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1. A Survey of Recent Dental School Graduates Regarding Care of Pediatric and Special Needs Patients
Matthew J. Madsen, University of Kentucky; Larry L. Cunningham, University of Kentucky; Jeffrey Johnson, University of Kentucky; Davis Potter, Kentucky Injury Prevention and Research Center; Anthony Clark, Private Practice
Purpose: A survey of recent dental school graduates to reflect practice habits. Questions were asked about the treatment of pediatric patients (children under sixteen years of age), medically compromised patients (ASA III or greater), and mentally handicapped patients. Additional questions regarded respondents’ level of confidence during procedures on specific groups of patients, as well as the approximate number of patients seen in the practice. A third section of the survey related to the perceived benefit additional training would be in the areas of medically compromised patients and pediatric patients.
Access to dental care for pediatric and special needs patients continues to be a problem in the United States. Caries in children is rampant in many states, despite recent attention to the problem at the national level. The objective of this study was to attempt to understand practice patterns and availability of care from recent dental graduates. A survey was sent to recent graduates (1997–2001) of five dental schools in the United States. Questions pertained to type of practice, numbers of children and special needs patients seen, acceptance of Medicaid, and assessment of the dentist’s training to meet the needs of these patients. One hundred ninety-four surveys were returned out of 840 for a response rate of 23 percent. Only 52 percent of the responders work in practices that accept Medicaid. Most (91.8 percent) treat children and are confident in their abilities to treat children and special needs patients. Interestingly, the majority indicated that they would have been willing to spend an additional year training in dental school if they were dedicated to pediatrics and special needs patients. The conclusion of the study is that recent graduates from five dental schools generally are confident in their abilities to treat these patients, but many do not accept Medicaid in their practices and the majority would choose additional training in dental school to treat special needs patients.
2. Predental Enrichment Activities of U.S. Colleges and Universities
Lauren E. Mentasti, University of Connecticut; Edward A. Thibodeau, University of Connecticut; David M. Demers, University of Connecticut
Purpose: To examine predental enrichment activities and their impact on the number of applicants from the nation’s top dental school feeder institutions (DSFI).
The DSFI were identified by their total number of applicants to dental schools and by their number of applicants per total student enrollment. A survey consisting of twenty-five yes/no questions on possible predental enrichment activities was administered by phone or sent by email to the top eighty-eight DSFI, with forty-nine responding. Pearson correlation coefficients were used to measure the relationships among the number of applicants, predental activities, and total student enrollment per institution. The total number of applicants/institution was correlated with the total student enrollment/ institution (r=.529) and the number of predental activities/institution (r=.520). No correlation was observed between the number of activities at an institution and applicants per thousand enrolled. The percentages of DSFI with specific enrichment activities were preprofessional health advising programs (96 percent), dental clubs (88 percent), volunteer programs (73 percent), specific predental advising (69 percent), practice interview sessions (61 percent), shadowing program (59 percent), personal statement workshops (53 percent), committee for letters of recommendation (49 percent), clinical observation program (45 percent), oral health outreach to elementary/middle schools (39 percent), on-campus dental care facilities (37 percent), dentistry overview/introduction course (31 percent), DAT review course (27 percent), predental honors society (20 percent), affiliated dental school (20 percent), ASDA chapter (18 percent), special interest/minority dental group (16 percent), scholarships for predental students (10 percent), combined degree program (10 percent), and predentistry as a major (6 percent). Sixteen of the DSFI reported ten or more enrichment activities.
While larger institutions produced more applicants and had more activities, there was no correlation between the number of applicants per 1,000 students enrolled and the number of enrichment activities at an institution. The two activities most common to the top feeder institutions were a preprofessional health advising program and a dental club. Results indicate that there are specific predental enrichment activities common to the top dental school feeder institutions in the United States and that a better understanding of these may assist non-feeder schools in developing or strengthening an interest in dentistry as a career option.
3. Advanced Standing Programs for Foreign-Trained Dentists in U.S. Dental Schools with a Focus on IDP-UCSF
Takashi Komabayashi, University of California, San Francisco; William F. Bird, University of California, San Francisco
Purpose: Foreign-trained dentists who want to practice in the United States are asked to participate in a U.S. dental school for a U.S. D.D.S. degree. However, no previous report has been made regarding advanced standing D.D.S. programs for foreign-trained dentists. Therefore, this study compares U.S. nationwide advanced standing D.D.S. programs for foreign-trained dentists (ASDDS) and results of the International Dentist Program at the University of California San Francisco (IDP-UCSF) (2000–04).
Nationwide distribution of ASDDS differs from state to state. All five California dental schools offer ASDDS, while ASDDS is offered at twenty-four other dental schools throughout the United States. Class size ranges from two to 100. Test of English as a Foreign Language (TOEFL) and National Board Dental Examination, Part I (NBDE I) are mandatory to apply in most cases. The minimum scores required range from CBT 213 (PBT 550) to CBT 250 (PBT 600) in TOEFL, and from 75 to 90 in NBDE I. Technical examination and interview are held. A length of study is two or three years, and some programs fully or partially integrate to the equivalent of the second or third year of the existing domestic dental school program, while others are completely independent. IDP-UCSF is a two-year program that begins in June of each year and culminates in a Doctor of Dental Science (D.D.S.) degree. The program has admitted twenty-two or more foreign-trained dentists yearly since 2000. More than half of the students are from the Republic of India. IDP-UCSF is unique in that it includes 1) complete integration to existing domestic D.D.S. program; 2) various sites for clinical training; 3) 100 percent passing rate in California state board examination and other regional examination boards; and 4) a high percentage of IDP-UCSF graduates has been accepted into postgraduate specialty programs.
Outcomes of this study are useful implications for curriculum development in U.S. dental programs for foreign-trained dentists.
4. Clinical Simulation: Ahead of the Game
Karen M. Gardner, University of British Columbia; Lance Rucker, University of British Columbia
Purpose: To introduce the concept of full clinical simulation in a fast-track curriculum.
The University of British Columbia introduces its clinical dentistry using full clinical simulation. We believe the total integration of students into the complete clinical setting from the outset of their clinical training allows a quicker and smoother transition into clinical dentistry. With the onset of a full problem-based learning (PBL) curriculum in 1994, we were asked to accept that our dental students would receive no clinical training until the final month (June) of the second year in our four-year program. In spite of this restriciton, the operative division was asked to have the students ready to perform Class I, II, III, and IVs on live patients within twelve weeks. Here’s how we did it. 1) In June of the second year, students are launched into a month-long intensive course for introduction of clinical skills, lovingly referred to as Boot Camp I. During this time, the students go from never having picked up a dental handpiece to passing a competency involving a Class I amalgam preparation and a Class II amalgam restoration. The students work in full clinical simulation, receiving lectures and clinical simulation training on rubber dam, matrix systems, hand instrumentation, cavity preparation principles, dental materials (amalgam, composite, glass ionomer, IRM), pediatric dentistry (fissure sealants), and other psychomotor skills. 2) The students return at the end of August to attend Boot Camp II (the first part of the third-year operative dentistry course). Between the end of August and the middle of October, they complete various exercises and clinical quizzes that lead to a competency exam at the end of September during which, in two hours, they complete the following: amalgam Class II preparation, amalgam Class II restoration, composite Class III preparation, and composite Class III restoration. 3) Within the next three weeks, they complete exercises in Class V glass ionomer and Class II composite preparation and restoration. 4) At least half of the class has been deemed competent to perform these procedures on patients by the middle of October (although this is carried out with intense instructor-student supervision ratios). The remainder perform these procedures when their competence dictates. 5) Almost all of the students have achieved complete clinical access to these procedures by early December. 6) Complex procedures are examined by the end of the second month of the second semester of the third year (February). Full clinical simulation allows the teaching to move at this pace because, we feel, students are fully integrated and thus do not have to spend time relearning the procedures when a new environment is introduced. That is, full clinical simulation (in the clinics) optimizes skill transfer from the simulation setting to clincal treatment settings. One concern with any fast-track program is the maturation factor. Students may have the skills to perform a certain set of procedures successfully on one or even a few occasions, but they simply lack confidence in their abilities to consistently produce acceptable results. Experienced instructors, both full- and part-time, report high confidence in the quality of skills displayed by students well trained in full clinical simulation. Advantages are that the program allows full integration into the first two years of the medical curriculum (PBL), a simulation lab is not required (chairs can be used for live patients when not being used in simulation), and it provides for a smooth transition into complete patient care. Disadvantages are that the program lacks maturation time, requires low student instructor ratio throughout the third year, students do not perform any clinical dentistry (in simulation) until the end of second year, and there is intense clinical training from the end of second year until the start of fourth year.
A fast-track approach to clinical training in dentistry is possible. It requires full clinical simulation and exquisite planning.
5. Blood Pressure Changes in Hypertensive Patients During Dental Treatment
Jody F. Schilling, University of Michigan; John P. Gobetti, University of Michigan
Purpose: To measure the changes in blood pressure (BP) of hypertensive patients during dental procedures to provide dentists with guidelines for the safe treatment of hypertensive patients. A literature review yielded limited information on the topic.
A convenience sample of seventy-nine patients at the University of Michigan School of Dentistry was used. Eligible patients had diagnosed/medically treated hypertension as defined in the JNC VII report. A Criticare 506DX electronic cuff remained on the arm to record initial, intraprocedural (specifically during perceived physical/ emotional stress), and final BPs. Additional data included patient demographics, pertinent medical history, and rating of dental anxiety perception. Study participants consisted of thirty-seven women and forty-two men with an average initial systolic (S) BP 148mm Hg (range 114 to >201), diastolic (D) BP 81mm Hg (50 to >113). The average number of BP readings per participant was ten (range two to twenty-eight). Average BP increase for all procedures was S 13mm Hg (range -18 [negative denotes decrease from initial BP] to >49), D 7mm Hg (-15 to >34). Each treatment category showed BP increases. Average increases and ranges of BP changes are as follows: extractions S 23 (0 to >49), D 12 (0 to >29); periodontal surgeries S 15 (–6 to >46), D 10 (–5 to >23); restorative S 15 (–14 to >44), D 5 (–7 to >19); periodontics (maintenance, scaling, root planing) S 12 (0 to >30), D 6 (–4 to >16); treatment plans and/or simple prophylaxis S 10 (–6 to >24), D 8 (–2 to >34); endodontics S 7 (–4 to >23), D 3 (–5 to >11); non-invasive prosthodontics S 3 (–18 to >28), D 5 (–15 to >32). S BP increase for all procedures correlated (p=0.036) with negative dental anxiety perception. BP of thirty-eight patients was measured during injections; the average increase was S 6 (–19 to >44), D 3 (–15 to >29). This study was funded by an NIDCR training grant.
Dentists should determine the risk of treating hypertensive patients based on initial patient BP, type of procedure, and patient perception of dental visits. While the average BP increases were not exceptional, the upper ranges of the BP changes were clinically significant. Although a limited sample, our data show BP increases in hypertensive patients during dental procedures, indicating that BP monitoring of hypertensive patients is essential.
6. Identifying and Teaching Generation X Dental Students
Matthew S. Milliner, University of Kentucky; Judith Skelton, University of Kentucky; Paul Osborne, University of Kentucky; Melody Ryan, University of Kentucky; Frank Romanelli, University of Kentucky
Purpose: To determine the degree to which dental students identify with the characteristics ascribed to Generation X’ers and to describe the implications of these characteristics for teaching and learning.
Cultural experiences and climate affect students’ attitudes, values, and beliefs. These influences have an impact on the learning of students and, therefore, should be taken into consideration by those teaching students. Dental educators are struggling to understand this generation of learners to maximize their professional experiences. Little information is available to determine how closely professional students identify with Generation X characteristics. Two surveys were employed in this study. The first instrument was modeled after a survey administered and described by Peter Sacks in his text, Generation X Goes to College. The survey instrument was meant to ascertain attitudes and beliefs of Generation X students. The second survey is a validated Generation X scale. Sixty-seven percent of dental students surveyed were male. Most students ranked the most important quality of an instructor as being warm and friendly. Most thought grades should be primarily based on knowledge and performance in a subject. The majority of students thought the average grade in their respective college should be a B. Further results will be presented.
Generation X students manifest a collective group of characteristics and traits that may affect learning aptitude. Knowledge and awareness of these traits both by faculty and students may improve teaching and learning.
7. Effective Learning Experiences in Dental School: A Qualitative Study
Sarah Hogan, Case Western Reserve University; Kristin Zakariasen Victoroff, Case Western Reserve University
Purpose: Students’ views of their educational experience can be an important source of information for curriculum assessment. Although quantitative methods, particularly surveys, are frequently used to gather such data, fewer studies have employed qualitative methods to examine students’ dental education experiences. The purpose of this study is to explore characteristics of effective learning experiences in dental school using a qualitative method.
All seventy third-year and seventy fourth-year dental students enrolled in one midwestern dental school were invited to participate in this study. During summer 2004, fifty-three dental students (thirty-two third years, twenty-one fourth years; thirty-five male, eighteen female) were interviewed using a critical incident interview technique. Each student was asked to describe 1) a specific, particularly effective learning incident that he or she had experienced in dental school and 2) a specific, particularly ineffective learning incident for comparison. Each interview was audiotaped. Students were assured that only the interviewer and one additional researcher would have access to the audiotapes. Data were coded, and themes were generated using techniques from grounded theory. The following are themes generated from the data that describe characteristics of effective learning experiences during dental school: 1) instructor characteristics (enthusiastic attitude, checking-in with students, interactive style), 2) learning format (clear focus, relevance, emphasis on concepts and understanding why), 3) learning process (effective demonstrations, opportunity to apply new knowledge, appropriate and timely feedback, opportunity to see the "big picture"), and 4) learning culture (openness to questions, focus on learning rather than performance).
Common themes emerged across a wide variety of learning incidents. Although further research is needed, these themes may have implications for individual course design and for the curriculum as a whole.
8. Utilization of Dental Students as Faculty to Compensate for Faculty Shortage
Jasmin Steven, University of Missouri-Kansas City; Reem N. Haj-Ali, University of Missouri-Kansas City; Cynthia S. Petrie, University of Missouri-Kansas City; Mary P. Walker, University of Missouri-Kansas City
Purpose: To evaluate whether senior dental students could function as effective educators in preclinical laboratory courses and whether such teaching experience could enhance their interest in teaching as part of their future career.
Five senior dental students and five full-time faculty were selected as instructors in a two-semester Dental Morphology and Occlusion preclinical lab course. The ninety-five first-year dental students (1DS) enrolled in this course were randomly assigned to be instructed by a full-time faculty (FF) in one semester and a student-faculty (SF) in the other semester. At the end of each semester, course evaluation forms were completed by the 1DS. The forms ranked faculty from 1 (poor) to 5 (excellent) in six different categories. The student-reported FF and SF performances were compared. In addition, the performances of the 1DS in the lab examinations were compared in respect to instructor type. The senior students were surveyed for their reactions to this teaching experience. The median (semi-interquartile range) performances of the FF and SF were as follows: contribution to knowledge [4.0 (0.5), 4.0 (0.0)], ability to create a positive learning environment [4.0 (0.5), 4.0 (0.5)], ability to communicate effectively [4.0 (0.5), 4.0 (1.0)], availability [3.5 (0.5), 4.0 (0.5)], fairness in grading [4.0 (0.5), 4.0 (0.25)], and overall teaching effectiveness [4.0 (0.5), 4.0 (0.5)] respectively. A Wilcoxon matched pairs signed rank test showed no statistically significant difference between the performance of SF and FF in all categories evaluated (p>.05). An independent t-test revealed no significant difference between the performances of 1DS that were instructed by FF versus those instructed by SF in both semesters (p>.05). In addition, such classroom teaching experience did not necessarily enhance the senior students’ interest in considering teaching as part of their future career.
Senior students appeared to function as effective educators in preclinical Morphology and Occlusion lab courses. Despite the fact that such experience did not influence students’ decision to consider academics as a future career, it provides a quick means to compensate for faculty shortage.
9. Student Perceptions and Use of Digital Textbooks
William Davenport, University of Nevada, Las Vegas; Matthew R. Wirig, University of Nevada, Las Vegas; William J. Curtis, University of Nevada, Las Vegas; Scott Redlinger, University of Nevada, Las Vegas; Paul Froude, University of Nevada, Las Vegas
Purpose: The concept of digital textbooks has been around for many years; however, the practicality of their use is still a matter of debate. In this study we will determine student perceptions of this technology. We will also determine the amount of time students study using either digital textbooks or traditional ones. By investigating the opinions and study habits of numerous dental students around the nation, we plan to provide evidence that either supports the use of digital textbooks or their removal from existing curricula.
Seven dental schools that currently use digital textbooks on DVD have been paired with seven schools that do not. The matching schools were chosen on the basis of similar demographics using the ASDA Guide to Dental Schools (2003). Criteria used for pairing included class size, entrance GPA, entrance science GPA, and DAT scores. Two surveys, one for the study group (schools that use digital textbooks) and one for the control (schools that use traditional textbooks), were constructed. These surveys were posted on a website, and the link was initially emailed to all students at one of the study schools. Seventy percent of the student body completed the survey resulting in an initial study group of 105 students. The link will be sent to all other participating schools. Preliminary results show that 74 percent of students prefer to have their textbooks on computer and 75 percent use their textbooks only as a supplement to class material or as a reference.
It appears that digital textbooks are a viable option to traditional textbooks. Preliminary results indicate that students prefer digital textbooks. Cost of the technology was not taken into account in this study but may appear to be a major deterrent for both students and administration.
10. General Dentists and Special Needs Patients: The Role of Undergraduate Dental Education
Loan P. Dao, University of Michigan; Samuel Zwetchkenbaum, University of Michigan; Marita R. Inglehart, University of Michigan
Purpose: To determine the effect of undergraduate dental education on general dentists’ professional behavior, practice characteristics, and attitudes concerning special needs patients.
In the year 2000, the first U.S. Surgeon General’s report on oral health concluded that special needs patients are one of the most underserved patient groups in the United States. The objective of this study was to investigate whether undergraduate dental education about treating special needs patients and patients with mental retardation will affect general dentists’ professional behavior, practice characteristics, and attitudes concerning special needs patients. Data were collected with a self-administered survey mailed to a random sample of 500 general dentists who were members of the Michigan Dental Association. The response rate was 41 percent (N=204). Most respondents were male (84.8 percent). The participants’ ages ranged from twenty-seven to ninety-two years (mean=50.1 years). Only 14.2 percent of the respondents reported that their undergraduate education had prepared them well to treat special needs patients, and only 11.7 percent indicated that they had been well prepared to treat patients with mental retardation. The more the respondents agreed that their undergraduate dental education had prepared them well to treat special needs patients and patients with mental retardation, the higher was the percentage of patients from lower socioeconomic backgrounds (r=.21; p.004; r=.20; p=.005) and patients covered by Medicaid (r=.14; p=.05; r=.16; p=.03). The more they agreed that their undergraduate education had prepared them well to treat special needs patients and patients with mental retardation, the more children with special needs (r=.19; p=.02; r=.18; p=.02) and the more adult and children with different disabilities (such as patients with motion, visual, or hearing impairments) they treated. Concerning their practice, the results showed that the better their undergraduate dental education had prepared them to treat special needs patients and patients with mental retardation, the better their practice was set up to treat these patients (r=.28; p=.000; r=.22; p=.002), and the more comfortable (r=.33; p=.000; r=.31; p=.000) and knowledgeable (r=.44; p=.000; r=.46; p=.000) their staff was concerning treating special needs patients. The degree to which these respondents liked to treat special needs patients and were comfortable treating them was significantly correlated with their perception of the quality of their undergraduate education concerning the treatment of special needs patients (r=.35; p=.000; r=.25; p=.000). This research showed that general dentists did not perceive that their undergraduate dental education had prepared them well to treat patients with special needs or mental retardation. However, the better they had been prepared, the more likely they were to treat these patients, the better their practice was set up to serve these patients, and the more positive their attitudes were towards treating these underserved patients. Given the high percentages of patients with special needs, it seems crucial that undergraduate dental curricula be examined concerning their inclusion of material concerning these patients.
11. Resource Utilization for Clinical Decisions Regarding Posterior Composite Restorations
Tabitha Strain, University of Missouri-Kansas City; Reem N. Haj-Ali, University of Missouri-Kansas City; Mary P. Walker, University of Missouri-Kansas City; Cynthia S. Petrie, University of Missouri-Kansas City; Karen B. Williams, University of Missouri-Kansas City
Purpose: To characterize the dental resource utilization patterns of a national sample of general dentists with respect to clinical decisions regarding posterior composite restorations.
A stratified random sample of dentists (n=2880) was obtained using the Academy of General Dentistry membership list. Members were mailed a questionnaire that elicited information about practice characteristics, resources used for clinical decision making, and CE attendance related to posterior composite restorations. Six hundred and ninety-nine dentists responded for a 24 percent response rate. The average years experience of the respondents was 20.6 years (11.6), with 67 percent being general AGD members, 26 percent Fellow, and 8 percent Master AGD members. AGD Master-level members were significantly more likely to use evidence-based (EB) resources (journals and professional meetings) than their counterparts (p<.05). When considering years of experience, use of EB resources was low for all respondents (14 percent) irrespective of experience. However, more experienced clinicians were more likely to use EB resources than recent graduates. Newer graduates were less likely to use information from manufacturers in clinical decisions (p<.05), but more likely to rely on colleagues as resources (p<.05). Patterns of Internet use for online information was not significantly different among experience groups; however, newer graduates were more likely to use this information source.
Although it is likely that newer graduates are exposed to EB dentistry, current patterns of use elicited in this survey suggest a low reliance on evidence-based resources in the practice of clinical dentistry.
12. Providing Care for Underserved Patients: The Role of Dental Education
Carlos S. Smith, University of Michigan; Todd V. Ester, University of Michigan; Marita R. Inglehart, University of Michigan
Purpose: To explore the role of dental education for dental students’ attitudes and intentions to treat underserved patients in their future professional lives and practicing dentists’ attitudes and actual behavior concerning treating underserved patients.
In the year 2000, the first U.S. Surgeon General’s report on oral health stressed the importance of providing oral health care to underserved patient groups such as underrepresented minority patients. The objective of this study was to explore whether dental education about underserved patient populations will affect dental students’ attitudes and intentions to treat underserved patients in their future professional lives and practicing dentists’ attitudes and actual behavior concerning treating underserved patients. Data were collected from 328 of the 423 students enrolled during the academic year 2003–04 at a midwestern dental school (response rate: 77.5 percent). In addition, surveys were mailed to 535 dental school alumni (response rate =43.7 percent; N=234). Overall, 67.4 percent of the students and 38 percent of the alumni indicated that their education prepared them well to treat patients from different socioeconomic backgrounds, 71.3 percent of students and 55.2 percent of alumni reported that they had been well educated to treat patients from different ethnicities, and 40.2 percent of students and 34.6 percent of alumni that they were well educated to treat special needs patients. The more the students agreed that their dental education had prepared them well to treat patients from different ethnic backgrounds, the more they intended to treat these patients in the future (r=.12; p=.033); the better their education prepared them to treat special needs patients, the more they intended to treat these patients in the future (r=.23; p=.000). The more the alumni dentists agreed that the dental school had prepared them well to treat patients in different communities and to gain insight into barriers to receiving dental care, the more likely they were to treat patients from different socioeconomic backgrounds (r=18; p=.009; r=.17; p=.01) and patients with disabilities (r=.17; p=.011; r=.22; p=.001). In addition, dentists’ attitudes concerning interacting with patients from different backgrounds, addressing community needs, and making a positive difference on public issues were significantly correlated with the degree to which they perceived they were well prepared by their dental education to treat patients in different communities (r=.16; p=.015). In conclusion, these findings showed that access to oral health care for currently underserved patients could potentially be increased if dental curricula would educate students more inclusively about treating patients from different backgrounds.
13. Younger Versus Older Adults Diagnosed with TMDs: Preliminary Findings
James A. Wysocki, State University of New York at Buffalo; Kimberley Zittel-Palamara, State University of New York at Buffalo; Yoly M. Gonzalez, State University of New York at Buffalo; R. Seiji Ohtake, State University of New York at Buffalo; Jude A. Fabiano, State University of New York at Buffalo
Purpose: Several epidemiological studies have shown that approximately 10 percent of the United States population experiences TMDs. The prevalence of these conditions is higher in younger adults and decreases in prevalence in older adults. To date, limited research examines differences between younger and older adults with TMDs. This study examined biobehavioral characteristic differences in sixty-seven patients who received multidisciplinary TMDs treatment in a university clinic.
This pilot study compared patients who were sixty years of age and older (n=11) to patients who were ages eighteen to fifty-nine (n=52). Each patient with an RDC diagnosis was administered standardized instruments to determine biobehavioral and social demographics. Biobehavioral differences were found, including being a Medicaid recipient, an anxiety diagnosis, taking psychotropic medication, tobacco use, and alcohol use. More young adults had Medicaid (n=14, 51.9 percent) versus those sixty and older. This difference was significant (Mann-Whitney Rank Sum Test [MWRST]: p=.023). Younger patients reported more anxiety (n=15, 53.6 percent) than did those sixty and older (28.6 percent). This difference was significant (MWRST: p=.051). Younger patients reported taking psychotropic medication more frequently (n=15, 55.6 percent) than did those sixty and older (28.6 percent). This difference was significant (MWRST: p=.006). Younger patients reported using tobacco more frequently (37.5 percent) with no patients sixty and older smoking. Patients who were sixty and older reported using alcohol more frequently (50 percent) than did younger patients (n=8, 33.3 percent). Aggregated smoking and alcohol data was significant (MWRST: p=.004). These results point to more financial and mental health concerns in the younger adult TMDs patients than those sixty and older.
It is possible that these observations are due to older adults’ less frequently seeking out mental health professionals, thereby neglecting to report a mental health condition. Instead, those sixty and older may be self-medicating an underlying mental health diagnosis with alcohol. Future research with larger sample sizes needs to be conducted in order to examine specific characteristics of biobehavioral and social issues presenting in older adults being treated for TMDs. Social work professionals are integral to the biobehavioral management of patients with TMDs.
14. Services for Special Needs Persons by African American Dentists in Tennessee
Erin S. Hughes, Meharry Medical College; Edwin H. Hines, Meharry Medical College; James E. Tyus, Meharry Medical College; William B. Butler, Meharry Medical College
Purpose: Special needs persons represent a significant underserved population for professional dental services. An estimated 50 percent or more of this population receives inadequate dental services. The level of services provided for this population by African American dentists is not well known. In this study, the special needs practice patterns of licensed African American dentists in Tennessee was determined.
A survey, designed to be culturally sensitive, including twenty culturally oriented incentives to respond, was mailed to 220 African American dentists in Tennessee. Of those, 125 surveys were completed and returned (56.8 percent). Results of the survey indicate that 75 percent of respondents work in private offices, with 85 percent accepting special needs patients. Of the respondents, approximately 27 percent treat zero to five cases/year, 37 percent treat six to twenty cases, 15 percent treat twenty-one to fifty cases, and 4 percent treat more than fifty special-needs persons/year. No handicap was identified as being not acceptable for treatment. Less than 10 percent of negative respondents indicated a lack of patient demand and/or dentist interest, and 12 percent identified other reasons. Seventy-five percent indicated a special interest in African American services. Some 80 percent were receptive to more information, and 75 percent gave positive responses to being placed on a national register of providers or would like more information. We conclude from the results of this study that African American dentists in Tennessee are outstanding sources for special needs services and these dentists represent an excellent opportunity for increased involvement in services for special needs populations.
15. Complementary and Alternative Medicine Awareness in Dentistry
Michael Capalbo, University of Connecticut; Michael Goupil, University of Connecticut
Purpose: The purpose of the first phase of this study was twofold: 1) to determine if Connecticut general dentists are inquiring about the complementary and alternative medicine (CAM) practices of their patients, and 2) to determine if the Connecticut dentists have knowledge in CAM or have any interest in being further educated in CAM. The next phase of this study was to determine if dental schools are currently teaching or planning to incorporate CAM in their dental curriculum.
The use of CAM is no longer excluded from health care in the United States and has been thrust into the mainstream of health care for many Americans. Between 1990 and 1997, there was a 47 percent increase in visits to alternative practitioners. In 1997, four in ten Americans were using at least one type of alternative medicine, and an estimated 15 million adults in 1997 took prescription medicine concurrently with herbal remedies and/or high-dose vitamins. The growing number of patients choosing to use CAM is evidence that the modern-day dental clinician needs to be aware that alternative medicine is a viable and popular option for many of their patients. It is becoming imperative that dentists are educated in the different types of CAM treatments and the effects that these treatments have on prescription drugs and dental care. Without the proper education about alternative medicine, dentists can not provide the highest quality health care to their patients. The purpose of the first phase of this study was twofold: to determine if Connecticut general dentists are inquiring about the CAM practices of their patients and to determine if they have knowledge of CAM or any interest in being further educated in CAM. The next phase was to determine if dental schools are currently teaching or planning to incorporate CAM in their dental curriculum. In Project 1, a random sample of active Connecticut general dentists was selected from the Connecticut State Dental Association’s 2002 roster. The population size was 1300, and 250 dentists were randomly selected. In Project 2, the population was fifty-two dental schools in the United States, all of which were sent a survey. In Project 1, we conducted our survey by mail between the dates of July 1 and August 30, 2003. The surveys were coded to maintain confidentiality. A cover letter reinforcing the importance of participation and objectives of the study, as well as the purpose of the code, was included along with a prepaid preaddressed return envelope. A second survey was sent to all nonrespondents on September 1, 2003. In Project 2, we conducted our survey by email. A cover letter that reinforced the objectives and importance of our study was included in the email. Data were analyzed using descriptive statistics and nonparametric statistics for frequency distribution. In Project 1, of the 250 surveys mailed, 237 reached the target audience; 190 were returned for a return rate of 80 percent. Of the 190 general dentists who returned the survey, 78.4 percent reported that they did not inquire about the CAM practices of their patients and 74 percent reported being interested in learning more about CAM in the future. In Project 2, of the fifty-two surveys sent out, twenty-seven were returned for a return rate of 52 percent. Of those, 7.4 percent of the schools reported currently incorporating CAM in their dental school curriculum, and none of the other respondents had any plan to incorporate CAM lectures into their curriculum.
In Project 1, survey results indicated that a majority of Connecticut general dentists were not inquiring about the CAM practices of their patients. Although most of the dentists surveyed expressed the desire to learn more about CAM, many were not aware of its prevalence of use among their patients. In Project 2, survey results indicated that a great majority of dental students are not being taught CAM in dental school and there are no plans to add CAM to the curriculum in the future.
16. Dental Student Response to an Oral Health Intake Record for Pediatric Patients: Update
Laurence D. Pfeiffer, Stony Brook University; Fred S. Ferguson, Stony Brook University
Purpose: Determine dental students’ response to the use of a new health intake record.
A pediatric health intake record (Pediatric Oral Health Concerns Record: POHCR) was designed that identifies risk factors to oral health, facilitates dental students’ understanding of pediatric oral health, and provides individualized oral health care and counseling to caregivers. The POHCR has been in clinical use for four years from 2001 to the present. The form has evolved from a concise double-sided paper form to an extensive form presented on clinic computers (Axium). The POHCR serves to present health and behavioral concerns that relate to risk for pediatric oral disease. A multiquestion survey was used to record students’ response concerning the POHCR. From the class of 2002, thirty-four students who had completed 290 hours of children’s dentistry clinic reported on the concise double-sided paper form. A different survey was given to twenty-nine students from the class of 2001 who had completed 290 hours of children’s dentistry clinic without use of the POHCR. In a partial report of the results, 91.3 percent of the class of 2002 reported that the POHCR helped in the interview with the parent/guardian, whereas 88.2 percent reported that the POHCR helped them understand caries risk factors. In the class of 2001 survey, 93 percent state they would have benefited from the POHCR in performing a more complete interview with the caregiver and the patient, while 82 percent reported the POHCR would have helped them perform a more efficient clinical exam and 97 percent reported it would have helped in the selection of proper oral health counseling. Finally, 93 percent of the class of 2001 reported that, with the use of the POHCR, they would have obtained a better understanding of oral health risk factors when interviewing a caregiver. From the class of 2003, thirty-three students who had completed 290 hours of children’s dentistry clinic reported on the more extensive paper form. In a partial report of the results, 100 percent of this class reported that the POHCR helped in the interview with the parent/guardian, and the same percentage reported that it helped them in understanding caries risk factors. From the class of 2004, twenty-seven students who had completed 290 hours of children’s dentistry clinic reported on the edited version of the form. In a partial report of the results, 100 percent reported that the POHCR helped in the interview with the parent/guardian, and the same percentage reported that the POHCR helped them in understanding caries risk factors. From the class of 2005, twenty-nine students who had completed 290 hours of children’s dentistry clinic reported on the new more extensive computerized form. In a partial report of the results, 100 percent reported that the POHCR helped in the interview with the parent/guardian, whereas 96.6 percent reported that the POHCR helped them in understanding caries risk factors. The results of the study support that dental students believed they benefited from the use of the POHCR and that it helped them have a better understanding of the risk factors for dental caries and provide individualized patient care. As pediatric oral health/disease is a multifactorial concern, determination of the risk concerns and recognition of the significance of oral findings are essential in the student’s ability to provide appropriate oral health counseling and care. The POHCR facilitates dental students’ ability to obtain this information, while also enhancing their communication skills.
17. Variations Between Health Care Professionals Regarding Herpes Labialis Management
Winnie Wong, University of Alberta; G. Wayne Raborn, University of Alberta; Michael Grace, University of Alberta
Purpose: To assist in the development of a qualitative analysis study instrument to be administered to patients who suffer with recurrent herpes labialis.
As part of the development of a qualitative analysis study instrument, four health professionals, selected for their varying types and level of expertise relative to patient contact, were interviewed regarding their interactions with herpes labialis patients. The pilot group of health professionals were a pediatric infectious diseases specialist, rheumatologist/allergist, oral pathologist, and pharmacist. The interviews were structured around questions about professional background, patient demographics and immune status, frequent presentation, complications, and treatment, while allowing further discussion into each professional’s area of expertise. Each interview lasted between forty-five and sixty minutes. A content analysis was applied to assess the interview data. The health professionals interviewed agree about the high prevalence of previous herpes infection (90–100 percent) and some form of trauma being a trigger for herpes outbreak. However, substantial variation in clinical philosophies and treatment recommendations arose based on the differing experiences of each health professional. The pharmacist typically interacted with immune competent herpes labialis patients, and recommendations focused on treatment with over the counter medications and prevention through promotion of a healthy lifestyle. Conversely, the medical and dental specialists generally encountered immune compromised patients with atypical presentation. Thus, recommendations focused on treatment and prevention of complications with prescription medications. This range in patient presentation, whether immune competent or compromised, led to differing opinions regarding prevention and treatment of herpes labialis with antivirals. Although this was a small sample size and pilot study, it shows that differences exist among health professionals as the experts to whom the public turns for advice. This variation in perspective and mechanisms is related to interaction with patients, emphasizing the need for coordination of care and continuing education to ensure quality patient service. The results of these interviews are being used to formulate questions for focus groups of herpes labialis patients and, ultimately, a large-scale qualitative analysis instrument to survey herpes labialis patients.
18. General Dentists and Pediatric Dental Patients: The Role of Dental Education
John P. Rich, University of Michigan; Lloyd Straffon, University of Michigan; Marita R. Inglehart, University of Michigan
Purpose: To investigate the effect of undergraduate dental education on general dentists’ practice characteristics, referral patterns, best practices, and challenges encountered when treating pediatric dental patients.
In the year 2000, the first U.S. Surgeon General’s report on oral health pointed to the importance of increasing access to oral health care for pediatric dental patients. The objective of this study was to investigate whether undergraduate dental education about treating pediatric dental patients affects general dentists’ practice characteristics, referral patterns, best practices, and challenges encountered when treating pediatric dental patients. Data were collected with a survey mailed to a random sample of 500 general dentists who were members of the Michigan Dental Association. The response rate was 48.2 percent (N=241). Only 40.4 percent of the respondents reported that their undergraduate education had prepared them well to treat child patients, and only 33.4 percent that their clinical experiences during dental school had prepared them well. The more the respondents agreed that their undergraduate dental education and their clinical experiences had prepared them well to treat pediatric patients, the more they agreed that their practice was set up to treat child patients (r=.25; p=.000; r=.31; p=.000) and that their staff was knowledgeable (r=.27; p=.000; r=.31; p=.000) and comfortable treating child patients (r=.24; p=.000; r=31; p=.000). The better they were prepared, the more different treatments they performed with pediatric patients (r=.23; p=.012; r=.20; p=.003), the less likely they were to refer these patients (r=20; p=.003; r=.20; p=.003), and the more likely they were to offer special arrangements and accommodations for pediatric patients (r=.14; p=.043; r=.12; p=.09). In conclusion, less than 50 percent of practicing general dentists reported that their undergraduate dental education had prepared them well to treat child patients. However, the better they had been prepared, both in general and during clinical encounters, the better their practice was set up to serve these patients, the less likely they were to refer these patients, and the more likely they were to perform various treatments on pediatric patients and to offer special arrangements. These results point to the significance of exploring how future dental providers can be prepared better for treating pediatric dental patients during their undergraduate education.
19. Use of, Knowledge About, and Attitudes Towards Computers at the National Autonomous University of Mexico Dental School
Miguel H. Torres-Urquidy, University of Pittsburgh; Javier de la Fuente Hernand, National Autonomous University of Mexico
Purpose: To determine the levels of utilization and understanding of computer technology among the student population.
The utilization of computer technology by dental students has not been measured in Mexico. The investigators translated into Spanish and adapted a survey that was previously validated in a measurement study. Then it was pretested with a random group of twenty students who were not part of the final sample. The survey was modified and distributed. The response rate of our sample was almost 100 percent. Of the total of 1569, the responses per year were: first year 24.3 percent (N=381), second year 26.6 percent (N=418), third year 15.5 percent (N= 243), fourth year 14.7 percent (N= 231), fifth year 18.7 percent (N=293); 72 percent were female. The use of computers in number of hours per week was 7.9 on average (median=6, mode=10). The school-related activities where the computer was used more frequently was searching Medline (fifth year, 30 percent once a month) and less frequently emailing patients (first year, 79 percent never); 72 percent of the students responded that self-learning has been part of their training experience in computers. For the students, the capability of computer systems of most importance was that "the system should be always functioning" (83 percent) followed by "the system should allow you to manage all patient information" (73 percent). In general, the study found that the effect of computers on practice is beneficial especially when accessing up-to-date information (55 percent answered highly beneficial). Strong statistical analysis was not used as part of this preliminary report. However, it is reasonable to assume that the use of computers by dental students increases throughout their dental training. A similar trend can be assumed for computer knowledge. Overall, the students’ attitudes were positive.
The use of computers can have a positive effect while training dental students; thus, dental educators should further explore the impact of information technology in dental education.
20. A Need for Oral Health Care in a Rural Community
Humaira Yousuf, University of Missouri-Kansas City; Michael McCunniff, University of Missouri-Kansas City; Karen Williams, University of Missouri-Kansas City
Purpose: The goal of this project is to conduct an empirically based, theoretically grounded, and methodologically valid needs assessment in rural Kansas that elicits parents’ attitudes, social norms, and perceived control with respect to their children’s oral health.
Early childhood caries (ECC) is a severe form of tooth decay that affects the primary dentition of young children. It is a national public health problem and also a statewide public health issue in rural Kansas, where children of low-income parents from certain ethnic minority groups are at a high risk for developing ECC. To prevent this chronic childhood disease, it is essential that parents be advised about ways to maintain their children’s oral health and decrease their exposure to risk factors for the disease. The needs assessments were administered in Pittsburgh, KS to a convenience sample of forty-two English-speaking parents of children, ages one day to five years, enrolled in the WIC (women, infant, and children) program, MIC (mother and infant clinic), and the Immunization clinic. The written questionnaire, grounded on the Theory of Planned Behavior (TPB), assessed sixty items based on the following domains: parents’ demographics, parental knowledge about ECC, parental attitudes/beliefs about cariogenic drinks, social norms about people likely to influence them on children’s dental care, control beliefs on how much power they have in preventing tooth decay in their children, and parental behavior towards their children’s dental needs. Using the SPSS Statistical program, we found that the greatest area of deficit lies in parental behavior, such that most children above the recommended age have not had their first dental visit. Overall understanding of the prolonged effect of exposure to sugared drinks was poor. Most parents didn’t comprehend the potential manifestations associated with ECC nor the importance of a primary dentition. Parents elicited positive attitudes with respect to their children’s dental needs. However for some, tooth decay is inevitable, which shows low perceived control in the population assessed. Results show that 55 percent of the participants will most likely follow through with a doctor’s or nurse’s recommendations about their child’s dental needs.
We propose an innovative community-specific intervention trial that will utilize educational programs at the chosen sites in Pittsburgh to counsel parents of high-risk children about ways to prevent ECC and empower them with control over their child’s oral health. Dental training will also be provided to specified pediatricians and health care providers in order to further relay the message to the parents and eventually produce a change in behavior as it relates to their child’s oral health.
21. Qualities of an Effective Teacher: The Dental Faculty Perspective
Diya Talwar, University of California, Los Angeles; Weilin Shih, University of California, Los Angeles
Purpose: To identify the qualities dental educators believe are important in an effective teacher.
Full- and part-time faculty at the UCLA School of Dentistry were asked to rate the importance of teaching traits for didactic, lab, and clinical instructors. Surveys were returned by fifty of the eighty-eight faculty members surveyed (57 percent). Data were analyzed by total faculty independent of gender; full-time vs. part-time status independent of gender; and by gender, independent of full-time status. Faculty rated clear organization as the most important quality for a didactic instructor, clear goals and expectations as most important for a lab instructor, and constructive feedback and availability most important for clinic instructors. Comparing full- and part-time faculty, full-time faculty felt basic lecturing skills were most important, while part-time faculty felt clear organization and knowledge of subject were most important in didactic teaching. In lab teaching, full-time faculty felt that fair standards were most important, while part-time faculty felt constructive feedback, availability, and time allocation were equally important. In clinical teaching, full-time faculty felt being a positive role model was most important, while part-time faculty felt fair standards, enthusiasm, and constructive feedback were most important. Gender differences were found for didactic and clinical teaching. In didactic teaching, women considered basic lecturing skills most important, while men felt that clear organization and knowledge of subject were equally important. For clinical instruction, men felt that a positive role model was most important while women felt that constructive feedback and availability were most important.
Faculty consider different teaching skills important, depending on the academic setting, with variations by full- and part-time status and gender. Recognizing these differences is important in designing interventions to improve teaching effectiveness.
22. Early Childhood Caries Needs Assessment: Focus on Native Americans
Ryan P. Wymore, University of Missouri-Kansas City; Thomas M. Darnall, University of Missouri-Kansas City
Purpose: To conduct a needs assessment in a Native American population in rural Kansas to assess parental knowledge dealing with early childhood caries.
Dental caries in children is a major problem in the United States and has been identified as the most common chronic childhood disease. Decay in young children often happens in a predictable pattern, termed early childhood caries (ECC). Different populations have been shown to be differently affected by early childhood caries, Native American children and children in rural areas being the worst affected. The purpose of this project was to conduct a needs assessment in a Native American population in rural Kansas. A convenience sample of parents were asked to participate in the project at the Prairie Band Potawatomi (PBP) Head Start located on the PBP Indian Reservation. The needs assessment was based on the Theory of Planned Behavior and used Likert-type, categorical, and dichotomous response questions. The instrument solicited information on demographics, knowledge, attitude, behavior, social norms, and perceived control related to ECC. Forty-eight percent of parents thought children’s tooth decay was inevitable. Knowledge about carcinogenicity of milk and information about the importance of baby teeth was low. Additionally, respondents were likely to take oral health advice from physicians and nurses. Results were from an empirically based needs assessment. Preconceived ideas can be deceiving, showing the importance of conducting a needs assessment prior to any intervention. The findings will be used in a theory-based educational program.
The results of this theory-based needs assessment should be utilized to assess the knowledge, perceptions, and behaviors of the parents who were studied and to design an effective education intervention for this particular site.
23. Alternatives to Private Practice After Dental School
Benjamin R. Walder, University of California, Los Angles; Ronald S. Mito, University of California, Los Angeles; Milton Clegg, United States Navy; David Neil, University of California, Los Angeles
Purpose: Comparison of dental school debt repayment options for dental practitioners.
As dental students approach graduation, they are often filled with a sense of uncertainty as to their futures and their need to rid themselves of student loan debts. There are many customary postgraduation options for the new graduate to pursue to achieve debt reduction or elimination of debt through the use of newly acquired skills as a dental practitioner. Such choices include postdoctoral general dentistry training, becoming associates, receiving additional specialty training, entering a practice with a partner or as a solo practitioner, or even joining the uniformed services as a dental practitioner with officer status. This study examines the opportunity afforded an enlisted dentist serving men and women exchanging student loan debt for time served in the uniformed services in the Health Professions Scholarship Program. In addition to picking up the payments for the student loan after graduation, the military also awards the student-candidate a modest cost of living stipend while attending dental school. Income and debt data used for this study were obtained from recent surveys conducted by the ADA, ADEA, and the University of North Carolina. Comparison models for this study were created to represent time required to pay the debt service of student loans using alternative solutions for the dental postgraduate. The income potential of the associate with debt, as compared to the uniformed services officer on scholarship with no debt after four years of military service, has unexpected similar outcomes.
The dental practitioner, in committing the required time in the uniform services and being rendered debt-free, will have a financial advantage over an associate practitioner in private practice with student loans after the same amount of time.
24. The Effect of Different Disinfection Methods on DIAGNOdent Readings
Elaine B. Lam, University of Missouri-Kansas City; Christopher Rice, University of Missouri-Kansas City
Purpose: To compare DIAGNOdent readings with traditional methods of caries detection on teeth that had been disinfected using three different regimens.
The KaVo DIAGNOdent has shown promise in several studies as an adjunct in caries detection. Many of these studies used extracted teeth that had been disinfected in a variety of ways. The effect of different disinfection methods on the accuracy of DIAGNOdent readings is unknown. A total of 161 extracted posterior teeth with intact occlusal surfaces were disinfected by one of three methods: autoclaving, formalin immersion for three weeks, or immersion in a 10 percent bleach solution for forty-eight hours. Each tooth was then independently examined by two experienced clinical faculty for caries using an explorer and conventional bitewing radiographs. One clinician also performed an examination with the DIAGNOdent unit. Each tooth was rated on a 1 to 5 scale for the presence of caries. After the initial examinations, each tooth had a Class I preparation to the DEJ. One clinician then reexamined all the teeth using the visual/ tactile method (the gold standard for this study) and the DIAGNOdent. Comparison of the three methods of caries detection with the post-preparation visual/tactile method reveals that the radiographs had the lowest sensitivity and specificity (36 percent and 59 percent), followed by the visual/tactile method (57 percent and 76 percent) and the DIAGNOdent (55 percent and 89 percent). After opening the occlusal surface, the DIAGNOdent had much higher values (81 percent and 89 percent). DIAGNOdent readings for the autoclaved group had markedly lower correlation values (Spearman rho =.383) than the formalin (rho =.753) or bleach (rho =.815) groups. The autoclaved teeth also generally appeared brittle and dry, while the formalin teeth had a light coat of white powder and the bleached teeth had a blue tint to the root structure.
Autoclaving extracted teeth appeared to adversely affect the accuracy of DIAGNOdent readings. Further studies should be carried out to confirm these preliminary results.
25. Elevated Expression of CXCL5 in a Model of Metastatic Head and Neck Squamous Cell Carcinoma
Ryan Edmunds, Virginia Commonwealth University; Hiroshi Miyazaki, Virginia Commonwealth University; Andrew Yeudall, Virginia Commonwealth University
Squamous cell carcinoma of the head and neck (HNSCC) is the sixth most common malignancy in the developed world. The combined five-year survival rate is extremely low (17 percent) for patients with metastatic disease. However, although metastasis to lymph nodes is a major contributory factor to HNSCC morbidity and mortality, the molecular and biochemical events that enable oral tumor cells to metastasize and survive at sites distant from the primary lesion are not well understood. Using cDNA microarray analysis to study global gene expression in a model of metastatic HNSCC, we identified elevated expression of the CXC-chemokine CXCL5 in HN12 cells, which were derived from highly metastatic HNSCC, but not in HN4 cells derived from the corresponding primary lesion. Using quantitative real-time PCR, we found that metastatic cells expressed CXCL5 transcripts at a level around 200-fold greater than primary tumor cells. In addition, treatment of cells with epidermal growth factor at concentrations that induced invasion of metastatic cells resulted in further enhancement of CXCL5 RNA levels. Western blotting of conditioned media collected from HNSCC cultures showed that metastatic cells secrete CXCL5 protein into the cell microenvironment, providing additional evidence that the elevated CXCL5 expression is functionally significant. Taken together, the data suggest that CXC chemokines are secreted at high levels by metastatic HNSCC cells and potentially play a pivotal role in regulating the metastatic behavior of these cells.
26. Teaching Head and Neck Anatomy Using Reconstructive Modeling: Update
Casey Allman, University of Nevada, Las Vegas; Brent Adams, University of Nevada, Las Vegas; Ray Rawson, Community College System of Southern Nevada; William D. Davenport, University of Nevada, Las Vegas
Purpose: To highlight a different approach to teaching functional Head and Neck Anatomy in a dental school curriculum and assess its validity as an appropriate teaching methodology.
A thorough understanding of head and neck anatomy is crucial to the practice of clinical dentistry. Traditionally, the dental student is first introduced to this information through cadaver dissection. This proven and well-accepted method of teaching this body of information is expensive in terms of dedicated laboratory space; material acquisition, preparation, and storage; and actual curriculum time. One of the goals of the UNLV School of Dental Medicine (SDM) integrated curriculum is the conservation of contact hours to allow for students to engage in enrichment opportunities as well as allow adequate time for independent study. Based on empirical data from the Dental Hygiene Program at the Community College of Southern Nevada (CCSN), UNLV SDM decided to adopt and expand the CCSN method of using reconstructive modeling for teaching functional head and neck anatomy (hygienists in Nevada have expanded duties). After examining nearly a decade of Hygiene National Board scores, we were confidant that this would be an effective and efficient way of teaching head and neck anatomy. Dr. Raymond Rawson, who developed the program for CCSN and serves as a director of our Head and Neck Anatomy course, has expanded it to meet the needs of our dental students. The UNLV course requires reconstructing essential head and neck anatomical structures using dental waxes and museum-grade skull replicas. Each student must model required sets of structures (e.g., muscles of mastication, the distribution of V2 and V3, the distribution of the maxillary artery, etc.) as well as choose specific individual projects (e.g., infratemporal fossa, posterior triangle, brainstem, and circle of Willis). Our use of this teaching methodology was introduced at the 2004 ADEA Annual Session. This presentation further elaborates this methodology and incorporates new data from the first cycle of national board scores at UNLV and student perceptions on preparedness for National Boards. A survey of time spent outside designated curriculum hours is also included. Additional class information will include the second and third cycle of students being taught using this methodology.
The value and success of this program will be fully realized when we have additional substantial data including several cycles of National Board scores (first class took boards in July 2004), grades in the preclinical and clinical courses, and clinical competency evaluations. We recognize the difficulty of evaluating a new program and establishing its precedence. However, we feel that the educational values and novelty of this approach are noteworthy. Long-term assessment will eventually produce sufficient data for reliable statistical predictions.
27. Development of a Parent Education Component in a Smokeless Tobacco Prevention Curriculum
Samuel A. McGuire, Case Western Reserve University; Catherine A. Demko, Case Western Reserve University; Lance T. Vernon, Case Western Reserve University
Purpose: To develop a culturally sensitive, parent-targeted curriculum component for inclusion in a school-based, comprehensive smokeless tobacco prevention program in Appalachian Ohio counties.
The use of smokeless tobacco products has been associated with negative health consequences, including oral cancer, leukoplakia, and other dental-related illnesses. It has been reported that nearly all initial use of tobacco occurs before high school graduation and is associated with social influences such as peer and parental use. Parents can play a key role in preventing uptake of this behavior through education, parental controls, and role-modeling. Educational materials targeting parental knowledge, attitudes, and behaviors about smokeless tobacco are not available. Therefore, the effect of a parental education component within a smokeless tobacco prevention curriculum for children has not been evaluated. We developed an informational brochure about smokeless tobacco for parents as part of a fifth grade school-based smokeless tobacco prevention curriculum implemented in the Appalachian counties of Ohio. The brochure will be taken home by students receiving the prevention curriculum, and responses to several discussion questions with parents will be a homework assignment for extra credit. A similar assignment requiring parental involvement was piloted in a fifth grade classroom with sixteen of twenty-four students returning a completed assignment. Using the framework of the Health Belief Model, the brochure is designed to increase awareness about the negative health consequences of smokeless tobacco (susceptibility and severity), the importance of parental involvement (benefits), specific suggestions for discussion material (self-efficacy), and instructions for a simple oral cancer self-screening. Content experts from the Appalachian region reviewed the brochure for content, readability, format, and cultural relevance. Reviewers prioritized topics for inclusion including the oral cancer screening photos and revised the formatting and visual aspects. Their reviews resulted in producing a more culturally relevant written message as well as the inclusion of a CD component from the Ohio Dental Association’s T.A.C.T.I.C. curriculum that contains an interview with a local family about the impact of smokeless tobacco. Development of this parent-targeted material will allow us to assess the effectiveness of a culturally sensitive parental component within a comprehensive smokeless tobacco prevention curriculum.
The process of developing a relevant health message for a distinct cultural population should include input from the local target audience to ensure effective communication.
28. Ability of the HLD (CALMod) Index to Identify Essential Orthodontic Treatment Need
Jerad L. West, University of California, San Francisco; Mary C. Cooke, University of California, San Francisco; Brian C. Lingg, University of California, San Francisco; Barbara Gerbert, University of California, San Francisco
Purpose: To determine if the HLD (CALMod) index identifies all patients for whom orthodontic treatment need is essential.
The HLD (CALMod) occlusal index is used by the state of California to determine whether Medicaid benefits should be applied to patients requiring orthodontic treatment. For a patient to become eligible for such benefits, a total score of 26 must be achieved based on a review of pretreatment study models or the patient must qualify as an eligible exception. Eligible exceptions generally indicate a severely handicapping malocclusion. The purpose of this study is to determine whether individuals requiring essential orthodontic treatment need, as determined by orthodontists, have access to Medicaid benefits, as determined by the HLD (CALMod) index. A panel of AAO member orthodontists evaluated 110 study models. Each model was rated on a scale of 1 to 12 as follows: 1-3, No Treatment Needed; 4–6, Treatment Elective; 7–9, Treatment Advisable; 10–12, Treatment Essential. Of the models evaluated, twenty-eight patients scored 9.5 or above indicating an essential treatment need. Using the HLD (CALMod) index resulted in five patients of 110 being eligible for Medicaid benefits with three patients scoring 26 or above and two meeting at least one of the eligible exceptions. Of the three patients scoring 26 or above on HLD (CALMod), the panel of orthodontists rated them in a range from 9 to 11, indicating a highly advisable to essential orthodontic need. The two patients meeting eligibility exceptions on HLD (CALMod) were rated at 8.75 (advisable need) and 10 (essential need). The results suggest that use of the HLD (CALMod) index may not provide Medicaid benefits for all patients needing essential orthodontic treatment.
The criteria by which the HLD (CALMod) index awards Medicaid benefits may not provide adequate access for patients requiring essential orthodontic need as determined by a consensus of orthodontists.
29. Dental Hygiene Students’ Preferences for Using Blackboard
Natasha N. Peyton, East Tennessee State University; W. Gail Barnes, East Tennessee State University (now at Forsyth Dental Hygiene)
Purpose: To ascertain the inclination for the use of Blackboard (Bb) in dental hygiene classes.
The profession of dental hygiene, like other professions, is becoming more technically based. This trend is also prevalent in dental hygiene education programs. Innovative dental hygiene programs have a vision that includes Internet-based components of the curriculum. In an effort to determine the students’ preference for the use of Blackboard in their classes, a survey was developed and administered to summer 2004 dental hygiene students (N=23) via one of their course’s Blackboard sites. The survey consisted of nine quantitative and qualitative (open-ended) questions and included a section on demographics. The data sample consisted of nineteen usable responses (82.6 percent response rate). To inform them of the survey, the students were sent a traditional email in addition to a voice email that was generated using WIMBA, a voice management server. The students logged onto a Blackboard course’s Announcement page, which instructed them to access the survey located in the Course Document section. Blackboard provided an analysis for the survey that included the percentage for each response of every question. The results indicated that the most favorable aspect when using Blackboard in dental hygiene courses was the "flexibility of classes, i.e., no specific lecture time or day" (100 percent). On the contrary, the students reported that the Blackboard "testing methods" (66.7 percent) were the least favorable aspect of using Blackboard. "Discussion forum questions," "chat rooms/synchronous communication," and "ability to work in groups/group collaboration" each reported an 11.1 percent response.
In summary, it is speculated from the survey responses that Blackboard, according to the students studied, is favored because of its flexibility with their schedules. However, course directors should consider modifying the testing delivery method by incorporating a more traditional pen and paper testing process.
30. Dental Hygiene Students Informed of the Profession Before Starting the Program
Ronda C. Poland, East Tennessee State University; W. Gail Barnes, East Tennessee State University (now at Forsyth Dental Hygiene)
Purpose: To determine if dental hygiene students were aware of the profession before they enrolled in their program.
The attrition rate for all students seems to be highest during the first term (semester or quarter) of a professional program, suggesting that many students appear to be unaware of the requirements of their chosen profession. Dental hygiene students are no exception. A study was recently developed to ascertain if dental hygiene students were aware of the professional responsibilities of a dental hygienist. A web-based survey was administered to dental hygiene students (N=23) who had recently completed three semesters of professional education. The survey was placed on a course’s Blackboard (Bb) site and consisted of ten quantitative and qualitative questions, including a section on demographics. The data sample consisted of nineteen usable responses (82.6 percent response rate). By means of a voice email (WIMBA, a voice management server on Bb 6.0), students were requested to complete the survey, which was located in the Course Document section of Bb. An analysis for each survey question was generated by Bb. The results indicated that only 33.3 percent of the students felt that they were "aware of what it entails to become a dental hygienist," whereas 56.6 percent were not. More specifically, students reported that they were aware that they would have to perform the following: "use instruments subgingivally" 22.2 percent; "probe patients" 44.4 percent; "polish and selectively polish" 89.8 percent; and "take radiographs" 89.9 percent. However, 55.6 percent of the students reported that they were not aware that "the condition of the oral health affects the entire body."
The present study demonstrates how professionally unprepared some dental hygiene students are before they begin a dental hygiene course of study. As part of the application process, some dental hygiene programs require students to observe a practicing hygienist for a specified number of hours in an effort to prepare them for their future profession. The researchers concur with this requirement.
31. Children’s Oral Health: Application of a Needs Assessment in a Rural and a Native American Community
Thomas M. Darnall, University of Missouri-Kansas City
Purpose: To assess the needs of a Native American population and a rural population and to show how population-specific, theoretically grounded empirical needs assessments inform future planning for meaningful community health interventions.
Early childhood caries (ECC) has been reported to be perhaps the most prevalent infectious disease of our nation’s children. This disease occurs in all racial and socioeconomic groups; however, it tends to be more prevalent in low-income children, in whom it occurs in epidemic proportions. Native American children and children in rural areas have been found to have the highest prevalence of this disease. The purpose of this project is to assess the needs of a Native American population and a rural population and to show how these population-specific, theoretically grounded empirical needs assessments inform future planning for meaningful community health interventions. A convenience sample of parents was asked to participate in the project at the Prairie Band Potawatomi (PBP) Head Start located on the PBP Indian Reservation and at the WIC clinic located in Pittsburg, KS. The needs assessment was based on the theory of planned behavior and used Likert-type, categorical, and dichotomous response questions. The instrument solicited information on demographics, knowledge, attitude, behavior, social norms, and perceived control related to ECC. Data from both sites was entered into the SPSS statistical program and compared on the survey domains. Just under half of the parents from both populations thought children’s tooth decay was inevitable. Knowledge about cariogenicity of milk and the importance of a child’s deciduous teeth was low. Among the WIC population there was a deficit in the parents’ knowledge of the cariogenic potential of juice in a cup or bottle; among the PBP population there was a deficit in the knowledge of the cariogenic potential of breast feeding at will. Additionally, respondents were likely to take advice from physicians and nurses. Community expectations do not always meet the national norm. To have a meaningful community health intervention, you need to know your community. To do this, you need to perform a theoretically grounded, empirical needs assessment for the specific population. These results will be used in future planning for educational interventions at both sites.
32. National Board Dental Examination Part I: Goals and Preparation
Haley Burdette, West Virginia University; Eleisha Nickoles, West Virginia University; Richard Crout, West Virginia University; Stanley Wearden, West Virginia University; Louise Veselicky, West Virginia University
Purpose: To evaluate students’ goals and traditional methods of preparation for the National Board Dental Examination Part I (NBDE I) along with students’ attitudes towards the efficacy of a new optional preparatory review course.
Passing the National Board Dental Examinations (NBDE) developed by the Joint Commission on National Dental Examinations of the American Dental Association is a general requirement for licensure in all states in the United States. The purpose of this study was to evaluate students’ goals and traditional methods of preparation for the National Board Dental Examination Part I (NBDE I) along with students’ attitudes towards the efficacy of a new optional preparatory review course. A twelve-item instrument, primarily Likert-scale questions, was administered to all second-year dental students prior to an elective NBDE I review course, after the course but before the NBDE I, then finally after receiving the NBDE I results. All questionnaires were coded to enable correlated student-wise comparisons at each time of administration. Respondents were asked questions concerning expectations for performance on each part of the exam, ranking preferences for preparation and attitudes toward a new elective review course’s value. Results revealed a response rate of 73.3 percent for the first and second administration followed by 22.2 percent for the final evaluation. Performance goals utilizing excellent as the highest to at least passing as the lowest for each part of the board exam significantly diminished between the first and later administrations. Ranking preferences for preparation revealed the use of Dental Decks as first choice, followed by the Kaplan course, and then a tie between the experimental review course and the board review book. Perceptions of perceived value of the new optional review course statistically significantly declined from the first administration. However, among those who completed the final evaluation, half agreed or strongly agreed that attending one or more sessions of the review course would have helped them prepare for the NBDE I.
In conclusion, performance goals for NBDE I significantly decreased between the first and later administration. Dental Decks were the first choice in the preparation, and the experimental optional review board course did not meet the students’ initial expectations.
33. Chairside Computer Use in Clinical Dentistry
Pedro L. Hernandez, University of Pittsburgh; Thankam Thyvalikakath, University of Pittsburgh; Miguel H. Torres-Urquidy, University of Pittsburgh; Heiko Spallek, University of Pittsburgh; Titus Schleyer, University of Pittsburgh
Purpose: To established a baseline measure of clinical computer use among general dentists.
More than 89 percent of all dentists use computers for administrative functions, yet only 25 percent of general dentists in the United States use computers at chairside. To date, computer use at chairside has not been formally studied. We have conducted a telephone survey with a random sample of 302 dentists who use computers at chairside in order to determine the hardware and software infrastructure, storage, and data entry patterns for patient information and their perceptions of the practice management system in use and clinical computing. As of August 2004, we have completed eighty-four interviews. Our preliminary results show that dentists who use computers at chairside are on average forty-eight years old, 85 percent of them are male, more than half have taken computer courses, and only 10 percent feel uncomfortable with computers. The majority of patient information is entered by dental assistants and hygienists. However, dentists typically record treatment plans, progress notes, and digital images. Information with a strong administrative connotation, such as appointments and treatment plans, is most often stored on the computer. Images and hard/soft tissue charts are stored less often on the computer, and other clinical information, such as the medical and dental history and progress notes, least often. Only 1 percent of the practices studied were completely paperless. Advantages of computers at chairside included fast, organized, and easy access to patient information, patient education, and improved workflow. Barriers for chairside computer use were lack of space, the steep learning curve for staff, infection control, the time required to enter data, cost, and cumbersome user interfaces. While 90 percent of the offices had Internet access, only 22 percent of dentists found it to be very essential for clinical purposes or accessed it at chairside. Final results of this study will be presented at the meeting.
The study showed that, despite rising computerization, much patient information is still stored on paper. The number of truly paperless practices is still very small.
34. Capturing and Integrating Video into a Website to Teach Operative Dentistry Techniques
Christopher Gamble, The Ohio State University; Mary Cliett, The Ohio State University; Pooja Misra, The Ohio State University; Joshua Merrill, The Ohio State University; Lindsay Pabst, The Ohio State University; Robert Rashid, The Ohio State University
Purpose: To edit and repurpose video captured during class demonstrations.
The creation of video for teaching operative cavity preparations and rubber dam techniques can be an expensive and time-consuming process. This project looked at using material captured during class demonstrations in a preclinical laboratory course. The video camera was connected to both a monitor output for display to the class and also to a computer video input. Lighting and magnification in this pilot proved to be difficult factors that had to be overcome. Two solutions were attempted: using a small camera mounted in the line of sight of the operator and using a camera with a telephoto lens at a distance. The captured material was then edited using iMovie and Final Cut Pro on a computer to produce two sets of video files. One set was created for use in web pages. This set comprised multiple short clips, each illustrating a small discrete part of the whole procedure. The other set was a complete (edited) movie meant for viewing with instructor commentary during a class session. The first set of small clips was linked with text in web pages for self-paced study independently by the students. It is planned to be included on a CD along with other teaching aides for study at home and in the preclinical laboratory.
When captured at the time of demonstration, video material can be repurposed for web pages and lecture room use.
35. Developing Operative Preparation Learning Assets
Joshua Merrill, The Ohio State University; Christopher Gamble, The Ohio State University; Pooja Misra, The Ohio State University; Mary Cliett, The Ohio State University; Lindsay Pabst, The Ohio State University; Robert Rashid, The Ohio State University
Purpose: To create a computer-based alternative to stone study models of operative preparations.
Virtual reality movie files are capable of relaying 3-D information on a computer screen and can be the foundation for useful learning assets. To be most effective, these assets must be able to be incorporated across different computing platforms and combined with other learning assets to provide learning objects for incorporation into different areas of dental education. Operative cavity preparations that are taught during the first year of preclinical study were cut in both Columbia and Kilgore typodont teeth. Multiple teeth were prepared so that each preparation could be illustrated in a series of steps. Steps were chosen that illustrated distinct steps in the creation of the cavity preparation. Digital images of each of the cavity preparation steps were captured at specific angles and degrees of rotation with the aide of Nikon D1x digital camera and macro lens mounted on a computer-controlled mechanical arm and Motion Control and Image Capture Software for ObjectMaker (Peace River Studios). After the collection of up to 612 photographs for each preparation, VR Worx (VR Toolbox) was used to combine and compress these images to create a QuickTime VR movie file. Each file showed either the separate stages of a cavity preparation viewable from all sides of the tooth or the finished cavity preparation viewable from all angles. Because the user has control of the rotation and different views, these virtual reality teeth are a reasonable substitute on the computer for the hand-held models traditionally used to illustrate operative cavity preparation. Once the capture system is set up for the capture and processing of images, the creation of additional images using different models is a task that can be delegated to non-experts. An example of this type of learning asset can be found at dent.osu.edu⁄operativedent⁄vr following the link 3-D Learning Asset.
Virtual reality tooth models appear to be a good alternative to stone models of cavity preparations.
36. Adding Directed Study to Virtual Study Models
Pooja Misra, The Ohio State University; Christopher Gamble, The Ohio State University; Mary Cliett, The Ohio State University; Joshua Merrill, The Ohio State University; Lindsay Pabst, The Ohio State University
Purpose: Creation of learning objects using 3-D models.
Just as having a stone study model is not sufficient for teaching students the concepts of cavity preparation, virtual reality tooth preparation models also lack guidance. A technique of combining the learning asset of a three-dimensional tooth model with text information about the different views was explored to create a learning object for teaching the steps of cavity preparation and the evaluation of the different classes of finished operative cavity preparations. A program (LiveStage Professional, Totally Hip Software) for combining different computer media such as text, graphics, animation, and movie files was used to add text information and instruction to specific views of the different stages of operative cavity preparations. A stage was created that was 640 pixels wide and 670 pixels tall. A virtual reality tooth model (640 by 420) pixels illustrating the different steps of an operative cavity preparation was inserted into the stage at the top. Below it, a 640x250 pixel text field was created. For each rotational step of the cavity preparation, text was added in the box giving instruction on how to proceed with the cavity preparation to the next step. The result was an interactive, rotating, three-dimensional tooth model with specific text associated with each stage of the cavity preparation. The model can be controlled by the computer user using basic click and drag of the mouse. Because the final file is a QuickTime movie, it is playable on different computer platforms and can be played alone or integrated into media such as web pages and PowerPoint slide presentations. Once a format has been determined, combining different learning assets (of varied media) can create a learning object that can be repurposed a variety of ways. An example of this type of learning object can be found at dent.osu.edu?/ operativedent?vr following the link 3-D Learning Object.
Learning objects based on three-dimensional virtual reality teeth can be used in variety of ways across multiple platforms.
37. Creation of an Operative Dentistry Website with Learning Objects
Mary Cliett, The Ohio State University; Christopher Gamble, The Ohio State University; Pooja Misra, The Ohio State University; Joshua Merrill, The Ohio State University; Lindsay Pabst, The Ohio State University
Purpose: Use a variety of learning objects to create a website for teaching cavity preparation.
Creating an operative dentistry site with three-dimensional virtual reality images of cavity preparation steps and fi
