Teaching rapid oral health deterioration risk assessment: A 5-year report

Impact of dental school critical thinking demonstrations carryover to practice: Survey of 5-year graduates

INTRODUCTION

Little literature exists on graduates' application to practice for explicit critical thinking skills learned in dental school.

PURPOSES

Discern the (1) degree to which graduates apply explicit critical thinking skillsets in practice; (2) degree of adaptation of critical thinking skillsets to practice; (3) frequency of use for critical thinking skillsets in practice; and (4) perceptions to improve critical thinking learning guidance in dental school.

METHODS

Five critical thinking exercises/skillsets were selected that had been in place over 5 years with at least one paper: geriatrics, treatment planning, technology decision making, ethics, evidence-based dentistry; each followed concepts from an emulation model in critical thinking. Electronic survey administered in 2023/2024 to alumni graduated in the last 5 years.

RESULTS

Of 98 (from 320 distributed) returned, 56 completed the entire survey. Dental school experiences positively influenced use of critical thinking skills in practice. On a five-point scale, mostly 4s and 5s were reported for "…benefit your thinking." Fifty-three percent reported "using ideas from the exercise and developed my own thought processes," 35% reported "using the thought process largely as offered in the college" and 5% reported "do not use the exercise." Sixty percent reported using the skillsets hourly or daily. With minor variations all skillsets were reported positively for use in practice.

CONCLUSIONS

A positive influence of critical thinking skills was gained from the college experience with explicit positive impact for each of the five critical thinking experiences. The questions may be a model for future follow-up studies of explicit dental school critical thinking exercises.

Understanding rapid oral health deterioration and its associated factors among older adults: A scoping review

Background

Understanding the pivotal interplay between systemic and oral health is paramount to ensuring holistic care, particularly among the aging demographic. Therefore, this review article aims to explore the emerging concept of Rapid Oral Health Deterioration (ROHD) by reviewing the current knowledge base among older adults and identifying knowledge gaps in this area of research.

Methods

This scoping review was conducted in line with Arksey and O'Malley's framework between December 2023 and March 2024 and reported while adhering to the PRISMA-ScR guidelines. A systematic database search was performed across three databases i.e. PubMed, Scopus, and EMBASE to collate the existing literature published in English between January 2013 and February 2024 addressing ROHD among older adults. After data charting, a critical appraisal of the selected studies was followed by qualitative thematic analysis.

Results

Among the 12 papers in this scoping review, 10 were cross-sectional studies, with one each of retrospective cohort and case-control studies. The qualitative thematic analysis of the selected articles resulted in the emergence of four main themes: risk factors for ROHD, attributes related to ROHD, challenges encountered in the management of ROHD, and management approaches for ROHD among older adults.

Conclusions

This scoping review provides an overview of the rapid deterioration of oral health among older adults. Age-related dental disease harms the quality of life and overall health. To avoid dental disorders and to maintain and improve oral health in older adults, an integrated and multidisciplinary approach is essential. If ROHD is not treated, it may lead to poor health, a lower quality of life, and in severe cases, systemic infections that increase hospitalizations and possibly cause death.

Student empathy in standardized patient experiences: Applying concepts from a critical thinking emulation model

INTRODUCTION

Clinician empathy can improve patient outcomes, but the literature is scant on patient-based, student-led experiences to demonstrate the projection of empathy in patient interactions.

PURPOSE/OBJECTIVES

(1) Develop a learning guide for observable behaviors communicating emotional and cognitive empathy and (2) determine whether the learning guide can be used as a rubric for assessing empathy in a standardized patient experience.

METHODS

Eleven standardized patients assessed 80 D3 students using a 4-point interval scale on 19 behavioral criteria in four domains: Initiation (four criteria); Health History and Caries Risk (four criteria); Treatment Planning (six criteria); and Communication Skills (five criteria). Standardized patients also provided qualitative feedback.

RESULTS

Standardized patients completed all 1520 interval scales on the rubric and 94% of 320 open-ended entries. Students performed well. Of the 1520 criterion interval scales, 1242 (81.7%) were rated "excellent." Wilcoxon signed-rank tests revealed Initiation scores (Mean [M] = 3.82, Standard deviation [SD] = 0.28) and Treatment Planning scores (M = 3.82, SD = 0.36) were significantly higher than Health History Scores (M = 3.75, SD = 0.34; p < 0.05). Qualitative feedback also was overwhelmingly positive for Treatment Planning and more equivocal for Health History.

CONCLUSIONS

The emulation model for students to demonstrate observable aspects of empathy is viable as both a learning guide and evaluation rubric in a standardized patient format. The next steps include the development of a succinct skillset for reinforcement in the patient setting and continued discussion on what best captures core observable aspects of empathy.

Oral Health Factors Related to Rapid Oral Health Deterioration among Older Adults: A Narrative Review

Older adults who face systemic health issues and lack adequate social support are at risk for oral health deterioration. How rapidly such changes take place depends on the severity of their medical condition and their ability to access oral health services in a timely manner. The management of dental caries and periodontal disease in this cohort is made complex by the interaction of local and host factors such as the presence of dry mouth, involvement of root surfaces, and altered wound healing. in addition to enhanced maintenance needs to avoid recurrence or progression. Tooth replacement can be beneficial in restoring oral function, allowing patients to enjoy a healthy and nutritious diet but requires careful consideration to avoid further damage to remaining dental units. Establishing a dental home for the older adult can facilitate routine surveillance, disease prevention, and patient/caregiver education to achieve oral health goals commensurate with overall health. This narrative review details oral health factors that are related to rapid oral health deterioration among older adults.

The Prevention, Diagnosis, and Treatment of Rapid Oral Health Deterioration (ROHD) among Older Adults

The world’s population is aging. Older adults are at risk for multiple chronic medical problems as they age. The management of these diseases requires these people to take a variety of medications, which may have undesired side effects. These medical issues can impact oral healthcare and result in a precipitous decline in oral health. A standardized teaching model has been developed to help novice dental practitioners learn how to access and treat oral health problems in older adults. This model is called rapid oral health deterioration (ROHD) risk assessment. The model has four steps for assessment and four categories of risk. This paper describes the components of the ROHD risk assessment, and how it can be used to prevent, diagnose and treat ROHD among older adults.

Rapid Oral Health Deterioration in Older People-A Narrative Review from a Socio-Economic Perspective

Poor oral health is a common morbidity in old age with older adults less likely to attend dental care and more likely to have dental disease; this situation is exacerbated by older adults retaining more teeth often with complex restorations. Evidence suggests that some older adults experience rapid oral health deterioration (ROHD). While more clinical and population level evidence is needed, current evidence suggests upstream changes addressing disadvantage through the social determinants of health (SDH) may impact broader disorders such as ROHD, often occurring as older adults become dependent. The aim of this paper is to conduct a narrative review to explore the social determinants of ROHD in older adults. The social determinants of health are important in understanding oral health including ROHD. This includes the important influence of the economic determinants. We explored the SDH as relevant to oral health and ROHD including using a framework based on that of the Fisher-Owens conceptual model (for children) but adapted for older adults. Better understanding of these relationships is likely to assist in future prevention and care.