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Following the adoption of competency-based education in dentistry in the 1990s, entrustable professional activities (EPAs) were introduced in the field of medicine in the mid-2000s to help educators better determine the competence of trainees. More recently, the field of dental education has begun exploring EPAs as a framework for assessing competence while ensuring compliance with accreditation standards. This paper explores one dental school's process of preparing for implementation of a major curriculum change using an EPA assessment framework, shifting away from the use of singular assessments for competency determination to a global and longitudinal approach using a constellation of data to determine practice readiness. This paper describes how the EPA framework was developed, including the complementary capacities, assessment tool development and programming, and data reporting to follow learner progression and determine practice readiness. We discuss lessons learned leading up to implementation, and we position this perspective as a space to describe opportunities and complexities to consider when using a longitudinal assessment system. We attend to the tension between the current language of Commission of Dental Accreditation Standards as "competencies" and the evolving conversation of operationalizing EPAs while addressing accreditation Standards. To do this, we describe the process of finalizing our EPA framework and preparing for initial implementation in a new curriculum.

To explore pre-doctoral faculty perceptions toward implementation of value-based care (VBC) in didactic and clinical teaching.This project was a collaborative effort between CareQuest and the University of North Carolina at Chapel Hill, Adams School of Dentistry introducing VBC to pre-doctoral dental faculty as part of a new curriculum. Following a faculty development session on VBC in June 2021, faculty and subject matter experts were invited to participate in qualitative interviews. Subject matter experts were interviewed to establish a baseline for VBC knowledge and understanding. Interviews were recorded and transcribed verbatim. Analysis was conducted by two analysts using ATLAS.ti and a thematic analysis approach.Six faculty and two subject matter experts participated in interviews. Although dental faculty demonstrated some understanding of VBC, they recognized that more training is required to build in-depth knowledge and implementation strategies for teaching dental students. Faculty discussed value-based concepts such as prevention-focused teaching, person-centered care, and disease management over invasive restoration of teeth, and how VBC is bringing about a paradigm shift in dentistry that needs to be reflected in dental education. They acknowledged a disconnect between VBC in didactic teaching versus clinical instruction. Those interviewed believed it would take time to shift faculty mindset and readiness to teach VBC, and continued efforts are needed at the leadership and faculty level for acceptance and implementation.Although dental faculty recognize that VBC can bring a shift in dental practice, more training and guidance to implement it in didactic and clinical teaching is needed.

Purpose To define faculty needs and services requested for the implementation of a faculty-centered curriculum support system (i.e., Academic Support Center [ASC]) to assist curriculum redesign. Methods Faculty and students were invited to participate in 60-min, one-on-one interviews to describe pain points in teaching and identify possible support services needed. Benchmarking through surveys of academic deans was also conducted to determine what services other institutions offer. Qualitative memos from interviews and survey data were analyzed to identify salient challenges and outline possible services that could benefit the school. This information was used to create a strategic plan for the ASC. Full-time faculty were requested to evaluate the ASC 6 and 12 months following the launch of the center in 2019. Results Fifty interviews were conducted with department chairs (n = 10), full-time faculty (n = 36), and students (n = 4). Six pain points identified by participants were time, resources, knowledge, confidence, organizational structure, and organizational culture. Participants generated solutions related to supporting teaching and learning, enhancing faculty experience, and assisting educational evaluation. Twenty-two schools responded to the benchmarking survey-approximately half acknowledged a centralized curriculum support service (n = 12, 54.5% of respondents). Services often focused on instructional design, education technology, and faculty onboarding to education. Faculty feedback following the ASC launch was generally positive and demonstrating progress toward the three priorities. Conclusion Needs assessment and benchmarking data can inform the design and implementation of centers that offer faculty-centered support structures around teaching, educational scholarship, and curriculum change.

Curriculum transformations represent opportunities to innovate; however, there are few examples to inform this process. In 2018, the University of North Carolina at Chapel Hill (UNC) Adams School of Dentistry began to transform the predoctoral curriculum to improve content integration, enhance team-based experiences, and develop leaders. Part of this experience has been crafting a conceptual curriculum guide or "blueprint" that outlines a vision for the design process and ensures the transformation achieves its goals. We describe how we created the UNC Blueprint for our revised curriculum, which defines who our graduates are, what they know, and what they can do. This approach has led us to develop a mapping taxonomy to ensure the student outcomes are appropriately aligned with content, instruction, and assessment throughout the curriculum. Last, we encourage others to be agile in their approach, create a common language among their teams, and frequently engage faculty to facilitate the process.

Odontogenic pain affects up to 54.9% of pregnant women1-3. This pain is often associated with pulpal and/or periapical infections that pose risks to women and their fetus. The American Dental Association in collaboration with the American College of Obstetricians and Gynecologists developed a consensus statement to affirm the importance of timely and appropriate oral health care as a critical component of a healthy pregnancy4. However, limited knowledge of endodontic procedure safety and related medication use often result in the avoidance of treatment during pregnancy. This article, a collaborative effort by specialists from endodontics, pediatric dentistry, and obstetrics, reviews the current evidence on the safety of medications commonly used in endodontics including local anesthetics, analgesics, anxiolytics, and antibiotics.

PURPOSE The entrustable professional activity (EPA) framework is an assessment approach used to define the educational outcomes of a program by outlining discrete work tasks learners are expected to perform independently upon graduation. This study outlines the development and evaluation of an EPA framework for predoctoral dental education at the University of North Carolina Adams School of Dentistry. METHODS The draft EPA framework was created in collaboration with a group of faculty members and included 15 statements that were mapped to relevant Commission on Dental Accreditation standards. The draft EPA framework was distributed to faculty via an electronic survey, requesting participants to evaluate whether the EPAs were well-defined; observable; measurable; expected of a general dentist; transferable to other practice settings; and required application of relevant knowledge, skills, and attitudes. In addition, participants were asked to identify the percentage of graduates who could perform these tasks independently and whether learners must be able to perform the list of EPAs upon graduation. RESULTS Sixty-eight faculty members completed the survey (72% response rate); participants represented all divisions across the school and had extensive dental practice experiences. Overall, participants agreed the EPAs met the defined criteria and were considered important for graduates to be able to demonstrate. Feedback from faculty voiced support for the EPA framework and identified concerns regarding the implementation due to potential faculty calibration and time constraints. CONCLUSION Evidence from this study supports additional research to explore how the EPA framework can be further developed in predoctoral and postgraduate dental education programs.

PURPOSE The Association of American Medical Colleges and American Dental Education Association have identified oral health knowledge, skills, and attitudes shared by both medical and dental professionals. Although oral health was deemed an essential competency for medical practitioners, our state struggled to ensure learners received proper training. This training deficit resulted in conducting a needs assessment and implementing an oral health interprofessional module at our schools. METHODS First-year medical students and clinical faculty were emailed surveys in 2016 to obtain baseline information. A team of faculty and students from the Schools of Medicine and Dentistry reviewed the curriculum to determine where to augment oral health content. An oral health module to teach a basic head, neck, and oral examination to first-year medical students during their patient-centered care small-group sessions was implemented and evaluated. RESULTS Only 13.6% of faculty respondents were aware of national oral health competency recommendations, and

Changes in U.S. health care delivery systems and Commission on Dental Accreditation standards provide impetus for interprofessional education (IPE) and collaborative practice, but roadmaps for engaging dental and dental hygiene faculty to incorporate IPE in a systematic manner are limited. The purpose of this report is to describe the process for creating a strategy and gathering a variety of baseline data to use for determining objectives and metrics and the subsequent development of an IPE strategic plan at the University of North Carolina (UNC) at Chapel Hill Adams School of Dentistry (SOD). SOD IPE committee members included representation from the UNC Schools of Dentistry, Medicine, Pharmacy, and Business. A three-phase framework was developed. Phase 1 (IPE assessment) was an internal environmental scan including a 2017 faculty survey, departmental mapping of IPE activities, comparison of UNC with national results on the IPE component of the American Dental Education Association (ADEA) survey of dental school seniors (2016 graduating class), identification of faculty joint/adjunct appointments at other UNC schools, and a strengths, weaknesses, opportunities, threats (SWOT) analysis. Phase 2 (visioning) consisted of development of IPE mission, vision, and priorities. In Phase 3 (implementation), priorities were developed. Data-gathering led to a strategic plan with three objectives: 1) increase faculty engagement and recognition, 2) develop predoctoral dentistry and dental hygiene IPE curricula, and 3) develop an infrastructure that supports IPE. Specific initiatives and activities, supporting metrics, and estimated costs were developed for each objective. The framework guided a systematic, transparent, and organized process for collecting and monitoring the evidence and directing activities. A three-year strategic plan for IPE was developed in 2017, and implementation is ongoing.

The University of North Carolina at Chapel Hill Adams School of Dentistry is developing a transformative curriculum that prepares students to enter contemporary practice. The Advocate, Clinician, and Thinker (ACT) framework will provide the basis for developing a resilient workforce capable of meeting emerging health care needs over the next 40 years.

The American Academy of Pediatrics (AAP) recommends an oral health risk assessment and referral to a dental home by a child's first birthday. We evaluated the adherence of primary care providers (PCPs) to AAP dental referral guidelines for children age4 years and barriers to implementation of these guidelines.A cross-sectional survey of PCPs randomly selected from the 435 practices in North Carolina identified as providing well-child visits for Medicaid children age4 years was completed in 2013. The PCPs' referral recommendations were assessed using 4 vignettes of 18-month-old children at various risk of dental caries (low, moderate, high, or highest) and different levels of dentist supply (adequate or inadequate). Barriers to guideline adherence specified in the Cabana framework were analyzed for their associations with PCP adherence, using logistic regression models stratified by caries risk and dentist supply.The survey yielded 219 (50%) usable responses from the sample of 435 PCPs. On average for all vignettes, 61% of providers chose a referral recommendation in agreement with guidelines. Underreferral averaged 40%. With adequate workforce, guideline-adherent responses varied from 26% for low-risk children to90% for high-risk children. An inadequate workforce reduced adherence for most levels of risk. Generally, correct knowledge of risk status, barriers to risk assessment, and pediatric practice were associated with adherence, but not always in the hypothesized direction.PCPs' adherence to referral guidelines varies according to caries risk and dentist supply, but generally they underrefer low- to moderate-risk patients by a significant degree.

Introduction Standardized patient (SP) methodology has been used in health professional education to help students develop communication, deeper diagnostic reasoning, and critical thinking skills. Few examples demonstrate the use of SPs to practice difficult conversations with pediatric caregivers in the pediatric dentistry literature. The objective of this educational activity was to describe the implementation of three SPs in a pediatric dentistry course for second-year dental students. Methods We developed three SP encounters covering interactions with caregivers of an infant with severe early childhood caries, an adolescent on the path to gender affirmation, and a child with autism and dental caries whose caregiver was resistant to fluoride- and silver-containing dental materials. We describe the case design process, rubric construction and calibration, student debriefing, and pandemic modifications. We evaluated the effectiveness of the implementation by thematic analysis of student reflections following each encounter using a qualitative descriptive framework. Results Eighty-three students completed each encounter. Qualitative analysis showed that students preferred a more realistic encounter by having a child or other distraction present. Students relied on different elements of motivational interviewing depending on the objective of each encounter and the age of the patient. Overall, the SP encounters were well received by students and faculty as an alternative or supplement to traditional student evaluation methods. Discussion We noted a number of lessons learned about implementing SP methodology in pediatric dental education. With these experiences now in place, future evaluations should measure student performance in the SP encounters against student performance during clinical care.

Background A virtual oral health care help line was established to provide consultation and triage for people with dental questions and concerns. Its goal during a pandemic was to keep patients from seeking unnecessary in-person care from emergency departments and urgent care clinics, especially when dental practices were closed or limited to providing essential urgent and emergency oral health care. Methods The Adams School of Dentistry, University of North Carolina at Chapel Hill, developed the Carolina Dentistry Virtual Oral Health Care Helpline using a quality improvement framework with faculty and staff member feedback. The process included establishing infrastructure (phone, video, protocols, referrals, documentation), personnel (scheduling, training, calibration), and internal and external communication. The authors collected retrospective information for descriptive evaluation of the first month’s operations. Results There were 337 telephone calls answered, of which 65 (19%) were administrative and 272 (81%) were related to dental concerns. Dental pain (54%) was the most prevalent reason for calling. Triage and Providers referred 107 of 175 callers (61%) to the school’s urgent care center. Of the 79 callers who received teleconsultations from virtual providers, 33 (42%) did not require additional follow-up, and 7 (9%) needed a follow-up phone call. Overall, 4 people were referred to community clinics, and 4 were referred to the emergency department. Conclusions The Helpline was launched quickly and improved through quality improvement cycles, and it provided a needed community dental service. The process resolved some patient concerns without their seeking urgent or emergency care. Practical Implications The pandemic has increased teledentistry practice. The authors describe establishing a dental school’s virtual oral health Helpline, which provides a framework for dental practices seeking to use this patient communication modality.

PURPOSE There is minimal research characterizing admission prerequisites courses across schools of dentistry. The purpose of this study was to typify didactic and laboratory course requirements and compare requirements based on institution demographics. METHODS In July 2019, the researchers evaluated websites from 76 North American dental schools to collect information on required and recommended courses, credit hour requirements, and institution demographics. Sub-group analyses evaluated differences in course and credit hour differences based on institution funding, degree program, location, and Carnegie Classification. RESULTS The most common required courses were general chemistry (97.4%), physics (93.4%), organic chemistry (92.1%), general biology (90.8%), communication (86.8%), and biochemistry (80.3%). The most common required laboratory courses were general chemistry (63.2%), organic chemistry (59.2%), general biology (55.3%), and physics (51.3%). Several institutions included unique course recommendations such as histology (40.7%), psychology (30.3%), art (18.4%), business (18.4%), sociology (15.8%), and embryology (14.5%). There were few differences based on institution classifications; however, differences were observed most often between institutions within and outside the United States. The study also identified 65.8% (n = 50) of schools have letter of recommendation requirements and 46.1% (n = 35) of schools require or recommend shadowing experiences with programs requesting a median of 60 hours (range 20-300 hours). CONCLUSIONS The study offers a contemporary characterization of prerequisite requirements and recommendations. In addition, the study raises critical questions about whether these standards reflect expectations for entering learners, if these requirements truly relate to learner success, and if these requirements prepare learners to be future-ready graduates.

PURPOSE The need to innovate predoctoral dental education is well established; however, there are few recent reports to guide substantial curriculum transformation. The purpose of this study was to describe faculty perspectives on their vision of future graduates, curriculum needs, and potential barriers to a successful redesign. This information would be used to inform strategic planning for the predoctoral curriculum transformation. METHODS Eighty full-time faculty from the University of North Carolina Adams School of Dentistry participated in 60-minute focus groups in March 2018. Focus group questions were developed to elicit perceptions about the current curriculum, what the dental graduate should know in 2040, and what is needed to engage faculty in curriculum change. Transcripts of the focus group sessions were analyzed by a third-party research group using qualitative thematic analysis to identify pertinent themes shared by participants. RESULTS Faculty identified that developing clinical skill that engages multiple specialties, student time to engage in advocacy activities, and opportunities to integrate biomedical, clinical, and behavioral sciences as critical features of the curriculum. They believed the 2040 graduate should be able to critically evaluate literature, exhibit strong leadership skills, and adapt to the changing healthcare environment. To better engage faculty in curriculum change, there needs to be dedicated time, sufficient resources, a clear plan, and greater collaboration across the school. CONCLUSION When embarking on curriculum transformation, engagement with faculty is a critical component of the change process. Focus groups can be used as a technique to better understand faculty perspectives about curricular needs and the overall vision.

A virtual oral health care help line was established to provide consultation and triage for people with dental questions and concerns. Its goal during a pandemic was to keep patients from seeking unnecessary in-person care from emergency departments and urgent care clinics, especially when dental practices were closed or limited to providing essential urgent and emergency oral health care.The Adams School of Dentistry, University of North Carolina at Chapel Hill, developed the Carolina Dentistry Virtual Oral Health Care Helpline using a quality improvement framework with faculty and staff member feedback. The process included establishing infrastructure (phone, video, protocols, referrals, documentation), personnel (scheduling, training, calibration), and internal and external communication. The authors collected retrospective information for descriptive evaluation of the first month's operations.There were 337 telephone calls answered, of which 65 (19%) were administrative and 272 (81%) were related to dental concerns. Dental pain (54%) was the most prevalent reason for calling. Triage and Providers referred 107 of 175 callers (61%) to the school's urgent care center. Of the 79 callers who received teleconsultations from virtual providers, 33 (42%) did not require additional follow-up, and 7 (9%) needed a follow-up phone call. Overall, 4 people were referred to community clinics, and 4 were referred to the emergency department.The Helpline was launched quickly and improved through quality improvement cycles, and it provided a needed community dental service. The process resolved some patient concerns without their seeking urgent or emergency care.The pandemic has increased teledentistry practice. The authors describe establishing a dental school's virtual oral health Helpline, which provides a framework for dental practices seeking to use this patient communication modality.

Knowledge gaps exist among providers and pregnant women about the importance and safety of oral health care around pregnancy. This article describes the current state of perinatal oral health and healthcare among underserved women in North Carolina (NC) and provides policy recommendations to improve their access to and utilization of dental services. A descriptive analysis is provided using (a) 2016 oral health surveillance data of a convenience sample of 459 pregnant women across NC, (b) 2014–2016 Medicaid dental provider and dental services utilization data for the Medicaid for Pregnant Women (MPW) program, and (c) 2017 Medicaid dental benefits policy. Surveillance data was not linked to Medicaid dental services utilization data. Less than 20% of pregnant women surveyed reported having a dental visit during pregnancy and oral screenings revealed 33% had untreated caries. Medicaid data showed a steady decline since 2014 in percentage of MPW beneficiaries utilizing any dental service—less than 10% as of 2016. MPW dental benefits lapse at delivery because dental care is not considered pregnancy-related in NC policy. Only 20% of practicing NC dentists provided care to MPW beneficiaries in 2015. Inadequacies in oral health knowledge, beliefs and practices exist among pregnant women, health care professionals and policymakers. Statewide efforts are needed to promote a standard of perinatal care that emphasizes collaborative practice and addresses existing barriers at the patient, provider and policy levels.

Orofacial growth and development is a complex process spanning the life course. This article provides an oral health overview in the context of overall growth, physical and social development from infancy through adolescence. It reviews oral health-specific developmental milestones during childhood (0-12 years) and adolescence (≥13 years). It examines issues particular to each age category or spanning multiple ages (eg, pediatric overweight and obesity, tobacco use, and dental trauma) in relation to oral health and development. In addition, the oral microbiome and its potential role in informing personalized oral health care across the life course is discussed.

OBJECTIVES To examine the Baby Oral Health Program's (bOHP) influence on dental visits for children 0 to 3 years and overall dental visits in four federally qualified health center (FQHC) clinics. METHODS Using an interrupted time series study design, administrative data were obtained for the year prior and following the intervention. The intervention included dental staff training on early childhood oral health, quality improvement, and monthly visits during the follow-up intervention period. Analysis included descriptive and segmented regression using aggregate patient visit data. RESULTS A total of 10,400 patients made 26,416 visits over the study period; 1,187 (11 percent) were children ≤3 years. Visit counts in the youngest age group increased 70 percent following the intervention. When controlling for the naturally increasing trend, the intervention added 8.7 (95 percent CI: 4.7, 12.8) early childhood patient-visits per clinic in the last month of the intervention period. The increase in visit counts in the youngest age group had no significant effect on other ages, except for a decline relative to the natural trend in patient-visits among 35-50 year olds (-32.3 less visits) following the intervention. The proportion of visits for all ages by ≤3 year olds increased from 5 to 8 percent following the intervention. CONCLUSIONS bOHP increased dental visits among children ≤3 years but the finding might be attributable to clinic changes coinciding with bOHP implementation that were not controlled with the study design. Additional studies are needed in populations experiencing challenges accessing dental care.

Objectives To determine acceptability and feasibility of a quality improvement (QI) collaborative in safety net dental practices, and evaluate its effects on financial stability, access, efficiency, and care for pregnant women and young children. Methods Five safety net dental practices participated in a 15-month learning collaborative utilizing business assessments, QI training, early childhood oral health training, and prenatal oral health training. Practices collected monthly data on: net revenue, no-show rates, total encounters, and number of encounters for young children and pregnant women. We analyzed quantitative data using paired t-tests before and after the collaborative and collected supplemental qualitative feedback from clinic staff through focus groups and directed email. Results All mean measures improved, including: higher monthly revenue ($28,380-$33,102, p = 0.37), decreased no-show rate (17.7-14.3%, p = 0.11), higher monthly dental health encounters (283-328, p = 0.08), and higher monthly encounters for young children (8.8-10.5, p = 0.65), and pregnant women (2.8-9.7, p = 0.29). Results varied by practice, with some demonstrating largest increases in encounters for young children and others pregnant women. Focus group participants reported that the collaborative improved access for pregnant women and young children, and that QI methods were often new and difficult. Conclusion for practice Participation by safety net dental practices in a QI collaborative is feasible and acceptable. Individual sites saw greater improvements in different outcomes areas, based on their own structures and needs. Future efforts should focus on specific needs of each dental practice and should offer additional QI training.

Objectives Oral diseases are very prevalent across the lifespan and impact overall health, yet are largely preventable. The Smiles for Life (SFL) curriculum was created to educate healthcare providers about oral disease and support integration of oral health and primary care. This study examines SFL's influence on clinical practice and education. Methods Surveys were sent to registered users of SFL. Users who self-identified as direct care providers (DCPs), or educators, were included in the analysis. Results Survey response rate was 18 percent, with 87 percent identifying as DCPs and 13 percent as educators. Across professions, 85 percent of DCPs reported SFL influencing their practice to some degree, with variance among profession type and experience. DCPs most commonly reported that SFL led them to improve how they conduct oral health activities, with 60 percent performing the activity more skillfully following completion of SFL. Fluoride varnish application was the most common practice behavior initiated, and caries risk assessments was the oral health activity affected to the greatest degree. A majority of educators (94 percent) reported that SFL led them to incorporate or enhance oral health in their teaching. SFL helped educators emphasize the importance of oral health, improved their ability to teach content, raised motivation, and reduced barriers to teaching oral health. Conclusions Data supports that SFL is positively influencing oral health practice across professions, especially in areas of caries risk assessment and fluoride varnish application. SFL improves the frequency and quality with which DCPs and educators participate in oral health activities, and facilitates oral health inclusion in primary care.

Poor maternal oral health during pregnancy is associated with adverse maternal and child outcomes, including preterm birth and early childhood caries. Subsequently, professional associations have developed prenatal oral health guidelines, but significant gaps exist in implementing guidelines into clinical practice. The purpose of this study was to develop and test the usability of an innovative, theory-driven, eHealth application ("app") to facilitate prenatal providers' (nurse practitioners and midwives) implementation of oral health promotion during prenatal care visits. App development was guided by previous research, an integrated conceptual framework, Scientific Advisory Board input, and consumer-engaged iterative processes utilizing mixed-methods (observations, surveys, in-depth interviews) among providers (n = 4) during 10 unique prenatal care visits at a federally qualified health care center. Triangulation of quantitative and qualitative data analysis produced descriptive frequencies and salient themes. Concepts and principles from the following theoretical frameworks informed intervention development and testing: Consolidated Framework for Implementation Research; Information-Motivation-Behavioral Skills Model; Health Literacy; and Brief Motivational Interviewing. Overall, providers reported the app was effective at providing the information, motivation, and behavioral skills needed to integrate oral health promotion (e.g., easy to use; provided cues to action via scripts and tailored education; and documented findings into the patient's record). Although providers reported high usability, time constraints and detailed patient counseling scripts were identified areas for improvement. Findings suggest that the eHealth app could serve as an innovative mechanism to assist providers in implementing the prenatal oral health guidelines into practice. Future research is needed to continue app development efforts and to determine efficacy and effectiveness in practice settings.

Optimal oral health education is limited in nursing curricula and may therefore, not translate as a priority for nurses in clinical practice.To evaluate the influence of an educational intervention on knowledge, confidence, practice behaviors, and perceived barriers of nursing students regarding preventive oral health services.Quasi-experimental pre-post survey study design.Sixty-four first-year Accelerated Bachelor of Nursing (ASBN) students at the University of North Carolina at Chapel Hill.Students were asked to complete oral-health-related questionnaires following didactic and clinical simulation on principles of oral health, oral screening, counseling, and referral to a dentist. A post-survey following clinical rotations was completed testing long-term effectiveness.Fifty-five (86%) ABSN students completed the pre-survey, 49 (77%) completed the post-survey; 44 (69%) completed both. Participants' showed a significant increase in knowledge from pre-post questionnaires for two of five questions (p = 0.04; p 0.0001). Confidence scores in performing oral screenings (p 0.0001) and counseling (p = 0.006) increased; while scores regarding referrals decreased (p = 0.718). Post-intervention, 37% reported performing oral screenings, 45% counseling, and 8% dental referrals. Respondents reported a significant increase in willingness to implement oral health services during clinical visits (p 0.0001).Mixed educational methods can successfully influence oral health knowledge and confidence among ABSN students and their willingness to perform in clinical practice.

The examination of the 3-year-old child for some dentists represents a first dental experience, although earlier examinations are advocated by a number of organizations for diagnostic, preventive, and treatment purposes. For a child who has not had a dental examination previously, the new environment, new people, and manipulation of tissues can be difficult or overwhelming. An initial examination of a child this age can also be demanding for the dentist, who is faced with potential behavior challenges, minimal to no clinical baseline, and the need to provide both immediate and long-term planning and treatment. An early examination provides an opportunity to establish a course of dental health for years to come. The aim of this chapter is to provide a comprehensive and systematic approach to collecting data on the child to have a better understanding of the child's present overall health status and especially his or her oral and dental development.

Objectives To examine professional guidelines and/or requirements of state and national dental organizations regarding the responsibility of dentists for after-hours emergency care. Methods Guidelines of national dental professional organizations, specialties, and all 50 state dental boards were examined for language pertaining to after-hours emergency care. Guidelines were categorized as: a) no guidelines; b) deferral to American Dental Association (ADA) guidelines; c) specific guidelines outlined. Results Most states and national guidelines were similar to the ADA: dentists are obliged to make reasonable arrangements for the emergency dental care of patients of-record and not-of-record. Oral surgery maintains the most stringent guidelines of all specialties. Results of the 50 states reviewed: no guidelines-16 states (32 percent), deferral to ADA guidelines-21 states (42 percent), and specific guidelines outlined-13 states (26 percent). Conclusions Current after-hours emergency guidelines are nonspecific and open to interpretation. Variability between state guidelines likely contribute to unnecessary hospital emergency visits and increased healthcare costs, undermining the goal of establishing and maintaining dental homes.

Background Pregnant women are vulnerable to a wide range of oral health conditions that could be harmful to their own health and future child. Despite the usefulness of regular dental service utilization in prevention and early detection of oral diseases, it is notably low among pregnant women. In this qualitative study, we aimed to explore barriers and facilitators influencing pregnant women’s dental service utilization. Methods Using a triangulation approach, we included pregnant women (n = 22) from two public health centers, midwives (n = 8) and dentists (n = 12) from 12 other public centers in Tehran (Iran). Data was gathered through face-to-face semi-structured interviewing and focus group discussion methods. The analysis of qualitative data was performed using conventional content analysis with MAXQDA10 software. Results Reported barriers of dental service utilization among pregnant women were categorized under emerging themes: Lack of knowledge and misbelief, cost of dental care, physiological changes, fear and other psychological conditions, time constraint, dentists’ unwillingness to accept pregnant women treatment, cultural taboos and lack of interprofessional collaboration. Solutions proposed by dentists, midwives and pregnant women to improve dental care utilization during pregnancy were categorized under three themes: Provision of knowledge, financial support and establishing supportive policies. Conclusions Understanding perceived barriers of dental service utilization during pregnancy can serve as baseline information for planning and formulating appropriate oral health education, financial support, and legislations tailored for lower income pregnant women, midwives and dentists in countries with developing oral health care system.

Objectives Limited information exists on the extent oral health is addressed in the context of prenatal care. This study sought to investigate characteristics of primary care physicians (PCP) who provide oral health counseling to pregnant women. Methods The study relied upon data from the 2013 Survey of PCP on Oral Health. Provision of oral health counseling to pregnant women (sometimes vs. rarely/never) was the primary outcome. Covariates included respondents’ demographic and practice characteristics, oral health-related training, knowledge, attitudes, preparedness and clinical behaviors. The analytical strategy included bivariate tests and multivariable Poisson regression modeling, accounting for the survey design; inference was based upon marginal effects estimation. Results Two-thirds of PCP (233 out of 366 respondents) reported providing oral health counseling to pregnant women. In bivariate comparisons, female PCP, PCP with oral health-specific instruction during medical training, favorable oral health-related attitudes, behaviors, preparedness, and knowledge were more likely to provide counseling (p

OBJECTIVES To evaluate characteristics of pregnant women served through the University of North Carolina's (UNC) prenatal oral health program (pOHP) dental clinic and community healthcare pathways to inform efforts in promoting prenatal oral health policies. METHODS The pOHP provides medical and dental students and practitioners with interprofessional experiences caring for pregnant women. A retrospective chart audit captured 314 pregnant women who made appointments over 33 months. Descriptive statistics and bivariate comparisons were computed to assess factors associated with dental appointment attendance and treatment completion. RESULTS There were 564 pregnant women, with mean age of 29 years and gestation of 25 weeks, referred to the pOHP dental clinic from UNC OB-GYN and 20 community sites. Only 56% (N = 314) scheduled an appointment. Of the 314 appointed women, 55% (N = 172) attended at least one appointment. The majority (87%) presented with acute and/or complex treatment needs. Medicaid status was positively associated with appointment attendance (P = 0.001). Less than half (42%) of the women completed treatment prior to delivery. Mean maternal age, gestational age, and weeks to estimated date of delivery (EDD) were not significantly associated with completed treatment. CONCLUSIONS This study provides descriptive evidence of an academic, interprofessional program's ability to provide safety-net dental care to pregnant women in the state of North Carolina. Results underscore the need for dental services among pregnant women, signaling for promotion of prenatal oral health clinical standards and informing policy on the state and national levels to maximize dental coverage.

Summary We examined the extent to which three predictors of children's recall, selected on the basis of their theoretical significance, contributed to the prediction of children's recall for the details of dental operative procedures in a diverse sample of 28 children (54–140 months of age). Parents provided information regarding their children's dental histories and preparation for the dental visit. We obtained behavioral indices of stress from video recordings of the procedures and interviewed the children shortly after treatment to assess their memory. In a significant model predicting open-ended recall, measures of prior dental experience and parent discussion emerged as unique predictors, although stress did not add to the prediction. The results attest to the importance of incorporating measures of individual differences in investigations of children's reports of their personal experiences. We discuss the importance of children's interpretations in understanding memory for stressful events.Copyright © 2015 John Wiley & Sons, Ltd.

Objectives Maternal oral disease during pregnancy is a significant public health issue due to its prevalence and lifecourse connections with adverse pregnancy/birth outcomes, early childhood caries, and chronic diseases. Although both medical and dental professional organizations have discipline-specific and co-endorsed guidelines, whether interventions exist that translate oral health evidence into practice remains unknown. Thus, we conducted a systematic review to examine the range, scope and impact of existing oral health promotion interventions during pregnancy. Methods Search terms related to oral health, health promotion, and pregnancy produced 7754 articles published before March 2013 from five search engines. Inclusion criteria: (i) intervention-based; (ii) quasi-experimental, experimental, or pretest/post-test design; (iii) pregnant women participants; (iv) outcomes including oral health knowledge, attitudes, and/or behaviors; (v) ≥5 participants; (vi) peer-review publication; and (vii) English language. Results All interventions (n = 7) were delivered in prenatal care settings and focused on education. Modalities varied, including the use of oral instruction and audiovisual presentations, in both individual and group formats; however, content was directed toward infant oral health. Few studies specifically addressed prenatal oral health guidelines. Primary outcomes measured included knowledge, beliefs, attitudes, self-efficacy and oral hygiene, and health-seeking behaviors. All but one study showed significant improvement in one of these outcomes postintervention. Conclusions Few oral health interventions among pregnant women addressed oral-related symptoms, hygiene behaviors, and potential oral–systemic implications specific to mothers. Subsequently, more theory- and evidence-based interventions addressing current prenatal oral health guidelines using rigorous designs are needed to improve oral and systemic health for both women and their offspring.

Interprofessional collaboration has become a critical component of accreditation standards in dentistry and medicine. This article reports on implementation in an academic setting of a prenatal oral health program (pOHP) that addresses coordinated care, accreditation standards, and new clinical practice guidelines. The pOHP is an educational intervention for third-year medical students, residents, and faculty members to deliver preventive oral health information and referral to a dental home for pregnant women. At the same time, senior dental students and faculty members are introduced to prenatal oral health principles and delivery of comprehensive oral health care to pregnant women. A systems-based approach was used to guide the pOHP implementation during the 2012-13 academic year. Participants were 96 third-year medical students (50% of the total in an obstetrics and gynecology clerkship) and all 81 fourth-year dental students. During that academic year, 126 dental referrals were made to the School of Dentistry, and 55 women presented for care, resulting in 50% (n=40) of dental students participating in the clinical experience and delivery of simple to complex oral health procedures. The prenatal period is a frequently missed opportunity to address oral health care. The pOHP is an interprofessional collaboration model designed to educate dental and medical providers and provide a system of referral for comprehensive clinical care of pregnant patients, including educating women about their oral health and that of their children. Such programs can help meet interprofessional accreditation standards and encourage implementation of practice guidelines.

To examine the Baby Oral Health Program's (bOHP) influence on dental visits for children 0 to 3 years and overall dental visits in four federally qualified health center (FQHC) clinics.Using an interrupted time series study design, administrative data were obtained for the year prior and following the intervention. The intervention included dental staff training on early childhood oral health, quality improvement, and monthly visits during the follow-up intervention period. Analysis included descriptive and segmented regression using aggregate patient visit data.A total of 10,400 patients made 26,416 visits over the study period; 1,187 (11 percent) were children ≤3 years. Visit counts in the youngest age group increased 70 percent following the intervention. When controlling for the naturally increasing trend, the intervention added 8.7 (95 percent CI: 4.7, 12.8) early childhood patient-visits per clinic in the last month of the intervention period. The increase in visit counts in the youngest age group had no significant effect on other ages, except for a decline relative to the natural trend in patient-visits among 35-50 year olds (-32.3 less visits) following the intervention. The proportion of visits for all ages by ≤3 year olds increased from 5 to 8 percent following the intervention.bOHP increased dental visits among children ≤3 years but the finding might be attributable to clinic changes coinciding with bOHP implementation that were not controlled with the study design. Additional studies are needed in populations experiencing challenges accessing dental care.

The aim of this study was to examine the influence of the Prenatal Oral Health Program (pOHP) at the University of North Carolina at Chapel Hill on medical students' oral health-related knowledge, confidence, attitudes, and dental referral practices. Specifically, the study sought to determine these students' ability to screen, counsel, and refer their patients to a dental home and their overall knowledge regarding the safety of dental treatment for pregnant patients. The study used a pre- and post-intervention survey design with intervention and control groups. Third-year medical students enrolled in an obstetrics and gynecology clerkship were surveyed between 2012 and 2014. The questionnaire assessed students' confidence and behaviors related to prenatal oral health counseling, screening, referral to a dental home, and knowledge about treatment safety during pregnancy. Intervention and control groups were determined by clerkship site. The intervention consisted of a 50-minute seminar on prenatal oral health principles, referral guidelines, and clinical systems changes. A total of 53 intervention and 32 control group students participated (57.4% response rate). The two groups were not significantly different at baseline in age, gender, having children, and residency goals. The results showed that the pOHP positively and significantly influenced students in the intervention group on all clinical constructs except their knowledge about treatment safety during pregnancy. Clinically examining a woman's mouth for signs of dental disease resulted in greater likelihood of making referrals by 26.5 times. These findings suggest that implementing prenatal oral health in a multi-method manner can effectively promote interdisciplinary coordinated care, meet interprofessional education accreditation standards, and aid in implementing practice guidelines in medical school curricula.

Oral health is an integral part of the overall health of children. Dental caries is a common and chronic disease process with significant short- and long-term consequences. The prevalence of dental caries for the youngest of children has not decreased over the past decade, despite improvements for older children. As health care professionals responsible for the overall health of children, pediatricians frequently confront morbidity associated with dental caries. Because the youngest children visit the pediatrician more often than they visit the dentist, it is important that pediatricians be knowledgeable about the disease process of dental caries, prevention of the disease, and interventions available to the pediatrician and the family to maintain and restore health.

Article Title and Bibliographic Information Can child temperament be related to ECC? Aminabadi NA, Ghoreishizadeh A, Ghoreishizadeh M, Oskouei SG, Ghojazadeh M. Caries Res 2014;48:3-12. Reviewers Robert G. Santos, BA, MA, PhD, Rocio Quinonez, BA, DMD, MS, MPH Purpose/Question To investigate the relationship of ECC and different traits of child temperament, directly and indirectly through nutritional and oral hygiene habits. Source of Funding Tabriz University of Medical Sciences Type of Study/Design Cross-sectional study Level of Evidence Level 2: Limited-quality, patient-oriented evidence Strength of Recommendation Grade Not applicable

The purpose of this study was to evaluate the knowledge, comfort, practice behaviors, and perceived barriers of dental hygienists in North Carolina regarding their delivery of oral health preventive services to infants and toddlers. A questionnaire was mailed to 2,000 dental hygienists randomly selected from the North Carolina Board of Dental Examiners database. The response rate was 43 percent. The majority of the respondents were female and worked in private practice. Forty-two percent reported that they delivered preventive care to infants/toddlers (action stage of readiness). Of the 58 percent who reported not delivering care, two-thirds were contemplating caring for this population (contemplation stage), but only 10 percent of these were very likely to make changes in the next six months. Those with higher comfort levels and fewer perceived practice constraints were more likely to be in the action stage. Although these dental hygienists may be willing to consider providing care, they perceived a lack of continuing education opportunities, unfamiliarity with pediatric guidelines, and their current practice situation as significant barriers. Strategies to increase comfort and diminish practice constraints for North Carolina dental hygienists should be considered to improve access to oral health care for infants and toddlers. Teaching strategies in dental hygiene education that include both didactic and clinical experiences in treating infants and toddlers could be beneficial.

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

National Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly onefourth of children and over one-half of adolescents experienced dental caries in their permanent teeth. The purpose of this review was to summarize the available clinical evidence regarding the effect of dental sealants for the prevention and management of pit-and-fissure occlusal carious lesions in primary and permanent molars, compared with a control without sealants, with fluoride varnishes, or with other head-to head comparisons.The authors included parallel and split-mouth randomized controlled trials that included at least 2 years of follow-up, which they identified using MEDLINE (via PubMed), Embase, LILACS, the Cochrane Central Register of Controlled Trials, and registers of ongoing trials. Pairs of reviewers independently conducted the selection of studies, data extraction, risk of bias assessments, and quality of the evidence assessments by using the Grading of Recommendations Assessment, Development and Evaluation approach.Of 2,869 records screened, the authors determined that 24 articles (representing 23 studies) proved eligible. Moderate-quality evidence suggested that participants who received sealants had a reduced risk of developing carious lesions in occlusal surfaces of permanent molars compared with those who did not receive sealants (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.08-0.27) after 7 or more years of follow-up. When the authors compared studies whose investigators had compared sealants with fluoride varnishes, they found that sealants reduced the incidence of carious lesions after 7 or more years of follow-up (OR, 0.19; 95% CI, 0.07-0.51); however, this finding was supported by low-quality evidence. On the basis of the evidence, the authors could not provide a hierarchy of effectiveness among the studies whose investigators had conducted head-to-head comparisons. The investigators of 2 trials provided information about adverse events, but they did not report any adverse events.Available evidence suggests that sealants are effective and safe to prevent or arrest the progression of noncavitated carious lesions compared with a control without sealants or fluoride varnishes. Further research is needed to provide information about the relative merits of the different types of sealant materials.