Are U.S. Dentists Adequately Trained to Care for Children?

For decades, dental educators have noted changes in predoctoral dental education in pediatric dentistry, beginning with shifts in patients' characteristics and their availability for dental schools. During the same period, national data exposed a lingering dental caries epidemic in U.S. children yet reported more treatment of young poor children. The professional literature suggests a reluctance of the general dental community to care for children, particularly the very young who would most benefit from a dental home. The purpose of this commentary was to weigh evidence of several decades of studies on this seeming contradiction and provide the perspectives of dental students in training, those seeking advanced pediatric dentistry education or providing it, and end-users of our educational system who employ U.S. dental graduates to care for children. The usefulness of dental education establishment indicators is also reviewed, and recommendations for improvement are proposed.

Preparedness of Entering Pediatric Dentistry Residents: Advanced Pediatric Program Directors' and First-Year Residents' Perspectives.

For children to receive needed oral health care, adequate training at both the predoctoral and postdoctoral levels of dental education is required, but previous studies have found inadequacies in predoctoral education that lead to general dentists' unwillingness to treat certain young populations. As another way of assessing predoctoral preparation, the aim of this study was to determine the perspectives of first-year residents and pediatric program directors about residents' preparedness to enter advanced education programs in pediatric dentistry. Surveys were sent to all 74 U.S. program directors and 360 first-year residents. The survey focused on procedures related to prevention, behavior management, restorative procedures, pulp therapy, sedation, and surgery, as well as treating patients funded by Medicaid and with special health care needs. Among the first-year residents, 173 surveys were returned for a 48% response rate; 61 directors returned surveys for an 82% response rate. Only half of the residents (55%) reported feeling adequately prepared for their first year in residency; less than half cited adequate preparation to place stainless steel crowns (SSCs) (42%) and perform pulpotomies (45%). Far fewer felt adequately prepared to provide treatment for children six months to three years of age, including examinations (29%), infant oral exams (27%), and children with severe caries (37%). The program directors were even less positive about the adequacy of residents' preparation. Only 17% deemed them adequately prepared to place SSCs and 13% to perform pulpotomies. Approximately half reported their first-year residents were inadequately prepared to treat very young children and children with severe caries (55% each). This study found that the perceived inadequacy of predoctoral education in pediatric dentistry was consistent at both the learner and educator levels, supporting previous studies identifying inadequacies in this area.

The future of pediatric dentistry advanced education: the need for change in training standards.

This report describes the background, rationale and process for revision of training standards for advanced educational programs in pediatric dentistry in the United States.

Evaluating the need for alternative didactic learning options in pediatric dental residency training.

The need for an alternative means of delivery of a didactic curriculum to pediatric dental residents is described. It is our hope with this project to encourage a much-needed didactic curriculum for programs lacking faculty and to endorse other programs in which academicians exist but cannot cover all the material with which a resident needs to become familiar in the two years of postgraduate residency training. A decrease in faculty number due to retirement, debt burden, or marginal recruitment techniques along with an increase in positions in pediatric dentistry residency programs poses a unique educational dilemma. Using a mixed-method research methodology, we sent a twelve-question survey to 105 pediatric dentistry residency program directors and department chairs, followed by eight telephone interviews. Results from a 55 percent return rate show that the debt burden of most pediatric dental residents is well over $100,000 and that this affects a resident's decision to enter academia, as does the relative lack of positive recruitment techniques and poor faculty remuneration. The survey results affirm the need for improvement in the didactic curriculum of pediatric dentistry residents and show that program directors and department chairs also feel that an alternative delivery method using DVD or online/web-based programs would be welcomed. Despite their extremely heavy workloads, educators are willing to contribute by providing lectures or reading lists in their area of expertise.

Demographics and quality profile of applicants to pediatric dentistry residencies.

PURPOSE: The purpose of this study was to use Postdoctoral Application Support Service (PASS) data to study the quality and demographic trends for pediatric dentistry residency applicants. METHODS: PASS data on grade point average (GPA) and National Dental Board Exam, Part I (NBI) scores were used to determine applicant quality. PASS demographic data included: (1) gender; (2) citizenship; (3) ethnicity; (4) previous practice of dentistry; and (5) completion of a residency or internship. RESULTS: GPAs showed a significant increase for the 6 years investigated. NBI scores also indicated a significant increase. Significantly more females than males applied to pediatric dentistry residencies. A significant increase in US/Canadian applicants was found. Ethnicity was similar to that of dental school graduates, with minor exceptions. In several of the years studied, there were significant differences in applicants who previously practiced dentistry or completed a residency/internship vs applicants who had no such previous experience. CONCLUSIONS: Significant increases in grade point averages and National Dental Board Exam, Part I scores suggest a high quality of pediatric dentistry residency applicants and this trend seem to be continuing. There are significantly more female than male applicants. More research is warranted on actual acceptance data.

American Academy of Pediatric Dentistry survey of US pediatric dentistry faculty members.

PURPOSE: This survey's purpose was to: (1) assess the status of the pediatric dentistry academic workforce; (2) determine if the current workforce is sufficient for pediatric and general dentistry education requirements; (3) address other workforce issues; and (4) explore factors influencing this faculty shortage, thereby narrowing the focus of other surveys. METHODS: In 2004, 130 pediatric dentistry faculty members completed a Web-based survey regarding workforce issues. Questions were asked regarding: (1) faculty characteristics; (2) job history prior to academics; (3) academic career longevity/motivators for change; and (4) private practice participation. RESULTS: Twenty-four percent indicated academic involvement for over 25 years, followed by 20% indicating 1- to 4-year involvement. Eighty-two percent of chairpersons had educators leave within the last 5 years, with 38% of positions remaining unfilled. Motivators for leaving included location (25%), family (19%), and faculty (12%). Twenty-three percent identified salary as an influential factor when considering an institution change, and 74% felt clinical tracks would aid in recruiting/retaining faculty. The majority of full-time faculty members maintained a part-time practice. CONCLUSIONS: Survey results indicate that pediatric dentistry mirrors the national dental faculty member shortage. Most troubling is the loss of educators after 5 and 10 years of teaching, perhaps due to salary disparities with private practice, tenure requirements, and family.