Dental education and dentists' attitudes and behavior concerning patients with autism

The number of patients diagnosed with autism spectrum disorders (ASD) in the United States has increased significantly. The objectives of this study were to explore general and pediatric dentists' professional attitudes and behavior towards patients with ASD; these dentists' perceptions of their dental education about these issues; and the relationships among their educational experiences, attitudes, and behaviors concerning patients with ASD. Survey data were collected from 162 general dentists in Michigan and 212 pediatric dentists across the United States. The results showed that 89 percent of pediatric dentists and 32 percent of general dentists treat patients with ASD. The respondents disagreed with statements indicating that their predoctoral dental education had prepared them well to treat patients with ASD. However, the better they felt prepared, the more likely they were to provide care for these patients. The frequency with which pediatric dentists said they use appropriate behavior management strategies when treating patients with ASD correlated with the quality of their educational experiences. In conclusion, given the growing number of patients with ASD, it is important to revisit dental education efforts targeted towards preparing future dental care providers for the treatment of patients with ASD and special needs.     

Access to dental care for children in the United States: a survey of general practitioners

BACKGROUND: In response to concern that inadequate dental school training may create a barrier to access to care for children, the authors conducted a survey concerning general practitioners' practice patterns involving child patients. METHODS: The authors requested a list of 4,970 randomly chosen general practitioners from the American Dental Association Survey Center. They then sent those dentists a written survey asking whether and in what numbers they treat children; the ages and caries levels of any children they do treat; their perceptions of their educational experiences in pediatric dentistry, and their perceived needs for continuing education in pediatric dentistry. They analyzed data using chi2. RESULTS: Ninety-one percent of the general dentists surveyed treated children, but those younger than 4 years of age, with high levels of caries, and whose care is funded by Medicaid were represented in very low numbers. The types of patients treated and procedures performed by the respondents were significantly (P < or = .05) associated with the intensity of the respondents' educational experiences, except for the number and types of Medicaid patients they treated. CONCLUSIONS: These data indicate that the vast majority of general practitioners treat children in their practices, but there still are groups of children for whom access to dental care is a problem. PRACTICE IMPLICATIONS: Very young children, children with high levels of caries and Medicaid-covered children have difficulty finding dental care in the general practice community.     

General dentists and special needs patients: does dental education matter?

Special needs patients are one of the underserved dental patient groups in the United States. This study investigates whether undergraduate dental education about special needs patients affects general dentists' a) professional behavior, b) practice characteristics, and c) attitudes concerning special needs patients. Data were collected from 208 general dentists (178 male/30 female; average age: 49.85 years) who were members of the Michigan Dental Association. The more the respondents agreed that dental education had prepared them well, the more likely they were to treat various types of special needs patients and to set up their practices so they could treat them and the more they liked treating these patients. In conclusion, most general dentists did not think their undergraduate dental education had prepared them well to treat special needs patients. However, the better they reported to have been educated, the more likely they were to treat special needs patients. Given the access to care problems for many special needs patients, it seems crucial to revise dental curricula and provide more didactic and clinical education concerning the treatment of special needs patients.     

Medicaid patients in dental school clinics: do personal and professional experiences matter?

The purpose of this study was to explore dental and dental hygiene students' and faculty members' personal experiences with Medicaid prior to coming to dental school as well as their professional/educational experiences with patients on Medicaid during their dental/dental hygiene education and how these experiences relate to their professional attitudes and behavior concerning treating patients on Medicaid. Survey data were collected from 317 dental students, fifty-five dental hygiene students, and fifty-seven clinical faculty members at the University of Michigan. The results showed that while responding students' confidence concerning treating Medicaid patients increased over the course of their education, their intention to treat these patients actually decreased. The more personal experiences with Medicaid these students had before dental school, the more they enjoyed treating Medicaid patients, the more confident they were when treating these patients, and the more likely they were to treat these patients in the future. The more professional experiences these students had during dental school, the more they enjoyed treating Medicaid patients, and the more confident they were when treating these patients, but the less likely they were to treat them in the future. In conclusion, experiences with Medicaid before dental school as well as professional experiences during dental education correlated with later professional attitudes and behaviors. The implications of these findings for dental education are explored.     

Child abuse and neglect: dental and dental hygiene students' educational experiences and knowledge

The objective of this study was to explore dental and dental hygiene students' educational experiences and knowledge concerning child abuse/neglect. Questionnaire data were collected from 233 dental (116 male/117 female; response rate=54.82 percent) and seventy-six dental hygiene students (all female; response rate=76.77 percent). Of those surveyed, 94.7 percent of the dental hygiene and 70.5 percent of the dental students reported having learned about child abuse/neglect in classroom settings, and 15.8 percent of the dental hygiene and 29.3 percent of the dental students reported having learned about it in clinical settings. Dental students reported more minutes of instruction about this topic than dental hygiene students (184.48 vs. 112.90 minutes; p=.006). Only 5.5 percent of the dental and 16.7 percent of the dental hygiene students defined child abuse correctly; 32.2 percent of the dental and 13.2 percent of the dental hygiene students did not know their legal responsibility concerning reporting child abuse; and 82.4 percent of the dental and 78.9 percent of the dental hygiene students did not know where to report child abuse. Dental care providers are likely to encounter child abuse and neglect in their professional lives and are legally required to respond to these matters. Dental and dental hygiene curricula should be revisited to ensure that students are adequately prepared for this professional task.     

Treating patients with herpes simplex virus infections: dental and dental hygiene students' knowledge, attitudes, and professional behavior

Dental and dental hygiene students frequently interact with patients with herpes simplex virus (HSV) infections, often simply referred to as cold sores. The objectives of this study were to assess dental and dental hygiene students' knowledge, attitudes, and professional behavior concerning the treatment of patients with HSV infections and to investigate the relationships among knowledge, attitudes, and professional behavior. Questionnaire data were collected from 337 dental and seventy-three dental hygiene students at regularly scheduled classes. Dental and dental hygiene students did not differ in their overall knowledge concerning HSV infections. Dental hygiene students were more apprehensive about treating patients with these infections, but used more appropriate professional behavior compared to dental students. Dental students' knowledge and appropriateness of professional behavior increased over the course of their education. Overall, it was found that an increase in student knowledge was associated with increased apprehension related to treating these patients. However, the more apprehensive they were, the more they engaged in appropriate professional behavior. Educating future health care providers about the treatment of patients with infectious and communicable diseases can potentially increase the students' apprehension/negative attitudes concerning providing care, while at the same time increasing appropriate professional behavior during their education. Addressing students' apprehensions might be a crucial moderator that will determine whether they will provide the best possible care for these patients in their future professional lives.     

Dental education and care for underserved patients: an analysis of students' intentions and alumni behavior

The U.S. surgeon general's report on oral health stressed the importance of providing dental care to underserved patients. The objectives of this study were to explore a) dental students' intentions and dentists' behavior concerning treating underserved patients, b) their perceptions of their education concerning these patients, and c) the relationship between dental education and their attitudes and behavior. Data were collected from 328 dental students (response rate: 77.5 percent) and 234 alumni (response rate: 43.7 percent). Only 67.4 percent of the students and 38 percent of the alumni indicated that their education had prepared them well to treat patients from different socioeconomic backgrounds; 71.3 percent of students and 55.2 percent of alumni responded that they had been well educated to treat patients from different ethnic/racial groups. The findings showed a positive relationship between the degree of curriculum focus on the importance of treating patients from all aspects of society and students' and alumni intentions to provide inclusive patient care to patients from diverse backgrounds. The more students agreed that their dental education had prepared them well to treat patients from different ethnic backgrounds, the more likely they were to report that they intended to treat these patients (r=.12; p=.033). In a similar manner, the more the alumni agreed that their dental education had prepared them well to treat patients in different communities, the more likely they were to treat patients from different socioeconomic backgrounds (r=.18; p=.009). In conclusion, these findings showed that access to oral health care for underserved patients could potentially be increased if dental students were more overtly educated about the importance of treating patients from all segments of society.     

Issues in the dental care management of patients with bloodborne infectious diseases: an opinion survey of dental school seniors

This study revealed some significant findings concerning the views of dental school seniors. Through a series of questions, we determined the opinions that seniors had about treating patients with bloodborne infections and the way they regarded their professional responsibility to provide care to these patients. We were able to identify that the majority of seniors had knowingly treated patients with one of these diseases, and believed that they had a professional obligation to do so. The study showed that these future professionals were aware of the risks related to disease transmission and they had real concerns about those risks; nevertheless, they were prepared to accept their professional obligation to provide care to these individuals. More than half of the survey population was fearful of treating patients with these diseases, and over half indicated that they would not treat these patients given the choice. This fear was compounded by their presumption that other patients would not want to be treated by a dentist who provides care to HBV/HIV patients, and by the presumption of increased cost of infection control. More than three fourths of these dental seniors agreed that treatment of infected patients would place them at higher risk. Nevertheless, in the face of this perceived danger, 62 percent indicated that they were willing to treat these patients, 79 percent said that they were capable of treating them, and 76 percent acknowledged the responsibility of the profession to treat. Another finding of note involves the treatment of infected patients and the effect that treatment experience had on the seniors' attitudes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ohio dental care providers' treatment of young children, 2002

BACKGROUND: Adequate access to dental care for young children--particularly those from low-income families--is a public concern. The authors conducted a survey of Ohio dental care providers to examine factors influencing their willingness to care for these children. METHODS: Random samples of Ohio general practitioner (GPs) dentists and pediatric dentists (PDs) and all Ohio safety-net dental clinics completed a mail survey regarding treatment of children aged 0 through 5 years. The authors categorized responses by provider type and further analyzed GPs' responses by years since graduation and geographic character. RESULTS: Few Ohio GPs (8 percent) recommended a first dental visit by 1 year of age. While 91 percent of GPs treated children aged 3 through 5 years, only 34 percent treated children aged 0 through 2 years, most often for emergency visits or examinations. Only 7 percent of all GPs and 29 percent of PDs accepted patients enrolled in Medicaid without limitations. CONCLUSIONS: Children's being young (0-2 years of age) and having Medicaid as a payment source made GPs substantially less likely to treat them. Children's being enrolled in Head Start made GPs somewhat more likely to treat them. PRACTICE IMPLICATIONS: New strategies for ensuring dental care access for young children from low-income families are necessary. Such strategies may take the form of interpeer advocacy, education, practice incentives or creation of coordinated GP and PD teams.     

Special Needs Dentistry: perception,attitudes and educational experience of Malaysian dental students

A compromised oral health condition amongst patients with special health care needs (SHCN) has been associated with the reluctance and shortage of skills of dental professionals in managing such patients. Lack of training and experience at the undergraduate level are reported barriers to the provision of care for this patient cohort. Undergraduate education therefore, plays an important role in producing professionals with the knowledge, skills and positive attitude in treating patients with SHCN. This study aims to determine the level of knowledge, comfort and attitudes of Malaysian undergraduate dental students towards caring for patients with SHCN, as well as their perception on education in this field. A self‐administered questionnaire was administered in the classroom style to final year undergraduate dental students in Malaysian public dental schools. Most students were aware of Special Needs Dentistry (SND) as a specialty after being informed by academic staff. The majority of the students demonstrated poor knowledge in defining SND and felt uncomfortable providing care for such patients. They perceived their undergraduate training in SND as inadequate with most students agreeing that they should receive didactic and clinical training at undergraduate level. A high percentage of students also expressed interest in pursuing postgraduate education in this area of dentistry despite the lack of educational exposure during undergraduate years. The study supports a need for educational reform to formulate a curriculum that is more patient‐centred, with earlier clinical exposure in various clinical settings for students to treat patients with special health care needs, applying the concept of holistic care in a variable clinical condition.     

A survey of senior dental students' experiences with young dental patients in Pennsylvania

The purpose of this study was to determine graduating dental students' perceptions about their training and experience in examination and treatment of infants and their plans to examine infants upon graduation. A survey was distributed to dental students graduating from Pennsylvania dental schools in 2007 and 2008. Of the returned surveys, 47.9 percent correctly identified 12 months as the recommended age for the first dental exam. Sixty-five percent of responders felt they would be comfortable performing exams on young children. This study's primary objective was to test the association between performance of a clinical exam in a young child, enjoyment of clinical and didactic pediatric dental experience, plans for additional training in pediatric dentistry and willingness to see children younger than two years old in practice. Performing a clinical exam on a young child was associated to willingness to see children younger than two years of age in practice. Early exposure (lecture or clinical) to young pediatric patients while in dental school was significantly associated to perceived comfort with oral exam of young patients but not to reported willingness to see them in practice.     

Effectiveness of local anesthesia in pediatric dental practice

BACKGROUND: Pain control in dental treatment for children is very important. The purpose of this study is to describe the characteristics of local anesthetic use by pediatric dentists and to examine factors related to its effectiveness in children. METHODS: The authors observed 361 patients in 17 pediatric dental practices in Washington state while each child received restorative or surgical dental treatment. The authors recorded data concerning local anesthetic use and effectiveness. The children's mean age was 87 months, and 181 (50.1 percent) of the patients were girls. A pediatric dentist observer rated each child's anxiety before the initial injection of local anesthetic and the effectiveness of pain control during restorative treatment. The observing dentist asked the treating dentist about the effectiveness of pain control after completion of treatment. RESULTS: Forty-two of 361 children (11.6 percent) were observed to experience ineffective pain control. Fourteen of 17 dentists (82.4 percent) were observed to have at least one patient in whom pain control was ineffective. Lidocaine (2 percent with 1:100,000 epinephrine) was used by 15 of 17 dentists (88.2 percent) and in 312 of 361 cases (86.4 percent). The average amount of agent was one cartridge (36 milligrams of lidocaine). Children who were anxious, who had symptoms before treatment, and who underwent more invasive operative and endodontic procedures were more likely to experience ineffective pain control. CONCLUSIONS: The data suggest that painful treatment is relatively frequent even in specialized pediatric practice. Variability in general practice is likely to be greater. CLINICAL IMPLICATIONS: The incidence of ineffective pain control may be less if clinicians use methods to reduce anxiety and perioperative infection and symptoms.     

Urgent care in the dental school setting: analysis of current environment and future challenges in emergency dental education

Urgent dental care education is a critical aspect of the D.D.S. curriculum as dental students must be adequately prepared to face real-world dental emergency challenges in practice. Dental emergency education is likely the most variable component of the dental curriculum. To assess potential differences in emergency education, a sixteen-question survey was sent to directors of urgent care of all fifty-six U.S. dental schools addressing clinic operation, demographics, treatment, integration into the D.D.S. curriculum, and provision of care for indigent populations. The response rate was 88 percent. Results indicate a need for earlier integration of urgent dental care education into the D.D.S. curriculum, more pediatric emergency experiences for D.D.S. students, and a more rigorous academic approach in assessing student competency while on rotation in the urgent care service. In addition, access to emergency dental care has become increasingly difficult for indigent populations due to lack of state-supported funds; further exploration of sources of external funding for such care is warranted.     

How can child life specialists help address dental fear and anxiety in children?: A review

BackgroundPainful pokes, buzzing drills, uncomfortable pressure, foreign tastes, and disturbing noises are all events that a child can experience in a single dental appointment. Each event has the potential to trigger dental fear and anxiety in pediatric patients. Dental fear and anxiety are common for children and can lead to the neglect of dental care into adulthood. Many behavioral interventions currently in practice focus on immediate behavior changes rather than long-term psychosocial well-being of children.ObjectiveThe purpose of this paper was to review the literature of pediatric dental fear and anxiety and provide reasoning for child life specialist intervention in the pediatric dental clinic.ResultsRooted in developmental theory, child life specialists advocate for the psychosocial care of children in various healthcare environments, including dental clinics. Child life specialists work to minimize pediatric fear and anxiety using various strategies, including psychological preparation. Psychological preparation is accomplished by the provision of developmentally appropriate education, therapeutic or medical play, and preparation books.ConclusionsFurther research is needed to establish the effectiveness of child life specialist intervention, such as psychological preparation, in pediatric dentistry at reducing pediatric dental fear and anxiety.     

Comparison of the behavior of children undergoing restorative dental treatment at the first visit versus the second visit in a private pediatric dental practice

The purpose of this study was to determine if there was a difference in the behavior of child patients undergoing restorative dental treatment at the first office visit versus those whose first restorative treatment visit was after an initial non-threatening dental visit in a private pediatric dental practice. For patients up to and including age 9, patient behavior was recorded during the restorative session using the Sarnat scale, which rate behavior in 5 levels, from completely cooperative to completely uncooperative. Variables such as age, method of payment, referral source and sex were also recorded. The results showed that there was no statistically significant difference in the behavior of children, who had the first restorative dental experience at the initial office visit versus those children who had the first restorative procedure after a non-invasive introductory visit in all instances. There were no differences according to age, sex, socio-economic status or source of referral. It is concluded that a child may not exhibit more negative behavior as a restorative dental patient when the first visit is for restorative therapy than if the restorative treatment is delivered at a later date after a non-threatening introduction to the dental environment. Thus, a pediatric dentist need not hesitate to treat a child at the first visit for fear that it may engender more negative behavior than if the restorative dental treatment was postponed until another time.     

Dental students' perceptions of community-based education: a retrospective study at a dental school in Brazil

Community-based educational activities have been introduced into health education programs across the world. However, research on students' perceptions of their experiences in these settings has been limited. The objectives of this study were to assess a group of Brazilian dental students' views of their experiences in a service-learning program focusing on pediatric dental care and to explore changes in their perceptions over the course of the program. Data were collected from fifty-five fourth-year dental students, who submitted a total of 185 reports at four points in time. The students spent sixteen of the 128 hours of their pediatric dentistry course in community-based education developing activities linked to pediatric dental care. Two professors rated each report as a positive or negative experience (Kappa 0.7) and recorded whether the students' reports reflected one or more of five types of response. The response types concerned dental treatment practice, multidisciplinary activities, observation of infant/toddler consultations, commitment of the outreach health team, and change of plans due to technical problems. The data showed that the students had a positive first impression after a short stay in a community-service program, but there was a decrease in the students' positive experiences over time (p<0.001). The students' perceptions of the outreach health team as "being not committed" (OR 6.82, 95 percent CI 2.12-21.90) and experiences of a "no change of plans due to technical problems" (OR 0.09, 95 percent CI 0.04-0.20) associated with negative student experiences.     

Mothers' perceptions of children's refusal to undergo dental treatment: an exploratory qualitative study

Very little is known about mothers' beliefs concerning children's refusal of dental treatment. This qualitative study aimed to explore mothers' perceptions of their children's refusal to submit to dental treatment. Semistructured interviews were conducted with 14 mothers of 4–12-yr-old children resistant to dental treatment who were attending two pediatric dentists. Thematic content analysis was used to interpret the data. From this, three categories were developed and labeled origins of child behavior, caregiver attitudes, and the culture of resistance. The origins of the children's behavior were related to the childs' temperament, behavior disorders, lack of affection, level of development, and refusal to submit to health procedures or other situations. Caregiver's attitudes included discipline, protection, incoherence, partnership in dental treatment, and mother–child feeling. The culture of resistance referred to the parents' or guardians' refusal of dental treatment and the mothers' recognition of this. In conclusion, the wide variety of mothers' accounts reinforced the idea that every child is unique, and it is not possible to standardize child behavior models in a dental setting.     

Trends in special care training in pediatric dental residencies

Pediatric dentist are often regarded by the dental community as the specialty group best prepared to treat patients with developmental disabilities. This may be because it is the only specialty that receives formal training in behavior management techniques. A questionnaire was mailed to the directors of all 55 ADA-accredited pediatric dental residency programs in the U.S. The purpose of the survey was two-fold: the first aim was to quantify the training that pediatric dental residents receive in providing care to persons with developmental disabilities. A second area of investigation addressed the issue of pediatric dentist continuing yo treat persons with developmental disabilities into adulthood. The survey determined that pediatric dental residency programs provide considerable training in "Special Care" dentistry. While adults with developmental disabilities continue to be treated in 48 percent of responding programs, 55 percent of the program directors stated outright that it should not be the role of pediatric dentist to provide treatment to this population.     

Sedation for pediatric dental patients

There are few areas of dental therapeutics as controversial as the pharmacologic management of fearful and uncooperative pediatric dental patients. A pediatric dentist is faced with one of the most difficult tasks in our profession: maximizing comfort and cooperation while minimizing risks and costs of dental care for the unmanageable child. Pharmacosedation provides the means for children to avoid psychologically traumatic experiences that might inhibit regular oral health care when they become adults. By controlling disruptive behaviors, the pediatric dentist is able to provide quality dental care in an environment that is pleasant for the child, the parent, and the practitioner.