adjustment. Cast gold copings with a chamfer margin (22.7 ± 24.7 µm) had a significantly (p < 0.05) smaller marginal gap than milled gold copings with a chamfer margin (27.9 ± 31.6 µm) following adjustments. Adjustments significantly decreased marginal gap for both cast groups (p < 0.05) and the milled chamfer bevel group (p < 0.05) but had no significant effect on the milled chamfer group. CONCLUSIONS: Within the limitations of this study, results indicate that gold restorations milled with the tested parameters provide a vertical marginal gap that is an acceptable alternative to traditional gold crown casting techniques.