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Case-writing within an integrated, systems-based health professions education curriculum presents many unique challenges. Specifically, case-writing in this context must consider integration of multidisciplinary learning objectives and synthesis of biomedical and clinical sciences. Establishing an effective process for content integration and determining who should be involved in the case-writing process can be a daunting task and this specific context requires a new model for effective casewriting. This paper provides a model for the cycle of case development, implementation, evaluation and modification in an integrated, systems-based health professions curriculum. We highlight how this collaborative case-writing model parallels the social constructivist approach promoted by the problem-based learning process in which our students engage.

A survey is conducted, to determine the correlation of sex and dental specialty associated with depression in dentists. The results show that female pediatric dentists and periodontists are more depressed than their male counterparts. Relevant statistical information is also provided.

Background: Dental surgery under general anesthesia (GA) is a common treatment for severe childhood caries and thus may serve as an event to motivate behavior change. The frequency of recurrent caries, however, indicates opportunities within current practice to change a child's oral health behaviors. Aim: To assess caregiver experiences related to their child's dental surgery to inform development of a behavioral intervention. Design: Semi‐structured interviews with caregivers of children receiving GA for dental surgery. Transcripts (n = 19) were analyzed using qualitative thematic methods. Results: Children were 2–5 years of age, mean 3.8 years. Limited access to GA services was a source of caregiver frustration and a barrier to caries treatment. Surgical events elicited emotional reactions including guilt, anxiety, and a sense of caregiver accountability for development of severe caries. There was variation in caregiver awareness and/or motivation to change oral health behaviors. Conclusions: A child's dental surgery under GA is an emotionally challenging event yet may inspire hope and expectations for improvement. Surgery offers an opportunity to implement interventions at a time when caregivers may be open to assistance with behavior change, though stress and anxiety may create barriers. Behavioral interventions should be tailored to individual caregiver needs/barriers and stage of developmental readiness. [ABSTRACT FROM AUTHOR]

The purpose of this study was to test whether an interactive, web-based training program is more effective than an existing, flat-text, e-learning program at improving oral health students' knowledge, motivation, and self-efficacy to address signs of disordered eating behaviors with patients. Eighteen oral health classes of dental and dental hygiene students were randomized to either the Intervention (interactive program; n=259) or Alternative (existing program; n=58) conditions. Hierarchical linear modeling assessed for posttest differences between groups while controlling for baseline measures. Improvement among Intervention participants was superior to those who completed the Alternative program for three of the six outcomes: benefits/bar-riers, self-efficacy, and skills-based knowledge (effect sizes ranging from 0.43 to 0.87). This study thus suggests that interactive training programs may be better than flat-text e-leaming programs for improving the skills-based knowledge and self-efficacy necessary for behavior change. [ABSTRACT FROM AUTHOR]

Four individuals who teach ethics in dental schools comment on a case in which negative financial information is revealed by one dentist when transferring records of a potential patient to another dentist. All commentators find varying degrees of ethical problem with disclosing such information. Professional codes discourage this practice. All commentators stress the importance of the potential new dentist developing a relationship based on professional standards, with the greatest emphasis placed on the patients health needs. Several of the commentators discuss positive ways of conducting a patient interview, including specific useful language. [ABSTRACT FROM AUTHOR]

Purpose: The purposes of this study were to: (1) determine the level of parental knowledge regarding initial trauma management; and (2) assess which factors could influence that level of knowledge. Methods: A self-administered questionnaire was given to parents of patients that attended 1 of 2 dental clinics. The questionnaire consisted of 3 parts and assessed patient and parental demographics and knowledge of dental trauma management. Results: Four hundred sixty-seven questionnaires were completed. Most patients had Medicaid insurance (79%). Most parents would seek care from a dentist (71% broken tooth; 62% avulsed tooth). Only 31% knew that avulsed permanent teeth could be placed back into the socket, and only 25% of parents chose milk as a transport medium for avulsed teeth. A mere 3% of parents answered all 5 trauma management questions correctly, and 10% had no correct responses. The number of correct responses was not affected by clinic location, history of previous trauma, sex, education, or insurance status. Parents of recalled patients had more correct responses (P<.05). Conclusion: Knowledge of dental trauma management was poor. The fact that parents of recalled patients were somewhat more knowledgeable suggests that the dental visit can be an effective vehicle for education. The management of dental trauma should be part of the dental health education provided at dental visits. [ABSTRACT FROM AUTHOR]

Objectives: A large study of risky pre-teen behavior provided an opportunity to examine self-reported toothbrushing frequency for stability over time and adequacy.Methods: 1115 metropolitan African-American children at risk for violence and drug use self-reported toothbrushing frequency in at least one of five measurement points from 5th to 8th grade as part of a larger study. Longitudinal data were available for 815 students.Results: 81% reported mainly twice daily, 8% reported mainly once daily, 10% changed over time, and 1% were consistently less than once daily.Conclusions: Overall, the children reported once or twice daily toothbrushing frequency, stable between 5th and 8th grades. A minority of children showed low or inconsistent frequencies and these results may indicate an opportunity for intervention to improve habits. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the relationship between a history of potentially traumatic events (PTE) and a child's behavior during dental treatment.Methods: Parents of healthy children, age four years and older and attending their initial dental appointment at a university pediatric dental clinic, were asked to complete the Traumatic Events Screening Inventory-Parent Report Revised and a demographic survey. Following the dental appointment, a pediatric dental resident reported the child's behavior using the Frankl scale.Results: A total of 170 parent-child pairs participated; 53 percent of parents indicated their child had experienced at least one PTE; 44 percent reported their child had a prior negative experience at the dentist. Adjusted multivariable logistic regression analysis showed no significant association between PTE history and poor dental behavior (P=0.994), but a significant association was observed between a previous negative dental experience and poor dental behavior (P=0.000) as well as between age (younger than five years old) and poor behavior (P=0.006).Conclusions: Children with a history of potentially traumatic events did not exhibit uncooperative behavior more often than those who did not. A previous negative dental experience and the child's young age were significantly associated with uncooperative behavior. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the effects of palatal stabilizing devices (PSDs) on accidental extubations (AEs) and other intubation complications in infants with breathing tubes at a neonatal intensive care unit (NICU) of a university hospital. PSDs are individually crafted acrylic oral devices for stabilizing breathing tubes in neonates. Methods: Charts of all first admission NICU neonates weighing less than 1,500 g were reviewed (N=733); 548 were intubated and had information available on birth weight, gender, transfer status, gestational age, length of admission, ventilator type, sedation, dates of intubations and extubations, number of accidental extubations, dates of PSD placement, and complications. Results: 153 subjects received PSDs, with 19 AEs; 395 received no PSDs, with 31AEs. Non-PSD neonates were intubated for a median of 3 and PSD neonates for 26 days. PSDs were associated with sedation, male gender, longer admissions, longer intubation periods, being on a high-frequency ventilator, and low birth weight (P<.05). 0.4 accidental extubations over 100 intubated patient days were recorded for the PSD vs 0.79 for the non-PSD group. Conclusions: Palatal stabilizing devices were not related to other complications of breathing tubes. The PSD group had fewer accidental extubations per days of intubation vs the non-PSD group. [ABSTRACT FROM AUTHOR]

Purpose: This study's purpose was to compare dental visits and oral health knowledge of African American (AA) and Hispanic American (HA) pregnant adolescents in a community health clinic. Methods: Demographics, oral health knowledge, oral hygiene, and dental visits during pregnancy were surveyed by anonymous questionnaire to adolescents who were pregnant at the time of the study or within the last year. Results: Responses from 50 AA and 61 HA adolescents between 12 and 20 years old were analyzed. Fourteen percent of AAs and 26 percent of HAs saw a dentist during pregnancy, while 26 percent of AAs and 16 percent of HAs reported regular 6-month visits when not pregnant. Fifty-two percent of AAs and 43 percent of HAs knew that oral health problems could affect the pregnancy or growth of the baby. Thirty-four percent of AAs and 56 percent of HAs knew that pregnancy was related to gum problems (P=.02). Logistic regression revealed the predictors of a dental visit during pregnancy, including living with a boyfriend/husband (P=.02, odds ratio=4.4, confidence interval=13-153) and dental visits when not pregnant (P<.001, OR=13.6, 0=3.7-50.5). Conclusions: Minority pregnant adolescents had only limited dental visits whether or not they were pregnant and possessed limited knowledge of oral health and pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study assessed the impact of a lecture on children's oral health knowledge of pregnant women from vulnerable African American (AA) and Hispanic of Mexican origin (HM) populations utilizing the same urban community health center prenatal education program. Methods: Participants heard one 45-minute lecture in English or Spanish on children's oral health, and completed a survey (English or Spanish) before and after the lecture. Results: Seven sessions provided 60 participants: (a) 30 AA; and (b) 30 HM. These two groups differed on: (1) educational attainment; (2) preferred language; (3) country of origin; and (4) baseline scores. They were similar in: (1) age; (2) frequency of,first mothers; and (3) final scores. Oral health knowledge significantly rose from baseline to the end of the lecture (ANOVA, P<.001). Educational attainment was associated with HM baseline scores (P=.04), whereas age was associated with AA final scores (P=.01). Conclusions: An oral health lecture within a prenatal program improved oral health knowledge for African American and Hispanic of Mexican origin pregnant women, though associated factors varied between the two groups. Further study is needed to explore long-term knowledge retention and effect on the future babies' oral health. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the sensitivity and specificity of the near-infrared light transillumination caries detection method by using DEXIS CariVu (DCV) for imaging of interproximal primary molar surfaces (IPMS). Methods: A retrospective evaluation of patient records at a university pediatric dentistry (PD) clinic identified 22 patients with unrestored IPMS, which had images of both bitewing radiography (BW) and DCV. A scoring system (no caries, incipient caries, dentinal caries) was developed for the study. Two investigators (pediatric dental faculty) identically scored 90 IPMS in both BW and DCV images, establishing benchmark IPMS scores. The 180 images were then compiled in a randomized order in a questionnaire, which was answered by 24 raters (PD residents and faculty) using the study caries scoring system. Data analysis included raters and experts' percent agreement, Vassar Stats for sensitivity and specificity, and Kendall's correlation coefficient for interrater reliability. Results: The overall agreement between raters and experts for DCV images was 48 percent (54 percent for no caries, 23 percent for incipient caries, and 68 percent for dentinal caries). The DCV's sensitivity and specificity to detect any caries were, respectively, 0.72 and 0.54, 0.60 and 0.53 for incipient caries, and 0.82 and 0.53 for dentinal caries. The BW's sensitivity and specificity to detect any caries were respectively, 0.82 and 0.87, 0.98 and 0.86 for incipient caries, and 0.99 and 0.87 for dentinal caries. The overall interrater reliability was 0.48 (95 percent confidence interval equals 0.46 to 0.50). Conclusion: The use of DCV as a stand-alone caries detection method for IPMS is limited. [ABSTRACT FROM AUTHOR]

Purpose: To identify factors that influence oral health behaviors in the pediatric population treated for caries under general anesthesia (GA). Methods: Nineteen semi-structured key informant interviews were conducted with caregivers while their children received comprehensive dental care under GA. Interviews were recorded on audio and professionally transcribed. Transcripts were coded using an inductive approach, with codes categorized and themes identified in an iterative process among four investigators. Results: Data from 14 English and five Spanish interviews were reported. Factors that impacted accessing dental services, toothbrushing, and sugar intake were related to experiences living with severe caries and family dynamics. Many caregivers found the process of accessing care challenging, with barriers ranging from a caregiver's denial of disease severity to insurance status and provider availability. Discordant dynamics between parents and their children hindered efforts to change oral health behaviors. Stress of daily life impacted the ability for some caregivers to prioritize oral health. Conclusion: Our findings provide a better understanding of how a family's experiences and dynamics prior to dental care under GA can serve as barriers to changing oral health behaviors within an urban, Medicaid-enrolled population. Future work should address the complexity and context of familial interactions in efforts to improve surgical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the relationship between a history of potentially traumatic events (PTE) and a child’s behavior during dental treatment. Methods: Parents of healthy children, age four years and older and attending their initial dental appointment at a university pediatric dental clinic, were asked to complete the Traumatic Events Screening Inventory-Parent Report Revised and a demographic survey. Following the dental appointment, a pediatric dental resident reported the child’s behavior using the Frank! scale. Results: A total of 170 parent-child pairs participated: 53 percent of parents indicated their child had experienced at least one PTE; 44 percent reported their child had a prior negative experience at the dentist. Adjusted multivariable logistic regression analysis showed no significant association between PTE history and poor dental behavior (P=0.994), but a significant association was observed between a previous negative dental experience and poor dental behavior (P=0.000) as well as between age (younger than five years old) and poor behavior (P=0.006). Conclusions: Children with a history of potentially traumatic events did not exhibit uncooperative behavior more often than those who did not. A previous negative dental experience and the child’s young age were significantly associated with uncooperative behavior. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate parental acceptance of provision of tobacco cessation and prevention education to children and parents by private practice pediatric dentists. Methods: Receptionists gave confidential questionnaires to parents of child dental patients in five private pediatric dentistry practices. Demographic information and questions about dentist interventions were asked, with the most intrusive questions concerning parental tobacco use. Results: Ninety-four percent (234) of parents responded. Over 90 percent of parents favored dentists speaking to 1) the child on the dangers of tobacco use and the benefits of avoiding tobacco, 2) parents about the effects of tobacco use on their children, and 3) parents about cessation. Among tobacco-using parents, 76 percent favored interventions directed at child tobacco use and warnings about adult smoking and children, dropping to 59 percent favoring dentist provisions of cessation education to parents. Users were less approving than nonusers on both parental interventions (P=.001). Conclusions: Parents showed high acceptance of various levels of tobacco interventions by pediatric dentists in private practice. Tobacco users, however, were less accepting than nonusers. Pediatric dentists may be more willing to provide such messages with this information, but they may also need training to prepare themselves to handle negative reactions. [ABSTRACT FROM AUTHOR]

Early childhood caries is prevalent in the United States, especially among Hispanic children. One consequence may be premature loss of primary teeth, raising concern about developmental challenges. This study examined speech sound articulation errors association with premature loss of the primary maxillary incisors of bilingual children (Spanish/English). Methods: Hispanic children were assessed with a speech sound articulation test at 7 to 10 years of age against their history of primary maxillary anterior incisor loss. The exposed group (N=25) experienced premature extraction of these incisors, and the unexposed group (N=8) had normal dental exfoliation. Results: The groups were similar regarding: age at speech assessment: gender; language spoken at home; socioeconomic status; caries prevalence; mean number of decayed, missing, filled and sealed teeth. Higher values for the dental articulation errors (P=.04) were revealed among exposed vs unexposed. Exposed boys had more total speech articulation errors (P=.03), dental-related errors (P=.048), and other errors (P=.04) than the unexposed boys, although of small sample size. Discussion: Bilingual children who experienced early primary tooth loss exhibited differences in speech sound production vs those who did not. Further research is warranted to determine the extent early tooth loss in bilingual children predicts speech problems. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate and compare intranasal (IN) and oral (PO) midazolam for effect on behavior, time of onset, maximum working time, efficacy, and safety for patients requiring dental care. Methods: Forty anxious subjects (20 IN, 20 PO, Frankl Scale 3 and 4, ages 2-6 years, ASA I and II) were sedated randomly with either IN (0.3 mg/kg) or PO (0.7 mg/kg) midazolam. The dental procedure under sedation was videotaped and rated by a blinded and calibrated evaluator using Houpt's behavior rating scale. Results: There was no statistical difference for overall behavior (F327=0.407; P=.749). The planned contrasts showed significant interactions between time and route (IN vs PO) between 25 and 30 minutes after starting sedation. The time of onset (P=.000) and the working time (P= .007) were significantly different between IN and P0 midazolam. There were no statistically significant differences in vital signs (O2 sat, HR, RR, BP) between PO and IN (P=.595). IN subjects showed more movement and less sleep toward the end of the dental procedures, and faster onset time but shorter working time than PO. Vital signs were stable throughout the procedures with no significant differences. Conclusions: Mean onset time was approximately 3 times faster with IN administration compared to PO administration. Mean working time was approximately 10 minutes longer with PO administration than it was with IN administration. Overall behavior under PO and IN was similar. However, more movement and less sleep were shown in subjects under IN than those under PO toward the end of the dental session. All vital signs were stable throughout the procedures and showed no significant differences between PO and IN administration. [ABSTRACT FROM AUTHOR]

Objective: To investigate factors affecting the internal brain drain of healthcare professionals in the Kingdom of Saudi Arabia., Methods: A cross-sectional study was conducted using an anonymous self-administered online questionnaire sent to all Saudi students enrolled in healthcare profession programs in North America. The data was collected between January and March 2008 at the University of Illinois at Chicago, Chicago, Illinois, United States of America. Results were analyzed using logistic regression analyses., Results: A total of 377 completed questionnaires were returned. Results revealed that 71% of respondents intended to return to work within the 2 major urban cities Riyadh and Jeddah. Respondents who completed their undergraduate studies in a large city were more likely to work in the same city (odds ratio [OR]=3.2; p=0.000; 95% confidence interval [CI] = 2.0-5.2). Furthermore, 51% of the students were willing to work in a rural area for a 50% or more increase in their salary. Finally, men were more willing to work in a rural area for a financial incentive (OR=2.3; p=0.006, 95% CI = 1.3-4.3)., Conclusion: This study suggests that realistic financial incentives would probably not suffice to attract Saudi healthcare providers to rural areas. The provision of medical schools in smaller cities and rural areas is predicted to be a more effective method for improving the current maldistribution of healthcare providers.