Population-based primary care and dental education: a new role for dental schools

'Schools without walls?' Developments and challenges in dental outreach teaching - report of a recent symposium

During the 2004 annual meeting of the International Association for Dental Research, the Education Research Group held a symposium on dental outreach teaching. After a brief introduction, which reviews relevant aspects of the relatively sparse literature, this paper summarises the proceedings, the themes and conclusions that emerged and the research issues that were identified. It aims to describe aspects of current practice around the world and to promote future discussion. Presenters gave details of outreach programmes for dental undergraduates in Australia, Finland, Malaysia (and Southeast Asia), the United Kingdom and the United States. From these presentations four themes emerged. They were: reasons for the introduction of outreach teaching, its perceived beneficial effects, organisational issues, educational issues. The reasons included a recognition of the need to educate dental undergraduates as members of 'care teams' in the environments and communities where they were ultimately like to work and the current shortage of both suitable patients and teachers (faculty) in many dental schools. A wide range of potential benefits and some disadvantages were identified. The organisational issues were, in the main, seen to relate to finance and administration. The educational issues included the need to train and monitor the performance of teachers at outreach clinics and to assess the performance of the undergraduates whilst at the outreach locations. It was concluded that new technology made it easier to teach at a distance and it was possible to create a dental 'school without walls'. It was recognised that few evaluations of dental outreach teaching have been carried out and that there were many research questions to be answered, including: whether it should be a voluntary or compulsory part of the undergraduate curriculum, how long it should last and what type of outcomes should be assessed.

Dental caries experience in northern Manhattan adolescents

OBJECTIVE

The study sought to document dental caries among adolescents residing in northern Manhattan, New York, by race, sex, and community.

METHODS

Clinical and demographic data were collected from children aged 12-17 years at five school-based dental clinics in northern Manhattan. Data on dental caries were collected by calibrated examiners using the National Institute of Dental and Craniofacial Research criteria for oral examinations.

RESULTS

A total of 566 children participated in the study. They were predominantly Hispanic (64%) or African American (28%). Compared to data from the National Health and Nutrition Examination Survey III, mean DMFT (3.36 vs 2.53; P<.01) and the prevalence of untreated disease (36% vs 16%; P<.01) were significantly higher for northern Manhattan adolescents. Of the adolescents evaluated, 13 percent had at least one severely carious tooth with pulpal involvement that required either extraction or endodontic therapy.

CONCLUSIONS

Adolescents in northern Manhattan have higher caries prevalence and higher levels of untreated caries than their national counterparts. Carious lesions progress to pulpal involvement in a high percentage of northern Manhattan children and require extraction or root canal therapy as treatment. There is an urgent need for affordable and available dental primary care services targeted to economically disadvantaged communities.

Implementing a community-based oral health care program: lessons learned

OBJECTIVES

The objective of this paper is to report key findings of a process evaluation that may be useful to other institutions seeking to implement a community-based oral health care program primarily targeting children in dentally underserved communities. By partnering with community-based organizations, public schools, and community health care providers, the Columbia University School of Oral and Dental Surgery (SDOS) established the Community DentCare Network (DentCare) in the Harlem and Washington Heights/Inwood neighborhoods of northern Manhattan. These low-income neighborhoods are characterized by poor oral health and have been designated by the federal government as health professions shortage areas.

METHODS

The method used in the process evaluation was open-ended qualitative interviewing by a sociologist with extensive experience in this methodology aided by a participant-observer within the DentCare program.

RESULTS

The heterogeneity of the two communities required different strategies and resources to gain trust and acceptance. Fundamental changes were required of SDOS over a 10-year period, beginning with prioritizing community service into a primary mission. Collaborating with medical clinics facilitated the implementation of the network when the partners shared the same philosophical goals. Faculty and staff with different skills were needed during the start-up and the sustained development phases of the program.

Periodontal infections and pre-term birth: early findings from a cohort of young minority women in New York

The aim of this report is to provide early data from an ongoing study examining (i) the relationship between periodontal infections and pre-term low birth weight (PLBW) in a cohort of young, minority, pregnant and post-partum women; and (ii) the effect of periodontal interventions on pregnancy outcome. During the first 2 yr of the study, 213 women were enrolled and examined clinically for dental plaque, calculus, bleeding on probing, and probing depth. Birth outcome data were available for 164 women, including one group (n = 74) subjected to oral prophylaxis during pregnancy, and a second group (n=90) who received no prenatal periodontal treatment. Subgingival plaque samples were available from 145 subjects (4 samples/subject) and were analyzed by checkerboard DNA hybridization with respect to 12 bacterial species. The prevalence of PLBW was 16.5% (27 cases) in this cohort. No differences in clinical periodontal status were observed between PLBW cases and women with normal birth outcome. However, PLBW mothers had significantly higher levels of Bacteroides forsythus and Campylobacter rectus, and consistently elevated counts for the other species examined. PLBW occurred in 18.9% of the women who did not receive periodontal intervention (17 cases), and in 13.5% (10 cases) of those who received such therapy.