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Exploring dental students' attitudes toward patient-centered management of dental fear

Daly, Kelly A; Heyman, Richard E; Shuster, Michelle; Smith Slep, Amy M; Wolff, Mark S
PURPOSE/OBJECTIVES/OBJECTIVE:A patient-centered care (PCC) paradigm undergirds modern dental education. PCC is particularly relevant in the management of patient dental fear. The aims of this study were three-fold: (a) to examine the preliminary psychometric properties of an author-designed survey administered to explore dental fear knowledge and perceptions, (b) to assess how 4th-year dental students regard dental fear, (c) and to investigate the relationship between students' knowledge and perceptions of dental fear and their clinical behavior. METHODS:In 2022, 4th-year dental students (N = 453) participated in a cross-sectional study. Participants completed a 16-item survey that assessed (a) knowledge and perceptions about dental fear, (b) common biases in patient fear assessment, and (c) patient management behaviors when fear is encountered. Exploratory factor analysis, descriptive statistics, and logistic regressions were run to address the study's aims. RESULTS:Exploratory factor analysis revealed three factors, with the two strongest factors pertaining to beliefs about the importance of dental fear (α = 0.87) and self-efficacy in managing fear (α = 0.74). Participants indicated that it is important to assess for dental fear and rated their self-efficacy in ability managing it as high. Ratings on both factors slightly increased the odds of engaging in routine patient screening for dental fear. Students also displayed assessment biases commonly seen among practicing dentists. CONCLUSION(S)/CONCLUSIONS:Results indicate educational gaps within the current behavioral-science training for dental students. Changes to improve advanced dental students' appreciation of their patients' dental fear are warranted.
PMID: 37920097
ISSN: 1930-7837
CID: 5625572

Leveraging technology to increase the disseminability of evidence-based treatment of dental fear: An uncontrolled pilot study

Heyman, Richard E; Daly, Kelly A; Slep, Amy M Smith; Wolff, Mark S
OBJECTIVES/OBJECTIVE:U.S. and global estimates indicate that over 30% of adults fear receiving dental care, including over 20% who have visited a dentist in the last year, leading to avoidance and degraded oral and systemic health. Although evidence-based cognitive-behavioral treatments for dental fear (CBT-DF) exist, they have little impact on the millions who seek dental care annually because they are not disseminable (6 h of in-chair time, delivered only in person at a few sites). We developed a disseminable CBT-DF stepped-care treatment comprising (Step 1) a mobile-health application and, for those who remain fearful, (Step 2) a 1-h, one-on-one psychological treatment session that allows practice during exposure to the patient's most-feared stimuli. We hypothesized that the treatment would (a) be rated highly on usability and credibility and (b) result in clinically consequential (i.e., lowering fear into the 0-3 "no/low fear" zone) and statistically significant changes in global dental fear. METHOD/METHODS:Racially/ethnically diverse patients (N = 48) with moderate to severe dental fear were recruited; all completed Step 1, and n = 16 completed Step 2. RESULTS:As hypothesized, users found the stepped-care treatment highly usable, credible, and helpful. Critically, this stepped-care approach produced reductions in patients' dental fear that were both clinically consequential (with half no longer fearful) and statistically significant (d = 1.11). CONCLUSIONS:This usable, credible, stepped-care approach to dental fear treatment holds promise for liberating evidence-based CBT-DF from specialty clinics, allowing broad dissemination.
PMID: 38114444
ISSN: 1752-7325
CID: 5611742

Exploring dental students"™ attitudes toward patient-centered management of dental fear

Daly, Kelly A.; Heyman, Richard E.; Shuster, Michelle; Smith Slep, Amy M.; Wolff, Mark S.
Purpose/Objectives: A patient-centered care (PCC) paradigm undergirds modern dental education. PCC is particularly relevant in the management of patient dental fear. The aims of this study were three-fold: (a) to examine the preliminary psychometric properties of an author-designed survey administered to explore dental fear knowledge and perceptions, (b) to assess how 4th-year dental students regard dental fear, (c) and to investigate the relationship between students' knowledge and perceptions of dental fear and their clinical behavior. Methods: In 2022, 4th-year dental students (N = 453) participated in a cross-sectional study. Participants completed a 16-item survey that assessed (a) knowledge and perceptions about dental fear, (b) common biases in patient fear assessment, and (c) patient management behaviors when fear is encountered. Exploratory factor analysis, descriptive statistics, and logistic regressions were run to address the study's aims. Results: Exploratory factor analysis revealed three factors, with the two strongest factors pertaining to beliefs about the importance of dental fear (α = 0.87) and self-efficacy in managing fear (α = 0.74). Participants indicated that it is important to assess for dental fear and rated their self-efficacy in ability managing it as high. Ratings on both factors slightly increased the odds of engaging in routine patient screening for dental fear. Students also displayed assessment biases commonly seen among practicing dentists. Conclusion(s): Results indicate educational gaps within the current behavioral-science training for dental students. Changes to improve advanced dental students"™ appreciation of their patients"™ dental fear are warranted.
SCOPUS:85175718556
ISSN: 0022-0337
CID: 5616352

Diagnosis of Biofilm-Associated Peri-Implant Disease Using a Fluorescence-Based Approach

Hwang, Geelsu; Blatz, Markus B; Wolff, Mark S; Steier, Liviu
Dental implants have become a routine component of daily dental practice and the demand for dental implants is expected to increase significantly in the future. Despite the high success rates of dental implants, failures do occur, resulting in discomfort, rampant destruction of the oral health, or painful and costly surgical replacement of a failed implant. Peri-implant diseases are inflammatory conditions affecting the soft/hard tissues surrounding a functional dental implant. Plenty of experimental evidence indicates that the accumulation of dental plaque at the soft tissue-implant interface and the subsequent local inflammatory response seems to be key in the pathogenesis of the peri-implant mucositis. Such peri-implant-soft tissue interface is less effective than natural teeth in resisting bacterial invasion, enhancing vulnerability to subsequent peri-implant disease. Furthermore, in certain individuals, it will progress to peri-implantitis, resulting in alveolar bone loss and implant failure. Although early diagnosis and accurate identification of risk factors are extremely important to effectively prevent peri-implant diseases, current systematic reviews revealed that a uniform classification and diagnostic methodology for peri-implantitis are lacking. Recent progress on fluorescence-based technology enabled rapid diagnosis of the disease and effective removal of plaques. Here, we briefly review biofilm-associated peri-implant diseases and propose a fluorescence-based approach for more accurate and objective diagnoses. A fluorescence-based diagnosis tool through headlights combined with special-filtered dental loupes may serve as a hands-free solution for both precise diagnosis and effective removal of plaque-biofilms.
PMCID:7996852
PMID: 33673438
ISSN: 2304-6767
CID: 4823342

Patient aggression toward dentists

Rhoades, Kimberly A; Heyman, Richard E; Eddy, J Mark; Haydt, Nicole C; Glazman, Jacqueline E; Dispirito, Zachary F; Fat, Sammie Jo; Guerrera, Charlotte M; Rascon, Allison N; Wolff, Mark S
BACKGROUND:Workplace violence toward health care professionals is both widespread and widely overlooked. Only 4 studies of aggression toward dentists have been published-none in the United States-with the prevalence of aggression ranging from 29% through 80%. The purpose of this study was to provide an initial estimate of rates of patient aggression in dental practices in the United States. METHODS:The authors surveyed 98 dentists recruited from the faculty and alumni network of a college of dentistry. Participants completed a confidential online survey assessing whether they had experienced any of 21 specific types of aggressive behaviors from their patients. RESULTS:Past-year aggression prevalence was 22.2%, 55.0%, and 44.4% for physical, verbal, and reputational aggression, respectively. Career prevalence was 45.5%, 74.0%, and 68.7% for physical, verbal, and reputational aggression, respectively. Rates did not differ by sex, race, ethnicity, specialty, age, years practicing, or average number of patients treated per day. CONCLUSIONS:Participants reported levels of physical, verbal, and reputational aggression at rates comparable with those of other health care professionals in the United States and abroad. Additional research with larger representative samples of dentists in the United States is necessary to confirm these prevalence estimates. Future research should also investigate predictors and outcomes of patient aggression and prevention and intervention strategies. PRACTICAL IMPLICATIONS/CONCLUSIONS:Substantial rates of patient aggression highlight the need to address this problem in dental practices. The authors discuss implications for the dental profession, including proactive steps that could be taken to reduce patient aggression in dental offices.
PMID: 32979955
ISSN: 1943-4723
CID: 5309892

Perspectives on meeting the COVID-19 testing challenge: A dental school collaborative

Donoff, R. Bruce; Poznansky, Mark; Kochman, David; Lieberthal, Bruce; Bhansali, Seema; Neale, Allison; Bryant, Daniel; Glickman, Robert; Moursi, Amr; Feldman, Cecile A.; Fine, Daniel; Kess, Steve; Alfano, Michael C.; Levy, Ari; Ismail, Amid; Rams, Thomas; Reddy, Michael; Gansky, Stuart; Ramneek, Rai; McCauley, Laurie K.; Eber, Robert; Wolff, Mark; Krumholz, Harlan
SCOPUS:85090117865
ISSN: 0022-0337
CID: 4612212

Patient aggression toward dental students

Rhoades, Kimberly A; Heyman, Richard E; Eddy, J Mark; Fat, Sammie Jo; Haydt, Nicole C; Glazman, Jacqueline E; Dispirito, Zachary F; Rascon, Allison N; Guerrera, Charlotte M; Wolff, Mark S
Aggression from patients is one of the risks faced by healthcare workers during a typical work week. This risk begins during training. Although rates of patient aggression have been estimated for nursing students and medical residents, studies of aggression toward dental students have not been conducted. To begin to address this knowledge gap, we surveyed 160 D.D.S. student dentists in their third- or fourth years who were attending a large urban college of dentistry during the 2018-2019 academic year. Each class had approximately 375 students, leading to a response rate of 21%. Approximately 28% of students reported experiencing at least 1 instance of physical aggression, 86% reported experiencing at least 1 instance of verbal aggression, and 36% reported experiencing at least 1 instance of reputational aggression. There were no differences in rates of experienced aggression by age or gender, but Hispanic or Latinx students were more likely to experience physical and reputational aggression than non-Hispanic White or Asian students. We discuss implications for dental education, including modifications to training clinic procedures and curriculum additions or modifications that may help prepare students to prevent and address patient aggression within the dental clinic environment.
PMID: 32022267
ISSN: 1930-7837
CID: 4301072

Comorbid conditions are a risk for osteonecrosis of the jaw unrelated to antiresorptive therapy

Fleisher, Kenneth E; Janal, Malvin N; Albstein, Nicole; Young, James; Bikhazi, Vanessa; Schwalb, Shlomit; Wolff, Mark; Glickman, Robert S
OBJECTIVE:is associated with one or more particular comorbidities. STUDY DESIGN/METHODS:or DH lesion to a control patient who had a history of dentoalveolar surgery with uneventful healing and no history of antiresorptive therapy. Comorbidity data included medical conditions and smoking. RESULTS:and DH than in controls [M(SD) = 1.94 (1.2) and 2.0 (1.3) vs 1.26 (0.89); both P < .001]. CONCLUSIONS:and DH.
PMID: 30449690
ISSN: 2212-4411
CID: 3479252

Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association

Slayton, Rebecca L; Urquhart, Olivia; Araujo, Marcelo W B; Fontana, Margherita; Guzmán-Armstrong, Sandra; Nascimento, Marcelle M; Nový, Brian B; Tinanoff, Norman; Weyant, Robert J; Wolff, Mark S; Young, Douglas A; Zero, Domenick T; Tampi, Malavika P; Pilcher, Lauren; Banfield, Laura; Carrasco-Labra, Alonso
BACKGROUND:An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated evidence-based clinical recommendations for the arrest or reversal of noncavitated and cavitated dental caries using nonrestorative treatments in children and adults. TYPES OF STUDIES REVIEWED/METHODS:The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane database of systematic reviews to identify randomized controlled trials reporting on nonrestorative treatments for noncavitated and cavitated carious lesions. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and move from the evidence to the decisions. RESULTS:The expert panel formulated 11 clinical recommendations, each specific to lesion type, tooth surface, and dentition. Of the most effective interventions, the panel provided recommendations for the use of 38% silver diamine fluoride, sealants, 5% sodium fluoride varnish, 1.23% acidulated phosphate fluoride gel, and 5,000 parts per million fluoride (1.1% sodium fluoride) toothpaste or gel, among others. The panel also provided a recommendation against the use of 10% casein phosphopeptide-amorphous calcium phosphate. CONCLUSIONS AND PRACTICAL IMPLICATIONS/UNASSIGNED:Although the recommended interventions are often used for caries prevention, or in conjunction with restorative treatment options, these approaches have shown to be effective in arresting or reversing carious lesions. Clinicians are encouraged to prioritize use of these interventions based on effectiveness, safety, and feasibility.
PMID: 30261951
ISSN: 1943-4723
CID: 3333342

Dentists: Critical aspects of their own and their community's disaster preparedness plan

Glotzer, David L; Perelman, Sharon C; Wolff, Mark S
The weather-related disasters in 2017 in Texas, Florida, Puerto Rico, the 2017-2018 wildfire seasons in California and Hurricanes Florence and Michael in 2018 have challenged all healthcare professionals, to have plans in place to protect their facility, patients, and staff from all possible hazards. These were "slowly developing" events, with enormous media coverage, and yet the results were still horrific. The need to have both a good evacuation plan and a good shelter-in-place plan has previously been dramatically demonstrated. When planning for disasters, it is critical for healthcare providers to understand the nature of a particular event and its possible consequences. When the concern arises about either an individual medical facility, or a whole community's well-being, a proper response requires significant levels of preparedness, education, and training. Comprehension of the threat and an understanding of the resources available to combat an event can significantly mitigate the possible damage. This article reviews a dental school curriculum to prepare students to respond to such contingencies while describing the goals, and sources for a disaster preparedness syllabus.
PMID: 30821342
ISSN: 1932-149x
CID: 3699022