Are dentists risking losing their relevance?

The Push to Integrate Mid-Level Providers into Dentistry

ADSA/NDBA Abstracts

BACKGROUND: Systematic evidence about how the public and users perceive and experience the quality of general dental care is in short supply, particularly in light of the recent changes in...

Day case and short stay surgery: 2

BackgroundPain management is crucial in pediatric dentistry to ensure patient comfort and foster positive attitudes toward dental care. Local anesthesia is essential for pain control, but the injection process often causes fear and anxiety in children. Topical anesthetics are used to alleviate injection-associated pain; however, conventional anesthetics lack sufficient adhesion and efficacy.AimThis study evaluated the clinical efficacy of a novel articaine mucoadhesive (AMA) patch formulated with 4% articaine for pain control during local anesthetic injections (inferior alveolar nerve block) and subgingival tooth preparation for stainless steel crown (SSC) placement.Materials and methodsThe Institutional Ethics Committee approved the study design (CDCRI/DEAN/ETHICSCOMMITTEE/PEDO/PG-02/2024). The study was conducted with 60 children aged 6–12 divided into two groups: local anesthetic site (inferior alveolar nerve block) and tooth preparation for SSC. Each group was further divided into subgroups that received either the articaine or placebo patches. Pain responses were assessed using sound-eye-motor (SEM) and visual analog scale (VAS) scores. A significance level of 5% was used for the analysis. Shapiro–Wilk and Mann–Whitney U tests were used to assess the data.ResultsThe AMA patch significantly reduced pain compared to the placebo (p = 0.001). The SEM and VAS scores for the articaine patch were 1.236 and 2.102 (local anesthetic site), and 1.547 and 2.477 (tooth preparation for SSC), respectively. There were no statistically significant differences between the groups (p > 0.7).ConclusionThe AMA patch demonstrated effective pain reduction during local anesthetic injection and tooth preparation, offering promising results for pediatric pain management, with enhanced compliance and localized effects.How to cite this articleDhote S, Deoghare A, PJ N, et al. Evaluating Pain Response and Clinical Efficacy of an Articaine Mucoadhesive Patch among 6–12-year-old Children during Local Anesthetic Injection and Subgingival Tooth Preparation: A Double-blind Nonrandomized Clinical Trial. Int J Clin Pediatr Dent 2025;18(9):1097–1102.

Inguinal herniorrhaphy is one of the most frequent operations and can be successfully performed using general, regional, or local anesthesia. Epidemiological data from both nationwide (1) and large regional (2,3) databases have found that general anesthesia is used in 60%–70% of cases, central neuraxis blockade in 10%–20%, and local infiltration anesthesia in only 5%– 15% of cases. Even though local anesthesia with sedation (so-called monitored anesthesia care) is a more cost-effective anesthetic technique for inguinal hernia repair (4), general and spinal anesthesia remain the most popular anesthetic techniques at universitybased teaching programs. Interestingly, specialized hernia centers use local infiltration anesthesia in more than 95% of these cases (5– 8).

BackgroundIn Sierra Leone (SL), a low-income country in West Africa, dental care is very limited, largely private, and with services focused in the capital Freetown. There is no formal dental education. Ten dentists supported by a similar number of dental care professionals (DCPs) serve a population of over 7.5 million people. The objective of this research was to estimate needs-led requirements for dental care and human resources for oral health to inform capacity building, based on a national survey of oral health in SL.MethodsA dedicated operational research (OR) decision tool was constructed in Microsoft Excel to support this project. First, total treatment needs were estimated from our national epidemiological survey data for three key ages (6, 12 and 15 years), collected using the ‘International Caries Classification and Management System (ICCMS)’ tool. Second, oral health needs were extrapolated to whole population levels for each year-group, based on census demographic data. Third, full time equivalent (FTE) workforce capacity needs were estimated for mid-level providers in the form of Dental Therapists (DTs) and non-dental personnel based on current oral disease management approaches and clinical timings for treatment procedures. Fourth, informed by an expert panel, three oral disease management scenarios were explored for the national population: (1) Conventional care (CC): comprising oral health promotion (including prevention), restorations and tooth extraction; (2) Surgical and Preventive care (S5&6P and S6P): comprising oral health promotion (inc. prevention) and tooth extraction (D5 and D6 together, & at D6 level only); and (3) Prevention only (P): consisting of oral health promotion (inc. prevention). Fifth, the findings were extrapolated to the whole population based on demography, assuming similar levels of treatment need.ResultsTo meet the needs of a single year-group of childrens’ needs, an average of 163 DTs (range: 133–188) would be required to deliver Conventional care (CC); 39 DTs (range: 30–45) to deliver basic Surgical and Preventive care (S6P); 54 DTs for more extended Surgical and Preventive care (S5&6P) (range 38–68); and 27 DTs (range: 25–32) to deliver Prevention only (P). When scaled up to the total population, an estimated 6,147 DTs (range: 5,565–6,870) would be required to deliver Conventional care (CC); 1,413 DTs (range: 1255–1438 DTs) to deliver basic Surgical and Preventive care (S6P); 2,000 DTs (range 1590–2236) for more extended Surgical and Preventive care (S5&6P) (range 1590–2236); and 1,028 DTs to deliver Prevention only (P) (range: 1016–1046). Furthermore, if oral health promotion activities, including individualised prevention, could be delivered by non-dental personnel, then the remaining surgical care could be delivered by 385 DTs (range: 251–488) for the S6P scenario which was deemed as the minimum basic baseline service involving extracting all teeth with extensive caries into dentine. More realistically, 972 DTs (range: 586–1179) would be needed for the S5&6P scenario in which all teeth with distinctive and extensive caries into dentine are extracted.ConclusionThe study demonstrates the huge dental workforce needs required to deliver even minimal oral health care to the Sierra Leone population. The gap between the current workforce and the oral health needs of the population is stark and requires urgent action. The study also demonstrates the potential for contemporary epidemiological tools to predict dental treatment needs and inform workforce capacity building in a low-income country, exploring a range of solutions involving mid-level providers and non-dental personnel.

The authors describe the impact of the Title VII, Section 747 Training in Primary Care Medicine and Dentistry (Title VII) grant program on the development, growth, and expansion of general and pediatric dentistry residency programs in the United States. They first briefly review the legislative history of the Title VII program as it pertains to dental education, followed by a historical overview of dental education in the United States, including a description of the differences between dental and medical education and the routes to professional practice. The authors then present an extensive assessment of the role of the Title VII grant program in building general and pediatric dental training capacity, diversifying the dental workforce, providing outreach and service to underserved and vulnerable populations, stimulating innovations in dental education, and engaging collaborative and interdisciplinary training with medicine. Finally, the authors call for broadening the scope of the Title VII program to allow for predoctoral training (dental student education) and faculty development in general and pediatric dentistry. In doing so, the Title VII program can more effectively address current and future challenges in dental education, dentist workforce, and disparities in oral health and access to care.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

To identify controlled clinical trials done exclusively in dental primary care and to classify the research according to design. Details of any procedures used to recruit general dental practitioners and any special organisational arrangements were also collected. A scoping literature review. Dental primary care defined as general dental practice, community and school dental settings. Published randomised controlled trials using randomised or quasi randomised approaches and controlled clinical trials were considered for inclusion in the review. Reports were excluded if they did not describe either a randomised controlled trial or a controlled trial. Studies were excluded if the setting was not primary dental care or the intervention was for non-dental conditions. Conference abstracts without a full report and trials published in a language other than English were also excluded. Experimental and quasi-experimental designs, clinical areas and different kinds of strategies used to recruit dentists, any organisational arrangements made to support research in dental primary care. The search of the Cochrane Oral Health Group Controlled Trials Register found 174 articles. Forty-three randomised controlled trials met the inclusion criteria. Trials to evaluate the effects of interventions for types of anaesthesia, periodontal diseases, smoking cessation techniques, dental materials, organisational aspects of dental care, patient anxiety, post extraction healing rates, antibiotics were identified. All were done in general dental practice. Trials in school and community settings were also included. Practice-based research needs to be encouraged to provide dental primary care with relevant evidence upon which effective treatment can be based. This review shows there are few trials done in dental primary care to inform clinical practice, most of which have been reported since 1997. The range of trial designs shows that this method of evaluation can be used to evaluate dental primary care interventions and this is promising for those with an interest in improving dental patient outcomes. More research on how to recruit dentists into clinical trial research must be done.

Objective To identify controlled clinical trials done in dental primary care and to classify the research according to design. Details of any procedures used to recruit general dental practitioners and any special organisational arrangements were also collected. Design A scoping literature review. Setting Dental primary care defined as general dental practice, community and school dental settings. Participants Published randomised controlled trials using randomised or quasi randomised approaches and controlled clinical trials were considered for inclusion in the review. Reports were excluded if they did not describe either a randomised controlled trial or a controlled trial. Studies were excluded if the setting was not primary dental care or the intervention was for non-dental conditions. Conference abstracts without a full report and trials published in a language other than English were also excluded. Main outcomes Experimental and quasi-experimental designs, clinical areas and different kinds of strategies used to recruit dentists, any organisational arrangements made to support research in dental primary care. Results The search of the Cochrane Oral Health Group Controlled Trials Register found 174 articles. 43 randomised controlled trials met the inclusion criteria. Trials to evaluate the effects of interventions for types of anaesthesia, periodontal diseases, smoking cessation techniques, dental materials, organisational aspects of dental care, patient anxiety, post extraction healing rates, antibiotics were identified. All were done in general dental practice. Trials in school and community settings were also included. Conclusions Practice-based research needs to be encouraged to provide dental primary care with relevant evidence upon which effective treatment can be based. This review shows there are few trials done in dental primary care to inform clinical practice, most of which have been reported since 1997. The range of trial designs shows that this method of evaluation can evaluate dental primary care interventions and this is promising for those with an interest in improving dental patient outcomes. More research on how to recruit dentists into clinical trial research must be done.

The primacy of the patient

AimDistinct subtypes of Alzheimer’s disease (AD) and related dementias (RD) might have different effects on dental care usage and economic burden. To determine the effects of AD and RD on...

There is limited information on the impact of cognition function on dental care utilization and costs. This study used the Medicare current beneficiaries survey in 2016 and included 4,268 participants 65+. Dental care utilization and costs were measured by self-report and included preventive and treatment events. Negative binomial regression and generalized linear regression were used to examine the impact of Alzheimer’s disease (AD) and related dementia (RD) on dental care utilization and costs. We found that AD was not associated with dental care utilization, but RD was associated with a lower number of total treatment dental care visits (IRR: 0.60; 95% CI: 0.37~0.98). RD was not associated with dental care costs, but AD was associated with higher total dental care costs (estimate: 1.08; 95% CI: 0.14~2.01) and higher out-of-pocket costs (estimate: 1.25; 95% CI: 0.17~2.32). AD and RD had different impacts on different types of dental care utilization and costs. Part of a symposium sponsored by the Oral Health Interest Group.

Our world is changing, and with it, academic dentistry must think and act anew! Dental education in the United States and Canada is challenged to produce a culturally and structurally competent workforce that will serve the needs of an aging population and the expectations of an increasingly globally connected and diverse society. As these two countries become even more racially/ethnically diverse, dental education must also increase the number of students of color graduating and entering the oral health professions and expand opportunities for historically underrepresented and marginalized groups to enter the academic ranks and assume leadership positions. Additionally, dental schools play a major role in advancing the care and treatment of underserved and disadvantaged populations. Through their triad missions of education, research, and service, the 68 US dental schools, excluding the four provisional schools, serve as dental “safety nets” for those who lack access to care in the dental private practice system. Since 2011, new dental schools now exist in California, Florida, Illinois, Maine, Missouri, New York, North Carolina, Texas, and Utah, and additional dental schools are in the planning stages. These new institutions have an opportunity to improve health equity through increased community engagement and academic/community partnerships. Important to their mission, dental schools also serve as bastions for biomedical and behavioral research and transformative curriculum changes that will use newer technology from research and discovery. America has one of the best oral health care delivery systems in the world, as evidenced by outcomes such as a longer lifespan with tooth retention, fluoridated water resulting in a 60% reduction in dental caries, and Americans valuing their oral health as seen in increased annual visits to the dentist for preventive and restorative care.1 However, these data are valid for those who can afford and access dental care. The United States Public Health Service (USPHS) identifies 6803 Dental Health Professional Shortage Areas (DHPSAs) where access to dental care is minimal or missing. An estimated 64 million adults and children reside in these DHPSAs. Additionally, the USPHS estimates that 11,181 more dentists are needed for a dentist-to-U.S.-population ratio of 1:3000.1 The practice of dentistry is changing. As with medicine, dentistry is seeing a decline in solo practice models. Only 24% of the 1381 graduating respondents to the 2021 ADEA Survey of US Dental School Seniors indicated they plan to enter solo practice.2 New dental professionals are emerging, such as dental therapists and community dental health coordinators. New practice models exist in Alaska, Arizona, Maine, Minnesota, Oregon, Vermont, and Washington. Three seminal reports, Dental Education at the Crosswords: Challenges and Change,3 Oral Health in America: A Report of the Surgeon General,4 and Missing Persons: Minorities in Health Professions,5 continue to influence dental education policy and trends, especially related to health equity, disparities, and access to dental care. Additionally, the 2021 release of the National Institutes of Health (NIH) report, Oral Health in America: Advances and Challenges, serves as a foundation for additional work in these areas.6 On the global health agenda, oral health is no longer a neglected issue. Approximately 3.5 million people throughout the world suffer from oral health diseases, and most of these individuals are socioeconomically disadvantaged or live in poverty. Furthermore, 10% of the world's population has severe periodontal (gum) disease, and globally, an estimated 530 million children suffer from dental caries of primary teeth.7 To call attention to this important issue, the World Health Organization's World Health Assembly adopted a May 2021 resolution on oral health, which also recognizes the intersections between oral health and achieving other United Nations Sustainable Development Goals, such as goal three on health and well-being.8 Additionally, it calls for the development of a framework that aligns oral health and noncommunicable diseases with universal health coverage agendas.9 Within the United States, the Healthy People 2030 initiative (US Department of Health and Human Services) also challenges our ability to reduce caries and improve oral health care.10 As more and more dental education faculty and administrators retire, academic dentistry must address succession planning, improve the representation of historically underrepresented persons in the academic ranks, and strengthen the belongingness factor for women, people of color, and marginalized groups. We must have hard conversations about gender equity and parity, antiracism, immigration, individuals with disabilities/abilities, social determinants of health, universal healthcare, and supporting the LGBTQ+ community. These difficult conversations must include actionable plans with accountability measures and transparency. We must use the data from ADEA's recent climate study of U.S. and Canadian dental schools and allied dental education programs, and other data, to create a culture of respect and design strategies that truly ensure a welcoming, safe, just, and humanistic environment in which all students, faculty, staff, residents, and fellows can succeed and have the resources to become their best. We must not only tangibly demonstrate that we believe in faculty inclusivity, but that the doors of academic dentistry are truly open to everyone. Furthermore, dental education must develop collective partnerships and networks to better invest in and provide more accessible oral health care and considerably expand the equitable pathways and opportunities to become oral healthcare professionals. This issue of the Journal of Dental Education (JDE) forces us to look back as we face not only current and post-pandemic health equity challenges, but also the disruptions which have rocked our society over the last several years and launched major new movements, such as MeToo, Black Lives Matter, Neurodiversity, and Stop Asian American Pacific Islander Hate. However, throughout this issue we also look forward to the future, imagining 21st-century leadership and envisioning an educational system that graduates students who not only have 21st-century competencies but who can address 21st-century complexities. ADEA's initiative “New Thinking for the New Century” is primed to help us embrace these changes and challenges. Lessons from our nation's history, dental education, world events, and current and post-pandemic health equity and economic challenges provide opportunities for transformative changes. Together, we must develop more integrated and resilient health systems and develop strategies to provide more inclusive and humanistic environments in dental education. Opportunities to catalyze institutional changes exist in interprofessional education (IPE), curriculum changes involving academic-community partnerships for community empowerment (ACE), diversifying dental education (DDE), research and technology development (RTD), and academic leadership reimagining (ALR). IPE: Opportunities for curriculum changes exist that improve graduates’ cultural and structural competency and increase access to equitable and affordable healthcare for the underserved. In 1997, only two dental schools had active IPE. Today, IPE is an accreditation mandate that affects all accredited dental schools. Additionally, IPE creates critical connections among students and residents in different health professions and provides early foundational team-based training. This foundational team-based learning provides the building blocks to advance future culturally competent patient-centered models that truly integrate oral, mental, behavioral, and primary health to improve access, patient safety, and treatment quality for persons living in poor, rural, and underresourced communities. ACE: Opportunities exist for sustainable academic-community partnerships that support educational goals and provide dental care to communities via outreach services by dental and dental hygiene students and faculty. The ADEA/W.K. Kellogg Foundation Minority Dental Faculty Development and Inclusion Program provided a model for sustainable partnerships that include pipeline and pathway recruitment, foundation and corporate support for institutional changes, and other resources. DDE: Opportunities to create a more inclusive and humanistic environment across dental education exist not only by participating in the ADEA climate study but through strategic planning and engaging in collective efforts to address key findings. Additionally, expanding pathway initiatives, such as the Summer Health Professions Education Program and the Texas A&M College of Dentistry's Bridge to Dentistry program, provide academic enrichment and career development opportunities to K-16 students who are historically underrepresented in dentistry. The ADEA Faculty Diversity Toolkit is a guide for dental education to develop faculty recruitment and retention plans to address related barriers and challenges.11 ADEA's new strategic recruitment plan, combined with the implementation of a new customer relationship management platform, will allow us to personalize outreach and connect to more diverse students. ADEA's efforts to bring the academic health professions together to increase the number of men of color entering dentistry and other health professions are also important avenues by which we seek to improve access and health equity in the United States. RTD: Opportunities exist for increased collaboration between the NIH and US dental schools through traditional research funding and community-based research grants that focus on improving the health of communities of color. An effort to include more dental schools in program project/center grants will increase patient-centered research and data outcomes. Salivary diagnosis, implantology, artificial intelligence, and robotics offer new avenues for dental discovery, translational research, and research collaboration. ALR: Reimagining leadership training in dental education will be a challenge for the ADEA Leadership Institute, Student Diversity Leadership Program, and other ADEA leadership development programs. Programs such as the Enid A. Neidle Scholar-in-Residence Program for women and the Executive Leadership in Academic Medicine program at Drexel University will continue to play a major role in developing academic leadership pipeline and pathway programs for the future. The ADEA Chapters for Students, Residents, and Fellows and ADEA's Academic Dental Careers Fellowship Program provide support and training for students interested in academic careers. Reimagining leadership, mentoring, and training programs will increase effective, collaborative, and diverse pathways to academic leadership in the future. Additionally, these mentoring and leadership development programs continue to serve important roles and progress has been made in some areas. For example, at the time of our writing, 25 (30%) of the deans (interim and permanent) at the 82 US and Canadian dental schools (including the four provisional schools) were women.12 In 2022, among deans (interim and permanent) at the 72 US dental schools (including the four provisional schools), 20 (28%) were women.12 Additionally, in 2022, 14 (19%) of the 72 US dental school deans (interim and permanent), including the four provisional schools, were people of color.12 In terms of student diversity at the 68 US dental schools (excluding the four provisional schools), 56% of the 2021 dental school first-time enrollees were women, and 20% of first-time enrollees were from historically underrepresented racially/ethnically diverse student populations.13 Although these numbers show some progress, they also reflect the important work that still needs to be done to expand leadership opportunities, implement succession planning strategies, and increase the number of historically underrepresented and marginalized students, faculty, staff, residents, and fellows in leadership positions throughout all facets of academic dentistry and oral health. The global pandemic has created a crisis with opportunities for collaboration similar to the period of innovation following World War II when battles were won against diseases such as smallpox, diphtheria, and polio. Additionally, dental educational institutions have the chance to not only expand upon gender equality but also lead in framing the dialogue on race and ethnicity to advance health equity and improve pathways and opportunities for historically underrepresented and marginalized students, fellows, faculty, staff, and residents. We do not know where new science, globalization, artificial intelligence, geo-political shifts, cyber threats, innovation, and societal challenges will lead us. However, we do know that global collaboration and resources will be required to build resilient health systems in the future that eliminate disease and promote good health and well-being for all. This includes dental education and oral health organizations working closely with governments, civil societies, the academic health professions, and other key health care and research stakeholders to address the increasing impact of climate threats and environmentally adverse health risks that are disproportionately impacting our most vulnerable populations and overall public health.14, 15 Additionally, our collective efforts will be required to create more inclusive, humanistic, accessible, and equitable environments throughout dental education where each person thrives, feels a strong connection, and has a sense of belonging. Let us, therefore, use this issue of the JDE for personal and institutional reflection to sharpen our moral imaginations and strengthen our dedication to inclusivity and our commitment to health equity. Most of all, let these pages challenge us to both think and act new! The authors have no conflicts of interests. This article is published in the Journal of Dental Education as part of a special issue. Manuscripts for this issue were solicited by invitation and peer reviewed. Any opinions expressed are those of the authors and do not represent the Journal of Dental Education or the American Dental Education Association.

The changing role of monitored anesthesia care in the ambulatory setting.