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BACKGROUND Dental surgery under general anesthesia (GA) is a common treatment for severe childhood caries and thus may serve as an event to motivate behavior change. The frequency of recurrent caries, however, indicates opportunities within current practice to change a child's oral health behaviors. AIM To assess caregiver experiences related to their child's dental surgery to inform development of a behavioral intervention. DESIGN Semi-structured interviews with caregivers of children receiving GA for dental surgery. Transcripts (n = 19) were analyzed using qualitative thematic methods. RESULTS Children were 2-5 years of age, mean 3.8 years. Limited access to GA services was a source of caregiver frustration and a barrier to caries treatment. Surgical events elicited emotional reactions including guilt, anxiety, and a sense of caregiver accountability for development of severe caries. There was variation in caregiver awareness and/or motivation to change oral health behaviors. CONCLUSIONS A child's dental surgery under GA is an emotionally challenging event yet may inspire hope and expectations for improvement. Surgery offers an opportunity to implement interventions at a time when caregivers may be open to assistance with behavior change, though stress and anxiety may create barriers. Behavioral interventions should be tailored to individual caregiver needs/barriers and stage of developmental readiness.

Case-based learning offers exposure to clinical situations that health professions students may not encounter in their training. The purposes of this study were to apply the Diffusion of Innovations conceptual framework to 1) identify characteristics of case studies that would increase their adoption among dental and dental hygiene faculty members and 2) develop and pretest interactive web-based case studies on sensitive oral-systemic health issues. The formative study spanned two phases using mixed methods (Phase 1: eight focus groups and four interviews; Phase 2: ten interviews and satisfaction surveys). Triangulation of quantitative and qualitative data revealed the following positive attributes of the developed case studies: relative advantage of active learning and modeling; compatibility with a variety of courses; observability of case-related knowledge and skills; independent learning; and modifiability for use with other oral-systemic health issues. These positive attributes are expected to increase the likelihood that dental and dental hygiene faculty members will adopt the developed case study once it is available for use. The themes identified in this study could be applied to the development of future case studies and may provide broader insight that might prove useful for exploring differences in case study use across dental and dental hygiene curricula.

Oral healthcare providers are likely to encounter a number of sensitive oral/systemic health issues whilst interacting with patients. The purpose of the current study was to develop and evaluate a framework aimed at oral healthcare providers to engage in active secondary prevention of eating disorders (i.e. early detection of oral manifestations of disordered eating behaviours, patient approach and communication, patient-specific oral treatment, and referral to care) for patients presenting with signs of disordered eating behaviours. The EAT Framework was developed based on the Brief Motivational Interviewing (B-MI) conceptual framework and comprises three continuous steps: Evaluating, Assessing, and Treating. Using a group-randomized control design, 11 dental hygiene (DH) and seven dental (D) classes from eight institutions were randomized to either the intervention or control conditions. Both groups completed pre- and post-intervention assessments. Hierarchical linear models were conducted to measure the effects of the intervention whilst controlling for baseline levels. Statistically significant improvements from pre- to post-intervention were observed in the Intervention group compared with the Control group on knowledge of eating disorders and oral findings, skills-based knowledge, and self-efficacy (all P < 0.01). Effect sizes ranged from 0.57 to 0.95. No statistically significant differences in outcomes were observed by type of student. Although the EAT Framework was developed as part of a larger study on secondary prevention of eating disorders, the procedures and skills presented can be applied to other sensitive oral/systemic health issues. Because the EAT Framework was developed by translating B-MI principles and procedures, the framework can be easily adopted as a non-confrontational method for patient communication.

The incorporation of web-based learning into the dental curriculum has been consistently recommended in the literature on reform in dental education. There has been growing support for web-based learning in dental and dental hygiene education as demonstrated by deans’ identifying this as a planned curricular innovation. The purpose of our study was to explore characteristics of e-courses that may serve to increase adoption among dental and dental hygiene faculty members. Eight ninety-minute focus groups (three dental; five dental hygiene) were conducted with dental (n=27) and dental hygiene (n=23) faculty members from six academic institutions. The resulting data were analyzed to identify two overarching themes and associated subthemes with regard to benefits and barriers influencing adoption of e-courses. A working conceptual framework, based on the Diffusion of Innovations, was developed from these themes to understand the characteristics that may influence the rate of adoption of e-courses among dental and dental hygiene faculty members. Analysis of the data revealed four main adoption barriers: 1) low perceived relative advantage to faculty members; 2) low compatibility with current curriculum; 3) high perceived time commitment; and 4) complexity of e-course development. This exploratory assessment identifies leverage points for facilitating the adoption and sustainability of e-courses in dental and dental hygiene education.

Diabetes mellitus is a major public health concern for the U.S. population because of its high prevalence and long-term health implications. The purpose of this study was to apply the Theory of Planned Behavior (TPB) to assess dental faculty member and student willingness to provide diabetes education and counseling to patients in a dental school. A survey was administered to dental students (n=101 respondents) and faculty members (n=39 respondents), and summary scores for seven diabetic educational activities and TPB constructs were calculated and analyzed. Participants were most willing to refer a patient to a physician for treatment and provide basic information about diabetes and oral health, and they were least willing to provide basic information about diabetic medications. Importance, self-efficacy, and barriers constructs predicted willingness to perform diabetic educational or counseling activities. Our findings suggest that, when developing innovative approaches to expand diabetic education and counseling in our dental education environment, programs should demonstrate how diabetic counseling can improve patients’ health and should include diabetic management skills-building in the curriculum.

Tobacco dependence education (TDE) continues to be a vital component of dental hygiene curricula-made even more important by the fact that tobacco cessation in adults in the United States has stagnated over the past ten years. This study was undertaken to assess the salient characteristics of TDE in U.S. dental hygiene programs. A fifty-one question survey was mailed to the program directors of all 283 accredited dental hygiene programs during the 2007-08 school year (this number does not include the programs in Illinois, which were excluded since they had participated in a previous study). A total of 187 schools returned the survey for a return rate of 66 percent. Curricular content, minutes spent on each topic, existing level of clinical competence measured, expected level of clinical competence, and resources used were assessed. Respondents reported an average of 6.7 hours spent on all identified components of tobacco education. While 77 percent of respondents reported formally assessing whether a student asked if a patient used tobacco, only 26 percent indicated having a formal competency utilizing all of the U.S. Public Health Service's Clinical Practice Guideline 5 As and 5 Rs. In contrast, 72 percent of program directors reported expecting their graduates to be competent in a moderate intervention that included all 5 As. Though there is a clear commitment to TDE among dental hygiene programs in the United States, we recommend training to a more intensive level of TDE in order to facilitate broader adoption of comprehensive, evidence-based guidelines.

Although oral health care providers (OHP) are key in the secondary prevention of eating disorders (ED), the majority are not engaged in assessment, referral, and case management. This innovative pilot project developed and evaluated a web-based training program for dental and dental hygiene students and providers on the secondary prevention of ED. The intervention combined didactic and skill-based objectives to train OHP on ED and its oral health effects, OHP roles, skills in identifying the oral signs of ED, communication, treatment, and referral. Using a convenience sample of OHP (n=66), a pre-/post-test evaluated short-term outcomes and user satisfaction. Results revealed statistically significant improvements in self-efficacy (p

In this pilot study, we tested a new program for training medical care providers in the primary prevention and early detection of oral cancer. The training program consisted of two modules: (1) oral cancer epidemiology and head and neck examinations for the early detection of oral cancer and (2) assessment and counseling of patients in tobacco cessation. On a pretraining questionnaire, the 8 participating clinicians (3 primary care physicians, 4ENT nurses, and 1 physician assistant) indicated that they had only a limited awareness of oral cancer, that they generally did not routinely examine asymptomatic patients for oral cancer, and that they engaged in only a limited amount of risk assessment/counseling with their patients. On a post-training questionnaire, they indicated that their training had been well received and would prompt them to increase their efforts to examine their patients for early signs of oral cancer and to counsel them about its risks.

Objective: To interview health professionals in a Latino community about the association between diabetes and periodontitis, and provide a basis to develop interventions for them to promote oral health and good glycemic control among patients with diabetes. Methods: Five dentists, seven nurses and two nutritionists were interviewed about their practices relevant to oral health and diabetes, knowledge about the association, beliefs about Latinos, recommendations on reaching others in their fields, and barriers. The interviews were audiotaped, transcribed, and analyzed qualitatively. Results: Professionals identified policy, community and practice barriers for promoting diabetic control and oral health. Conclusions: Producing a resource list, cross-educating professionals about diabetes and oral health, training professionals to better serve Latino patients, developing appropriate protocols for each profession regarding the association between diabetes and periodontitis, and educating the community about diabetic control, oral health and disease prevention were identified as potential strategies to improve oral health among Latino persons with diabetes.

Objectives: A large study of risky pre-teen behavior provided an opportunity to examine self-reported toothbrushing frequency for stability over time and adequacy. Methods: 1115 metropolitan African-American children at risk for violence and drug use self-reported toothbrushing frequency in at least one of five measurement points from 5th to 8th grade as part of a larger study. Longitudinal data were available for 815 students. Results: 81% reported mainly twice daily, 8% reported mainly once daily, 10% changed over time, and 1% were consistently less than once daily. Conclusions: Overall, the children reported once or twice daily toothbrushing frequency, stable between 5th and 8th grades. A minority of children showed low or inconsistent frequencies and these results may provide an opportunity for intervention to improve habits.

In an article published in the April 2004 issue of the Journal of Dental Education , Dr. Charles Bertolami proposed that our ethics curricula don’t work due to the limitations of didactic education. He suggested that ethics should be taught as a “precurriculum” course prior to entering dental school and that the dental school ethics course should be elective and consist of small groups of students who are guided to introspection to understand their true self-interest. He argued that “enlightened” self-interest is the best means to motivate students to behave ethically. Our article was stimulated by Bertolami’s contentions. Six essays are presented that offer perspectives on the issue of professional ethics and ethics instruction from the viewpoints of students, administrators, and faculty at one dental school. The student essays support the difference between teaching about ethics and changing behavior and discuss the pressures to cheat in dental school. Bertolami’s proposition regarding the role of self-interest in ethical decision making is examined. The final essays discuss the ways that ethics curricula and dental schools can encourage students to internalize the values of dentistry. They conclude that while some of Bertolami’s propositions may have merit, many do not seem to accomplish the desired goals of inculcating ethics or enhancing ethical behavior in dental students, and they encourage further discussion of ethical instruction.

Race has been shown to affect the quality of physician-patient relations. In view of this, dentistry must consider whether race also affects dentist-patient relations. The purpose of this study was to explore whether orthodontic residents showed more social connection and concern for European ancestry patients, were more negative to minority patients, and appropriately used interventions designed to overcome cultural differences. Communications in sixty-eight dentist-patient encounters were analyzed using the Roter Interaction Analysis System (RIAS). The frequencies of each type of utterance were examined accord- ing to the patient's race/ethnicity. The race/ethnic groups were European (nineteen), African American (eleven), Latino (thirty- four), and Asian (four). In 90 percent of the sessions, the resident and the patient were of different ethnicity. Residents used social connection utterances more with European ancestry patients, but used personal utterances more with Latino patients. Residents did not use open-ended questions or probes for patient understanding more with minority patients. The communication patterns observed in this study were similar to those reported in the literature. This study has limitations, but additional research may confirm that residents communicate differently with patients by race and could use more appropriate methods of dealing with cross-cultural situations. More research on cross-cultural communication is needed.

The purpose of this research was to explore the changes that occurred in dental students9 counseling techniques as a result of training in Brief Motivational Interviewing (BMI). A randomized pretest, posttest design was used with eleven students in each group. Baseline and posttraining measures of students9 counseling techniques and the characteristics of the counseling session with standardized patients were made. The measures were: student behavior from videotapes, patient involvement in the treatment, establishment of good doctor-patient rapport, perceived efficacy in promoting patient change, and student confidence and interest in the task. MANOVA found significant differences between the trained and the untrained groups (F = 4.019, p = 0.018). Training resulted in sessions in which students used more BMI techniques and patients were more actively involved. No changes were seen in the other variables. Future studies must examine whether more experience will improve the students9 ability to use BMI to enhance patient rapport, to increase their sense of competence and interest in doing counseling, and to determine the effectiveness of the counseling to encourage patient smoking cessation.

The periapical areas of 16 teeth from 6 human mandibular jaw specimens were randomly examined by 3 observers using conventional radiography with Kodak E-speed film and radiovisiography (with variable contrast and with fixed contrast). Each periapical area was examined preoperatively and after #2, #4, #6, and #8 sized bur periapical lesions were created in the cortical bone. The three radiographic methods were compared by repeated-measures ANOVA of the accuracy scores for the 16 periapical lesions. Accuracy increased with size of lesion, but did not vary by method. Repeated-measures ANOVA of the accuracy scores of only the smallest and no lesion condition showed that conventional radiography and radiovisiography (variable contrast) have opposite strengths. Conventional radiography tended to be more accurate in the no lesion condition, whereas radiovisiography using variable contrast was somewhat more accurate in the smallest lesion condition. The accuracy of radiovisiography with fixed contrast was not significantly different from the other two methods.

Background Caries prevention traditionally has emphasized the restriction of cariogenic foods and beverages, but it has placed less emphasis on how the choice, combination and sequence of consumed foods and beverages may help reduce plaque acidogenicity. The authors conducted a study to examine whether whole milk, 100 percent apple juice or tap water affect dental plaque acidity in people after a sugary challenge. Methods Twenty adults participated in a randomized controlled crossover study. Participants consumed four combinations of foods: 20 grams of dry sugary Froot Loops (FL) (Kellogg's, Battle Creek, Mich.) cereal, 20 g of FL followed by 50 milliliters of milk (FL/milk), 20 g of FL followed by 50 mL of juice (FL/juice) and 20 g of FL followed by 50 mL of water (FL/water). The authors used a touch microelectrode to take plaque pH readings at the interproximal space just below the contact area between the maxillary premolars on both left and right sides at two and five minutes after FL consumption and at two to 30 minutes after milk, juice or water consumption. Results Consumption of FL plaque pH (standard deviation [SD]) was 5.83 (0.68) at 30 minutes, whereas plaque pH (SD) in the FL/milk group was 6.48 (0.30), which was significantly higher than that for FL/juice (5.83 [0.49]) or FL/water (6.02 [0.41]) ( P Conclusion Drinking milk after a sugary cereal challenge significantly reduced plaque pH drop due to the sugary challenge. Practical Implications When discussing the cariogenicity of foods and beverages with patients, dentists and other health care professionals should emphasize that the order of ingesting sugary and nonsugary foods is important and may affect their oral health.

Oral healthcare providers have a clinical opportunity for early detection of disordered eating behaviors because they are often the first health professionals to observe overt oral and physical signs. Curricula regarding early recognition of this oral/systemic medical condition are limited in oral health educational programs. Web-based learning can supplement and reinforce traditional learning and has the potential to develop skills. The study purpose was to determine the efficacy of a theory-driven Web-based training program to increase the capacity of oral health students to perform behaviors related to the secondary prevention of disordered eating behaviors. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance evaluation framework, a longitudinal group-randomized controlled trial involving 27 oral health classes from 12 oral health education programs in the United States was implemented to assess the efficacy of the Web-based training on attitudes, knowledge, self-efficacy and skills related to the secondary prevention of disordered eating behaviors. Mixed-model analysis of covariance indicated substantial improvements among students in the intervention group (effect sizes: 0.51-0.83) on all six outcomes of interest. Results suggest that the Web-based training program may increase the capacity of oral healthcare providers to deliver secondary prevention of disordered eating behaviors. Implications and value of using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework are discussed.

INTRODUCTION The US Public Health Service calls for health professionals to provide tobacco dependence counseling for patients. The purpose of this study was to understand how dental hygiene programs make decisions about and provide training for tobacco dependence counseling to help them graduate more fully competent hygienists. METHODS We conducted interviews (N = 32) with mainly program and clinic directors from 19 US dental hygiene education programs for this qualitative case study. We explored fluoride therapy training and tooth whitening training for comparison. Two analysts summarized the transcripts into a case study for each program. RESULTS All programs reported a similar process of learning about and choosing a method for teaching the topics explored. The programs used a common process, ADPIE (assess, diagnose, plan, implement, evaluate), to structure students'clinical encounters. Almost all programs train students to ask about tobacco use and to advise quitting, but few programs train students to effectively help patients to quit and only 2 programs evaluated the competence of all students to provide such training. ADPIE shows promise for integrating tobacco dependence treatment more fully into the clinical training of dental hygiene students. Comparison to tooth whitening and fluoride therapy training indicated that complexity of the treatment and alignment with dental hygiene's mission were themes related to training decisions. CONCLUSION Full implementation of tobacco dependence counseling into dental hygiene education requires a commitment by dental hygiene educators to train students and faculty in counseling techniques and their evaluation. We identified an existing clinical structure as showing promise for facilitating improvement.

This study investigated the use of alendronate in the formation of new dentin in vitro. Extracted human premolar and molar teeth with immature apices were grown in tissue culture medium for 60 days. Six control specimens were grown without alendronate in the medium, and 22 experimental specimens were grown with alendronate at [10(-9) M] in the medium. Newly formed dentin was stained with tetracycline and procion brilliant red at days 1 to 3, 30 to 33, and 60. Specimens were decalcified and 5-micron sections were prepared for examination using fluorescent microscopy. New dentin formation was measured in microns at the most apical region, at 125-micron from the apical measurement and at 250-micron from the apical measurement. The alendronate group had 57.15% more growth than the control group at the most apical region, and this difference was significant (p = 0.0001). The results indicate that alendronate at [10(-9) M] is effective in accelerating dentin formation in vitro.

A multicenter retrospective review of 172 epineural digital nerve repairs using microsurgical techniques was performed. A total of 71 men and 25 women ranged in age from 5 to 64 years (mean age, 33.3 years). Sharp injuries occurred in 55.6% of patients and mild crush occurred in 44.4%. Isolated nerve injuries occurred in only 24.6% of patients. The majority of digital nerve injuries involved other structures: flexor tendons (33.5%), tendons and fractures (9.0%), and fractures (4.2%). Replantations were performed in 18 digits (21.6%) and revascularizations in 7 digits (7.2%). Injury to repair was less than 1 day in 47.8%, 2 to 7 days in 22.6%, 8 to 30 days in 23.3%, and 31 to 300 days in 6.3%. Follow-up averaged 22.2 months (range, 6-77 months). The authors found a significant correlation between age and recovery of sensibility as measured by Weber's two-point discrimination test (p < 0.001). Patients older than 40 years demonstrated significantly poorer recovery of sensibility than patients younger than 40 years. A trend of better sensibility return was noted in the younger age decades (

Stress, burnout, substance abuse and suicide among dentists have been studied, yet no study in the United States has specifically addressed depression in e dentists. The objective of the authors' study was to determine if sex and dental specialty were correlated with depression in dentists.The authors conducted a survey of a sample of dentists chosen randomly from the American Dental Association's mailing list of member dentists. The survey, stratified by sex and specialty, resulted in 560 responses, for a 53 percent response rate. The authors used the Zung Self-Rating Depression Scale to measure depression. The authors examined the respondents' sex, age, number of children, marital status, specialty, practice type, location of practice, years in practice and hours worked per week.The rate of depression in the overall sample was 9 percent. Sex was associated with depression (P.001), but specialty was not. However, multiple regression analysis found that sex was significantly related to depression in only two specialties: periodontics and pediatric dentistry. Overall, the regression model explained an unimpressive 6 percent of the variance in depression scores. The most important finding of the study was that only 15 percent of depressed dentists were receiving treatment.The survey results showed that only female pediatric dentists and periodontists were more depressed than their male counterparts. None of the other variables studied contributed significantly to the understanding of depression in dentists. Depressed dentists, like other depressed people, tend not to seek treatment.Depression and serious depression occur among dentists, and much of it is untreated. Because depression is harmful to dentists and raises quality-of-care issues, they should be educated to help them recognize depression and encouraged to seek treatment.

The purpose of this study was to test whether an interactive, web-based training program is more effective than an existing, flat-text, e-learning program at improving oral health students' knowledge, motivation, and self-efficacy to address signs of disordered eating behaviors with patients. Eighteen oral health classes of dental and dental hygiene students were randomized to either the Intervention (interactive program; n=259) or Alternative (existing program; n=58) conditions. Hierarchical linear modeling assessed for posttest differences between groups while controlling for baseline measures. Improvement among Intervention participants was superior to those who completed the Alternative program for three of the six outcomes: benefits/barriers, self-efficacy, and skills-based knowledge (effect sizes ranging from 0.43 to 0.87). This study thus suggests that interactive training programs may be better than flat-text e-learning programs for improving the skills-based knowledge and self-efficacy necessary for behavior change.

The concept of shared decision making (SDM) is an important emerging trend in clinical medicine but has received little or no attention in the dental literature. Decision aids can play a useful role in SDM by helping patients and clinicians choose among reasonable alternative treatment options. The purpose of this study was to develop and test an Endodontic Decision Board (EndoDB) for chairside use to help clarify treatment alternatives, benefits, risks, prognosis, and costs when root canal therapy or extraction of a tooth was indicated. The hypothesis was that the use of the EndoDB would lead to improved patient knowledge, greater satisfaction with the decision-making process, and no difference in anxiety when compared to the standard discussion and informed consent process (usual care). The EndoDB was tested in a randomized controlled trial in a postgraduate endodontics clinic. After treatment discussion, a brief questionnaire was completed by the patient to measure knowledge, satisfaction, and anxiety. Patients in the EndoDB group (n=32) demonstrated a small, but statistically significant, increase in knowledge (t-test; difference=+0.37; p=0.03) compared to the usual care group (n=35). There was no difference between groups in the measures of satisfaction or anxiety (Mann-Whitney U-test; p>0.05). Decision aids may emerge as a useful tool to facilitate SDM and evidence-based clinical practice.