Community-Based Dental Education Research Articles

Impact of coronavirus disease 2019 pandemic on dental student's performance across disciplines during community site rotations: A comparative analysis.

The coronavirus disease 2019 (COVID-19) pandemic disrupted educational frameworks worldwide, particularly affecting health professions education. The impact on students varied based on local pandemic severity, public health policies, and institutional capacities. Our observational, retrospective study evaluated the impact of the COVID-19 pandemic on senior dental students' performance during community rotations at Indiana University School of Dentistry. Data from student self-assessments and faculty evaluations, collected as part of the Community-Based Dental Education (CBDE) course between 2018 to 2022 was utilized. Five key domains of patient care: diagnosis and treatment planning, clinical skills, time management, interprofessional collaboration, and professionalism was assesed using a 5-point Likert scale. Pre- and post-pandemic comparisons of self-reported student evaluation and faculty assessment scores were conducted using two-sample t-tests, with ANOVA used to analyze cohort differences. Significant declines were observed in mean scores for diagnosis and treatment planning, clinical skills, time management, and interprofessional collaboration during the post-COVID period compared to pre-COVID levels (p<0.05). Conversely, an increase in average scores related to students' professionalism was noted, although this difference was not statistically significant (p>0.05). Class cohort-wise analysis showed similar patterns, with all cohorts experiencing significant declines in the aforementioned areas (p<0.05) and non-significant increases in professionalism scores (p>0.05). This study findings underscore the challenges faced by dental education in adapting to pandemic-induced disruptions and highlight the importance of adaptive approaches and support systems to address these challenges. Moving forward, resolving disparities in assessments and comprehending the various factors influencing student performance will be crucial to preserving the adaptability and effectiveness of dentistry education in the face of adversity.

HIV/AIDS-Associated Knowledge and Attitudes towards Treating Disadvantaged Communities among Pre-Community-Based Dental Education Dental Students in the U.S.

This study examines HIV/AIDS-associated knowledge and attitudes towards treating disadvantaged communities among predoctoral dental students in U.S. dental schools who have not yet commenced their Community-Based Dental Education (CBDE) training. It also compares the difference in the knowledge and attitudes between students with reported community engagement with PLWHA and those without. Our study comprised 89 predoctoral dental students within their D1-D3 years of dental school who had not yet initiated their Community-Based Dental Education (referred to as pre-CBDE dental students). Their responses were collected via an online survey. The participants were 68% females, 94% heterosexual, and with a mean age (years) of 25.9 ± 3.5 SD. The majority (62%) were in their first (D1) and second (D2) years of dental education. Of the thirty knowledge questions, only five received a minimum of 90% correct responses. Similarly, we found no statistical differences in most of the knowledge/attitude sections between those with and without prior PLWHA exposure. Encouragingly, 90% of our participants reported prior experience working with disadvantaged communities. Early community engagement fosters a sense of professional responsibility towards administering dental care to disadvantaged communities and we propose that it must be encouraged among aspiring dental school students.

Challenges in implementing community-based dental education programs in Australia: The lived experiences of program coordinators.

The benefits of community-based dental education (CBDE) are well documented and reach far beyond students' educational growth, encompassing advantages for both dental schools and their community partners. Nonetheless, barriers associated with administering CBDE programs can have a significant impact on program outcomes. This study aims to explore the challenges faced by dental school CBDE coordinators in implementing and managing their programs. This Interpretive Phenomenological study employed in-depth semi-structured interviews with CBDE program coordinators from Australian dental schools (n=6). Interviews, conducted between February and May 2023, via Microsoft Teams, were audio and video recorded and lasted an average of one hour each. Interviews were analyzed using NVivo 13. Questions explored administrative challenges, required resources, student management issues, and development goals for CBDE programs. Data analysis included deductive and inductive coding through a seven-step iterative process, organizing information into codes and sub-codes, forming emerging themes. Four major themes with subthemes emerged: 1) Program administration, encompassing challenges in scheduling, coordinating, and adapting to changes; 2) Funding, crucial for establishing and maintaining remote educational sites; 3) Student experience management, highlighting student supervision, student behavior, and exposure; and 4) Partner site relationships, particularly in clinical supervisor recruitment and training. The successful implementation requires meticulous planning, effective coordination, and recognition of CBDE as an educational activity that should be grounded in evidence-based pedagogy. Dental institutions are therefore encouraged to establish collaborative partnerships with local community organizations, allocate resources for outreach initiatives, and facilitate appropriate guidance to coordinators, students, and external clinical supervisors.

Community-based dental education in Iranian dental schools

BackgroundCommunity-based dental education (CBDE) has been an essential advancement in dental education in recent decades, enhancing it in many aspects. This study aimed to determine the characteristics and improvements of CBDE in dental schools in Iran.MethodsIn the present descriptive study, an electronic questionnaire, including 18 “yes/no”, “multiple choice”, and “short answer” questions about the nature and extent of CBDE and students’ experience in CBDE, was used. In early 2021, the questionnaires were mailed to the deans of all 43 dental schools in Iran under the supervision of the Council for Dental Education of the Iranian Ministry of Health and Medical Education. Reminder calls were made after 6 and 12 weeks. Dental schools that did not follow the CBDE program were excluded. The responses were analyzed descriptively.ResultsThirty-six dental schools completed the questionnaire (response rate: 84%). Seventeen schools (47%) reported having CBDE in their dental program. Sites lacking a well-equipped dental setting were the most used out of all extramural sites. The number of weeks dedicated to CBDE ranged between 1 and 20 (median: 4). The most common dental procedures practiced in extramural sites were pediatric dentistry (100%), restorative dentistry (71%), and dental examination (59%). The student-to-supervisor ratio in CBDE ranged between 3 and 15 (median: 5). In most schools (65%), the staff involved in directing CBDE were Community Oral Health PhDs.ConclusionsAn increasing number of Iranian dental schools have integrated CBDE into their undergraduate dental curriculum. The characteristics and extent of this educational strategy vary widely among dental schools. CBDE can be more effective by making positive changes in dental programs.

Student and clinical supervisor perceptions of community-based dental educational experiences: A scoping review.

This scoping review was conducted to map the breadth of experiences in community-based dental education (CBDE), as reported by students and clinical supervisors. This scoping review was conducted following the structured framework proposed by Arksey and O'Malley and adhering to PRISMA-SCR guidelines for scoping reviews. Applying specified eligibility criteria, a systematic search of four electronic databases (PubMed, Scopus, Embase, and Web of Science) was followed by data extraction and data synthesis of full-text articles. Research was conducted between June 2022 and September 2022. Sixteen articles were identified for the final full-text review. Utilizing a narrative thematic review, the following five domains emerged: preparation for autonomous practice, understanding of primary care dentistry, understanding of health disparities and patient needs, clinical confidence, clinical diversity, and skill development, and perspectives on quality of teaching and assessment. Community/outreach dental education effectively supplements traditional dental school-based education from the perspectives of students and community-based clinical supervisors.

Community-Based Dental Education (CBDE): A Survey of Current Program Implementation at Australian Dental Schools.

Community-based dental education (CBDE) diverges from traditional dental school training methods by integrating dental students into primary care community settings. This immersive approach enables students to refine their clinical and hands-on skills while serving the oral health needs of underserved populations. This study aimed to identify ways in which Australian dental schools are currently implementing CBDE and compared to current evidence. This study utilized a 24-item, self-completion survey, adapted from existing questionnaires, which was sent to the CBDE coordinators in the nine eligible dental programs in Australia between mid-January 2023 and mid-April 2023. The survey consisted of multiple-choice, binary, and open-ended questions, including information on the level of student involvement, types of external clinics used, length of rotations, student supervision and assessment, pre-rotation preparation, and post-rotation evaluation, as well as challenges faced in implementing programs. Six of the nine invited coordinators responded, resulting in a 66.7% response rate. All participants confirmed that their schools had a community-based teaching program. All six respondents reported that participation in external clinics is required for graduation. Implementation of CBDE appears to be influenced by (1) level of student involvement, (2) the types of clinics utilised, (3) allocation and length of rotation, (4) student supervision and assessment, (5) pre-rotation preparation, and (6) post-rotation evaluation. Six (n = 6) institutions reported requiring a post-rotation reflection from students and all respondents reported seeking feedback from clinical supervisors at external sites. Emerging themes from open-ended questions highlight challenges in coordinating external rosters, securing funding, supervising students at external sites, and ensuring diverse types of student exposure during external rotations. This study provided insights into the implementation of CBDE in Australian dental schools. Results outlined in this research offer valuable insights for dental schools aiming to enhance their programs and improve student learning outcomes.

'The dental nurse played a vital role in helping to manage the patient': a thematic analysis of undergraduate dental students' reflective journals from outreach placements.

Introduction Community-based dental education, or 'outreach', forms a key part of dental courses in some high-income countries. Its educational benefits are well-established and once graduated, participants feel better prepared for their early career. Yet, it is less clear what students actually learn while on placements.Materials and method Qualitative document and thematic analysis of a convenience sample of anonymised dental student reflective journals (n = 51).Results The reflective journals described varied and broadly positive learning experiences. Analysis identified a number of themes of learning. Most related to the process and outcomes of care, but two key themes - dental anxiety and teamworking - were interrelated with both. Within teamworking, dental nurses appeared important in students' learning. Three process interrelated themes of learning were identified in the data. These were: tailoring your approach; communication and time; and evidence-based dentistry and minimising risk. Two broad interrelated themes relating to outcomes for patients and students were also identified: trust and confidence; and professionalism and personal development.Conclusion This research identified important and potentially transformative learning from outreach placements. This included how dental anxiety impacts patients and the dental team, the importance of teamworking, and the role of dental nurses in students' experiential learning.

Foreign-trained dentists' reflections on access to care after participating in a community-based dental education curriculum.

Many people suffer poor oral health due to dentists not providing care to them. The number of foreign-trained dentists in the US is increasing, yet little is known about their involvement in providing care to underserved populations. Dental education programs use community-based dental education (CBDE) to expose dental students to access to care issues, and encourage them to provide care to underserved populations upon graduation. The aim of this study was to assess foreign-trained dentists' attitudes about access to care issues after completing a CBDE course at a dental school in the Midwest. Fifty-two dentists participated in the CBDE program from 2018 to 2019, as part of an advanced standing curriculum, and completed guided, reflective essays. Forty-seven dentists agreed to have their essays anonymously coded for research. Four researchers reviewed the essays independently, developed a coding scheme, and recoded to agreement. The main themes dentists mentioned were the affect of the CBDE program on enhancing their clinical skills, fostering an awareness of healthcare system inadequacies, as well as an awareness of how specific social determinants limit access to care, and helping to encourage a sense of personal and professional responsibility to address access to care issues. This study highlights the value of CBDE on helping future dental providers learn about and reflect on access to care issues. It also provides insight into foreign-trained dentists' attitudes about access to care issues, and supports their participation in CBDE programs to foster their contributions in addressing access to care issues in the US.

Financial assessment of the community-based dental education program at the Indiana University School of Dentistry.

There is a gap in access to oral health services for millions of Americans residing in health professional shortage areas. The community-based dental education program at the Indiana University School of Dentistry is an innovative model that aims to improve access to oral health services in rural underserved Indiana. With this study, our goal was to assess the financial implications of the program over a period of 3 years (2018-2021). Proxy estimates for the revenue generated by students at the community clinic sites were calculated and compared against the implementation costs of the program as well as revenue lost by the school during the rotation period. Descriptive statistics were used to assess the quantitative impact of the program over the 3 years. The total of 7460 patients who were offered care as part of this program were mostly from the uninsured group or were covered under Medicaid. According to our cost-benefit analysis which was conducted during the peak of the coronavirus disease 2019 (COVID-19) pandemic, the total revenue of $1,777,097 was generated by students at the community sites through the 3-year period. The revenue generated was still more than the dollar amount invested in running the program, given the timeline of the study was when elective services were mostly suspended. We conclude community programs like these have an impact beyond the dollar value; they can be modeled to be cost-effective, improve access to oral health services for millions of Americans in underserved settings and at the same time provide a great learning experience for dental students.

Community dental health coordinators' role in community-based pediatric dental education.

The University of Alabama at Birmingham (UAB) School of Dentistry utilized a Community Dental Health Coordinator (CDHC) to transform a community-based dental education rotation into a positive learning experience for senior dental students. Based in a county health department's Women, Infant, and Children's (WIC) clinic and dental clinic, the initial rotation before implementation of the CDHC was received poorly by students and community partners. This paper reports how CDHC involvement improved student experiences with pediatric patients. In 2018, the CDHC embedded in the WIC clinic where student rotations occur and developed relationships with the community partners to identify key issues. The CDHC then implemented qualitative improvements, including a restructured workflow, preparatory educational modules, and assessment systems to address the issues. Student performance reports, focus group discussions, and a postgraduation questionnaire provided data for evaluation of performance. By year 3, dental appointments for patients under age 6 increased, resulting in 95% of UAB students seeing this age patient; 74% completed four or more. Three-quarters of students reported performing restorative procedures on children. Student and community partner acceptance of the rotation also improved. Postgraduation questionnaires (32% response rate) indicate 35% of graduates continue to treat Medicaid patients after graduation. The CDHC's unique skills in community relationship-building, community-based dental screenings, and pediatric dental care coordination produced measurable improvements in community participation and student clinical experiences. The CDHC can be a vital part of dental education, especially in community education settings. Community-based dental education generated measurable improvements in students' clinical experiences.

Students’ viewpoints on a community-based dental education course in an Iranian faculty of dentistry: A conventional content analysis study

Background : Community-based dental education helps nurture a generation of dentists who pay more attention to community needs. The purpose of this qualitative study was to explore the viewpoints of dental students about a community-based dentistry course conducted at the Dental School of the Kurdistan University of Medical Sciences in Sanandaj. Methods: In all, 36 senior dentistry students provided children aged 6 to 14 from an underprivileged background with care and preventive services under the indirect supervision of a dental instructor. At the end of the course in May 2018, individual and group interviews were conducted to obtain students’ viewpoints on the course. The collected data was categorized and analyzed using MAXQDA 10. Testing of acceptability, dependability, stability, verifiability, fittingness and transferability criteria were applied to evaluate the accuracy and reliability of the qualitative data. Results: The results were categorized into two main themes: weaknesses and strengths of the clinical experience. Four main categories of the course’s strengths were identified: personal development, deeper understanding of oral health in the community, becoming familiar with executive and managerial systems, and payment and financial issues. Three main categories of the course’s weaknesses were identified: executive problems, issues around coordination and planning, and limiting coverage of the dental services provided to Levels I and II. Conclusion: The most important aspects of these courses from the students’ viewpoints were providing the opportunity to individual and professional development and gaining a broader perspective on preventive dentistry.

Preparedness of dental under-graduate students towards practicing endodontics in rural and remote areas of India.

Background:Undergraduate students can provide valuable opinions and suggestions for modifying the educational program for the enhancement of learning. Therefore, the aim of this study was to explore the preparedness of undergraduate dental students with regard to practice endodontics in the rural and remote areas of India.Materials and Methods:The present cross-sectional questionnaire-based study was conducted among dental undergraduates (interns). The survey was conducted among the students of 3 private dental colleges. For the data collection, a close-ended questionnaire was designed to test the knowledge for performing endodontic therapy, root canal therapy (RCT), attitude, and behavior of performing these procedures in the rural set-ups. Unpaired t test and one way analysis of variance (ANOVA) was used to compare the significant difference based on demographics and Pearson's correlation was applied to find the associations among knowledge, attitude, and behavior of study participants. The level of significance was set at below 0.05.Results:A total of 79 students participated, out of which 22 respondents were males (27.8%), and 57 were females (72.15%). Overall mean knowledge scores for endodontics was 9.72 ± 2.19, and the scores of female students were slightly higher than males, whereas the attitude and behavior were better in males but there was no statistical significant difference between both the genders (P > 0.05). A statistically significant positive correlation was observed between attitude and behavior on practicing endodontics in rural settings among study subjects (P < 0.05).Conclusion:These findings highlights the necessity for taking initiatives to enhance the community-based dental education programs by various dental colleges for improving oral health care access for rural and isolated populations.

Dental Students' Non-Clinical Learning During Community-Based Experiences: A Survey of U.S. Dental Schools.

Dental schools use community-based dental education (CBDE) to ensure students gain experience in treating diverse and underserved patient populations. However, it is unclear to what extent schools utilize CBDE experiences to increase students' knowledge of structural factors impacting access to care. The aim of this study was to determine the level and types of non- clinical learning included in CBDE experiences and how that learning is being assessed across U.S. dental schools. This cross- sectional analysis used an 18-item questionnaire distributed to associate deans and CBDE directors at all 66 U.S. dental schools. The questions focused on rotation structure, CBDE objectives, and didactic content for CBDE programs. Representatives from 31 schools-public (71%) and private (29%)-responded, for a 44% response rate. The primary objectives for the community-based rotations were reported to be demonstrating cultural competence in diverse clinical settings (93.1%), addressing access to care (86.2%), and diagnosing and treating oral diseases (75.9%). Of the respondents, 73% reported that their schools supported clinical experiences with non-clinical didactic course work, which addressed access to care (95%), professional responsibility (91%), social determinants of health (86%), the U.S. health care system (77%), health policy (73%), practice management (73%), motivational interviewing (50%), and public presentation training (32%). The results suggest that U.S. dental schools are using CBDE rotations to provide didactic content and assessing students on their knowledge of access to care, social determinants of health, interprofessional practice, and oral health policy. These important aspects of students' education provide additional evidence of the value of CBDE in dental education.

Dental Students' Intent to Practice in Rural Communities Before and After Community-Based Rotations in a Rural Area.

Community-based dental education (CBDE) has the potential to positively impact the educational process in a manner that both contributes to educational outcomes and shapes the learner's behavior. The aim of this study was to determine the correlation between dental students' intended practice location and the size of their hometown and to assess any impact their CBDE rotation in a rural location had on practice location intention. From March 7, 2016, to August 12, 2018, fourth-year students at one U.S. dental school were invited to complete a ten-item questionnaire prior to and after their four-week clinical rotations at a rural clinic. Of the 123 dental students on rotation at the clinic during this time, 106 completed the pre-rotation survey and 112 the post-rotation survey, for response rates of 86% and 91%, respectively. Prior to the rotation, 58.6% selected one of the rural locations as an ideal practice location, and that percentage increased slightly to 61.4% after the rotation; the difference was not statistically significant (p=0.984). The results did show a significant increase from pre to post rotation for women intending to practice in rural communities (p=0.0413). This study found that students' intent to practice in a rural location was not significantly affected by a clinical rotation in a rural clinic; however, there was strong evidence that students from rural communities intended to practice in rural communities after graduation.

Influence of Community-Based Dental Education on Practice Choice: Preliminary Data from East Carolina University.

Maldistribution of the dental workforce contributes to poor access to oral health care. Community-based dental education (CBDE) may help to address this problem by using experiential learning to encourage new dentists to practice in underserved areas. The East Carolina University School of Dental Medicine (East Carolina University SoDM) employs a multifaceted strategy, including CBDE, to increase the number of dentists practicing in underserved areas of North Carolina. The aim of this study was to assess the influence of CBDE and other factors on practice choice among East Carolina University SoDM graduates. This cross-sectional study assessed practice intentions before and after a senior-year CBDE experience. Data were obtained for students in three graduating years from written student reflections and self-reported practice plans solicited at graduation. Of the total 156 students between 2015 and 2017 (52 each year), all students participated in at least one component of this evaluation: all students (100%) completed required student reflections, and 148 (95%) provided pre-graduation practice plans. Data were also obtained on alumni practice characteristics via a survey of recent graduates; 72 alumni (46% response rate) participated in the alumni survey. The assessments found positive attitudes towards the CBDE program before and after participation, although areas for improvement relating to business management and financial viability were reported. The majority of alumni respondents (67%) remained in the state to practice after graduation, with half reporting practicing in rural areas. For most alumni respondents (>75%), debt, salary, benefits, type of patient population, and desire to own/run a business were important factors other than the CBDE program influencing their practice choice. Nearly half of them (45.8%) rated desire to work in a public health setting as an important factor. This study provides preliminary evidence of the effectiveness of this educational model in retaining new dentists within the state to address the critical shortage of dentists in North Carolina.

Benefits and Challenges of Partner Site Engagement with Community-Based Dental Education Programs: The Partner Sites' Perspectives.

The aim of this qualitative study was to examine the perspectives of key personnel at partner sites providing community learning experiences to dental students to gain more understanding of the effects that community-based programs have on the sites themselves. Fourteen semi-structured interviews were conducted in 2015 with individuals from nine extramural sites. Interviewees had a range of roles from clinicians to CEOs, with six also reporting they were faculty preceptors. Three of the researchers developed a coding scheme focused on the benefits and challenges that community sites experience from participating in a community-based dental education (CBDE) program. Each coder then reviewed the interview transcripts independently before final group discussions and recoding to agreement. The main themes related to benefits were recruiting future dentists, staying current with clinical developments, sites' indirectly improving their missions by exposing students to broader roles of oral health providers, raising awareness regarding the need for dentistry in community settings, and nurturing a positive workplace environment. The main themes related to challenges were balancing education and training for students with clinical demands, communication with the university, and managing distinctive clinical and professional characteristics of students. This study's participants reported that the main benefit of CBDE for partner sites was dentist recruitment. The study also provided insights for both partner sites and dental schools to consider when developing and maintaining these partnerships.

Assessing Dental Students' Readiness to Treat Populations That Are Underserved: A Scoping Review.

In North America, all dental schools have adopted some form of community-based dental education (CBDE) or service-learning, but little is known about the areas being researched and reported in published studies. The aim of this study was to conduct a scoping review to determine what areas of research had been conducted to determine the effects of CBDE on dental students' readiness to treat populations that are underserved. A systematic search of articles published in English or French since 2000 was performed on July 29, 2015, and combined quantitative and qualitative synthesis of data was conducted. Of the 32 studies evaluated, 23 (72%) were quantitative, seven (22%) were qualitative, and two were multi-method. The majority (66%) used self-report methods, most frequently surveys. Participants in 50% of the studies were fourth-year dental students; the others assessed third- and fourth-year (13%), first- and second-year (6%), and first-year (13%) students. Dentists were the participants in three studies (9%), with dentists and students in one study (3%). Either the types of populations receiving care were unspecified or four or more groups were pooled together in 25 studies (78%), while two focused on children, one on rural populations, one on elderly populations, two on persons with special health care needs, and one on low-income populations. The study areas were wide-ranging, but generally fell into three categories: student performance (37.5%), teaching approaches and evaluation methods (37.5%), and perceptions of CBDE (25%). This review identified many research gaps for determining whether students are prepared to treat populations that are underserved. The disparate nature of CBDE research demonstrates a compelling argument for determining elements that define student readiness to care for patients who are underserved and for research that includes the voices of patients, curriculum development, and more comprehensive and rigorous evaluation methodologies.

Care Provided by Students in Community-Based Dental Education: Helping Meet Oral Health Needs in Underserved Communities.

Since 2000, reports have documented the challenges faced by many Americans in receiving oral health care and the consequences of inadequate care such as high levels of dental caries among many U.S. children. To help address this problem, many dental schools now include community-based dental education (CBDE) in their curricula, placing students in extramural clinics where they provide care in underserved communities. CBDE is intended to both broaden the education of future oral health professionals and expand care for patients in community clinics. The aim of this study was to develop a three-year profile of the patients seen and the care provided by students at extramural clinics associated with one U.S. dental school. Three student cohorts participated in the rotations: final-year students in the Doctor of Dental Surgery, Bachelor of Science in Dental Hygiene, and Master of Dental Therapy programs. The study was a retrospective analysis of data retrieved from the school's database for three consecutive academic years. The data included patients' demographics and special health care needs status (based on information collected by students from their patients) and procedures students performed while on rotations. For the three-year period, the results showed a total of 43,128 patients were treated by 418 student providers. Approximately 25% of all encounters were with pediatric patients. Students completed 5,908 child prophylaxis, 5,386 topical fluoride varnish, and 7,678 sealant procedures on pediatric patients. Annually, 7% of the total patients treated had special health care needs. The results show that these students in CBDE rotations provided a substantial amount of oral health care at extramural sites and gained additional experience in caring for a diverse population of patients and performing a wide range of procedures.

Impact of Community-Based Clinical Training on Dental Students' Confidence in Treating Pediatric Patients.

With a significant need for more general dentists to provide care for pediatric patients, previous studies have found that community-based clinical training experience with children increased dental students' willingness to provide care to pediatric patients after graduation. The aim of our study was to determine the impact of community-based clinical training with pediatric patients on dental students' self-perceived confidence in treating pediatric patients, both overall and related to specific procedures. Of the total 105 fourth-year dental students at one U.S. dental school invited to participate in the study in academic year 2011-12, 76 completed the survey about their community-based dental education (CBDE), for a 72% response rate. Over half of the respondents (55%) reported feeling more confident in treating pediatric patients after their rotations. The increase in confidence was not associated with demographics. The placement of sealants (p=0.0022) and experience in giving local anesthesia (p=0.0008) were the two procedures most strongly associated with the increase in confidence. Also, these students received more experience in pulp therapy, extractions, and treating children up to three years of age during their community-based rotations than in the school-based clinic. In this study, greater exposure to pediatric dental clinical experiences during CBDE increased the students' confidence in treating pediatric patients. These results suggest that community-based experiences are useful in supplementing the school-based pediatric clinical experience, including increasing entry-level dentists' confidence in treating pediatric patients.

A Reflection Curriculum for Longitudinal Community-Based Clinical Experiences: Impact on Student Perceptions of the Safety Net.

Community-based dental education (CBDE) allows dental students to be immersed in community settings and provide care to populations that are underserved. Exposure to those groups during training may impact provider attitudes, which may be strengthened by supporting students' reflection and exploration of their own attitudes. The aim of this study was to describe the implementation and preliminary results of a pilot longitudinal reflection curriculum integrated into a community-based clinical experience (CBCE) for senior dental students at one U.S. dental school and to report the impact of the reflection curriculum and CBCE on student experiences with populations that are underserved. In academic year 2015-16, all 35 senior dental students at one U.S. dental school were invited to complete an 11-item survey before and after completing a 12-week CBCE with integrated, longitudinal online reflections. Students received feedback from a faculty member after each reflection. All 35 students completed the survey, for a 100% response rate. After the CBCE, the students reported improved clinical efficiency and increased confidence in treatment planning and in treating dental emergencies and dentally anxious patients. They also reported improved understanding of the structure and relevance of community health centers, the role of different health care team members, and the impact of health policy. There was no significant difference in future plans to work with groups that are underserved. These results suggest that the CBCE and reflection curriculum had a positive impact on the students' clinical confidence as well as expanding their understanding of the broader oral health care delivery system. To address persistent oral health disparities, dental schools should continue to adopt CBDE programming that will prepare providers to effectively care for populations that are underserved.