Evidence-based dentistry can effectively be taught to dental care professional students - A mixed methods study

BACKGROUND

Little research exists in the teaching of evidence-based dentistry (EBD) to students in the fields of dental hygiene, dental nursing and orthodontic therapy. This study aims to analyse the effect of a 1-day EBD programme on knowledge and confidence whilst also gaining insight into students' experience of the intervention.

METHOD

A mixed methods study was utilised with explanatory sequential design. The population consisted of dental hygiene (DH), dental nursing (DN) and orthodontic therapy (OT) students (N = 44). The intervention consisted of a 1-day active learning EBD programme, delivered via group projects and lectures. In the initial quantitative phase, a standardised questionnaire pre- and post -intervention measured changes in confidence for all participants, whilst change in knowledge was measured for DH and OT students only. Following this, focus groups were scheduled for all members of each discipline 3 months post-intervention for DN and 2 months post-intervention for DH and OT students. Semi-structured focus group schedules were drawn up, and groups organised according to the outcomes of quantitative data analysis. Qualitative results were analysed using a deductive adaptation of Burnard's thematic content analysis.

RESULTS

Forty-two students took part (94.45%) in this study. Median knowledge scores increased from zero to two of five (P < .001), whilst median confidence score doubled from four to eight of eight (P < .001). Results of thematic content analysis were coincident with quantitative results; however, it also provided constructive feedback regarding design and content of the course.

CONCLUSIONS

A 1-day bespoke programme in EBD increased students' confidence and knowledge in EBD skills. However, the findings further suggest that two successive half-day training sessions instead of one full-day training, tied in with coursework that requires the application of the acquired skills, may increase the learning experience further.

The value of education in special care dentistry as a means of reducing inequalities in oral health

People with disability are subject to inequality in oral health both in terms of prevalence of disease and unmet healthcare needs. Over 18% of the global population is living with moderate to severe functional problems related to disability, and a large proportion of these persons will require Special Care Dentistry at some point in their lifetime. It is estimated that 90% of people requiring Special Care Dentistry should be able to access treatment in a local, primary care setting. Provision of such primary care is only possible through the education and training of dentists. The literature suggests that it is vital for the dental team to develop the necessary skills and gain experience treating people with special needs in order to ensure access to the provision of oral health care. Education in Special Care Dentistry worldwide might be improved by the development of a recognised academic and clinical discipline and by providing international curricula guidelines based on the International Classification of Functioning, Disability and Health (ICF, WHO). This article aims to discuss the role and value of promoting and harmonising education in Special Care Dentistry as a means of reducing inequalities in oral health.

The prevalence of dental caries and fissure sealants in 12 year old children by disadvantaged status in Dublin (Ireland)

OBJECTIVE

The aim was to record dental caries levels and the presence of fissure sealants in 12-year-old schoolchildren whose domestic water supply had been fluoridated since birth in Dublin (Ireland).

RESEARCH DESIGN

Cross-sectional study. Participants A representative, random sample of 12-year-old schoolchildren in north-west Dublin.

OUTCOME MEASURES

Dental caries levels were recorded using WHO criteria and fissure sealant was recorded when sealant was detectable on a permanent molar tooth. Medical card ownership, as a surrogate for disadvantage, was recorded by use of a questionnaire.

RESULTS

Three-hundred and thirty-two (332) children were examined. The mean DMFT was 0.80 (SD 1.24). Analysis (Mann-Whitney U test) based on stratification of the sample according to medical-card status revealed no statistically significant difference between DMFT median scores of children of medical-card holders (i.e., social disadvantage background) and non medical-card holders (p-value = 0.23). However, the data revealed a social gradient in the presence of at least one fissure sealant. Approximately 10% more children in the group of medical-card holders had no fissure sealants present. Fisher's exact test was used to examine the association between the absence of fissure sealants and at least one fissure sealant between the two groups and was considered to be statistically significant (p-value = 0.04).

CONCLUSION

This study demonstrated a social gradient in the presence of fissure sealants, but no such gradient in dental caries levels. This demonstrates the importance of population-based measures in the prevention of dental caries, such as water fluoridation, in reducing oral health inequalities.

Assessing the oral health of school-age children and the current school-based dental screening programme in Freiburg (Germany)

Germany has a three-tiered system of education at secondary school level, divided into the school types 'Hauptschule', Realschule' and 'Gymnasium'. All students receive, when aged 6-12 years, a uniform annual dental examination and oral health education programme.

OBJECTIVES

The aim of this cross-sectional study was to report on the dental caries levels of school-age children stratified into these three different school types at secondary school level to enable oral healthcare personnel to administer a focused, school-based dental screening and education programme according to patients' needs rather than a uniform dental examination.

METHODS

A representative, random sample of 12-year-old school children in Freiburg (Germany) was examined and dental caries was recorded using WHO criteria.

RESULTS

A total of 322 12-year-old children participated. The mean DMFT was 0.69. An examination of the distribution of the DMFT score revealed that its distribution is positively skewed. For this reason, this study provides summary analyses based on medians and a non-parametric rank sum test. The non-parametric Kruskal-Wallis H-test showed a highly significant difference between median scores across the different school types (P-value = 0.004). The significance was a result of the 'Gymnasium' distribution of DMFT scores which differed markedly from the other two school types.

CONCLUSIONS

The finding of the present study suggests that it may be useful to stratify the school dental screening and education programme according to school type and to prioritize children who attend 'Realschule' and 'Hauptschule'. This shift should systematically target children with the greatest need for dental care.

The prevalence of dental fluorosis in relation to water or salt fluoridation and reported use of fluoride toothpaste in school-age children

AIM

To compare prevalence of dental fluorosis (DF) in permanent teeth in children whose domestic water supply was fluoridated since birth with that in a community where fluoridated salt was available. A second aim was to analyse the relationship between DF prevalence and reported use of fluoride toothpaste in early childhood.

STUDY DESIGN

Cross-sectional study.

METHODS

A representative, random sample of 12-year-old children was examined in water fluoridated Dublin (Ireland) and non-water fluoridated Freiburg (Germany), where fluoridated salt was available. DF was recorded using the Dean's Index. The child's early experience of toothpaste use was recorded using a questionnaire.

RESULTS

377 children in Dublin and 322 children in Freiburg were examined. In Dublin 11.7% of the whole sample had a 'Questionable' level of DF, 9.8% had 'Very Mild', 3.7% had 'Mild' and 0.3% had 'Moderate' fluorosis. The corresponding percentages in Freiburg for all children were 10.9%, 4.0%, 3.4% and 0%. The results suggest that children in Dublin started brushing their teeth at an older age than in Freiburg, but no difference in DF levels was found between 'early' and 'late' users.

STATISTICS

Fisher's test revealed that the difference in DF levels between the two populations was statistically significant (p=0.03).

CONCLUSIONS

The prevalence of aesthetically important DF ('Mild' and 'Moderate') was low and similar in both communities and considerably lower than the expected level at water fluoridation concentrations of 1 ppm. However, the prevalence of 'Very Mild' fluorosis was twice as frequent in Dublin than in Freiburg.