Showing papers in "Journal of Dental Education in 2008"

TMJ disorders: future innovations in diagnostics and therapeutics.

Abstract: Because their etiologies and pathogenesis are poorly understood, temporomandibular joint (TMJ) diseases are difficult to diagnose and manage. All current approaches to treatments of TMJ diseases are largely palliative. Definitive and rational diagnoses or treatments can only be achieved through a comprehensive understanding of the etiologies, predisposing factors, and pathogenesis of TMJ diseases. While much work remains to be done in this field, novel findings in biomedicine and developments in imaging and computer technologies are beginning to provide us with a vision of future innovations in the diagnostics and therapeutics of TMJ disorders. These advances include the identification and use of local or systemic biomarkers to diagnose disease or monitor improvements in therapy; the use of imaging technologies for earlier and more sensitive diagnostics; and the use of biomedicine, biomimetics, and imaging to design and manufacture bioengineered joints. Such advances are likely to help to customize and enhance the quality of care we provide to patients with TMJ disorders.

Does Orthodontic Treatment Affect Patients’ Quality of Life?

Abstract: The oral-facial region is usually an area of significant concern for the individual because it draws the most attention from other people in interpersonal interactions and is the primary source of vocal, physical, and emotional communication. As a result, patients who seek orthodontic treatment are concerned with improving their appearance and social acceptance, often more than they are with improving their oral function or health. Enhancing these aspects of quality of life is an important motive for undergoing orthodontic treatment. Regardless of age, patients’ and their parents’ or caregivers’ expectations about improvements in oral function, esthetics, social acceptance, and body image are important for both general dentists and orthodontists to consider when advising patients about these procedures and during the treatment process. This review of research on the impact of conventional and surgical orthodontics on quality of life examines the association between oral health-related quality of life and severity and type of malocclusion, as well as the impact of treatment and patient characteristics on quality of life. The article will emphasize the importance of clinicians’ having a clear understanding, before initiating treatment, of their patients’ quality of life and their expectations about improvements in specific domains of quality of life.

Assessing dental students' competence: best practice recommendations in the performance assessment literature and investigation of current practices in predoctoral dental education.

Abstract: In this article, the Task Force on Student Outcomes Assessment of the American Dental Education Association's Commission on Change and Innovation in Dental Education describes the current status of student outcomes assessment in U.S. dental education. This review is divided into six sections. The first summarizes the literature on assessment of dental students' performance. Section two discusses catalysts, with a focus on problem-based learning, for development of new assessment methods, while the third section presents several resources and guides that can be used to inform selection of assessment techniques for various domains of competence. The fourth section describes the methodology and results of a 2008 survey of current assessment practices in U.S. dental schools. In the fifth section, findings from this survey are discussed within the context of competency-based education, the educational model for the predoctoral curriculum endorsed by the American Dental Education Association and prescribed by the Commission on Dental Accreditation. The article concludes with a summary of assessments recommended as optimal strategies to measure three components of professional competence based on the triangulation model. The survey of assessment practices in predoctoral education was completed by 931 course directors, representing 45 percent of course directors nationwide, from fifty-three of the fifty-six U.S. dental schools. Survey findings indicate that five traditional mainstays of student performance evaluation-multiple-choice testing, lab practicals, daily grades, clinical competency exams, and procedural requirements-still comprise the primary assessment tools in dental education. The survey revealed that a group of newer assessment techniques, although frequently identified as best practices in the literature and commonly used in other areas of health professions education, are rarely employed in predoctoral dental education.

Esthetic orthodontic treatment using the invisalign appliance for moderate to complex malocclusions.

Abstract: In this report, three patients were treated with a new treatment protocol for Invisalign to demonstrate that a variety of complex malocclusions can be successfully treated using this protocol, including correction of moderate crowding, correction of moderate Class II division 1, and deep overbite. Previous studies of Invisalign showed significant limitations for more complex orthodontic treatment, although a few recent case reports have shown successfully completed moderate to difficult orthodontic malocclusions. One reason for the discrepancy is that the earlier studies were done during the first four years of the appliance development (now ten years of clinical use), when significant problems existed with accomplishing bodily movement, torquing of roots, extrusions, and rotations of premolars and canines. The new protocol included new methods for anterior/posterior corrections, showing on the computer the effect of elastics for Class II treatment simulated as a one-stage anterior/posterior movement at the end of treatment. Staging for interproximal reduction (IPR) is now automatically staged when there is better access to interproximal contacts to avoid IPR where significant overlap between teeth is present to avoid performing IPR on surfaces that may be damaged by instruments such as burs, strips, and disks when cut on a sharp angle. Staging for tooth movements is now also done to enable combination movements to occur simultaneously for each tooth with the tooth that needs to move the most (the lead tooth) determining the minimum number of stages required. All other teeth move at a slower rate than the lead tooth throughout the duration of treatment. Attachments are now placed in the middle of the crown automatically for rotation and automatically sized in proportion to the clinical crown. Use of 1 mm thick (buccal-lingual dimension) horizontal beveled rectangular attachments is standard on premolars for retention of aligners during intrusive movements, such as leveling the lower curve of Spee in deep overbite for extrusions and for control of the tooth long axis during torquing movements. Staging of tooth movements now track linear and rotational velocities of teeth separately with the number of treatment stages determined by the lead tooth based on its rotational or linear maximum velocities at no more than two degrees of rotation per stage. Simultaneous movements are done for all teeth providing visible space (approximately 0.05 mm) between teeth during movements past other teeth using expansion instead of IPR as a primary way to increase space available for correction of crowding.

The Critical Incident Technique: A Useful Tool for Conducting Qualitative Research

Abstract: The critical incident technique (CIT) is a well-established qualitative research tool used in many areas of the health sciences, including nursing, medicine, and dentistry, and their respective education systems. It is a flexible set of principles that can be modified and adapted to meet the specific situation at hand. By gathering factual reports made by observers, researchers can build a picture of the situation under study. The CIT maximizes the positive and minimizes the negative attributes of anecdotes, effectively turning anecdotes into data. In this, the first of two companion articles, the origins and current state of the CIT and its potential applications in dentistry and dental education are described.

Effect of magnification loupes on dental hygiene student posture.

Abstract: The chair-side work posture of dental hygienists has long been a concern because of health-related problems potentially caused or exacerbated by poor posture. The purpose of this study was to investigate if using magnification loupes improved dental hygiene students' posture during provision of treatment. The treatment chosen was hand-scaling, and the effect of the timing of introduction of the loupes to students was also examined. Thirty-five novice dental hygiene students took part in the study. Each student was assessed providing dental hygiene care with and without loupes, thus controlling for innate differences in natural posture. Students were randomized into two groups. Group one used loupes in the first session and did not use them for the second session. Group two reversed this sequence. At the end of each session, all students were videotaped while performing scaling procedures. Their posture was assessed using an adapted version of Branson et al.'s Posture Assessment Instrument (PAI). Four raters assessed students at three time periods for nine posture components on the PAI. A paired t-test compared scores with and without loupes for each student. Scores showed a significant improvement in posture when using loupes (p<0.0001), and these improvements were significantly more pronounced for students starting loupes immediately on entering the program compared with students who delayed until the second session (p<0.1). These results suggest a significant postural benefit is realized by requiring students to master the use of magnification loupes as early as possible within the curriculum.

Effects of Malocclusions and Orthodontics on Periodontal Health: Evidence from a Systematic Review

Abstract: Many patients seek orthodontic treatment for esthetic improvement. These patients mostly present with mal-alignment of the anterior teeth. The positive effects of orthodontic treatment on their appearance and self-esteem are easy to envision. However, does orthodontic treatment provide dental health benefits in addition to the esthetic benefits? Do malocclusions harm the periodontium? Is correcting malocclusions with orthodontic treatment beneficial for periodontal health? The purpose of this study is to present evidence available on this topic. Two systematic reviews were conducted to address these questions: does a malocclusion affect periodontal health, and does orthodontic treatment affect periodontal health? Inclusion and exclusion criteria were established for both reviews, and an electronic search and a hand search were conducted. Several papers were included in both reviews, but the overall quality of the studies was weak. The first review found a correlation between the presence of a malocclusion and periodontal disease. Subjects with greater malocclusion have more severe periodontal disease. This may be dependent on oral health status. One should keep in mind that an association does not necessarily mean causation. The second review identified an absence of reliable evidence on the effects of orthodontic treatment on periodontal health. The existing low-quality evidence suggests that orthodontic therapy results in small detrimental effects to the periodontium. The results of both reviews do not warrant recommendation for orthodontic treatment to prevent future periodontal problems, except for specific unusual malocclusions.

Joining the podcast revolution.

Abstract: In recent years, there has been a growing interest in the latest generation of web-based tools such as podcasts. Podcasts are media files that can be distributed via the Internet and played on computers and handheld devices, including iPods or other digital audio players. The essence of podcasting is the creation of audio and/or video content for an audience that wants to listen to what they want, when they want, where they want, and how they want. With students now more mobile than ever, the idea of being able to access information without being linked to a certain physical location is very attractive. In the specific context of dental education, lectures and clinical procedures can be recorded by academic staff and distributed over the Internet to students as an audio or video podcast. The objective of this article is to review the most important concepts in podcasting, using simple and nontechnical terminology. In addition, this review aims to stimulate and encourage dental educators to employ this technology as a tool to enhance the learning experience of undergraduate and postgraduate dental students.

Is Dentistry at Risk? A Case for Interprofessional Education

Abstract: The goal of interprofessional education (IPE) is to bring various professional groups together in the educational environment to promote collaborative practice and improve the health care of patients. Interest in IPE has been sparked by several factors in the health care system, including the increased awareness of oral-systemic connections, an aging population, the shift of the burden of illness from acute to chronic care, and lack of access to basic oral care. Increasingly, since the publication of the U.S. surgeon general's report in 2000, the dialogue surrounding IPE in dentistry has escalated. But how has dentistry changed regarding IPE since the report was released? This position paper argues that little has changed in the way dental students are taught and prepared to participate in IPE. The authors contend that academic dentistry and organized dentistry must take the lead in initiating and demanding IPE if dental students are to be prepared to work in the health care environment of the twenty-first century. Included are reasons why IPE is necessary and why dentistry must lead the conversation and participate in the solution to the oral health care crisis. It explores existing models and alternate approaches to IPE, barriers to implementation, and proposed strategies for academic institutions.

Does exposure to a procedural video enhance preclinical dental student performance in fixed prosthodontics

Abstract: To try to alleviate the issue of dental students having an inadequate field of view during live demonstrations of fixed prosthodontic preparations, an instructional video depicting the step-by-step procedures involved in an all-ceramic tooth preparation and provisional crown fabrication (practical exam 1, PE1) was created. Fifty-five second-year dental students were given a personal copy of the video after a lecture and an in-class viewing of the material. Throughout the course, students watched live demonstrations of tooth preparations and then practiced individually on mannequins. The scores achieved by the students on three practical exams (PE1, PE2, and PE3) were compared to those recorded by a class one year prior to the development of the video. The students exposed to the video performed significantly better on PE1 in comparison to the previous year’s class, as well as compared to their own performance on the other two practical exams that had no supplementary teaching aids. A significant, moderate-level correlation was detected between exposure to the video and PE1. Ninety-six percent of the students reported on their end-of-year evaluation that the video helped them to prepare for PE1. The results of this study suggest that instructional videos may aid in the teaching of fixed prosthodontics.

Do Dental Educators Need to Improve Their Approach to Teaching Rubber Dam Use

Abstract: Most dentists are educated in rubber dam use in dental school, but there is often disparity between what is taught for various restorative procedures and what is practiced in the private sector. It is a common, although undocumented, belief that few practicing dentists routinely use rubber dam isolation. This study repeated a survey conducted in 1985 evaluating U.S. general dentists' attitudes toward rubber dam usage to see if improvement is needed in current dental educators' approach to this topic. Four hundred dentists were selected randomly from ten major geographically diverse cities using the website YellowPages.com. Each was mailed a letter requesting survey participation, which included a pre-stamped, pre-addressed postcard with the survey printed on the back. The target population, general dentists, returned 164 surveys (41 percent). Their responses can be summarized as follows: 71 percent do amalgams-of those, 53 percent never use a rubber dam whereas 12 percent always use a rubber dam; 100 percent do anterior direct resin composites-of those, 45 percent never use a rubber dam whereas 17 percent always use a rubber dam; 98 percent do posterior direct resin composites-of those, 39 percent never use a rubber dam and 18 percent always use a rubber dam; and 78 percent do endodontic procedures-of those, 11 percent never use a rubber dam whereas 58 percent always use a rubber dam. Most (74 percent) felt that their dental school rubber dam training was adequate; 42 percent felt that its use has an effect on the quality of restorative dentistry. Their most common reasons for not using a dam were the following: inconvenience (40 percent); unnecessary (28 percent); other (12 percent); patient refusal (11 percent); and time (9 percent). No respondent indicated that "cost" was a reason for not using rubber dams. This study indicates that many general dentists in this country continue to ignore the rubber dam for many restorative and some endodontic procedures. It indicates that predoctoral dental educators need to look for opportunities for improvement to reduce the discrepancy between what is taught and the general practice of dentistry.

The revitalization of U.S. dental education.

Abstract: Revitalization of dental education in the United States is an imperative, but it depends mainly on the willingness of dental school faculty to make great changes. My remarks address a system of education of dental professionals in relation to other health professionals whose vision seems at times to have surpassed ours. I advocate for a revitalization of our profession in order to stand at the fore when it comes to ensuring the health and well-being of the public. Thanks to advances in molecular medicine, health care is being transformed from a system of treating disease to one that provides predictive, preemptive, and personalized care. This presentation makes recommendations for rethinking the current system of dental education in order to elevate dentistry to its rightful place as a vibrant health care leader. Dental education needs to be a source of new knowledge, discovery, and innovation to sustain its legacy as a learned profession. Graduates must be lifelong learners who can critically evaluate science and technology for the good of their patients. Future dentists should be providers of primary care, yet data suggest that the organizational structure to support this vision is lacking. The accreditation system, interrelated with licensure and National Boards, needs to set a better floor. While independence is an admirable goal, I see too much variation in the accreditation system. We must overcome fears and politics to upgrade the profession as pharmacy did when it introduced the Pharm.D. degree. With that came a change in the entire system of pharmacy education and clinical practice and recognition of pharmacists as members of an interdisciplinary health care team. Dentistry and dental education are doing a lot that is good, but we must and can do even better if the profession is to thrive as a respected member of the health professions delivering high-quality, evidence-based care to the public. Dental students, faculty, and practitioners must have command of new and coming scientific advances and technologies that will have a profound impact on the practice of dentistry. We must take the long view in educating our students so they will, as practitioners, be able to expertly evaluate and use new technologies throughout their careers. With regard to technologies, three examples may help clarify their future importance in dentistry: 1) oral fluids and tissues are natural tools for health surveillance; 2) within the next five to ten years, microarrays of all 700 bacterial species will be available for diagnostic purposes as will treatment tied to this diagnostic tool; and 3) biomarkers of inflammation will continue to develop into chair-side technologies with appropriate treatments. These three examples-along with spectacular advances in imaging, materials science, stem cell biology, and regenerative medicine-signal the need for rigorous change in dental education and practice. If we desire twenty-first century clinicians, we are obligated to teach students to "learn how to learn." We must teach them to practice evidence-based dental medicine. We must teach them to operate as members of interdisciplinary, primary health care teams. Moreover, we must ensure that the face of the profession-its practitioners-reflects the rich diversity of the community. Attendees at the Macy convocation are in a position to provide leadership, to work with appropriate organizations, and to enable Pharm.D.-like consensus. It behooves us to agree on a unified vision for revitalizing dental education. The vision should be based on a set of principles, either those originally laid out by W.J. Gies in 1926 or ones that may be a better fit with this day and age. The following are several recommendations for transformative change in dental education. In my view, based on my experience as a dental professional and leader, and by looking beyond our educational boundaries to places like MIT, I believe that they may be the most promising: 1) think BIG!; 2) involve students in hands-on learning experiences from day one; and 3) provide students and the profession with the tools to tackle major biomedical, clinical care, and societal issues including access to care, cost of care, HIV, emerging infectious diseases, elder care, and many others. In fact, I believe that we already know what to do to upgrade the dental profession. We need to make it happen. We need to act as catalysts for change. We understand that change is necessary but continue to struggle with implementing sustained curriculum reform and regulatory reform. Why? Partly because we have not convinced the dental profession and the education community that a crisis really exists. "Crisis" may sound to the uninformed like crying wolf, especially in a climate in which dentists in private practice are doing exceedingly well. Further, we have not provided a compelling vision for the future. Transformation will require a profound reexamination of what we are doing today and what is necessary for survival and sustained growth. We must keep pace with new knowledge and methods of teaching-unless, of course, we choose to subscribe to the facetious message of W. Edwards Deming, who is credited with rebuilding the Japanese economy after World War II: "It is not necessary to change. Survival is not mandatory."

Team-based learning using an audience response system: an innovative method of teaching diagnosis to undergraduate dental students.

Abstract: A team-based learning (TBL) approach was used to facilitate student learning and performance in a sophomore preclinical endodontic course. TBL is based upon the division of a class into small groups of students using a problem-based learning approach. The purpose of this project was to improve student ability to diagnose diseases utilizing TBL combined with an audience response system (ARS). Three measures were used to assess the outcomes: 1) pre- and posttest scores, 2) a diagnostic skills assessment during the final examination, and 3) an attitudinal survey completed by the students. At the beginning of the course, second-year students (n=64) were evaluated to determine entry-level knowledge. Six groups of ten to eleven students each were pretested, followed by a parallel posttest following the implementation of the TBL experience. Students’ performance on the posttest (63.4 percent) showed improved results when compared to the pretest (36.9 percent). Students also exhibited improved diagnostic skills with the final examination. The results of the students’ attitudinal survey indicated an 80 percent agreement that TBL enhanced their powers of critical analysis.

Combining normative and psychosocial perceptions for assessing orthodontic treatment needs.

Abstract: Whereas perceptions of malocclusion by the public are mainly subjective, currently orthodontic treatment needs are predominantly determined using normative need. There are considerable differences between normative and subjective perceptions of orthodontic need. Yet clinical measures determine current provision of orthodontic services, whereas subjective oral health-related quality of life (OHRQoL) measures are seldom used and play a small part in need assessment despite predicting perceived need. The sociodental approach to assessing orthodontic treatment needs overcomes deficiencies of the sole use of normative need. It is a gradual integration process, estimating orthodontic needs by combining normative and psychosocial perspectives, as well as considering behavioral factors affecting outcomes of orthodontic treatment and scientific evidence about the effectiveness of interventions. To be appropriately used in needs assessment, an OHRQoL measure should provide condition-specific estimates of the impact of malocclusion on daily life. The sociodental approach attempts to replicate the characteristics of good clinical practice using a structured, rational, and coherent system for assessing orthodontic needs and, therefore, is a useful tool in planning oral health services.

Characteristics of effective classroom teachers as identified by students and professionals: a qualitative study.

Abstract: This qualitative research study identified criteria for teacher quality preferences as perceived by current and past students. A two-question, open-ended survey asking what qualities learners liked most and least in a teacher/presenter was given to two groups: students (Group A) from medicine, dentistry, and related residency programs; and dentists and physicians (Group B) who had graduated at least three years previously and who attended a minimum of two days of continuing education courses in lecture format each year. A total of 300 subjects provided 2,295 written responses. Descriptive words within the responses were coded and grouped according to similar relationships, resulting in the emergence of twenty-one defined categories that were further refined into three core categories: personality, process, and performance. Results showed that the two groups appear to have different preferences in teacher/presenter characteristics. For Group A (students), the categories of content design, content organization, and content development were at the forefront of their preferences. Group B (professionals) overwhelmingly favored elements of speaker self-confidence and expertise. Both groups highly valued expertise and speaking style. These findings can be used to develop curriculum, enhance faculty members' teaching skills, and plan continuing education programs.

Dental Education from the Students’ Perspective: Curriculum and Climate

Abstract: This cross-sectional study compares morale among dental students at five western U.S. dental schools, relates morale to various aspects of the school environment, and determines a prioritized list of the most important aspects of dental education from the students’ perspective. Survey data were collected from students at the end of their first, second, and third years. Respondents answered several questions associated with student morale and listed the three best aspects and three greatest challenges of their school. Lastly, respondents ranked seven different aspects of dental education in order of importance. Surveys were returned by 742 students (66 percent response). Student morale varied significantly in different educational institutions. Morale tended to be lower among third-year students and higher among first-year students. Poor student-faculty relations was the factor most strongly associated with decreased morale. Similarly, positive atmosphere was the factor most frequently associated with high morale. Faculty and clinic experience were the most frequently cited positive aspects of schools; curriculum and clinic experience were the most commonly cited negative aspects. Students commonly perceived clinical experience to be the most important aspect of their education. As students neared graduation, they perceived business management as more important and lab work as less important.

Bisphosphonates and Osteonecrosis of the Jaws

Abstract: Bisphosphonates are important drugs that are increasingly prescribed to reduce the morbidity associated with osteoclast-mediated bone diseases. Shortly after the turn of the century, a variety of case reports described a necrosis of the jaw bone in patients using bisphosphonates. Currently, an exposed area of necrotic jaw bone present for at least eight weeks in patients using bisphosphonates has been defined as a bisphosphonate-associated osteonecrosis (BON) by the American Dental Association. BON may occur spontaneously but is more frequently associated with local trauma to the jaw. At this time, a causal relationship between BON and bisphosphonates has not been demonstrated. This review will evaluate current data related to the occurrence, risk, prevention, treatment, and management of BON.

Assessment of Teaching Effectiveness in U.S. Dental Schools and the Value of Triangulation

Abstract: The routine evaluation of teaching effectiveness is important in improving faculty, departmental, and institutional efforts. There are three main categories of assessments: those performed by students, peers, and self. Although each category is independently valid, a collection of data from all three categories leads to a more comprehensive outcome and a creation of a triangulation model. The purpose of this study was to identify commonly used methods of assessing teaching effectiveness and to suggest the use of a triangulation model, which has been advocated in the literature on performance assessment as an optimal approach for evaluating teaching effectiveness. A twelve-question survey was sent to all U.S. dental schools to identify evaluation methods as well as to find evidence of triangulation. Thirty-nine out of fifty-seven schools responded. The majority of the schools used student evaluations (81 percent) and peer reviews (78 percent). A minority of schools reported using self-evaluations (31 percent). Less than one in five dental schools reported using all three strategies to achieve triangulation (19 percent). The three most commonly used evaluation methods ("performed routinely") were all in the student evaluation category. Less than half of the schools routinely evaluated clinical teaching effectiveness by any means (42 percent). In conclusion, dental schools should implement a triangulation process, in which evaluation data are obtained from students, peers, and self to provide a comprehensive and composite assessment of teaching effectiveness.

Dental School Vacant Budgeted Faculty Positions, Academic Years 2005–06 and 2006–07

Abstract: The annual turnover of dental school faculty creates a varying number of vacant budgeted positions at any given time. The American Dental Education Association (ADEA) conducts an annual survey to determine the status and characteristics of these vacant faculty positions. In addition, ADEA conducts an annual survey of dental educators to maintain a database on the size and characteristics of dental school faculty, including data on the distribution of full-time, part-time, and volunteer faculty, reasons for faculty separations, and sources of new faculty. The number of vacant budgeted faculty positions within U.S. dental schools increased throughout the 1990s, with a peak of 358 positions in 2000. Following this peak, the number of vacancies declined, falling to 275 in 2004-05. Since that time, there has been a rapid increase in the number of estimated vacancies, reaching 417 in 2005-06, then falling slightly to 406 in 2006-07. The 2005-06 and 2006-07 faculty vacancies surveys explore these increases, along with information relevant to trends in the faculty workforce, factors influencing faculty vacancies, and the impact of vacant positions on dental schools.

Mindfulness and Professionalism in Dentistry

Abstract: To improve the effectiveness of teaching professionalism, the authors propose introducing mindfulness practice into the dental curriculum. The qualities cultivated through mindfulness meditation practice closely resemble the global attitudes of professionalism. Professionalism and mindfulness are broad overlapping constructs with a common prosocial aim: letting go of selfish, short-sighted rewards and promoting the long-term common good. Both constructs also aim for the highest quality of life for practitioners and patients alike. Based on a selective review of the medical literature, we suggest that mindfulness practice should help improve attentiveness, self-awareness, acceptance, wisdom, and self-care in dentistry. We briefly review the role of mindfulness in higher education, as well as current attempts at Dalhousie University to integrate mindfulness into the dental and dental hygiene curricula.

A blended learning course taught to different groups of learners in a dental school: follow-up evaluation.

Abstract: This article reports the results of a follow-up study conducted to investigate students' perceptions about a blended learning health informatics course that combined online and traditional classroom instruction. The course is taught to five different groups of students at the School of Clinical Dentistry of the University of Sheffield each academic year: first-, third-, and fourth-year dental students, dental hygiene and therapy students, and postgraduate dental students. The goal of the study was to determine the impact of the modifications made to the course after the first year of implementation. To accomplish this goal, students' perceptions of this blended learning course were compared after the first and second implementations. The methodology used for this study was action research. The data were collected using three processes: questionnaires were used to collect contextual data from the students taking the course; a student-led, nominal group technique was used to collect group data from the participants; and a non-participant observer technique was used to record the context in which certain group and individual behaviors occurred. Depending on group assignment, between 41.5 and 91.5 percent of students believed that the blended-learning course had added to their skills. The online learning environment was perceived as a useful resource by 75 percent of students in four of the five student groups, but only 45 percent of the fourth-year dental students indicated it was a useful resource. The perceived lack of sufficient online support material was one of the main concerns of the students at the nominal group evaluation sessions. The non-participant observer technique identified different engagement levels among the student groups. Discernible differences were identified, with improvement in some areas and a decline in others compared to a previous evaluation. The change in the delivery method influenced the students' comprehension of the material negatively and the learning environment positively, but did not influence online collaboration among students.

A Virtual System for Cavity Preparation in Endodontics

Abstract: This article presents a novel virtual teeth drilling system designed to aid dentists, dental students, and researchers in getting acquainted with teeth anatomy, the handling of drilling instruments, and the challenges associated with drilling procedures during endodontic therapy. The system is designed to be used for educational and research purposes in dental schools. The application features a 3D face and oral cavity model constructed using anatomical data that can be adapted to the characteristics of a specific patient using either facial photographs or 3D data. Animation of the models is also feasible. Virtual drilling using a Phantom Desktop (Sensable Technologies Inc., Woburn, MA) force feedback haptic device is performed within the oral cavity on 3D volumetric and surface models of teeth, obtained from serial cross sections of natural teeth. Final results and intermediate steps of the drilling procedure can be saved on a file for future use. The application has the potential to be a very promising educational and research tool that allows the user to practice virtual teeth drilling for endodontic cavity preparation or other related procedures on high-detail teeth models placed within an adaptable and animated 3D face and oral cavity model.

Some Paradoxes in Competency-Based Dental Education

Abstract: Competency-based dental education was introduced in 1993 and has proven to be a robust innovation, guiding curricular design, clinical education and evaluation, and accreditation. At the same time, it has been irregularly implemented and is understood in different ways. These paradoxes were explored in a survey of academic and clinical deans and chairs of departments of endodontics and restorative dentistry at U.S. and Canadian dental schools. It was confirmed that fewer than half of the respondents can identify the ADEA and ADA definition of competency. Significant differences were reported in the perceived understanding and value placed on competencies and their impact on dental education. Differences were also found to exist in evaluation practices and in how evaluation data are used to determine students' readiness for graduation. It is concluded that the openness of the competency concept is one reason for its longevity and usefulness in dental education.

Brazilian Dental Students’ Perceptions About Medical Emergencies: A Qualitative Exploratory Study

Abstract: Dental students have little understanding about medical emergencies, and there is very little in-depth data about the importance they place on this important area that is fundamental to their professional training. This study aimed to identify the perceptions of a group of undergraduate dental students about the dentistry-medical emergency interface. Twenty undergraduate dental students at the Federal University of Goias, Brazil, took part in this study. The data were collected through in-depth interviews with these students and were interpreted using qualitative content analysis. Two themes emerged from this data analysis: dentistry as a comprehensive health science, and students' knowledge, feelings, and attitudes about medical emergencies in the dental office. Based on the students' perceptions, an interface between dentistry and medical emergencies in the dental office was proposed that is comprised of the following intertwined concepts: 1) dentistry is a health science profession that should focus on the whole patient instead of being limited to the oral cavity; 2) medical emergencies do occur in the dental office, but students' minimal knowledge about these incidents and their etiology causes feelings of insecurity, dissatisfaction, and a limited appreciation of the dentists' responsibility; and 3) the inability to perform proper basic life support (BLS) technique in the dental office is the ultimate consequence. Undergraduate health courses need to develop strategies to teach professionals and students appropriate behavior and attitudes when facing life-threatening emergencies.

Evidence-based practice among a group of Malaysian dental practitioners.

Abstract: The objective of this study was to assess dentists' knowledge and use of evidence-based practice (EBP), including their attitudes toward and perceptions of barriers that limit the use of EBP. A cross-sectional survey was used with self-administered questionnaires involving dental practitioners in the state of Selangor, Malaysia. One hundred ninety-three replies were returned, for a response rate of 50.3 percent. More than two-thirds (135/193, 69.9 percent) of the respondents had heard of EBP. Out of the 135 respondents who had heard of EBP, a majority agreed it was a decision-making process based on evidence (127/135, 94.2 percent) and involved a series of steps from formulating the research question, locating and assessing the evidence, to applying it if suitable (129/135, 95.6 percent). Out of the 135 respondents who had heard of EBP, a high percentage agreed that EBP improved their knowledge and skills (132/135, 97.8 percent) and treatment quality (132/135, 97.8 percent). For advice, a majority of the 135 respondents frequently consulted friends and colleagues (123/135, 91.1 percent), made referrals (120/135, 88.9 percent), consulted textbooks (112/135, 83.0 percent), and referred to electronic databases (90/135, 66.7 percent). Out of the 135 respondents, many perceived EBP as very important (59/135, 43.7 percent) and important (58/135, 43.0 percent) and were interested to learn further information about EBP (132/135, 97.8 percent). The main reported barriers were lack of time (87/135, 64.4 percent), financial constraints (54/135, 40.0 percent), and lack of knowledge (38/135, 28.1 percent). A majority of the 135 respondents had knowledge of and positive attitudes towards EBP. However, due to barriers, a majority of them preferred colleagues, textbooks, and referrals for advice instead of seeking evidence from electronic databases.

Dental students' self-assessment of preclinical examinations.

Abstract: Accurate self-assessment is an important attribute for practicing dentists and, therefore, an important skill to develop in dental students. Our purpose was to examine the relationship between faculty and student assessments of preclinical prosth- odontic procedures. Seventy-six second-year students completed two consecutive examinations and two self-assessments. The examinations involved setting maxillary denture teeth on a model to simulate the clinical procedure of a complete maxillary denture. Results indicated no significant increases in examination or student self-assessment mean scores; however, regression analysis indicated changes in student self-assessment scores explained 16.3 percent of the variation in examination scores. In essence, improvement in student self-assessment predicted improvement in examination scores among dental students completing a preclinical dental procedure.

Introducing Dental Students to Evidence-Based Decisions in Dental Care

Abstract: Practicing evidence-based dentistry is a process of lifelong and self-directed learning. Teaching evidence-based dentistry to dental students is the key to increasing the uptake of evidence-based treatments and practices in dentistry. This article describes the procedures undertaken to teach undergraduate dental students at the University of Toronto Faculty of Dentistry how to produce systematic reviews as a module in clinical epidemiology. Nine selected reports have been summarized as examples of the outputs of this module. At the end of the module, students are asked to participate in a survey and anonymously fill out a questionnaire to evaluate the module. Students' evaluation of the module in the 2005-06 (n= 64) and 2006-07 (n=57) academic years were extracted for data analysis. Overall, the majority of students found the module an enjoyable way of learning that has improved their ability to gather information, apply existing evidence to a clinical question, evaluate information, and further develop their communication skills. This module was also effective in raising students' awareness of the importance of evidence-based clinical practice. It is essential to establish the fundamentals of evidence-based practice during the undergraduate curriculum to assist dental students in learning the skills to practice evidence-based dentistry.

Dental Education Economics: Challenges and Innovative Strategies

Abstract: This article reviews current dental education economic challenges such as increasing student tuition and debt, decreasing funds for faculty salaries and the associated faculty shortage, and the high cost of clinic operations and their effect on the future of dentistry. Management tactics to address these issues are also reviewed. Despite recent efforts to change the clinical education model, implementation of proposed faculty recruitment and compensation programs, and creation of education- corporate partnerships, the authors argue that the current economics of public dental education is not sustainable. To remain viable, the dental education system must adopt transformational actions to re-engineer the program for long-term stability. The proposed re-engineering includes strategies in the following three areas: 1) educational process redesign, 2) reduction and redistribution of time in dental school, and 3) development of a regional curriculum. The intent of these strategies is to address the financial challenges, while educating adequate numbers of dentists at a reasonable cost to both the student and the institution in addition to maintaining dental education within research universities as a learned profession.

The implications of gender stereotypes for the dentist-patient relationship.

Abstract: This study assessed whether traditionally based gender stereotypes are applied to dentists. Awareness of gender-driven preconceptions can help dentists anticipate patient expectations that play a role in the clinician-patient relationship. A sample of 106 college students and fifty-four non-college students completed a one-page survey that assessed whether seven traits were viewed as more characteristic of male dentists, female dentists, or neither gender. While there was no trait that over 50 percent of respondents considered more typical of either gender, female dentists were viewed as significantly more likely to make patients feel relaxed and to take time to discuss ailments with them, perceptions found most frequently among those respondents who expressed a preference for a female dentist. Male dentists were perceived as significantly more likely to expect a patient to endure pain without complaints, more devoted to career than family, and more likely to seem to be in charge and to be attracted to the power of their profession. The findings indicate that dental students should be encouraged to consider how patients’ preconceived gender-based expectations and assumptions may influence rapport and communication between patients and dentists.

Dental education in a flat world: advocating for increased global collaboration and standardization.

Abstract: Globalization is a broad term referring to the increasing connectivity, integration, and interdependence of economies, societies, technologies, cultures, and political and ecological spheres across the world. This position paper was developed by a working group of the 2007 American Dental Education Association (ADEA) Leadership Institute. The authors explore the effect that globalization has had on dentistry and dental education to date and hypothesize what dental education could look like in the years ahead. While the paper is written from a North American perspective, some of the authors bring international expertise and experience to the topic of global dental education in a flat world. Specific issues and barriers addressed in this position paper include variations in accreditation and licensure requirements in dental education throughout the world; the historical development of dental education models (odontology and stomatology) and the need for congruency of these models in the global environment; the competency-based model of education and its relevance to development and implementation of global dental competencies; and the slow adoption of technological advances in dental education for promoting collaborations and encouraging resource sharing among countries. These challenges are discussed as they affect the implementation of a standardized global dental education that can lead to improved access to oral health care services and better oral and overall health for the citizens of the world.