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.

Community-Based Dental Education (CBDE): A Survey of Current Program Implementation at Australian Dental Schools

Purpose

Community-based dental education (CBDE) diverges from traditional dental school training methods by integrating dental students into primary care community settings. This immersive approach enables students to refine their clinical and hands-on skills while serving the oral health needs of underserved populations. This study aimed to identify ways in which Australian dental schools are currently implementing CBDE and compared to current evidence.

Materials and Methods

This study utilized a 24-item, self-completion survey, adapted from existing questionnaires, which was sent to the CBDE coordinators in the nine eligible dental programs in Australia between mid-January 2023 and mid-April 2023. The survey consisted of multiple-choice, binary, and open-ended questions, including information on the level of student involvement, types of external clinics used, length of rotations, student supervision and assessment, pre-rotation preparation, and post-rotation evaluation, as well as challenges faced in implementing programs.

Results

Six of the nine invited coordinators responded, resulting in a 66.7% response rate. All participants confirmed that their schools had a community-based teaching program. All six respondents reported that participation in external clinics is required for graduation. Implementation of CBDE appears to be influenced by (1) level of student involvement, (2) the types of clinics utilised, (3) allocation and length of rotation, (4) student supervision and assessment, (5) pre-rotation preparation, and (6) post-rotation evaluation. Six (n = 6) institutions reported requiring a post-rotation reflection from students and all respondents reported seeking feedback from clinical supervisors at external sites. Emerging themes from open-ended questions highlight challenges in coordinating external rosters, securing funding, supervising students at external sites, and ensuring diverse types of student exposure during external rotations.

Conclusion

This study provided insights into the implementation of CBDE in Australian dental schools. Results outlined in this research offer valuable insights for dental schools aiming to enhance their programs and improve student learning outcomes.

Community-based education programmes in the context of dental education: A scoping review

BACKGROUND

Community education programmes are vital tools for teaching skills, such as understanding the larger cultural, economic and social determinants of health and how these factors impact people's health. It is currently unclear whether community education programmes in the field of dentistry deliver adequate value. This review aims to scope, collate and analyse globally published evidence concerning community education programmes in dentistry from inception, to gain an understanding of the intentions for these programmes and establish whether outcomes have shifted over time from the original intentions.

METHODS

Arksey and O'Malley's framework for scoping reviews was employed to guide the reviewers. A systematic search of electronic databases and the reference lists in key papers was conducted.

RESULTS

A systematic search concerning community education in dentistry identified a total of 140 papers for full-text evaluations. After further exclusions, 115 articles were selected for data charting. There was a lack of clarity in the literature concerning programmes' definitions and strategies for achieving intentions. Origins, intentions and motivations of the programmes were identified. The literature largely focused on assessing students' clinical treatment skills, contradicting the programme's original idea and intentions. Only a few studies incorporated patient and community perspectives, and the majority of assessments were self-reported, primarily by students.

CONCLUSIONS

There is broad interest in integrating community education into dental curricula to teach complex concepts, dental public health principles and to ensure professional skills development. We identified issues in the literature around programme definitions, strategies, measurement approaches and programme success requiring additional research.

Positive impacts of oral health services provision by a student-led primary care clinic to an Australian rural indigenous community

BACKGROUND

This study aimed to determine whether oral health services provision by a dental student clinical outplacement embedded within a Community Controlled Health Service positively impacted a rural Indigenous community and to explore the nature of these benefits.

METHODS

Aggregated and de-identified 2017, 2018 and 2019 student-led clinic services provision data were retrospectively analysed. The change in services mix over time was measured. Rural outplacement clinic operational costs to the university were estimated. Government-funded local public dental clinic waiting list and services provision data were used to identify any student clinic establishment effect.

RESULTS

The student-led clinic services mix shifted over time from mainly acute care for toothache towards prevention of disease and tooth restoration, indicating an improvement in patient oral health and correspondingly reduced system costs. Imputed value of 2017-2019 student-led clinic services provision totalled almost AUD$1 million. Government public clinic waiting list times decreased after full establishment of the student-led clinic, indicating decreased pressure on the public system.

CONCLUSION

The Community Controlled Health Service and university partnership improved community oral health care access, its timely delivery and simultaneously provided valuable human capital development from the student training experience. The student-led clinic's targeted Indigenous community showed oral health improvement over time. © 2023 Australian Dental Association.

Bridging the health gap: Measuring the unmet social needs of patients within a dental school clinic

OBJECTIVES

As safety-net clinics, dental school clinics are uniquely positioned to evaluate the unmet social need. There is evidence that patients treated in a safety-net type clinic, such as dental schools, report experiencing one or more of the determinants of health. However, there is limited evidence describing screening for Social Determinants of Health (SDOH) in dental clinics. The purpose of this study is to gain knowledge of the types of social determinants of health that exist in a dental school clinic and how it is reflected in the geographic region of the school.

METHODS

This cross-sectional prospective study used a 20-item questionnaire assessed unmet social needs in a predoctoral clinic. The questionnaire contained multiple choice and binary yes/no questions, organized under SDOH domains: housing, food, transportation, utilities, childcare, employment, education, finances, and personal safety. Socioeconomic and demographic information was captured. The questionnaire was administered via iPad using Qualtrics XM. The data were descriptively and quantitatively analyzed at a significance level of p ≤ 0.05.

RESULTS

There were 175 respondents with a 93.6% response rate, males (49.7%), females (49.1%), and 1.1% nonbinary. Overall, 135 (77.1%) respondents reported having at least one unmet social need. The greatest number of unmet needs was in the domains of employment and finances, with 44% and 41.7% respectively. Respondents who were unable to work stated they often or sometimes worried about running out of food before getting money to buy more, (p = 0.0002), and or the food didn't last before there was money to get more (p = 0.00007). A comparison of annual incomes of respondents earning less than $40K with those earning $40K or more, demonstrated statistically significant differences in unmet social needs for housing (p < 0.0001), food (p = 0.0003, p < 0.0001), utilities (p = 0.0484), employment (p = 0.0016), education (p < 0.0001), and finances (p < 0.0001).

CONCLUSION

Screening patients in the dental clinic was an efficient way to uncover the level of unmet social needs. Annual household income was a predominant driver of unmet social needs: with the greatest number of unmet needs existing in the domains of employment and finances. The results suggest that screening for social determinants of health dental school clinics could be incorporated into routine patient data collection.

Financial assessment of the community-based dental education program at the Indiana University School of Dentistry

BACKGROUND

There is a gap in access to oral health services for millions of Americans residing in health professional shortage areas. The community-based dental education program at the Indiana University School of Dentistry is an innovative model that aims to improve access to oral health services in rural underserved Indiana.

OBJECTIVE

With this study, our goal was to assess the financial implications of the program over a period of 3 years (2018-2021).

METHODS

Proxy estimates for the revenue generated by students at the community clinic sites were calculated and compared against the implementation costs of the program as well as revenue lost by the school during the rotation period. Descriptive statistics were used to assess the quantitative impact of the program over the 3 years.

RESULTS

The total of 7460 patients who were offered care as part of this program were mostly from the uninsured group or were covered under Medicaid. According to our cost-benefit analysis which was conducted during the peak of the coronavirus disease 2019 (COVID-19) pandemic, the total revenue of $1,777,097 was generated by students at the community sites through the 3-year period. The revenue generated was still more than the dollar amount invested in running the program, given the timeline of the study was when elective services were mostly suspended.

CONCLUDE

We conclude community programs like these have an impact beyond the dollar value; they can be modeled to be cost-effective, improve access to oral health services for millions of Americans in underserved settings and at the same time provide a great learning experience for dental students.

Practice patterns of postgraduate trained dentists in the United States

OBJECTIVE

Postgraduate dental (PGD) primary care training has grown significantly. This study examines the individual, educational, community, and policy factors that predict practice patterns of PGD-trained dentists.

STUDY DESIGN

Individual dentist records from the 2017 American Dental Association Masterfile, with indicators of Medicaid participation and practice in a Federally Qualified Health Center (FQHC), were linked to postdoctoral training, community/practice location, and state policy factors. Generalized logistic models, adjusted for these factors, were used to predict PGD-trained dentists: (1a) serving Medicaid children, (1b) accepting new Medicaid patients, and (2) working in an FQHC.

RESULTS

Individual attributes that predicted serving Medicaid children included all race/gender combinations (vs. White females), and foreign-trained dentists and contractors/employees/associates (vs. practice owners). Black women are most likely to work in an FQHC. Residency attributes that predicted serving Medicaid children and working in an FQHC were Health Resources and Services Administration postdoctoral funding and being community based. Dentists practicing in rural or high-poverty communities were more likely to serve Medicaid children and work at FQHCs. States with higher levels of graduate medical education investment, higher Medicaid rates, and more generous adult dental Medicaid benefits increased the likelihood of serving Medicaid children, while states with more expansive adult dental Medicaid benefits increased the likelihood of working in an FQHC.

CONCLUSION

Federal training investment in PGD education combined with Medicaid payment and coverage policies can strongly impact access to dental care for vulnerable populations. Yet, oral health equity cannot be achieved without increasing dentist workforce diversity.

Advancing Social Mission Research: A Call to Action

Social mission efforts in health professions education are designed to advance health equity and address the health disparities of the society in which they exist. While there is growing evidence that social mission-related interventions are associated with intended outcomes such as practice in underserved communities, student diversity, and students graduating with skills and knowledge that prepare them to address societal needs, critical evidence gaps remain that limit the possibility of generalizing findings and using social mission strategically to advance health equity. At a time when COVID-19 has been laying bare health disparities related to systemic racism and maldistribution of resources, understanding how health professions training can produce the workforce needed to advance health equity becomes even more imperative. Yet, data and methods limitations are hindering progress in this critical research. The authors present an overview of the social mission research landscape; their review of the research led them to conclude that more rigorous research and data collection are needed to determine the link between social mission activities in health professions education and advances in health equity. To accelerate understanding of how health professions education and training can advance health equity, the authors propose a social mission research road map that includes (1) creating a social mission research community by consolidating stakeholders, (2) building a solid foundation for the research through development of a consensus-driven logic framework and research agenda, and (3) laying out the data and methodological needs that are imperative to strengthening the social mission evidence base and identifying opportunities to address these needs. Core to achieving these milestones is leadership from an organizing body that can serve as a hub for social mission research and engage stakeholder groups in building the evidence base for social mission strategies that will ultimately advance health equity.

Opioid Prescription Trends in a US Dental School Clinic, 2014-2018: A Retrospective Study Using Electronic Health Record Data

OBJECTIVES

Opioid misuse and abuse continues to be a grave public health concern in the United States. The aim of this study was to use electronic health records (EHRs) from a US dental school clinic to retrospectively analyze trends in opioid prescription frequencies.

DESIGN

A database review was conducted using EHR data from 20 patient care clinics in a dental school over a 5-year period during which local, state, and national policies and guidelines to mitigate harm from opioid misuse were introduced.

SETTING

University of Michigan School of Dentistry, state of Michigan.

OUTCOME MEASURE

Descriptive statistics using measures of frequency and distribution of opioid prescriptions written were compared over a 5-year period by dental school clinic specialty, CDT (Code on Dental Procedures and Nomenclature) procedure, drug type, and patient age/gender.

RESULTS

From 2014 to 2018, a total of 12 401 opioid-based prescriptions were written by dental providers in the school's patient care clinics. An ARIMA (autoregressive integrated moving average) model time trend analysis demonstrated a significant decrease in the number of prescribed opioids after 2016.

CONCLUSIONS

While causal relationships cannot be drawn between drug abuse and prescription trends alone, this exploratory study provided a better understanding of prescription frequency patterns that can help monitor distribution of opioids and identify areas where future public health interventions may be needed. Dental education institutions have an obligation to ensure a competent health care workforce as well as unique opportunities to support regional and national public health strategies aimed at reducing misuse of opioids.

Community partnerships within a novel dental school urgent care center: Student perceptions

PURPOSE/OBJECTIVES

Oral health inequities and limited access to care cause patients to seek dental treatment in hospital emergency departments. In addition, conventional clinic models and curricular limitations may result in inadequate experiences for students learning urgent dental care. The aim of the current study was to investigate student perceptions of a novel dental school urgent care clinic model.

METHODS

A mixed-methods, cross-sectional study design was used to survey third-year and fourth-year students at a Midwest dental school in spring 2020 about their experiences providing patient care in the school's internal urgent care center. Along with a structured curriculum, the urgent care clinic model incorporates an on-site partnership with a community health center and a hospital emergency department affiliation that serves as a referral base to provide students with their learning experiences.

RESULTS

Of 81 students, 78 completed the survey (96% response rate). The majority of students treated 50 or more patients. From their urgent care experiences, a majority of students felt prepared to manage patients with acute dental pain and swelling (72/77, 94%), and reported a better understanding of interprofessional collaborations in dentistry (42/77, 55%) and the importance of providing urgent dental care to underserved patients (72/77, 94%). Most students (64/75, 85%) were more likely to offer urgent dental care services to underserved populations in future practice.

CONCLUSION

This collaborative school-based urgent care clinic model incorporating community partnerships provided transformative learning experiences, positively impacted student perceptions of their learning, and influenced future practice behaviors related to urgent dental care.

Process and outcome evaluation of the Oral Health Improvement through Outreach (OHIO) Project

Academic dental institutions serve a foundational role in meeting the oral health needs of Americans through community-based learning experiences.

PURPOSE

The purpose of this study was to longitudinally evaluate an ongoing primary objective of the Oral Health Improvement through Outreach (OHIO) Project Program, which is to build strong partnerships between The Ohio State University (OSU) College of Dentistry (CoD) and community-based dental facilities and increase access to dental care for underserved populations.

METHODS

Upon exempt Institutional Review Board approval (2004H0067), a longitudinal evaluation study was conducted of 15 years of the OHIO Project during the 2004-2019 academic years. Descriptive statistics were used to evaluate the OHIO Project using process and outcome evaluation methods.

RESULTS

The data from 107,510 patients were analyzed. Process evaluation revealed the OHIO Project has been reaching the target population of communities with dental care needs and limited access, as evidenced by the main methods of patient payment/non-payment and the quantity of completed restorative/oral surgery procedures. Outcome evaluation revealed the OHIO Project has been building strong partnerships between the CoD and communities to address dental care needs and improve access, as evidenced by the increased number and distribution of the community-based facilities throughout Ohio.

CONCLUSION

Process and outcome evaluation revealed the OHIO Project has been meeting its primary goal of building strong partnerships between the CoD and OHIO Project community-based facilities to address the basic dental needs and increase access for Ohio residents. Future research is needed to evaluate the dental student impact of providing community-based care.