Social determinants of health linked with oral health in a representative sample of U.S. adults

BACKGROUND

Oral diseases remain a significant public health problem worldwide, with growing gaps in oral health status among various socioeconomic groups. The objective of the current study is to analyze the impact of different social determinants of health (SDOH) on oral health outcomes (frequency of dental visits, self-reported oral health status, embarrassment because of oral health status, and tooth loss) among a representative sample of United States (U.S.) adults.

METHODS

Cross-sectional data for this observational study came from adults aged 18 and above (N = 5,320) participating in the nationally representative 2021 State of Oral Health Equity in America survey. Bivariate and multivariable analyses were conducted to examine the associations between oral health outcomes (dependent variables) and SDOH independent variables: structural (race/ethnicity, income, education); and intermediary (lack of transportation, food insecurity, racial discrimination, and housing instability), controlling for the confounding variables of age, gender, employment status, dental insurance, self-rated mental/emotional health, self-rated physical health, presence of one or more chronic conditions, and having had a routine physical examination in the past year.

RESULTS

When controlling for confounding variables, Black adults were less likely than White adults to have had a dental visit in the last year (odds ratio (OR) = 0.72 (95% confidence interval (CI) = 0.57-0.92, p < 0.05), more likely to report feeling self-conscious or embarrassed due to their oral health (OR = 1.67 (95% CI = 1.31-2.12, p < 0.05), and more likely to have at least one permanent tooth removed (OR = 1.67 (95% CI = 1.31-2.13, p < 0.05). Higher income and more education were significantly associated with greater odds of rating one's oral health positively and having had a dental visit in the past year and lesser odds of feeling self-conscious or having at least one tooth removed (p's < 0.05). All four intermediary determinants were associated with significant (p < 0.05) and negative odds of having a dental visit in the past year and reporting positive oral health, and with positive odds of having at least one permanent tooth removed. The odds of feeling self-conscious or embarrassed due to their oral health were significantly and positive associated with all intermediary determinants except for racial discrimination (OR = 1.21, 95% CI = 1.00-1.46).

CONCLUSIONS

Significant inequities still exist in the U.S. regarding SDOH and their relationship to oral health. Improving oral health will involve addressing SDOH. Successful policy and public health interventions must address not only structural factors but also intermediary SDOH.

Assessing the experience of dental students with an asynchronous online course about racism, cultural competence

PURPOSE

University of Pennsylvania School of Dental Medicine and the University of Pennsylvania School of Social Policy and Practice (SP2) designed an asynchronous online course about racism and cultural competence to address student concerns about harmful interactions with peers across race/ethnicity. The Penn Experience Course establishes common language and concepts to facilitate difficult conversations about racism in the classroom and clinical spaces.

METHODS

The course included six modules addressing the history of racism in the Philadelphia area and at the University of Pennsylvania: implicit bias and microaggressions; racism and other forms of oppression; gender identity and sexuality; construction of whiteness and white supremacy ideology; cultural humility, disparities, and equity; and access in healthcare. Students completed pre- and post-course surveys about their likelihood of engaging with the neighborhood surrounding Penn, confidence discussing the topics covered, and general experience with the course.

RESULTS

Four hundred forty-nine students completed post-course surveys, 220 of which could be linked to precourse survey responses. Overwhelmingly, students reported a positive experience with the course, an increase in their likelihood to engage with the Penn neighborhood, and increased confidence in discussing course topics with peers. Many students suggested incorporating synchronous discussion, while a smaller group expressed resentment about the focus on whiteness, white fragility, and anti-Black racism. Several students of color expressed concern that the course centered the learning needs of white students.

CONCLUSION

Asynchronous online content offers an effective and efficient way of teaching dental students about the basics of cultural competence. Educators should anticipate resistance from some white students and the distinct learning needs of students of color.

The association between students' emotional intelligence, cultural competency, and cultural awareness

INTRODUCTION

Emphasis has been placed on health professionals' employment of social and behavioral skills to negotiate complex patient-clinician relationships. One example is a professional's ability to provide culturally appropriate care. This study evaluated the relationship between pharmacy students' cultural awareness, emotional intelligence, and their ability to engage in appropriate cross-cultural interactions as measured by a cultural competency scale.

METHODS

A cross-sectional study was conducted in first-year pharmacy students using three distinct survey instruments to measure cultural awareness, emotional intelligence, and cultural competence. Demographic characteristics assessed included gender, race, ethnicity, and previous cultural competency training. Descriptive statistics were used to characterize performance on each survey instrument. Pearson's correlation was used to evaluate the statistical significance of associations observed between the variables measured within the study.

RESULTS

Forty-four students responded, of which 34% had previous cultural competency training. No statistically significant associations were observed between overall cultural competence, emotional intelligence, or cultural awareness. The self-cultural scale (part of the cultural awareness scale) was significantly related to higher overall emotional intelligence scores (P = .02). Previous cultural competency training was associated with significantly higher scores on the cultural competence scale (P = .004). Previous cultural competency training was also associated with enhanced ability to perceive one's own emotions as measured by the emotional intelligence scale (P = .02).

CONCLUSIONS

Previous exposure to cultural competency training impacts cultural competence scores most significantly.

Cultural awareness training for dental students

OBJECTIVES

This study aimed to assess the impact of a full-day workshop on increasing cultural awareness among incoming first-year (DDS-I) and post-doctoral (PGY-I) dental students at the Columbia University College of Dental Medicine.

METHODS

The workshop focused on developing students' cultural awareness regarding dimensions of identity, recognition of power and privilege, importance of cross-cultural understanding and communication, and the role of self-reflection through direct teaching, interactive discussions, and reflective writing. A convenience sample of 83 DDS-I and 30 PGY-I students from the 2019 enrollment class were recruited. Assessments included pre- and post-workshop surveys, facilitator interviews, and a formal workshop evaluation. Descriptive and bivariate analyses of students' responses were performed to assess cultural awareness within and between student groups. Facilitator interviews and student feedback were analyzed qualitatively to identify emerging themes.

RESULTS

Global cultural awareness among both student groups was higher in the post-workshop survey (for DDS-I, mean = 3.46, SD = 0.38; for PGY-I, mean = 3.47, SD = 0.30) than in the pre-workshop survey (for DDS-I, mean = 2.98, SD = 0.34; for PGY-I, mean = 2.90, SD = 0.47), which represented a statistically significant difference (p < 0.001 for both comparisons). Quantitative analysis revealed that the workshop provided a platform to discuss sensitive topics, increased cultural awareness among students and faculty, and provided faculty with different perspectives about culture awareness.

CONCLUSIONS

The full-day workshop achieved its goals of increasing dental students' self-perceived cultural awareness and capacity to establish cross-cultural professional relationships.

Cultural competence of Australian dental students

BACKGROUND

Australia possesses a highly multicultural demographic, and thus dental practitioners are likely to regularly encounter culturally and linguistically diverse individuals. It is important for dental practitioners to be culturally competent, however, cultural competency education is highly variable in the curricula of dentistry and oral health courses in Australia, and research is largely limited to dentistry students. This study aims to investigate and compare perceived attitudes, beliefs and practices of cultural competence amongst first and final year Doctor of Dental Surgery (DDS) and Bachelor of Oral Health (BOH) students at the University of Melbourne Dental School.

METHODS

Following ethics approval, anonymous questionnaires were completed by 213 participants. The questionnaire was adapted from Schwarz's Healthcare Provider Cultural Competence Instrument and consisted of five scales. Data was analysed using SPSS V 24.0 software.

RESULTS

A total of 213 students participated in this study (response rate = 88%) The majority of participants were female (n = 114, 53.5%) and the mean age of 23.5 years (range 18-40). The majority of participants were Australian born (n = 110) with 74.6% (n = 159) first generation Australians. Participants who identified as Australian represented 35.7% (n = 76) with 66.1% (n = 141) identified as partly Australian. Multivariate analysis indicated that, after controlling for other independent variables in the model, those who had the highest cultural competence score were female, who self-identify as "Australian", who were in the final year. Furthermore, those who were in the final BOH year scored significatively higher than final year DDS students.

CONCLUSION

The findings of this study suggest that there is a significant difference in students self-reported cultural competence at different stages of their education. This may be attributed to differences in cultural competence education, scope of practice and the type of patient encounters and role modelling that students may experience. Future research should involve follow up to create longitudinal data, as well as research at other dental schools in Australia and overseas.

Teaching Cultural Competence and Cultural Humility in Dental Medicine

Dental students need to be equipped as clinicians to treat diverse communities and to recognize oral health disparities that are rooted in the social determinants of health. Library instruction is frequently focused on information literacy topics. Within the health sciences this might include critical appraisal or evidence synthesis, and instruction centered on locating and using library resources. This paper details the unique experiences of two liaison librarians to the School of Dental Medicine who taught the topics of cultural competence and cultural humility to first-year dental medicine students. While the authors do not discuss typical information literacy instruction in this paper, they share strategies used to design the instruction sessions, reflections on teaching these themes, lessons learned, and suggestions for other liaison librarians who might have an interest in teaching about cultural competence or cultural humility.

A scoping review on social justice education in current undergraduate dental curricula

BACKGROUND

A recent shift in educational components within healthcare has pushed dentistry toward a greater understanding of the role of social components on oral health. There has also been an increased awareness of inappropriate conduct among dental students.

STUDY DESIGN AND METHODS

A scoping review was conducted to determine if, how, and when social-justice-oriented education has been incorporated into dental curricula worldwide. A systematic and reiterative search of articles was performed on February 22, 2018, and combined quantitative and qualitative synthesis of data. An updated search was done on September 26, 2019.

PRIMARY RESULTS

Seventy-three studies were evaluated: 46 quantitative (63%), 24 qualitative (33%), 3 multimethods (4%). The majority used self-reported surveys and questionnaires (66%), while the remaining used interviews (9.5%), student reflections (16%) and focus groups (5.5%). Studies included dental students only (78%); dental students with dental hygiene students (5.5%) or faculty/staff (4.1%); dental students in year 1 (17%), year 2 (1.6%), year 3 (1.6%), year 4 (14.2%); first- and second-year students (3%); third- and fourth-year students (1.6%); all years of study (20%); and academic year not specified (41%). The study areas included "learning in dental school," "experiencing dental school," "focusing on cultural competency," and "addressing dental ethics and social responsibility."

PRINCIPAL CONCLUSIONS

Three major research gaps were identified: no discussion of a social contract between dentists and society, no explicit social justice-oriented topics within undergraduate dental curricula, and no standardized tool to measure these topics. Further research is necessary to understand how such topics can be included in dental curricula to form socially competent dentists.

Curriculum development in final year dentistry to enhance competency and professionalism for contemporary general dental practice

INTRODUCTION

General dentistry is the most common area of practice, and new dentists must have the competency and skills to safely deliver patient care. In New Zealand (NZ), completion of a 5-year Bachelor of Dental Surgery (BDS) degree enables graduates to register with the Dental Council in NZ. This necessitates that the clinical component of the curriculum in final year dentistry (BDS5) transparently delivers learning opportunities and evaluates competency for independent practice. A review of the BDS5 Clinical Practice course was undertaken in 2015 and a revised curriculum introduced in 2016.

CURRICULUM

We present a BDS5 curriculum for a Clinical Practice course that is learner focused with emphasis on comprehensive patient-centred care, competency and professional practice. Learning opportunities and assessment processes are described alongside teacher training. These changes have provided students scaffolding to support clinical and professional development, and accommodate different learning preferences. The outcomes align with the competency requirements of the NZ regulatory body for registration as a general dental practitioner. Since its introduction 3 years ago, ongoing feedback from students and staff has been positive and indicates the curriculum is effective in achieving its objectives.

CONCLUSIONS

This curriculum provides a firm foundation for students transitioning to independent clinical practice in the community and supports the professional development of clinical teachers. It may also be translated to other areas of health education to ensure the delivery of quality holistic patient care.

Characteristics of Patients Discontinuing Care

Objectives: Due to lower fees, dental school clinics (DSCs) may provide dental care for vulnerable populations. This study evaluates factors associated with patients deciding to discontinue care at a DSC. Methods: This is a retrospective analysis of a patient transfer form that was implemented to smooth transition of a patient when their student provider graduated. Forms provided deidentified information about characteristics and unmet dental needs. Descriptive and bivariate statistics were used to identify associations between patient characteristics and deciding to continue treatment in the student practice. Results: Of 1894 patients, 73.4% continued care. Financial limitations were most commonly reported as the reason for discontinuing care (30.1%). Patients speaking a language other than English or who had reported financial barriers were significantly less likely to continue care. Conclusions: Dental school patients from vulnerable groups are more likely to discontinue care. Dental schools should implement programs that will assist patients in maintaining a dental home.

Teaching Cultural Competence in Dental Education: A Systematic Review and Exploration of Implications for Indigenous Populations in Australia

Indigenous and other minority populations worldwide experience higher rates of disease including poor oral health than other populations. Cultural competence of practitioners is increasingly being recognized as fundamental to health care and quality of life in addressing these disparities. The aims of this study were to conduct a systematic review of the literature about teaching cultural competence in dental education and to explore the particular relevance of that teaching for the oral health care of Indigenous populations in Australia. A systematic review employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was conducted of published studies that explored cultural competency interventions in dental curricula. A total of 258 studies from 2004 to 2015 were identified; after removing duplications and applying criteria for exclusion, 12 were selected for analysis, involving 1,360 participants. The principal themes identified in the qualitative analysis of these studies were curriculum content, curriculum delivery, community service-learning, reflective writing, and evaluation. Students need knowledge of health disparities and community health to better understand the perspectives of culturally diverse populations and to communicate effectively with people from various cultures. The principal strategies that improved cultural competence in the articles examined in this study were educational seminars, community service-learning, and reflective writing. These findings suggest that integration of cultural competency curricula using a combination of didactic or online training, community engagement, and reflective writing may increase the cultural knowledge and skills of dental students.

Addressing Oral Health Disparities Via Educational Foci on Cultural Competence

An ever-present challenge for the oral health profession is to reduce the extent of oral disease among racial and ethnic minority populations. Adding to this complex dilemma is the linkage between oral health and systemic health. We describe enhanced cultural competency, in the context of individual cultural beliefs, values, language, practice, and health behaviors, among dental professionals, as one approach to meeting the dental care needs of the underserved. An overview and examples of teaching methods used by University of Florida dental educators to enhance student cultural competency is provided. Evidence-based evaluation results provide evidence of methodology efficacy. We conclude by describing actions that can be implemented by academic dental institutions to facilitate development of culturally competent practitioners.

Incorporating Antiracism Coursework into a Cultural Competency Curriculum

Creating a socially conscious educational environment is an imperative if health care practitioners are to have a significant impact on health inequities. The effects of practitioner bias, prejudice, and discrimination on health and health outcomes have been well documented in the literature. Individuals being trained to provide health care will be entering into an increasingly diverse world and must be equipped with the appropriate knowledge and skills in order to meet the needs of those seeking their care. Cultural competency training in medical education has evolved over the past 15 years since the Institute of Medicine's 2002 report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. As research on the effectiveness of this training has emerged, several authors have called for the integration of antiracism training into the cultural competency curriculum, but few have found effective ways of doing so. This article describes the approach of one midwifery program in order to inform clinical education programs across the spectrum of health care practitioners.