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Ramaswamy V, Danciu T, Kennedy EN, Romito L, Stewart D, Gul G, Marucha P, Quinonez RB. American Dental Education Association Compendium Entrustable Professional Activities Workgroup report. J Dent Educ 2024; 88:639-653. [PMID: 38693898 DOI: 10.1002/jdd.13542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE Entrustable professional activities (EPAs) are discrete clinical tasks that can be evaluated to help define readiness for independent practice in the health professions and are intended to increase trust in the dental graduate. EPAs provide a framework that bridges competencies to clinical practice. This report describes the work of the American Dental Education Association (ADEA) Compendium EPA Workgroup to develop a list of EPAs for dental education and supportive resources, including specifications and a glossary. METHODS Preliminary work including literature and resource review, mapping of existing competencies, and review of other health professions' EPAs informed the development of our EPAs list. Workgroup members achieved consensus using a modified Delphi process. A Qualtrics survey using a validated rubric for the assessment of EPAs as described in peer-reviewed literature was used. Dental educators, including academic deans, were surveyed for feedback on the content and format of the EPAs. RESULTS Based on findings in the literature analysis of existing EPAs and competencies in health professions, a list of EPAs was developed along with a description of specifications. The EPA workgroup (nine members from multiple institutions) used the Delphi process in receiving feedback from various experts. A list of 11 core EPAs was vetted by dental educators including academic deans (n = ∼23), and the process of development was reviewed by EPAs experts outside dental education. A glossary was developed to align language. CONCLUSION These EPAs define the scope of dental practice. This report represents Phase 1 of the EPA framework development and vetting process. Future directions will include a broader vetting of the EPA list, faculty development, and national standardized technology that support this work to optimize implementation.
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Affiliation(s)
- Vidya Ramaswamy
- Director for Curriculum Evaluation and Promotion of Teaching and Learning at the University of Michigan, School of Dentistry, Ann Arbor, Michigan, USA
| | - Theodora Danciu
- Clinical Professor and Director of Engaged Learning and Assessment at the University of Michigan, School of Dentistry, Ann Arbor, Michigan, USA
| | - Erinne N Kennedy
- Assistant Professor and Assistant Dean for Curriculum and Integrated Learning at Kansas City University College of Dental Medicine, Joplin, Missouri, USA
| | - Laura Romito
- Professor and Associate Dean of Education and Academic Affairs at the Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - Denice Stewart
- Adjunct Professor at the University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Gulsun Gul
- Chief of Innovation, Clinical Education & Public Health at the American Dental Education Association, Washington, District of Columbia, USA
| | - Phillip Marucha
- Co-Chair, ADEA EPA group; Professor, Oregon Health & Science University School of Dentistry, Portland, Oregon, USA
| | - Rocio B Quinonez
- Co-Chair, ADEA EPA group; Professor and Associate Dean for Curriculum, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
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Janusz CB, Doan TT, Gebremariam A, Rose A, Keels MA, Quinonez RB, Eckert G, Yanca E, Fontana M, Prosser LA. A Cost-Effectiveness Analysis of Population-Level Dental Caries Prevention Strategies in US Children. Acad Pediatr 2024:S1876-2859(24)00061-5. [PMID: 38548263 DOI: 10.1016/j.acap.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE To improve oral health disparities and outcomes among US children impacted by dental caries, there is a need to understand the cost-effectiveness of a targeted, risk-based versus universal-based approach for caries prevention. METHODS Health and economic outcomes were simulated in a cohort of 50,000 US children aged 1-18 years, comparing current practice (CP) to risk-based-prevention (RBP) and prevention-for-all (PFA) strategies using health care sector and limited societal perspectives. Prevention included biannual oral health exams and fluoride varnish application, and one-time dental sealant placement. The primary outcome is the cost-effectiveness ratio (ICER), defined as the additional cost per quality-adjusted life year (QALY) gained when comparing each strategy to the next least costly one. RESULTS For RBP compared to CP, the ICER was US$83,000/QALY from the health care sector perspective; for PFA compared to RBP the ICER was US$154,000/QALY. Using a limited societal perspective that includes caregiver time spent attending dental or medical setting visits, RBP compared to CP yielded a ratio of $119,000/QALY and PFA compared to RBP was $235,000/QALY. Results were most sensitive to changes in the probability of pain from an episode of dental caries, costs for prevention and restoration, and the loss in health-related quality of life due to dental caries pain. Scenario analyses evaluating a reduced intensity of prevention services yielded lower ICERs. CONCLUSION Using a risk-based approach that identifies and targets children at increased risk for dental caries to guide the delivery of prevention services represents an economic value similar to other pediatric prevention programs.
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Affiliation(s)
- Cara B Janusz
- Susan B. Meister Child Health and Evaluation Research (CHEAR) Center (CB Janusz, T Doan, A Gebremariam, A Rose, and LA Prosser), Department of Pediatrics, University of Michigan, Ann Arbor, Mich.
| | - Tran T Doan
- Susan B. Meister Child Health and Evaluation Research (CHEAR) Center (CB Janusz, T Doan, A Gebremariam, A Rose, and LA Prosser), Department of Pediatrics, University of Michigan, Ann Arbor, Mich; Department of Health Management and Policy (T Doan and LA Prosser), School of Public Health, University of Michigan, Ann Arbor, Mich; Department of Pediatrics (T Doan), University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Acham Gebremariam
- Susan B. Meister Child Health and Evaluation Research (CHEAR) Center (CB Janusz, T Doan, A Gebremariam, A Rose, and LA Prosser), Department of Pediatrics, University of Michigan, Ann Arbor, Mich
| | - Angela Rose
- Susan B. Meister Child Health and Evaluation Research (CHEAR) Center (CB Janusz, T Doan, A Gebremariam, A Rose, and LA Prosser), Department of Pediatrics, University of Michigan, Ann Arbor, Mich
| | - Martha A Keels
- Department of Pediatrics (MA Keels), Duke University, Durham, NC; Division of Pediatric Dentistry and Public Health (MA Keels and RB Quinonez), University of North Carolina Adams School of Dentistry, Chapel Hill, NC
| | - Rocio B Quinonez
- Division of Pediatric Dentistry and Public Health (MA Keels and RB Quinonez), University of North Carolina Adams School of Dentistry, Chapel Hill, NC
| | - George Eckert
- Department of Biostatistics and Health Data Science (G Eckert and E Yanca), Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Bloomington, Ind
| | - Emily Yanca
- Department of Biostatistics and Health Data Science (G Eckert and E Yanca), Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Bloomington, Ind
| | - Margherita Fontana
- Department of Cariology (M Fontana), Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Lisa A Prosser
- Susan B. Meister Child Health and Evaluation Research (CHEAR) Center (CB Janusz, T Doan, A Gebremariam, A Rose, and LA Prosser), Department of Pediatrics, University of Michigan, Ann Arbor, Mich; Department of Health Management and Policy (T Doan and LA Prosser), School of Public Health, University of Michigan, Ann Arbor, Mich
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Quinonez RB, Broome A, Nesbit S, Tittemore A, Kowlowitz V, Duqum I, Uyan D, Musskopf ML, Phillips K, Moretti A, Mason M, Jacobs A, Brian Z, Simancas-Pallares M, Swift EJ, Ramaswamy V, Guthmiller JM. Developing entrustable professional activities for general dentistry at the University of North Carolina. J Dent Educ 2023; 87:1718-1724. [PMID: 37740716 DOI: 10.1002/jdd.13374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION As part of curriculum innovation, the University of North Carolina (UNC) Adams School of Dentistry identified core entrustable professional activities (EPAs) that graduates must demonstrate for practice readiness. This paper describes the development of the UNC EPAs and the perceptions of the general dentistry faculty. METHODS Upon establishing a blueprint of knowledge, skills, and attitudes of UNC graduates, using a distributed leadership approach, faculty teams developed EPAs focused on the patient care process. The American Dental Education Association Compendium of Clinical Competency Assessments and Commission on Dental Accreditation Standards informed the team's work. Perceptions of the assessment framework were examined using a questionnaire completed by 13 general dentistry faculty considering the importance, accuracy, and agreement of each EPA, associated domains of competence, and encounter management on a 6-point rating scale. RESULTS Distributed leadership was a useful strategy in EPA development to disperse decision-making and build ownership. Through multiple iterations, four EPAs (assessment, plan of care, collaborative care, and provision of care) with associated sub-EPAs emerged. EPAs included a description, required knowledge and skills, and rubrics for assessment. The general dentistry faculty reported a high level of importance, accuracy, and agreement with EPAs, domains of competence, and encounter management. DISCUSSION EPAs provide a standardized manner to describe the comprehensive work dentists perform, shifting away from individual competencies. The UNC EPAs provide the foundation for longitudinal measures of competence preparing graduates for independent practice. With limited EPAs frameworks available in dentistry, we aim to inform the development and implementation of EPAs across dental education.
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Affiliation(s)
- Rocio B Quinonez
- University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Angela Broome
- Division of Diagnostic Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Sam Nesbit
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Ashley Tittemore
- University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Vicki Kowlowitz
- University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Ibrahim Duqum
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Dilek Uyan
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Marta L Musskopf
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Keith Phillips
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Antonio Moretti
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Matt Mason
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Alexa Jacobs
- University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Zachary Brian
- Division of Pediatric and Public Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Miguel Simancas-Pallares
- Division of Pediatric and Public Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Edward J Swift
- University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Vidya Ramaswamy
- University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Janet M Guthmiller
- University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
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Danciu T, Quinonez RB, Ramaswamy V, Murdoch-Kinch CA. Author's Response. J Am Dent Assoc 2023; 154:968. [PMID: 37737769 DOI: 10.1016/j.adaj.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Theodora Danciu
- Professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Rocio B Quinonez
- Professor and Associate Dean for Curriculum, Division of Pediatric Dentistry and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Vidya Ramaswamy
- Director of Evaluation and Promotion of Teaching and Learning, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Carol Anne Murdoch-Kinch
- Professor, Department of Oral Pathology, Medicine, and Radiology, Interim Chancellor, Indiana University-Purdue University Indianapolis, Indianapolis, IN
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Brame JL, Quinonez RB, Ciszek BP, Weintraub JA. Implementing a Prenatal Oral Health Program for Dental Students: Lessons Learned. Health Promot Pract 2023:15248399231207070. [PMID: 37904487 DOI: 10.1177/15248399231207070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
The Prenatal Oral Health Program (pOHP) was developed to educate dental students on prenatal oral health and promote access to dental care for pregnant women. Program advancement has occurred in support of quality improvement. This mixed-methods design combined quantitative data from fourth-year dental students who participated the pOHP (N = 81) and qualitative data from a student-faculty-staff focus group discussion (N = 7). Different clinical structures, appropriate leveling in the curriculum, management with a patient care coordinator, and inclusion of interprofessional learning experiences (IPE) were compared. The survey response rate was 96.4% (N = 81). Trends were noted between students who provided clinical care for a pregnant patient (31%) versus those who did not. Results indicated that an integrated clinic was preferred, though students who had treated a pOHP patient showed greater support for a standalone clinic model. Survey and focus group data agreed that pOHP should occur during the third-year dental school training; however, students with patient experience favored second-year placement. Survey and focus group data emphasize the importance of a patient care coordinator for clinical management and IPE as an essential learning element. Innovating new clinical models requires a period of evolution to determine preferred and sustainable infrastructure. Results reveal the advantages and disadvantages of various program implementation models and demonstrate that student perceptions were influenced by their clinical experiences. Study findings will inform implementation and guide other programs as they create and modify existing curricula to enhance prenatal oral health.
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Affiliation(s)
- Jennifer L Brame
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rocio B Quinonez
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brittney P Ciszek
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- The University of Utah, Salt Lake City, UT, USA
| | - Jane A Weintraub
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Vamos CA, Cayama MR, Mahony H, Griner SB, Quinonez RB, Boggess K, Beckstead J, Daley EM. Oral health during pregnancy: an analysis of interprofessional guideline awareness and practice behaviors among prenatal and oral health providers. BMC Pregnancy Childbirth 2023; 23:721. [PMID: 37821843 PMCID: PMC10566079 DOI: 10.1186/s12884-023-06032-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Poor oral health during pregnancy has significant implications across the life course, including increased risk for adverse pregnancy, birth outcomes, and the development of early childhood caries. In efforts to improve perinatal oral health in the United States, a set of national interprofessional guidelines were developed that include recommended practice behaviors for both oral health providers and prenatal providers. The purpose of this study was to examine guideline awareness, familiarity, beliefs, and practice behaviors among both provider types. METHODS Prenatal providers and oral health providers in Florida were recruited via random and convenience sampling to complete an online survey guided by the Consolidated Framework for Implementation Research (CFIR) and the Cabana Framework. The present analysis focused on the Individuals Involved domain (CFIR), awareness and familiarity with the guidelines (Cabana Framework), confidence, and practice behaviors as recommended by prenatal oral health guidelines (assess, advise, refer, share/coordinate). Data were analyzed using chi-square tests, independent samples t-tests, Pearson correlation coefficients, and one-way analysis of variance (ANOVA) and analyses were conducted in SPSS. RESULTS Prenatal and oral health providers did not differ significantly in their awareness of the guidelines, but awareness was significantly associated with three of the four practice behaviors for prenatal providers. Familiarity with the guidelines was significantly higher among oral health providers and was associated with all four practice behaviors for both provider types. Five out of ten oral health belief items were significantly associated with practicing the guidelines among prenatal providers, but only two among oral health providers. Confidence in performing the practice behaviors was significantly associated with guideline implementation among both groups. Years in practice was significantly associated with performing practice behaviors for prenatal providers, but not for oral health providers. CONCLUSIONS Our findings highlight the importance of professional organizations and the role of clinical guidelines on practice behaviors. Although provider education is a key implementation strategy, organizational and policy-level system changes could also be critical in supporting practice behaviors.
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Affiliation(s)
- Cheryl A Vamos
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd MDC 56, Tampa, FL, 33612, USA.
| | - Morgan Richardson Cayama
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd MDC 56, Tampa, FL, 33612, USA
| | - Helen Mahony
- College of Social Sciences and Public Policy, Florida State University, 113 Collegiate Loop, Tallahassee, FL, 32304, USA
| | - Stacey B Griner
- School of Public Health, The University of North Texas Health Science Center at Fort Worth, 3500 Camp Bowie Blvd Fort Worth, Fort Worth, TX, 76107, USA
| | - Rocio B Quinonez
- Division of Pediatric Dentistry and Public Health, Department of Pediatrics, Schools of Dentistry and Medicine, University of North Carolina at Chapel Hill, 385 S. Columbia St., Chapel Hill, NC, 27599, USA
| | - Kim Boggess
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, 3009 Old Clinic Building, Campus Box 7570, Chapel Hill, NC, 27599, USA
| | - Jason Beckstead
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd MDC 56, Tampa, FL, 33612, USA
| | - Ellen M Daley
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd MDC 56, Tampa, FL, 33612, USA
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Kornegay EC, Hayon E, Gisler S, Bell G, Wilder R, Stewart S, Quinonez RB. Preparing learners to ACT as change agents: Early implementation of leadership curricula in dental education. J Dent Educ 2023; 87:1257-1270. [PMID: 37248729 DOI: 10.1002/jdd.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/01/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Graduates of dental schools are expected to become leaders in their practices, communities, and profession. Yet, formal leadership training is underutilized in U.S. dental school curricula to help learners develop these skills. The objective of this study was to understand third- and fourth-year dental students' perceptions of their initial semester of Bell Leadership Institute training as part of the novel Advocate, Clinician, Thinker curriculum at the UNC Adams School of Dentistry. METHODS Focus groups of 52 third- and fourth-year dental students were conducted after the completion of the first semester of leadership seminars. Session notes were transcribed, and qualitative analysis was performed to help elucidate student perceptions of the value and pertinence of the leadership seminars. RESULTS Participants valued the opportunities to self-reflect, develop listening skills, and learn strategies to address and mitigate conflict through the leadership seminars. Perceptions of seminar length, frequency, and structure were varied. Participants also noted that explicit connections and applications of leadership topics to the field of dentistry would improve the quality of the programing. Feedback from 52 focus group participants suggests a general appreciation for curriculum-integrated leadership training. CONCLUSION Early implementation of seminar-style leadership training in dental school curricula appears to be a productive avenue for developing critical leadership skills in dental school graduates.
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Affiliation(s)
- Elizabeth C Kornegay
- Division of Comprehensive Health, The UNC-CH Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Ellen Hayon
- Bell Leadership Institute, Chapel Hill, North Carolina, USA
| | - Susan Gisler
- Bell Leadership Institute, Chapel Hill, North Carolina, USA
| | - Gerald Bell
- Bell Leadership Institute, Chapel Hill, North Carolina, USA
| | - Rebecca Wilder
- The UNC-CH Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Shadoe Stewart
- Department of Periodontology, The UNC-CH Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Rocio B Quinonez
- The UNC-CH Adams School of Dentistry, Chapel Hill, North Carolina, USA
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Quinonez RB, Zomorodi M, Broome A, Mason M, Duqum I. Using a change management model to develop and implement dental curricula: A case study. J Dent Educ 2023; 87:1279-1283. [PMID: 37401448 DOI: 10.1002/jdd.13289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/17/2023] [Accepted: 05/10/2023] [Indexed: 07/05/2023]
Abstract
Curriculum transformation is a guiding principle and driving force to continued institutional growth and innovation in oral health education. The transformation process starts from the need and desire for change to achieve the strategic goals of curriculum invocation. The design and implementation process must follow a systematic approach to ensure the oral health curricula are meeting the demands of preparing learners for their future careers and are in line with the institutional strategic goals and processes. The process of curriculum transformation needs to be carefully crafted and implemented to include all constituents and have clear and measurable outcomes to define its path and results. The University of North Carolina at Chapel Hill Adams School of Dentistry is undergoing the journey of oral health curriculum innovation and transformation. The goal of this paper is to describe the change management process using Kotter's organizational model that may apply to other schools aiming to innovate dental curricula.
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Affiliation(s)
- Rocio B Quinonez
- Division of Pediatric Dentistry and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Meg Zomorodi
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Angela Broome
- Division of Diagnostic Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matt Mason
- Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ibrahim Duqum
- Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Quinonez RB, Danciu T, Ramaswamy V, Murdoch-Kinch CA. Bridging the gap between dental education and clinical practice: The entrustable professional activities model. J Am Dent Assoc 2023; 154:687-689. [PMID: 37354198 DOI: 10.1016/j.adaj.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 06/26/2023]
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McLeod CD, Kornegay EC, Tiwari T, Mason MR, Mathews RB, Apostolon DN, Heaton LJ, Wright JT, Quinonez RB. Pre-doctoral dental faculty perceptions toward value-based care: An exploratory study. J Dent Educ 2023; 87:189-197. [PMID: 36131371 DOI: 10.1002/jdd.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To explore pre-doctoral faculty perceptions toward implementation of value-based care (VBC) in didactic and clinical teaching. METHODS This project was a collaborative effort between CareQuest and the University of North Carolina at Chapel Hill, Adams School of Dentistry introducing VBC to pre-doctoral dental faculty as part of a new curriculum. Following a faculty development session on VBC in June 2021, faculty and subject matter experts were invited to participate in qualitative interviews. Subject matter experts were interviewed to establish a baseline for VBC knowledge and understanding. Interviews were recorded and transcribed verbatim. Analysis was conducted by two analysts using ATLAS.ti and a thematic analysis approach. RESULTS Six faculty and two subject matter experts participated in interviews. Although dental faculty demonstrated some understanding of VBC, they recognized that more training is required to build in-depth knowledge and implementation strategies for teaching dental students. Faculty discussed value-based concepts such as prevention-focused teaching, person-centered care, and disease management over invasive restoration of teeth, and how VBC is bringing about a paradigm shift in dentistry that needs to be reflected in dental education. They acknowledged a disconnect between VBC in didactic teaching versus clinical instruction. Those interviewed believed it would take time to shift faculty mindset and readiness to teach VBC, and continued efforts are needed at the leadership and faculty level for acceptance and implementation. CONCLUSIONS Although dental faculty recognize that VBC can bring a shift in dental practice, more training and guidance to implement it in didactic and clinical teaching is needed.
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Affiliation(s)
| | - Elizabeth C Kornegay
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Tamanna Tiwari
- Department of Community Dentistry & Population Health, University of Colorado School of Dental Medicine, Aurora, Colorado, USA
| | - Matthew R Mason
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | | | | | - Lisa J Heaton
- CareQuest Institute for Oral Health, Boston, Massachusetts, USA
| | - John T Wright
- Division of Pediatrics and Public Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Rocio B Quinonez
- Division of Pediatrics and Public Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
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Gill SA, Quinonez RB, Deutchman M, Conklin CE, Rizzolo D, Rabago D, Haidet P, Silk H. Integrating Oral Health into Health Professions School Curricula. Med Educ Online 2022; 27:2090308. [PMID: 35733361 PMCID: PMC9245988 DOI: 10.1080/10872981.2022.2090308] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/13/2022] [Indexed: 05/25/2023]
Abstract
Oral health is essential to human health. Conditions associated with poor oral health involve all organ systems and many major disease categories including infectious disease, cardiovascular disease, chronic pain, cancer, and mental health. Outcomes are also associated with health equity. Medical education organizations including the Association of American Medical Colleges and National Academy of Medicine recommend that oral health be part of medical education. However, oral health is not traditionally included in many medical school, physician assistant, or nurse practitioner curricula. Several challenges explain this exclusion including lack of time, expertise, and prioritization; we therefore provide suggestions for integrating oral health education into the health professions school curriculum. These recommendations offer guidance for enhancing the oral health curriculum across institutions. We include key organizational and foundational steps, strategies to link oral health with existing content, and approaches to achieve curricular sustainability.
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Affiliation(s)
- Stephanie A. Gill
- Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Rocio B. Quinonez
- Office of Academic Affairs, University of North Carolina Adams School of Dentistry, Chapel Hill, NC, USA
| | - Mark Deutchman
- Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Charles E. Conklin
- Department of Surgery, and Tread Director for Oral Health and Oral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Denise Rizzolo
- Assessment and Evaluation Specialist for the Physician Assistant Education Association, Washington, DC, USA
| | - David Rabago
- Faculty Development, Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Paul Haidet
- Departments of Medicine, Humanities, and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Hugh Silk
- Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA, USA
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Kornegay EC, Hunt R, King J, Quinonez RB. Think big! Implementing a transition to practice workshop for graduating dental students. J Dent Educ 2022; 86 Suppl 3:1719-1723. [PMID: 35244211 DOI: 10.1002/jdd.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/10/2022] [Accepted: 02/21/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Elizabeth C Kornegay
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Richard Hunt
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Jack King
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Rocio B Quinonez
- Division of Pediatrics and Public Health and the Associate Dean for Curriculum, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
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Vamos CA, Griner SB, Daley EM, Cayama MR, Beckstead J, Boggess K, Quinonez RB, Damschroder L. Prenatal oral health guidelines: a theory- and practice-informed approach to survey development using a modified-Delphi technique and cognitive interviews. Implement Sci Commun 2022; 3:126. [PMID: 36443891 PMCID: PMC9703729 DOI: 10.1186/s43058-022-00363-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/15/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pregnancy presents an opportune time for oral health promotion and intervention; however, implementation of the prenatal oral health guidelines remains a challenge among prenatal and oral health providers. The purpose of this study was twofold: To employ a theory-based approach to identify high-priority Consolidated Framework for Implementation Research (CFIR) constructs with the greatest potential to impact prenatal oral health guideline implementation, and to operationalize and pre-test survey items based on the prioritized CFIR constructs. Identifying barriers and facilitators to guideline implementation will inform the development of targeted interventions that address gaps in adherence which can positively impact oral-systemic health. METHODS The online survey development process employed three rounds of a modified-Delphi technique with prenatal (i.e., MD/DO, CNM) and oral health (i.e., DMD) Practice Advisory Board Members, cognitive interviews with prenatal and oral health providers, and deliberations among the research team and a Scientific Advisory Board (OBGYN, pediatric dentist, and researchers). High-impact CFIR constructs were identified and translated into survey items that were subsequently piloted and finalized. RESULTS During three modified-Delphi rounds, a total of 39 CFIR constructs were evaluated with final input and deliberations with the Practice Advisory Board, Scientific Advisory Board, and the research team achieving consensus on 19 constructs. The instrument was pre-tested with four prenatal and two oral health providers. Overall, participants reported that the survey items were feasible to respond to, took an appropriate length of time to complete, and were well-organized. Participants identified specific areas of improvement to clarify CFIR items. The final survey instrument included 21 CFIR items across four domains, with five constructs included from the intervention characteristics domain, two from the process domain, two from the outer setting domain, and 12 from the inner setting domain. CONCLUSIONS Lessons learned from the survey development process include the importance of soliciting diverse scientific and practice-based input, distinguishing between importance/impact and direction of impact (barrier/facilitator), and the need for additional qualitative methods during interdisciplinary collaborations. Overall, this study illustrated an iterative approach to identifying high-priority CFIR constructs that may influence the implementation of the prenatal oral health guidelines into practice settings.
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Affiliation(s)
- Cheryl A. Vamos
- grid.170693.a0000 0001 2353 285XCollege of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd MDC 56, Tampa, FL 33612 USA
| | - Stacey B. Griner
- grid.266871.c0000 0000 9765 6057School of Public Health, The University of North Texas Health Science Center at Fort Worth, 3500 Camp Bowie Blvd, Fort Worth, TX 76107 USA
| | - Ellen M. Daley
- grid.170693.a0000 0001 2353 285XCollege of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd MDC 56, Tampa, FL 33612 USA
| | - Morgan Richardson Cayama
- grid.170693.a0000 0001 2353 285XCollege of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd MDC 56, Tampa, FL 33612 USA
| | - Jason Beckstead
- grid.170693.a0000 0001 2353 285XCollege of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd MDC 56, Tampa, FL 33612 USA
| | - Kim Boggess
- grid.10698.360000000122483208Department of Obstetrics and Gynecology, School of Medicine, University of North, Carolina at Chapel Hill, CB 7516, Chapel Hill, NC 27599 USA
| | - Rocio B. Quinonez
- grid.10698.360000000122483208Department of Pediatric Dentistry, Schools of Dentistry, Pediatrics and Public Health, University of North Carolina at Chapel Hill, CB 7450, Chapel Hill, NC 27599 USA
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Quinonez RB, Tittemore A, Mason M, Broome A, Wolcott M, Kornegay EC, Duqum I, Fearnow B, Phillips K, King J, Swift EJ. Preparing for implementation of an entrustable professional activity assessment framework. J Dent Educ 2022; 86:1529-1534. [PMID: 35762732 DOI: 10.1002/jdd.13014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/03/2022] [Accepted: 05/20/2022] [Indexed: 11/11/2022]
Abstract
Following the adoption of competency-based education in dentistry in the 1990s, entrustable professional activities (EPAs) were introduced in the field of medicine in the mid-2000s to help educators better determine the competence of trainees. More recently, the field of dental education has begun exploring EPAs as a framework for assessing competence while ensuring compliance with accreditation standards. This paper explores one dental school's process of preparing for implementation of a major curriculum change using an EPA assessment framework, shifting away from the use of singular assessments for competency determination to a global and longitudinal approach using a constellation of data to determine practice readiness. This paper describes how the EPA framework was developed, including the complementary capacities, assessment tool development and programming, and data reporting to follow learner progression and determine practice readiness. We discuss lessons learned leading up to implementation, and we position this perspective as a space to describe opportunities and complexities to consider when using a longitudinal assessment system. We attend to the tension between the current language of Commission of Dental Accreditation Standards as "competencies" and the evolving conversation of operationalizing EPAs while addressing accreditation Standards. To do this, we describe the process of finalizing our EPA framework and preparing for initial implementation in a new curriculum.
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Affiliation(s)
- Rocio B Quinonez
- Division of Pediatric Dentistry and Public Health/Academic Affairs, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashley Tittemore
- UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matthew Mason
- Division of Comprehensive Oral Health, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Angela Broome
- Division of Diagnostic Science, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael Wolcott
- Division of Primary Care, High Point University School of Dental Medicine and Oral Health; Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy; Division of Oral and Craniofacial Health Sciences, UNC Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Elizabeth C Kornegay
- Division of Comprehensive Oral Health, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ibrahim Duqum
- Division of Comprehensive Oral Health, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bethany Fearnow
- Academic Support Center, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Keith Phillips
- Division of Comprehensive Oral Health, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jack King
- Division of Comprehensive Oral Health, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Edward J Swift
- Division of Comprehensive Oral Health/Academic Affairs, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Meyer BD, Fearnow B, Smith HL, Morgan SG, Quinonez RB. Implementing Standardized Patient Caregivers to Practice Difficult Conversations in a Pediatric Dentistry Course. MedEdPORTAL 2022; 18:11201. [PMID: 35036525 PMCID: PMC8720916 DOI: 10.15766/mep_2374-8265.11201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/31/2021] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Standardized patient (SP) methodology has been used in health professional education to help students develop communication, deeper diagnostic reasoning, and critical thinking skills. Few examples demonstrate the use of SPs to practice difficult conversations with pediatric caregivers in the pediatric dentistry literature. The objective of this educational activity was to describe the implementation of three SPs in a pediatric dentistry course for second-year dental students. METHODS We developed three SP encounters covering interactions with caregivers of an infant with severe early childhood caries, an adolescent on the path to gender affirmation, and a child with autism and dental caries whose caregiver was resistant to fluoride- and silver-containing dental materials. We describe the case design process, rubric construction and calibration, student debriefing, and pandemic modifications. We evaluated the effectiveness of the implementation by thematic analysis of student reflections following each encounter using a qualitative descriptive framework. RESULTS Eighty-three students completed each encounter. Qualitative analysis showed that students preferred a more realistic encounter by having a child or other distraction present. Students relied on different elements of motivational interviewing depending on the objective of each encounter and the age of the patient. Overall, the SP encounters were well received by students and faculty as an alternative or supplement to traditional student evaluation methods. DISCUSSION We noted a number of lessons learned about implementing SP methodology in pediatric dental education. With these experiences now in place, future evaluations should measure student performance in the SP encounters against student performance during clinical care.
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Affiliation(s)
- Beau D. Meyer
- Assistant Professor, Division of Pediatric Dentistry, The Ohio State University College of Dentistry
- Corresponding author:
| | - Bethany Fearnow
- Curriculum Innovation Consultant, Academic Affairs, University of North Carolina at Chapel Hill Adams School of Dentistry
| | - Hannah L. Smith
- Fourth-Year Dental Student, University of North Carolina at Chapel Hill Adams School of Dentistry
| | - Sarah G. Morgan
- Fourth-Year Dental Student, University of North Carolina at Chapel Hill Adams School of Dentistry
| | - Rocio B. Quinonez
- Professor, Division of Pediatric and Public Health, and Associate Dean for Educational Leadership and Innovation, Academic Affairs, University of North Carolina at Chapel Hill Adams School of Dentistry
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Wolcott MD, Fearnow B, Moore Z, Stallard J, Tittemore AJ, Quinonez RB. How to create a faculty-centered curriculum support system: Launching the Academic Support Center (ASC) to inspire excellence in curriculum change. J Dent Educ 2021; 85:1362-1372. [PMID: 33848011 DOI: 10.1002/jdd.12613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/11/2021] [Accepted: 03/26/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE To define faculty needs and services requested for the implementation of a faculty-centered curriculum support system (i.e., Academic Support Center [ASC]) to assist curriculum redesign. METHODS Faculty and students were invited to participate in 60-min, one-on-one interviews to describe pain points in teaching and identify possible support services needed. Benchmarking through surveys of academic deans was also conducted to determine what services other institutions offer. Qualitative memos from interviews and survey data were analyzed to identify salient challenges and outline possible services that could benefit the school. This information was used to create a strategic plan for the ASC. Full-time faculty were requested to evaluate the ASC 6 and 12 months following the launch of the center in 2019. RESULTS Fifty interviews were conducted with department chairs (n = 10), full-time faculty (n = 36), and students (n = 4). Six pain points identified by participants were time, resources, knowledge, confidence, organizational structure, and organizational culture. Participants generated solutions related to supporting teaching and learning, enhancing faculty experience, and assisting educational evaluation. Twenty-two schools responded to the benchmarking survey-approximately half acknowledged a centralized curriculum support service (n = 12, 54.5% of respondents). Services often focused on instructional design, education technology, and faculty onboarding to education. Faculty feedback following the ASC launch was generally positive and demonstrating progress toward the three priorities. CONCLUSION Needs assessment and benchmarking data can inform the design and implementation of centers that offer faculty-centered support structures around teaching, educational scholarship, and curriculum change.
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Affiliation(s)
- Michael D Wolcott
- Division of Oral and Craniofacial Health Sciences, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bethany Fearnow
- Academic Affairs, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Zach Moore
- Academic Affairs, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jacob Stallard
- Academic Affairs, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashley J Tittemore
- Academic Affairs, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rocio B Quinonez
- Division of Pediatric and Public Health, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Kornegay EC, Jackson TH, LaGarry-Cahoon A, Reside JM, Wolcott MD, Quinonez RB. "I don't think the problem's the student…I think it's us": Engaging faculty in curriculum innovation. J Dent Educ 2020; 85:582-588. [PMID: 33289087 DOI: 10.1002/jdd.12495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/27/2020] [Accepted: 11/14/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE The need to innovate predoctoral dental education is well established; however, there are few recent reports to guide substantial curriculum transformation. The purpose of this study was to describe faculty perspectives on their vision of future graduates, curriculum needs, and potential barriers to a successful redesign. This information would be used to inform strategic planning for the predoctoral curriculum transformation. METHODS Eighty full-time faculty from the University of North Carolina Adams School of Dentistry participated in 60-minute focus groups in March 2018. Focus group questions were developed to elicit perceptions about the current curriculum, what the dental graduate should know in 2040, and what is needed to engage faculty in curriculum change. Transcripts of the focus group sessions were analyzed by a third-party research group using qualitative thematic analysis to identify pertinent themes shared by participants. RESULTS Faculty identified that developing clinical skill that engages multiple specialties, student time to engage in advocacy activities, and opportunities to integrate biomedical, clinical, and behavioral sciences as critical features of the curriculum. They believed the 2040 graduate should be able to critically evaluate literature, exhibit strong leadership skills, and adapt to the changing healthcare environment. To better engage faculty in curriculum change, there needs to be dedicated time, sufficient resources, a clear plan, and greater collaboration across the school. CONCLUSION When embarking on curriculum transformation, engagement with faculty is a critical component of the change process. Focus groups can be used as a technique to better understand faculty perspectives about curricular needs and the overall vision.
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Affiliation(s)
- Elizabeth C Kornegay
- Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Tate H Jackson
- Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Jonathan M Reside
- Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michael D Wolcott
- Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Rocio B Quinonez
- Division of Pediatrics and Public Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
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Quinonez RB, Santos RG, Eckert GJ, Keels MA, Levy S, Levy BT, Jackson R, Fontana M. Influence of Temperament As a Risk Indicator for Early Childhood Caries. Pediatr Dent 2020; 42:470-475. [PMID: 33369559 PMCID: PMC7773143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose: To evaluate the association between temperament and caries. Methods: A total of 408 primary caregiver-child pairs were followed for 36 months; they completed the Early Childhood Behavior Questionnaire Very Short-Form (ECBQ-VSF) at age four years. Demographic, behavioral, and clinical data were obtained at ages one, two-and-a-half, and four years, with caries experience assessed each time using the International Caries Detection and Assessment System (ICDAS). The ECBQ-VSF (36 items) was used to measure three child temperament domains: (1) surgency; (2) negative affect; and (3) effortful control. The associations between cavitated carious lesion experience by age four years (decayed, missing, and filled primary surfaces [dmfs] score greater than zero; d equals ICDAS score greater than or equal to three) and the three ECBQ-VSF temperament domains were analyzed using generalized estimating equation models. Results: Temperament domains predicted the number of carious surfaces (dmfs). After adjusting for covariates, every one-point increase in surgency and one-point increase in negative affect were associated with 77 percent and 31 percent increases in dmfs, respectively (P<0.05), and every one-point increase in effortful control was associated with a 39 percent decrease in dmfs (P<0.05). Conclusions: By age four years, children with higher levels of surgency and negative affect have a higher caries experience, whereas children with greater effortful control have a lower caries experience.
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Affiliation(s)
- Rocio B Quinonez
- Dr. Quinonez is professor, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA;,
| | - Robert G Santos
- Dr. Santos is an assistant professor, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - George J Eckert
- Mr. Eckert is a biostatistician supervisor, Department of Biostatistics, School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Ind., USA
| | - Martha Ann Keels
- Dr. Keels is an adjunct professor, Department of Pediatrics and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA
| | - Steven Levy
- Dr. S. Levy is a Wright-Bush-Shreves endowed professor of research, Department of Preventive and Community Dentistry, College of Dentistry, and professor, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Barcey T Levy
- Dr. B. T. Levy is a professor and Iowa Academy of Family Physicians endowed chair for Rural Research, Department of Family Medicine, Carver College of Medicine, and Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Richard Jackson
- Dr. Jackson is an adjunct associate professor, Department of Cariology, Operative Dentistry and Dental Public Health, School of Dentistry, Indiana University, Indianapolis, Ind., USA
| | - Margherita Fontana
- Dr. Fontana is Clifford Nelson endowed professor, Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Mich., USA
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Weintraub JA, Quinonez RB, Smith AJT, Ciarrocca K, Fouad AF, Shazib MA, Kraszeski MM, Rankin DB, Matthews NS. Responding to a pandemic: Development of the Carolina Dentistry Virtual Oral Health Care Helpline. J Am Dent Assoc 2020; 151:825-834. [PMID: 33121604 DOI: 10.1016/j.adaj.2020.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/31/2020] [Accepted: 08/08/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND A virtual oral health care help line was established to provide consultation and triage for people with dental questions and concerns. Its goal during a pandemic was to keep patients from seeking unnecessary in-person care from emergency departments and urgent care clinics, especially when dental practices were closed or limited to providing essential urgent and emergency oral health care. METHODS The Adams School of Dentistry, University of North Carolina at Chapel Hill, developed the Carolina Dentistry Virtual Oral Health Care Helpline using a quality improvement framework with faculty and staff member feedback. The process included establishing infrastructure (phone, video, protocols, referrals, documentation), personnel (scheduling, training, calibration), and internal and external communication. The authors collected retrospective information for descriptive evaluation of the first month's operations. RESULTS There were 337 telephone calls answered, of which 65 (19%) were administrative and 272 (81%) were related to dental concerns. Dental pain (54%) was the most prevalent reason for calling. Triage and Providers referred 107 of 175 callers (61%) to the school's urgent care center. Of the 79 callers who received teleconsultations from virtual providers, 33 (42%) did not require additional follow-up, and 7 (9%) needed a follow-up phone call. Overall, 4 people were referred to community clinics, and 4 were referred to the emergency department. CONCLUSIONS The Helpline was launched quickly and improved through quality improvement cycles, and it provided a needed community dental service. The process resolved some patient concerns without their seeking urgent or emergency care. PRACTICAL IMPLICATIONS The pandemic has increased teledentistry practice. The authors describe establishing a dental school's virtual oral health Helpline, which provides a framework for dental practices seeking to use this patient communication modality.
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Wolcott MD, Reside JM, Bobbitt LJ, Quinonez RB. Characterization of school of dentistry prerequisite courses and recommendations for admission. J Dent Educ 2020; 85:293-299. [PMID: 33094508 DOI: 10.1002/jdd.12460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/14/2020] [Accepted: 10/06/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE There is minimal research characterizing admission prerequisites courses across schools of dentistry. The purpose of this study was to typify didactic and laboratory course requirements and compare requirements based on institution demographics. METHODS In July 2019, the researchers evaluated websites from 76 North American dental schools to collect information on required and recommended courses, credit hour requirements, and institution demographics. Sub-group analyses evaluated differences in course and credit hour differences based on institution funding, degree program, location, and Carnegie Classification. RESULTS The most common required courses were general chemistry (97.4%), physics (93.4%), organic chemistry (92.1%), general biology (90.8%), communication (86.8%), and biochemistry (80.3%). The most common required laboratory courses were general chemistry (63.2%), organic chemistry (59.2%), general biology (55.3%), and physics (51.3%). Several institutions included unique course recommendations such as histology (40.7%), psychology (30.3%), art (18.4%), business (18.4%), sociology (15.8%), and embryology (14.5%). There were few differences based on institution classifications; however, differences were observed most often between institutions within and outside the United States. The study also identified 65.8% (n = 50) of schools have letter of recommendation requirements and 46.1% (n = 35) of schools require or recommend shadowing experiences with programs requesting a median of 60 hours (range 20-300 hours). CONCLUSIONS The study offers a contemporary characterization of prerequisite requirements and recommendations. In addition, the study raises critical questions about whether these standards reflect expectations for entering learners, if these requirements truly relate to learner success, and if these requirements prepare learners to be future-ready graduates.
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Affiliation(s)
- Michael D Wolcott
- Division of Oral and Craniofacial Health Sciences, University of North Carolina Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Jonathan M Reside
- Division of Comprehensive Oral Health, University of North Carolina Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Laura J Bobbitt
- Vanderbilt University Medical Center in Nashville, Nashville, Tennessee, USA
| | - Rocio B Quinonez
- Division of Pediatrics and Public Health, University of North Carolina Adams School of Dentistry, Chapel Hill, North Carolina, USA
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Wolcott MD, Quinonez RB, Tittemore AJ, LaGarry‐Cahoon A, Zomorodi M, Reside JM, Jackson TH. Developing a curriculum blueprint and taxonomy: Process, progress, and pivots. J Dent Educ 2020; 84:1368-1377. [DOI: 10.1002/jdd.12412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Michael D. Wolcott
- Division of Oral and Craniofacial Health Sciences University of North Carolina Adams School of Dentistry Chapel Hill North Carolina USA
- Division of Practice Advancement and Clinical Education University of North Carolina Eshelman School of Pharmacy Chapel Hill North Carolina USA
| | - Rocio B. Quinonez
- Division of Pediatrics and Public Health University of North Carolina Adams School of Dentistry Chapel Hill North Carolina USA
| | - Ashley J. Tittemore
- Office of the Dean University of North Carolina Adams School of Dentistry Chapel Hill North Carolina USA
| | | | - Meg Zomorodi
- University of North Carolina School of Nursing Chapel Hill North Carolina USA
- Office of Interprofessional Education and Practice University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Jonathan M. Reside
- Division of Comprehensive Oral Health University of North Carolina Adams School of Dentistry Chapel Hill North Carolina USA
| | - Tate H. Jackson
- Division of Craniofacial and Surgical Care University of North Carolina Adams School of Dentistry Chapel Hill North Carolina USA
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Wolcott MD, Mason MR, Broome AM, Tittemore AJ, De Rossi SS, Quinonez RB. Faculty perspectives of an entrustable professional activity (EPA) framework in predoctoral dental education. J Dent Educ 2020; 84:955-963. [DOI: 10.1002/jdd.12373] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/26/2020] [Accepted: 08/04/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Michael D. Wolcott
- Division of Oral and Craniofacial Health Sciences UNC Adams School of Dentistry, University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
- Division of Practice Advancement and Clinical Education UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Matthew R. Mason
- Division of Comprehensive Oral Health UNC Adams School of Dentistry, University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Angela M. Broome
- Division of Diagnostic Sciences UNC Adams School of Dentistry, University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Ashley J. Tittemore
- Office of the Dean UNC Adams School of Dentistry, University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Scott S. De Rossi
- Office of the Dean UNC Adams School of Dentistry, University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Rocio B. Quinonez
- Division of Pediatric and Public Health UNC Adams School of Dentistry, University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
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Wolcott MD, Quinonez RB, Ramaswamy V, Murdoch‐Kinch CA. Can we talk about trust? Exploring the relevance of “Entrustable Professional Activities” in dental education. J Dent Educ 2020; 84:945-948. [DOI: 10.1002/jdd.12354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/19/2020] [Accepted: 07/26/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Michael D. Wolcott
- Division of Oral and Craniofacial Health Sciences University of North Carolina Adams School of Dentistry Chapel Hill North Carolina USA
| | - Rocio B. Quinonez
- Division of Pediatrics and Public Health University of North Carolina Adams School of Dentistry Chapel Hill North Carolina USA
| | - Vidya Ramaswamy
- Curriculum and Program Evaluation University of Michigan School of Dentistry Ann Arbor Michigan USA
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Meyer BD, Fearnow, BS B, Quinonez RB. Asynchronous pediatric caregiver simulation in a virtual setting during the COVID pandemic. J Dent Educ 2020; 85:1114-1116. [PMID: 32673404 PMCID: PMC7404519 DOI: 10.1002/jdd.12319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Beau D. Meyer
- Division of Pediatric and Public Health at the University of North Carolina at Chapel Hill Adams School of DentistryChapel HillNorth CarolinaUSA
- Division of Pediatric Dentistry at the Ohio State University College of DentistryColumbusOhioUSA
| | - Bethany Fearnow, BS
- Curriculum Innovation Consultant in Academic AffairsUniversity of North Carolina at Chapel Hill Adams School of DentistryChapel HillNorth CarolinaUSA
| | - Rocio B. Quinonez
- Division of Pediatric and Public HealthAcademic AffairsUniversity of North Carolina at Chapel Hill Adams School of DentistryChapel HillNorth CarolinaUSA
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Padilla R, Kowlowitz V, Quinonez RB, Ciarrocca K, Gilchrist MJ, Gilliland KO, Koonce TF, Lampiris L, Beck Dallaghan GL. Working collaboratively across schools to promote oral health education through interprofessional education. J Dent Educ 2020; 84:1108-1116. [PMID: 32585048 DOI: 10.1002/jdd.12252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE The Association of American Medical Colleges and American Dental Education Association have identified oral health knowledge, skills, and attitudes shared by both medical and dental professionals. Although oral health was deemed an essential competency for medical practitioners, our state struggled to ensure learners received proper training. This training deficit resulted in conducting a needs assessment and implementing an oral health interprofessional module at our schools. METHODS First-year medical students and clinical faculty were emailed surveys in 2016 to obtain baseline information. A team of faculty and students from the Schools of Medicine and Dentistry reviewed the curriculum to determine where to augment oral health content. An oral health module to teach a basic head, neck, and oral examination to first-year medical students during their patient-centered care small-group sessions was implemented and evaluated. RESULTS Only 13.6% of faculty respondents were aware of national oral health competency recommendations, and <50% rated oral health important for primary care physicians (PCPs) to include in history, physical exam, or oral health counseling. On baseline, ≤25% of PCP respondents reported integrating the listed skills in their practice, and most indicated lacking expertise to teach oral health. Teaching sessions were rated helpful by students and faculty. After the teaching sessions, ratings on the importance of including oral health significantly increased from baseline. CONCLUSION Collaboration between Schools of Dentistry and Medicine successfully integrated oral health into medical school curriculum and improved the tutors' attitudes of its importance.
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Affiliation(s)
- Ricardo Padilla
- Oral and Maxillofacial Pathology Graduate Program, UNC Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Vicki Kowlowitz
- UNC Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Rocio B Quinonez
- Educational Leadership and Innovation, UNC Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Katharine Ciarrocca
- Interprofessional Education and Practice, UNC Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Michael J Gilchrist
- Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Kurt O Gilliland
- Cell Biology and Physiology, and Curriculum, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Thomas F Koonce
- Department of Family Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Lewis Lampiris
- Community Engagement, UNC Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Gary L Beck Dallaghan
- Educational Scholarship, and Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
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Ather A, Zhong S, Rosenbaum AJ, Quinonez RB, Khan AA. Pharmacotherapy during Pregnancy: An Endodontic Perspective. J Endod 2020; 46:1185-1194. [PMID: 32590023 DOI: 10.1016/j.joen.2020.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/06/2020] [Accepted: 05/31/2020] [Indexed: 12/27/2022]
Abstract
Odontogenic pain affects up to 54.9% of pregnant women1-3. This pain is often associated with pulpal and/or periapical infections that pose risks to women and their fetus. The American Dental Association in collaboration with the American College of Obstetricians and Gynecologists developed a consensus statement to affirm the importance of timely and appropriate oral health care as a critical component of a healthy pregnancy4. However, limited knowledge of endodontic procedure safety and related medication use often result in the avoidance of treatment during pregnancy. This article, a collaborative effort by specialists from endodontics, pediatric dentistry, and obstetrics, reviews the current evidence on the safety of medications commonly used in endodontics including local anesthetics, analgesics, anxiolytics, and antibiotics.
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Affiliation(s)
- Amber Ather
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Sheng Zhong
- Private Practice, Endodontics Associates Limited, Roseville, Minnesota
| | - Alan J Rosenbaum
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, Texas
| | - Rocio B Quinonez
- Department of Pediatric Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, Texas
| | - Asma A Khan
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
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Brame JL, Quinonez RB, Phillips C. Implementing a Prenatal Oral Health Program in Dental Hygiene Curriculum. J Dent Hyg 2020; 94:56-64. [PMID: 33376123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/20/2020] [Indexed: 06/12/2023]
Abstract
Purpose: Inadequate prenatal oral health education in dental hygiene (DH) curricula can negatively impact patient care by graduating clinicians lacking competence in the provision of care for this population. The purpose of this study was to assess the knowledge, opinions, and willingness of DH students to provide oral care services to pregnant patients before and after participating in a prenatal oral health educational program (pOHP).Methods: Senior DH students were invited to complete a baseline and post-program survey to evaluate their experiences in the pOHP at the University of North Carolina, Chapel Hill. All senior DH students attended a one-hour lecture on prenatal oral health guidelines and practices prior to their clinical rotation in the pOHP. Each survey consisted of items on knowledge, confidence, and attitudes related to screening, counseling, and willingness to provide oral care services to pregnant patients.Results: Over a period of three years, 93 DH students (n=93) completed both the baseline and post-program surveys for a 96.8% response rate. Participants reported gains in knowledge and confidence for screening and counseling pregnant patients. Post-program survey respondents agreed that dental providers should deliver oral health counselling to pregnant women (99%, n=93) and perform an oral health examination during prenatal care (99%, n=92). Nearly all of the respondents, (98%; n=90) reported they are likely to take care of pregnant women upon graduation and deliver preventive oral health messaging to this population (98%, n=91).Conclusion: Dental hygiene student participants in a prenatal oral health program (pHOP) demonstrated positive trends in increasing knowledge and confidence in screening and counseling pregnant patients in the dental setting. Inclusion of a clinical experience played an influential role in changes in knowledge regarding the safety of care during pregnancy, indicating a need for both didactic and clinical immersion opportunities to enhance cognitive and affective transformations.
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Vamos CA, Griner SB, Kirchharr C, Green SM, DeBate R, Daley EM, Quinonez RB, Boggess KA, Jacobs T, Christiansen S. The development of a theory-based eHealth app prototype to promote oral health during prenatal care visits. Transl Behav Med 2019; 9:1100-1111. [PMID: 31009536 PMCID: PMC6875649 DOI: 10.1093/tbm/ibz047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Poor maternal oral health during pregnancy is associated with adverse maternal and child outcomes, including preterm birth and early childhood caries. Subsequently, professional associations have developed prenatal oral health guidelines, but significant gaps exist in implementing guidelines into clinical practice. The purpose of this study was to develop and test the usability of an innovative, theory-driven, eHealth application ("app") to facilitate prenatal providers' (nurse practitioners and midwives) implementation of oral health promotion during prenatal care visits. App development was guided by previous research, an integrated conceptual framework, Scientific Advisory Board input, and consumer-engaged iterative processes utilizing mixed-methods (observations, surveys, in-depth interviews) among providers (n = 4) during 10 unique prenatal care visits at a federally qualified health care center. Triangulation of quantitative and qualitative data analysis produced descriptive frequencies and salient themes. Concepts and principles from the following theoretical frameworks informed intervention development and testing: Consolidated Framework for Implementation Research; Information-Motivation-Behavioral Skills Model; Health Literacy; and Brief Motivational Interviewing. Overall, providers reported the app was effective at providing the information, motivation, and behavioral skills needed to integrate oral health promotion (e.g., easy to use; provided cues to action via scripts and tailored education; and documented findings into the patient's record). Although providers reported high usability, time constraints and detailed patient counseling scripts were identified areas for improvement. Findings suggest that the eHealth app could serve as an innovative mechanism to assist providers in implementing the prenatal oral health guidelines into practice. Future research is needed to continue app development efforts and to determine efficacy and effectiveness in practice settings.
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Affiliation(s)
- Cheryl A Vamos
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Stacey B Griner
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Claire Kirchharr
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Shana M Green
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Rita DeBate
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Ellen M Daley
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Rocio B Quinonez
- Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Kim A Boggess
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Tom Jacobs
- Custom Thinking Media, LLC, Eugene, OR, USA
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Weintraub JA, Quinonez RB, Friga PN, Kowlowitz V, Ciarrocca K. Development of a Dental School Strategic Plan to Inform Interprofessional Education. J Dent Educ 2019; 83:1411-1419. [PMID: 31501256 DOI: 10.21815/jde.019.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/07/2019] [Indexed: 11/20/2022]
Abstract
Changes in U.S. health care delivery systems and Commission on Dental Accreditation standards provide impetus for interprofessional education (IPE) and collaborative practice, but roadmaps for engaging dental and dental hygiene faculty to incorporate IPE in a systematic manner are limited. The purpose of this report is to describe the process for creating a strategy and gathering a variety of baseline data to use for determining objectives and metrics and the subsequent development of an IPE strategic plan at the University of North Carolina (UNC) at Chapel Hill Adams School of Dentistry (SOD). SOD IPE committee members included representation from the UNC Schools of Dentistry, Medicine, Pharmacy, and Business. A three-phase framework was developed. Phase 1 (IPE assessment) was an internal environmental scan including a 2017 faculty survey, departmental mapping of IPE activities, comparison of UNC with national results on the IPE component of the American Dental Education Association (ADEA) survey of dental school seniors (2016 graduating class), identification of faculty joint/adjunct appointments at other UNC schools, and a strengths, weaknesses, opportunities, threats (SWOT) analysis. Phase 2 (visioning) consisted of development of IPE mission, vision, and priorities. In Phase 3 (implementation), priorities were developed. Data-gathering led to a strategic plan with three objectives: 1) increase faculty engagement and recognition, 2) develop predoctoral dentistry and dental hygiene IPE curricula, and 3) develop an infrastructure that supports IPE. Specific initiatives and activities, supporting metrics, and estimated costs were developed for each objective. The framework guided a systematic, transparent, and organized process for collecting and monitoring the evidence and directing activities. A three-year strategic plan for IPE was developed in 2017, and implementation is ongoing.
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Affiliation(s)
- Jane A Weintraub
- Jane A. Weintraub, DDS, MPH, is Rozier Douglass Distinguished Professor of Dental Public Health, Division of Pediatric and Public Health, and former Dean, University of North Carolina at Chapel Hill Adams School of Dentistry; Rocio B. Quinonez, DMD, MS, MPH, is Associate Dean for Educational Leadership and Innovation and Professor, Division of Pediatric and Public Health, University of North Carolina at Chapel Hill Adams School of Dentistry; Paul N. Friga, MBA, PhD, is Clinical Associate Professor of Strategy and Entrepreneurship, University of North Carolina at Chapel Hill Kenan-Flagler Business School; Vicki Kowlowitz, PhD, is Evaluation, Teaching, and Learning Consultant, Academic Support Center, University of North Carolina at Chapel Hill Adams School of Dentistry; and Katharine Ciarrocca, DMD, MSEd, is Associate Professor and Director of Interprofessional Education and Practice, Division of Diagnostic Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry.
| | - Rocio B Quinonez
- Jane A. Weintraub, DDS, MPH, is Rozier Douglass Distinguished Professor of Dental Public Health, Division of Pediatric and Public Health, and former Dean, University of North Carolina at Chapel Hill Adams School of Dentistry; Rocio B. Quinonez, DMD, MS, MPH, is Associate Dean for Educational Leadership and Innovation and Professor, Division of Pediatric and Public Health, University of North Carolina at Chapel Hill Adams School of Dentistry; Paul N. Friga, MBA, PhD, is Clinical Associate Professor of Strategy and Entrepreneurship, University of North Carolina at Chapel Hill Kenan-Flagler Business School; Vicki Kowlowitz, PhD, is Evaluation, Teaching, and Learning Consultant, Academic Support Center, University of North Carolina at Chapel Hill Adams School of Dentistry; and Katharine Ciarrocca, DMD, MSEd, is Associate Professor and Director of Interprofessional Education and Practice, Division of Diagnostic Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry
| | - Paul N Friga
- Jane A. Weintraub, DDS, MPH, is Rozier Douglass Distinguished Professor of Dental Public Health, Division of Pediatric and Public Health, and former Dean, University of North Carolina at Chapel Hill Adams School of Dentistry; Rocio B. Quinonez, DMD, MS, MPH, is Associate Dean for Educational Leadership and Innovation and Professor, Division of Pediatric and Public Health, University of North Carolina at Chapel Hill Adams School of Dentistry; Paul N. Friga, MBA, PhD, is Clinical Associate Professor of Strategy and Entrepreneurship, University of North Carolina at Chapel Hill Kenan-Flagler Business School; Vicki Kowlowitz, PhD, is Evaluation, Teaching, and Learning Consultant, Academic Support Center, University of North Carolina at Chapel Hill Adams School of Dentistry; and Katharine Ciarrocca, DMD, MSEd, is Associate Professor and Director of Interprofessional Education and Practice, Division of Diagnostic Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry
| | - Vicki Kowlowitz
- Jane A. Weintraub, DDS, MPH, is Rozier Douglass Distinguished Professor of Dental Public Health, Division of Pediatric and Public Health, and former Dean, University of North Carolina at Chapel Hill Adams School of Dentistry; Rocio B. Quinonez, DMD, MS, MPH, is Associate Dean for Educational Leadership and Innovation and Professor, Division of Pediatric and Public Health, University of North Carolina at Chapel Hill Adams School of Dentistry; Paul N. Friga, MBA, PhD, is Clinical Associate Professor of Strategy and Entrepreneurship, University of North Carolina at Chapel Hill Kenan-Flagler Business School; Vicki Kowlowitz, PhD, is Evaluation, Teaching, and Learning Consultant, Academic Support Center, University of North Carolina at Chapel Hill Adams School of Dentistry; and Katharine Ciarrocca, DMD, MSEd, is Associate Professor and Director of Interprofessional Education and Practice, Division of Diagnostic Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry
| | - Katharine Ciarrocca
- Jane A. Weintraub, DDS, MPH, is Rozier Douglass Distinguished Professor of Dental Public Health, Division of Pediatric and Public Health, and former Dean, University of North Carolina at Chapel Hill Adams School of Dentistry; Rocio B. Quinonez, DMD, MS, MPH, is Associate Dean for Educational Leadership and Innovation and Professor, Division of Pediatric and Public Health, University of North Carolina at Chapel Hill Adams School of Dentistry; Paul N. Friga, MBA, PhD, is Clinical Associate Professor of Strategy and Entrepreneurship, University of North Carolina at Chapel Hill Kenan-Flagler Business School; Vicki Kowlowitz, PhD, is Evaluation, Teaching, and Learning Consultant, Academic Support Center, University of North Carolina at Chapel Hill Adams School of Dentistry; and Katharine Ciarrocca, DMD, MSEd, is Associate Professor and Director of Interprofessional Education and Practice, Division of Diagnostic Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry
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Quinonez RB, Wolcott MD, Reside JM, Jackson TH, Kornegay EC, King JD, Ciarrocca K, Kowlowitz V, Swift EJ, Zomorodi M, La Garry AE, Greene JA, De Rossi SS. Call for ACTion: Transforming Dental Education at the University of North Carolina at Chapel Hill. N C Med J 2019; 80:182-185. [PMID: 31072952 DOI: 10.18043/ncm.80.3.182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The University of North Carolina at Chapel Hill Adams School of Dentistry is developing a transformative curriculum that prepares students to enter contemporary practice. The Advocate, Clinician, and Thinker (ACT) framework will provide the basis for developing a resilient workforce capable of meeting emerging health care needs over the next 40 years.
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Affiliation(s)
- Rocio B Quinonez
- professor and associate dean for educational leadership and innovation, Office of Academic Affairs, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael D Wolcott
- assistant professor and director of educational resources and scholarship, Office of Academic Affairs, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jonathan M Reside
- clinical assistant professor, Department of Periodontology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tate H Jackson
- assistant professor, Department of Orthodontics, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elizabeth C Kornegay
- clinical assistant professor, Department of Periodontology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jack D King
- clinical associate professor, Department of Restorative Sciences, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katharine Ciarrocca
- associate professor, Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Vicki Kowlowitz
- evaluation, teaching and learning consultant, Academic Affairs, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Edward J Swift
- professor and vice dean for education, Office of Academic Affairs, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Meg Zomorodi
- associate professor and assistant provost for interprofessional education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alison E La Garry
- clinical assistant professor, School of Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeffrey A Greene
- professor and academic dean, School of Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Scott S De Rossi
- professor and dean, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Acharya B, Adewumi AO, Al-Batayneh OB, Alcaraz A, Allareddy V, Alrayyes SM, Amini H, Andrews P, Beavers KS, Brecher E, Brewer RJ, Brownstein JN, Casamassimo PS, Cehreli ZC, Chi DL, Christensen JR, Christensen SJ, Cooke M, da Fonseca MA, Dahlke WO, Donly KJ, Fida Z, Fields H, Flaitz CM, Florez FLE, Fournier S, Fuks AB, Geneser MK, Gilbaugh GJ, Gosnell ES, Gross EL, Gross SH, Guelmann M, Hallett KB, Hammersmith KJ, Haney KL, Hodgson BD, Holan G, Hughes CC, Ignelzi MA, Jackson JG, Jamjoom F, Kanellis MJ, Kantaputra PN, Khajotia SS, Knobloch L, Kupietzky A, Law CS, Leary KS, Mabry TR, Marek CL, McTigue DJ, Meyer BD, Nelson T, Ng MW, Nowak AJ, Nuni E, Owais AI, Pahel BT, Quinonez RB, Ram D, Rayes SK, Sasa IS, Schwartz SB, Seale NS, Sheats RD, Shenkin JD, Sivaraman SS, Skotowski MC, Slayton RL, Spadinger A, Stark TR, Stenberg WV, Studen-Pavlovich D, Sulyanto RM, Tanbonliong T, Thikkurissy S, Timmons SR, Tinanoff N, Townsend JA, Velan E, Vieira AM, Vinall CV, Waggoner WF, Wallen J, Weber-Gasparoni K, Wells MH, Wood AJ, Wright JT, Yar Khan V, Yepes JF, Yoon AJS, Zawaideh F. Contributors. Pediatr Dent 2019. [DOI: 10.1016/b978-0-323-60826-8.00108-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Quinonez RB, Christensen JR, Fields H. Examination, Diagnosis, and Treatment Planning. Pediatr Dent 2019. [DOI: 10.1016/b978-0-323-60826-8.00019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Byrd MG, Quinonez RB, Lipp K, Chuang A, Phillips C, Weintraub JA. Translating prenatal oral health clinical standards into dental education: results and policy implications. J Public Health Dent 2018; 79:25-33. [PMID: 30286261 DOI: 10.1111/jphd.12291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/02/2018] [Accepted: 09/04/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate characteristics of pregnant women served through the University of North Carolina's (UNC) prenatal oral health program (pOHP) dental clinic and community healthcare pathways to inform efforts in promoting prenatal oral health policies. METHODS The pOHP provides medical and dental students and practitioners with interprofessional experiences caring for pregnant women. A retrospective chart audit captured 314 pregnant women who made appointments over 33 months. Descriptive statistics and bivariate comparisons were computed to assess factors associated with dental appointment attendance and treatment completion. RESULTS There were 564 pregnant women, with mean age of 29 years and gestation of 25 weeks, referred to the pOHP dental clinic from UNC OB-GYN and 20 community sites. Only 56% (N = 314) scheduled an appointment. Of the 314 appointed women, 55% (N = 172) attended at least one appointment. The majority (87%) presented with acute and/or complex treatment needs. Medicaid status was positively associated with appointment attendance (P = 0.001). Less than half (42%) of the women completed treatment prior to delivery. Mean maternal age, gestational age, and weeks to estimated date of delivery (EDD) were not significantly associated with completed treatment. CONCLUSIONS This study provides descriptive evidence of an academic, interprofessional program's ability to provide safety-net dental care to pregnant women in the state of North Carolina. Results underscore the need for dental services among pregnant women, signaling for promotion of prenatal oral health clinical standards and informing policy on the state and national levels to maximize dental coverage.
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Affiliation(s)
- M Gentry Byrd
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Rocio B Quinonez
- Departments of Pediatrics and Pediatric Dentistry, Schools of Medicine and Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Kelly Lipp
- Private Practice Pediatric Dentist, Charlotte, NC, USA
| | - Alice Chuang
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Ceib Phillips
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Jane A Weintraub
- Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
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Abstract
Orofacial growth and development is a complex process spanning the life course. This article provides an oral health overview in the context of overall growth, physical and social development from infancy through adolescence. It reviews oral health-specific developmental milestones during childhood (0-12 years) and adolescence (≥13 years). It examines issues particular to each age category or spanning multiple ages (eg, pediatric overweight and obesity, tobacco use, and dental trauma) in relation to oral health and development. In addition, the oral microbiome and its potential role in informing personalized oral health care across the life course is discussed.
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Affiliation(s)
- Bhavna T Pahel
- Department of Pediatric Dentistry, UNC School of Dentistry, University of North Carolina at Chapel Hill, 4501B Koury Oral Health Sciences Building, CB# 7450, Chapel Hill, NC 27599-7450, USA; Private Practice: Village Family Dental, 510 Hickory Ridge Drive, Suite 101, Greensboro, NC 27409-9779, USA.
| | - Anne Rowan-Legg
- Department of Pediatrics, University of Ottawa and Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada
| | - Rocio B Quinonez
- Departments of Pediatric Dentistry and Academic Affairs, School of Dentistry, The University of North Carolina at Chapel Hill, 1611 Koury Oral Health Sciences Building, CB# 7450, Chapel Hill, NC 27599-7450, USA
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Quinonez RB, Rozier RG, Mattison K, Joshi N, Preisser JS. Implementing an early childhood oral health program in a federally qualified health center in North Carolina. J Public Health Dent 2018; 78:329-336. [PMID: 30103268 DOI: 10.1111/jphd.12276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 05/04/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the Baby Oral Health Program's (bOHP) influence on dental visits for children 0 to 3 years and overall dental visits in four federally qualified health center (FQHC) clinics. METHODS Using an interrupted time series study design, administrative data were obtained for the year prior and following the intervention. The intervention included dental staff training on early childhood oral health, quality improvement, and monthly visits during the follow-up intervention period. Analysis included descriptive and segmented regression using aggregate patient visit data. RESULTS A total of 10,400 patients made 26,416 visits over the study period; 1,187 (11 percent) were children ≤3 years. Visit counts in the youngest age group increased 70 percent following the intervention. When controlling for the naturally increasing trend, the intervention added 8.7 (95 percent CI: 4.7, 12.8) early childhood patient-visits per clinic in the last month of the intervention period. The increase in visit counts in the youngest age group had no significant effect on other ages, except for a decline relative to the natural trend in patient-visits among 35-50 year olds (-32.3 less visits) following the intervention. The proportion of visits for all ages by ≤3 year olds increased from 5 to 8 percent following the intervention. CONCLUSIONS bOHP increased dental visits among children ≤3 years but the finding might be attributable to clinic changes coinciding with bOHP implementation that were not controlled with the study design. Additional studies are needed in populations experiencing challenges accessing dental care.
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Affiliation(s)
- Rocio B Quinonez
- Department of Pediatric Dentistry and Pediatrics, Schools of Dentistry and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R Gary Rozier
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Neha Joshi
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John S Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Wright JT, Tampi MP, Graham L, Estrich C, Crall JJ, Fontana M, Gillette EJ, Nový BB, Dhar V, Donly K, Hewlett ER, Quinonez RB, Chaffin J, Crespin M, Iafolla T, Siegal MD, Carrasco-Labra A. Sealants for preventing and arresting pit-and-fissure occlusal caries in primary and permanent molars: A systematic review of randomized controlled trials-a report of the American Dental Association and the American Academy of Pediatric Dentistry. J Am Dent Assoc 2018; 147:631-645.e18. [PMID: 27470524 DOI: 10.1016/j.adaj.2016.06.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/03/2016] [Accepted: 06/07/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND National Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly one-fourth of children and over one-half of adolescents experienced dental caries in their permanent teeth. The purpose of this review was to summarize the available clinical evidence regarding the effect of dental sealants for the prevention and management of pit-and-fissure occlusal carious lesions in primary and permanent molars, compared with a control without sealants, with fluoride varnishes, or with other head-to head comparisons. TYPE OF STUDIES REVIEWED The authors included parallel and split-mouth randomized controlled trials that included at least 2 years of follow-up, which they identified using MEDLINE (via PubMed), Embase, LILACS, the Cochrane Central Register of Controlled Trials, and registers of ongoing trials. Pairs of reviewers independently conducted the selection of studies, data extraction, risk of bias assessments, and quality of the evidence assessments by using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Of 2,869 records screened, the authors determined that 24 articles (representing 23 studies) proved eligible. Moderate-quality evidence suggested that participants who received sealants had a reduced risk of developing carious lesions in occlusal surfaces of permanent molars compared with those who did not receive sealants (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.08-0.27) after 7 or more years of follow-up. When the authors compared studies whose investigators had compared sealants with fluoride varnishes, they found that sealants reduced the incidence of carious lesions after 7 or more years of follow-up (OR, 0.19; 95% CI, 0.07-0.51); however, this finding was supported by low-quality evidence. On the basis of the evidence, the authors could not provide a hierarchy of effectiveness among the studies whose investigators had conducted head-to-head comparisons. The investigators of 2 trials provided information about adverse events, but they did not report any adverse events. CONCLUSIONS AND PRACTICAL IMPLICATIONS Available evidence suggests that sealants are effective and safe to prevent or arrest the progression of noncavitated carious lesions compared with a control without sealants or fluoride varnishes. Further research is needed to provide information about the relative merits of the different types of sealant materials.
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Leone SM, Quinonez RB, Chuang A, Begue A, Kerns A, Jackson J, Phillips C. Introduction of Prenatal Oral Health into Medical Students' Obstetrics Training. J Dent Educ 2017; 81:1405-1412. [PMID: 31990373 DOI: 10.21815/jde.017.100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/08/2017] [Indexed: 11/20/2022]
Abstract
The aim of this study was to examine the influence of the Prenatal Oral Health Program (pOHP) at the University of North Carolina at Chapel Hill on medical students' oral health-related knowledge, confidence, attitudes, and dental referral practices. Specifically, the study sought to determine these students' ability to screen, counsel, and refer their patients to a dental home and their overall knowledge regarding the safety of dental treatment for pregnant patients. The study used a pre- and post-intervention survey design with intervention and control groups. Third-year medical students enrolled in an obstetrics and gynecology clerkship were surveyed between 2012 and 2014. The questionnaire assessed students' confidence and behaviors related to prenatal oral health counseling, screening, referral to a dental home, and knowledge about treatment safety during pregnancy. Intervention and control groups were determined by clerkship site. The intervention consisted of a 50-minute seminar on prenatal oral health principles, referral guidelines, and clinical systems changes. A total of 53 intervention and 32 control group students participated (57.4% response rate). The two groups were not significantly different at baseline in age, gender, having children, and residency goals. The results showed that the pOHP positively and significantly influenced students in the intervention group on all clinical constructs except their knowledge about treatment safety during pregnancy. Clinically examining a woman's mouth for signs of dental disease resulted in greater likelihood of making referrals by 26.5 times. These findings suggest that implementing prenatal oral health in a multi-method manner can effectively promote interdisciplinary coordinated care, meet interprofessional education accreditation standards, and aid in implementing practice guidelines in medical school curricula.
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Affiliation(s)
- Siena M Leone
- Department of Otolaryngology and Head and Neck Surgery, Section of Dentistry, Wake Forest University Health Sciences.,School of Dentistry, University of North Carolina, Chapel Hill
| | - Rocio B Quinonez
- Departments of Pediatric Dentistry and Pediatrics, Schools of Medicine and Dentistry, University of North Carolina, Chapel Hill
| | - Alice Chuang
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill
| | | | | | | | - Ceib Phillips
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill
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Wright JT, Crall JJ, Fontana M, Gillette EJ, Nový BB, Dhar V, Donly K, Hewlett ER, Quinonez RB, Chaffin J, Crespin M, Iafolla T, Siegal MD, Tampi MP, Graham L, Estrich C, Carrasco-Labra A. Evidence-based clinical practice guideline for the use of pit-and-fissure sealants. J Am Dent Assoc 2016; 147:672-682.e12. [DOI: 10.1016/j.adaj.2016.06.001] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/24/2016] [Accepted: 06/01/2016] [Indexed: 12/19/2022]
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Sams LD, Rozier RG, Quinonez RB. Training Requirements and Curriculum Content for Primary Care Providers Delivering Preventive Oral Health Services to Children Enrolled in Medicaid. Fam Med 2016; 48:556-560. [PMID: 27472794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite the emphasis on delivery of preventive oral health services in non-dental settings, limited information exists about state Medicaid policies and strategies to educate practicing physicians in the delivery of these services. This study aims to determine: (1) training requirements and policies for reimbursement of oral health services, (2) teaching delivery methods used to train physicians, and (3) curricula content available to providers among states that reimburse non-dental providers for oral health services. METHODS Using Web-based Internet searches as the primary data source, and a supplemental e-mail survey of all states offering in-person training, we assessed training requirements, methods of delivery for training, and curriculum content for states with Medicaid reimbursement to primary care providers delivering preventive oral health services. RESULTS of descriptive analyses are presented for information collected and updated in 2014. RESULTS Forty-two states provide training sessions or resources to providers, 34 requiring provider training before reimbursement for oral health services. Web-based training is the most common CME delivery method. Only small differences in curricular content were reported by the 11 states that use in-person didactic sessions as the delivery method. CONCLUSIONS Although we found that most states require training and curricular content is similar, training was most often delivered using Web-based courses without any additional delivery methods. Research is needed to evaluate the impact of a mixture of training methods and other quality improvement methods on increased adoption and implementation of preventive oral health services in medical practices.
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Affiliation(s)
- Lattice D Sams
- Department of Dental Ecology, School of Dentistry, Gillings School of Global Public Health
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Wright JT, Tampi MP, Graham L, Estrich C, Crall JJ, Fontana M, Gillette EJ, Nový BB, Dhar V, Donly K, Hewlett ER, Quinonez RB, Chaffin J, Crespin M, Iafolla T, Siegal MD, Carrasco-Labra A. Sealants for Preventing and Arresting Pit-and-fissure Occlusal Caries in Primary and Permanent Molars. Pediatr Dent 2016; 38:282-308. [PMID: 27557916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND National Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly onefourth of children and over one-half of adolescents experienced dental caries in their permanent teeth. The purpose of this review was to summarize the available clinical evidence regarding the effect of dental sealants for the prevention and management of pit-and-fissure occlusal carious lesions in primary and permanent molars, compared with a control without sealants, with fluoride varnishes, or with other head-to head comparisons. TYPE OF STUDIES REVIEWED The authors included parallel and split-mouth randomized controlled trials that included at least 2 years of follow-up, which they identified using MEDLINE (via PubMed), Embase, LILACS, the Cochrane Central Register of Controlled Trials, and registers of ongoing trials. Pairs of reviewers independently conducted the selection of studies, data extraction, risk of bias assessments, and quality of the evidence assessments by using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Of 2,869 records screened, the authors determined that 24 articles (representing 23 studies) proved eligible. Moderate-quality evidence suggested that participants who received sealants had a reduced risk of developing carious lesions in occlusal surfaces of permanent molars compared with those who did not receive sealants (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.08-0.27) after 7 or more years of follow-up. When the authors compared studies whose investigators had compared sealants with fluoride varnishes, they found that sealants reduced the incidence of carious lesions after 7 or more years of follow-up (OR, 0.19; 95% CI, 0.07-0.51); however, this finding was supported by low-quality evidence. On the basis of the evidence, the authors could not provide a hierarchy of effectiveness among the studies whose investigators had conducted head-to-head comparisons. The investigators of 2 trials provided information about adverse events, but they did not report any adverse events. CONCLUSIONS AND PRACTICAL IMPLICATIONS Available evidence suggests that sealants are effective and safe to prevent or arrest the progression of noncavitated carious lesions compared with a control without sealants or fluoride varnishes. Further research is needed to provide information about the relative merits of the different types of sealant materials.
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Affiliation(s)
- John T Wright
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA
| | - Malavika P Tampi
- Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, Ill., USA.
| | - Laurel Graham
- American Academy of Pediatric Dentistry, Chicago, Ill., USA
| | - Cameron Estrich
- Scientific Information, Science Institute, American Dental Association, Chicago, Ill., USA
| | - James J Crall
- Division of Public Health and Community Dentistry, School of Dentistry, University of California, Los Angeles, Los Angeles, Calif, USA
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Mich, USA
| | - E Jane Gillette
- School of Dentistry, University of Washington, Seattle, Wash., and a private practitioner, Bozeman, Mont, USA
| | | | - Vineet Dhar
- Division of Pediatric Dentistry, School of Dentistry, University of Maryland, Baltimore, Md, USA
| | - Kevin Donly
- Department of Developmental Dentistry, School of Dentistry, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Edmond R Hewlett
- Section of Restorative Dentistry, School of Dentistry, University of California, Los Angeles, Los Angeles, Calif, USA
| | - Rocio B Quinonez
- Department of Pediatric Dentistry and Pediatrics, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA
| | - Jeffrey Chaffin
- Delta Dental of Iowa, Johnston, Iowa, USA; College of Graduate Health Studies, A.T. Still University, Mesa, Ariz., USA; Association of State and Territorial Dental Directors, Reno, Nev., USA
| | - Matt Crespin
- Children's Health Alliance of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, Wis
| | - Timothy Iafolla
- Program Analysis and Reports Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Md., USA
| | - Mark D Siegal
- College of Dentistry, The Ohio State University, Columbus, Ohio, USA; American Association of Public Health Dentistry, Springfield, Ill., USA
| | - Alonso Carrasco-Labra
- Center for Evidence-Based Dentistry, American Dental Association, Chicago, Ill., USA; Evidence-Based Dentistry Unit and Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Santiago, Chile; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Byrd G, Quinonez RB, Offenbacher S, Keels MA, Guthmiller JM. Coordinated Pediatric and Periodontal Dental Care of a Child with Down syndrome. Pediatr Dent 2015; 37:381-385. [PMID: 26314608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this report was to describe the management of an eight-year-old Bulgarian male with Down syndrome presenting with periodontitis as a manifestation of systemic disease in the early mixed dentition. Treatment involved full-mouth mechanical debridement and extraction of hopeless teeth under general anesthesia followed by systemic antibiotics and chemical adjunctive therapy. Microbial culture and sensitivity testing aided in diagnosis and guided treatment decisions. This case report demonstrates a multidisciplinary approach in the management of aggressive periodontal disease in an internationally adopted pediatric patient with special health care needs.
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Affiliation(s)
- Gentry Byrd
- School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA
| | - Rocio B Quinonez
- Department of Pediatric Dentistry and Pediatrics, Schools of Dentistry and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA.
| | - Steven Offenbacher
- Department of Periodontology, School of Dentistry, at the University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA
| | - Martha Ann Keels
- Departments of Surgery and Pediatrics, Duke University Hospital, Durham, N.C., USA
| | - Janet M Guthmiller
- Dean, University of Nebraska Medical Center College of Dentistry, Lincoln, N.E., USA
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Vamos CA, Thompson EL, Avendano M, Daley EM, Quinonez RB, Boggess K. Oral health promotion interventions during pregnancy: a systematic review. Community Dent Oral Epidemiol 2015; 43:385-96. [PMID: 25959402 DOI: 10.1111/cdoe.12167] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 03/31/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Maternal oral disease during pregnancy is a significant public health issue due to its prevalence and lifecourse connections with adverse pregnancy/birth outcomes, early childhood caries, and chronic diseases. Although both medical and dental professional organizations have discipline-specific and co-endorsed guidelines, whether interventions exist that translate oral health evidence into practice remains unknown. Thus, we conducted a systematic review to examine the range, scope and impact of existing oral health promotion interventions during pregnancy. METHODS Search terms related to oral health, health promotion, and pregnancy produced 7754 articles published before March 2013 from five search engines. INCLUSION CRITERIA (i) intervention-based; (ii) quasi-experimental, experimental, or pretest/post-test design; (iii) pregnant women participants; (iv) outcomes including oral health knowledge, attitudes, and/or behaviors; (v) ≥5 participants; (vi) peer-review publication; and (vii) English language. RESULTS All interventions (n = 7) were delivered in prenatal care settings and focused on education. Modalities varied, including the use of oral instruction and audiovisual presentations, in both individual and group formats; however, content was directed toward infant oral health. Few studies specifically addressed prenatal oral health guidelines. Primary outcomes measured included knowledge, beliefs, attitudes, self-efficacy and oral hygiene, and health-seeking behaviors. All but one study showed significant improvement in one of these outcomes postintervention. CONCLUSIONS Few oral health interventions among pregnant women addressed oral-related symptoms, hygiene behaviors, and potential oral-systemic implications specific to mothers. Subsequently, more theory- and evidence-based interventions addressing current prenatal oral health guidelines using rigorous designs are needed to improve oral and systemic health for both women and their offspring.
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Affiliation(s)
- Cheryl A Vamos
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Erika L Thompson
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Maryouri Avendano
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Ellen M Daley
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Rocio B Quinonez
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kim Boggess
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Jackson JT, Quinonez RB, Kerns AK, Chuang A, Eidson RS, Boggess KA, Weintraub JA. Implementing a prenatal oral health program through interprofessional collaboration. J Dent Educ 2015; 79:241-248. [PMID: 25729017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Interprofessional collaboration has become a critical component of accreditation standards in dentistry and medicine. This article reports on implementation in an academic setting of a prenatal oral health program (pOHP) that addresses coordinated care, accreditation standards, and new clinical practice guidelines. The pOHP is an educational intervention for third-year medical students, residents, and faculty members to deliver preventive oral health information and referral to a dental home for pregnant women. At the same time, senior dental students and faculty members are introduced to prenatal oral health principles and delivery of comprehensive oral health care to pregnant women. A systems-based approach was used to guide the pOHP implementation during the 2012-13 academic year. Participants were 96 third-year medical students (50% of the total in an obstetrics and gynecology clerkship) and all 81 fourth-year dental students. During that academic year, 126 dental referrals were made to the School of Dentistry, and 55 women presented for care, resulting in 50% (n=40) of dental students participating in the clinical experience and delivery of simple to complex oral health procedures. The prenatal period is a frequently missed opportunity to address oral health care. The pOHP is an interprofessional collaboration model designed to educate dental and medical providers and provide a system of referral for comprehensive clinical care of pregnant patients, including educating women about their oral health and that of their children. Such programs can help meet interprofessional accreditation standards and encourage implementation of practice guidelines.
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Affiliation(s)
- Jeffrey T Jackson
- Dr. Jackson is a Pediatric Dental Resident, College of Dentistry, University of Florida; this research was conducted while he was a student at the School of Dentistry, University of North Carolina at Chapel Hill; Dr. Quinonez is Associate Professor, Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill; Dr. Kerns is a Pediatric Dental Resident, School of Dentistry, Virginia Commonwealth University; Dr. Chuang is Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill; Dr. Eidson is Clinical Associate Professor, Department of Operative Dentistry, School of Dentistry, University of North Carolina at Chapel Hill; Dr. Boggess is Professor, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, School of Medicine, University of North Carolina at Chapel Hill; and Dr. Weintraub is Alumni Distinguished Professor, Department of Dental Ecology, and Dean, School of Dentistry, University of North Carolina at Chapel Hill
| | - Rocio B Quinonez
- Dr. Jackson is a Pediatric Dental Resident, College of Dentistry, University of Florida; this research was conducted while he was a student at the School of Dentistry, University of North Carolina at Chapel Hill; Dr. Quinonez is Associate Professor, Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill; Dr. Kerns is a Pediatric Dental Resident, School of Dentistry, Virginia Commonwealth University; Dr. Chuang is Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill; Dr. Eidson is Clinical Associate Professor, Department of Operative Dentistry, School of Dentistry, University of North Carolina at Chapel Hill; Dr. Boggess is Professor, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, School of Medicine, University of North Carolina at Chapel Hill; and Dr. Weintraub is Alumni Distinguished Professor, Department of Dental Ecology, and Dean, School of Dentistry, University of North Carolina at Chapel Hill.
| | - Amanda K Kerns
- Dr. Jackson is a Pediatric Dental Resident, College of Dentistry, University of Florida; this research was conducted while he was a student at the School of Dentistry, University of North Carolina at Chapel Hill; Dr. Quinonez is Associate Professor, Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill; Dr. Kerns is a Pediatric Dental Resident, School of Dentistry, Virginia Commonwealth University; Dr. Chuang is Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill; Dr. Eidson is Clinical Associate Professor, Department of Operative Dentistry, School of Dentistry, University of North Carolina at Chapel Hill; Dr. Boggess is Professor, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, School of Medicine, University of North Carolina at Chapel Hill; and Dr. Weintraub is Alumni Distinguished Professor, Department of Dental Ecology, and Dean, School of Dentistry, University of North Carolina at Chapel Hill
| | - Alice Chuang
- Dr. Jackson is a Pediatric Dental Resident, College of Dentistry, University of Florida; this research was conducted while he was a student at the School of Dentistry, University of North Carolina at Chapel Hill; Dr. Quinonez is Associate Professor, Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill; Dr. Kerns is a Pediatric Dental Resident, School of Dentistry, Virginia Commonwealth University; Dr. Chuang is Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill; Dr. Eidson is Clinical Associate Professor, Department of Operative Dentistry, School of Dentistry, University of North Carolina at Chapel Hill; Dr. Boggess is Professor, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, School of Medicine, University of North Carolina at Chapel Hill; and Dr. Weintraub is Alumni Distinguished Professor, Department of Dental Ecology, and Dean, School of Dentistry, University of North Carolina at Chapel Hill
| | - R Scott Eidson
- Dr. Jackson is a Pediatric Dental Resident, College of Dentistry, University of Florida; this research was conducted while he was a student at the School of Dentistry, University of North Carolina at Chapel Hill; Dr. Quinonez is Associate Professor, Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill; Dr. Kerns is a Pediatric Dental Resident, School of Dentistry, Virginia Commonwealth University; Dr. Chuang is Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill; Dr. Eidson is Clinical Associate Professor, Department of Operative Dentistry, School of Dentistry, University of North Carolina at Chapel Hill; Dr. Boggess is Professor, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, School of Medicine, University of North Carolina at Chapel Hill; and Dr. Weintraub is Alumni Distinguished Professor, Department of Dental Ecology, and Dean, School of Dentistry, University of North Carolina at Chapel Hill
| | - Kim A Boggess
- Dr. Jackson is a Pediatric Dental Resident, College of Dentistry, University of Florida; this research was conducted while he was a student at the School of Dentistry, University of North Carolina at Chapel Hill; Dr. Quinonez is Associate Professor, Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill; Dr. Kerns is a Pediatric Dental Resident, School of Dentistry, Virginia Commonwealth University; Dr. Chuang is Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill; Dr. Eidson is Clinical Associate Professor, Department of Operative Dentistry, School of Dentistry, University of North Carolina at Chapel Hill; Dr. Boggess is Professor, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, School of Medicine, University of North Carolina at Chapel Hill; and Dr. Weintraub is Alumni Distinguished Professor, Department of Dental Ecology, and Dean, School of Dentistry, University of North Carolina at Chapel Hill
| | - Jane A Weintraub
- Dr. Jackson is a Pediatric Dental Resident, College of Dentistry, University of Florida; this research was conducted while he was a student at the School of Dentistry, University of North Carolina at Chapel Hill; Dr. Quinonez is Associate Professor, Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill; Dr. Kerns is a Pediatric Dental Resident, School of Dentistry, Virginia Commonwealth University; Dr. Chuang is Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill; Dr. Eidson is Clinical Associate Professor, Department of Operative Dentistry, School of Dentistry, University of North Carolina at Chapel Hill; Dr. Boggess is Professor, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, School of Medicine, University of North Carolina at Chapel Hill; and Dr. Weintraub is Alumni Distinguished Professor, Department of Dental Ecology, and Dean, School of Dentistry, University of North Carolina at Chapel Hill
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Quinonez RB, Kranz AM, Lewis CW, Barone L, Boulter S, O'Connor KG, Keels MA. Oral health opinions and practices of pediatricians: updated results from a national survey. Acad Pediatr 2014; 14:616-23. [PMID: 25439160 PMCID: PMC4254652 DOI: 10.1016/j.acap.2014.07.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 06/30/2014] [Accepted: 07/02/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Professional guidelines and state Medicaid policies encourage pediatricians to provide oral health screening, anticipatory guidance, and fluoride varnish application to young patients. Because oral health activities are becoming more common in medical offices, the objective of this study was to assess pediatricians' attitudes and practices related to oral health and examine changes since 2008. METHODS As part of the 2012 Periodic Survey of Fellows, a random sample of 1638 members of the American Academy of Pediatrics was surveyed on their participation in oral health promotion activities. Univariate statistics were used to examine pediatricians' attitudes, practices, and barriers related to screening, risk assessment, counseling, and topical fluoride application among patients from birth to 3 years of age. Bivariate statistics were used to examine changes since 2008. RESULTS Analyses were limited to 402 pediatricians who provided preventive care (51% of all respondents). Most respondents supported providing oral health activities in medical offices, but fewer reported engaging in these activities with most patients. Significantly more respondents agreed they should apply fluoride varnish (2008, 19%; 2012, 41%), but only 7% report doing so with >75% of patients. Although significantly more respondents reported receiving oral health training, limited time, lack of training and billing remain barriers to delivering these services. CONCLUSIONS Pediatricians continue to have widespread support for, but less direct involvement with oral health activities in clinical practice. Existing methods of training should be examined to identify methods effective at increasing pediatricians' participation in oral health activities.
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Affiliation(s)
- Rocio B Quinonez
- Department of Pediatric Dentistry and Pediatrics, Schools of Medicine and Dentistry, University of North Carolina at Chapel Hill.
| | - Ashley M Kranz
- Department of Dental Research, School of Dentistry, University of North Carolina at Chapel Hill
| | - Charlotte W Lewis
- Division of General Pediatrics, University of Washington and Craniofacial Center, Seattle Children's Hospital, Seattle, Wash
| | - Lauren Barone
- Division of Pediatric Practice, American Academy of Pediatrics, Elk Grove Village, Ill
| | - Suzanne Boulter
- Department of Pediatrics and Community and Family Medicine, Geisel School of Medicine at Dartmouth Medical School, Hanover, NH
| | - Karen G O'Connor
- Department of Research, American Academy of Pediatrics, Elk Grove Village, Ill
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Sim CJ, Iida H, Vann WF, Quinonez RB, Steiner MJ. Dietary recommendations for infants and toddlers among pediatric dentists in North Carolina. Pediatr Dent 2014; 36:322-328. [PMID: 25197998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The purposes of this study were to: describe practice patterns, knowledge, and attitudes of pediatric dentists in North Carolina (N.C.) in delivering dietary recommendations to the parents/caregivers of infants and toddlers; and identify barriers that limit the implementation of related recommendations. METHODS Our survey instrument included 30 questions covering eight domains of barriers to guideline adherence. Surveys were mailed to 150 practicing pediatric dentists in N.C. Descriptive and bivariate analyses were performed. Exploratory factor analysis was used to identify subscales and inform the multivariable model. RESULTS The response rate was 57 percent (86/150), 80 percent of whom reported providing infant and toddler feeding recommendations routinely. Knowledge of and agreement with the recommendation regarding breast-feeding duration was lower than that for bottle-feeding recommendations. Stepwise logistic regression analysis indicated that survey respondents were less likely to provide dietary recommendations regularly to the parents/caregivers of infants and toddlers when they have practice constraints and the respondents disagree with American Academy of Pediatrics (AAP) and American Academy of Pediatric Dentistry (AAPD) recommendations on bottle and juice consumption. CONCLUSIONS Most respondents routinely provide dietary recommendations to the parents/caregivers of infants and toddlers. Disagreement with AAP and AAPD recommendations on bottle, and juice consumption as well as practice constraints impedes practitioners from providing dietary recommendations regularly to the parents/caregivers of infants and toddlers.
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Affiliation(s)
- Chien J Sim
- National University Health System, Singapore.
| | - Hiroko Iida
- New York State Oral Health Center of Excellence, Rochester, N.Y., USA
| | - William F Vann
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA
| | - Rocio B Quinonez
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA
| | - Michael J Steiner
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA
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Long CM, Quinonez RB, Rozier RG, Kranz AM, Lee JY. Barriers to pediatricians' adherence to American Academy of Pediatrics oral health referral guidelines: North Carolina general dentists' opinions. Pediatr Dent 2014; 36:309-15. [PMID: 25197996 PMCID: PMC4523089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The purposes of this study were to: (1) assess knowledge, attitudes, and behaviors of North Carolina general dentists (GDs) regarding American Academy of Pediatrics (AAP) dental referral guidelines; and (2) determine factors that influence pediatricians' ability to comply with AAP guidelines. METHODS One thousand GDs were surveyed to determine barriers toward acceptance of physician referrals of infants and toddlers. The primary outcome using ordered logistic regression was GDs' acceptance of children described in five case scenarios, with different levels of risk and oral health status. RESULTS GDs believed pediatricians should refer patients at risk for caries to a dentist. While 61 to 75 percent of GDs were willing to accept low caries risk referrals of infants and toddlers, only 35 percent would accept referrals when caries was present. Predictors of referral acceptance were correct knowledge about AAP guidelines (OR=2.0, 95%CI=1.2-3.3), confidence in providing preventive care to infants and toddlers (OR=2.6, 95%CI=1.3-4.9), and agreement that parents see importance in dental referrals (OR=2.1, 95% CI=1.2-3.6). CONCLUSIONS This study identified factors influencing acceptance of pediatrician referrals for the age one dental visit among North Carolina GDs and highlighted challenges pediatricians face in referring young children for dental care.
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Affiliation(s)
| | - Rocio B Quinonez
- University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA
| | - R Gary Rozier
- Department of Pediatric Dentistry, School of Dentistry; at the University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA
| | - Ashley M Kranz
- Department of Health Policy and Management, Gillings School of Global Public Health; at the University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA
| | - Jessica Y Lee
- Department of Dental Research; at the University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA
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Quinonez RB, Kranz AM, Long M, Rozier RG. Care coordination among pediatricians and dentists: a cross-sectional study of opinions of North Carolina dentists. BMC Oral Health 2014; 14:33. [PMID: 24708785 PMCID: PMC3997217 DOI: 10.1186/1472-6831-14-33] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 04/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Care coordination between physicians and dentists remains a challenge. This study of dentists providing pediatric dental care examined their opinions about physicians' role in oral health and identified factors associated with these opinions. METHODS North Carolina general and pediatric dentists were surveyed on their opinions of how physicians should proceed after caries risk assessment and evaluation of an 18-month-old, low risk child. We estimated two multinomial logistic regression models to examine dentists' responses to the scenario under the circumstances of an adequate and a limited dental workforce. RESULTS Among 376 dentists, 52% of dentists indicated physicians should immediately refer this child to a dental home with an adequate dental workforce. With a limited workforce, 34% recommended immediate referral. Regression analysis indicated that with an adequate workforce guideline awareness was associated with a significantly lower relative risk of dentists' recommending the child remain in the medical home than immediate referral. CONCLUSIONS Dentists' opinions and professional guidelines on how physicians should promote early childhood oral health differ and warrant strategies to address such inconsistencies. Without consistent guidelines and their application, there is a missed opportunity to influence provider opinions to improve access to dental care.
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Affiliation(s)
- Rocio B Quinonez
- Department of Pediatric Dentistry and Pediatrics, Schools of Medicine and Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ashley M Kranz
- Department of Dental Research, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - R Gary Rozier
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Quinonez RB, Nelson T. Pediatric behavior guidance in the 21st century workshop C report - advocacy and policy. Pediatr Dent 2014; 36:158-160. [PMID: 24717756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This report outlines a series of recommendations derived from an advocacy and policy workshop at the 2013 American Academy of Pediatric Dentistry (AAPD) Behavior Guidance Symposium. The committee charge was to address two questions: (1) what should be done to change public and media perception of behavior guidance, if anything, and: (2) what should be done to insure that needed behavior guidance techniques will be available for practicing pediatric dentists in the future. Members of the workshop voiced a wide variety of opinions and impressions of how public perception and media promotion of behavior guidance affect the practice of pediatric dentistry. A diverse assortment of strategies to promote the availability of these techniques in the future was suggested. This report will serve to inform policy and advocacy efforts by AAPD to improve children's oral health and promote excellence in patient care.
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Affiliation(s)
- Rocio B Quinonez
- Associate professor, Department of Pediatric Dentistry and Pediatrics, Schools of Dentistry and Medicine, University of North Carolina and Chapel Hill, Chapel Hill, N.C., USA.
| | - Travis Nelson
- Clinical assistant and professor, Department of Pediatric Dentistry, University of Washington, Seattle, Wash., USA
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Ruiz VR, Quinonez RB, Wilder RS, Phillips C. Infant and Toddler Oral Health: Attitudes and Practice Behaviors of North Carolina Dental Hygienists. J Dent Educ 2014. [DOI: 10.1002/j.0022-0337.2014.78.1.tb05665.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Viviana R. Ruiz
- University of Illinois at Chicago College of Dentistry; this project was conducted while she was a student in the Master's of Science program in dental hygiene education, University of North Carolina at Chapel Hill
| | - Rocio B. Quinonez
- Departments of Pediatric Dentistry and Pediatrics; Schools of Dentistry and Medicine, University of North Carolina at Chapel Hill
| | | | - Ceib Phillips
- Department of Orthodontics and Assistant Dean for Advanced Education/Graduate Programs; School of Dentistry, University of North Carolina at Chapel Hill
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Ruiz VR, Quinonez RB, Wilder RS, Phillips C. Infant and toddler oral health: attitudes and practice behaviors of North Carolina dental hygienists. J Dent Educ 2014; 78:146-156. [PMID: 24385533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to evaluate the knowledge, comfort, practice behaviors, and perceived barriers of dental hygienists in North Carolina regarding their delivery of oral health preventive services to infants and toddlers. A questionnaire was mailed to 2,000 dental hygienists randomly selected from the North Carolina Board of Dental Examiners database. The response rate was 43 percent. The majority of the respondents were female and worked in private practice. Forty-two percent reported that they delivered preventive care to infants/toddlers (action stage of readiness). Of the 58 percent who reported not delivering care, two-thirds were contemplating caring for this population (contemplation stage), but only 10 percent of these were very likely to make changes in the next six months. Those with higher comfort levels and fewer perceived practice constraints were more likely to be in the action stage. Although these dental hygienists may be willing to consider providing care, they perceived a lack of continuing education opportunities, unfamiliarity with pediatric guidelines, and their current practice situation as significant barriers. Strategies to increase comfort and diminish practice constraints for North Carolina dental hygienists should be considered to improve access to oral health care for infants and toddlers. Teaching strategies in dental hygiene education that include both didactic and clinical experiences in treating infants and toddlers could be beneficial.
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