Dental Students’ Clinical Expectations and Experiences Treating Persons with Disabilities

Bridging the Gap: Dental Students' Attitudes toward Persons with Disabilities (PWDs)

BACKGROUND

Persons with disabilities (PWDs) face significant barriers in accessing dental care, resulting in poorer oral health outcomes compared to the general population. To reduce dental healthcare disparities, dental professionals must develop positive attitudes and acquire the necessary skills to treat PWDs effectively. This study aimed to assess the experiences, education, training levels, and attitudes of dental students and interns toward PWDs, and to explore the relationships between their exposure to PWDs, their education/training regarding managing PWDs, and their attitudes toward PWDs.

METHODS

Participants were recruited using convenience sampling. From May to June 2023, a pretested, validated online questionnaire (developed based on existing survey instruments and modified to fit the study context) was distributed to 98 eligible dental students and interns at King Faisal University. Descriptive and analytical statistics were used for analysis.

RESULTS

The response rate was 88.78%. There was a statistically positive correlation between students' exposure to PWDs and their attitudes (p < 0.05). Statistically significant relationships were found between students' education/training and their attitudes towards educational experiences and instructors (p < 0.01) and interpersonal interactions with PWDs (p < 0.05). No statistically significant relationship existed between the year of study and future encounters with PWDs (p = 0.176). Additionally, 42.5% of students felt inadequately prepared to treat PWDs, and 88.5% expressed a desire for further education. Notably, 20.7% reported no training on PWDs, while 70.1% preferred clinical education.

CONCLUSIONS

The study underscores the importance of exposure and training in shaping dental students' attitudes toward PWDs. Dental schools should prioritize structured teaching, greater contact with the disabled community, and hands-on experiences to ensure dental professionals are both well prepared and positively inclined to treat PWDs. These findings have significant implications for improving dental education curricula.

Advancing dental care access for patients with disabilities: A global scoping review of predoctoral training

OBJECTIVE

To examine predoctoral training programs that address the unique needs of patients with special healthcare needs (SHCN) and provide an overview of current global training initiatives, while exploring innovative approaches to enhance dental students' preparation in managing SHCN patients.

METHODS

A scoping review (SR) was conducted focusing on three key concepts: dental education, pre-doctoral training, and intellectual disability/developmental disability. The search encompassed five databases including Medline, Embase, Dentistry and Oral Sciences Source (EBSCO), Global Health (EBSCO), and WHO Global Index Medicus, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. EndNote and Covidence were utilized to prevent duplication and facilitate title/abstract screening.

RESULTS

After screening abstracts, a total of 2309 articles were initially identified with 28 articles meeting eligibility criteria for data extraction relevant to the research question. Two major categories characterized the key findings included in the review: 12 interventional studies and 16 perception-based studies.

CONCLUSION

This SR revealed that dental students are not adequately trained to treat special needs populations; consequentially, dental students lack confidence in providing high-quality care to this demographic. The absence of standardized training poses a global challenge, exacerbating care disparities. Addressing this issue is crucial to better prepare dental students and advance equitable access and quality care for underserved populations.

The global distribution of special needs dentistry across dental school curricula

INTRODUCTION

Special needs dentistry (SND) is an emerging dental specialty, with ongoing developments in education and clinical practice focused towards the tailored management of individuals with special needs (SN). Patients with SN have a higher prevalence of oral diseases and unmet dental needs compared to the general population. Although inadequate training and experience in managing patients with SN has been highlighted as a significant barrier to accessing care, there is limited data about the extent of SND teaching at the entry-to-practice or higher levels.

METHODS

This work is the first to map SND curricula globally, across 180 countries and 1265 dental schools.

RESULTS

Although 74.62% of dental schools were found in developing economies, the distribution of programs that reported SND in their courses was highly skewed towards developed countries. In terms of advanced degrees, beyond basic entry-to-practice training, the USA delivered 60% of the SND programs, followed by Canada (15.56%), UK (13.33%), and Australia (8.89%). The term SND appeared in 33.95% of entry-to-practice level program curricula and was less commonly used in transitioning economies. Only 112 SND-specialized practitioners enter the workforce globally each year from developed economies, and all but three advanced degrees are found in G7 countries.

CONCLUSION

By exploring the impact of economic status on its distribution, this paper highlighted the lack of SND representation in dental curricula, especially amongst programs in transitioning or developing economies. Education of both general dentists and specialists is critical as a collaborative effort is needed to manage the growing population of patients with SN.

Educational strategies for oral assistance for the disabled and their effects on dentistry students' formation: A systematic review

AIMS

This systematic review aimed to analyze the influence of educational strategies for oral health care for Persons with disabilities (PwDs) on the technical, ethical, and social training of undergraduate dental students.

METHODS AND RESULTS

An extensive search was performed in the following databases: Cochrane, Embase, PubMed, Scopus, Web of Science, LILACS/BBO and OpenGrey database. Observational, nonrandomized, and quantitative comparisons before and after some type of educational strategy in undergraduate dentistry was included. The risk of bias was assessed using the risk of bias in nonrandomized intervention studies (ROBINS-I) tool. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Nine were included and suggested that a significant improvement was observed in the technical training of undergraduate dental students although there was no consensus on the acquisition of ethical/social competences after the application of educational strategies. The included studies presented a moderate to serious risk of bias, and the certainty of evidence for both, technical and ethical/social evaluative constructs, as very low.

CONCLUSION

Although studies show that awareness regarding PwD significantly increases technical skills in dental students, the evidence is poor due to the high risk of bias and inconsistency observed in both the technical and ethical/social constructs; further studies on this topic are therefore essential. Prospero: (CRD42021288463).

Training dental hygiene students to care for patients with disabilities

OBJECTIVE

The purpose of this study was to evaluate the impact of a novel training programme on dental hygiene students' knowledge, attitudes, and beliefs about caring for individuals with disabilities.

METHODS

A mixed methods approach was used. Students from five dental hygiene programmes based at community colleges completed a two-hour didactic training session to supplement their existing special care dentistry coursework. Students completed an original 14-item pretest and posttest before and after the training that assessed attitudes and beliefs, and two validated posttests that assessed knowledge. Afterwards, students completed a clinical rotation in an advanced care dental clinic at a local academic institution, gaining hands-on experience with equipment and patient treatment. Descriptive statistics were used to report training scores, types of services rendered, and modifications to treatment. Student comments about their experiences were assessed using thematic analysis.

RESULTS

Two hundred and ninety-four students completed didactic training, and 261 completed clinical rotations. Posttest scores indicated positive improvements in knowledge, attitudes, and beliefs. All students provided direct patient care. Sixty-nine percent treated patients with intellectual and developmental disabilities; 75% placed silver diamine fluoride or fluoride varnish. Altered patient positioning was used by 70.5%. Most students (95.4%) reported that their experience positively changed their attitudes towards caring for patients with disabilities in the future. Eight themes emerged, notably increased comfort and confidence, a willingness and desire to treat patients, the acquisition of new skills, and clinician behaviours of empathy and compassion towards others.

CONCLUSION

Training can help prepare dental hygiene students with the confidence and skills to address the oral health needs of individuals with disabilities.

Intersection of the iADH undergraduate curriculum in special care dentistry and the association of Canadian faculties of dentistry competencies framework

AIMS

To map the International Association of Disability and Oral Health (iADH) curriculum to the Association of Canadian Faculties of Dentistry (ACFD) competencies framework to develop a strategy for teaching special care dentistry (SCD) using the International Classification of Functioning, Disability, and Health (ICF). To review the literature to identify educational methodologies that support teaching SCD competencies.

METHODS

The 20 subdomains of the ACFD competencies framework were mapped to the 18 subdomains of the iADH competency matrix. A literature review of methods, techniques, or innovations used to teach SCD was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and the Sample, Phenomenon of Interest, Design, Evaluation, and Research Type (SPIDER) tool.

RESULTS

The iADH curriculum was mapped to the ACFD competencies in the areas of patient care, professionalism, communication and collaboration, practice information management, and health promotion. A total of 176 articles from PubMed and 10 resources from MedEdPortal were identified in the literature search. Eleven articles met the inclusion and exclusion criteria. The overall quantity and quality of studies was low. Experiential learning in either a dental school or hospital-based program seemed to improve knowledge of SCD and to incite greater willingness to treat patients requiring SCD.

CONCLUSIONS

Case-based learning, computer-based modules, standardized patients, and clinical practice are educational strategies for teaching SCD competencies. The integration of SCD into the undergraduate dental curriculum seems feasible, as most required competencies are transferable to all dental disciplines. Furthermore, the ICF provides a functional model that is a patient-centered approach and is applicable to dentistry beyond SCD.

Educational strategies in oral healthcare for the disabled and their effects on dental students' training

PURPOSE

To evaluate the effects of didactic and clinical training of dental students in treating Persons with Disabilities (PwD) on their self-perceptions about treating PWD.

METHODS

A pre-and postevaluation of a didactic-clinical educational strategy targeting oral health care of PwD was conducted among fourth-year undergraduate dental students at a Brazilian dental school. Semi-structured questionnaires were used to assess the following work environment parameters: technical, organizational, social, ethical, and managerial acumen. Data were analyzed using Fisher's exact and chi-square tests, with a significance level of 5% (p < 0.05), to verify possible associations between the quantitative variables. A qualitative analysis was conducted through collective subject discourse.

RESULTS

Significant differences were found in the self-perception of students' knowledge and abilities in providing low-complexity care for PwD before and after the training program (p = 0.025). Students were more confident about managing and organizing the work environment (p = 0.007) and providing humanized care to PwD (p = 0.042) posttraining program. Additionally, a decrease in the feeling of insecurity (p = 0.014) and feelings of pity, fear, or prejudice toward PwD (p < 0.001) were observed posttraining program.

CONCLUSIONS

Didactic and clinical training interventions for treating PwD improved the work environment of undergraduate dental students in technical, managerial, organizational, and ethical/social dimensions.

Experiences of adults with intellectual disabilities accessing acute hospital services: A systematic review of the international evidence

Adults with intellectual disabilities experience significant physical and mental health needs when compared to their typically developing peers. Previous research evidences that many people with intellectual disabilities have negative encounters within acute hospitals. The aim of this systematic review was to identify the specific views and experiences of adults with intellectual disabilities when accessing acute hospital services arising from the available literature. The review commenced in June 2019 and was updated in May 2020. A systematic search of five electronic databases including CINAHL Plus, MEDLINE, Web of Science, SCOPUS and PsycINFO was undertaken. Studies published from 2014, peer-reviewed, written in English and referred to adults with intellectual disabilities aged 18 plus and acute hospital settings were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Critical Appraisal Skills Programme quality assurance checklist were used to review all selected papers. Five studies from a total of 421 were deemed suitable for inclusion in the review as the voices of adults with intellectual disabilities were present. Poor communication from healthcare staff towards adults with intellectual disabilities emerged in four studies while the use of the hospital passport and the intellectual disability liaison nurse to significantly improve the hospital experience for adults with intellectual disabilities was identified in two of the studies. Following a systematic and thematic analysis of the studies, three main overarching themes emerged: communication; information sharing; and compassion and respect. Despite the national and international focus on improving healthcare for people with intellectual disabilities, this review highlights lack of communication, inadequate information sharing and issues related to compassionate care and respect. The review identifies the possibility that an increased use of hospital passports and an extension of the intellectual disability liaison nursing roles may enhance the hospital experience for people with intellectual disabilities.

Dental Students' Perceptions before and after Attending a Centre for Children with Special Needs: A Qualitative Study on Situated Learning

Objectives: To develop an in-depth understanding of the perceptions and experiences of senior dental students before and after fieldwork visits to a centre for children with special needs. Methods: A qualitative study utilised open-ended questions and involved 39 fifth-year dental students. A thematic analysis of the collected responses was undertaken, and a hierarchy of themes and subthemes were developed. Results: Analysis of the pre-visit responses revealed three main themes and a number of subthemes: 'negative expectations', 'positive expectations', and 'pain expectations'. Similarly, four main themes with a number of subthemes emerged from the post-visit responses: 'positive perceptions', 'negative perceptions', 'oral problems observed', and 'recommendations'. Conclusions: Within the study limits, different perspectives were extracted. Prior to the fieldwork visit, students expressed their lack of self-confidence and inadequate preparation. Following the situated learning visit experience, students' perceptions of managing special needs children was positively influenced. Students were happy to be exposed to such an experience, but hoped for better organisation and specialised supervision in the future.

Practicing Dentists' Self-Efficacy and Associated Factors in Managing the Treatment of Adults with Mental and Physical Disabilities: An Exploratory Cross-Sectional Study in Riyadh, Saudi Arabia

Background: Provision of oral healthcare to adults with mental and physical disabilities (AMPD) remains a challenging area across various healthcare systems. The present study aimed to assess self-reported efficacy and investigate factors associated with self-efficacy in the management of AMPD among practicing dentists in Saudi Arabia. Methods: A pilot-tested, self-administered questionnaire was distributed to a convenience sample of 1000 dentists. Descriptive and inferential analyses were performed on the collected responses. Results: Among the respondents (54%), 43% were males. Only 14% described their self-efficacy in managing AMPD as "High". Multivariable regression analyses revealed significant associations between "High" self-efficacy and male gender (Odd ratio (OR) = 2.39, 95% CI = 1.16-4.89), experience practicing dentistry for 11 years or more (OR = 2.19, 95% CI = 1.04-4.47), specialization in pediatric dentistry (OR = 3.98, 95% CI = 1.31-12.07), previous experience in managing AMPD (OR = 4.23, 95% CI = 1.59-11.22), and awareness of regulations for managing AMPD (OR = 2.62, 95% CI = 1.42-4.38). The interaction of gender x age was significantly associated (p = 0.028) with "High" self-efficacy. Gender-stratified analyses revealed a significant association between age and "High" self-efficacy among male dentists only. Conclusions: The findings of the present study highlight that a large percentage of dentists reported "Low/Moderate" self-efficacy in managing AMPD, particularly among female dentists. However, further studies are required to verify the factors associated with self-efficacy in the present study, and to identify other factors that may influence self-efficacy in managing AMPD.