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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.

The aim of this study was to determine if the timing of a case-based discussion affected dental students' assessment scores. The study specifically investigated whether the timing of a 60-minute case-based discussion before or after a 90-minute lecture affected students' performance on a quiz on topics in pediatric dentistry. In addition, students' preferences for the timing of the case discussion and confidence in the material with different timings were assessed in a survey. In a crossover design, all 52 second-year students in fall 2016 at one U.S. dental school participated in a case-based discussion either before or after lectures on stainless steel crowns and pulp therapy, compared to a control unit on space maintenance with no case-based discussion. The students took quizzes and responded to questionnaires a week after the lectures. A total of 45 (87%) of the 52 students consented to have their scores used. The results showed that the students performed better on the quiz when participating in a case-based discussion after the lecture compared to the discussion before the lecture (after mean=6.1±0.8 vs. before mean=5.5±1.3). The students' control quiz mean following a lecture with no associated case discussion was 6.3±0.8. Students also expressed more confidence when the case was held after the lecture (12.7 vs. 11.6, p=0.02) and preferred the case after (p=0.01). This study found that higher quiz and confidence scores resulted when a case discussion was held after (vs. before) a lecture. When dental educators consider adding a case discussion to a lecture format as a method of increasing students' active learning, these results suggest that having the case discussion after the lecture may be more effective for learners new to the material.

The aims of this study were to compare third-year dental students' satisfaction and level of learning in case-based learning (CBL) versus team-based learning (TBL) and the resources required in those two methodologies. Level of learning was assessed for both knowledge and application, and resources were defined as student and faculty time and rooms. In academic year 2018-19, all 68 third-year dental students in one U.S. dental school were enrolled in two sequential semester-long courses; the first used CBL, and the second used TBL. After each course, students and faculty facilitators completed surveys, and data from students' knowledge and application exams were collected. The student surveys asked students to report their satisfaction with the learning methodology (CBL or TBL); the faculty surveys asked the faculty facilitators to report the resources used for each methodology. Forty-five of 68 students (66%) consented to participate; however, a larger number of students completed surveys in the two semesters (69% for CBL and 87% for TBL). Fourteen of 16 (88%) faculty facilitators completed the CBL survey, and five of the six (83%) completed the TBL survey. Overall, the results showed that students' satisfaction was higher with CBL than TBL (Mann-Whitney U = 882.0; p

The aim of this qualitative study was to examine the perspectives of key personnel at partner sites providing community learning experiences to dental students to gain more understanding of the effects that community-based programs have on the sites themselves. Fourteen semi-structured interviews were conducted in 2015 with individuals from nine extramural sites. Interviewees had a range of roles from clinicians to CEOs, with six also reporting they were faculty preceptors. Three of the researchers developed a coding scheme focused on the benefits and challenges that community sites experience from participating in a community-based dental education (CBDE) program. Each coder then reviewed the interview transcripts independently before final group discussions and recoding to agreement. The main themes related to benefits were recruiting future dentists, staying current with clinical developments, sites' indirectly improving their missions by exposing students to broader roles of oral health providers, raising awareness regarding the need for dentistry in community settings, and nurturing a positive workplace environment. The main themes related to challenges were balancing education and training for students with clinical demands, communication with the university, and managing distinctive clinical and professional characteristics of students. This study's participants reported that the main benefit of CBDE for partner sites was dentist recruitment. The study also provided insights for both partner sites and dental schools to consider when developing and maintaining these partnerships.

The purpose of this study was to examine the relationship between a history of potentially traumatic events (PTE) and a child's behavior during dental treatment.Parents of healthy children, age four years and older and attending their initial dental appointment at a university pediatric dental clinic, were asked to complete the Traumatic Events Screening Inventory-Parent Report Revised and a demographic survey. Following the dental appointment, a pediatric dental resident reported the child's behavior using the Frankl scale.A total of 170 parent-child pairs participated; 53 percent of parents indicated their child had experienced at least one PTE; 44 percent reported their child had a prior negative experience at the dentist. Adjusted multivariable logistic regression analysis showed no significant association between PTE history and poor dental behavior (P=0.994), but a significant association was observed between a previous negative dental experience and poor dental behavior (P=0.000) as well as between age (younger than five years old) and poor behavior (P=0.006).Children with a history of potentially traumatic events did not exhibit uncooperative behavior more often than those who did not. A previous negative dental experience and the child's young age were significantly associated with uncooperative behavior.

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.

The purpose of this study was to examine gender disparities in dental leadership and academics in the United States. Nine journals that represent the dental specialties and high published impact factors were selected to analyze the percentage of female dentists' first and senior authorship for the years 1986, 1990, 1995, 2000, 2005, and 2008. Data on appointment status and female deanship were collected from the American Dental Association (ADA) survey, and the trends were studied. The proportion of female presidents in ADA-recognized specialty organizations was also calculated. Overall, the increase in first female authorship was not statistically significant, but the increase of last female authorship was statistically significant in a linear trend over the years. The percentage of tenured female faculty members and female deans in U.S. dental schools increased by factors of 1.7 and 9, respectively, during the study period. However, female involvement in professional organizations was limited. Findings from this study indicate that female participation in authorship and leadership has increased over time. Nevertheless, females are still a minority in dental academics and leadership.

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.

Case-writing within an integrated, systems-based health professions education curriculum presents many unique challenges. Specifically, case-writing in this context must consider integration of multidisciplinary learning objectives and synthesis of biomedical and clinical sciences. Establishing an effective process for content integration and determining who should be involved in the case-writing process can be a daunting task and this specific context requires a new model for effective casewriting. This paper provides a model for the cycle of case development, implementation, evaluation and modification in an integrated, systems-based health professions curriculum. We highlight how this collaborative case-writing model parallels the social constructivist approach promoted by the problem-based learning process in which our students engage.

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.

Objective . The purpose of this study was to compare microleakage of glass ionomer materials (GIC) using two different modes of cavity preparation: a high-speed hand piece and an erbium/yttrium–aluminum–garnet (Er/YAG) laser. Methods . Eighty caries free permanent molar teeth had class V preparations cut on both the buccal and lingual surfaces. The high-speed hand piece was used to prepare a class V cavity preparation on the buccal surface and an Er/YAG laser was used to prepare a class V cavity preparation on the lingual surface. GIC or resin modified GIC was used as the restorative material. The teeth were thermocycled for 7000 cycles, placed in 2% basic fushin for 24 h, sectioned in the center of each restoration, and analyzed under a stereomicroscope. Results . There was no statistical difference in microleakage between the two modes of cavity preparations. The gingival margins had more microleakage than the occlusal margins for both GIC materials and the resin modified GIC showed significantly more leakage than the conventional GIC. Conclusions . The Er/YAG laser provided an equivalent method of tooth removal when evaluated for microleakage of GIC materials compared to a high-speed hand piece.

To evaluate parental acceptance of provision of tobacco cessation and prevention education to children and parents by private practice pediatric dentists.Receptionists gave confidential questionnaires to parents of child dental patients in five private pediatric dentistry practices. Demographic information and questions about dentist interventions were asked, with the most intrusive questions concerning parental tobacco use.Ninety-four percent (234) of parents responded. Over 90 percent of parents favored dentists speaking to 1) the child on the dangers of tobacco use and the benefits of avoiding tobacco, 2) parents about the effects of tobacco use on their children, and 3) parents about cessation. Among tobacco-using parents, 76 percent favored interventions directed at child tobacco use and warnings about adult smoking and children, dropping to 59 percent favoring dentist provisions of cessation education to parents. Users were less approving than nonusers on both parental interventions (P=.001).Parents showed high acceptance of various levels of tobacco interventions by pediatric dentists in private practice. Tobacco users, however, were less accepting than nonusers. Pediatric dentists may be more willing to provide such messages with this information, but they may also need training to prepare themselves to handle negative reactions.

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 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.

To investigate factors affecting the internal brain drain of healthcare professionals in the Kingdom of Saudi Arabia.A cross-sectional study was conducted using an anonymous self-administered online questionnaire sent to all Saudi students enrolled in healthcare profession programs in North America. The data was collected between January and March 2008 at the University of Illinois at Chicago, Chicago, Illinois, United States of America. Results were analyzed using logistic regression analyses.A total of 377 completed questionnaires were returned. Results revealed that 71% of respondents intended to return to work within the 2 major urban cities Riyadh and Jeddah. Respondents who completed their undergraduate studies in a large city were more likely to work in the same city (odds ratio [OR]=3.2; p=0.000; 95% confidence interval [CI] = 2.0-5.2). Furthermore, 51% of the students were willing to work in a rural area for a 50% or more increase in their salary. Finally, men were more willing to work in a rural area for a financial incentive (OR=2.3; p=0.006, 95% CI = 1.3-4.3).This study suggests that realistic financial incentives would probably not suffice to attract Saudi healthcare providers to rural areas. The provision of medical schools in smaller cities and rural areas is predicted to be a more effective method for improving the current maldistribution of healthcare providers.

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.

Early childhood caries is prevalent in the United States, especially among Hispanic children. One consequence may be premature loss of primary teeth, raising concern about developmental challenges. This study examined speech sound articulation errors association with premature loss of the primary maxillary incisors of bilingual children (Spanish/English).Hispanic children were assessed with a speech sound articulation test at 7 to 10 years of age against their history of primary maxillary anterior incisor loss. The exposed group (N =25) experienced premature extraction of these incisors, and the unexposed group (N =8) had normal dental exfoliation.The groups were similar regarding: age at speech assessment; gender; language spoken at home; socioeconomic status; caries prevalence; mean number of decayed, missing, filled and sealed teeth. Higher values for the dental articulation errors (P=.04) were revealed among exposed vs unexposed. Exposed boys had more total speech articulation errors (P=.03), dental-related errors (P=.048), and other errors (P=.04) than the unexposed boys, although of small sample size.Bilingual children who experienced early primary tooth loss exhibited differences in speech sound production vs those who did not. Further research is warranted to determine the extent early tooth loss in bilingual children predicts speech problems.

This study evaluated the effects of palatal stabilizing devices (PSDs) on accidental extubations (AEs) and other intubation complications in infants with breathing tubes at a neonatal intensive care unit (NICU) of a university hospital. PSDs are individually crafted acrylic oral devices for stabilizing breathing tubes in neonates.Charts of all first admission NICU neonates weighing less than 1,500 g were reviewed (N =733); 548 were intubated and had information available on birth weight, gender, transfer status, gestational age, length of admission, ventilator type, sedation, dates of intubations and extubations, number of accidental extubations, dates of PSD placement, and complications.153 subjects received PSDs, with 19 AEs; 395 received no PSDs, with 31 AEs. Non-PSD neonates were intubated for a median of 3 and PSD neonates for 26 days. PSDs were associated with sedation, male gender, longer admissions, longer intubation periods, being on a high-frequency ventilator, and low birth weight (P.05). 0.4 accidental extubations over 100 intubated patient days were recorded for the PSD vs 0.79 for the non-PSD group.Palatal stabilizing devices were not related to other complications of breathing tubes. The PSD group had fewer accidental extubations per days of intubation vs the non-PSD group.

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.

Four individuals who teach ethics in dental schools comment on a case in which negative financial information is revealed by one dentist when transferring records of a potential patient to another dentist. All commentators find varying degrees of ethical problem with disclosing such information. Professional codes discourage this practice. All commentators stress the importance of the potential new dentist developing a relationship based on professional standards, with the greatest emphasis placed on the patient's health needs. Several of the commentators discuss positive ways of conducting a patient interview, including specific useful language.

The purposes of this study were to: (1) determine the level of parental knowledge regarding initial trauma management; and (2) assess which factors could influence that level of knowledge.A self-administered questionnaire was given to parents of patients that attended 1 of 2 dental clinics. The questionnaire consisted of 3 parts and assessed patient and parental demographics and knowledge of dental trauma management.Four hundred sixty-seven questionnaires were completed. Most patients had Medicaid insurance (79%). Most parents would seek care from a dentist (71% broken tooth; 62% avulsed tooth). Only 31% knew that avulsed permanent teeth could be placed back into the socket, and only 25% of parents chose milk as a transport medium for avulsed teeth. A mere 3% of parents answered all 5 trauma management questions correctly, and 10% had no correct responses. The number of correct responses was not affected by clinic location, history of previous trauma, sex, education, or insurance status. Parents of recalled patients had more correct responses (P.05).Knowledge of dental trauma management was poor. The fact that parents of recalled patients were somewhat more knowledgeable suggests that the dental visit can be an effective vehicle for education. The management of dental trauma should be part of the dental health education provided at dental visits.

This paper includes an update of a Cochrane systematic review on tobacco use cessation (TUC) in dental settings as well as narrative reviews of possible approaches to TUC and a more detailed discussion of referral for specialist TUC services. On the basis of these reviews we conclude that interventions for tobacco users in the dental setting increase the odds of quitting tobacco. However, the evidence is derived largely from patients using smokeless tobacco. Pharmacotherapy (such as nicotine replacements, bupropion and varenicline) is recommended for TUC in medical settings but has received little assessment in dental applications, although such evidence to date is promising. Whether the dental setting or referral to specialist TUC services is the most effective strategy to help people to quit tobacco use is unclear. An effective specialist service providing best available TUC care alone may not be the answer. Clearly, such services should be both accessible and convenient for tobacco users. Closer integration of specialist services with referrers would also be advantageous in order to guide and support oral health professionals make their referral and to maximise follow-up of referred tobacco users. Future research direction may consider investigating the most effective components of TUC in the dental settings and community-based trials should be a priority. Pharmacotherapy, particularly nicotine replacement therapy, should be more widely examined in dental settings. We also recommend that various models of referral to external and competent in-house TUC specialist services should be examined with both experimental and qualitative approaches. In addition to overall success of TUC, important research questions include facilitators and barriers to TUC in dental settings, preferences for specialist referral, and experiences of tobacco users attempting to quit, with dental professionals or specialist services, respectively.

Motivational Interviewing (MI) is a style of encouraging and supporting patients in making their own choices in matters concerning their health. MI is emerging in health care as a viable strategy for enhancing a patient's intrinsic motivation to change self care. The purpose of this pilot study was to determine the effects and level of incorporation of coaching to improve MI adherence of dental hygiene students' patient education presentations as measured by parts of the Motivational Interviewing Integrity Coding System (MITI) and Motivational Interviewing Skills Code (MISC).A convenience sample of second year dental hygiene students from a Midwestern community college were invited to participate in the study. This pilot study utilized a pre- and post-test design to evaluate the effect of coaching to improve MI scores of students. Students were audio taped during 2 brief patient education sessions. Upon completion of the first tape, students received feedback and coaching in MI and then made a second tape of a brief patient education encounter.Student subjects changed behavior scores in the direction appropriate to MI following coaching on most measures. Summary scores indicate an improvement in the use of open questions, complex reflections and MI adherence, but not in change talk or reflections-to-questions ratio.The use of coaching sessions improved the skills of dental hygiene students learning MI-adherent behaviors.

This study's purpose was to compare dental visits and oral health knowledge of African American (AA) and Hispanic American (HA) pregnant adolescents in a community health clinic.Demographics, oral health knowledge, oral hygiene, and dental visits during pregnoncy were surveyed by anonymous questionnaire to adolescents who were pregnant at the time of the study or within the last year.Responses from 50 AA and 61 HA adolescents between 12 and 20 years old were analyzed. Fourteen percent of AAs and 26 percent of HAs saw a dentist during pregnancy, while 26 percent of AAs and 16 percent of HAs reported regular 6-month visits when not pregnant. Fifty-two percent of AAs and 43 percent of HAs knew that oral health problems could affect the pregnancy or growth of the baby. Thirty-four percent of AAs and 56 percent of HAs knew that pregnancy was related to gum problems (P = .02). Logistic regression revealed the predictors of a dental visit during pregnancy, including living with a boyfriend/husband (P = .02, odds ratio = 4.4, confidence interval = 13-153) and dental visits when not pregnant (P.001, OR = 13.6, CI = 3.7-50.5).Minority pregnant adolescents had only limited dental visits whether or not they were pregnant and possessed limited knowledge of oral health and pregnancy outcomes.

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, 4 ENT 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.

Forty extracted human single-rooted teeth were sequentially instrumented with nickel-titanium rotary files to a size 0.36 mm at the working length. Ten teeth were randomly assigned to the two control groups. The other 30 teeth were randomly divided into three groups and were obturated by a 5-mm apical plug of either Super-EBA, IRM, or laterally condensed gutta-percha and Roth's sealer. After 2 days, and at 1 month, the samples were tested for microleakage by the fluid filtration system under 15 psi. The negative controls were used to consider the time that it took the fluid filtration system to stabilize. A one-way analysis of variance showed that, at 1 month post obturation, there was no statistical difference in the ability of the three materials to seal the apex from coronal microleakage. However, at 2 days, Super-EBA gave a significantly better seal than IRM or laterally condensed gutta-percha and sealer.

This study assessed the impact of a lecture on children's oral health knowledge of pregnant women from vulnerable African American (AA) and Hispanic of Mexican origin (HM) populations utilizing the same urban community health center prenatal education program.Participants heard one 45-minute lecture in English or Spanish on children's oral health, and completed a survey (English or Spanish) before and after the lecture.Seven sessions provided 60 participants: (a) 30 AA; and (b) 30 HM. These two groups differed on: (1) educational attainment; (2) preferred language; (3) country of origin; and (4) baseline scores. They were similar in: (1) age; (2) frequency of first mothers; and (3) final scores. Oral health knowledge significantly rose from baseline to the end of the lecture (ANOVA, P.001). Educational attainment was associated with HM baseline scores (P = .04), whereas age was associated with AA final scores (P = .01).An oral health lecture within a prenatal program improved oral health knowledge for African American and Hispanic of Mexican origin pregnant women, though associated factors varied between the two groups. Further study is needed to explore long-term knowledge retention and effect on the future babies' oral health.

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; p0.05). Decision aids may emerge as a useful tool to facilitate SDM and evidence-based clinical practice.

The purpose of this study was to evaluate and compare intranasal (IN) and oral (PO) midazolam for effect on behavior, time of onset, maximum working time, efficacy, and safety for patients requiring dental care.Forty anxious subjects (20 IN, 20 PO, Frankl Scale 3 and 4, ages 2-6 years, ASA I and II) were sedated randomly with either IN (0.3 mg/kg) or PO (0.7 mg/kg) midazolam. The dental procedure under sedation was videotaped and rated by a blinded and calibrated evaluator using Houpt's behavior rating scale.There was no statistical difference for overall behavior (F3,27 = 0.407; P = .749). The planned contrasts showed significant interactions between time and route (IN vs PO) between 25 and 30 minutes after starting sedation. The time of onset (P = .000) and the working time (P = .007) were significantly different between IN and PO midazolam. There were no statistically significant differences in vital signs (O2 sat, HR, RR, BP) between PO and IN (P = .595). IN subjects showed more movement and less sleep toward the end of the dental procedures, and faster onset time but shorter working time than PO. Vital signs were stable throughout the procedures with no significant differences.Mean onset time was approximately 3 times faster with IN administration compared to PO administration. Mean working time was approximately 10 minutes longer with PO administration than it was with IN administration. Overall behavior under PO and IN was similar. However, more movement and less sleep were shown in subjects under IN than those under PO toward the end of the dental session. All vital signs were stable throughout the procedures and showed no significant differences between PO and IN administration.

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 according 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 students' 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 students' 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 students' 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.

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 (

This study evaluated and compared the corrosion susceptibility of stainless-steel and nickel-titanium (NiTi) endodontic files immersed in sodium hypochlorite. For each of the stainless-steel files (Kerr K-Flex, Caulk Flex-O, and Union Broach Flex-R) plus the NiTi files (Union Broach NiTi and Tulsa NiTi), the cutting flutes of 24 ISO size 20 files were immersed into 5.25% sodium hypochlorite. Their open circuit potential (OCP) was recorded for 1 h on a strip chart with high impedance. The strip chart recording for each file was classified into a stability score: (i) stable, (ii) unstable, or (iii) erratic. The OCP was measured by a potentiostat and a standard calomel electrode reference. The OCP classification of unstable and erratic for the files evaluated were as follows: K-Flex (16%), Flex-R (12%), Flex-O (75%), Union Broach NiTi (62%), and Tulsa NiTi (0%). After OCP testing, each of the 120 files was inspected by light microscopy at x 25. The frequencies of visually observed corrosion were detected as follows: K-Flex (2/24), Flex-R (1/24), Flex-O (6/24), Union Broach NiTi (2/24), and Tulsa NiTi (0/24). There was a significant difference in corrosion frequency between brands when evaluated by OCP and light microscopy; however, there was no significant difference between stainless steel and NiTi.

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.