Advanced Education In General Dentistry Research Articles

Sleep medicine education in the United States advanced dental education programs.

Dental sleep medicine is an emerging field within dentistry. While limited education in sleep medicine has been reported among US predoctoral dental schools, no study has been conducted among postgraduate dental programs. This study compared the extent and exposure to sleep medicine education among US postgraduate programs in orthodontics, pediatric dentistry, orofacial pain (OFP), general practice residency (GPR), and advanced education in general dentistry (AEGD). A REDCap survey was distributed among N=391 US postgraduate programs investigating the nature, content, and modality of sleep education during the 2023-24 academic year. Among 68 responding programs (43.1% GPR, 18.5% AEGD, 18.5% orthodontics, 12.3% pediatric dentistry, and 7.7% OFP), faculty with sleep training constituted 7.5%, with 2.6% being board certified in sleep medicine. Approximately 41.8% of programs offered sleep medicine courses, with differences among specialties (100% OFP, 42.9% GPR, 37.5% pediatric dentistry, 33.3% orthodontics, 16.7% AEGD; p=0.032). Didactic teaching comprised 7.8±14.6h/year (range 0h/year in 21.5% to 80h/year in 1.5%), with differences across programs (OFP=44.0±17.7, orthodontics=8.7±11.0, GPR=5.0±8.0, pediatric dentistry=2.1±1.9, and AEGD=2.9±5.4; p<0.001), and constituted the primary modality of instruction (mainly obstructive sleep apnea, bruxism, sleep physiology). Screening and treatment for sleep-related disorders were provided by 35.9% and 37.9% of programs, respectively, with variations among specialties (p=0.004). Our findings revealed an average of 7.8h/year of didactic sleep medicine instruction, which differed across specialties. OFP offered the highest level of didactic and clinical training. These findings emphasize the need for increased dental sleep medicine education to address the increasing involvement of dental professionals in managing sleep-related disorders.

ORAL HEALTH: THE MOST UNMET HEALTH CARE NEED FOR MEDICALLY VULNERABLE ELDERLY WITH OR WITHOUT DEMENTIA

Abstract Individuals aged 65 and older are living longer with multiple chronic conditions, leading to a larger population of medically vulnerable elderly with or without dementia. Consequently, only an interdisciplinary health system can meet the comprehensive health needs for older adults. Historically, Oral Health (OH) is the most unmet need in healthcare, particularly in older adults. This is due to several barriers including Interprofessional Education (IPE) and Interprofessional Collaboration (IPC). Therefore, there is a growing gap between OH and overall health. We conducted two studies in the past 4 years. The first study included pre-doctorate healthcare students (Medical, Nursing, Dental and Pharmacy) evaluating their IPE during their educational training and the influence of their education later as practitioners. The result of this study revealed an unsatisfactory IPE that would lead to minimum or no interdisciplinary collaboration. The second study (2019 to 2022) included dental residents in a one year post graduate program “Advanced Education in General Dentistry” (AEGD). In each year we collected a survey at the beginning of the residency program asking the level of comfort treating medically vulnerable elderly as a provider in a health team. We then exposed them to a comprehensive geriatric oral health both didactics and clinical skills. The same survey was again conducted at the end of the residency. The study revealed adequate training increased the level of residents’ ability to provide care within a health team. Interdisciplinary health services require interdisciplinary educational training to close the gap between oral health and overall health.

Linking current dental education to gerontological education to meet the oral health needs of growing aging populations.

This study aimed to recognize the gaps in dental education by studying the current level of geriatric oral health training of recent graduated dentists who have been admitted into an Advanced Education in General Dentistry (AEGD) program. The AEGD program was developed along with the Age-Friendly 4Ms model to enhance current dental education. We adopted the Rapid Cycle Quality Improvement model to test the effectiveness of the training for AEGD residents from 2019 to 2022. A total of 18 residents participated (6 residents each year). A 5-question survey was administered before and after the rotation and Wilcoxon signed-rank with Fisher Exact tests were conducted to compare pre- and post- rotation results. All 18 residents have completed pre- and post-program surveys. They self-reported minimal to no training in preparation to provide care to older adults with multiple chronic conditions. After the rotation, residents' confidence in treating older adults was significantly increased (p = 0.011). Meanwhile, residents gained knowledge to apply the 4Ms framework (what matters, medication, mentation, and mobility) to their practices (p = 0.015) and provide age-friendly care for older adults. The study identified and addressed the missing link in dental education to gerontological and geriatrics education. More clinical rotations and didactic training to equip residents with competences of providing geriatric oral health are strongly recommended.

Survival analysis of zirconia implant-supported, fixed complete dentures: A 5-year retrospective cohort study.

Existing data on the mid-term to long-term survival rates of zirconia implant-supported, fixed complete dentures (Zir-IFCDs) are lacking. The purpose of this retrospective clinical study was to assess the prosthetic survival rate in patients treated with Zir-IFCDs. The patient record system at the Dental College of Georgia (DCG), Augusta University was searched to identify all patients treated with Zir-IFCDs from 2015 through 2022 by the DCG graduate prosthodontic, general practice residency, and Advanced Education in General Dentistry (AEGD) programs. Reasons for replacement were grouped as failure of veneering porcelain, framework fracture, implant loss, patient-driven concerns, excessive occlusal wear, and other. A total of 67 arches were found that met the inclusion criteria, 46 maxillary and 21 mandibular. The median follow-up time was 8.5 months (interquartile range, 2.7 to 30.9 months). A total of 9 of the 67 arches were identified as having failed (4 maxillary, 5 mandibular), requiring replacement. Reasons for failure were as follows: 3 framework fractures, 2 implant losses, 2 patient-related concerns, 1 fracture of veneering porcelain, and 1 unknown. The combined survival rate (Kaplan-Meier, log-normal modeling) for Zir-IFCDs was 88.8% at 1 year and 72.5% at 5 years CONCLUSIONS: Based on the findings, the Zir-IFCDs investigated had a survival rate lower than that reported in similar studies, though higher than published results for metal-acrylic resin-IFCDs. The most common source of failure was fracture of the zirconia framework. Thickness of the zirconia framework, interocclusal space, cantilever length, occlusal force, and status of the opposing dentition may have been associated with framework failures and should be investigated further.

Behavioral Health Within Primary Care Postgraduate Dental Curricula: A Mixed Methods Study.

This study evaluated the integration of behavioral health topics (anxiety disorder, depressive disorder, eating disorders, opioid use disorder, and intimate partner violence) into primary care postgraduate dental curricula. We used a sequential mixed methods approach. We sent a 46-item online questionnaire to directors of 265 Advanced Education in Graduate Dentistry programs and General Practice Residency programs asking about inclusion of behavioral health content in their curriculum. Multivariate logistic regression analysis was used to identify factors associated with inclusion of this content. We also interviewed 13 of the program directors, conducted content analysis, and identified themes pertaining to inclusion. A total of 111 program directors completed the survey (42% response rate). Less than 50% of programs taught their residents to identify anxiety disorder, depressive disorder, eating disorders, and intimate partner violence (86% taught identification of opioid use disorder). From the interviews, we identified 8 main themes: influences on the inclusion of behavioral health in the curriculum; training strategies; reasons for incorporating the training strategies; training outcomes (ie, ways in which residents were evaluated); training outputs (ie, ways in which a program's success was quantified); barriers to inclusion; solutions to barriers; and reflections on how the current program can be made better. Programs housed in settings with no to minimal integration were 91% less likely (odds ratio = 0.09; 95% CI, 0.02-0.47) to include identifying depressive disorder in their curriculum compared with programs in settings with close to full integration. Other influences for including behavioral health content were organizational/government standards and patient populations. Barriers to including behavioral health training included organizational culture and lack of time. Advanced Education in General Dentistry and General Practice Residency programs need to make greater efforts to include in their curricula training on behavioral health conditions, particularly anxiety disorder, depressive disorder, eating disorders, and intimate partner violence.

Personality traits and risk of posttraumatic stress disorder among dental residents during COVID-19 crisis.

Purpose/objectivesThe coronavirus disease 2019 (COVID‐19) pandemic has presented mental health challenges among healthcare professionals, including posttraumatic stress disorder (PTSD). Few studies have examined PTSD predictors in dental settings. This cross‐sectional study aimed to describe the relationship between personality traits and PTSD symptoms among US dental residents engaged in patient care during the pandemic.MethodsAn online survey was administered to residents in advanced education in general dentistry, dental anesthesia, general practice residency, oral and maxillofacial surgery, and pediatric dentistry programs between September 2020 and April 2021. The survey included a sociodemographic questionnaire, the Big Five Inventory, and the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Logistic regression models, analysis of variance, and Tukey tests were used to examine the association between variables and PTSD scores and assess differences in personality traits and PTSD by specialty.ResultsAmong 149 respondents (mean age = 29.9 ± 4.9 years; 57.0% female), 53.7% reported experiencing stress during the pandemic. Many residents (38.9%) were not aware of available mental health resources. A total of 17.4% of residents met the diagnostic criteria for PTSD, but only 1.3% reported a previous PTSD diagnosis. The most significant predictors of PTSD were neuroticism (odds ratio = 2.90, p = 0.046) and stress unrelated to the resident's program role during the pandemic (odds ratio = 5.88, p = 0.02).ConclusionsPTSD symptoms were highly prevalent among dental residents, with stress and neuroticism being the most significant predictors.

Comparison of clinical competency self-assessments among Advanced Education in General Dentistry (AEGD) residents before and during COVID-19 pandemic.

Purpose/objectivesSelf‐assessment of clinical competence is an important tool for effective learning and training for some educational programs. The New York University (NYU) Langone Hospital's Advanced Education in General Dentistry (AEGD) Program has had its residents complete self‐assessment of clinical competency evaluations for many years. The evaluation is used to understand the residents’ perception of their own clinical skill upon beginning the program and to determine the necessary resources to provide to the residents for them to meet program standards. The same evaluation is completed by the residents 6 months later to determine if they perceived advancement in their clinical performance while in the program. Dental education, along with other fields of education was disrupted by the coronavirus disease 2019 (COVID‐19) pandemic. The purpose of this study was to examine the impact of COVID‐19 on clinical competency self‐assessments among the NYU Langone AEGD residents before and during the pandemic.MethodsIn this cross‐sectional study, data was collected from two AEGD cohorts representing 2019–2020 and 2020–2021 academic years; from July 2019 (n = 196) to January 2020 (n = 189) and July 2020 (n = 202) to January 2021 (n = 184). The self‐assessment evaluations were administered via an online residency management platform on the first days of July and January of the academic year. The survey consisted of 48 questions on “clinical skills and performance” as established by CODA standards for postdoctoral general dentistry programs.ResultsSurvey response rate was 100% for both cohorts. When comparing results, the findings indicate the COVID‐19 pandemic had interrupted clinical learning during dental school. However, training through the AEGD program led to improvements in perceived clinical competence by the residents in mid‐program evaluation.ConclusionThe self‐assessment evaluation can be used as a tool to enhance training as part of the AEGD program's performance improvement plan.

Oral medicine education in predoctoral programs in US dental schools.

the purpose of the study was to explore the structure of oral medicine (OM) education in predoctoral dental programs in the United States and to evaluate the students' perception of OM as a dental specialty. Two anonymous Qualtrics surveys (Qualtrics, Provo, UT, USA) were distributed electronically to the academic deans of all the Commission on Dental Accreditation (CODA) accredited dental schools in the United States. Upon completing the survey, the academic deans were asked to forward the student surveys to their students. Note that 26.8% (18/67 dental schools) of academic deans that participated in the survey, 224 senior students responded to the student survey. The results showed that the median number of OM specialists involved in teaching OM to predoctoral students was two. Oral cancer screening and diagnosis and management of oral mucosal diseases were identified by the majority of respondents (95.7%; n=214 and 96.5%; n=216), respectively, as part of the scope of practice of OM specialists. Although most students reported Advanced Education in General Dentistry (AEGD) and General Practice Residency (GPR) (18.67% n=42 each) as postgraduate specialties of interest, students' positive impression in OM increased by a crude average of 0.4 with each additional OM faculty member in the school (p=0.000; 95% CI 0.207-0.594). OM faculty members are in an important position to enhance dental students' perception and interest in OM as a specialty, which would lead to improved awareness of the scope of the specialty and consideration of pursuing specialty training.

Effectiveness of online training of first and second year AEGD residents in identifying, referring, and managing patients at-risk for substance use and opioid disorders.

Dentists have contributed greatly to the opioid epidemic, dispensing roughly 8.6% of opioids totaling over 18 million prescriptions in a 12-month period from July 2016 to June 2017 and report educational gaps regarding screening techniques for substance misuse and an unfamiliarity with available referral resources. The purpose of this study was to determine the knowledge and comfort level of residents in identifying, referring, and managing patients who are at risk for opioid use or substance use disorder in the dental setting before and after an online case-based training course. Thirty-five first year (PGY1) and 11 second year (PGY2) advanced education in general dentistry (AEGD) residents participated in an online training course that aimed to assess knowledge in the domains of identifying, referring, and managing patients at risk for substance abuse disorder and opioid use in an academic setting. There were nine subdomains within the three major domains that further assessed resident comfort and knowledge. Before and after training, data were collected and analyzed. Analysis of the results indicated that (1) the training modules increased resident comfort in identifying (p=0.011), referring (p=0.032), and managing (p=0.002) patients at risk for opioid substance use. (2) PGY1 residents benefited more than PGY2 residents in identifying (p=0.034) and the manage domains (p<0.001). (3) Residents viewed the module quality, usefulness, and applicability favorably. Further analysis of the nine subdomains is presented. Our study suggests that dental curricula would benefit from incorporating training of residents in identifying, referring, and managing patients at risk for substance use disorder and opioid use.

What non-clinical factors influence the general dentist\u2013specialist relationship in Canada?

BackgroundThe general dentist–specialist relationship is important for effective patient care and the professional environment. This study explores the non-clinical factors that may influence the general dentist–specialist relationship in Canada.MethodsA cross-sectional web-based survey of a sample of general dentists across Canada was conducted (N ≈ 11,300). The survey collected information on practitioner (e.g., age, gender, years of practice) and practice (e.g., location, ownership) factors. Two outcomes were assessed: not perceiving specialists as completely collegial and perceiving competitive pressure from specialists. Binary and multivariable logistic regression analysis was conducted.ResultsA total of 1328 general dentists responded, yielding a response rate of 11.7%. The strongest associations for perceiving specialists as not completely collegial include being a practice owner (OR = 2.15, 95% CI 1.23, 3.74), working in two or more practices (OR = 1.69, 95% CI 1.07, 2.65), practicing in a small population center (OR = 0.46, 95% CI 0.22, 0.94), and contributing equally to the household income (OR = 0.47, 95% CI 0.26, 0.84). The strongest associations with perceiving medium/large competitive pressure from specialists include having a general practice residency or advanced education in general dentistry (OR = 2.00, 95% CI 1.17, 3.41) and having specialists in close proximity to the practice (OR = 2.52, 95% CI 1.12, 5.69).ConclusionPractitioner and practice factors, mostly related to business and dental care market dynamics, are associated with the potential for strained relationships between general dentists and specialists in Canada. This study points to the need for dental professional organizations to openly discuss the current state of the dental care market, as it has important implications for the profession.

Context matters: Integration of social determinants of health in AEGD and GPR curricula.

To examine the integration of social determinants of health (SDH) in the US Advanced Education in General Dentistry (AEGD) and General Practice Residency (GPR) programs. This study used an explanatory sequential mixed-methods approach. A 46-question survey was sent to all 265 AEGD and GPR programs in February 2019. Descriptive statistics and multivariate analyses were conducted to identify factors influencing SDH curricular inclusion. A convenience sample of program directors (PDs) was interviewed between June and December 2019. Through content analysis, themes and subthemes were identified. Of the 265 AEGD and GPR PDs, 111 completed the survey (42% response rate). Almost three-quarters of PDs (72%) agreed that it was important for residents to understand basic SDH concepts. However, programs lacked eight of the 10 surveyed SDH subtopics. The odds of teaching five or more SDH subtopics were 0.09 (95% CI: 0.02-0.41) for programs with none-to-minimal levels of SDH integration in their clinical settings compared to close-to-fully integrated ones. Coding of PD interviews (N=13) identified five major themes: 1. influences to integrate SDH, 2. training strategies, outcomes, and outputs, 3. reasons for training strategies, 4. barriers and solutions, and 5. future integration goals. Most PDs cited delivering SDH content during patient care and reported time and organizational culture being barriers to more curricular inclusion. AEGD and GPR curricula are deficient in SDH content and risk underpreparing residents for caring for the underserved. PDs and organizational leaders must prioritize SDH inclusion in order to train dentists for integrated person-centered care.

An evaluation of the geriatric dental curricula within Advanced Education in General Dentistry and General Practice Residency programs in the United States.

To compare the geriatric dentistry curricula between Advanced Education in General Dentistry (AEGD) and General Practice Residency (GPR) programs. A 108-item survey was developed to assess residents' didactic and clinical experiences pertaining to geriatric patients. Surveys were mailed in 2018 to all AEGD (N=89) and GPR (N=180) program directors. Statistical analysis consisted of descriptive and bivariate analyses with the chi-square test, Fisher's exact test, and the Wilcoxon rank sum test (alpha=.05). Twenty-four AEGD and fifty-eight GPR directors completed surveys (response rate=30%). Seventy-one percent of responding programs reported mandatory didactic training pertaining to frail and functionally dependent geriatric adults. Ninety-nine percent of respondents reported that residents provided treatment to geriatric patients; however, they were less likely to perform procedures on frail and functionally dependent patients. Only 15% of respondents provided nursing home care. Considering all patient encounters, responding GPR programs were more likely than AEGD programs to treat patients using IV bisphosphonates (63%vs 25%; P<.01), undergoing chemotherapy (48%vs 16%; P=.02), and undergoing head and neck radiation therapy (55%vs 25%; P=.02). A majority of responding AEGD and GPR programs reported providing educational experiences pertaining to geriatric patients; however, GPR programs reported treating more medically complex patients than AEGD programs.

The development and implementation of a training program for pediatric dentistry residents working with patients diagnosed with ASD in a special needs dental clinic.

Oral health care is the most prevalent unmet health care need among all U.S. children age 17 and under in the U.S., and this includes those with special health care needs (SHCN). Children with SHCN experience unique barriers to receiving oral care including challenging behaviors, inadequate insurance coverage, and a lack of trained dentists. Despite the need for specialized training to successfully provide dental care to children with SHCN, few dental programs offer the necessary educational preparation. The Nova Southeastern University College of Dentistry was funded by the Health Resources and Services Administration to prepare pediatric and Advanced Education in General Dentistry (AEGD) dental residents in the care of children, adolescents, and adults with SHCN. The purpose of this paper is to describe the didactic and clinical training program and to provide data on the program's impact.

Success, clinical performance and patient satisfaction of direct fibre-reinforced composite fixed partial dentures - a two-year clinical study.

To evaluate the success, clinical performance and patient satisfaction of directly placed fibre-reinforced composite (FRC) fixed partial dentures (FPDs) in 2 years. One hundred sixty-seven FRC FPDs (120 subjects) were directly fabricated to restore a single missing tooth by six Advanced Education in General Dentistry (AEGD) residents. The FRC FPDs recipients were randomised into two groups according to the fibre materials (pre-impregnated glass or polyethylene). Clinical performance was evaluated at baseline (2 weeks), 6, 12 and 24 months by two calibrated evaluators for prosthesis adaptation, colour match, marginal discoloration, surface roughness, caries and post-operative sensitivity using modified United State Public Health Service (USPHS) criteria. Prosthesis appearance, colour, chewing ability and overall satisfaction were evaluated by patients using a visual analogue scale (VAS). Kaplan-Meier estimation was used to estimate the prosthesis success. Ninety-four patients with 137 FRC FPDs returned (21·67% attrition rate for study subjects, 17·94% for FRC FPDs). Seventeen FRC FPDs failed, due to one-end (n = 4) or two-ends (n = 4) debonding or pontic fracture (n = 9). The cumulative 2-year success rate was 84·32% and survival rate was 92·7%; there were no statistically significant differences between the groups according to different missing tooth location, retention type or fibre materials (P > 0·05). Patient satisfaction regarding prosthesis appearance, col-our, chewing ability and overall satisfaction was rated high on the VAS (mean >80 mm) for all criteria at all time points. The FRC FPDs (restoring single tooth) fabricated by AEGD residents achieved acceptable success and survival rates in a 2-year follow-up.

Training Needs for General Dentistry Residents to Place and Restore Two‐Implant‐Retained Mandibular Overdentures

Implant therapy is rapidly becoming a standard of care for replacing missing dentition. Predoctoral dental curricula include some training in the implant restorative phase but offer limited exposure to the surgical phase, so it is important for postdoctoral general dentistry residency programs to provide competency training in all phases of implant therapy. The aim of this study was to determine the training needed for general dentistry residents to achieve competence in this area, specifically by defining the number of clinical experiences necessary in both the surgical and prosthetic phases of implant-retained mandibular overdenture construction (IRMOD). Fifteen Advanced Education in General Dentistry (AEGD) residents at one academic dental institution placed two implants in a total of 50 patients with edentulous mandibles and subsequently restored them with IRMOD. The supervising faculty member and the residents evaluated the competency level on a five-point scale after each implant placement and prosthetic case completion. According to the faculty evaluations, the residents achieved surgical competence after placing two implants in four to six cases and prosthetic management competence after restoring two to four cases of IRMOD. All 50 patients were satisfied with the treatment outcomes of IRMOD. This study concluded that general dentistry residents could potentially achieve competence in both the surgical and prosthetic phases of implant therapy while enrolled in an AEGD program.

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AEGD Programs: Why Now, Why More?

With an increased number of dental schools graduating more dentists, along with the opening of new dental schools throughout the United States, more graduating dental students are considering utilizing Advanced Education in General Dentistry (AEGD) programs as a means to increase their understanding of the complexity of modern dentistry and to gain additional training and experience before heading into practice. This position paper describes how these programs can aid in transforming the face of dental education to address the needs of graduates and best educate the next generation of dental professionals. Its purpose is to examine reasons why dental students are choosing to participate in AEGD programs and to support a call for additional programs. An online survey of current AEGD residents was conducted to investigate reasons why they chose to enter this specific postgraduate opportunity. This position paper will also discuss how AEGD programs can be an effective training mechanism to address problematic issues such as access to care and dental licensure. Interest in AEGD programs will continue to rise, and this paper provides support for the expansion of such programs.

Pre‐ and Postdoctoral Dental Education Compared to Practice Patterns in Special Care Dentistry

There has been limited research into the impact of predoctoral experiences and postdoctoral general dentistry residencies on the practice patterns of dentists in the care of patients with special or complex needs. This study was undertaken to determine if educational experiences with special populations had a relationship to practice patterns after graduation or residency. University of the Pacific alumni who graduated between 1997 and 2007 were surveyed regarding their pre- and postdoctoral dental education and their practice patterns for the care of patients categorized as medically compromised, frail elders, and developmentally disabled. Definitions for each patient category were provided. Alumni were asked about their practice setting and postdoctoral education. Thirty-one percent (n=526) of those surveyed responded. Regression analyses showed respondents not in private practice were more likely to have completed a postdoctoral general dentistry program (Advanced Education in General Dentistry or General Practice Residency) after dental school compared to respondents in private practice (p<0.001). Across all age groups, respondents not in private practice treated significantly more patients with developmental disabilities than those in private practice (p<0.001). Respondents not in private practice treated more medically compromised patients younger than age sixty-five compared to respondents in private practice (p<0.01). Interestingly, those in private practice treated significantly more patients over sixty-five who were also classified as medically compromised (p<0.05). Pacific alumni who completed postdoctoral training in general dentistry were found to practice more often in non-private practice settings. Alumni in non-private practice settings reported treating a higher percentage of medically compromised patients below age sixty-five than their counterparts in a typical private practice. The pre- and postdoctoral experiences of treating special needs populations appear to have a relationship to graduates' practice setting and patient population.

A Collaboration to Enhance Oral Health Care for Survivors of Domestic Violence: Women's Domestic Violence Shelters and Nova Southeastern University's College of Dental Medicine

Nova Southeastern University College of Dental Medicine (NSU-CDM) has developed a program to educate its Advanced Education in General Dentistry (AEGD) residents to provide oral health services to survivors of domestic violence. NSU-CDM worked in collaboration with three community-based sites in Florida's Dade and Broward counties that provide residential and outpatient services to women survivors of domestic violence. The educational program includes didactic instruction and clinical rotations utilizing portable dental equipment assembled at the community-based sites. The central element of the program was the establishment of a partnership between NSU-CDM and local community-based organizations that serve women who have experienced domestic violence. This collaboration enabled the school to involve a range of key stakeholders in program development and implementation and to successfully establish dental clinics at two shelter sites. In total, NSU-CDM provided dental care to over 250 women, and twenty AEGD residents completed both the didactic and clinical rotations of the domestic violence education program. Elements identified as being essential to successful collaborations between oral health clinics and shelter settings are described.

Advanced Dental Education Programs: Status and Implications for Access to Care in California

Primary care residencies in dentistry include general practice residency and advanced education in general dentistry--collectively known as postdoctoral general--dentistry and pediatric dentistry. These primary care programs are the most likely to serve underserved populations during the training experience. An expansion of primary care dental residency positions in California has the potential to positively impact access to care in California. However, there are significant political and financial barriers to realizing this potential.