Haptics in fixed prosthodontics and their role in dental education: A literature review

Technological progress leads to new advances in dental education. One of the applications involves the use of virtual and augmented reality as educational aids. The emerging question is to establish if and how these enhancements may prove beneficial to the overall student learning process. A review of recent literature was conducted with the aim of providing evidence for the development of relevant clinical guidelines. The proposed topic attempted to provide answers to the questions of (a) how participants perform when using haptic devices compared to traditional tooth preparation methods on typodonts, (b) how the use of simulators is perceived by both students and educators, and (c) what added value simulators may have in prosthetic dentistry training. The main findings of this study showed that participants expressed satisfaction with the educational experience, finding it both stimulating and very similar to the actual clinical environment. However, differences between haptic and conventional methods were also apparent. Haptics was a significant predictor of clinical crown performance. Significantly better results and shorter preparation times tended to increase with experience. In conclusion, self-directed learning appears to be beneficial in the clinical education that follows data-driven approach. At the pre-laboratory level, simulators may act as an initial familiarization instrument. At the preclinical level, they may aid in detecting students who require extra assistance, or to provide extra training hours for students lacking adequate competency to enter the clinical training phase.

Medical emergencies in a dental school clinic - A 12-year review and lessons learned

PURPOSE

The aims of this study were to estimate the type and frequency of different medical emergencies that occurred over the study period (twelve years) and discuss the lessons learned and the modifications made in the curriculum to better equip dental students and faculty in their management.

MATERIALS AND METHODS

A retrospective study was conducted to evaluate all medical emergencies that needed activation of the response team at our school from 2008 to 2020.

RESULTS

The emergency response system was activated 250 times during the 12-year period. There were 132 medical emergencies in the pre-doctoral clinic and 105 events in the post-doctoral clinic (p 0.0680). Most of the emergencies occurred in patients between 45 and 64 years of age. Syncope occurs most often followed by adverse cardiovascular, respiratory, anxiety, and hypoglycemic events.

CONCLUSIONS

Medical emergencies occurring in a dental school provide a unique opportunity for students to gain experience in their management. The key lies in preparing the students and faculty to prevent them from occurring, but should these occur, then they should be able to promptly recognize symptoms and institute prompt intervention.

Effect of educational intervention on computer-aided-design and computer-aided-manufacturing technology to preclinical dental students

INTRODUCTION

This study evaluated the effectiveness of a video presentation instruction compared to the prevailing traditional lecture provided in the preclinical classroom when introducing computer-aided design/computer-aided manufacturing (CAD/CAM) technology.

MATERIALS AND METHODS

This study was conducted as a controlled educational trial (single-blind) on 120 first-year dental students. Students were assigned to two learning groups: the control (n = 60, traditional lecture) and the intervention (n = 60, video presentation). Both groups completed a self-efficacy scale (SES) survey before instruction. Then, the intervention group actively participated in a one-session video presentation while the control group was given a traditional lecture. After the presentations, student knowledge was assessed with a hands-on simulated exercise that was scored out of 60 points. At last, students completed a post-instruction student perception and attitude (SPA) survey. Inferential hypothesis testing was conducted with two-sample t-tests, and significance was defined as p ≤ .05.

RESULTS

There were no significant differences in the student pre-instruction SES scores between the control and intervention groups. After the video learning, CAD/CAM knowledge application during the hands-on simulated exercise showed significantly higher results in the intervention group as the assessment scores from the intervention group averaged 13.6 ± 2.0 points higher than the control group (p < .001). The results from the post-instruction SPA survey showed no statistically significant difference between groups.

CONCLUSION

With the video presentation technique, our first-year dental students were able to greatly enhance their CAD/CAM application skills. The results from this study could be applied at other dental educational institutions with potential similar outcomes.

Postgraduate education to expand access to dental care: A roadmap to community dental program development

Evidence indicates an increasing shortage of dentists in communities across the United States with potentially significant implications for oral health, as well as overall health and well-being. One strategy to increase access to dental care in rural and underserved communities is community-based postgraduate dental training. However, developing new dental programs requires navigating complex accreditation, financial and community governance, among other, barriers. The Roadmap for Teaching Health Center Dental Program Development presents a framework that guides institutions through the successive steps of developing new postgraduate training programs from identification of need to ultimate maintenance and sustainability. The tool assists programs in anticipating and understanding requirements, reducing time, expense, and uncertainty. While the framework was developed for community-based programs, the steps are applicable to postgraduate programs sponsored by academic institutions as well.

Resident selection, assessment, and management: Proceedings of the 2022 ADEA Advanced Dental Education Summit

The fifth biennial Advanced Dental Education Summit was organized by the ADEA Council on Advanced Education Programs. With a focus on "Resident selection, assessment, and management," the summit aimed to discuss best practices for selecting, assessing, and managing advanced education residents. Expert presentations covered the resident's journey from interview to graduation, emphasizing strategies for supporting resident wellness, success, and evaluation. The summit provided recommendations, including the incorporation of psychosocial assessments in the selection process, early recognition of behavioral issues, clearly defining clinical competencies, and creating a culture of wellness through supportive policies and structures.

Trends in postgraduate dental training in the United States

OBJECTIVE

This study examines the individual, educational, and policy factors that predict dentists pursuing postgraduate dental (PGD) training.

METHODS

Individual dentist records from the 2017 American Dental Association Masterfile were linked with pre-doctoral training attributes and state-level dental policy factors. Generalized logistic models, adjusted for individual, educational, and policy factors, were used to predict: (1) attending any PGD program, and (2) primary (i.e., advanced general practice, pediatrics, or dental public health, per the Health Resources and Services Administration [HRSA]) versus specialty care.

RESULTS

The majority of new PGD residency slots (77%) were in primary care. Women held 56% of primary care slots; men held 62% of specialty slots. Individual characteristics that predicted PGD primary care training included being Black, Hispanic, Asian, or other race; being male or older age reduced the odds. Pre-doctoral school characteristics that predicted PGD primary care training included having a pre-doctoral HRSA grant, affiliation with an academic medical center, and being a historically Black college/university; being a private school or in a small metro area lowered the odds. At the policy level, the strongest predictors of attending PGD primary care training are a residency requirement in the state you currently practice in and federal graduate medical education (GME) investment per residency slot.

CONCLUSION

Pursuing PGD training is variable based on the race/ethnicity/gender of the dentist. Federal investments in pre-doctoral dental education and GME can drive equity, as they significantly increase the odds that dentists will go on to PGD training, as do state licensure requirements.

Practice patterns of postgraduate trained dentists in the United States

OBJECTIVE

Postgraduate dental (PGD) primary care training has grown significantly. This study examines the individual, educational, community, and policy factors that predict practice patterns of PGD-trained dentists.

STUDY DESIGN

Individual dentist records from the 2017 American Dental Association Masterfile, with indicators of Medicaid participation and practice in a Federally Qualified Health Center (FQHC), were linked to postdoctoral training, community/practice location, and state policy factors. Generalized logistic models, adjusted for these factors, were used to predict PGD-trained dentists: (1a) serving Medicaid children, (1b) accepting new Medicaid patients, and (2) working in an FQHC.

RESULTS

Individual attributes that predicted serving Medicaid children included all race/gender combinations (vs. White females), and foreign-trained dentists and contractors/employees/associates (vs. practice owners). Black women are most likely to work in an FQHC. Residency attributes that predicted serving Medicaid children and working in an FQHC were Health Resources and Services Administration postdoctoral funding and being community based. Dentists practicing in rural or high-poverty communities were more likely to serve Medicaid children and work at FQHCs. States with higher levels of graduate medical education investment, higher Medicaid rates, and more generous adult dental Medicaid benefits increased the likelihood of serving Medicaid children, while states with more expansive adult dental Medicaid benefits increased the likelihood of working in an FQHC.

CONCLUSION

Federal training investment in PGD education combined with Medicaid payment and coverage policies can strongly impact access to dental care for vulnerable populations. Yet, oral health equity cannot be achieved without increasing dentist workforce diversity.

What do dental students expect from oral and maxillofacial surgery externships?

INTRODUCTION

Limited information exists on the goals and expectations of dental students from oral and maxillofacial surgery (OMS) externships. This information is valuable to OMS residency programs. Dental students use externships to gain insight into various OMS residency programs.  The purpose of this project was to answer the following question: "what do dental students expect from OMS externships?"

PURPOSE

The aim of this study was to report the expectations of dental students from OMS externships.

MATERIALS AND METHODS

This cross-sectional study took place from June 2015 to September 2019. Every student completing an Emory OMS externship completed an anonymous survey. The survey consisted of questions regarding (1) demographics, (2) previous OMS experience, and (3) open-ended questions regarding expectations and sources of anxiety. Answers were grouped into categories with similar answers. Descriptive statistics summarized data.

RESULTS

Of 116 externs who completed the survey, the majority were males (n = 80, 68.9%) with a mean age of 25 (range 21-30) years old in the 3rd/4th year of dental school. Most had previous OMS experience (n = 103, 89.6%) and plan to apply to OMS residency (n = 104, 90.4%). Most externs hoped to learn about life as a resident and the scope and culture of the program. Externs expressed the highest level of anxiety regarding their own experience and/or knowledge level.

CONCLUSIONS

This project demonstrated that during the externship, externs expect to gain insight into the daily activities, scope, and culture of the OMS program they are visiting.

Impact of COVID-19 on advanced dental education: Perspectives of dental residents in Wuhan

PURPOSE

This study investigated the impact of coronavirus disease 2019 (COVID-19) from the perspectives of dental residents in Wuhan, the former COVID-19 epicenter of China.

METHODS

A survey form was sent to 424 residents in the School of Stomatology, Wuhan University (WHUSS) in September 2020. The form included 23 questions on demographics, study situation of residents during the COVID-19 outbreak, effect of COVID-19 on graduates, and status of residents who returned to clinic training.

RESULTS

A total of 361 (85%) survey forms were collected. Over 70% of respondents felt anxious during Wuhan lockdown. Most respondents continued studying (94%) mainly through free online resources (79%). The majority reported improvement in didactic knowledge (80%), but the respondents' perceptions of their clinical skills, especially those in Wuhan, did not change (41%) or worsened (40%) (p < 0.05). Most graduates (88%) reported having found jobs or continued study. Among the 209 responders who returned to clinical training, 52% felt no concern about COVID-19 infection, 89% thought they were equipped with adequate personal protective equipment (PPE), and 57% indicated that they received sufficient knowledge for preventing COVID-19 in clinic. Most respondents agreed that the way to gain the knowledge for preventing COVID-19 in clinic was training at dental school (93%).

CONCLUSION

Although online study has been appreciated by residents, concern about clinical skill learning in the COVID-19 hardest-hit area has arisen. Most graduates felt that the impact of COVID-19 on their immediate postgraduation career was limited. Teaching about infection control in dental schools seemed effective to develop a positive attitude for residents after they returned to clinical training.

Survey of Dental Anesthesiology program directors' preferences regarding the candidate application and interview process

PURPOSE/OBJECTIVES

Dental Anesthesiology recently gained specialty recognition in 2019. Program directors' preferences for candidates applying to this newly recognized specialty are not well known. This study sought to assess these preferences by surveying the program directors of advanced dental education programs in Dental Anesthesiology.

METHODS AND MATERIALS

The survey consisted of eleven questions on candidate qualities, academic application criteria, standardized examinations, shadowing, externships, sedation experience, and interview format.

RESULTS

The survey achieved a response rate of 100% with all nine program directors completing the survey. The study found that program directors tended to rank integrity, interpersonal/communication skills, assumes responsibility, team player, and reliability among the top five candidate qualities. Program directors tended to rank professional evaluations, institutional evaluations, externship, shadowing (a practicing anesthesiologist), and standardized tests among the top five academic application criteria. Program directors largely preferred differentiating candidates with a standardized examination, such as the Comprehensive Basic Science Examination (CBSE) or the creation of a new examination specific for Dental Anesthesiology application. Program directors largely recommended shadowing and externships but were largely indifferent to a candidate's experience or certification in sedation. All nine program directors opted for virtual interviews in 2020.

CONCLUSIONS

The findings of this descriptive, cross-sectional study may have significant implications for the candidate application and interview process into the field of Dental Anesthesiology.

Predoctoral dental implant education techniques-students' perception and attitude

PURPOSE

Dental implant (DI) therapy is in high demand and can only be rendered efficiently to graduating dentists by effective teaching methodologies. This study aimed to assess the perceptions and attitudes of dental graduates towards predoctoral DI education techniques and rehabilitation by DI.

METHODS

A total of 26 well-structured questionnaires were distributed to 120 final-year students. Modified advanced teaching methodologies such as e-learning, small-group teaching-problem-based learning (SGT-PBL), and team-based learning were implemented for teaching DI. Its effects were assessed using a questionnaire set: the first section (DI Rehabilitation) with 12 questions and the second (DI teaching methods) with 14 questions. Statistical analysis was done using the Chi-square test, and a P-value < 0.05 was considered statistically significant.

RESULTS

The response rate was 95.83%. Seventy-five percent of the students recommended DI for patients, and 78% of them agreed to it themselves. On comparing teaching methods for DI, on and before level 12, small-group teaching (PBL) was significantly at a higher proportion (P = 0.002), followed by seminars (P < 0.001). Students preferred small-group teaching PBL (60%), followed by e-learning (15%) and demonstration (10%). Ninety-two percent of the students agreed that DI is an important subject in the "bachelor of dental surgery" (BDS) program, but 78% of them felt that time was insufficient to complete the DI syllabus.

CONCLUSIONS

The modified teaching methodologies used at level 12 for teaching DI enhanced students' interest and knowledge. The SGT-PBL teaching method was the most preferred. It is recommended that dental implantology topics should be started early in the undergraduate curriculum, and the topics should be widely divided throughout BDS.

Piloting a first-year resident-as-teacher workshop to foster evidence-based teaching

PURPOSE

Residents function as important educators of dental students; however, they often have limited training in educational best-practices. Resident-as-teacher programs have been designed and implemented in other health professions to prepare residents to teach in clinic and classroom settings. In this research, we describe the design, implementation, and evaluation of a 2-day workshop for first-year advanced dental residents.

METHODS

The program engaged residents in techniques to: (1) foster psychological safety, (2) use the cognitive apprenticeship framework, (3) deliver quality feedback, and (4) conduct effective didactic instruction. Nineteen first-year residents attended 2 four-hour workshops in July 2019. The impact of the program was evaluated using Kirkpatrick's model, which included participant reactions, learning, and self-reported behaviors.

RESULTS

Most residents (at least 83.3%) reported the value and quality of the workshop was high or very high. With regard to knowledge, residents had statistically significant higher scores after the workshop on knowledge questions about cognitive apprenticeship (P < 0.01), feedback strategies (P < 0.05), and classroom instruction techniques (P < 0.05). Resident reported self-efficacy had a statistically significantly increase (P < 0.05) after the workshop in psychological safety, cognitive apprenticeship, and most items related to providing feedback; there were few changes in self-efficacy on classroom instruction strategies.

CONCLUSION

Overall, a workshop to prepare residents as teachers can improve knowledge and self-efficacy in evidence-based educational practices.

Pediatric Dentists' Educational Experiences, Attitudes, and Professional Behavior Concerning Resin Infiltration: Implications for Dental Education

Minimally invasive dentistry (MID) is receiving increased attention. Resin infiltration (RI) is one micro-invasive technique for treating initial caries by sealing white spot lesions on tooth surfaces. The aims of this study were to assess pediatric dentists' RI-related educational experiences, attitudes, and professional behavior and to determine if their educational experiences were significantly related to their professional attitudes and behavior regarding RI. This cross-sectional study used an online survey to collect data from members of the American Academy of Pediatric Dentistry (AAPD) in March-April 2017. Of the 2,367 AAPD members invited to participate, 43 emails could not be delivered, and 273 surveys were completed, for a response rate of 11.8%. While only 9% of the 273 respondents reported that their classroom-based dental education had informed them about RI and only 1% that it had prepared them well to use RI with pediatric patients, higher percentages said they had been informed/prepared well by their classroom-based (24%) and clinical residency education (12%). The majority wanted to learn more about RI (71%) and would like to take a related CE course (59%). The respondents' average RI-related attitudes were positive (on five-point scale with 1=worst attitude: Mean=3.84). Regarding use of RI, 28% of respondents said they used RI sometimes and 4% often/very often, with 64% considering implementing RI in their clinics. Graduation year did not correlate with RI attitudes and use. However, the more education about RI the respondents had received during their residency (r=0.20; p<0.01) and in professional development after graduation (r=0.34; p<0.001), the more they used RI in their own work. This study found that the pediatric dentists' RI-related education was positively correlated with their professional behavior. Increasing predoctoral, resident, and continuing professional education about RI should therefore be considered.

Postdoctoral Periodontics Programs

Historically, predoctoral and advanced dental education programs used two-dimensional panoramic and periapical radiographs for implant planning. Three-dimensional (3D) Cone Beam Computed Tomography (CBCT) imaging has improved visualization of anatomic structures that can positively influence implant planning and surgical implant placement. The aim of this study was to assess how U.S. postdoctoral periodontics programs have incorporated CBCT technology into their curricula. A ten-question survey was sent to all 57 U.S. postdoctoral periodontics programs in November-December 2018. Thirty-seven responses were received, for a 65% response rate. All participating programs reported providing residents access to CBCT machines, and most of their residents received some training in the acquisition and interpretation of CBCT images. Nearly all (95%) participating programs provided training to apply implant planning software. Among the participating programs, 14% reported using a surgical guide fabricated with a CBCT scan 76-100% of the time, and 60% reported obtaining a CBCT scan for implant cases 76-100% of the time. These results suggest that, while residents are receiving training in CBCT and implant planning, it is not used often. There may be merit in adopting the American Academy of Oral and Maxillofacial Radiology's recommendation to use 3D imaging for all implant planning, with CBCT as the imaging modality of choice.

Pediatric Dental Residency Program Directors' Perspectives on and Use of Social Media for Resident Selection and Education

Residency programs are increasingly using social media for a variety of purposes. The aim of this study was to assess the views of U.S. pediatric dental residency program directors on their programs' participation in social media and use of social media in resident selection and education. This cross-sectional study used an electronic survey sent to all 89 U.S. program directors in 2018 to assess the use of social media and obtain demographic information. Forty-six surveys were completed, for a 52% response rate. Regarding resident selection, 76% of the responding directors said their programs did not conduct any online assessment of residency candidates, although 51% responded that social media postings could influence their decisions. For resident education, 78% said their programs did not provide training in challenges posed to evidence-based dentistry by social media, yet 89% expressed concern about the influence of expert opinions via social media on clinical decision making. Regarding participation in social media, 50% of respondents said their programs used social media to promote the program. These results point to a need for further evaluation of possible knowledge and behavior gaps among residency program directors and for development of formal social media assessment and education models for use in pediatric dentistry and other residency programs.

Residents' Perspectives on and Application of Dental Public Health Competencies Using Case-Based Methods

The aims of this study were to qualitatively assess dental public health (DPH) residents' perspectives on teaching methods for DPH competencies and to develop and implement a case-based simulation to address those competencies, constructed on the basis of the qualitative assessment. Focus group discussions were conducted with 18 DPH residents enrolled in two university-based DPH programs. Topic areas discussed in the two focus groups were perceived value of DPH competencies, ways to acquire new DPH skills/abilities, and additional skills/abilities needed by DPH residents. The focus groups' responses showed that the residents felt competent in the analytical thinking competencies such as research methodology and critiquing literature. They emphasized the importance of learning leadership skills and reported feeling somewhat uncertain about their mastery of the policy and advocacy and system evaluation competencies. Of the two distinct categories of DPH skills and competencies- analytical/critical thinking and practical competencies-these residents reported that a greater proportion of time needed to be devoted to integrating the practical competencies into their education. Based on the residents' feedback, the authors developed a structured seminar series taking a case-based approach to simulate real-world DPH problems, using real and semi-hypothetical planning projects to meet the residents' perceived needs and covering gaps between didactic learning and practice.

Redefining Medical Competencies for an Oral Medicine Specialty Training Curriculum Using a Modified Delphi Technique

This article describes the development of medical competencies for oral medicine specialty training in the UK and Ireland by a collaborative working group using a modified Delphi technique. The current specialty training curriculum for oral medicine (OM) in the UK was developed by a working group including members of the British Society for Oral Medicine (BSOM) and members of the Specialty Advisory Committee for Additional Dental Specialties (SACADS) and adopted by the UK General Dental Council (GDC) in 2010. When the curriculum was developed, the entry requirements for specialty training in OM included undergraduate degrees in both dentistry and medicine. At the time of adoption, the requirement for a medical degree was removed. Medical competencies were assumed to have been delivered in medical undergraduate and postgraduate training. Accordingly, there was a need to define the medical competencies for OM specialty training to benefit trainees, trainers, and assessors. In 2018, a group comprising specialty trainers, recent former specialty trainees, and current specialty trainees in OM held face-to-face meetings in addition to email discussions and developed an updated curriculum document to better reflect the medical competencies required in specialty training. A collaborative modified Delphi approach was used to evaluate medical foundation competencies and to include only those that were considered relevant to OM specialty training. A list of relevant and achievable medical competencies was determined that has been approved by SACADS and will be incorporated into a revised OM curriculum from the UK GDC. The newly agreed-upon document for medical competencies in OM specialty training will serve as a reference for trainees, trainers, and assessors and reflects a successful use of a modified Delphi approach.

Retrospective Evaluation of the Status of Advanced Dental Education in Prosthodontics from 2006 to 2016

The aim of this study was to analyze information about advanced education programs in prosthodontics (AEPPs) collected in American Dental Association (ADA) surveys on advanced dental education from 2006-07 to 2016-17. Data recorded included number of AEPPs and information on program directors, applicants, and enrollees in AEPPs. The results showed that, from 2006 to 2016, there was an increase in the number of AEPPs and enrollment of prosthodontic residents, and the number of applicants per program more than doubled. Despite these increases, steps are needed to increase the number of underrepresented minority residents in prosthodontics. Also, a periodic survey of prosthodontic residents to identify their goals, experiences during training, and career plans could benefit the specialty by providing more insight into the future prosthodontic workforce.

Defining Endodontic Residents' Clinical Experiences: A National Survey

Endodontic residency programs across the U.S. vary in the exposure they provide to residents in procedures, protocols, and equipment. Having information on the range of clinical experiences provided in programs would be useful for program directors and for applicants who are seeking the best fit for their residency. The aim of this study was to collect information from residents in U.S. endodontic residency programs about the procedures and equipment they experienced in their programs. In January 2018, a 14-question survey was emailed to all 437 endodontic residents with an email address in the 2016-17 American Association of Endodontists Membership Directory. Survey items asked about the number of endodontic procedures, techniques employed, and products used in residents' programs. A total of 133 endodontic residents responded to all or part of the survey, for a 30% response rate. The majority reported completing 151-250 nonsurgical root canals, 26-50 nonsurgical retreatments, 0-10 surgical retreatments, and 0-10 regenerative endodontic procedures during their residencies. All respondents said they used a surgical operating microscope (SOM), and 82% reported using a multi-file rotary system for nonsurgical procedures. Respondents reported that the main instruments they used were Dentsply Sirona file systems, and the most commonly used obturation technique was warm vertical compaction/condensation, reported by 92% of respondents. These endodontic residents reported being exposed to a variety of procedures, products, and protocols during their residency. Based on information they provided, prospective endodontic residency applicants can expect to use the SOM for treatment, to gain extensive experience in primary nonsurgical endodontic treatment, and to not perform endodontic surgery during their first year of postgraduate training.

Blended Module-Based Teaching in Biostatistics and Research Methodology: A Retrospective Study with Postgraduate Dental Students

Information technology has stimulated efforts to reform teaching methods in dental education. Most of these efforts involve a shift from conventional mode to the more technology-savvy and student-centered approach. The aim of this study was to compare postgraduate dental students' academic performance using two teaching methodologies (video-based learning and blended module-based learning) in a biostatistics and research methodology course in a master's program at a dental college in India. This retrospective study involved two groups of students enrolled in the master's program with different years of admission: Group I in 2013-14 (n=80) and Group II in 2015-16 (n=80). Group I students learned the subjects with video-based learning, whereas Group II students were taught using a blended module program using a small-group learning system called Process-Oriented Guided Inquiry Learning (POGIL). The students' final course evaluation (summative assessment) and formative assessment (during course assessments) were compared for the two groups. The students' final course evaluation was derived from an end-of-year written examination, whereas the formative assessment was recorded with written tests and projects during the course. In the results, the summative assessment did not show a significant difference between Group I (68.2±13.4) and Group II (66.4±11.9) (p=0.39). The formative assessment showed a significant difference (p<0.001) in favor of the Group II students. In this study, the blended module-based teaching produced similar scores on the final exam to the video-based lectures, but it produced significantly better results on the in-course assessments. The latter finding could be attributed to the incorporation of small-group learning and POGIL.

Teaching dental undergraduate students restorative CAD/CAM technology: evaluation of a new concept

OBJECTIVES

The use of computer-aided design/computer-aided manufacturing (CAD/CAM) technology in restorative dentistry has increased significantly and should consequently be taught more intensively at university dental schools. This study describes the evaluation of a new CAD/CAM teaching concept.

METHODS

CAD/CAM technology was implemented into a 4th-year clinical student course according to Miller's pyramid principle. Fifty-eight students with no clinical experience participated in a 2-day theoretical and practical introductory course and rated its didactic outcome (Questionnaire 1). Students selected the fabrication method for indirect single tooth restorations during a 5-month patient treatment course. 54 conventional (e.max Press) and 68 CAD/CAM (Lava Ultimate) indirect Cerec-method restorations were fabricated and seated adhesively (Syntac, Variolink II). The success of the CAD/CAM integration was analyzed by the students, who were grouped according to their selected fabrication method (Questionnaire 2), as follows: Group A (CAD/CAM, n = 18); Group B (conventional and CAD/CAM, n = 17); Group C (conventional, n = 23).

RESULTS

The questionnaire ratings were expressed as a percentage of the number of students' answers and are presented as diagrams. 95% of all the students in all the groups wanted CAD/CAM technology to be integrated into the subsequent (5th-year) clinical course. The rating for the CAD/CAM introductory course on a scale of 1 (very good) to 6 (poor) was 1.86 on average for the theoretical part, and 2.20 for the practical part. Statistically significant differences were found among the technology groupings (Pearson's chi-squared test, P < 0.05).

CONCLUSIONS

CAD/CAM technology was highly welcomed by the 4th-year students and was introduced successfully into the clinical student course. Students tended to favor technology in accordance with the extent of its clinical application.

Preliminary Performance of the Advanced Dental Admission Test (ADAT): Association Between ADAT Scores and Other Variables for Applicants to Residency Programs at a U.S. Dental School

Historically, dental residency programs have used numerical assessment criteria to evaluate and identify qualified candidates for admission. Recent elimination of such assessment tools has undermined many programs' holistic evaluation process. The Advanced Dental Admission Test (ADAT) was developed and recently piloted in hopes of addressing this issue. The aim of this study was to evaluate the preliminary performance and validity of the ADAT by exploring the association between ADAT scores and other variables for a sample of applicants to residency programs. The WebAdMIT admissions database was used to identify the test scores and educational and demographic information of 92 individuals who completed the pilot ADAT and were seeking a 2017 postgraduate specialty position at Indiana University School of Dentistry. The results showed that the ADAT had strong to weak correlations with certain applicant variables (p<0.05). No significant differences were found for age, race, school location, or country of origin. However, males performed better than females (p<0.05), and non-Hispanics performed better than Hispanics (p<0.01). ADAT component scores were also higher for individuals with a history of research activity (p<0.05). This study found that significant associations existed between the ADAT and indices typically associated with competitive applicants. These findings suggest that the ADAT may serve as a useful numerical assessment instrument, with the potential to identify high-performing candidates. Furthermore, the ADAT seemed to be a plausible option for programs seeking to incorporate a quantitative assessment instrument as part of a holistic candidate selection process.

U.S. Maxillofacial Prosthetics Programs: Fellows' and Directors' Perspectives

Maxillofacial prosthetics (MFP) programs in the U.S. select only a limited number of applicants for fellowship positions. The aims of this study were to survey MFP fellows about which factors influenced their choice of programs and to survey MFP directors about what they considered critical factors in the selection process. Surveys were sent to all eight directors and 13 fellows at all eight U.S. MFP programs in June 2015. The directors' questions asked about general information, resident selection process, letters of recommendation, interview process, and decision process. The fellows' questions addressed their demographics, program-related factors, and future goals. The directors' surveys were sent directly to the directors, and the fellows' surveys were sent to the directors for distribution. The survey response rate for the directors was 87.5% (N=7), and that of the fellows was 53.8% (N=7). In selecting fellows for programs, responding directors reported the interview process was most important, followed by letters of recommendation, personal statement, and prosthodontic program grades. Responding fellows reported that location, variety of treatment, patient volume provided, and clinical education were crucial components in their choice of program. This information may be useful to MFP programs and fellows in the continuing development of this specialty.

Research Productivity of Directors of U.S. Advanced Education in Prosthodontics Programs

The aims of this study were to measure the research productivity of directors of U.S. advanced education in prosthodontics programs (AEPP) and to identify associations between the directors' publication metrics and professional characteristics. A list of AEPP directors was obtained from the American College of Prosthodontists website in December 2015. Information on gender, academic rank, and highest degree was collected from the institutional website for each individual. Citation databases (Scopus and Google Scholar) were searched for each director's h-index and i10-index (both indexes are based on numbers of citations of the author's articles) and total numbers of publications and citations. The search identified 50 AEPP directors. The majority were male and had a primary appointment at a university. Most held the rank of associate professor or professor and held both DDS and MS degrees. The mean h-index and i10-index of all directors were 6.32±6.97 and 6.84±10.77, respectively. Their mean numbers of publications and citations were 24.60±31.21 and 288.40±625.97, respectively. The analysis showed that the program directors affiliated with a university had significantly higher mean values for all indexes than those of non-university-affiliated program directors. Professors had productivity metrics significantly higher than those of other ranks in all measures of research productivity.

U.S. and Canadian Orthodontic Faculty Professional Satisfaction: A Survey Study

The aims of this study were to evaluate U.S. and Canadian orthodontic faculty members' degree of job satisfaction and to assess the relationship between job satisfaction and factors such as full-time/part-time status, tenure status, age, and teaching training. This information is needed to set long-term goals for improving the recruitment and retention of full-time and part-time faculty. In August 2016, all members of the Council on Orthodontic Education Society of Educators and faculty members of the American Association of Orthodontists were invited via email to participate in a 34-question survey, which collected demographic data and asked respondents to report their degree of satisfaction on seven factors. Out of 645 individuals invited to participate, 133 completed all items on the survey (response rate 20.6%). The results showed that faculty time commitment, rank/position in the institution, and tenure status affected respondents' levels of satisfaction regarding quantity of clinical time, value placed on teaching by their institution and students, and leadership of their department chair. In the open-ended responses, increased compensation, more teaching time, and less administrative activity were the most frequent recommendations to improve satisfaction levels. About half (52%) of the respondents reported being satisfied with their financial compensation. Respondents whose institutions gave them training opportunities in teaching skills were 4.78 times more satisfied than those not given those opportunities. The results suggest that reduction of administrative workload, creation of meaningful faculty development programs, more feedback and sharing of information about requirements for promotion, and improvement of financial compensation could improve recruitment and retention of orthodontic educators.

The Status of Interdisciplinary Education in Advanced Education Programs at U.S. Dental Schools

Interdisciplinary education (IDE) during dental residencies can help produce dentists who work more efficiently to provide continuous and reliable patient care. The aim of this study was to assess the extent and type of interdisciplinary education in dental residency programs at U.S. dental schools. A 24-item survey addressing didactic courses and patient care was sent to academic and/or clinical deans at 65 U.S. dental schools in fall 2016; they were asked to forward the survey to the appropriate person in their school. The questions addressed IDE characteristics such as the academic home for IDE, focus areas, defined outcomes, program objectives, and perceived institutional barriers. Of the 65 schools invited to participate, 31 responded to the survey for an overall response rate of 48%. Of those schools, 23 (74%) reported having IDE for their advanced/postgraduate students. Among the schools with IDE, their IDE learning experiences primarily involved residents in different disciplines participating in clinical case group projects and small group workshops, and 77% of IDE faculty taught in department-specific clinical spaces as opposed to teaching together in a single clinic. The respondents identified barriers to implementing IDE such as a lack of clearly defined competencies, logistical challenges including academic calendars and scheduling, and faculty resistance. Also, 43% reported that their institutions did not have a program to support IDE faculty development. At the time of this survey, most of the respondents did not have a clearly defined IDE model consisting of competencies, defined assessments, and milestones.

Is There an Association Between Comprehensive Basic Science Examination Score and Acceptance into an Oral and Maxillofacial Surgery Residency Program?

Sparse data exist regarding the association between applicants' Comprehensive Basic Science Examination (CBSE) scores and acceptance into an oral and maxillofacial surgery (OMFS) residency program. The aims of this study were to assess the association between applicants' CBSE scores and acceptance into one OMFS residency program; to determine the association between other applicant-related variables and acceptance into the program; and to identify the mean CBSE score of accepted applicants by their dental schools' American Association of Oral and Maxillofacial Surgeons (AAOMS) district. For this retrospective data analysis conducted in 2017, the study sample consisted of applicants to the University of Illinois at Chicago OMFS residency program for the application cycles of 2013-14, 2014-15, and 2015-16. The primary predictor variable was CBSE score. The primary outcome variable was acceptance to the program. A total of 477 applicants were in the sample. In the multivariate analysis, CBSE score was found to be significantly associated with an increased chance of acceptance into the program (OR=1.11, 95% CI: 1.08, 1.15; p<0.001). Other variables associated with acceptance, though to a non-significant degree, were age (p=0.01), dental school grade point average (GPA) (p=0.01), and number of externships completed prior to application (p=0.02). These findings may be useful for both applicants and program directors.

Application of OSCE for Stage Assessment in Standardized Training for Oral Residents

The aim of this study was to establish and implement an objective structured clinical examination (OSCE) for stage assessment in standardized training for oral residents, evaluating its validity and suitability. An OSCE was established for stage assessment of 158 residents in a program in Jiangsu Province, China. Its validity and suitability were evaluated using indices such as reliability and discrimination coefficients of assessment results. The established OSCE had eight stations: interpretation of auxiliary examination results, basic knowledge, doctor-patient communication and clinical examination, clinical case analysis, medical record and prescription writing, public skills, first aid skills, and specialist's operation skills. The mean overall score and consistency coefficient (Cronbach's alpha) for the test subjects were 83.64±3.69 points and 0.732, respectively. The developed OSCE was reasonably established, with credible assessment results, and indices such as mean and discrimination coefficient of test scores from each station were appropriate. Therefore, the proposed protocol was found to be reliable and suitable.

Effect of Advocacy Training During Dental Education on Pediatric Dentists' Interest in Advocating for Community Water Fluoridation

Dentists, like other health professionals, are uniquely positioned to be public health advocates. One venue where dental students can become skilled public health advocates is in dental education programs. However, debates about the need and importance of integrating advocacy training into dental curricula exist. Therefore, the aim of this study was to assess the association between pediatric dentists' interest in and willingness to participate in an advocacy-related activity and their prior training in advocacy during dental education. The advocacy activity used in the study related to community water fluoridation (CWF). A 22-item pilot-tested online survey was sent in February-May 2016 to 5,394 pediatric dentists who were members of the American Academy of Pediatric Dentistry. The final response rate was 16% (n=830). Most (77%) of the respondents were willing to advocate for CWF initiatives at the community and/or state levels. Only 44% of the respondents reported receiving training in advocacy during their predoctoral dental and/or pediatric dental residency education. The pediatric dentists who were willing to advocate for CWF initiatives had 2.7 times (95% CI: 1.63-4.39, p<0.0001) the odds of having received advocacy training during their dental education compared to those who were unwilling. These results suggest a positive association between the pediatric dentists' willingness to advocate for CWF and their prior advocacy training during dental education. This finding provides support for the Commission on Dental Accreditation's requirement for pediatric dental residency programs to train residents in advocacy. Because dentists are respected leaders in their community, the study results also support the integration of advocacy training into predoctoral dental curricula.

An Emergency Simulation Course in a Postdoctoral General Dentistry Program: The New York Presbyterian/Weill Cornell Medicine Experience

Dentists can encounter life-threatening medical emergencies during the provision of routine dental care and must therefore be comfortable with the management of these emergencies. High-fidelity simulation has been used routinely in medical and surgical training and is a recognized and effective educational and assessment tool. The aim of this study was to develop and evaluate a new high-fidelity simulation training course in medical emergency management for residents in the General Practice Residency program at New York Presbyterian/Weill Cornell Medicine. In academic years 2014-16, first-year GPR residents were required to take a simulation course covering medical emergency scenarios that are commonly encountered in the dental office. The course involved a team approach to emergency management with active participation by faculty and residents and with each training session followed by feedback and a formal review of the emergencies covered. Evaluation was achieved through completion of questionnaires by the residents following each session. A total of 14 residents (seven in each year) participated, completing 78 questionnaires in the two-year period. They gave the course an overall rating of 4.91 on a scale from 1 to 5, indicating strong agreement with the utility of the course as a learning tool in medical emergency management training. This course is now fully integrated into the GPR educational program at this institution and is a successful component of the emergency medicine curriculum.

Developing Prosthodontic Residents' Communication Strategies with Edentulous Patients: A Pilot Study

The aim of this study was to investigate whether prosthodontic residents' attitudes toward provider-client communication would be shaped by a tailor-made communications skills course. In 2016, the pre-intervention attitudes of all six second- and third-year prosthodontic residents in a three-year residency at an academic dental institution in India were assessed using the Communication Skills Attitude Scale (CSAS). The residents' performance was then video-recorded while they treated complete denture patients and was analyzed using the Kalamazoo scale, a validated scale for communication skills assessment. The residents' weaknesses were identified, and a custom-made generic module was designed along with individual guidance counseling for addressing aspects relevant to complete denture patients. The residents' attitudes were again assessed immediately after they completed the training using CSAS, as well as after two and four months using Balint sessions. Analysis of the recordings showed that few of the deficiencies during intraoral procedures were contextual, and the Kalamazoo scale did not address them: these were noted as being "beyond Kalamazoo." After the training, the residents reported awareness of their weaknesses and feeling motivated to practice their newly acquired skills. The Balint sessions showed that they had started valuing patients' agendas and the rapport-building process, and they reported transfer of skills when treating other types of prosthodontic patients. In this study, a customized communication skills module brought about a positive change in residents' attitudes, which was sustained over four months. Similar training could be implemented in other dental specialties.

Dental, Dental Hygiene, and Advanced Dental Students' Use, Knowledge, and Beliefs Regarding Tobacco Products

Using cigarettes and alternative tobacco products (ATPs) is associated with negative oral health outcomes, and dental health professionals are poised to help patients quit. The aim of this study was to determine dental, dental hygiene, and advanced dental students' use, knowledge, and beliefs about cigarettes and ATPs, including perceptions about their education in tobacco dependence treatment and counseling experience. All 1,783 students enrolled in the dental, dental hygiene, and postdoctoral dental programs at the New York University College of Dentistry were invited to participate in the survey in 2016. A total of 708 students at least partially completed the survey, for a response rate of 39.7%. In the results, 146 of the students (20.1%) reported ever using cigarettes, while 253 (35.7%) reported ever using any ATP. Regarding tobacco use intervention, the students reported they had not received enough training on ATPs, were neutral about cigarettes, and were somewhat confident and not so confident counseling a cigarette smoker or ATP user, respectively. By their fourth year, 77.8% of the dental students reported they had counseled someone to stop smoking cigarettes, but only 40.7% had counseled someone to stop using ATPs. Overall, all groups of students reported feeling more confident and had received more education on interventions for cigarettes than for ATPs (p<0.001). These students reported low confidence in helping people quit tobacco and did not perceive they had received enough training on intervening with patients on use of cigarettes and ATPs. These findings call for a revised tobacco education curriculum for dental, dental hygiene, and advanced dental students, focused on building knowledge and confidence for promoting tobacco dependence treatment.

Current Status of Postdoctoral and Graduate Programs in Dentistry

Advanced dental education has evolved in the context of societal needs and economic trends to its current status. Graduate programs have positioned their role in the context of health systems and health science education trends in hospitals, interprofessional clinical care teams, and dental schools and oral health care systems. Graduate dental education has been a critical factor in developing teams in trauma care, craniofacial disorders, pediatric and adult medicine, and oncology. The misalignment of the mission of graduate dental programs and the demands of private practice has posed a challenge in the evolution of programs as educational programs have been directed towards tertiary and indigent care while the practice community focuses on largely healthy affluent patients for complex clinical interventions. Those seeking graduate dental education today are smaller in number and include more international dental graduates than in the past. Graduate dental education in general dentistry and in the nine recognized dental specialties now includes Commission on Dental Accreditation (CODA) recognition of training standards as part of its accreditation process and a CODA accreditation process for areas of clinical education not recognized as specialties by the American Dental Association. Current types of programs include fellowship training for students in recognized specialties. This article was written as part of the project "Advancing Dental Education in the 21^st Century."

Factors Influencing Dental Students' Interest in Advanced Periodontal Education: Perspectives of Department Chairs

The number of graduates of U.S. dental schools enrolled in U.S. postdoctoral programs in periodontics has been decreasing. The aims of this study were to determine the perspectives of periodontics department chairs regarding 1) features of a school's predoctoral curriculum that promote student interest in advanced periodontal education and 2) characteristics of a periodontal residency program that make it more attractive to dental students over other specialty programs. In 2015, a 14-question survey was designed and sent to chairs of periodontics departments at all 65 U.S. dental schools at the time. Questions addressed number of instructional hours; specialty clinic rotations; elective courses; number of applicants to periodontal residency; existence of a residency program; length of the residency program; and externships, fellowships, and financial stipends offered. The survey response rate was 73.8%. The results showed that departments offering more than seven clinical credit hours in periodontics to predoctoral students had the greatest number of residency applicants. Most of the applicants were from institutions that offered specialty clinic rotations, elective courses, and residency programs in periodontics. The number of applicants did not change significantly if a stipend or fellowship was offered. However, the availability of an externship was significantly associated with a greater number of applicants (p=0.042). These results suggest that offering periodontal clinical rotations, elective courses, and especially externships in periodontics during predoctoral education may encourage more graduating students to pursue postdoctoral periodontal education.

Is the Advanced Dental Admission Test (ADAT) the Metric Needed to Assist with Postgraduate Admissions? Two Viewpoints: Viewpoint 1: The ADAT Provides a Viable Solution to Help Postgraduate Programs Differentiate Applicants and Viewpoint 2: The ADAT Has Questionable Utility and Value for Postgraduate Admissions

In 2012, when the National Board Dental Examination (NBDE) was changed from a numerical scoring system to pass/fail, advanced dental education programs lost a metric widely used for differentiating applicants to those programs. The American Dental Association (ADA) has developed the Advanced Dental Admission Test (ADAT) to address this issue. Implementation of the ADAT began in 2016 with a pilot program, which has not yet been widely accepted in the overall admissions process. This Point/Counterpoint explores the benefits and challenges of using the ADAT for postgraduate admissions. Viewpoint 1 supports use of the ADAT, arguing that the test provides a viable, long-term solution to this immediate need. In contrast, Viewpoint 2 questions the need for and appropriateness of this additional academic measure for postgraduate admissions.

Graduate Periodontics Programs' Integration of Implant Provisionalization in Core Curricula: Implementation of CODA Standard 4-10.2.d

The aim of this descriptive study was to provide an overview of the status of implementation of Commission on Dental Accreditation (CODA) Standard 4-10.2.d (Provisionalization of Dental Implants) by U.S. graduate periodontics programs since its introduction in 2013. Surveys were sent in May 2015 to 56 accredited postdoctoral periodontics program directors to ascertain program director characteristics; status of planning, implementation, and curriculum resulting from adoption of Standard 4-10.2.d; preferred clinical protocols for implant provisionalization; interdisciplinary educational collaborators; and competency assessment mechanisms. The survey response rate was 52% (N=29); the majority were male, aged 55 or older, and had held their position for less than ten years. Among the responding programs, 93% had formal educational curricula established in implant provisionalization. Graduate periodontics (96%) and prosthodontics (63%) faculty members were predominantly involved with curriculum planning. Of these programs, 96% used immediate implant provisionalization, with direct (chairside) provisionalization protocols (86%) being preferred over indirect protocols (14%) and polyethylethylketone provisional abutments (75%) being preferred to titanium (25%) provisional abutments. Straight and concave transmucosal emergence profile designs (46% each) were preferred in teaching, with only 8% of programs favoring convex transmucosal profiles. A majority of responding programs (67%) lacked protocols for communicating to the restorative referral a mechanism to duplicate the mature peri-implant mucosal architecture. Regional location did not play a significant role in any educational component related to implant provisionalization for these graduate periodontal programs. Overall, this study found that a clear majority of graduate periodontics programs had established formal curricula related to implant provisionalization, with substantial clinical and philosophical consensus within the specialty.

Do Standard Bibliometric Measures Correlate with Academic Rank of Full-Time Pediatric Dentistry Faculty Members?

The aim of this cross-sectional study was to assess the relationship between quantitative measures of research productivity and academic rank for full-time pediatric dentistry faculty members in accredited U.S. and Canadian residency programs. For each pediatric dentist in the study group, academic rank and bibliometric factors derived from publicly available databases were recorded. Academic ranks were lecturer/instructor, assistant professor, associate professor, and professor. Bibliometric factors were mean total number of publications, mean total number of citations, maximum number of citations for a single work, and h-index (a measure of the impact of publications, determined by total number of publications h that had at least h citations each). The study sample was comprised of 267 pediatric dentists: 4% were lecturers/instructors, 44% were assistant professors, 30% were associate professors, and 22% were professors. The mean number of publications for the sample was 15.4±27.8. The mean number of citations was 218.4±482.0. The mean h-index was 4.9±6.6. The h-index was strongly correlated with academic rank (r=0.60, p=0.001). For this sample, an h-index of ≥3 was identified as a threshold for promotion to associate professor, and an h-index of ≥6 was identified as a threshold for promotion to professor. The h-index was strongly correlated with the academic rank of these pediatric dental faculty members, suggesting that this index may be considered a measure for promotion, along with a faculty member's quality and quantity of research, teaching, service, and clinical activities.

Faculty Development for Metro New York City Postdoctoral Dental Program Directors: Delphi Assessment and Program Response

Faculty development for dental academicians is essential to cultivate a continuous faculty workforce, retain existing faculty members, enhance their teaching skill sets, and remain responsive to changing program requirements and curricular reforms. To maximize the utility of dental faculty development, it is important to systematically assess and address faculty members' perceived training needs. The aims of this study were to determine priority topics among one group of postdoctoral program directors and to translate those topics into faculty development programs as part of Columbia University's Health Resources and Services Administration (HRSA)-sponsored faculty training program for primary care educators. The study was conducted in 2013-16. A Delphi consensus technique was implemented with three sequential surveys of 26 New York City metropolitan area general, pediatric, and public health dentistry residency program directors. On the first survey, the five respondents (19% response rate) identified 31 topics. On the second survey, 17 respondents (response rate 65%) rated the 15 most important topics. In the third and final round, 19 respondents (73% response rate) ranked teaching research methods and teaching literature reviews as the topics of greatest interest. Overall, the responses highlighted needs for faculty development on teaching research methods, motivating trainees, trainee evaluation, and clinical care assessment. Based on these results, a series of six Faculty Forums was developed and implemented for dental educators in the metropolitan area, starting with the topic of teaching research methods. The process flow used for assessing training needs and developing and evaluating training can be applied to a variety of populations of educators.

Cross-Sectional Analysis of National Dental Residency Match Data

The Dental Residency Match (DRM) program provides an ethical and unbiased selection process for applicants to postdoctoral dental programs, based on mutual interests of applicants and programs. The aims of this study were to conduct a descriptive analysis of DRM metrics for the years 2008 to 2015 and to test the hypothesis that there was a difference in number of ranks submitted between programs that filled all their offered positions and those that did not. DRM metrics data from years 2008 to 2015 were obtained from the National Matching Service. Trend analyses and panel data assessments were made. Six types of postdoctoral dental programs (GPR, AEGD, oral and maxillofacial surgery, pediatric dentistry, orthodontics, and dental anesthesiology) participate in the DRM program. The results showed that the number of programs participating and number of residency positions offered increased over the study period. The programs that filled all their positions ranked more applicants than the programs that did not fill their positions (p<0.05). The number of acceptable applicants increased over the study period for all programs except those in dental anesthesiology. These results suggest that participation in DRM is increasing, most programs are able to fill their positions with acceptable applicants, and programs seeking to fill all their positions need to submit a large number of ranks.

Career and Professional Satisfaction of Oral and Maxillofacial Surgery Residents, Academic Surgeons, and Private Practitioners: Does Gender Matter?

The aims of this study were to determine whether male vs. female oral and maxillofacial surgery (OMS) residents, academic surgeons (i.e., faculty members), and private practitioners in the U.S. differed in their general career satisfaction and job/professional satisfaction. Survey data were collected in 2011-12 from 267 OMS residents (response rate 55%), 271 OMS academic surgeons (response rate 31%), and 417 OMS private practitioners (response rates 13% web-based survey and 29% postal mail survey). The results showed that while the male vs. female OMS private practitioners and academic surgeons did not differ in their career satisfaction, the female residents had a lower career satisfaction than the male residents (on four-point scale with 4=most satisfied: 3.03 vs. 3.65; p<0.01). The male vs. female OMS private practitioners and academic surgeons also did not differ in their job satisfaction. However, the female residents agreed on average less that they were able to practice OMS in the way they want, felt less proud to be an oral and maxillofacial surgeon, were less satisfied with their career, and were more likely to consider a career change in the next five years than the male residents. While these male and female oral and maxillofacial surgeons in private practice and academia did not differ in their career and job satisfaction, the male and female residents differed significantly, with female residents reporting a significantly poorer career and job satisfaction than male residents. Future research needs to explore ways to improve career and professional satisfaction of female OMS residents.

The Global Footprint of Oral Medicine Specialists: The University of Pennsylvania Experience

The aim of this study was to analyze the global footprint of oral medicine specialists who graduated from the University of Pennsylvania oral medicine residency program. In 2016, a cross-sectional electronic survey was distributed to 53 graduates of that program, asking about their current geographical location and professional status. Of those 53 graduates, 23 (43%) completed the survey with 22 reporting their current location and 21 reporting their current professional status. The results showed that 17 graduates were located within the U.S., and five were located internationally. Twelve graduates were in full-time academic positions, three were in part-time academic positions/part-time private practice, three were in full-time private practice, two were in postdoctoral training programs, and one was not employed. This study found that oral medicine specialists trained at the University of Pennsylvania were located both domestically and internationally. The majority held faculty positions at academic institutions with fewer involved in private practice. This program may thus be considered a source of future dental academicians.

Should PGY-1 Be Mandatory in Dental Education? Two Viewpoints: Viewpoint 1: PGY-1 Provides Benefits That Support Making It Mandatory and Viewpoint 2: PGY-1 Should Be Available for Dental Graduates But Not Mandatory

This Point/Counterpoint considers whether a general dentistry postgraduate year one (PGY-1) residency should be required for all new graduates who do not pursue specialty training. Currently, New York and Delaware require PGY-1 for dental licensure, while other states offer it as an alternative to a clinical examination for obtaining licensure. Viewpoint 1 supports the position that PGY-1 should be mandatory by presenting evidence that PGY-1 residencies fulfill new graduates' need for additional clinical training, enhance their professionalism and practice management skills, and improve access to care. The authors also discuss two barriers-the limited number of postdoctoral positions and the high cost-and suggest ways to overcome them. In contrast, Viewpoint 2 opposes mandatory PGY-1 training. While these authors consider the same core concepts as Viewpoint 1 (education and access to care), they present alternative methods for addressing perceived educational shortcomings in predoctoral curricula. They also examine the competing needs of underserved populations and residents and the resulting impact on access to care, and they discuss the potential conflict of interest associated with asking PGY-1 program directors to assess their residents' competence for licensure.

Survey of Advanced Education in Prosthodontics Directors and Residents on Practices in Esthetic Dentistry

The aim of this study was to determine the difference between the intended education by advanced education in prosthodontics (AEP) program directors and the perceived education received by AEP residents with respect to concepts of esthetic dentistry. Residents' confidence levels and current practices were also determined based on program level, with first- and second-year residents combined into "junior residents" and third- and fourth-year residents combined into "senior residents." Surveys were distributed to all U.S. and Canadian AEP program directors (N=52) in 2014 and residents (N=393) in 2015. The seven questions asked of directors and 20 asked of residents assessed resident training. The response rate for directors was 59.6% and for residents was 27.3%. Statistically significant results were found between the responding program directors' perceived education on esthetic principles and the responding residents' perceived education. The senior-level residents were more confident in each of the categories than residents at the junior level, although the difference was only significant for selecting porcelain systems to match inherent translucency, transfer of information to the laboratory, and surface staining or characterization. There was a difference between the program directors' intended teaching and the residents' perceptions with regards to bleaching, shade matching, selection of porcelain systems, transfer of information to the laboratory, and surface staining or characterization. The residents' confidence levels were higher at the senior level than those at the junior level in selecting porcelain systems, transfer of information to the laboratory, and staining/characterization. Faculty members in advanced prosthodontics programs may be able to use these findings to improve their residents' education in these areas.

The Effect of Awareness of American Board of Orthodontics Criteria on Treatment Outcomes in a Postgraduate Dental Clinic

The aims of this study were to evaluate the posttreatment outcomes in a postgraduate orthodontic clinic following a course on American Board of Orthodontics Cast and Radiograph Evaluation (ABO-CRE); to compare the outcomes of postgraduate students who took the course before and after finishing treatment of their cases; and to assess if the need for orthodontic treatment as determined by the Index of Orthodontic Treatment Need (IOTN) at the beginning of treatment affected students' final scores. A course on ABO-CRE was given to second- (group A), third- (group B), and fourth- (group C) year postgraduate students at Yeditepe University, Istanbul, Turkey, in 2012. Pre- and posttreatment plaster models of 253 cases (group A) were treated by students in 2011-12. An additional 251 (group B, 2012-13) and 341 (group C, 2013-14) cases were evaluated in the first and second years after the course, respectively. The models were graded retrospectively using the ABO-CRE and IOTN. The results showed that the total mean scores on the posttreatment plaster models were significantly higher in the pre-course group than the first- and second-year post-course group (p<0.05 and p<0.01, respectively). The borderline cases (grade 3) received a lower score on the ABO-CRE than the cases with need (grade 4) (p<0.01) and severe need (grade 5) (p<0.01) for orthodontic treatment. Increasing awareness by giving information about the ABO-CRE significantly improved the posttreatment success of these postgraduate students. After the course, treatment outcomes in the following year were better than two years later, suggesting it may be useful to teach the course annually to refresh students' knowledge.

Postgraduate Orthodontics Students' and Mentors' Perceptions of Portfolios and Discussion as Tools for Development of Reflection

The aim of this study was to analyze the effects of a portfolio learning strategy designed to develop students' reflection abilities in a postgraduate orthodontic program in the UK. Nine first-year postgraduate orthodontic students and seven mentors participated in the one-year program, which included a reflective portfolio, mentorship, and discussion. After the program, the students' and mentors' perceptions were collected using focus groups and individual interviews, respectively. The data were analyzed using thematic analysis. Four categories emerged. The first, reflection, was considered a skill to learn, and time was needed for students to fully understand its meaning and achieve its outcomes. The second theme, characteristics of reflection, was descriptive at the beginning and more critical at the end of the experience. The third theme, outcomes of reflection, involved students' improved problem-solving and action-planning abilities and increased self-awareness, motivation, confidence, and communication skills. In the fourth theme, stimulation of reflection, students did not agree with mentors regarding the importance of reflective writing, but they recognized the value of the portfolio's reflective log in facilitating the reflective process. There was greater agreement between students and mentors regarding discussions with mentors and among peers as tools to achieve higher levels of reflection. Overall, these students and mentors considered the strategy an effective tool for improving students' reflection.

The Development of Dental Anesthesiology As a Discipline and Its Role As a Model of Interdisciplinary Collaboration

The majority of dental procedures can be performed with an awake patient and the use of a local anesthetic, but when deep sedation and general anesthesia are needed, they typically are provided by those dentists with advanced training in anesthesiology, i.e., oral and maxillofacial surgeons and dentist anesthesiologists. Dental anesthesiology began with the discovery of anesthesia by a dentist in 1844 and has been recognized as a separate discipline in dentistry for nearly 70 years. Training over this time evolved from apprenticeships to one-year training programs, and in 2007, the Commission on Dental Accreditation (CODA) began accrediting two-year dental anesthesiology training programs. Since 2015, in recognition of the increasing complexity of the discipline, training has required three years of postgraduate study. The number of dentist anesthesiologists has grown with the increasing demand for anesthesia services by both the public and the profession. However, the present number of dentist anesthesiologists is not sufficient to meet the demand, so additional programs and growth in current programs are needed. Another valuable aspect of this discipline is its role as a positive example of interdepartmental collaboration since dental anesthesiology faculty, as members of a support discipline, typically work across many of the other departments in a dental school. This article reviews the history of the discipline, describes the educational goals and CODA standards for dental anesthesiology programs, using one program as an example, and discusses the needs and challenges that will shape the discipline's development in the future.

Identifying Multilevel Barriers to Tobacco Intervention in Postdoctoral Dental Education

The aims of this mixed-methods study were to assess tobacco treatment behaviors among residents and faculty in dental specialty postdoctoral programs and to explore factors in training and practice related to tobacco treatment education. Surveys and focus groups were conducted with a convenience sample of participants at three postdoctoral residency programs in New York City. Surveys assessed tobacco cessation training and behaviors. Focus groups explored barriers to implementing tobacco cessation treatment in educational settings. Data were collected between May and December 2013. Among the 160 faculty and residents identified as potentially eligible for the study, 60 were invited by program directors to participate, and 50 subsequently completed the survey and participated in a focus group (response rate of 31.3%). Survey results indicated high levels of asking patients about tobacco use and advising patients to quit. In contrast, specific tobacco cessation assistance and follow-up care occurred less frequently. There were statistically significant differences in tobacco cessation intervention across the specialties surveyed, but not between residents and faculty. Focus group comments were grouped into three broad areas: clinician factors, organizational support, and structural and contextual factors. Focus group results indicated that participants experienced significant organizational and structural barriers to learning about and providing tobacco treatment. Participants from each specialty indicated that multi-level barriers impeded their provision of evidence-based tobacco cessation interventions in postdoctoral educational settings. They suggested that didactic education should be reinforced by organizational- and systems-level changes to facilitate comprehensive tobacco education and effective cessation treatment in future dental practice.

Knowledge, Attitudes, and Practices of Pediatric Dentists Regarding Speech Evaluation of Patients: Implications for Dental Education

The aim of this cross-sectional study was to determine pediatric dentists' attitudes about speech evaluation in the dental setting and assess their knowledge of speech development and pathology. In October 2013, members of the American Academy of Pediatric Dentistry were invited to participate in an electronic questionnaire. Categories of questions were demographics, attitudes and confidence in speech pathology, and theoretical and practical knowledge of speech development and speech pathology. Theoretical knowledge was assessed using questions about phonetics and speech milestones. Practical knowledge was determined with three 30-second interview-style video clips. A total of 539 responses were received for a response rate of 10.4%. The majority of respondents reported feeling that speech evaluation should be part of the pediatric dental visit (72.8%) and felt confident in their ability to detect speech issues (73.2%). However, they did poorly on the theoretical knowledge questions (41.9%) as well as the practical knowledge questions (8.5%). There was a statistically significant difference in theoretical score between gender and type of occupation (p<0.05). This difference was not observed when examining practical knowledge. This study suggests that although pediatric dentists are in an ideal position to aid in the detection of speech issues, they currently have insufficient training and knowledge to do so.

Educators' and Applicants' Views of the Postdoctoral Pediatric Dentistry Admission Process: A Qualitative Study

The postdoctoral application and matching process in dental education is a high-stakes and resource-intensive process for all involved. While programs seek the most qualified candidates, applicants strive to be competitive to increase their likelihood of being accepted to a desirable program. There are limited data regarding either subjective or objective factors underlying the complex interplay between programs and applicants. This qualitative study sought to provide insight into the stakeholders' experiences and views on the matching process. Telephone and in-person interviews were conducted with ten pediatric dentistry program directors and ten recent applicants to pediatric dentistry programs in the United States in 2013-14. Participants were selected to represent the geographic (five districts of the American Academy of Pediatric Dentistry) and institutional (hospital- or university-based) diversity of pediatric dentistry programs. Interviews were recorded and transcribed verbatim. Veracity and need for more information were the themes most often articulated by both groups. The program directors most valued teachability and self-motivation as desirable applicant characteristics. The applicants relied primarily on subjective sources to gather information about programs and prioritized location and financial factors as pivotal for their rankings. Both groups appreciated the uniformity of the current application process and highlighted several weaknesses and areas for improvement. These results shed light on the postdoctoral matching process in pediatric dentistry via a qualitative description of stakeholders' experiences and viewpoints. These insights can serve as a basis for improving and refining the matching process.