Past, Present, and Future of Predoctoral Dental Education in Orofacial Pain and TMDs: A Call for Interprofessional Education

Knowledge and experience of dentists with patients with trigeminal neuralgia: A prospective, cross-sectional survey study

OBJECTIVE

Trigeminal neuralgia (TN) and orofacial pain (OFP) patients frequently refer to dentists. It is often confused with odontogenic pain and dental procedures are performed. In this study, the authors aimed to reveal the knowledge and experience of dentists about TN.

METHODS

This is a cross-sectional study that includes dentists who participate in volunteering via an online questionnaire. The questionnaire form contains demographic data, TN treatment, and diagnosis consisting of 18 questions.

RESULTS

The data of 229 dentists were examined. Almost 82% of the participants reportedly knew the diagnostic criteria of TN and 61.6% reported that they had previously referred patients with TN. The most frequently confused diagnosis was odontogenic pains (45.9%).

CONCLUSION

TN diagnostic criteria should be included more often in the education of dentists. Thus, it is possible to prevent unnecessary dental procedures. There is a need to increase knowledge on this subject with further studies involving dental students.

Temporomandibular disorders: knowledge, competency, and attitudes of predoctoral dental students

OBJECTIVE

To evaluate knowledge, competency, and attitudes related to temporomandibular disorders (TMD) among predoctoral dental students, and to investigate the curricular organization of contents related to TMD and occlusion.

METHODS

Predoctoral dental students (n = 147) answered a questionnaire with topics related to TMD. Another questionnaire evaluated the organization of TMD and occlusion courses.

RESULTS

Contents related to TMD and occlusion were taught in the same course in all dental schools. The students' responses showed low agreement with the current gold standards pertaining to TMD. Most students declared that they did not feel confident to treat patients with TMD (62.6%), were not satisfied with the content pertaining to TMD (55.8%), and considered a lack of clinical practice to be the primary limitation in their training (59.2%).

DISCUSSION

Students' knowledge of basic concepts related to TMD was limited, highlighting the need for readjustment of the dental curriculum to increase clinical experience.

Attitudes of dental and chiropractic students towards a shared learning programme-An interprofessional learning model

INTRODUCTION

Interprofessional learning (IPL) is the first stage towards the goal of interprofessional collaborative care. To enhance IPL experience, the School of Dentistry, International Medical University developed an IPL model based on the core competencies and the learning outcomes for dental and chiropractic students in their second and fourth year, respectively. The model was based on experiential learning and adult learning theories in addition to Miller's framework for clinical competencies.

METHODS

The programme was developed as a student-centred, collaborative approach to achieve the learning outcomes for dental and chiropractic students. Second-year dental students (n = 46) and chiropractic students (n = 23) in their fourth year participated in the programme. The focus of the programme was to address the prevention of work-related musculoskeletal disorders (WMSDs) amongst dental students and to provide the chiropractic students with the opportunity to assess and identify risk factors for WMSDs in the dental setting. The readiness for interprofessional learning scale (RIPLS) questionnaire was completed prior to the interprofessional education programme and once again afterwards to determine dental and chiropractic students' awareness of roles and responsibilities of the other profession, and their attitudes to interprofessional education and teamwork.

RESULTS

Dental and chiropractic students showed similar levels of readiness for shared learning. The results of this study suggest that the IPL programme contributed to the development of the students' positive perceptions towards the positive professional identity and the roles of other healthcare professionals.

CONCLUSION

This study provides initial support for the integrated interprofessional learning experiences within the school. The results of the study will shape future curricula changes to further strengthen interprofessional education and subsequent interprofessional collaborative care.

Perceived Practitioner Barriers to the Management of Orofacial Pain in the Kingdom of Saudi Arabia: A Cross-sectional Study

Background:

Orofacial Pain (OFP) is a group of non-dental painful conditions affecting the oral cavity and facial area.

Objectives:

The objective of this study was to explore which barriers to manage the patient with chronic OFP as perceived by general dentists versus dental specialists and to investigate whether if professionals with degrees from their home country versus another country or number of years of professional experience differ in their perceptions.

Methods:

A closed-end questionnaire was hand-delivered to 600 participants [300 general dentists and 300 dental specialists] in four major provinces in Saudi Arabia. Demographic data were expressed as frequency. Proportional t-tests and chi-square tests were used to analyse intergroup differences. Statistical significance for all analyses was set at P-value < 0.05.

Results:

Overall, the response rate was 56.6% (340/600). Around two-thirds of the participants were general dentists (60.9%), while the remainder were dental specialists (39.1%). There was an obvious consensus by the participants that “Low payment/reimbursement” and “Lack of OFP knowledge” were among the most common barriers (85% and 83.5%, respectively). In contrast, “Legal risks” were the least frequently reported factor (38.8%). The most commonly reported barrier by general dentists was “Shortage of patients/lack of demand;” this was significantly different from the experience of dental specialists (87% vs. 72.2%; P- value < 0.01). In terms of the country of graduation or years of experience, there were no significant differences.

Conclusion:

The study demonstrates the existence of many significant barriers other than OFP knowledge, such as reimbursement, facility and demand that could present obstacles and challenges to the management of OFP by general dentists and dental specialists. Most participants believed that dentists should manage this condition and that OFP courses should be included in the dental school curriculum.

Orofacial pain education in dentistry: A path to improving patient care and reducing the population burden of chronic pain

Dentists stand in an optimal position to prevent and manage patients suffering from chronic orofacial pain (OFP) disorders, such as temporomandibular disorders, burning mouth syndrome, trigeminal neuralgia, persistent idiopathic dentoalveolar pain, among others. However, there are consistent reports highlighting a lack of knowledge and confidence in diagnosing and treating OFP among dental students, recent graduates, and trained dentists, which leads to misdiagnosis, unnecessary costs, delay in appropriate care and possible harm to patients. Education in OFP is necessary to improve the quality of general dental care and reduce individual and societal burden of chronic pain through prevention and improved quality of life for OFP patients. Our aims are to emphasize the goals of OFP education, to identify barriers for its implementation, and to suggest possible avenues to improve OFP education in general, postgraduate, and continuing dental education levels, including proposed minimum OFP competencies for all dentists. Moreover, patient perspectives are also incorporated, including a testimony from a person with OFP. General dentists, OFP experts, educators, researchers, patients, and policy makers need to combine efforts in order to successfully address the urgent need for quality OFP education.

Integrating Oral and Overall Health Care: Building a Foundation for Interprofessional Education and Collaborative Practice

Interprofessional education (IPE) and interprofessional practice (IPP) are game-changers. They will completely alter the way that health professionals are educated and the way that health care is delivered. The transition from our current silo-based approach to team-based education and practice is under way, and there is nothing that can be done to stop them from happening. This article will provide a historical context to the development of IPE in health professions education, identify ways in which the dental professions have addressed these developments, and provide recommendations for opportunities for the dental professions to engage in IPE and IPP, especially for the benefit of the people we serve as patients and current students and learners who will be practicing in a collaborative environment with other health professionals in the future.

Seeking treatment for temporomandibular disorders: What patients can expect from non-dental health care providers

The dental profession has long been the primary source for clinical management of patients with temporomandibular disorders (TMDs). However, patients with a facial pain problem may seek diagnosis and/or treatment from other health care providers. These providers may be physicians or other professional-level practitioners, or they could be members of various allied groups, such as physical therapists or occupational therapists. However, little has been written about what patients might experience if they seek care outside of the dental profession. This article reports the results of an Internet survey of non-dental professionaland allied health care professionals to learn what they might offer to patients who may be seeking treatment for TMDs. The official organizational websites for all groups, as well as the websites of individual practitioners in each group, were reviewed. Most of the official websites had little or no information about TMDs, but some members of every group surveyed were offering to treat TMDs in their offices. The variety of treatments being offered went far beyond the boundaries of appropriate TMD management in the 21st century. These results are presented with a critical discussion of each concept or practice, as well as advice for both dentists and patients to deal with this situation.

Knowledge About Chronic Orofacial Pain Among General Dentists of Kermanshah, Iran

Background and Objective:

Diagnosis and treatment of chronic orofacial pain are one of the most challenging issues in dentistry. The purpose of this study was to assess the knowledge of general dentists regarding orofacial pain in Kermanshah, Iran.

Methods:

This cross-sectional study was conducted in 2016 including general dentists of Kermanshah city. A researcher-designed questionnaire was administered to collect demographic data as well as measuring knowledge of the dentists in four sections including etiology, clinical presentations, physical examination, and treatment of chronic orofacial pain. The questionnaire had acceptable validity (content validity > 0.9) and reliability (intraclass correlation coefficient= 0.857 for test re-test; Cronbach’s alpha= 0.72 for internal consistency). The data were analyzed by the SPSS software (ver. 18.0) using Spearman’s correlation coefficient (P < 0.05).

Results:

There were 121 male (72.9%) and 45 female (27.1%) dentists with mean (SD) age of 40.55 (8.03) years and mean (SD) practice history of 13.28 (8.43) years. Mean (SD) knowledge score was 10.54 (2.36) (maximum possible score= 15). 48.2% of dentists had good knowledge in overall. 48.2% about etiology, 45.2% about clinical presentations, 36.1% about physical examination, and 7.8% about treatment had good knowledge. Knowledge had direct and significant relationship with age (r = 0.179; P = 0.022) and practice history (r = 0.18; P = 0.021).

Conclusion:

The results showed that the studied dentists did not have enough knowledge about chronic orofacial pain especially in the treatment field. Therefore, it is recommended to implement educational programs to improve their knowledge.

Design, construction, and technical implementation of a web-based interdisciplinary symptom evaluation (WISE) - a heuristic proposal for orofacial pain and temporomandibular disorders

BACKGROUND

Medical symptoms independent of body location burden individuals to varying degrees and may require care by more than one expert. Various paper and computer-based tools exist that aim to comprehensively capture data for optimal clinical management and research.

METHODS

A web-based interdisciplinary symptom evaluation (WISE) was newly designed, constructed, and technically implemented. For worldwide applicability and to avoid copyright infringements, open source software tools and free validated questionnaires available in multiple languages were used. Highly secure data storage limits access strictly to those who use the tool for collecting, storing, and evaluating their data. Concept and implementation is illustrated by a WISE sample tailored for the requirements of a single center in Switzerland providing interdisciplinary care to orofacial pain and temporomandibular disorder patients.

RESULTS

By combining a symptom- burden checklist with in-depth questionnaires serving as case-finding instruments, an algorithm was developed that assists in clarifying case complexity and need for targeted expert evaluation. This novel modular approach provides a personalized, response-tailored instrument for the time- and cost-effective collection of symptom-burden focused quantitative data. The tool includes body drawing options and instructional videos. It is applicable for biopsychosocial evaluation in a variety of clinical settings and offers direct feedback by a case report summary.

CONCLUSIONS

In clinical practice, the new instrument assists in clarifying case complexity and referral need, based on symptom burden and response -tailored case finding. It provides single-case summary reports from a biopsychosocial perspective and includes graphical symptom maps. Secure, centrally stored data collection of anonymous data is possible. The tool enables personalized medicine, facilitates interprofessional education and collaboration, and allows for multicenter patient-reported outcomes research.

Current panorama of temporomandibular disorders' field in Brazil

In 2012, the recognition of the specialty of Temporomandibular Disorders and Orofacial Pain completed ten years. Given this scenario, it is extremely important to track the current situation of this field of knowledge in Brazil, specifically in the area of research and training. We hope to discuss the importance of the recognition of this specialty and the inclusion of these subjects in undergraduate programs in Dentistry.