Elevating dentistry through diversity

Responsible artificial intelligence for addressing equity in oral healthcare

Oral diseases pose a significant burden on global healthcare. While many oral conditions are preventable and manageable through regular dental office visits, a substantial portion of the population faces obstacles in accessing essential and affordable quality oral healthcare. In this mini review, we describe the issue of inequity and bias in oral healthcare and discuss various strategies to address these challenges, with an emphasis on the application of artificial intelligence (AI). Recent advances in AI technologies have led to significant performance improvements in oral healthcare. AI also holds tremendous potential for advancing equity in oral healthcare, yet its application must be approached with caution to prevent the exacerbation of inequities. The "black box" approaches of some advanced AI models raise uncertainty about their operations and decision-making processes. To this end, we discuss the use of interpretable and explainable AI techniques in enhancing transparency and trustworthiness. Those techniques, aimed at augmenting rather than replacing oral health practitioners' judgment and skills, have the potential to achieve personalized dental and oral care that is unbiased, equitable, and transparent. Overall, achieving equity in oral healthcare through the responsible use of AI requires collective efforts from all stakeholders involved in the design, implementation, regulation, and utilization of AI systems. We use the United States as an example due to its uniquely diverse population, making it an excellent model for our discussion. However, the general and responsible AI strategies suggested in this article can be applied to address equity in oral healthcare on a global level.

Identifying factors influencing orthodontic residency program selection

PURPOSE

The desirability of Orthodontic Residency remains high today relative to the past 30 years. This investigation seeks to re-assess factors influencing Orthodontic Residency program selection amidst contemporary challenges and changes, including increasing student debt, reduced residency stipends, and shifting practice models.

METHODS

This mixed-methods study consisted of interviews (qualitative) and surveys (quantitative). Fifteen final-year dental students and first-year orthodontic residents were interviewed one-on-one following a topic guide and then transcripts were analyzed using MAXQDA2022 to identify values, factors, and influences related to program selection and ranking. Qualitative findings and previous studies provided the basis for a survey distributed to residency applicants in 2020-22. Data were analyzed with bivariate and descriptive statistics with stratification by debt group.

RESULTS

Interviews (N = 15) elevated the importance of location, interview experience, program cost, and clinical education. Surveys (N = 239) identified the most desirable factors for program selection: satisfied residents, strong clinical training with multiple techniques, good interview impressions, low cost, high patient numbers, a strong reputation, and good clinical facilities with new technology. Less desirable factors include programs that are hospital-based, certificate-only, research-intensive, and require considerable after-hours work.

CONCLUSIONS

Clinical education and interview experiences are key for residency selection, consistent with prior studies, though program cost has grown in importance. Findings can help guide orthodontic programs in recruiting applicants and suggest a need to limit educational costs.

Discrimination and Dignity Experiences in Prior Oral Care Visits Predict Racialized Oral Health Inequities Among Nationally Representative US Adults

Racism, an oppressive and fallacious sociopolitical hierarchy, is a fundamental cause of oral health inequities worldwide. Everyday discrimination is associated with worse self-rated oral health, toothache and adult tooth loss, and lower oral care utilization. Few studies examine discrimination or microaggressions within oral care settings or their effects on oral health outcomes. We adapted the seven-item Everyday Discrimination Scale to the oral care setting (EDSOC); developed a four-item Dignity in Oral Care Scale (DOCS); fielded them to a probability-based nationally representative sample of US households as part of the 2022 State of Oral Health Equity in America survey (SOHEA, n = 5682); and examined associations between EDSOC and DOCS scores and three outcomes: self-rated oral health, duration since last oral care visit, and planning for future preventive/routine oral care. Nearly, all EDSCOC and DOCS measures were significantly associated with oral health outcomes. Discrimination experience in dental settings had an additive effect on reporting fair/poor oral health and a suppressive effect on planning a future dental visit. Indignity experience doubled-to-quadrupled the likelihood of reporting fair/poor oral health, not having visited a dentist in 2 years, and not planning a future oral care visit. Racio-ethnically minoritized patients may experience the unjust double bind of resolving urgent dental or completing preventive services needs amidst being treated in a discriminatory manner or without dignity. Oral health stakeholders should invest more effort to understand relationships between racism and oral health outcomes and introduce evidence-based interventions to ultimately abolish this societal harm.

An Exploration of Black Men's Attitudes and Experiences Communicating with Dentists about Oral and Pharyngeal Cancer

BACKGROUND

Poor oral and pharyngeal cancer (OPC) survival among Black men is partially due to their limited knowledge about OPCs, which is exacerbated by dentists' limited training and discomfort in discussing OPC risk factors. The purpose of this study was to assess the attitudes and experiences that Black men have communicating with dentists about OPCs.

METHODS

To qualitatively assess these attitudes and experiences, a focus group guide and recruitment strategy were developed using a community engagement approach. Data were analyzed using grounded theory.

RESULTS

Twenty-three self-identified Black men participated in three focus groups through the Zoom platform (mean age of 46.1 years). Four main themes emerged, which identified that participants: (1) had little knowledge of OPCs; (2) felt that addressing OPC risk among Black men was not a priority for dentists; (3) stressed the importance of dentists acknowledging the complexity of how race and gender affects Black men's healthcare experiences; and (4) expressed a benefit to receiving information from multiple social networks.

CONCLUSION

The focus groups provided context for how dentists might engage with Black men in discussions about OPC prevention and treatment.

A decade of grassroots pathway programming: Saturday Academy at New York University College of Dentistry

BACKGROUND

Successful pathway programs require early and sustained support of student participants.

PURPOSE

We present the history and outcomes of a successful decade of continuous, grassroots, pathway programming at an individual dental institution.

METHODS

Programmatic data were used to evaluate information on program participant demographics, academic pursuits, and career interests. Descriptive analyses were used to report on program enrollment as well as alumni academic and career outcomes.

RESULTS

Between the years of 2013 and 2022, 346 high-school students participated in Saturday Academy at NYU Dentistry. Of the 240 college-aged and older program alumni, 72% (n = 172) have shared their academic and career plans after high-school. At the time of publication, 78% (134/172) of alumni that have maintained contact with Saturday Academy and have expressed interest in pursuing a career in the health professions. Of the 172 alumni, 14% (n = 24) have enrolled in or graduated from a health professional program (dental hygiene, nursing, accelerated dental or medical program, dental or medical school, or other health professional program). Of these alumni (24/172), half (n = 12) have pursued education in the dental professions, specifically.

CONCLUSION

Saturday Academy at NYU Dentistry is an example of a sustainable and impactful pathway program in dental education and its outcomes support the merit of calls for increased institutional commitment and support of similar initiatives.

Perceptions on pregnancy and parenthood among program directors in pediatric dentistry

PURPOSE

This cross-sectional study assessed the perceptions of pediatric dental residency program directors (PDs) regarding policies and attitudes on pregnancy and parenthood during residency training.

METHODS

A 28-item electronic survey was administered to PDs of pediatric dental residencies in the United States. Statistical tests were performed. Variables were reported as counts (percentages) and compared using Fischer's exact test and chi-squared tests at a significance level of 0.05.

RESULTS

Forty-two of the 97 PDs completed the survey for 43% response rate. Almost all programs had a formal maternal leave policy, but perceptions and policies varied regarding the effects of both pregnancy and parenthood on residents during training. Chi-square results compared if parenthood had a negative impact on the well-being a female trainee versus a male trainee had a p-value < .05.

CONCLUSIONS

There appeared to be a lack of national uniformity regarding program policies on parental leave. Most PDs perceived having a child during residency had at least one negative effect on their female residents. Finally, PDs were likely to perceive parenthood to adversely impact the well-being and work of female trainees more so than their male counterparts.

Diversity in forensic sciences: Black, Indigenous, and People of Color (BIPOC) representation in different medicolegal fields in the United States

The benefits of a diverse and inclusive working environment are well documented. This study examined forensic science literature, demographic data reported from professional organizations, and demographic surveys to compile information regarding racial and ethnic diversity within different subdisciplines of forensic science. Results showed that practitioners self-identified as Black or Hispanic were underrepresented in scientific fields closely related to forensic science. Moreover, Black, Indigenous, and People of Color (BIPOC) students were underrepresented at the undergraduate level, despite increasing college enrollments. This lack of representation may have consequences on knowledge production and innovation. By recognizing the current status of diversity in forensic science, this study is the first step toward mitigating the trend of underrepresentation. We encourage professional organizations to be transparent about the diversity in their membership and provide actual practitioner demographic statistics. These data are beneficial to studying the effects of underrepresentation and developing effective strategies to improve representation.

Oral health inequities: Recommended public policies to achieve health equity

In the United States (US), racial and ethnic minority populations experience poorer oral health than the general population. Social and commercial determinants of health embedded in structural and institutional racism and/or discrimination generate and exacerbate oral health inequities. We provide examples of oral health disparities (including oral health status and workforce issues) among selected racial and ethnic minority groups in the US. In addition, we compiled four priority areas based on research over the last two decades to guide actions to improve oral health equity. These four priority areas aim to improve health care models, interventions, and policies to help close gaps and reduce disparities in oral health and access to dental care.

Building sustainable approaches to recruit, retain, and professionalize Black, Latinx, and American Indian students interested in dental careers

BACKGROUND

Only twelve percent of dentists in 2020 self-identified as being Black, Latinx, or "Other," which includes American Indian. Moreover, the proportion of dentists from these groups profoundly fails to reflect the demographic composition of the U.S. overall. Evidence-based, ethically-grounded approaches are needed to successfully and continuously recruit and retain Black, Latinx, and American Indian dental students. We explored the barriers and opportunities to sustainable pathways to the dental profession.

METHODS

We conducted focus groups in 2021 with current Black, Latinx, and American Indian dental students and key informant interviews with dental school administrators using elicitation guides developed for this project. We completed a thematic analysis of data to identify and check findings to strengthen validity.

RESULTS

We identified the following successes, challenges, and opportunities for recruiting Black, Latinx, and American Indian dental students. Successes include institutional investment to build and sustain pathways, yet many of these practices are institution- or administrator-specific and may defy replication. Challenges are more widespread, and include weak accreditation standards; systemic bias and failure to consider candidates holistically in admissions decisions; costs associated with admissions test preparation and volunteer shadowing; transportation, geography, school culture and language/citizenship status. Opportunities include mentoring, scholarships, removing bias from admissions, institutional financial investment in pathway programs, and peer norming among programs.

CONCLUSION

Building sustainable pathways involve early support of students, removing systemic biases, and institutional commitments to equity to create a workforce to meet population needs.

Racism and oral health equity in the United States: Identifying its effects and providing future directions

While racial/ethnic oral health inequities have been documented for many years in the United States, the potential role of racism has not been examined until recently. In fact, the common practice has been to attribute racial/ethnic disparities in oral health to low socioeconomic position and/or the lack of access to care. In contrast, racism is considered a fundamental cause of a broad range of adverse health outcomes for racial/ethnic minorities. Emerging evidence on oral health suggests that racism can affect access to oral health and clinical decision-making by acting as a social determinant of health (SDoH). Specifically, SDoHs may affect access to quality dental care due to the lack of dental insurance, low dentist-population ratio in racial/ethnic minority communities and the lack of diversity in the dental profession. We describe potential mechanisms through which racism can affect important SDoHs that are essential to oral health equity, outline recommendations to mitigate its existing negative effects and propose interventions to minimize pathogenic effects of racism on oral health outcomes in the population.