bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Phase I Pew National Dental education Program on U.S. schools of dental medicine
Authors: Feldman CA , Baumritter A , Levy J , Angeles R , Bloom BS , Pauly M , Liu H , Meisner B
Published: June 2020

This paper presents the results of four telephone surveys conducted by the Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, as part of its evaluation of the Pew National Dental Education Program (PNDEP), a five year, +4F8.7 million program established by The Pew Charitable Trusts to help dental schools respond to the changing health care environment. The four annual surveys were conducted between 1985 and 1988. The interviews were conducted with the deans from nearly all dental schools operating in the United States at the time of study or the principal investigators of the schools funded under Phase I and Phase II PNDEP grants. Their purpose was to determine the level of each school's involvement in PNDEP and in specific strategic planning activities, as well as to evaluate the impact of the Pew Program on both the individual schools and dental education nationwide. All systematic differences between schools funded (FD) PNDEP and those not funded (NFD) were examined. Overall, schools gained a better understanding of their environment. Schools also reported increased participation in and commitment to planning among their different constituencies (e.g., faculty, administration, students, alumni). By the end of Phase I, more PNDEP Phase I funded schools reported being involved in implementing strategic plans. Funded schools also were more likely to report PNDEP increased their understanding of strategic planning, improved communication, and helped encourage the emergence of new leaders.
Association membership of full‐time faculty in dental schools
Authors: Solomon ES
Published: June 2020

Based on the current participation rates in the Association, most full‐time faculty who are members of the AADS are White males tenured in the clinical sciences. The American Association of Dental Schools has captured a fair share of the full‐time dental school faculty as members, but there is still considerable room for growth. In particular, as the composition of the dental school faculty diversifies, we must be sure that all elements of dental education are represented in the Association. Membership in the ranks of junior faculty is low, and currently the members of ethnic minorities and women are disproportionally represented there. There are 2,381 additional potential members among full‐time faculty at U.S. dental schools who represent a large and important force for dental education. The effectiveness of the Association would be enhanced by the inclusion of these full‐time faculty along with the thousands of part‐time faculty, allied dental educators, and members of postdoctoral dental educational programs. In terms of attendance at the AADS Annual Session, almost all the attenders at the meeting this year were Association members (97 percent). Overall attendance at the Annual Session was quite good with about 60 percent of the full‐time faculty Association members attending. Attendance rates among the categories we investigated did vary somewhat but not as much as membership by category. In general, dental school faculty who join the Association attend the Annual Session.
The basics of decision analysis
Authors: Kent DL
Published: June 2020

Historically, decision analysis (DA) arose from economics, psychology, and statistics. Medical and dental applications have developed over the past two decades. While decision psychology explores how people make their decisions, the DA process involves construction of a model and development of insights into the strengths and uncertainties about recommendations derived from analysis of model outputs. Uncertainties are represented as probabilities and values are assigned to desirable or adverse outcomes according to preferences expressed by the decision maker. The model unifies probabilities and values by calculation of the expected value for each decision choice. The decision maker can improve his or her insight into uncertainties in the model by conducting sensitivity analyses, and can take action based on this improved insight. The DA process is illustrated using the decision to take or skip influenza vaccination. People's decision making behavior for this problem has also been analyzed using methods from decision psychology. Distinctions between clinical DA and cost‐effectiveness analysis are given, as are caveats about especially complicated subtopics in decision analysis for medical problems. In closing, opportunities for further study of decision analysis are presented.
Dental implants and decision making
Authors: Zarb GA , Lewis DW
Published: June 2020

Treatment choice and effectiveness in prosthodontics has largely depended on educated anecdote and asseveration. Still, this approach has to a very large extent enabled dentists to enrich the quality of their patients' lives. However, the trade‐off between the need for prosthetic intervention per se and the biologic price inherent in certain therapeutic endeavors has demanded strict concerns regarding clinical decision making and treatment outcomes. The technique of implant prosthodontics is certainly one that has focussed such concerns, particularly since the concept of osseointegration was introduced to North American dentists at the 1982 Toronto Conference. Clinical research and opinion in this area have elicited both clinical euphoria and polarization vis‐a‐vis newer possibilities for resolving the predicaments of partial or complete edentulism. The past decade has witnessed clinical trials, as well as highly relevant exemplary reports, on the application of the osseointegration technique. It is now necessary to compare the merits of implant prosthodontics to traditional therapies, and to determine those criteria which comprise optimal functional and aesthetic restoration, with minimal risk of morbidity, along with cost concerns. This paper seeks to provide a systematic and rational basis for the identification of such criteria.
The search for a profile of aptitudes that characterize dentists
Authors: Simon JF , Chambers DW
Published: June 2020

This article is a reinterpretation of an unsuccessful attempt to develop a standard battery of aptitude measures to distinguish practicing dentists. Of 22 potential predictors used by a firm specializing in aptitude testing and career counseling, the national sample of 116 dentists tested showed few differences from the norm group, and some differences were counterintuitive. For example dentists performed no better than the norm on spatial visualization and worse than the norm on several measures of language skill and on finger dexterity. Based on these findings, this paper argues that a broad conceptualization is required when attempting to characterize the aptitudes necessary to complete dental education and to maintain a dental practice. The apparent inconsistency between these findings and successful prediction of performance in laboratory courses using available admissions instruments is explained.
Oral health promotion for the older adult: implications for dental and dental hygiene practitioners
Authors: Entwistle BA
Published: June 2020

The role of the dental and dental hygiene practitioner in geriatric oral health promotion can be viewed in terms of three questions. What purposeful or directed steps have been taken to improve oral health promotion? How can health promotion be improved? How can education and research help the practitioner? Professional associations, educators, researchers, school curricula, instructional programs, and dental products companies have tried to improve oral health promotion. At each level, communication of information and effective use of information has been compromised. Geriatric oral health promotion can be improved by increased understanding of: (1) health promotion concepts, (2) cultural and generational issues, (3) chronic oral conditions, (4) patients' perspective, (5) promoting behavior change, (6) listening skills, (7) patients' everyday realities, (8) integrating oral health issues into other health promotion activities, (9) creating easy to understand health education materials, and (10) lobbying for third party reimbursement for oral health promotion.
Health services and women's oral health
Authors: O'Mullane D , Whelton H , Galvin N
Published: June 2020

Apart from tooth loss and edentulism, data on the relative levels of oral health of men and women are scarce. Evidence from Europe and to a lesser extent from the U.S. shows that women have fewer natural teeth present than men and have higher levels of edentulism. In Europe there is some evidence that socially deprived rural women have the highest levels of edentulism. Due to the lack of adequate detail in published reports of studies, it is difficult to relate the oral health of women with the availability, acceptability, and accessibility of dental services. Women tend to attend for dental care more regularly than men though there is some evidence that women are more fearful of dental treatment and also perceive cost as a barrier to dental care. Data from the Republic of Ireland suggest that women working in the home have higher levels of tooth loss and edentulism than those working outside the home. There is a need for consensus on methods of reporting oral health data in major descriptive studies. Further research is required to investigate why women tend to lose their natural teeth at an earlier age than men.
Curriculum focus: traditional dental education confronts the new biology and social responsibility
Authors: Boyd MA
Published: June 2020

The traditional dental education base does not suggest that graduates are prepared only for private general practice. It promises much, much more. It is the beginning of what any graduate may wish or want it to be. In fact it is necessary for new graduates contemplating private practice to seek more in the way of practice management if they plan to be successful in that model. Such is also the case for additional study if one wants to pursue a specialty; further training in the scientific method to undertake research; or further study in education for a teaching career. The predoctoral program promises to be just a beginning, but a sound and sensible beginning. The current foundation model of the predoctoral curriculum continues to serve society and the profession very well. It provides the necessary grounding in the fundamentals of basic medical sciences, clinical biological sciences, and behavioral sciences upon which any graduate can build and pursue a career beyond what is thought to be the traditional role model of the private practice of general dentistry. Faculty members and dental programs can choose, if they desire, to tailor mission statements to reflect a changing emphasis. This could help dental applicants become more thoughtful and self‐selective in considering one of many different career options available. Given the emerging demographic profile and trends in needs, the curriculum emphasis could be altered to encourage a change in the balance or proportion of graduates who undertake career options in a postdoctoral experience, in public health, research, teaching, administration, the military, hospital, or specialty practice.(ABSTRACT TRUNCATED AT 250 WORDS)
The dental scientist model
Authors: McHugh WD
Published: June 2020

A case has been presented for strengthening the science‐base of the future dentist. Such a development is essential and inevitable and we must plan the changes in the dental education continuum that will facilitate it. Transfer of advanced clinical training to mandatory post‐doctoral education will control the economic impact of the change and improve the education of the dentist tomorrow.
The program directors' perspective on the goals and objectives of advanced general dentistry training
Authors: Badner VM , Lockhart PB , Hicks JL
Published: June 2020

In September of 1991, all postgraduate general dentistry (PGD) program directors (Advanced Education in General Dentistry [AEGD] and General Practice Residency [GPR] directors [n = 325]) were surveyed to ascertain their opinions of the ideal goals and objectives of PGD programs. The response rate was 81.5 percent (n = 265). The directors rated the relative importance of various PGD program goals and objectives. The average of all the items rated was 3.4 on a scale ranging from 1 = unimportant to 4 = very important. The respondents identified several clinical and didactic subject areas that they considered very important including; infection control, CPR, dental and medical emergencies, diagnosing dentoalveolar trauma, diagnosing oral pathology, and assessment and treatment of patients with medical conditions. They also identified several training areas which were beyond the scope of a PGD program, e.g., research techniques, pediatric sedation, and selected advanced clinical procedures in dentistry (implantology and orthodontics) which require a long time to complete. In general, there was substantial agreement among the directors of different program types and sites as to the relative importance of various program goals. The largest differences were found among directors of programs from different sites, e.g., hospitals versus dental schools as opposed to directors from different program types, e.g., GPR versus AEGD. There is now a need to determine the relationship of these identified idealized goals and differences to program outcomes for the graduates of PGDs.
Design and validation of mirror skills instruction
Authors: Knight GW , Guenzel PJ
Published: June 2020

Students contorted to achieve direct vision indicate that training of mirror skills is absent or ineffective. Training referenced in the literature is not described or amounts to practice using a mirror to perform a psychomotor task often marginally related to dental procedures. No complete task analysis of mirror use is reported. In this study, the authors applied instructional engineering principles to 1) analyze the task and design instruction, 2) validate instruction, and 3) foster mirror use. First‐year students (experimentals) completed the new mirror instruction as well as the regular course instruction. A randomly selected group of second‐year students who had not completed the mirror instruction but had completed a similar course comprised the control group for the validation. Sets of randomly grouped experimental subjects evaluated a maxillary preparation using mirror vision at three times during the semester and one time a year later. The controls evaluated the same preparation the first time only. Accuracy in describing the critical features of the preparation was used as an indicator of mirror skill. All subjects were observed for mirror use during a practical examination involving maxillary preparations. All groups were equivalent on entering GPA, DAT‐A, and DAT‐P. Experimental groups made significant improvement in measures of mirror vision skill over time. Experimental groups 2, 3, and 4 significantly outperformed controls on the same measures and demonstrated significantly higher rate of mirror use during the practical exam. The mirror skills instruction appears valid.
Dental school teaching clinics as cost centers
Authors: Doherty N , Cordes D
Published: June 2020

Increasing net patient revenues from teaching clinics is one of the alternatives available to dental schools seeking to alleviate economic pressures. Managerial decisions directed to this end require accurate and useful data on clinic finances and economic organization. An important step in this direction can be taken by defining the teaching clinic as a cost center, that is as an economic entity in a dental school with identifiable specific resources, costs, and revenues. This paper describes the accounting and economics frameworks within which resources and costs are classified and allocated into direct and indirect, and fixed and variable categories. The development and structure of a cost‐revenue model designed for the teaching clinics at the University of Connecticut School of Dental Medicine is described to illustrate an application of the cost center concept.
Decision making in periodontics: a review of outcome measures
Authors: Matthews DC
Published: June 2020

Clinical decisions regarding selection of appropriate periodontal therapy is a multifactorial process involving the assimilation of information from clinical experiences, relevant research, and patient preferences for anticipated outcomes. In order to select the treatment which is most beneficial to patients, a rational, systematic approach to decision making is needed. Clinical experience is a key factor in decision making, but one not easily controlled for. Research to date has focused on clinical or proximate outcomes as a measurement of treatment efficacy, but few of these studies provide the highest level of evidence. While Quality of Life issues play an important role in treatment selection, patient‐based outcomes have not been well researched in dentistry. This paper outlines a method clinicians can use to evaluate treatment efficacy studies. In addition, the evidence from longitudinal periodontal treatment efficacy studies is reviewed and the use of patient‐based outcome measures is examined.
A profile of patients in six dental school clinics and implications for the future
Authors: Damiano PC , Warren JJ
Published: June 2020

Surveys were conducted of patients receiving care at six dental school clinics in the United States during a one‐week period in the fall of 1993. Survey data were analyzed to determine who was using services provided by these dental schools, the types of services being provided, and why people chose to receive their care at these dental schools. Eighty‐one percent of the patients indicated that low cost was an important reason for seeking care at a dental school; the patients receiving care at these dental schools tended to be low income. Seventy‐six percent paid for some or all of their care out of pocket. As dental schools reevaluate their mission regarding patient care issues and assess the impact of their decisions, information about dental school clinics, particularly who seeks care there and why, should be an important consideration.
Assessment of alcohol and tobacco use in dental schools' health history forms
Authors: Yellowitz JA , Goodman HS , Horowitz AM , al‐Tannir MA
Published: June 2020

Health history forms are an integral component of students' clinical and didactic training in physical assessment and often serve as a model for students to use in their future practices. This study examined how alcohol and tobacco use are assessed in patient health history forms used in the dental schools of the United States and Canada (n = 63). Deans of schools were requested to send a copy of their health history and other supplemental forms used for patient care. The response rate was 98 percent. Almost 25 percent of the schools' forms did not address either alcohol or tobacco use; 37 percent failed to address one or both risk behaviors; 25 percent did not request tobacco information; and 36 percent did not address alcohol use. Major inconsistencies regarding the inclusion, content, and quantity of alcohol and tobacco questions were noted. Consensus among dental schools as to which questions to include in their health forms was not apparent.
Development of a computer program for teaching periodontal diagnosis based on clinical epidemiological principles
Authors: Fung K , Ellen RP , McCulloch CA
Published: June 2020

Multimedia teaching tools in dental education are still rare. This paper describes the development of an inexpensive yet powerful computer program for instruction in the principles of clinical epidemiology. The application was developed in the context of periodontal diagnostic methodologies at the third year D.D.S. level. Principles of probabilistic thinking are invoked as the student is guided from the application of raw research data to the derivation of likelihood ratios and how they affect clinical decision making. A questionnaire was used to evaluate student satisfaction with the program and the responses indicated good acceptance of the concepts presented in the program and an interest in further computer‐aided instruction.
Decision‐support systems in dentistry
Authors: White SC
Published: June 2020

Decision‐support systems hold a specialized body of knowledge in computerized form such that the non‐ specialist can obtain expert‐level information. The goal of these systems in clinical sciences is usually to assist patient care by providing the clinician with improved diagnosis or treatment planning. Decision‐support systems consist of three components: the user interface through which the clinician or patient enters signs or symptoms, the set of data describing clinical knowledge in the domain of the program, and an inference engine to manipulate the data set in light of a patient's specific signs or symptoms to arrive at a diagnosis or treatment plan. Such systems usually use one of three mechanisms of analysis alone or in combination: classification trees, Bayesian conditional probabilities, or rule‐based (heuristic) systems. Numerous problems must be solved before decision‐support systems will become commonplace in clinical practice. Data entry of patients' signs and symptoms is often tedious. The quality of the clinician's initial observations is of great importance in determining the quality of the output. It is also often difficult to convey to a program the subtlety of clinical information observed. Knowledge required in clinical data bases is often unavailable or imprecise. As these and other challenges are addressed we can anticipate increased utility of decision support programs in the future.
Reducing confirmation bias in clinical decision‐making
Authors: Eli I
Published: June 2020

Schematic, category‐based thinking is a common approach to reduce uncertainty. Once the stimulus in question is categorized under a scheme, there is a tendency to look for features that fit the scheme. We have a tendency toward “positive testing” that is, to test instances we think will fit our hypothesis, paying less attention to those that will not (confirmation bias). Schematic, category‐based thinking interferes with the process of decision‐making in general and in medicine and dentistry in particular. To reduce schematic thinking and to avoid confirmation bias, one must acknowledge their existence. It is the task of dental educators to open the existing schemes and encourage broad, even controversial thinking that will focus on more than one hypothesis.
A survey of predoctoral dental basic pharmacology education
Authors: Robertson LT
Published: June 2020

A survey of fifty‐one of the fifty‐three dental schools in the continental United States provided information about pharmacology curriculum content and time allocation. Most dental schools offer a traditional didactic course in basic pharmacology, with about 50 percent of the medical school‐based (MSB) and 75 percent of the dental school‐based (DSB) programs providing additional pharmacology material in other basic and clinical courses. The four combined medical‐dental (M‐D) student courses have more hours of instruction, clinical conferences and reviews, and number of instructors than either the dental school‐ or medical school‐based courses. DSB and MSB pharmacology courses were similar in most regards, with a relatively low compliance with the current curriculum guidelines. The DSB and MSB courses provided more time for neuropharmacology and less time for agents related to various organ systems than the M‐D courses. There is considerable potential to improve pharmacology instruction by expanding the inclusion of pharmacology in other courses, increasing the number of clinical conferences and discussions, and offering problem‐based‐learning sessions.
Limitations of the profit‐volume model in analyzing dental teaching clinics
Authors: DuBois LM
Published: June 2020

Use of the cost center concept and the profit‐ volume model has been advocated to analyze the fiscal position of dental teaching clinics. While these methods are helpful in solving specific management dilemmas, they have three identifiable limitations in describing the overall fiscal position of dental teaching clinics. The purpose of this paper is to review these limitations and to discuss their implication.
Potential effects of opportunity cost on dental school patients
Authors: Shulman JD
Published: June 2020

Predoctoral clinic fees are set below those of private practices to attract patients. Treatment in a predoctoral clinic requires more and longer appointments and patients spend more time waiting to be seen than in a private practice. This time has a value that economists call opportunity cost, the value of the next best alternative (the hourly wage for an employed patient). A model comparing total cost (fee plus opportunity cost) of treatment in dental schools and private practices for insured and uninsured patients is presented. As patient income increases, the total cost of some treatment plans becomes higher in dental schools than in private practices. To insured patients, however, the out‐of‐pocket cost of a treatment plan depends on copayments rather than fees. This makes predoctoral clinics less competitive. Considering opportunity cost further increases dental schools' lack of competitiveness. For insured patients, more treatment plans will have a lower total cost in private practice. Clinic directors must realize that if opportunity costs are not reduced, the market may dictate that fees be lowered to remain competitive with private practitioners. They are in competition for patients based on total cost, and efficiencies that reduce opportunity cost may increase revenue and attract patients.
Dentist‐patient interactions in treatment decision‐making: a qualitative study
Authors: Redford M , Gift HC
Published: June 2020

The growing involvement of patients, third party payers, and government in the financing, planning, and delivery of health services has heightened the demand for knowledge about the process of rendering care. This study used a qualitative methodology to examine dentist‐patient interactions in treatment decision‐making. A series of focus groups was conducted with dentists and patients participating in an ongoing investigation of dental treatment planning conducted at the University of North Carolina. Study findings indicate that dentist‐patient interactions play an important role in treatment decision‐making and that both are predicated on a variety of non‐clinical factors. Dentists' intuition and judgment seem to be used not only to select desired health outcomes and the means for achieving them, but also to depart from the ideal and/or to modify treatment plan presentation on a patient‐to‐patient basis. Patients' impressions of dentists' examination styles, personalities, and ability to relate to them as individuals seem to mediate both treatment acceptance and willingness to participate in the decision‐making process. Results of this investigation suggest that any effort aimed at improving dental treatment decision‐making needs to acknowledge the interplay of clinical and psychosocial factors.
A computerized business simulation for dental practice management
Authors: Willis DO , Smith  , Golden P
Published: June 2020

Computerized simulations have been used for many years for teaching principles of management in business schools. This paper describes the development of a computerized business simulation for use in dental school practice management courses. The simulation is in a competitive game format. It requires students to formulate strategies and to implement management decisions that reinforce and fulfill that strategy. Participants use the outcomes of these decisions to formulate new management decisions for the upcoming period. Student response to participation in the simulation has been positive, with students indicating that participation is valuable for developing better understanding of analytical business management techniques and interpersonal techniques such as group process and leadership skills.
Motivational factors in the choice of postdoctoral general dentistry programs
Authors: Lockhart PB , Gentry AC , Pulliam C , Curtis JW
Published: June 2020

This study explored the importance of various personal and professional factors that may influence choices concerning postdoctoral training in general dentistry. We sent an eighty‐one‐question survey to all individuals (N = 1,995) who were registered to participate in the Postdoctoral Dental Matching Program (MATCH) and analyzed 599 returned surveys from those applying to GPR and/or AEGD programs. Approximately twenty questions addressed each of four time periods in the application process. Over half of respondents felt that learning more medicine, increasing their speed with dental procedures, gaining confidence in clinical skills, and treating compromised patients were very important. Over one‐third of respondents felt that program location, salary and benefits, program philosophy and faculty, and nondental training experiences were very important. Females felt that thirty‐five items were more important than did their male counterparts, whereas males indicated that two items were more important. While there were some differences between applicants to AEGD versus GPR programs, there were far more areas where the applicants to each of these programs shared common concerns. The data suggest that the majority of individuals who consider postgraduate general dentistry programs perceive a lack of experience at the predoctoral level relating to clinical dentistry in general and specifically to their understanding of medical principles and managing compromised patients.
An outcomes assessment of a hybrid‐PBL course in treatment planning
Authors: Walton JN , Clark DC , Glick N
Published: June 2020

As part of an ongoing process of curriculum development, a new course was developed at the University of British Columbia (UBC) to address problems such as lack of student enjoyment of the learning process, poor student preparedness for clinical treatment planning, and underdeveloped critical thinking skills in students beginning their clinical experience. The new course utilized a hybrid problem‐based learning (PBL) format that provided students with an overview in lecture format while encouraging active learning in small group tutorials and seminars. Half the second‐year class was randomly selected to participate in the new course, while the other half received the standard lectures on the subject. An outcomes assessment examined whether the aforementioned problems had been addressed in the new course. Course participants completed a post‐course evaluation, and all students completed a self‐assessment of their preparedness and progress in treatment planning and diagnostic. Clinical instructors, who were blind to the identity of the new course participants, were asked to independently assess each student using the same criteria. Results indicate that students who participated in the hybrid‐PBL course enjoyed the learning process and later rated themselves as being better prepared and improving more in the areas of treatment planning and diagnostic records than their counterparts, although the latter results were not routinely statistically significant (p < 0.1). Instructor evaluations supported these differences between the two groups.
Science and the shifting paradigm in dental education
Authors: Greene JC
Published: June 2020

Dental education is faced with continuing challenges to adjust to external as well as internal pressures. These pressures are coming from a variety of sources that are often inconsistent in the nature and direction of change they would bring about. Pressure on the future direction of dental education are coming from sources such as an Institute of Medicine report, Pew Health Professions Commission reports, changes in the academic health centers in response to health care reform, and expectations of parent universities. Reactions to these and other forces are bringing about changes in the nature and extent of scientific research in schools of dentistry. As the educational programs continue to evolve, research will receive greater attention, and more of it will be funded from private sources.
Outcomes comparison of solo‐practitioner and group practice models
Authors: Cameron CA , Phillips SL , Chasteen JE
Published: June 2020

A solo‐practitioner care delivery model is utilized in the predoctoral teaching clinics at the University of Washington School of Dentistry. This model requires students to independently manage their practices using central resources. The model is perceived as cumbersome for patients and students and as failing to achieve optimum educational and productivity outcomes. During the 1995–96 academic year, a group practice model of patient care delivery was pilot tested to assess whether productivity, educational, and care delivery outcomes could be enhanced in comparison to the solo‐practitioner model. This group practice model combined third‐ and fourth‐year students for purposes of sharing resources and collaborating in patient care delivery. Resources dedicated to each group practice included a practice advisor, shared patient care coordinator, dental assistant, and shared clinic receptionist. Two group practices and twenty‐five student solo practitioners participated in the study. Based upon an analysis of productivity, participant, and patient data, the group practice participants had greater billing volume, better attendance, enhanced satisfaction with the staff/faculty support and their ability to fill appointments, and generally comparable patient satisfaction ratings. These results suggest that the group practice model, through the dedication of resources and collaboration of providers, could enhance the outcomes of the clinical education program.
Developing competency systems: a never‐ending story
Authors: Glassman P , Chambers DW
Published: June 2020

A competency system in its whole and its parts is described. Such a system can help dental educators rationally and efficiently organize and articulate educational programs, curricula, and courses. Repeated iterations of standard setting, design of experiences, and appraisal can reduce the need for less desirable rework or remediation and rejection of the objects of the experience such as dismissing students. Such an iterative process is one in which there is constant cyclical improvement which can move a dental education organization to develop a shared vision and become a true learning organization.
Knowledge of ethical lapses and other experiences on clinical licensure examinations
Authors: Feil P , Meeske J , Fortman J
Published: June 2020

While clinical licensure examinations claim to protect the public from incompetent practitioners, serious problems related to issues of validity, reliability, and ethics have been reported. The ethical lapses are difficult to document, and reports of problems have been strictly anecdotal. This study's primary purpose was to verify those anecdotal reports by mailing a twenty‐one‐item survey to a national random sample of one thousand general dentists who graduated from a United States‐accredited dental school between 1980 and 1994. For those who responded (42.9 percent) results show that 23.9 percent did not arrange for follow‐up care for the patient even though it was indicated. Eight percent reported knowledge of instances where a lesion was intentionally created; 19.3 percent knew of premature treatment provided for purposes of the examination; 13.7 percent knew of a colleague who coerced a patient into accepting treatment; 32.5 percent reported knowledge of unnecessary radiographs. About half of all respondents agreed that the examination was not an accurate assessment of ability, and a similar proportion doubted that human patients were necessary. A more reliable and valid assessment strategy that does not jeopardize patient care is needed.
Dental students' sexual harassment experiences and attitudes
Authors: Webster DB , Smith TA , Marshall EO , Seaver DC , Szeluga MA , Lillich TT
Published: June 2020

The objective of this study was to describe the sexual harassment experiences and attitudes of students at the University of Kentucky College of Dentistry. A twenty‐six‐item questionnaire was developed and administered to 170 dental students in years one through four of the curriculum. Five questions explored students' personal experiences with sexual harassment–whether they had been harassed or had observed harassment; twenty‐one questions addressed students' attitudes about sexual harassment. Computations of mean differences in Likert‐type scale responses for the twenty‐one attitude items were completed using independent t‐tests for the following variables: gender, whether respondents had been sexually harassed or had observed harassment of others, and years in dental education. Almost 15 percent of the students reported being sexually harassed at least once in dental college. Females were sexually harassed more often than males (p < .01), and second, third, and fourth year students more often than first year students (p < .05). Additionally, 30 percent of the students reported witnessing sexual harassment in the college. Harassers included faculty (88 percent), dental students (8 percent), and others (4 percent). Differences (p < .05) in sexual harassment attitudes were found when responses were analyzed by gender, by whether students had been sexually harassed, by whether they had witnessed harassment, and by years in dental education. The data show that sexual harassment occurs in the college. Dental faculty and students could benefit from programs to educate them about sexual harassment, how to prevent it from occurring, and how to respond if they are sexually harassed.
Pilot study of dental hygienists' comfort and confidence levels and care planning for patients with disabilities
Authors: Johnson TL
Published: June 2020

A questionnaire assessing comfort levels and behaviors of dental hygienists concerning treatment of patients with special needs or disabilities was mailed to a random sample of 175 practicing dental hygienists in Idaho. All respondents had seen patients with disabilities, although 53 percent had never completed a formal course or received training directed specifically toward this population. Survey respondents were moderately to always comfortable treating special needs and disabled patients. Use of a wheelchair was the only disability in which clinicians were significantly more comfortable with treatment following completion of a course or receipt of training. Severity of a patient's disability and limited time were considered moderate to very high barriers to the provision of dental hygiene care. Recommended treatment planning techniques are being used to a limited extent, and respondents were slightly to moderately confident using alternative communication and treatment techniques. The findings suggest that although education or training was not strongly associated with comfort and confidence levels of these dental hygienists, they were interested in opportunities for further training in caring for patients with special needs.
Management of patients needing antibiotic prophylaxis in a dental education setting
Authors: Johnson TE , Froeschle ML , Lange BM , Marx DB
Published: June 2020

The management of antibiotic prophylaxed (ABX) patients at an educational institution was evaluated to identify areas for improvement. Management criteria, reflecting guidelines to prevent oral‐induced hematogenous microbial seeding, were pretested and applied to 1,225 record entries of eighty‐five patients needing ABX for dental treatment between 1991 and 1996. Seven hundred twenty‐two of the visits had 857 management or documentation problems, including no documentation indicating whether or not patients premedicated (n = 281); incomplete, insufficient, or repeated treatment (n = 214); and preventive concerns (n = 172), among others. The proportion of providers' patient visits with one or more management problems differed significantly (p < 0.001) by provider type, as did the distribution of problem categories (documentation, treatment, preventive, and scheduling concerns p < 0.001; compliance issues p < 0.005). Fifty‐one percent of postgraduates' and 39 percent of faculty's record entries omitted patients' ABX status. Improved documentation, outcome measures, and patient, faculty and student education are indicated.
A corpus‐linguistic investigation of dental English
Authors: Carlson DM
Published: June 2020

This article begins by presenting corpus linguistics and explaining how the corpus approach to language analysis can be used to investigate the language of dentistry. It then reports findings from an analysis that was carried out with readily available software and a corpus of 1,400 dental research abstracts. Included is information about word frequency in dental abstracts and also about how certain words tend to co‐occur in sentences and form regular patterns. The article concludes with a discussion of ways that corpus‐based findings can be applied to the teaching of English to non‐native speakers of the language, many of whom will need English skills for their future careers in dentistry.
Teaching nightguard bleaching and other tooth‐whitening procedures in North American dental schools
Authors: Frazier KB , Haywood VB
Published: June 2020

Tooth‐whitening using carbamide peroxide delivered in a custom‐fitted tray (nightguard bleaching) is a relatively new procedure, yet it is currently one of the most commonly used types of esthetic dental treatment in private practice. This study determined the extent that nightguard bleaching (NGB) has been included in dental school curricula. All sixty‐five dental schools in North America were surveyed about curriculum content and treatment protocol for the use of nightguard and other bleaching procedures, generating an 82 percent response. The survey covered eighteen subject areas related to NGB ranging from clinical requirements and indications to products and recall intervals used. The most commonly taught tooth‐whitening procedure was NGB, which was most often taught by operative and restorative faculty. Although no schools had clinical requirements for NGB, 92 percent taught it. The most common indications for NGB were esthetic shade change and pre‐restorative lightening of teeth. Unrestored caries, defective restorations, and pre‐existing sensitivity were common contraindications. Most schools do not use a specific NGB consent form, but most use written patient instructions. Most schools use at least two different NGB products, bleach for two to four weeks, and use reservoired and scalloped trays. An average of 25 percent of NGB patients were estimated to develop sensitivity, for which treatment recommendations include fluoride, desensitizing toothpaste, and reduced exposure time. Curriculum time and safety concerns were reasons for not teaching NGB (8 percent schools). Most schools indicated that the relative importance of NGB in the curriculum was increasing.
Cultivating critical thinking in the clinical learning environment
Authors: Behar‐Horenstein LS , Dolan TA , Courts FJ , Mitchell GS
Published: June 2020

The dental education knowledge base suggests a lack of understanding and research about how to teach critical thinking skills in the clinical learning environment. The acquisition of critical thinking skills is essential to the development of future practitioners, yet difficult to measure quantitatively. This study used qualitative research methods to assess the frequency and nature of teaching critical thinking skills in the University of Florida College of Dentistry predoctoral student clinics. Thirteen faculty and forty‐four students in six clinics (oral diagnosis/treatment planning, endodontics, periodontology, operative dentistry, prosthodontics, and emergency care/oral surgery) were observed by an independent evaluator. Critical thinking skills were infrequently taught, and teacher‐dominated instruction predominated. The findings underscore the need for thoughtful curriculum planning prior to predoctoral clinical instruction and periodic appraisal of clinical instruction. Suggestions for improving critical thinking in the clinical learning environment are presented.
Definitions of Risk
Authors: Burt Brian A.
Published: June 2020

Risk‐related terms such as risk factor, modifiable risk factor, demographic risk factor, risk indicator, determinant, and risk marker are often not well defined in the literature. This short report supports the use of a 1996 definition of risk factor, as probably the most commonly used term related to risk, for the Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life, March 26‐28, 2001.
Does Low Birthweight Increase the Risk of Caries? A Systematic Review
Authors: Burt Brian A. , Pai Satishchandra
Published: June 2020

Low birthweight is a major public health and social problem in the United States. While a long list of mortality and morbidity conditions have been associated with low birthweight, dental conditions have not received much attention. This systematic review addresses this question: Do low‐birthweight children (birthweight <2500 grams) subsequently develop more caries than do children with normal‐to‐high birthweight? The MEDLINE and EMBASE databases were searched for English‐language papers published between January 1966 and July 2000 using a search expression developed in conjunction with an experienced librarian. There were 198 papers located in the initial search; a title and abstract review to identify clearly irrelevant papers reduced this number to 37. Two readers each read these papers, and application of predetermined inclusion/exclusion criteria reduced this number to only four papers. Quality criteria were established for scoring each of these papers on evidence tables. The maximum score for each paper was 100; the four papers rated scored between 31 and 61. Results showed that no relationship between low birthweight and subsequent development of caries was reported in any of the four papers. However, conclusions must be cautious because of the scarcity of studies on the subject and the limited scope of the four papers judged. The relationship of low birthweight to subsequent development of caries, especially in the permanent dentition, needs further exploration.
Methods of Stopping or Reversing Early Carious Lesions Fluoride: A European Perspective
Authors: Treasure Elizabeth T.
Published: June 2020

The purpose of this review was to discuss the findings of the systematic review of the management of the early carious lesion with fluoride from a European perspective. The review was checked, and the overall finding that the evidence was incomplete was confirmed. It was suggested that the reason that few data were available was that clinical trials had not been designed to answer this question and that the baseline of healthy teeth and surfaces with very early lesions were rarely quantified. The European perspective would want to identify a clinical method that could manage these lesions better than the home use of fluoride toothpaste. Future research was recommended in the form of several systematic reviews and re‐analysis of existing data. Only then could further studies be recommended. In modern European dentistry, restoring these lesions is not an option.