A study of the reasons for irregular dental attendance in a private dental college in a rural setup.

Indian J Dent Res. 2007 Apr-Jun;18(2):78-81

Authors: George AC, Hoshing A, Joshi NV

The mouth is regarded as a mirror and the gateway to health. Integration is required between the dental practitioner and the patient, if good dental health is to be attained. Various treatment modalities of late frequently require appointments, which are more than one in number for completion of the entire treatment program. This study was taken up to determine the impact of reported dental attendance patterns of patients on the oral health and treatment quality in teaching hospitals and also on the quality of life in rural areas. AIMS AND OBJECTIVES: 1. To assess the reasons for irregular dental care in the patients attending the clinics in teaching hospitals. 2. To assess the satisfaction of the patient as regards the treatment rendered in the teaching institutes. 3. To correlate the gender of the patient with the regularity in the recall attendance. MATERIALS AND METHODS: A hospital-based cross-sectional study was conducted using a systematic random sampling method and every alternate subject was selected from the patients attending the OPD of Department of Periodontics and Community Dentistry. The data was collected using the interview method with the help of a structured, pretested questionnaire. RESULTS AND CONCLUSION: Out of 288 patients, 94 failed to attend the recall appointments. In these 94 patients, various reasons for not attending recall were assessed and lack of time was found to be the most common reason for non-attendance. Relationship between age and reasons for not reporting was found to be significant (P < 0.01). Patient satisfaction survey showed that 51.54% of the patients were satisfied with the dental treatment rendered. The present study also showed that males are more prompt in attending recall appointments as compared to females. A positive and significant correlation between literacy and patient reporting status was found (P< 0.01).

PMID: 17502713 [PubMed - indexed for MEDLINE]

Educating dental students about oral health care access disparities.

J Dent Educ. 2006 Nov;70(11):1208-11

Authors: Graham BS

Dental educators provide learning experiences for dental students that help them develop the belief that universal access to oral health care is a social justice imperative that will compel them to provide care to underserved patients after they graduate. To accomplish these learning outcomes, dental schools first recruit underrepresented minority students and students with previous volunteerism experiences. Dental educators then expose dental students to learning experiences in the classroom and in the community, dental school-based clinics, and community health clinics, to help them to develop the requisite knowledge, values, and competencies for serving underserved populations. The long-term, educational outcomes of these learning experiences have not been assessed to date. Systematic surveys should be conducted of dentists who have had these educational experiences to measure the number who actually care for the underserved in private dental offices, community health "safety net" clinics, and the Indian and Public Health Services.

PMID: 17106036 [PubMed - indexed for MEDLINE]

The effectiveness of school dental screening: a cluster-randomized control trial.

J Dent Res. 2006 Oct;85(10):924-8

Authors: Milsom K, Blinkhorn A, Worthington H, Threlfall A, Buchanan K, Kearney-Mitchell P, Tickle M

Dental screening of children in schools is undertaken in many countries. There is no evidence that this activity is effective. The objective of our study was to determine if school dental screening of children reduces untreated disease or improves attendance at the population level. A four-arm cluster-randomized controlled trial was undertaken in the northwest of England. In total, 16,864 children aged 6-9 years in 168 schools were randomly allocated to 3 test groups, which received screening according to different models, and a control, which received no intervention. There were no significant differences in caries increment in the primary and secondary dentitions or in the proportions of children attending a dentist after screening between the control group and the 3 intervention arms. School dental screening delivered according to 3 different models was not effective at reducing levels of active caries and increasing attendance in the population under study.

PMID: 16998133 [PubMed - indexed for MEDLINE]

Using a multifaceted approach including community-based service-learning to enrich formal ethics instruction in a dental school setting.

J Dent Educ. 2006 Jun;70(6):652-61

Authors: Gadbury-Amyot CC, Simmer-Beck M, McCunniff M, Williams KB

The purpose of this investigation was to examine the degree to which a multifaceted approach to formal ethics instruction including community-based service-learning can enrich the learning environment and how it influences students' attitudes and perceptions about their role as oral health care providers, access to care, disparity, and working in a diverse community. Students' attitudes were evaluated prior to and following the seven-week course to determine if community-based service-learning had any impact on their perceptions. Factor analysis was conducted; and based on the identified factor structure, subscales were computed and used for subsequent analyses of change in attitude over time (pre- and post-test results) and to compare assessment of experience between discipline groups (dental and dental hygiene) as well as gender. There was a statistically significant difference in student attitudes from the beginning of the course to the end about volunteering in the community (p=.036). Additionally, there was a statistically significant difference (p<.01) between male and female students related to course impact on career choice and personal ability. Female students reported the course had a greater impact on their career choice and personal ability than did males. Students were required to complete a reflection paper on their service-learning experience. Reflective papers were analyzed using the qualitative constant comparative method. Reflective papers served as a rich source of information for understanding student perceptions related to their role as oral health care providers, access to oral health care, disparity, and cultural competence. Both dental and dental hygiene students indicated a desire for additional opportunities to participate in community-based service-learning activities and a desire for addressing the current access to care issues in their curricula. We found that a multifaceted approach to ethics instruction incorporating a community-based service-learning component provided an enriched environment for the discussion of several ethical issues facing oral health care providers today.

PMID: 16741133 [PubMed - indexed for MEDLINE]

Self-perceived public health competency among recent dental graduates.

J Dent Educ. 2006 May;70(5):571-9

Authors: Bernab&#xE9; E, Ludeña MA, Beltrán-Neira RJ

The aim of this study was to assess the level of self-perceived competency in dental public health in recent graduates from the Faculty of Stomatology of the Universidad Peruana Cayetano Heredia. One hundred and nineteen graduates (28.6 percent males and 71.4 percent females) were asked to rate their self-perception of proficiency on each of the twenty-one dental public health functions identified in a dental practice competency matrix. Students assessed their competence in these dental public health functions using a three-point ordinal scale with 0 indicating "not at all competent," 1 indicating "competent," and 2 indicating "very competent." Males scored themselves higher than females for items concerning "design, develop, and evaluate community restorative interventions," "apply basic maintenance to dental equipment and instruments," and "participate in an epidemiological surveillance system." However, there were no significant differences for any item according to age. A confirmatory factorial analysis provided two factors with Eigenvalues greater than one (13.09 and 1.53, respectively), which explained 62.3 percent and 7.3 percent of the variance in the graduates' responses respectively. However, the fact that all twenty-one dental public health functions loaded higher than 0.55 on the first factor led to the conclusion that the dental public health competency is perceived by students to be a one-dimensional construct. Graduates perceived themselves as very competent for solving dental health needs at the community level. This study also provided further evidence in support of the rationale for the competency-based dental curriculum of the Faculty of Stomatology of the Universidad Peruana Cayetano Heredia.

PMID: 16687643 [PubMed - indexed for MEDLINE]

A randomized controlled trial of outreach placement's effect on dental students' clinical confidence.

J Dent Educ. 2006 May;70(5):566-70

Authors: Smith M, Lennon MA, Brook AH, Robinson PG

This randomized controlled trial compared the effects of outreach placement with traditional, exclusively dental school-based clinical experience on students' confidence in providing treatment for patients presenting with common dental problems. Senior dental students (n=49) were allocated at random to existing dental school-based clinics or placement in primary care clinics to work supervised by local dentists. At baseline, students self-rated their global confidence on a five-point scale. These measures were repeated at follow-up, augmented by a transition judgment and a then-test of confidence (asking students to look back and re-rate their pre-placement confidence). Groups were comparable at baseline. Follow-up scores for global confidence were similar between groups. The outreach group scored higher in the transition judgment (mean 3.7, SD 0.9) than the control group (mean 3.1, SD 1.1, P=0.05). In the then-test, on reflection, the outreach group considered their baseline ratings of confidence were overoptimistic (mean then-test scores 3.2, SD 0.9 and baseline 3.7, SD 0.5) while the control group thought theirs were accurate (mean then-test scores 3.8, SD 0.7 and baseline 3.6, SD 0.8, P=0.01). The findings suggest dental outreach training in primary care settings is more effective than dental school training alone in improving students' confidence in tackling clinical situations. The measurement of change in confidence is complicated by shifts in students' internal scales arising from insights gained on outreach.

PMID: 16687642 [PubMed - indexed for MEDLINE]

Prevalence of dental caries, severity, and pattern in age 6 to 7-year-old children in a selected community in Saudi Arabia.

J Contemp Dent Pract. 2006 May 1;7(2):46-54

Authors: Al-Malik MI, Rehbini YA

AIMS: The aim of this study was to determine the prevalence, severity, and pattern of dental caries in 6 to 7-year-old children in military primary schools in Jeddah city, Saudi Arabia. METHODS AND MATERIALS: A random sample of 300 children (6 to 7-year-olds) was drawn from six schools of military dependents. Clinical examinations were carried out under standardized conditions by two trained and calibrated examiners (MAM) and (YR). Caries were diagnosed using the British Association for the Study of Community Dentistry (BASCD) criteria. RESULTS: Caries were diagnosed in 288 (96%) of the children, and only 4% were clinically caries free. Mean decayed, missing, and filled teeth (dmft) for the 300 children was 8.06 (+ 4.04) per child and mean decayed, missing, and filled surfaces (dmfs) was 23.18 (+ 15.64). The teeth most affected by caries were mandibular primary second molars (83.35%), and the least affected were mandibular primary central incisors (1.15%). CONCLUSIONS: The level of caries was higher than seen in children of equivalent age in other studies. The level of caries is expected to increase in permanent dentition. The above findings stress the need for an effective program of oral prevention in these children, such as a school dental health education program for children and their parents in order to improve their oral health status.

PMID: 16685294 [PubMed - indexed for MEDLINE]

Dental education and care for underserved patients: an analysis of students' intentions and alumni behavior.

J Dent Educ. 2006 Apr;70(4):398-408

Authors: Smith CS, Ester TV, Inglehart MR

The U.S. surgeon general's report on oral health stressed the importance of providing dental care to underserved patients. The objectives of this study were to explore a) dental students' intentions and dentists' behavior concerning treating underserved patients, b) their perceptions of their education concerning these patients, and c) the relationship between dental education and their attitudes and behavior. Data were collected from 328 dental students (response rate: 77.5 percent) and 234 alumni (response rate: 43.7 percent). Only 67.4 percent of the students and 38 percent of the alumni indicated that their education had prepared them well to treat patients from different socioeconomic backgrounds; 71.3 percent of students and 55.2 percent of alumni responded that they had been well educated to treat patients from different ethnic/racial groups. The findings showed a positive relationship between the degree of curriculum focus on the importance of treating patients from all aspects of society and students' and alumni intentions to provide inclusive patient care to patients from diverse backgrounds. The more students agreed that their dental education had prepared them well to treat patients from different ethnic backgrounds, the more likely they were to report that they intended to treat these patients (r=.12; p=.033). In a similar manner, the more the alumni agreed that their dental education had prepared them well to treat patients in different communities, the more likely they were to treat patients from different socioeconomic backgrounds (r=.18; p=.009). In conclusion, these findings showed that access to oral health care for underserved patients could potentially be increased if dental students were more overtly educated about the importance of treating patients from all segments of society.

PMID: 16595532 [PubMed - indexed for MEDLINE]

A framework for service-learning in dental education.

J Dent Educ. 2006 Feb;70(2):115-23

Authors: Yoder KM

Service-learning has become an important component of higher education. Integrating service-learning into dental and dental hygiene curricula will foster graduates who are better prepared to work effectively among diverse populations and to function dynamically in the health policy arena. Although the phrase is familiar to dental educators, there is not a consistent understanding of what comprises this pedagogy. This article offers a framework for service-learning in dental education and describes ten components that characterize true service-learning. This framework can provide a common understanding of this form of experiential education that brings community engagement and educational objectives together. More effective programs can be built around a shared understanding of the characteristics and goals of service-learning in dental education.

PMID: 16478925 [PubMed - indexed for MEDLINE]

Oral research in primary care.

Adv Dent Res. 2005 Dec;18(3):37-8

Authors: Burke FM, O'Mullane D

PMID: 16385009 [PubMed - indexed for MEDLINE]

Clinical competence of graduates of community-based and traditional curricula.

J Dent Educ. 2005 Dec;69(12):1324-31

Authors: DeCastro JE, Bolger D, Feldman CA

As community-based dental education programs proliferate, so do concerns about the quality of education at extramural sites. While there have been some comparisons of the effects of community-based programs on attitudes and perceptions of competency, there is virtually no information about whether such programs can train students to carry out standard dental procedures as well as if they were prepared in the dental school proper. To address this gap in our knowledge about the educational outcomes of community-based programs, the following performance measures were retrospectively compared for 457 students in traditional senior year curricula and fifty seniors in a community-based program: scores and pass/fail rates on the Northeastern Regional Boards (NERB), clinical production, passage of competencies, and on-time graduation rates. Students in the CODE (Community-Oriented Dental Education) program at the University of Medicine and Dentistry of New Jersey (UMDNJ)-New Jersey Dental School (NJDS) demonstrated significantly higher scores on the restorative section of the NERB, but this did not translate into a better overall pass rate. CODE students passed the same competencies as graduates of the traditional program, yet demonstrated appreciably higher clinical productivity and on-time graduation rates. The additional clinical experiences for the CODE students may be a factor in their higher board scores. Based on these data, it is concluded that community-based dental educational programs can be at least as effective as intramural (school-based) educational experiences in providing students with a sound clinical education.

PMID: 16352768 [PubMed - indexed for MEDLINE]

Safety-net dental clinics.

J Am Dent Assoc. 2005 Jul;136(7):1013-21

Authors: Byck GR, Cooksey JA, Russinof H

BACKGROUND: Federal policy supports and funds community-based clinics to provide health care to low-income and underserved groups. This study examines the role of community dental safety-net clinics in providing dental care for these populations. METHODS: The authors administered a cross-sectional survey of all identified safety-net dental clinics in Illinois. Seventy-one of 94 clinics responded (response rate, 76 percent), describing their history, operations, patients, staffing and dentist relationships. An in-depth analysis of 57 clinics presents comparisons of three categories of clinics, sponsored by community health centers (23), local health departments (21) and private services agencies (13). RESULTS: Clinics were distributed across the state; 80 percent were located in facilities with other health care providers, and all provided dental care to low-income and other underserved groups. Clinics provided more than 3100 annual dental visits, operated with limited staffing and budgets, and had referral relationships with local dentists. Clinics with full-time dentists or any dental hygienists had higher annual numbers of dental visits. CONCLUSIONS: These clinics provide dental care to groups with traditional access barriers. Although they represent a small portion of all dental care, their mission and role make them a key component of strategies to address the dental access problem. PRACTICE IMPLICATIONS: Local and state dental practitioners and coalitions seeking to expand dental access should consider their community dental safety-net clinics as partners. Efforts to expand theese clinics should include considering optimizing staffing for better dental productivity.

PMID: 16060476 [PubMed - indexed for MEDLINE]

Atraumatic restorative treatment for prevention and treatment of caries in an underserved community.

Am J Public Health. 2005 Aug;95(8):1338-9

Authors: Lopez N, Simpser-Rafalin S, Berthold P

We evaluated the acceptability and effectiveness of atraumatic restorative treatment to prevent and treat caries in an underserved community in Mexico. We placed 370 restorations and 193 sealants in 118 children aged 5 to 18; 85% reported no pain, and 93% were comfortable with their restorations. We then evaluated the children 1 and 2 years later. At 2-year evaluation, 66% of restorations and 35% of sealants were retained. Atraumatic restorative treatment is acceptable and effective to control and prevent decay in a socioeconomically deprived community.

PMID: 16006415 [PubMed - indexed for MEDLINE]

Addressing oral health disparities in settings without a research-intensive dental school: collaborative strategies.

Ethn Dis. 2005;15(2):187-90

Authors: Easa D, Harrigan R, Hammatt Z, Greer M, Kuba C, Davis J, Beck JD, Offenbacher S

Research suggests that oral health is linked to systemic health, and those with poor oral health are potentially at greater risk for important diseases, including cardiovascular disease, stroke, diabetes mellitus, and adverse pregnancy outcomes. Asians and Pacific Islanders (APIs) in Hawaii have high rates of many such diseases. Studies in children in Hawaii have revealed disparities in dental health; for example, API children have significantly higher rates of cavities than other groups. Hence, conducting further study is vital in adults, particularly APIs, to assess oral health and its correlation to overall health outcomes. Given the lack of a dental school and the lack of fluoridated water in the state, the University of Hawaii's John A. Burns School of Medicine (ABSOM) has identified the need to assume a leadership role in creating effective community-based oral health research and treatment programs. With the support of the National Institute of Dental and Craniofacial Research, JABSOM fostered a collaborative relationship with the University of North Carolina at Chapel Hill School of Dentistry, a premiere research-intensive dental school, the Waimanalo Health Center, and the Hawaii State Department of Health. This partnership has worked together to implement a community-based approach to performing research designed to illuminate disparities and develop innovative strategies to promote oral health in Hawaii's diverse populations. We hope that this collaborative, culturally competent approach may serve as a model for use in other settings without a research-intensive dental school.

PMID: 15825963 [PubMed - indexed for MEDLINE]

Nationwide survey of work environment perceptions and dentists' salaries in community health centers.

J Am Dent Assoc. 2005 Feb;136(2):214-20

Authors: Bolin KA, Shulman JD

BACKGROUND: Experienced private practitioners make up a significant proportion of dentists entering community health center (CHC) practices. The authors conducted a study to identify sources of dissatisfaction that affect the retention of these dentists and to determine current CHC dentist salaries. METHODS: CHC dentists nationwide were surveyed regarding salary and job satisfaction indicators. The authors mailed 569 surveys, and the response rate was 73.8 percent. The authors explored associations between job satisfaction indicators, salaries and dentists' intentions to leave the CHCs. RESULTS: Practitioners in private practice are the largest group of dentists recruited by CHCs (54.5 percent). However, 31.2 percent of currently employed dentists do not intend to remain in CHC dental practices. Salary was not associated significantly with the intention to leave. Years of experience, freedom of professional judgment, altruistic motivation, importance placed on loan repayment and amount of administrative time allowed were associated significantly with career change intentions. CONCLUSIONS: Periodic salary surveys can monitor factors associated with recruitment and retention of dentists in community and migrant health centers, and standardized exit surveys can identify factors causing dissatisfaction among dentists who leave. PRACTICE IMPLICATIONS: Employment opportunities in public nonprofit practices are increasing under current federal grant programs. However, unless job satisfaction issues are addressed adequately with dentists in social safety net programs, additional work force needs will not be met.

PMID: 15782528 [PubMed - indexed for MEDLINE]

Pipeline, profession, and practice program: evaluating change in dental education.

J Dent Educ. 2005 Feb;69(2):239-48

Authors: Andersen RM, Davidson PL, Atchison KA, Hewlett E, Freed JR, Friedman JA, Thind A, Gutierrez JJ, Nakazono TT, Carreon DC

This article describes the conceptual and analytical framework that will be used to assess the effectiveness of the Pipeline, Profession, and Practice: Community-Based Dental Education Program. The evaluation will use a mixed method qualitative and quantitative data collection, analysis, and triangulation. Baseline measures are reported using data from the 2003 ADEA survey of dental school seniors. Baseline measures show the dental schools are confronting a major recruitment challenge that will require short and long pipeline efforts to attract and retain underrepresented and low-income (URM/LI) persons. Gaps were found between the perceptions of URM and non-URM students in the adequacy of the curricula. The majority of all seniors described the current extramural clinical rotations as positive experiences, but URMs were more likely to report the experience improved their ability to care for diverse groups.

PMID: 15689608 [PubMed - indexed for MEDLINE]

The origins and design of the Dental Pipeline program.

J Dent Educ. 2005 Feb;69(2):232-8

Authors: Bailit HL, Formicola AJ, Herbert KD, Stavisky JS, Zamora G

Funded by The Robert Wood Johnson Foundation and the California Endowment and with student financial aid from the W.K. Kellogg Foundation, the primary goal of the Pipeline, Profession, and Practice: Community-Based Dental Education program is to reduce disparities in access to dental care. In a national competition, fifteen dental schools were selected to participate. By the final year (2007) of the five-year project, the schools are expected to achieve three objectives: 1) increase the time (sixty days/year) that senior students and residents spend in patient-centered community clinics and practices treating underserved populations; 2) provide didactic and clinical courses for students and residents that prepare them for their community experiences; and 3) recruit more underrepresented minority and low-income students. The national program office that directs the project is located at Columbia University, and a national advisory committee oversees the program for the sponsoring organizations. The challenge is to demonstrate that the Pipeline objectives are achievable and that the program is sustainable without external support.

PMID: 15689607 [PubMed - indexed for MEDLINE]

Dentistry for persons with special needs: how should it be recognized?

J Dent Educ. 2004 Aug;68(8):803-6

Authors: Ettinger RL, Chalmers J, Frenkel H

PMID: 15286100 [PubMed - indexed for MEDLINE]

Practice and community: a working group report.

J Dent Educ. 2004 Jul;68(7 Suppl):45-6

Authors: Harper H, Studen-Pavlovich D

PMID: 15282253 [PubMed - indexed for MEDLINE]

Blatant bias.

J Am Dent Assoc. 2004 Jun;135(6):698; author reply 698

Authors: Casamassimo P

PMID: 15270144 [PubMed - indexed for MEDLINE]

Salient points.

J Am Dent Assoc. 2004 Jun;135(6):696, 698; author reply 698

Authors: Turchi LJ

PMID: 15270143 [PubMed - indexed for MEDLINE]

Message questioned.

J Am Dent Assoc. 2004 Jun;135(6):696; author reply 698

Authors: Anderson P

PMID: 15270142 [PubMed - indexed for MEDLINE]

Using information technology and community-based research to improve the dental health-care system.

Adv Dent Res. 2003 Dec;17:86-8

Authors: Atchison KA

It is commonly acknowledged that the United States' health-care system produces some of the finest care in the world for some people but fails to meet the needs of others. The Institute of Medicine (IOM) issued six aims for a redesigned health-care system, that it be: safe, effective, patient-centered, timely, efficient, and equitable. The purpose of this paper is to use an ongoing community-based study to illustrate current problems in the provision of oral health services that could be addressed through information technology. Appropriate use of information technology can assist dental schools and clinics in community-based clinical outcomes research needed to assemble the evidence base for improving oral health care. This conference serves as an important steppingstone to establish a means for information technology to improve the community's oral health.

PMID: 15126215 [PubMed - indexed for MEDLINE]

Health services research.

Adv Dent Res. 2003 Dec;17:82-5

Authors: Bailit HL

The major barriers to the collection of primary population-based dental services data are: (1) Dentists do not use standard record systems; (2) few dentists use electronic records; and (3) it is costly to abstract paper dental records. The value of secondary data from paid insurance claims is limited, because dentists code only services delivered and not diagnoses, and it is difficult to obtain and merge claims from multiple insurance carriers. In a national demonstration project on the impact of community-based dental education programs on the care provided to underserved populations, we have developed a simplified dental visit encounter system. Senior students and residents from 15 dental schools (approximately 200 to 300 community delivery sites) will use computers or scannable paper forms to collect basic patient demographic and service data on several hundred thousand patient visits. Within the next 10 years, more dentists will use electronic records. To be of value to researchers, these data need to be collected according to a standardized record format and to be available regionally from public or private insurers.

PMID: 15126214 [PubMed - indexed for MEDLINE]

A predoctoral clinical geriatric dentistry rotation at the University of the Pacific School of Dentistry.

J Dent Educ. 2004 Apr;68(4):454-9

Authors: Ch&#xE1;vez EM, LaBarre EE

Predoctoral dental students from University of the Pacific School of Dentistry provide initial and yearly dental evaluations for participants of On Lok Senior Health Services on site at On Lok centers. Student dentists also complete some dental procedures including denture fabrication, adjustments and repairs, hard and soft relines, scaling/root planing, polishing, and limited restorative treatments. A wide range of age-prevalent oral conditions such as candidiasis and xerostomia are identified and treated or managed. Students may also be called upon to present patient needs weekly to a member of the interdisciplinary team for discussion. Students periodically review instructions and devices for oral health care with the On Lok staff. The program is intended to be mutually beneficial to the participants of On Lok and Pacific student dentists. While the majority of comprehensive and emergency services are provided by On Lok staff dentists and contract specialists, the student dentist program has broadened the scope of the oral health program at On Lok and has been well integrated with the other day services. Meanwhile, Pacific students gain experience identifying and managing the complex social, economic, and health needs of frail elders in San Francisco.

PMID: 15112923 [PubMed - indexed for MEDLINE]

Dental hygienists and dental therapists.

J Dent Educ. 2004 Apr;68(4):413

Authors: Wyche CJ

PMID: 15112917 [PubMed - indexed for MEDLINE]

(Sub)standard of care: will culture trump competence in California?

J Am Dent Assoc. 2004 Mar;135(3):274, 276

Authors: Jeffcoat MK

PMID: 15058609 [PubMed - indexed for MEDLINE]

Evaluation of a fissure sealant program as part of community-based teaching and training.

J Dent Educ. 2004 Jan;68(1):50-4

Authors: van Wyk PJ, Kroon J, White JG

Since 1995 the Department of Community Dentistry of the University of Pretoria has been involved in the rendering of mobile primary oral health care services to children in the Hammanskraal area of Gauteng, South Africa, as part of their students' community-based training. Mokonyama Primary School was identified as the first school where a primary oral health care service could be rendered. The objective of this study was to evaluate the impact (outcomes) of a fissure sealant program on the dentition status of the school children. Seven years after the implementation of the program, the dentition status of children at Mokonyama was compared with that of a comparable group of children from the same area who were not exposed to the program. The results showed that the decayed, missing, and filled teeth in the primary dentition (dmft) in the six-year-old group in Mokonyama (1.74) did not differ significantly from the dmft (1.43) of the control group (p = 0.49). The decayed, missing, and filled teeth in the permanent dentition (DMFT) of 0.59 for the fifteen-year-old group in Mokonyama, however, differed significantly (p = 0.0001) from the DMFT of the control group (2.38). Fifteen-year-old children in Mokonyama had 75.2 percent fewer caries than their counterparts in the control group.

PMID: 14761173 [PubMed - indexed for MEDLINE]

Developing a pediatric oral health therapist to help address oral health disparities among children.

J Dent Educ. 2004 Jan;68(1):8-20; discussion 21-2

Authors: Nash DA

Oral Health in America: A Report of the Surgeon General documented the profound and significant disparities that exist in the oral health of children in the United States. Recently, the country has been issued a National Call to Action to Promote Oral Health, under the leadership of the Office of the Surgeon General. Among the significant factors contributing to the disparities problem is the access to oral health care by disadvantaged populations. There are inadequate numbers of dentists able and willing to treat children, particularly poor and minority children. In the early part of the twentieth century, New Zealand faced a significant problem with oral disease among its children and introduced a School Dental Service staffed by allied dental professionals, known as "school dental nurses," who had received two years training in caring for the teeth of children. A number of other countries have since adopted this model. This article reviews attempts to develop a comparable approach in the United States. Furthermore, it justifies and advocates the development of pediatric oral health therapists in the United States as a means of addressing the disparities problem that exists in this nation. These pediatric oral health therapists would be trained in a two-year program to provide dental care services to children. The article concludes by asserting that such action is a practical and cost-effective way for dentistry to fulfill its professional obligation to care for the oral health of all children, thus ensuring justice in oral health for America's children.

PMID: 14761168 [PubMed - indexed for MEDLINE]

Identifying and responding to competing needs: a case study of a dental school-operated community dental clinic.

J Dent Educ. 2003 Nov;67(11):1243-51

Authors: Christie D, Maida CA, Freed JR, Marcus M

Dental schools face challenges and competing needs when they seek to initiate or expand their community dental programs. This article uses a dental school community clinic as a case study to frame the tensions between competing needs of educational requirements, access to dental care, financial viability, and service to the community that clinics must learn to manage if they are to be successful. The identification of competing needs provides community-oriented dental school clinics the ability to examine factors that come into play as communities and their environments change. The outcome of this assessment process is strategies that can facilitate the provision of a higher level of services more efficiently, while at the same time taking into account future limitations in availability of resources. The concluding section of this article presents a model for a community-based dental clinic that is directed more toward patient care, involves dentists/specialists as primary providers, allows postdoctoral residents to take on more responsibility, and allows dental students to provide patient care on a more regular and longitudinal basis.

PMID: 14650506 [PubMed - indexed for MEDLINE]

Reflective learning in community-based dental education.

J Dent Educ. 2003 Nov;67(11):1234-42

Authors: Strauss R, Mofidi M, Sandler ES, Williamson R, McMurtry BA, Carl LS, Neal EM

Learners gain additional value from community-based education when they are guided through a reflective process. The purpose of this article is to describe how structured reflection assignments and methods are incorporated in the University of North Carolina School of Dentistry's community-based DISC (Dentistry in Service to Communities) program. The following strategies are described as ways to enrich community-based learning experiences for dental students: photographic documentation; written narratives; critical incident reports; and mentored post-experiential small group discussions. Fieldwork and course-related examples are drawn from community-based dental experiences to illustrate how reflective teaching approaches can enhance student learning. A directed process of reflection is suggested as a way to increase the impact of the community learning experience.

PMID: 14650505 [PubMed - indexed for MEDLINE]

Alumni perspectives on community-based and traditional curricula.

J Dent Educ. 2003 Apr;67(4):418-26

Authors: DeCastro JE, Matheson PB, Panagakos FS, Stewart DC, Feldman CA

In 1994, the University of Medicine and Dentistry of New Jersey-New Jersey Dental School (UMDNJ-NJDS) launched the Community-Oriented Dental Education (CODE) program. The CODE program provides senior dental students the opportunity to spend four days per week providing dental care in a community-based clinic. A survey of graduates of CODE (n = 55) and randomly selected graduates of the traditional curriculum (n = 110) was conducted via mail to determine attitudes relating to community service (CS), community-based learning (CBL), reasons for participating in their clinical program, perceived levels of clinical preparedness at graduation, and practice choices. A total of 111 surveys (66.9 percent) were returned to NJDS, with 84.6 percent of CODE alumni responding and 59.0 percent of traditional alumni (TA) responding. Of the 111 surveys returned, sixty-five (58.6 percent) were completed by TA, and forty-six (41.4 percent) were completed by CODE alumni. There were no differences among CODE and TA regarding attitudes toward CS and tendency to practice in underserved areas or to accept Medicaid payments. There were, however, some differences in attitudes toward CBL, reasons for applying or not applying to the CODE program, perceived impact of clinical education on graduates' preparedness, views of the extent to which the programs encouraged students to choose public or private areas of practice, and perceptions of how the desire to help communities influenced career and practice decisions. Some of these findings may be useful to schools as they plan extramural education programs.

PMID: 12749571 [PubMed - indexed for MEDLINE]

A comparison of private and public dental students' perceptions of extramural programming.

J Dent Educ. 2003 Apr;67(4):412-7

Authors: Ayers CS, Abrams RA, McCunniff MD, Goldstein BR

This project was undertaken to compare the opinions of private and public dental school students' perceptions concerning extramural programming, which is defined as any aspect of the curriculum in which undergraduate dental students provide dental care outside the main dental facility. A survey instrument was used to collect data from undergraduate students at a private (N = 267; 88.4 percent response rate) and at a public (N = 213; 67.2 percent response rate) dental school. When asked to rate the value of various extramural sites in making them a better dentist, both groups rated private dental offices the most valuable and prisons the least valuable. When questioned about the amount of time students should spend each year in extramural programming, private students, overall, desired 34 percent more time than did public students. When asked what percentage of the total time spent in extramural programming students should spend providing various categories of dental care, public school students thought 26 percent more time should be spent rendering preventive services/health education than did the private students. The private students indicated a stronger desire (13 percent more) for rendering clinical services than did public students. Both private and public students were most likely to enter group private practice after graduation. The increasing interest in community-based programs makes the information gained from this study useful for future curriculum planning.

PMID: 12749570 [PubMed - indexed for MEDLINE]

Reexamining educational philosophy: the issue of professional responsibility, "Cleveland First".

J Dent Educ. 2003 Apr;67(4):406-11

Authors: Wotman S, Lalumandier J, Canion S, Zakariasen K

This paper proposes a shift of emphasis in the dental curriculum from measures to protect and improve the oral health of individuals to measures to protect and improve the oral health of the community or society. This shift represents a fundamental change in educational philosophy of the dental school. To illustrate this shift in emphasis, this paper describes a demonstration project to test the feasibility of this approach involving all seventy first-year students in the Case Western Reserve University School of Dentistry in a four-week experience placing dental sealants in erupting molars of second and sixth graders in fifty schools of the Cleveland City School System. In future years, the program is expected to reach all second and sixth graders in the Cleveland School System. The experience is a required integral component of the curriculum, involving every student in the class, and is designed to make a demonstrable difference in oral health in the City of Cleveland. The experience is reinforced with course material on professional responsibility. The school is developing additional intensive experiences for second-, third-, and fourth-year classes involving smoking prevention for adolescents, oral health maintenance for nursing home residents, and dental care delivery in the inner city. The initial year of the program has had effects on students' responses to other elements of the first-year curriculum that go beyond the experience of placing sealants in children's teeth. The focused efforts of dental students every year are expected to have a measurable effect on the disparities in oral health found in the City of Cleveland as well as a measurable effect on dental students' and dentists' attitudes concerning professional responsibility.

PMID: 12749569 [PubMed - indexed for MEDLINE]

Views of practicing dentists regarding a mandatory fifth year of training.

J Dent Educ. 2003 Mar;67(3):317-27

Authors: Lefever KH, Atchison KA, McCauley KR, Mito RD, Engelhardt R

As part of a U.S. Health Resources and Services Administration-funded evaluation of the impact of federal funding on postgraduate general dentistry programs, a random sample of 6,725 dentists graduating in 1989, 1993, and 1997 were surveyed regarding practice patterns, advanced training, populations served, services provided, and their position on a mandatory fifth year of training. Responses (1,965) showed 48 percent supporting a mandatory year and 52 percent not supportive. Open-ended comments were provided by 1,626 respondents. The main reasons for supporting a mandatory fifth year were the need for more instructional time and need for a transition year. Individual choice, no value in a fifth year of dental school, mentoring available elsewhere, and cost were cited in opposition. The following respondents were significantly more likely than other respondents to support a mandatory fifth year: individuals who had completed an AEGD, GPR, or specialty program; were Asian; held salaried positions in a community clinic, nursing home, or hospital; or described themselves as a consultant. Graduates in 1993 and 1997 were less supportive of a mandatory fifth year than were 1989 graduates. Significant differences in the reasons offered in support of respondents' positions on the issue were observed among AEGD, GPR, specialists, and nonspecialists and the three cohort years.

PMID: 12665061 [PubMed - indexed for MEDLINE]

Why is providing dental care to people with mental retardation and other developmental disabilities such a low priority?

Public Health Rep. 2002 Sep-Oct;117(5):435-9

Authors: Waldman HB, Perlman SP

PMID: 12500959 [PubMed - indexed for MEDLINE]

Dentists in general and community practice: a Scottish survey.

Br Dent J. 2002 Sep 28;193(6):333-7

Authors: Russell E, Leggate M

OBJECTIVES: To identify the available workforce in general dental practice and to describe the job satisfaction, career and retirement plans of dentists in general and community practice. DESIGN: A postal cross-sectional survey. SETTING: Primary care dentists practising in Scotland in 2000. MATERIALS AND METHODS: Semi-structured questionnaires were sent to all primary care dentists identified from the Scottish Dental Practice Division as being in practice in Scotland. RESULTS: The response rate was 70% (1,335 GDPs and 187 CDPs). Although most dentists in both the GDS and CDS stated that they enjoyed their work, 35% of GDPs would not now choose dentistry as a career. Eighty-three per cent of the GDPs' time was spent on clinical work, of which 5% was not NHS-funded. Daily demotivation was reported by 70%, most commonly citing the job itself and the NHS 'treadmill'. Two-thirds of CDPs were women, as were half of GDPs aged less than 30. Only 35% of CDPs planned early retirement but 80% of them felt underused. Two-thirds of GDPs planned to retire in their mid-50s, and a further quarter planned to work part-time. Of the former, only a quarter agreed that nothing would induce them to work beyond this time. CONCLUSION: Conditions of work within primary care dentistry require modification to retain the current workforce and accommodate the increasing proportion of women. Part-time employment packages may encourage older practitioners to work for longer, and allow younger practitioners to fulfil family or personal commitments.

PMID: 12368892 [PubMed - indexed for MEDLINE]

Is service still a part of dentistry?

J Am Dent Assoc. 2002 Jul;133(7):987-9

Authors: Christensen GJ

Recent years have brought an observable trend for the profession to be oriented toward self-service and income, rather than the known goal of all professions: service. Dentistry offers the time and resources for practitioners to provide free or discounted services, both dental and nondental, to the public. I encourage a change of direction and increased involvement in the many types of service activities noted in this article.

PMID: 12148683 [PubMed - indexed for MEDLINE]

Effectiveness of community-based salaried orthodontic services provided in England and Wales.

J Orthod. 2002 Jun;29(2):119-23

Authors: Radnzic D

OBJECTIVES: To assess the effectiveness of the salaried Community Orthodontic Services in England and Wales, using occlusal indices, and to determine the predictors of treatment outcome. DESIGN: A retrospective investigation. A random stratified sample of districts where Community Orthodontic Services are provided was selected and visited during 1997. METHOD: All community orthodontists in England and Wales, and CDS managers who could be identified were asked to take part in this study. A stratified random sample of 15 per cent of the districts where community orthodontic services were provided was selected and a sample of the records of treated patients was examined. RESULTS: The orthodontists in the sample were providing treatment for patients clearly in need of treatment. There were, however, some variations between districts. Similarly, when the effectiveness of treatment in terms of dento-alveolar change was evaluated, the mean change in PAR and percentage PAR reduction was high. Again, there were variations between the districts. CONCLUSIONS: The Community Orthodontic Service provides effective orthodontic treatment to many individuals clearly in need of that treatment. The most significant predictor of treatment outcome was the use of two-arch fixed appliances, which produced the best treatment outcome

PMID: 12114461 [PubMed - indexed for MEDLINE]

Better opportunities for women dentists: a review of the contribution of women dentists to the workforce.

Br Dent J. 2002 Feb 23;192(4):191-6

Authors: Murray JJ

In June 2000 the Department of Health commissioned a review to examine the need for improvements to the employment opportunities for women dentists in the National Health Service (NHS) across England. Dame Margaret Seward carried out the review, which was published in September 2001. The review was considered necessary for four main reasons. Firstly, workforce panning, because now more than 50% of new entrants to dental undergraduate courses in the UK are female and by 2020 over 50% of all practising dentists will be female. Secondly, evidence that 50% of women in dentistry work for no more than two days per week for the NHS. Thirdly, most women work either as associates in general dental practice (GDP) or in the Community Dental Service (CDS). Lastly, the perception that women find it difficult to return to dentistry after taking a career break.

PMID: 11931482 [PubMed - indexed for MEDLINE]

U.S. and Canadian dental school involvement in extramural programming.

J Dent Educ. 2001 Nov;65(11):1272-7

Authors: Ayers CS, Abrams R, Robinson M

This project was undertaken from July 1999 to August 2000 to identify the status of extramural programming (that is, a program that has undergraduate dental students providing any aspect of dental care to individuals in settings outside the main clinical facility of the school) in North American dental schools. A survey instrument was mailed to all United States and Canadian dental schools concerning student involvement in extramural programming. The response rate was 79.7 percent. Of the schools responding, 3.9 percent did not offer extramural programming. The type of extramural sites, the percentage of schools offering each type of site, and the mean number of weeks students are at each site were as follows: hospital clinics--71 percent, 2.5 weeks; public health clinics--65 percent, 6 weeks; schools and day care centers--49, 1.7 weeks; private dental offices--37 percent, 2 weeks; and "other"--29 percent, 2.5 weeks. The average number of weeks spent at extramural site(s) per class was: freshman 1.9 weeks (SD=4.3); sophomores 2.3 weeks (SD=4.2); juniors 2.6 weeks (SD=1.9); and seniors 5.3 weeks (SD=6.7). Of total student time in extramural programming, 43.3 percent was spent delivering basic clinical services, 24.4 percent comprehensive clinical services, 11.8 percent health education, 11.8 percent preventive dentistry, and 8.7 percent community activities. From the data collected it is apparent that the majority of North American dental schools are providing a variety of extramural experiences for their dental students. It was found that student involvement in extramural programming increases gradually from the freshman to the senior year.

PMID: 11765874 [PubMed - indexed for MEDLINE]

Creating a school without walls and building a learning organization: a case study.

J Dent Educ. 2001 Nov;65(11):1253-63; discussion 1264-5

Authors: Frankl SN, Gibbons-Carr M

Abstract: This article describes the genesis of a "school without walls" philosophy and the implementation of learning organization principles at Boston University School of Dental Medicine (BUSDM). In Peter Senge's five-discipline approach to organizational learning, a learning organization is defined as "an organization that is continually expanding its capacity to create its future." It is an organization that changes and innovates based on continuous learning, which in BUSDM's case constituted learning from industry trends, patients, students, staff, faculty, and other key stakeholders. Most important, such organizations successfully translate that learning into effective action. It is this capacity to innovate and create change that is critical to competitive advantage and success in a changing environment. This case study of organizational change provides a discussion of the conceptual framework guiding the design and implementation of the learning organization and the chronology of transformation that occurred in three phases over a period of twenty years. We also describe the lessons we learned and the lessons that are still emerging.

PMID: 11765872 [PubMed - indexed for MEDLINE]

University of Kentucky community-based field experience: program description.

J Dent Educ. 2001 Nov;65(11):1238-42

Authors: Skelton J, Mullins MR, Kaplan AL, West KP, Smith TA

Community-based field experiences (CBFE) provide students with exemplary experiential learning opportunities. The purposes of this paper are to describe the University of Kentucky College of Dentistry (UKCD) CBFE and report the results of a two-year, self-report survey that assessed the primary course goal, students' perceptions of change in knowledge and skills related to nineteen areas of patient care (n = 90, 100% return rate), and their overall rating of the program. Knowledge and skill data were analyzed using the non-parametric binomial test for comparing proportions. A significant (.05 level) majority of students reported increases in knowledge in all areas to which they were exposed. Descriptive frequencies summarizing the results of the total CBFE experience indicate that the majority of students felt it was a positive experience. The CBFE continues to be a meaningful element in the UKCD curriculum as it provides students with a relevant, authentic educational experience.

PMID: 11765870 [PubMed - indexed for MEDLINE]

Community care.

Br Dent J. 2001 Sep 8;191(5):226-7

Authors: Brooks JA

PMID: 11575751 [PubMed - indexed for MEDLINE]

Bringing the mountain to Mohammed: a mobile dental team serves a community-based program for people with HIV/AIDS.

Am J Public Health. 2001 Aug;91(8):1187-9

Authors: Zabos GP, Trinh C

In spite of the direct referral system and family-centered model of primary oral health care linking medical and dental care providers, most HIV-positive patients at the Columbia Presbyterian Medical Center received only emergency and episodic dental care between 1993 and 1998. To improve access to dental care for HIV/AIDS patients, a mobile program, called WE CARE, was developed and colocated in community-based organizations serving HIV-infected people. WE CARE provided preventive, early intervention, and comprehensive oral health services to minorities, low-income women and children, homeless youths, gays and lesbians, transgender individuals, and victims of past abuse. More efforts to colocate dental services with HIV/AIDS care at community-based organizations are urgently needed.

PMID: 11499099 [PubMed - indexed for MEDLINE]

A clinical minimum data set for primary dental care.

Br Dent J. 2001 Jun 23;190(12):663-7

Authors: Ireland RS, Jenner AM, Williams MJ, Tickle M

OBJECTIVE: To achieve consensus within primary dental care on the contents of a clinical minimum data set to measure oral health status. DESIGN: Using the Delphi process a simple random sample of 30 LDCs and 10 CDS services in England were asked to rank a list of existing clinical indicators in order of their perceived importance as a means of measuring oral health. A nominated panel representing the stakeholder organisations of primary dental care reviewed this ranking and identified a core group of clinical indicators to be included in a clinical minimum data set. RESULTS: An 80 percent response rate to the Delphi process was achieved. Consensus was reached on a core group of 10 indicators, which can provide information on patient's perceptions of pain, function and appearance, and professional measurements of caries, teeth present, periodontal disease, oral sepsis, presence of mucosal pathology and tooth wear. CONCLUSIONS: A representative sample of primary care dentists in England and the key representative organisations of primary dental care achieved consensus on the contents of a clinical minimum data set to record oral health status in primary dental care. This is a first step in standardising the measurement of oral health status across primary care.

PMID: 11453156 [PubMed - indexed for MEDLINE]

A joint approach to treating dental phobics between community dental services and specialist psychotherapy services--a single case report.

Br Dent J. 2001 Apr 28;190(8):431-2

Authors: Wilson KI, Davies JG

A 41-year-old male patient presented at the local dental hospital requesting treatment under IV sedation, a treatment that he had had for the past 25 years. The patient was referred to the specialist psychotherapy services for cognitive behavioural therapy (CBT), and received a 1 hour course of therapy. He was then introduced to dental services, and at this visit had a check-up, OPG, and treatment planning discussion. At a subsequent visit he had local anaesthetic, three fillings, and a scale and polish. The patient is now able to return to general dental practice, after only a brief therapeutic intervention, and subsequent dental treatment. The present and future cost saving to the NHS is substantial compared with the treatment method initially sought by the patient.

PMID: 11352391 [PubMed - indexed for MEDLINE]

Special needs dentistry.

Br Dent J. 2001 Feb 10;190(3):112

Authors: Dalley K

PMID: 11236911 [PubMed - indexed for MEDLINE]

Community socioeconomic status and children's dental health.

J Am Dent Assoc. 2001 Feb;132(2):216-22

Authors: Gillcrist JA, Brumley DE, Blackford JU

BACKGROUND: Although a substantial decline in dental caries has occurred among U.S. children, not everyone has benefited equally. The first-ever surgeon general's report on oral health in America indicates that the burden of oral diseases is found in poor Americans. This study investigates the relationship between community socioeconomic status, or SES, and dental health of children. METHODS: An oral health survey of 17,256 children, representing 93 percent of children residing in 62 Tennessee communities, was conducted in public elementary schools during the 1996-1997 school year. Portable dental equipment was used for examinations, and data from each examination were entered directly into a laptop computer. The authors performed analyses of covariance to examine the relationship between community SES (low/medium/high) and dental health, controlling for community fluoridation. RESULTS: Community SES was significantly related to caries experience in the primary teeth, the proportion of untreated caries in the primary and permanent teeth, dental treatment needs, dental sealants and incisor trauma. Overall, dental health was significantly worse for low-SES communities than for medium- and high-SES communities. CONCLUSION: The authors conclude that all specific dental indexes used to measure children's dental health in this study, with the exceptions of caries experience in the permanent teeth and sealant presence, were inversely related to the communities' SES. The percentage of children with dental sealants was directly related to the community's SES. PRACTICE IMPLICATIONS: Further improvements in oral health will necessitate that community-based preventive programs and access to quality dental care be made available to children who are identified as being at highest risk of experiencing oral disease.

PMID: 11217596 [PubMed - indexed for MEDLINE]

The identification of agreed criteria for referral following the dental inspection of children in the school setting.

Br Dent J. 1999 Jan 9;186(1):37-40

Authors: Milsom K, Tickle M, Jenner A, Moulding G

AIM: To clarify the function of the school based dental inspection. OBJECTIVE: For representatives of the Community Dental Service, General Dental Service and Hospital Dental Service to identify an agreed set of criteria for the referral of children following school dental inspection. DESIGN: Qualitative research methodology used to establish a consensus for the inclusion of referral criteria following dental screening. SETTING: Ellesmere Port, Cheshire, England. MATERIALS: A Delphi technique was used to establish a consensus amongst the study participants on the inclusion of nine possible criteria for referral following dental screening. All participants scored each criterion in the range 1-9, with a score of 1 indicating that referral of individuals with the condition should definitely not take place, and a score of 9 indicating referral should definitely take place. Referral criteria were accepted only if they achieved a group median score of 7 or more, with an interquartile range of three scale points, with the lower value being no less than 7. RESULTS: Four of the nine possible criteria met the agreed group standard for inclusion: 'Sepsis', 'Caries in the secondary dentition', 'Overjet > 10 mm', and 'Registered & caries in the permanent dentition'. CONCLUSION: It is possible to agree clear criteria for the referral of children following the school dental inspection.

PMID: 10028741 [PubMed - indexed for MEDLINE]