Geriatric oral health competency among dental providers

Postgraduate dental resident education: A pilot in age-friendly "mentation" training

OBJECTIVE

Postdoctoral dental education in caring for older adults lacks didactic and clinical training in mentation topics, one of the core elements of the Age-Friendly Health Systems (AFHS) framework. Our primary goal was to launch a pilot project in clinical geriatrics focusing on older adults' mentation concerns, with a secondary goal to improve dental residents' confidence and competence in dental care and oral health.

BACKGROUND

Age-friendly care elements are not routinely incorporated into the dental education of residents caring for older adults with cognitive impairment or dementia. Therefore, we implemented a pilot educational project, providing the missing educational opportunity for residents in geriatric training covering cognitive impairment and focusing on Alzheimer's disease and related dementias.

MATERIALS AND METHODS

We designed educational sessions through a needs assessment, focus group discussions, and expert validation. We developed three e-Learning modules covering mentation concerns and dementia screening. We tested the modules in a pilot study of 15 dental postdoctoral residents as an essential part of their clinical practice.

RESULTS

The dementia dental learning module increased the residents' satisfaction with didactic preparedness (4.45 ± $ \pm \ $ 0.97) and knowledge acquisition (4.36 ± $ \pm \ $ 0.84). Residents strongly believed that learning about the AFHS-mentation topic would improve patient care.

CONCLUSION

Our pilot study is a pioneer project in support of a new AFHS-themed dental curriculum for clinical education. Further expansion of the age-friendly principles to include mobility, medications, and what matters to older adults will establish a model framework of redesigned geriatric dental education for academic centers.

Knowledge of Xerostomia and Angular Cheilitis in Geriatric Population among Clinical Dental Students: An Institutional Cross-Sectional Study

Aim

Assessing the knowledge of clinical dental students regarding prevalent geriatric oral diseases is crucial in evaluating their clinical competency. This study focuses on analyzing dental students' knowledge of angular cheilitis (AC) and xerostomia in elderly patients.

Materials and Methods

In this analytical cross-sectional investigation, clinical dental students from Universitas Airlangga were involved. We employed simple random sampling to select a minimum of 76 students and gathered data, including demographic information and knowledge about AC and xerostomia, through an online questionnaire. Respondents were then categorized into three groups based on their knowledge level: poor, moderate, and good. We utilized coefficient contingency and odds ratio analysis to explore relationships and effects between demographic factors and knowledge levels.

Results

The study findings indicated that a significant majority of respondents demonstrated a high level of comprehension regarding AC (58.4%). Conversely, a notable proportion of respondents exhibited limited knowledge regarding xerostomia (66.3%). Furthermore, our correlation analysis, which aimed to identify potential associations between knowledge levels and intrinsic factors such as gender, clinical interest, and proximity to geriatric individuals, did not reveal any statistically significant relationships (P > 0.05).

Conclusion

Within the population of clinical dental students, there is a commendable level of knowledge concerning AC in the geriatric demographic. However, a substantial segment of students lacks adequate understanding when it comes to xerostomia.

Linking current dental education to gerontological education to meet the oral health needs of growing aging populations

Objective

This study aimed to recognize the gaps in dental education by studying the current level of geriatric oral health training of recent graduated dentists who have been admitted into an Advanced Education in General Dentistry (AEGD) program.

Methods

The AEGD program was developed along with the Age-Friendly 4Ms model to enhance current dental education. We adopted the Rapid Cycle Quality Improvement model to test the effectiveness of the training for AEGD residents from 2019 to 2022. A total of 18 residents participated (6 residents each year). A 5-question survey was administered before and after the rotation and Wilcoxon signed-rank with Fisher Exact tests were conducted to compare pre- and post- rotation results.

Results

All 18 residents have completed pre- and post-program surveys. They self-reported minimal to no training in preparation to provide care to older adults with multiple chronic conditions. After the rotation, residents' confidence in treating older adults was significantly increased (p = 0.011). Meanwhile, residents gained knowledge to apply the 4Ms framework (what matters, medication, mentation, and mobility) to their practices (p = 0.015) and provide age-friendly care for older adults.

Conclusion

The study identified and addressed the missing link in dental education to gerontological and geriatrics education. More clinical rotations and didactic training to equip residents with competences of providing geriatric oral health are strongly recommended.

Oral Health Strategies: Surveying the Present to Plan the Future of Community-Based Learning

Introduction: Oral health literacy relates to the capacity of individuals to acquire, understand and to act upon oral health information to make appropriate health decisions. This scientific review's main goal is to analyze the strategies that improve oral health literacy within the community, specifically oriented to a community-based learning model focused on the most vulnerable risk groups in society. Materials and Methods: The current review is based on the literature on oral health literacy within community-based learning strategies. The present review selected scientific studies by searching MEDLINE and related databases, such as Web of Science and PUBMED, and by consulting existing bibliographies. Results: Based on the application of the inclusion criteria to the abstracts, 45 publications were retrieved which explicitly dealt with the definitions of oral health literacy, community-based learning, and service learning. Several studies have demonstrated that health consumers with low health literacy fail to understand the available health information. Therefore, innovative oral health literacy strategies should be undertaken. Service learning is an example of an educational approach where the student learns specific soft skills in the classroom and collaborates directly with an agency or institution and engages in reflection activities to deepen their understanding of what is being taught. Conclusions: One of the main strategies used to incorporate the oral health professional in social responsibility and direct contact in the community is through experiencing community-based learning projects. The future graduate must be an educator capable of educating patients in order to themselves acquire high-level skills in oral health literacy.

Cross sectional study on the competence and confidence of dental students and graduates in the management of medically compromised patients and acute medical emergencies

A rapidly aging population means many people have multiple health issues leading to an increased risk of acute medical emergencies. The objective of this study was to evaluate how essential experiential learning is in developing dental graduates' ability to manage medically compromised patients. Three hundred and twenty-seven students and graduates were invited to participate in an online survey to rate their confidence in managing medically compromised patients and acute medical emergencies using a 5-point Likert scale. Competence of knowledge was evaluated using 30 multiple choice questions (MCQs) across six domains. The respondents were also asked whether a theory-only training adequately prepared them to manage medically compromised patients, or whether it must be supplemented with clinical training. Two-hundred and sixty-four responses were collected from 75 undergraduates (UG), 96 junior dental officers (JDO) and 93 senior dental officers (SDO). The UG reported that they infrequently managed medically compromised patients, whereas both the JDO and SDO reported having frequent encounters with these patients. The mean confidence scale in the management of medically compromised patients were 2.62, 3.50 and 3.69 (out of 5), respectively. In contrast, their confidence scale in the management of acute medical emergencies was 2.05, 2.33 and 2.50 (out of 5), respectively. The MCQ scores were 25.51, 26.44 and 26.86 out of 30, respectively. The outcomes of the JDO and SDO were significantly better than the UG (t-tests, p<0.05). All three groups responded that a theory-only training in dental school did not adequately prepare them to manage medically compromised patients. Both the JDO and SDO felt that their clinical work experience better prepared them to manage these patients. Experiential learning from "real-life" clinical experience is an essential component in developing graduates' confidence and competence in the management of medically compromised patients. A dental curriculum with theory-only training in this aspect is inadequate.

Current oral health services and the divergent needs of the baby boom cohorts

The two cohorts of Baby Boomers, the Early (born between 1945 and 1955) and the Late (born between 1956 and 1964), have some subtle yet distinct differences when it comes to their oral health and oral health related behaviors. Unlike their predecessors, the Baby Boomer cohorts are retaining more teeth, as there is a sharp fall in edentulous rates in this population. The oral health care community is now facing unparalleled challenges in providing and maintaining the oral health of this unique cohort who are keeping their teeth longer, have multiple comorbidities, and are living longer than previous generations. This paper draws from the latest studies, scientific data and research to describe a realistic picture of the oral health services available to and utilized by the Baby Boomers. The factors affecting utilization, their rising needs, demands, expectations, and areas where improvement is needed for the Baby Boomer are also reported here.

Is dental education meeting the oral health needs of older adults?

The aim of this article is to highlight the importance of promoting oral health for the geriatric population and implementing change to address their complex oral and systemic health needs. Oral healthcare providers are unequipped to meet the demanding oral health needs of the aging population, resulting in a geriatric oral health crisis that needs immediate attention and action. Despite the advancements in geriatric education over the last two decades, the geriatric curriculum in 2022 is still inadequate, and varies greatly among different US dental schools for both pre- and postdoctoral programs. Predoctoral students are graduating without being sufficiently trained to identify and treat the dental issues of older adults due to lack of a purposely planned curriculum with balanced didactic and clinical exposure. It is critical to have a trained and competent workforce that meets the oral health needs of current and future older adults. To change the present environment, there is a need for curriculum redesign, faculty development, and training. In addition, more research to evaluate pre- and postdoctoral geriatric dentistry curricula, their impact on increasing access to care, and the likelihood of graduating dentists competent to treat functionally dependent and frail older adults is needed. Furthermore, decision-makers in dental education, national dental organizations, and government institutions must support policies that integrate oral health into overall health through robust reimbursement mechanisms, including a dental benefit in Medicare, and recognition of geriatric dentistry as a specialty.