Impact of experiential learning on dental students' training in nitrous oxide inhalation sedation

Dental students and recent dental graduates' perceptions of preparedness in treating pediatric patients

PURPOSE/OBJECTIVES

To survey potential applicants applying to advanced education in pediatric dental programs and evaluate their preparedness upon graduating from an accredited dental school.

METHODS

Attendees of a virtual externship of a University program were recruited to participate in a web-based survey. The survey collected demographic data, current levels of confidence with various pediatric clinical procedures, predicted confidence with those procedures, and number of procedures completed. Chi-Square and analysis of variance statistics were performed on resulting data to determine statistical significance.

RESULTS

Fifty-three participants completed the survey in its entirety (n = 53). Most respondents reported adequate didactic training, mean score of 3.6 (range 0-5) and a moderate to high impact of coronavirus disease 2019 on their overall training with a mean score of 4.9 (range 0-10). Current dental students reported that they are "not confident at all" (<2.0) for 15/24 (63%) of the procedures. Graduates reported "somewhat confident" (<3.0) for 13/24 (54%) of the categories. Both students and graduates report the lowest levels of confidence for managing dental trauma, invasive treatment of young patients (<4 years of age), and patients with special healthcare needs. Dental students self-reported the expectation to feel more confident throughout their matriculation; however, their clinical experience was still reported to be limited. Students did not report reaching the level of "confident" for 75% of the procedures.

CONCLUSION

Dental students and recent dental graduates alike perceive themselves to be under prepared for practice and do not feel confident in performing pediatric dental procedures. This study can provide dental schools, program directors, recent graduates, and dental students with an understanding of areas where they are under prepared and could offer areas where curricula and clinical experiences could be updated or modified.

What is better for psychiatry: Titrated or fixed concentrations of nitrous oxide?

Medication dosages are crucial-no single dose fits all. My paper compares the safety, scientific and practical applicability of fixed 25-50% concentrations of nitrous oxide (N₂O) with the variable titrated concentrations of Psychotropic Analgesic N₂O (PAN), as used in dentistry, and neuropsychiatry. A crucial difference is that PAN is always titrated, via an open circuit (nasal mask), to the minimum concentration (dose), which ensures full consciousness, cooperation, comfort and relaxation. With PAN, the goal is subject comfort, not dose. In contrast, fixed goal concentrations are usually given via relatively closed circuits (full facial mask/similar) without account for individual patient's dose-response. Hence, fixed concentrations, in N₂O sensitive subjects, could result in unconsciousness and other adverse effects (nausea, vomiting, anxiety, aspiration, might occur; requiring an anaesthesiologist for patient safety. PAN is titrated using each subject's subjective and objective responses as the guide to the ideal concentration. Thus, when PAN is used, there is no fixed concentration even for a single subject, nor is an anaesthesiologist required. Furthermore, there is a greater scientific rationale for using PAN, because the receptor systems involved are better known, whilst those for fixed concentrations are not. The PAN or dental titration method has been safely used in general dentistry for over 70 years and as an investigative, diagnostic and therapeutic tool for neuropsychiatry for over 40 years. Clinical applications include substance abuse detoxification, ameliorating depression, and investigations of schizophrenia, human orgasm, pain perception and basic neuroscience. By contrast, the experience with fixed doses in psychiatry is limited.

Assessment of Nitrous Oxide Inhalation Sedation Module in Kuwait: A Survey on Undergraduate Dental Training Curriculum

INTRODUCTION

The use of nitrous oxide/oxygen (N₂O/O₂) inhalation sedation in dentistry has increased worldwide. This study aimed to evaluate the nitrous oxide/oxygen (N₂O/O₂) inhalation sedation undergraduate teaching curriculum at Kuwait University Faculty of Dentistry.

METHODS

A cross-sectional survey involving dental students in their clinical years (5th, 6th, and 7th years) at Kuwait University Faculty of Dentistry was conducted. Participation was voluntary and anonymous. The Likert scale-based survey comprised 17 statements that assessed various aspects of N₂O/O₂ inhalation sedation in dental procedures. Continuous data variables were compared among different groups using one-way analysis of variance (ANOVA). Categorical data variables were compared using either the Chi-squared test or Fisher's exact test.

RESULTS

Fifty-six students participated in this survey-based study. All students attended an approximately equal number of practical hands-on-training sessions, with a mean of 1.7 (± 1.1) sessions (p = 0.813). Most students expressed confidence in administering N₂O/O₂ inhalation sedation with an insignificant difference between each group (p = 0.276). However, low confidence level was observed in certain intraoperative and postoperative management aspects of providing N₂O/O₂ to patients.

CONCLUSION

This study indicated that the teaching curriculum regarding N₂O/O₂ inhalation sedation should be regularly evaluated. The quality of students' educational pathways should also be assessed through surveys to improve and develop dental school curricula to the highest standard levels.