Development of entrustable professional activities for post-doctorate pediatric dentistry education

PURPOSE

To identify the core components of pediatric dentistry defining entrustable professional activities (EPAs) representing the profession.

METHODS

Potential core components of pediatric dentistry and corresponding domains were identified through review of literature and existing pediatric dentistry standards. A modified Delphi technique was utilized to rate these candidate EPAs to achieve consensus around prioritized EPAs.

RESULTS

Eleven participants participated in all three rounds of the Delphi. After three rounds, 16 candidate EPAs reached consensus for pediatric dentistry. Each EPA fell into one of four domains: "assessment and planning," "provision of care," "behavior guidance," and "professional development." An original candidate EPA focused on non-pharmacological behavior guidance was deemed too broad by the Delphi. This EPA was subsequently developed into three separate components on nitrous oxide analgesia, moderate sedation, and general anesthesia.

CONCLUSIONS

Prioritized EPAs will help define the essential activities of the profession and provide a framework for creating assessments to ensure that graduating pediatric residents are ready for unsupervised practice.

Perinatal Oral Health Among Underserved Women: A Call to Action for North Carolina Patients, Providers and Policymakers

INTRODUCTION

Knowledge gaps exist among providers and pregnant women about the importance and safety of oral health care around pregnancy. This article describes the current state of perinatal oral health and healthcare among underserved women in North Carolina (NC) and provides policy recommendations to improve their access to and utilization of dental services.

METHODS

A descriptive analysis is provided using (a) 2016 oral health surveillance data of a convenience sample of 459 pregnant women across NC, (b) 2014-2016 Medicaid dental provider and dental services utilization data for the Medicaid for Pregnant Women (MPW) program, and (c) 2017 Medicaid dental benefits policy. Surveillance data was not linked to Medicaid dental services utilization data.

RESULTS

Less than 20% of pregnant women surveyed reported having a dental visit during pregnancy and oral screenings revealed 33% had untreated caries. Medicaid data showed a steady decline since 2014 in percentage of MPW beneficiaries utilizing any dental service-less than 10% as of 2016. MPW dental benefits lapse at delivery because dental care is not considered pregnancy-related in NC policy. Only 20% of practicing NC dentists provided care to MPW beneficiaries in 2015.

DISCUSSION

Inadequacies in oral health knowledge, beliefs and practices exist among pregnant women, health care professionals and policymakers. Statewide efforts are needed to promote a standard of perinatal care that emphasizes collaborative practice and addresses existing barriers at the patient, provider and policy levels.

Promoting oral health in nursing education through interprofessional collaborative practice: A quasi-experimental survey study design

BACKGROUND

Optimal oral health education is limited in nursing curricula and may therefore, not translate as a priority for nurses in clinical practice.

OBJECTIVES

To evaluate the influence of an educational intervention on knowledge, confidence, practice behaviors, and perceived barriers of nursing students regarding preventive oral health services.

DESIGN

Quasi-experimental pre-post survey study design.

PARTICIPANTS

Sixty-four first-year Accelerated Bachelor of Nursing (ASBN) students at the University of North Carolina at Chapel Hill.

METHODS

Students were asked to complete oral-health-related questionnaires following didactic and clinical simulation on principles of oral health, oral screening, counseling, and referral to a dentist. A post-survey following clinical rotations was completed testing long-term effectiveness.

RESULTS

Fifty-five (86%) ABSN students completed the pre-survey, 49 (77%) completed the post-survey; 44 (69%) completed both. Participants' showed a significant increase in knowledge from pre-post questionnaires for two of five questions (p = 0.04; p < 0.0001). Confidence scores in performing oral screenings (p < 0.0001) and counseling (p = 0.006) increased; while scores regarding referrals decreased (p = 0.718). Post-intervention, 37% reported performing oral screenings, 45% counseling, and 8% dental referrals. Respondents reported a significant increase in willingness to implement oral health services during clinical visits (p < 0.0001).

CONCLUSION

Mixed educational methods can successfully influence oral health knowledge and confidence among ABSN students and their willingness to perform in clinical practice.

Interprofessional Education: Oral Health in the Medical Curriculum

Schools of medicine and dentistry on the same geographical campus have an opportunity to promote oral health by training physicians to become more skilled in screening for oral disease in addition to counseling and referring patients to dental health professionals.

Addressing early preventive oral health care among young children: a pilot evaluation of the Baby Oral Health Program (bOHP) among dental professionals

PURPOSE

Many communities lack dental professionals with the knowledge and behavioral skills needed to deliver care to young children (<3 years). This study aimed to examine the impact of an intervention (the Baby Oral Health Program (bHOP)) on dental providers' knowledge, values, confidence and practice behaviors regarding preventive oral health care to young children (<3 years), and assess the feasibility and satisfaction of the bOHP among dental providers in a Canadian community setting.

METHODS

A quasi-experimental design was employed, with 24 intervention (4.5 hour workshop, and booster session 1 month following) and 18 control group participants completing pre- and post-surveys.

RESULTS

A significant group interaction effect emerged for value and knowledge (p<0.05), with participants in the intervention group demonstrating significantly higher baseline to post-intervention change scores. No significant group differences were found for confidence and practice behaviors (p>0.05). Mean scores for perceived workshop usefulness and perceived influence on practice were high.

CONCLUSION

Findings suggest that bOHP is effective in increasing dental professionals' knowledge and values about the importance of preventive oral health among young children. However, consideration to provider's stage of readiness to change and more systems-based approaches to enhancing early oral health interventions should be assessed.

Preoperative assessment for children requiring dental treatment under general anesthesia

OBJECTIVE

This study aimed to describe children <6 years requiring general anesthesia for dental treatment and factors associated with a change in medical management prior to surgery.

STUDY DESIGN

This case series reviewed the past medical history and preoperative assessment of patients referred for dental preoperative evaluations at a single institution (2005-2008). A "deflection" was defined as a recommendation to change preoperative or operative care based on the preoperative assessment. The sample was analyzed using descriptive, bivariate, and multivariate analyses.

RESULTS

Of 648 subjects (aged 9 months to 6 years, mean 3.9 years), 63% had a past medical history abnormality and 38% had previous surgery. In total, 14% were deflected, most commonly because of the addition of infective endocarditis prophylaxis (29%). A history of coagulation disorder had the strongest association with deflection (P < .0001, odds ratio = 10.0, 95% confidence interval = 4.6-22.1), followed by cardiac anomalies.

CONCLUSION

Preoperative assessments for pediatric dental treatment frequently identify medical problems resulting in treatment plan alterations.

The relationship between child temperament and early childhood caries

PURPOSE

Among the potential risk factors associated with nursing caries/baby bottle tooth decay--a subset of Early Childhood Caries (ECC)--is a "strong-tempered" behavioral style in the child. However, the few empirical studies that have investigated this description remain controversial. The research goal of this study was to operationalize the "strong-tempered" profile and investigate its association to parental feeding practices and ECC levels.

METHODS

In an observational-correlational study design, 58 children (ASA I), ages 18 to 70 months (M = 43 months, SD = 17), were reliably assessed for ECC levels by a clinical evaluator. A second evaluator, blind to ECC status, interviewed parents using a demographic survey, a feeding practices measure, and the EAS Temperament Survey for Children.

RESULTS

Multiple regression analyses indicated that none of the four temperament factors (Emotionality, Activity, Sociability, and Shyness) significantly predicted duration of feeding habit defined as the length of time in months that the child breast or bottle fed, whichever lasted the longest. However, the combination of greater duration of feeding habit and higher levels of Shyness predicted all three measures of ECC: the presence or absence of caries (r2 = .19, P < .001), the number of carious teeth (r2 = .23, P < .001) and the number of carious surfaces (r2 = .21, P < .001). Furthermore, the addition of Native status significantly increased the predictive value of all of three models (r2 = .37, r2 = .43, r2 = .29, respectively, Ps < .0001).

CONCLUSION

Temperament did not predict the duration of feeding habit but together, shyness and duration of feeding habit was associated with ECC.

Temperament and trait anxiety as predictors of child behavior prior to general anesthesia for dental surgery

Children's individual styles of interaction with the environment (temperament) influence stable tendencies towards distress (trait anxiety) and context-specific manifestations of distress (state anxiety). Measures of temperament and trait anxiety were examined as predictors of state anxiety (i.e., disruptive behaviors) in the presurgical setting. During a 2-month period, 51 nonpremedicated, healthy children (M = 3 years of age) were consecutively studied-as they presented to a hospital setting for dental treatment under general anesthesia (GA). Using correlation and backward multiple regression analyses, one temperament category (shyness), but not trait anxiety (the revised CMAS), predicted disruptive behaviors (the revised MBPRS) during preseparation (r2 = .16, P = .0038) and separation (r2 = .09, P = .0281) from parents. Shyness, age, and gender best predicted disruptive behaviors during preseparation (multiple R2 = .31, P = .0005). Temperament (a) predicts children's distress in the presurgical setting, and (b) appears to be moderated by age, gender, and interpersonal factors. Awareness of temperamental influences can help predict children's behavior and aid in the presurgical care of children.