Evaluating video-based lectures on YouTube for dental education.

PURPOSE/OBJECTIVES: Multimedia presentations and online platforms are used in dental education. Though studies indicate the benefits of video-based lectures (VBLs), data regarding user reception and optimal video features in dental education are limited, particularly on Web 2.0 platforms like YouTube. Given increasing technology integration and remote learning, dental educators need evidence to guide implementation of YouTube videos as a freely available resource. The purpose of this study is to determine video metrics, viewership and format efficacy for dental education videos. METHODS: First, a cross-sectional survey was conducted of viewers (N = 683) of the Mental Dental educational videos on YouTube. Analytics were evaluated for 677 200 viewers to assess audience demographics, retention and optimal video length. Second, a randomized crossover study was conducted of dental students (N = 101) who watched VBLs in either slideshow or pencast formats and were tested on content learning to compare format efficacy. RESULTS: Most viewers of Mental Dental videos were dental students (44.2%) and professionals (37.8%) who would likely recommend the platform to a friend or colleague (Net Promoter Score = 82.1). Audience retention declined steadily at 1.34% per minute, independent of video length. Quiz performance did not differ between slideshow and pencast videos, with students having a slight preference for slideshows (P = 0.049). CONCLUSIONS: Dental students and professionals use VBLs and are likely to recommend them to friends and colleagues. There is no optimal video length to maximize audience retention and lecture format (slideshow vs. pencast) does not significantly impact content learning. Results can guide implementation of VBLs in dental curricula.

"I don't think the problem's the student I think it's us": Engaging faculty in curriculum innovation.

PURPOSE: The need to innovate predoctoral dental education is well established; however, there are few recent reports to guide substantial curriculum transformation. The purpose of this study was to describe faculty perspectives on their vision of future graduates, curriculum needs, and potential barriers to a successful redesign. This information would be used to inform strategic planning for the predoctoral curriculum transformation. METHODS: Eighty full-time faculty from the University of North Carolina Adams School of Dentistry participated in 60-minute focus groups in March 2018. Focus group questions were developed to elicit perceptions about the current curriculum, what the dental graduate should know in 2040, and what is needed to engage faculty in curriculum change. Transcripts of the focus group sessions were analyzed by a third-party research group using qualitative thematic analysis to identify pertinent themes shared by participants. RESULTS: Faculty identified that developing clinical skill that engages multiple specialties, student time to engage in advocacy activities, and opportunities to integrate biomedical, clinical, and behavioral sciences as critical features of the curriculum. They believed the 2040 graduate should be able to critically evaluate literature, exhibit strong leadership skills, and adapt to the changing healthcare environment. To better engage faculty in curriculum change, there needs to be dedicated time, sufficient resources, a clear plan, and greater collaboration across the school. CONCLUSION: When embarking on curriculum transformation, engagement with faculty is a critical component of the change process. Focus groups can be used as a technique to better understand faculty perspectives about curricular needs and the overall vision.

Developing a curriculum blueprint and taxonomy: Process, progress, and pivots.

Curriculum transformations represent opportunities to innovate; however, there are few examples to inform this process. In 2018, the University of North Carolina at Chapel Hill (UNC) Adams School of Dentistry began to transform the predoctoral curriculum to improve content integration, enhance team-based experiences, and develop leaders. Part of this experience has been crafting a conceptual curriculum guide or "blueprint" that outlines a vision for the design process and ensures the transformation achieves its goals. We describe how we created the UNC Blueprint for our revised curriculum, which defines who our graduates are, what they know, and what they can do. This approach has led us to develop a mapping taxonomy to ensure the student outcomes are appropriately aligned with content, instruction, and assessment throughout the curriculum. Last, we encourage others to be agile in their approach, create a common language among their teams, and frequently engage faculty to facilitate the process.

Traumatic dental injuries in preschool-age children: Prevalence and risk factors.

This study examined the prevalence, socio-demographic correlates, and clinical predictors of traumatic dental injuries (TDIs) in the primary dentition among a community-based sample of preschool-age children. The sample comprised 1,546 preschool-age children (mean age 49 [range: 24-71] months) in North Carolina public preschools, enrolled in a population-based investigation among young children and their parents in North Carolina. Information on socio-demographic, extraoral, and intraoral characteristics was collected and analyzed with bivariate and multivariate methods, including logistic regression modeling and marginal effects estimation. The prevalence of dental trauma was 47% and 8% of TDI cases were "severe" (pulp exposure, tooth displacement, discolored or necrotic tooth, or tooth loss). In bivariate analyses, overjet and lip incompetence were significantly associated with TDI. Overjet remained positively associated with severe trauma in multivariate analysis, OR = 1.4, 95% confidence interval (CI) [1.2, 1.6], corresponding to an absolute 1.3%, 95% CI [0.7, 1.8], increase in the likelihood of severe trauma, per millimeter of overjet. Children with increased overjet (>3 mm) were 3.8, 95% CI [2.0, 7.4], times as likely to have experienced severe TDI compared with those with ≤3 mm. Overjet is a strong risk factor for TDIs in the primary dentition. Incorporating and operationalizing this information may help TDI prevention and related anticipatory guidance for families of preschool-age children.

Call for ACTion: Transforming Dental Education at the University of North Carolina at Chapel Hill.

The University of North Carolina at Chapel Hill Adams School of Dentistry is developing a transformative curriculum that prepares students to enter contemporary practice. The Advocate, Clinician, and Thinker (ACT) framework will provide the basis for developing a resilient workforce capable of meeting emerging health care needs over the next 40 years.

Diagnostic accuracy of intraoral photographic orthodontic records.

OBJECTIVE: The aims of this study were (1) to investigate how relevant intraoral photographs are to contemporary orthodontic diagnosis and (2) to assess orthodontists' ability to accurately diagnose angle classification and dental midlines using standardized intraoral photographs. METHODS: Study participants were orthodontists who completed a survey regarding photography protocols and their use of intraoral photographs for diagnosis. Each participant was randomized to complete 1 visual diagnostic task regarding either angle classification or midlines. Accuracy was compared across groups and camera angulations. RESULTS: In all, 80% of 192 respondents reported using photographs and clinic notes to plan orthodontic treatment; 50% also included dental casts. For the angle task, accuracy judging molar and canine classification was 79.9% and 51.3%, respectively with ideal standardized photographs. As camera angulation deviated, accuracy decreased significantly (P < 0.0001). For the midline task, accuracy judging the direction of deviation decreased with a small camera angulation change yet increased with a large change (P < 0.001). CONCLUSIONS: When using ideal intraoral photographs alone to diagnose angle classification and midline relationships, accuracy is not likely to be greater than 80%. As camera angulation becomes less ideal, by 15 degrees when judging angle classification or 4 degrees when judging midlines, accuracy is likely to significantly decrease. CLINICAL SIGNIFICANCE: For the clinician who wants to have the most accurate and complete records, our results suggest that intra-oral photos alone may not be adequate when it comes to judging occlusal relationships such as angle classification and esthetic parameters like midlines. When using ideal intraoral photographs to diagnose angle classification and midline relationships, accuracy is not likely to be greater than 80%. As camera angulation becomes less ideal, by as little as 15 degrees when judging angle classification or 4 degrees when judging midlines, accuracy is likely to decrease significantly. Understanding these limitations will allow clinicians to improve both their clinical photography technique and their diagnostic skills.

Self-Directed Digital Learning: When Do Dental Students Study?

The Growth and Development (G&D) curriculum at the University of North Carolina at Chapel Hill School of Dentistry uses self-directed web-based learning modules in the place of lectures and includes scheduled self-study times during the 8 am-5 pm school hours. The aim of this study was to use direct observation to evaluate dental students' access patterns with the self-directed, web-based learning modules in relation to planned self-study time allocated across the curriculum, proximity to course examinations, and course performance. Module access for all 80 students in the DDS Class of 2014 was recorded for date and time across the four G&D courses. Module access data were used to determine likelihood of usage during scheduled time and frequency of usage in three timeframes: >7, 3 to 7, and 0 to 2 days before the final exam. The results showed a statistically significant difference in the likelihood of module access during scheduled time across the curriculum (p<0.0001). Among the students, 64% accessed modules at least once during scheduled time in G&D1, but only 10%, 19%, and 18% in G&D2, G&D3, and G&D4, respectively. For all courses, the proportion of module accesses was significantly higher 0-2 days before an exam compared to the other two timeframes. Module access also differed significantly within each timeframe across all four courses (p<0.001). There was no association between module access and course performance. In this non-traditional, non-lecture, self-directed curriculum, students rarely accessed learning modules during syllabus-budgeted self-study time and accessed modules more frequently as course exams approached.

Extraction frequencies at a university orthodontic clinic in the 21st century: Demographic and diagnostic factors affecting the likelihood of extraction.

INTRODUCTION: The aims of this study were to report contemporary orthodontic extraction frequencies at a university center and to investigate what patient-related factors might influence the likelihood of extraction. METHODS: The records of 2184 consecutive patients treated at the University of North Carolina from 2000 to 2011 were analyzed. Year-by-year rates for overall orthodontic extractions and for extraction of 4 first premolars were calculated. Logistic regression, adjusting for all recorded patient risk factors for extraction, was used to examine both the changes in extraction frequencies over time and the influence of individual patient factors on the odds of extraction. RESULTS: Small linear decreases in orthodontic extraction frequency overall (OR, 0.91; 95% CI, 0.88-0.95) and in extraction of 4 first premolars (OR, 0.95; 95% CI, 0.90-0.99) were seen. The overall extraction rate was 37.4% in 2000, and it fell just below 25% from 2006 onward. Four first premolar extraction rates ranged from 8.9% to 16.5%. Extractions were significantly more likely as crowding and overjet increased (OR, 1.2; 95% CI, 1.14-1.25; OR, 1.1; 95% CI. 1.07-1.19), as overbite decreased (OR, 0.8; 95% CI, 0.77-0.89), with Class II dental or skeletal relationships (OR, 1.5; 95% CI, 1.12- 2.05; OR, 1.4; 95% CI, 1.04-1.85), and for nonwhite patients (OR, 3.0; 95% CI, 2.2-4.06 for other races; OR, 4.1; 95% CI, 3.03-5.66 for African Americans). CONCLUSIONS: Extractions were just as likely to be associated with Class II dental and skeletal problems and with open-bite problems as with crowding alone.

Enhanced Facial Symmetry Assessment in Orthodontists.

Assessing facial symmetry is an evolutionarily important process, which suggests that individual differences in this ability should exist. As existing data are inconclusive, the current study explored whether a group trained in facial symmetry assessment, orthodontists, possessed enhanced abilities. Symmetry assessment was measured using face and non-face stimuli among orthodontic residents and two control groups: university participants with no symmetry training and airport security luggage screeners, a group previously shown to possess expert visual search skills unrelated to facial symmetry. Orthodontic residents were more accurate at assessing symmetry in both upright and inverted faces compared to both control groups, but not for non-face stimuli. These differences are not likely due to motivational biases or a speed-accuracy tradeoff-orthodontic residents were slower than the university participants but not the security screeners. Understanding such individual differences in facial symmetry assessment may inform the perception of facial attractiveness.

Face symmetry assessment abilities: Clinical implications for diagnosing asymmetry.

INTRODUCTION: An accurate assessment of face symmetry is necessary for the development of a dentofacial diagnosis in orthodontics, and an understanding of individual differences in perception of face symmetry between patients and providers is needed to facilitate successful treatment. METHODS: Orthodontists, general dentists, and control participants completed a series of tasks to assess symmetry. Judgments were made on pairs of upright faces (similar to the longitudinal assessment of photographic patient records), inverted faces, and dot patterns. Participants completed questionnaires regarding clinical practice, education level, and self-confidence ratings for symmetry assessment abilities. RESULTS: Orthodontists showed expertise compared with controls (P <0.001), whereas dentists showed no advantage over controls. Orthodontists performed better than dentists, however, in only the most difficult face symmetry judgments (P = 0.006). For both orthodontists and dentists, accuracy increased significantly when assessing symmetry in upright vs inverted faces (t = 3.7, P = 0.001; t = 2.7, P = 0.02, respectively). CONCLUSIONS: Orthodontists showed expertise in assessing face symmetry compared with both laypersons and general dentists, and they were more accurate when judging upright than inverted faces. When using accurate longitudinal photographic records to assess changing face symmetry, orthodontists are likely to be incorrect in less than 15% of cases, suggesting that assistance from some additional technology is infrequently needed for diagnosis.

Changes in the pattern of patients receiving surgical-orthodontic treatment.

INTRODUCTION: The characteristics of patients who seek and accept orthognathic surgery appear to be changing over time but have not been well documented in the 21st century. METHODS: Records for patients who had orthognathic surgery at the University of North Carolina from 1996 to 2000 and from 2006 to 2010 were reviewed to collect data for changes in the prevalence of patients with mandibular deficiency (Class II), maxillary deficiency or mandibular prognathism (Class III), long face, and asymmetry problems. The changes were compared with those in previous time periods and at other locations. RESULTS: Between 1996 and 2000 and between 2006 and 2010, the percentage of Class III patients increased from 35% to 54%, and the percentage of Class II patients decreased from 59% to 41%, while the percentages for long face and asymmetry showed little change. The decrease in Class II patients was accentuation of a long-term trend; the increase in Class III patients occurred only after the turn of the century. CONCLUSIONS: A similar but less-marked change has been noted at some but not all other locations in the United States. It appears to be related primarily to an increase in the numbers of African Americans, Native Americans, Hispanics, and Asians who now are seeking surgical treatment, but it also has been affected by changes in where orthognathic surgery is performed, decisions by third-party payers (insurance and Medicaid) about coverage for treatment, and the availability of nonsurgical orthodontic treatment options for Class II patients.

Effectiveness of web-based teaching modules: test-enhanced learning in dental education.

The purpose of our study was to evaluate the effectiveness of self-tests as a component of web-based self-instruction in predoctoral orthodontics and pediatric dentistry. To this end, the usage patterns of online teaching modules and self-tests by students enrolled in three courses at the University of North Carolina at Chapel Hill School of Dentistry were monitored and correlated to final exam grade and course average. We recorded the frequency of access to thirty relevant teaching modules and twenty-nine relevant self-tests for 157 second- and third-year D.D.S. students during the course of our data collection. There was a statistically significant positive correlation between frequency of accessing self-tests and course performance in one course that was totally based on self-instruction with seminars and multiple-choice examination (Level IV): Spearman correlation between frequency of self-test access and final exam grade, rho=0.23, p=0.044; correlation between frequency of self-test access and course average: rho=0.39, p=0.0004. In the other two courses we monitored, which included content beyond self-instruction with self-tests, the correlations were positive but not statistically significant. The students' use of online learning resources varied significantly from one course (Level I) to the next (Level II): Wilcoxon matched pairs signed-rank tests, S=-515.5, p=.0057 and S=1086, p<0.0001. The data from this study suggest that increased use of web-based self-tests may be correlated with more effective learning in predoctoral dental education by virtue of the testing effect and that dental students' usage of resources for learning changes significantly over the course of their education.