JDR Clinical & Translational Research最新文献

Introduction: Dental caries is the most common chronic childhood disease in the United States. Topical fluoride varnish (TFV) is a simple evidence-based preventive procedure shown to reduce early childhood caries and is approved for the primary care setting; however, rates of TFV application nationally are low. Less than 10% of eligible children received TFV at 1 academic family medicine group during well-child visits. This study assessed the clinician-reported barriers and facilitators to TFV application in that group to inform quality improvement efforts.

Methods: Using an exploratory sequential design, we developed a 29-item survey assessing knowledge, attitudes, and perceived barriers and facilitators to TFV application. The survey was distributed to outpatient family medicine practice clinicians in a mid-Atlantic academic health center in July 2020. Data were analyzed by univariate descriptive statistics.

Results: Of 163 eligible clinicians, 93 (57%) completed the survey, including 60 MD/DO attending physicians, 12 advanced practice clinicians (5 physician assistants, 7 nurse practitioners), and 21 resident physicians. The most frequently reported facilitator was having TFV supplies preplaced in the examination room (92%), followed by nursing staff providing patient education (84%). The most frequently reported barrier was time constraints (61%), followed by the belief that dentists already provide TFV (47%). Advanced practice clinicians expressed a greater need for hands-on training, while residents prioritized refreshers on eligibility and billing. Attending physicians were more likely to report insufficient time for parent education as a barrier.

Conclusions: The study highlights key workflow and education-related barriers affecting TFV application in family medicine. Strategies such as interprofessional workflow optimization, previsit planning, and enhanced EHR documentation may address these barriers. Findings support the need for quality improvement initiatives to integrate TFV more effectively into routine pediatric preventive care, ultimately improving early childhood caries prevention.Knowledge Transfer Statement:Despite recommendations for topical fluoride varnish in primary medical care, application rates remain low due to time constraints, workflow inefficiencies, and unclear clinician roles. This study identifies key barriers and facilitators, highlighting the need for team-based workflows, previsit planning, electronic health record enhancements, and targeted training. Findings can inform quality improvement initiatives to streamline topical fluoride varnish application, optimize interprofessional collaboration, and enhance early childhood caries prevention in primary medical care settings.

Background: Graduates of U.S. dental schools must meet curriculum and competency requirements set by the school and by the Commission on Dental Accreditation. Little is known about the impact of this training on recent alumni in practice. This cross-sectional study surveyed recent alumni about their preparedness and comfort in treating the oral health needs of children before and after a curriculum change in the predoctoral pediatric dental clinical course. Results were used to inform future curriculum improvement.

Methods: Five classes of dental school alumni were surveyed at least 6 mo after graduation. Information about their practice setting, patient pool demographics, comfort and preparedness in diagnosing and treating common pediatric oral health conditions, and open-ended thoughts on caring for the oral health needs of children were obtained. Responses were analyzed before and after a curriculum change that introduced predoctoral students to patient care in the graduate pediatric dental clinic.

Results: Electronic and mailed paper surveys were sent to 552 alumni, with 218 (39.3%) returned. A majority (91.1%) reported seeing pediatric dental patients in practice. There was no difference in the incidence of seeing pediatric patients before or after the curriculum change. Participants reported high comfort and confidence in diagnosing pediatric oral health conditions, and there were no significant differences seen pre or post intervention.

Conclusions: Surveyed alumni reported similar comfort levels in diagnosing and treating common pediatric oral health conditions both before and after the curriculum change. General dentist alumni still struggle with recommending that the first dental visit happen at the eruption of the first tooth or the child's first birthday. More information is needed to assess how to educate competent clinicians in a predoctoral setting.Knowledge Transfer Statement:The recommendations from this article can be used by dental educators to improve clinical and didactic teaching and to ensure dental learners' education and competency.

Each day there is growing evidence surrounding the relationship of oral disease and general health. With increasing recognition of the science describing the nature of associations between oral health and general health, as well as the global acknowledgment of oral disease as one of the most common noncommunicable diseases, global attention of dentistry's role in primary care and universal health coverage is increasing. As the evidence continues to mount, opportunities to modify existing health care systems and related barriers will elevate policy, programs, training, and the need for public health approaches to transcend existing inflexible health care operations, training, and research. Oral health has a critical role in collaborative actions to improve the health of individuals and communities.Knowledge Transfer Statement:Oral health is an essential component of general health. Including oral health within health systems, processes, and training is critical to the health of individuals and communities.

Aims: This work examines and describes dental health among people seeking asylum and refugees (PSAR) who are evaluated by the Respond service. This includes access to and use of oral health products, access to dental care, and experience of dental pain.

Materials and methods: The Respond service pilot offered holistic health assessments to PSAR in temporary accommodation within North Central London between July 2021 and March 2023. Relevant data were extracted from anonymized health records of individuals seen by Respond. Data were analyzed with SPSS (version 28.0.0.0; IBM) to produce descriptive statistics and regression models.

Results: An overall 1,390 PSAR were included; 78.7% were male. The mean ages of adults and children were 31.6 and 6.8 y. Seventy-seven countries of birth were reported, most commonly Iran (23.1%). Over two-thirds (67.1%) of PSAR were not accompanied by family members; only 17.2% had UK family links. The mean travel duration was 769.3 days; migration reasons were multifactorial, including persecution (31.2%) and conflict (20.5%). In addition, 77.3% of PSAR reported having access to a toothbrush; only 50.8% indicated routinely brushing their teeth, with 38.9% having seen a dentist in <36 mo. Dental pain was common (28.8%). Only 45.8% of children (<16 y) had access to a toothbrush, 32.3% were brushing their teeth twice daily, and 9.7% cited dental pain. Logistic regression identified significant predictors of routine toothbrushing, access to dental care, and dental pain. Female PSAR were more likely to routinely brush their teeth (adjusted odds ratio [OR], 3.19; P < 0.001) and access dental care (adjusted OR, 0.57; P < 0.05). PSAR aged 30 to 39 y (adjusted OR, 1.97; P < 0.05) and those with informal travel modes (adjusted OR, 1.82; P < 0.001) were more likely to experience pain.

Conclusion: There is variation in the dental experience of PSAR, but a significant proportion are failing to perform routine toothbrushing, are not regularly accessing dental care, and are experiencing dental pain.Knowledge Transfer Statement: The results of this analysis suggest that there is variation in the dental experience of people seeking asylum and refugees, but many are failing to perform routine toothbrushing, are not regularly accessing dental care, and are experiencing dental pain.

Background: Dental providers frequently deliver care for individuals with chronic medical conditions (CMCs) such as hypertension, diabetes mellitus, and obesity and should be prepared to address their oral and systemic health needs. The goal of this study was to assess the current integration of CMC education into advanced education in general dentistry (AEGD) and general practice residency (GPR) curricula.

Methods: A 46-question cross-sectional survey was sent electronically to all 265 U.S. AEGD and GPR program directors (PDs) in February 2019. The survey consisted of multiple-choice questions about CMC curricular content, mode of delivery, barriers to teaching the content, evaluation technique, and competence of residents upon graduation. The survey was adapted from relevant literature and prior validated surveys. The data were analyzed using univariate statistics such as frequencies and percentages to describe all survey items.

Results: Of the 265 programs surveyed, 42% of PDs responded (N = 111). Most agreed that it was important for residents to receive training to identify diabetes (88%), hypertension (90%), and obesity (78%). However, only 62% of PDs taught their residents to identify obesity compared with hypertension (90%) and diabetes (85%). Regarding health assessments, nearly half the PDs reported that their residents do not collect body mass index for obesity, while only 12% and 4% were not collecting HbA1c values and blood pressure, respectively. In addition, among residents being evaluated, 65% of PDs agreed that their residents were competent in knowing health system resources for obesity compared with hypertension (78%) and diabetes (76%).

Conclusion: While most programs are teaching their residents to identify diabetes and hypertension, greater focus on obesity is needed. Increased efforts should be devoted to closing this gap in dental training so that residents are comfortable not only discussing medical conditions with their patients but also with performing regular chairside examinations, providing counseling, and making appropriate referrals.Knowledge Transfer Statement:The results of this study can be used by educators charged with creating and revising curricula for postgraduate dental residency programs. Knowing the current status of the integration of primary care topics into such programs can assist in the identification of existing curricular gaps and solutions to barriers. This could lead to the development of better integrated curricula, which will result in more comprehensive care for patients.

Purpose/objectives: This study documents lessons learned from the revision of the predoctoral advanced pediatric dentistry course administered during the academic year 2019-2020. Insight on the use of and recommendations for adopting the Six-Step Approach for dental curriculum revision are provided.

Methods: Thomas et al.'s Curriculum Development for Medical Education: A Six-Step Approach was adapted and applied by dental faculty after the predoctoral director completed a Medical Education Principles and Practice course. Literature review, anonymous student and faculty surveys administered via Qualtrics, individual faculty feedback sessions, and aggregate course data were assessed.

Results: The identification of the specific health care problem to be solved and the assessment of targeted learners and learning environment helped clarify course goals and specific measurable objectives. With a shared understanding of learners' needs, faculty united in adopting new educational strategies to promote the achievement of revised objectives. This facilitated rapid course implementation. Evaluation results demonstrated increased student engagement and faculty satisfaction.

Conclusions: The framework provided by the Six-Step Approach aided the revision of the pediatric dental curriculum, clarified goals of promoting learner engagement, and increased faculty enjoyment of teaching. Dental educators may find this framework useful when revising their curricula.Knowledge Transfer Statement:This article aims to support dental educators in familiarizing themselves with and using a defined approach to curriculum development.

Objectives: Physiologic and behavioral changes during pregnancy adversely affect oral health. Despite practice guidelines stating that dental care is a safe and necessary part of prenatal care, some dental providers remain reluctant to treat pregnant persons. Only a single investigation (at New York University [NYU]) has evaluated the knowledge, attitudes, and willingness of dental faculty to treat pregnant persons. Faculty affect the treatment preferences of their students and therefore have an outsized influence on prenatal dental care.

Methods: We cross-sectionally administered an anonymous 14-item REDCap survey to faculty from the Eastman Institute for Oral Health, School of Medicine and Dentistry, University of Rochester (UR), to evaluate their knowledge, attitudes, and willingness to provide dental treatment for pregnant persons. We compared these results against NYU data.

Results: Sixty-five (72.2%) UR faculty completed the survey. Most agreed that women should see a dentist during pregnancy (90.8%) and that dental treatment should be part of prenatal care (98.5%). However, only 47.7% were aware of professional practice guidelines for oral health during pregnancy, and 21.5% reported liability concerns when treating pregnant persons. UR faculty knew more about the relationship between maternal and child oral health than NYU faculty. Using the combined data set (UR + NYU), we found that concern about liability was a significant predictor of unwillingness to treat pregnant persons, and this relationship remained when controlling for knowledge and covariates.

Conclusion: While dental faculty's knowledge and attitudes were generally in line with current guidelines for oral care during pregnancy, 1 in 5 UR faculty reported liability concerns. In the combined data set, we found that those with liability concerns were 5 times more unwilling to provide dental care to pregnant persons. Continuing education based on evidence and current guidelines on oral health in pregnant women should be considered necessary but may be insufficient to improve dental care for pregnant women.Knowledge Transfer Statement:In the United States, only about 50% of pregnant persons report a dental visit during this vulnerable time. Dental faculty members transfer their beliefs, knowledge, attitudes, and willingness to treat pregnant persons to their students. These study results demonstrate that many faculty are unaware of the professional practice guidelines and that knowledge and attitudes affect willingness to treat pregnant persons. Continuing education based on current guidelines for the oral health of pregnant persons is necessary but may be insufficient to affect willingness.

Introduction: Children referred for comprehensive dental care under general anesthesia, due to severe early childhood caries, have a high risk of continued caries progression in posttreatment years.

Objectives: To assess the effect of a phone-delivered, motivational interviewing-based parental support program on caries recurrence and oral health habits in preschool children treated under general anesthesia for severe early childhood caries.

Methods: The prospective design of this 2-arm randomized clinical trial (allocation ratio 1:1; blinded outcome assessment) comprised 151 patients from pediatric dental departments in the Stockholm region of Sweden. Inclusion criteria were healthy children aged <6 y with early childhood caries who were scheduled for treatment under general anesthesia. Control group parents received standard advice on toothbrushing and sugar reduction. Intervention group parents received planned phone counseling with an oral health coach every other week for 1 y, based on motivational interviewing principles, offered in Arabic, English, Polish, Turkish, and Swedish. The primary outcome was caries progression 1 and 2 y postsurgery, assessed using the International Caries Detection and Assessment System. Secondary outcomes were parent-reported daily toothbrushing and dietary habits.

Results: Sixty-five percent of the control group and 77% of the intervention group experienced caries relapse on at least 1 new surface after 1 y (nonsignificant). At the 2-y follow-up, relapse rates were 53% (control group) and 71% (intervention group; P < 0.05) compared with baseline. The intervention group was significantly less likely to engage in adverse oral health behaviors such as snacking on sweets (intervention group, 10%; control group 33%) and sweet drinks (intervention group 9%; control group, 29%) after 1 y. No group differences in daily fluoride toothpaste brushing occurred.

Conclusion: The motivational interviewing-based parental support program improved dietary habits but showed no effect on caries recurrence in children treated under general anesthesia for early childhood caries.

Clinicaltrials: gov NCT02487043Knowledge Transfer Statement:The findings of this study can assist clinicians, public health leaders, and researchers in tailoring preventative behavior-focused programs for early childhood caries. These results may improve the understanding of how behavioral interventions that involve parents of young children affect caries prevention, highlighting approaches that are less likely to be effective and guiding future efforts toward more promising strategies for high-risk populations.

Background: U.S. dental school graduates must complete competencies in oral health care across the life course. While they have met these requirements, little is known about graduates' assessment of how this training prepared them for practice. Future practice setting may affect the training needs of dental school graduates. This quality improvement survey looked at alumni narratives regarding their predoctoral training in pediatric dentistry, the adequacy of this training, how practice setting influenced their training needs, and what recommendations they would make for curriculum change.

Methods: As part of a larger survey, semi-structured interviews were conducted of 14 recent alumni in general dental practice; the questions covered their graduation year, current practice setting, recollection of their predoctoral pediatric dental training, the adequacy of that training, and recommendations on how to prepare future graduates to care for pediatric dental patients. Interviews were transcribed and assessed for these themes.

Results: Half of the practitioners were in private practice, and half worked in rural or community clinics. Recent alumni felt comfortable and confident treating the oral health needs of a pediatric population but overwhelmingly said that they wanted more hands-on experience in dental school. They especially highlighted the need to see patients with challenging behavior and more complex operative treatment needs. Alumni working in rural areas or community clinics emphasized the need for these skills because of the lack of referral options.

Conclusions: Recent alumni wish they had had more hands-on pediatric dental experiences in dental school to better prepare them for the challenges they face in practice. These experiences may be limited, and one suggestion would be to channel these opportunities to practitioners who will work in areas where there are insufficient resources and fewer options for referral.Knowledge Transfer Statement:The recommendations from this article can be used by dental educators to improve clinical and didactic teaching and to ensure dental learners' education and competency.

Clinician educators who teach dental residents in the fast-paced clinic, such as in emergency dental care, often face numerous challenges. Time for clinical teaching is limited in the setting of significant clinical workload, complex medical conditions of patients, and the need for documentation and satisfaction of clinic productivity goals at the same time. Little is known about effective clinical teaching methods or tools that could enrich learning opportunities and increase dental residents' clinical competency in a busy clinic environment when there are time constraints to teach. The One-Minute Preceptor (OMP) model is an innovative teaching method originally used for clinical teaching in family medicine residency trainings that has been shown to be an effective teaching tool, resulting in the increased confidence and clinical skills of residents. It focuses on identifying the needs of each individual learner, teaching to the needs, and providing feedback by using a 5 micro-skill approach: get a commitment, probe for supporting evidence, teach general rules, reinforce what was right, and correct mistakes. We propose using the OMP model to teach dental residents in a dental emergency clinical setting to allow the clinician educator to take full advantage of the entire encounter to maximize the time available for teaching and improve clinical teaching efficacy and efficiency and for dental residents to practice clinical reasoning and identify their own knowledge gaps in emergency dental care settings.Knowledge Transfer Statement:The recommendations from this article can be used by postgraduate dental training programs to improve clinical teaching and ensure dental residents' education and competency.