Assessing Patient Discomfort in Smartphone-Based Teledentistry From the Perspective of Dental Professionals: Qualitative Interview Study

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.

Work-related musculoskeletal disorders (WRMSDs) refer to injuries or conditions that affect the muscles, tendons, nerves, and other components of the musculoskeletal system, often resulting from repetitive movements, sustained static postures, or prolonged periods of sitting and standing. Dental professionals and students are particularly susceptible due to the physically demanding nature of clinical practice. These disorders can adversely affect professional performance, productivity, and overall quality of life. The present study aimed to determine the prevalence, associated risk factors, and potential consequences of WRMSDs among dental students and professionals at Umm Al-Qura University, Makkah, Saudi Arabia. A cross-sectional survey was conducted among dental students and professionals at Umm Al-Qura University. Data were collected using a self-administered, structured online questionnaire designed to assess the prevalence of WRMSDs, associated risk factors, and management strategies. Statistical analysis was performed using IBM SPSS Statistics software, with the level of significance set at p < 0.05. Among the respondents, 67.8% were under 25 years of age, and 59.8% were female. More than half (55.6%) reported experiencing WRMSD symptoms in at least one body region during the past year, with 36.8% indicating chronic pain. The most commonly affected areas were the neck (56.9%), and lower back (52.3%). The leading contributing factors were inappropriate posture (44.8%) and prolonged sitting (29.7%). The most affected quality-of-life domains included increased stress and anxiety (33.1%), sleep disturbances (30.0%), and reduced academic or occupational performance (25.0%). Despite the high prevalence, 77% of participants did not seek professional care. The most frequently reported pain management strategies were the use of analgesics (31.4%) and engagement in physical activity (29.3%). This study demonstrates a high burden of WRMSDs among dental students and professionals, with symptoms primarily affecting the neck and lower back. Incorporating ergonomic training and structured occupational health programs into dental education and clinical practice may reduce long-term functional impairment and improve overall well-being.

Should Dental Care Make a Transition?

This study explored how dental students and dental professionals perceive risks of using digital and social media (DSM) in a dental professional context and validated a questionnaire to measure DSM perceived risks specifically among dental students and dental professionals. A cross-sectional survey study was carried out amongst dental students (undergraduate and postgraduate) and dental professionals at a dental school in the UK. Data were collected using a 38-item questionnaire developed using interviews, experts' evaluation, and previous perceived risks studies of internet services and social media. Risk factors were identified using exploratory factor analysis (EFA). The internal consistency of the extracted factors was determined by Cronbach's α-coefficient reliability test. A total of 301 dental students and dental professionals completed the questionnaire. EFA identified eight factors perceived by dental students and professionals as critical to their DSM use. Some identified perceived risks were associated with all DSM users in the general context (e.g., personal privacy, and negative impact on self-image), but others were specific to the dental professional context (e.g., breaches of patients' confidentiality, public deception, and reputational damage). The identified factors explained 63.55% of the variance with eigenvalues >1. Cronbach's alpha for the total questionnaire was 0.9. This study data has deepened the understanding of perceived risks that influence dental students and professionals' DSM use. This will help develop education, training, and guidance to mitigate and manage the risks associated with DSM use in the dental professional context.

Background: Eating disorders (EDs) are serious mental health conditions characterized by disordered eating behaviors and excessive concern about body weight, shape, or food intake, affecting an individual's psychological, physical, and oral health. Oral health professionals are often the first to recognize these signs and symptoms, thus playing a crucial role in early detection and timely intervention. Aim: To assess the knowledge of dental students and professionals regarding the psychological, physical, and oral health implications of EDs. Material and Methods: A cross-sectional study was conducted using a structured and validated questionnaire among 193 clinical-year dental students (DS) and 40 practicing dental professionals (DP) in Malaysia, selected through a convenience sampling method. The questionnaire consisted of three sections: demographic data, and assessments of knowledge and awareness regarding the psychological, physical, and oral health manifestations of EDs. Differences in participants' knowledge was assessed using Fisher’s exact test and the Chi-square test. A p-value of &lt;0.05 was considered statistically significant. Results: Participants showed poor knowledge of certain EDs symptoms, including gender predilection (DS: 34.7%, DP: 35.0%), low body weight (DS: 41.5%, DP: 52.5%), parotid gland enlargement (DS: 28.5%, DP: 25.0%), and poor oral hygiene (DS: 36.3%, DP: 47.5%). Good level of knowledge was noted for associations with stress and anxiety (DS: 89.6%, DP: 90.0%), and mirror checking (DS: 78.2%, DP: 65.0%). Moderate knowledge was observed for social withdrawal (DS: 51.3%, DP: 50.0%), knuckle bruises, (DS: 51.3%, DP: 57.5%), low self-esteem (DS: 69.4%, DP: 72.5%), nail erosion, dental caries, hypersensitivity, angular cheilitis, and oral pain/burning(DS: 59.6%, DP: 55.0%). Significant differences between DS and DP were found for mirror checking (p&lt;0.05), oral candidiasis (p&lt;0.05), and symptoms such as burning sensation, taste changes, and unexplained oral pain (p&lt;0.05). Conclusions: DS and DP demonstrated varying levels of knowledge about EDs, with poor levels of knowledge on certain key physical and oral manifestations. Therefore, integrating education on EDs into dental training is essential to support early diagnosis and timely referral.

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.

497 Dental profession represents an important segment of human health services around the globe and is expanding at an enormous pace. Like all other components of human health-related services, dental and oro-facial health teams are striving hard to excel in provision of high quality services to all parts of human population. The new scientific revolutionary era of molecular biology, genetic tissue engineering, bioinformatics and nanotechnology appear to reshape the current trends and practices in dental care education, services and curriculum designing. Internationally, there is a paradigm shift to new research-based, objectively structured and clinically oriented curriculum, which should not only be able to produce health care professionals with a broad knowledge and expertise of existing medical and dental scientific concepts, but also with a vision to develop new strategies in prevention and management of human diseases with a major emphasis on evidence based clinical practices.1 However, available health education systems both in under developed and developing countries, especially when discussed in relation to dental profession’s education in Pakistan, appear to lag far behind in this revolutionary era of scientific development. Current trends in dental health education and existing curriculum designs are unable to serve the dental students, professionals and patients to benefit from the modernization of established scientific concepts. Presently followed and practiced clinical dentistry concepts and techniques are perhaps rather old and mainly focus on the symptomatic relief of oral health related issues and rehabilitation or repair of damaged or lost natural body parts. The very important components like oral health care education and prevention of these disease conditions are greatly neglected in the presently working system of dental health education. The community based dental programs are still in an infancy stage and are suffering from the neglect of higher decision making bodies and even of the dental professional organizations. The supportive utilization of print and electronic media authorities in spreading the health care awareness to masses is still an unknown facility. The assimilation and incorporation of recent advancements and technologies has been very slow in the existing dental education system. There is a major deficiency of the highly educated, technically skilled personals in most of our dental educational institutes. There is also a deficiency of modern, state-of-art equipments especially when it comes to research infrastructure. This is probably not due to lack of financial resources, but mainly due to lack of awareness, limited global vision and/or neglect from the responsibilities towards the rights of the dental profession. This deficiency is in no doubt, going to affect the existing international standing of the human resources and will directly damage the local and national socio-economical status as well. There is a dire need of revitalizing the current curriculum designs, education style and technical facilities to keep ourselves abreast with the modern world. There should be a paradigm shift towards research oriented and clinical based scientific methodologies with emphasized training on medical jurisprudence and human consumer rights as well. However, this continued evolution will be a hard task for the faculty, administration and external constituencies because of its high cost, overcrowded schedules, unique demands of clinical training, changing nature of teaching/ assessment methods and a large scope of new material impacting all areas of dental educational program.2 In

BackgroundThe concept of minimal intervention dentistry (MID) includes both delayed restorative treatment and conservative caries removal, and is now recognised as an evidence-based approach for dental caries management. In order to determine if dental professionals in Russia are incorporating this concept into their clinical practice, we investigated the restorative treatment decisions of Russian dentists and dental students, and the factors associated with these decisions.MethodsWe included 171 general dental practitioners and dental therapists (collectively referred to here as “dentists”) from North-West Russia, and 76 dental undergraduate students from the Northern State Medical University in Arkhangelsk (response rate of 11.5% and 67.9%, respectively). Participants completed a questionnaire, which collected background information (sex, region of work, place of dental school graduation, practice type, years of working experience, working in an urban or rural area, and specialisation in restorative dentistry) and information on restorative treatment decisions for proximal and occlusal carious lesions of permanent teeth. Treatment options in accordance with MID were defined as intervention at dentin level and minimally invasive cavity preparation. Multinomial logistic regression was used for statistical analysis.ResultsFor the proximal carious lesion, 9.4% of participants said they would employ both MID treatment options; 60.7% said they would choose only one; and 29.9% said they would use neither option. For the occlusal carious lesion, the corresponding figures were 37.2%, 52.1%, and 10.7%. No differences in restorative treatment options were observed among general dental practitioners, dental therapists, and dental students. For the proximal carious lesion, dentists from regions outside Arkhangelsk had 4.15 (95% confidence interval [CI] 1.13–15.27) times higher odds of following one versus both MID treatment options. For the occlusal carious lesion, working experience above 15 years was associated with higher odds of using only one versus both MID treatment options (adjusted odds ratio = 3.04, 95% CI 1.33–6.91). Almost all respondents preferred tooth-coloured materials for restorations; more than 75% chose resin-based composite.ConclusionsThe majority of Russian dentists and dental students do not apply the MID concept when treating dental caries in permanent teeth. Clinical protocols on dental caries treatment and dental school curriculums should be updated to place an enhanced focus on evidence-based practice and preventive strategies. Further studies with larger samples of Russian dentists and dental students and alternative methods of recruitment are needed to validate our results.

BackgroundHealth care professionals’ educational preparation and practices significantly influence care experiences and health outcomes. Deficient awareness of the impact of stereotypes, biases, prejudices, and social determinants of health (SDH) can lead to negative care experiences, strained health care professional-patient relationships, and health disparities. Addressing these challenges necessitates enhancing health care professionals’ skills, including inclusive communication, cultural humility, recognition of SDH, and fostering empathy and compassion, promoting health equity and better care experiences.ObjectiveThis research aims to introduce a mobile health (mHealth) app designed using a digital experiential learning (DEL) approach to strengthen health care professionals’ competencies, thereby improving patient care experiences and promoting health equity. The key objectives are to deliver essential health care skills, such as cultivating cultural humility, developing inclusive communication proficiencies, understanding the lasting impact of SDH, comprehending how implicit and explicit biases affect health outcomes, fostering compassionate and empathetic clinical attitudes, and promoting continuous professional development. Together, these aims advance patient-centered care and help reduce health disparities.MethodsThe mHealth app integrates virtual reality–based serious role-playing hypothetical scenarios and a life course module to provide health care professionals with immersive first-person learning experiences. The scenarios include a Syrian refugee with limited English proficiency and an African American pregnant woman with a history of opioid use disorder, each lasting ≈30 minutes to deliver essential health care skills. The pre- and postassessment questionnaires are integrated within the app to measure the learning outcomes of diverse professionals who voluntarily engaged with the app. Distinct hypotheses were formulated and evaluated, referring to specific questionnaire items to assess the app’s impact on professionals’ skills and attitudes.ResultsThe mHealth app significantly enhanced health care professionals’ skills and attitudes, including increased confidence, preparedness for patient interactions, awareness of the lasting impact of SDH, positive beliefs, reduced prejudice, improved perspectives on patient responsibility and external factors, as well as greater compassion and empathy. These outcomes, obtained through evaluating distinct hypotheses and analysis supported by multiple statistical approaches, including CI analysis, Cohen d effect sizes, odds ratios, 1-tailed paired t tests, and descriptive response distributions, directly align with the study’s objectives, fostering health equity and patient-centered care. Overall, the app effectively improved health care professionals’ competencies, contributing to better care experiences and outcomes while promoting health equity.ConclusionsThis study delivers a comprehensive data-driven evaluation that validates the effectiveness of the mHealth app in enhancing health care professionals’ skills and fostering health equity. It addresses challenges in health care education by delivering a scalable, accessible, and immersive learning platform. Supported by virtual reality technology and an experiential learning framework, the mHealth app presents a promising avenue to empower health care professionals with skills to provide patient-centered care in diverse, complex settings.

The purpose of this study was to identify and compare the perspectives of dental students towards their career choice and dental education in Japan and Sweden. One hundred and fourteen dental students from the Nippon Dental University, Japan and 43 dental students from the Karolinska Institutet, Sweden participated in this study. Information was derived from a self-answered questionnaire consisting of five items for career choice and six items for dental education. Chi-square test and Wilcoxon signed-rank test were used for comparison. Significant differences were detected for 10 questionnaire items between the two countries. Regarding motivation towards the career choice, 44% of Swedish students indicated interpersonal motives related to helping other people, whereas 32% of Japanese students indicated expectations of their family in the dental profession. As future career options, 64% of Japanese and 47% of Swedish students planned to work as general dentists. More Swedish students (37%) preferred specialisation than Japanese students (17%). Nearly three-quarters of the Swedish students were satisfied with the teaching faculty of their school, whilst only 32% of the Japanese students indicated content. The perspectives of dental students were different in Japan and Sweden. This study provides a description of the perspectives of Japanese and Swedish dental students and enables better understanding of career decision and dental curriculum issues.

RESPONSE TO COMMENTARY

Defining professionalism and developing educational interventions that foster and assess student professionalism are integral to dental education. Nevertheless, conceptual, methodological and pedagogic differences define the academic field, leaving students, educators and the profession itself struggling to make meaningful progress on how best to elicit and monitor dental student professionalism. This article proposes that more progress can be made on this important issue when a contextualised, sociological assessment of dentistry and dental professionalism is undertaken. We contend that identifying some of the socio-cultural demands in UK dental students' lives, and acknowledging how these pressures shape their interactions with the UK dental education system, provides a nuanced and contemporaneous understanding of what it means to be an oral health care professional at a time of social and health care upheaval. Dental educators can use this insight to work towards being more understanding of and responsive to dental student professional development.

BackgroundTo improve workers’ health and well-being, workplace interventions have been developed, but utilization and reach are unsatisfactory, and effects are small. In recent years, new approaches such as mobile health (mHealth) apps are being developed, but the evidence base is poor. Research is needed to examine its potential and to assess when, where, and for whom mHealth is efficacious in the occupational setting. To develop interventions for workers that actually will be adopted, insight into user satisfaction and technology acceptance is necessary. For this purpose, various qualitative evaluation methods are available.ObjectiveThe objectives of this study were to gain insight into (1) the opinions and experiences of employees and experts on drivers and barriers using an mHealth app in the working context and (2) the added value of three different qualitative methods that are available to evaluate mHealth apps in a working context: interviews with employees, focus groups with employees, and a focus group with experts.MethodsEmployees of a high-tech company and experts were asked to use an mHealth app for at least 3 weeks before participating in a qualitative evaluation. Twenty-two employees participated in interviews, 15 employees participated in three focus groups, and 6 experts participated in one focus group. Two researchers independently coded, categorized, and analyzed all quotes yielded from these evaluation methods with a codebook using constructs from user satisfaction and technology acceptance theories.ResultsInterviewing employees yielded 785 quotes, focus groups with employees yielded 266 quotes, and the focus group with experts yielded 132 quotes. Overall, participants muted enthusiasm about the app. Combined results from the three evaluation methods showed drivers and barriers for technology, user characteristics, context, privacy, and autonomy. A comparison between the three qualitative methods showed that issues revealed by experts only slightly overlapped with those expressed by employees. In addition, it was seen that the type of evaluation yielded different results.ConclusionsFindings from this study provide the following recommendations for organizations that are planning to provide mHealth apps to their workers and for developers of mHealth apps: (1) system performance influences adoption and adherence, (2) relevancy and benefits of the mHealth app should be clear to the user and should address users’ characteristics, (3) app should take into account the work context, and (4) employees should be alerted to their right to privacy and use of personal data. Furthermore, a qualitative evaluation of mHealth apps in a work setting might benefit from combining more than one method. Factors to consider when selecting a qualitative research method are the design, development stage, and implementation of the app; the working context in which it is being used; employees’ mental models; practicability; resources; and skills required of experts and users.

Firmly establishing oral health care professionals’ roles as vaccinators within the health care system

The changing role of dental hygienists deserves dental and dental hygiene educators' attention. The first aim of this survey study was to assess University of Michigan dental, dental hygiene, and graduate students' and faculty members' perceptions of dental hygienists' roles; their attitudes and behaviors related to clinical interactions between dental and dental hygiene students; and perceived benefits of engaging dental hygiene students as peer teachers for dental students. The second aim was to assess whether one group of dental students' experiences with dental hygiene student peer teaching affected their perceptions of the dental hygiene profession. Survey respondents were 57 dental hygiene students in all three years of the program (response rate 60% to 100%); 476 dental students in all four years (response rate 56% to 100%); 28 dental and dental hygiene graduate students (response rate 28%); and 67 dental and dental hygiene faculty members (response rate 56%). Compared to the other groups, dental students reported the lowest average number of services dental hygienists can provide (p≤0.001) and the lowest average number of patient groups for which dental hygienists can provide periodontal care (p<0.001). Dental students also had the least positive attitudes about clinical interactions between dental hygiene and dental students (p<0.001) and perceived the fewest benefits of dental hygiene student peer teaching (p<0.001) before experiencing peer teaching. After experiencing dental hygiene student peer teaching, the dental students' perceptions of dental hygienists' roles, attitudes about clinical interactions with dental hygienists, and perceived benefits of dental hygiene student peer teachers improved and were more positive than the responses of their peers with no peer teaching experiences. These results suggest that dental hygiene student peer teaching may improve dental students' perceptions of dental hygienists' roles and attitudes about intraprofessional care.