North American Dental Schools Research Articles

"OPERATIVE DENTISTRY: The Vanishing Discipline," a reprint with Foreword.

"OPERATIVE DENTISTRY: The Vanishing Discipline," a reprint with Foreword.

Economic and Clinical Impact of Digitally Produced Dentures.

Digital denture technology has been gradually moving to the mainstream of dentistry over the last 25 years. Implementation of a four-step system utilizing in-house CAD/CAM milling technology may create cost savings for the clinical program in a dental university setting. An analysis was completed to evaluate the cost savings, if any, of fabricating complete dentures digitally versus traditionally through an outside lab. A large clinic at a North American dental school began fabricating digital dentures in 2019 utilizing the four-step Ivoclar system. A combination of 3D printing and CAD/CAM milling produced multiple denture products used in the steps of the digital process, including the final milled complete denture. A significant cost savings was achieved, both in terms of material cost and in chair time cost when compared to traditional laboratory fabricated complete dentures. A large clinic at a North American dental school introduced digital denture technology into the student clinical experience. This digital technology has created a cost-saving benefit when fabricating digital dentures. Using 3D printing for the preliminary steps resulted in substantial cost savings. Fewer visits to complete the denture fabrication steps, along with fewer postinsertion visits, added further savings. Patient satisfaction with the digital denture process has been consistently high, as has student and faculty satisfaction with the final product.

Prerequisites in Behavioral Sciences and Business Revisited a Decade Later: Ongoing Opportunities for Dental Education

Introduction: Ten years ago a study reported on the lack of prerequisites in behavioral sciences and business management for entry into dental college. The primary objective of this follow-up study was to assess the current status of similar prerequisite courses in both U.S. and Canadian dental schools. Materials and Methods: Required and recommended courses in behavioral sciences and in business in each North American dental school’s official online publication were analyzed in December 2019. Admissions requirements were readily available in sixty-five of the sixty-eight U.S. dental schools and in all ten schools in Canada; three U.S. schools were contacted by phone to collect the information. Result: Only nine (13.2%) U.S. and four (40%) Canada schools required at least one behavioral sciences course; however, thirty-nine (57.3%) U.S. and six (60%) Canada schools recommended a behavioral sciences course, most often in psychology, sociology, or communication. Zero (0%) of the total seventy-eight dental schools required a course in business; however, eighteen (26.5%) U.S. and two (20%) Canada schools recommended a business course, most often economics. Conclusion: The authors strongly encourage the dental education community to again reconsider establishment of a minimum core of behavioral sciences and business courses as prerequisites in predoctoral dental education. Doing so will provide a much needed stronger foundation upon which to build upon in the curricula of dental schools.

A Comparison of Undergraduate Prosthodontic Teaching of Removable Partial Dentures in Saudi Arabian Dental Colleges with North American and Turkish Dental Schools.

ABSTRACTObjectives:To meet the needs of society, it is obligatory to provide standardized skill training to undergraduate students in dental colleges. Surveys related to teaching curriculum are valuable means to evaluate education across the country. The aim of this study was to find the trends in the undergraduate teaching curriculum, by determining the differences in the teaching methods and principles of fabrication of removable partial dentures in dental colleges in Saudi Arabia and to compare these with the curriculum of North American dental schools and Turkish dental schools.Materials and Methods:An online survey was conducted in 23 dental colleges of Saudi Arabia. Descriptive data analysis was performed to synopsize the information.Results:Eighteen out of 23 (78.23%) dental colleges of Saudi Arabia answered the questionnaire; 88.9% of the colleges follow the practice of using custom trays for making final impressions; and 44.4% of the colleges use only polyvinyl siloxane for making final impressions. Semiadjustable articulators were commonly used for mounting study casts (61.1%) and master casts (66.6%). An in-house production laboratory is present in 72.2% of the colleges. Cobalt–chromium alloy is used in 94.4% of the colleges for the framework. A set protocol for postinsertion adjustment visits is followed in 94.4% of the colleges.Conclusions:Dental colleges of Saudi Arabia have similar standards of removable partial denture education at the undergraduate level, with variations in a few aspects. Removable partial denture teaching programs of Saudi Arabian dental colleges are comparable to similar programs in dental schools of the United States and Turkey.

Characterization of school of dentistry prerequisite courses and recommendations for admission.

There is minimal research characterizing admission prerequisites courses across schools of dentistry. The purpose of this study was to typify didactic and laboratory course requirements and compare requirements based on institution demographics. In July 2019, the researchers evaluated websites from 76 North American dental schools to collect information on required and recommended courses, credit hour requirements, and institution demographics. Sub-group analyses evaluated differences in course and credit hour differences based on institution funding, degree program, location, and Carnegie Classification. The most common required courses were general chemistry (97.4%), physics (93.4%), organic chemistry (92.1%), general biology (90.8%), communication (86.8%), and biochemistry (80.3%). The most common required laboratory courses were general chemistry (63.2%), organic chemistry (59.2%), general biology (55.3%), and physics (51.3%). Several institutions included unique course recommendations such as histology (40.7%), psychology (30.3%), art (18.4%), business (18.4%), sociology (15.8%), and embryology (14.5%). There were few differences based on institution classifications; however, differences were observed most often between institutions within and outside the United States. The study also identified 65.8% (n=50) of schools have letter of recommendation requirements and 46.1% (n=35) of schools require or recommend shadowing experiences with programs requesting a median of 60hours (range 20-300hours). The study offers a contemporary characterization of prerequisite requirements and recommendations. In addition, the study raises critical questions about whether these standards reflect expectations for entering learners, if these requirements truly relate to learner success, and if these requirements prepare learners to be future-ready graduates.

Introducing legislative advocacy into the dental school curriculum: A mixed-methods evaluation.

The aim of this project was to evaluate a legislative advocacy exercise in pediatric dentistry at 1 North American dental school. A mixed-methods approach was employed using focus groups and questionnaires. All third-year dental students (n=84) participated in an exercise as part of the pediatric dentistry course. Participation in the program evaluation was voluntary. Questionnaires were administered to assess students' advocacy beliefs, behaviors, self-efficacy, and knowledge 1 week before and 1 week after the exercise. Six months later, a focus group with questionnaire non-respondents (n=9) was conducted to explore participants' attitudes and beliefs about oral health advocacy within the dental school curriculum. The focus group followed a semi-structured guide, and transcripts were analyzed using thematic content analysis. Questionnaires were returned from 27 students before (33% response rate) and 23 students (28% response rate) following the advocacy exercise. Students' advocacy beliefs, behaviors, and knowledge showed no change, whereas self-efficacy improved following the advocacy exercise. Students enjoyed the advocacy exercise and viewed it as a positive addition to the curriculum; however, they requested more exposure to advocacy across the curriculum. Students described the power of their collective voice rather than a single person as a major driver of policy change. These findings suggest that curricular changes should incorporate experiential advocacy activities more frequently to help students learn about and gain advocacy skills.

Assessment of Digital Workflow in Predoctoral Education and Patient Care in North American Dental Schools.

Technology has revolutionized the field of dentistry, and digital workflow has become commonplace in everyday dental practices. However, are future practitioners prepared to enter into an increasingly digitized world? The aim of this study was to determine the extent to which digital modalities were being taught to predoctoral dental students and used for patient care in dental schools throughout North America. A 35-question survey was sent in February 2019 to all 76 dental schools in the U.S. and Canada. After 90 days, 54 recorded responses were received, for a 71% response rate. Students were reported to be using CAD/CAM technology in 50 (93%) of the 54 responding schools. While almost all schools responding to the survey were using digital scanning, there was disparity among them in terms of the types and frequency of procedures for which digital impressions were utilized. This study found that the incorporation of CAD/CAM technology in predoctoral dental curricula varied widely. However, it was clear that the relative dearth of well-trained faculty members and the number of CAD/CAM units available to students limited its use. It is imperative that more emphasis is placed on the utilization of digital workflow in North American dental schools for future practitioners to practice contemporary restorative dentistry.

Preclinical Competency Testing in North American Dental Schools and Opinions About Possible Standardization.

In the U.S., the Commission on Dental Accreditation (CODA) requires that dental schools use competency-based assessments and standardized levels of proficiency to ensure that students are prepared for patient care after graduation. No such comprehensive standardized preclinical testing is required in the CODA standards. The aim of this study was to determine the use of preclinical competency assessments for students transitioning from preclinical to clinical education in North American dental schools and respondents' perceptions of the need for standardization in preclinical testing. An electronic survey was sent to the academic deans of all 76 U.S. and Canadian dental schools in July 2018 asking if the school used competency exams to assess preclinical students prior to entering patient care and, if so, about the type of tests and disciplines tested, student remediation, and reasons for revisions. The survey also asked for the respondents' perspectives on potential preclinical assessment standardization. Respondents from 28 U.S. and two Canadian schools participated in the survey, for a 39.5% response rate. The majority (92.3%) of respondents said their school considered preclinical competency assessments to be good indicators of students' readiness for transitioning into patient care, yet 40.0% reported their schools had no comprehensive preclinical testing, and 13.8% had no preclinical testing in endodontics, periodontics, prosthetics, or restorative dentistry. Regarding type of comprehensive preclinical assessment used, 71.4% reported using typodont-based exams, 46.4% used written comprehensive exams, and 42.9% used objective structured clinical examinations (OSCEs); respondents could select all that applied on this item. Of the respondents whose schools had preclinical competency assessments, 72.4% had a review mechanism in place to evaluate its effectiveness. Overall, this study found that 60% of the participating schools had some form of preclinical testing, but there were no agreed-upon competencies to determine preclinical dental students' readiness for safe patient care in their clinical education.

Disinfection Trends of Dental X-ray Machines in North American Dental Schools

Introduction: This study evaluates the trends in the disinfection of the dental X-ray machines in North American dental schools. The methods of disinfection were compared to the Centers for Disease Control (CDC) guidelines. Materials and Methods: A survey posed the question of whether plastic barrier wrap, bag, disinfecting wipes, or a combination were used for infection control of the tube head. Additional information was gathered from the dental schools’ infection policy guides and clinic manuals available online. Results: Of the forty-two Canadian and US dental schools surveyed, 24% used disinfectant wipes, 19% used bags, 19% used plastic surface barriers, and 38% used a combination. Conclusion: The majority of schools used a combination of the three methods, and all institutions abided by the CDC guidelines. As bags are more cumbersome to use with a rectangular collimator, wipes and barriers are arguably better methods to disinfect the X-ray tube head.

Examining the Case for Dental Hygienists' Teaching Predoctoral Dental Students: A Two-Part Study.

Dental students in North American dental schools are exposed to faculty members with various professional backgrounds. These faculty members may include dentists, dental hygienists, and scientists without clinical dental credentials. The practice of dental hygienists' educating predoctoral dental students has not been well documented. The aims of this two-part study were to investigate the parameters of didactic, preclinical, and clinical instruction of dental students by dental hygienist faculty members in North American dental schools and to explore dental students' perceptions of this form of teaching. In part one, a survey was sent electronically to the clinical or academic affairs deans of all 76 American Dental Education Association (ADEA) member dental schools in 2017. Twenty-nine responded, for a 38.2% response rate. In 76% of the responding schools, dental hygienists were teaching dental students. Most respondents reported that, in their schools, the minimum degree required to teach didactically was a master's, while a bachelor's degree was required for preclinical and clinical courses. There was no significant association between dental hygienists' instructing dental students and having a dental hygiene educational program at the institution. In part two of the study, a questionnaire was completed by 102 graduating dental students (85% response rate) at one U.S. university to evaluate the impact of dental hygienist educators. Among the respondents, 87% reported feeling that dental hygienists were very effective educators. There were no significant differences in responses between traditional and advanced standing international dental students. This study found that dental hygienists were educating dental students in many North American dental schools and were doing so in curricular content beyond periodontics and that their educational contributions at a sample school were valued by the dental students there.

Have Women Broken the Glass Ceiling in North American Dental Leadership?

In the last few decades, the number of women graduating from North American (NA) dental schools has increased significantly. Thus, we aimed to determine women's representation in leadership positions in NA dental and specialty associations/organizations, dental education, and dental journals, as well as the proportion of men/women researcher members of the American Association for Dental Research (AADR). We contacted NA dental associations to provide us with the total number and the men/women distribution of their members. Men/women distributions in leadership positions were accessible from the internet, as were data on the sex of deans of NA dental schools. Data on the editors in chief of NA dental journals were gathered from their websites, and the AADR provided the number and sex of its researcher members. Collected data underwent descriptive statistics and binomial tests (α = 0.05). Our findings suggest that women are underrepresented in leadership positions within the major NA dental professional associations. While the median ratio of women leaders to women members in professional associations is 0.91 in Canada, it is only 0.67 in the United States. The same underrepresentation of women is evident in the leadership of the Canadian Dental Association and the American Dental Association. We found that women are underrepresented as deans and editors in chief for NA oral health journals. Only 16 of 77 NA dental school deans are women, while 3 of 38 dental journals have women editors in chief. The probability of finding these ratios by chance is low. However, the number of women dental researcher AADR members underwent an overall increase in the past decade, while the number of men declined. These results suggest that, despite the increase in women dentists, it will take time and effort to ensure that they move through the pipeline to senior leadership positions in the same manner as their male colleagues.

The Teaching of Personalized Dentistry in North American Dental Schools: Changes from 2014 to 2017.

The aim of this study was to assess the development of personalized dentistry in the curricula of North American dental schools from 2014 to 2017. In 2014, a web-based survey on personalized medicine/dentistry (PM/PD) was distributed to academic deans of all U.S. (n=65) and Canadian (n=10) dental schools with graduating classes. The results (n=42; 56% response rate) showed that few schools had plans for implementation of PM/PD at the time, even though the majority of respondents reported feeling that PM/PD should be taught in the curriculum and will impact clinical practice in the future. A three-year followup survey in 2017, sent to the same 75 schools, was designed to reassess the teaching/practice of PM/PD in dental schools in both didactic and clinical curricula. In the results of the 2017 survey (n=30; 40% response rate), the majority of respondents reported feeling that PM/PD should be taught in dental curricula. However, while most respondents indicated their schools did not teach PM/PD as a portion of their didactic curricula, they reported that specific pertinent PM/PD topics were taught as part of other courses in their curricula. The 2017 survey also evaluated the use of seven genetics-based and eight non-genetics-based PM/PD diagnostics in the schools' clinical curricula. Overall, non-genetics-based diagnostics were used more often than genetics-based diagnostics, and the use of genetics-based diagnostics was more prevalent in postgraduate than predoctoral clinics. Personalized dentistry will inevitably be part of the dental professional's future and should be reflected in basic science research, clinical settings, and dental school curricula in both predoctoral and postgraduate programs.

Qualifications and Characteristics North American Dental Deans Seek in Department Chairpersons

The aim of this study was to determine whether deans of North American dental schools perceived that one category of department chairperson skills (leadership or management) was more important than the other for their chairpersons to be successful. A secondary purpose was to determine the professional qualifications and personal characteristics these deans perceived contributed most to the success of department chairpersons and whether those differed by the research emphasis of the school. An email survey was sent in 2016 to all 75 deans of U.S. and Canadian dental schools with graduating classes. Section one of the survey was an open response section asking deans to list the five most essential characteristics of a successful department chairperson. Section two asked deans to rank the importance of eight listed professional qualifications, and the last section asked deans to rate the importance of four leadership and four management traits that could contribute to the success of their chairpersons. Questions about characteristics of the deans and the schools were also included. A response rate of 46.7% was obtained. The most frequent characteristics listed in the open response section were in the categories of vision, academic expertise, and integrity. The three most highly ranked professional qualifications were previous teaching experience, previous administrative experience, and history of external research funding. Four of the eight professional qualifications were ranked differently by deans of high compared to moderate research-intensive schools (p<0.05). Overall, the respondents rated leadership skills more highly than management skills (p=0.002) as important for departmental chairpersons.

Methods and Purposes for Conducting Students' Course Evaluations Reported by North American Dental School and Dental Hygiene Program Leaders: A Preliminary Survey Study.

The aim of this preliminary survey study was to determine the perceptions of leaders of dental schools and dental hygiene programs regarding methods of and purposes for conducting students' course evaluations and their role in course improvement, curriculum design, and faculty assessment. A short electronic survey was distributed in 2016 to the academic deans of all 76 dental schools in the U.S. and Canada and a convenience sample of program directors of 232 of the total 332 accredited dental hygiene programs. Individuals from 93 institutions responded for an overall response rate of 30%: 30 of 76 dental schools (39.5% response rate) and 63 of the 232 dental hygiene programs (27% response rate). All of the respondents (100%) reported that their institutions' full-time faculty members were assessed by students in course evaluations for each course and semester they taught. However, only 78% reported that their part-time faculty members were evaluated by students. Course evaluations were mandatory in 62% (n=58) of the responding institutions, with the remaining 38% (n=35) optional. Respondents indicated course directors received the evaluation results for purposes of annual review (n=73, 78%) and instructional review (n=70, 75%). Further investigation of the use and effects of student evaluations is needed to better understand their role in faculty assessment and other aspects of the administration of dental schools and dental hygiene programs.

A Survey of Dental Implant Instruction in Predoctoral Dental Curricula in North America.

The aim of this study was to investigate the extent and forms of predoctoral implant dentistry instruction in North American dental schools and to identify future directions and challenges. The survey collected data on curriculum content, departmental oversight, techniques, and materials, as well as current problems to be solved. The 30-question survey was sent in 2012 to the dean or administrator in charge of the predoctoral curriculum of all 73 dental schools in the U.S. and Canada at the time; four reminders were sent. Forty-seven schools responded, for a response rate of 64%. Of the 47 responding schools, 46 (98%) offered didactic instruction (mean of 17 hours); 87% had a laboratory component (mean of 14.46 hours); and 57% had a clinical requirement. In the responding schools, students had an average of 1.85 implant restorative cases and 0.61 surgical cases. Forty-two of the schools (89%) had implemented observation of implant surgery and/or assisting with implant surgery in their curricula. Major challenges reported in implementing a comprehensive predoctoral implant curriculum included expense of implant systems to the schools and to patients, shortage of predoctoral cases, and lack of curriculum time and trained faculty. These results show that implant education for predoctoral dental students continues to expand, with a trend towards more preclinical exercises and clinical experiences and fewer didactic courses.

Humanism in Dental Education: A Comparison of Theory, Intention, and Stakeholder Perceptions at a North American Dental School.

In today's dental education environment, a humanistic culture is an expectation for all U.S. dental schools, codified in 2013 by its inclusion in the Commission on Dental Accreditation's standards for accreditation. The University of the Pacific Arthur A. Dugoni School of Dentistry has made an active commitment to humanism since the mid-1970s. The aim of this study was to determine how well the school's students and faculty and staff members perceived the school was living up to its formal aspirational values and who was benefitting from the humanistic culture. Using an electronic survey, data were collected from a total of 195 students, faculty members, and staff members in 2014. Respondents were 15% of the 492 full- and part-time faculty members; 9% of the total student population of 540; and 29% of 255 staff members. In the responses, humanism was described as manifest by attributes such as caring, understanding, respect, and compassion. Although the findings confirmed the value of a humanistic culture, some portions of the school's formal definition and goals, such as good work ethic, professional responsibility, high ethical standards, increasing independence, and attainment of competence, appeared less frequently in responses. Authentic assessment of institutional culture proved challenging. Focus groups offered additional ways to assess how effectively the school lives its core value of humanism. There was recognition that more varied, robust methods were needed to assess institutional alignment with stated goals for a humanistic learning environment.

Exploring Faculty Knowledge and Perceptions of Copyright at U.S. Dental Schools: A Pilot Study

The aims of this pilot study were to investigate current copyright training and support provided to faculty at North American dental schools and to examine faculty members' knowledge and attitudes related to specific copyright issues. In 2015, a survey with questions about faculty members' comfort about their own and their colleagues' knowledge and application of various copyright issues was designed and distributed. True/false questions were asked to determine the extent of knowledge about copyright. Participants were given eight scenarios depicting examples of behavior related to copyright issues and asked to indicate whether the behavior in the scenario was ethical or unethical and compliant with or infringing upon copyright. A total of 104 participants completed the survey, all at U.S. dental schools; the numbers in the non-faculty groups were small, so the analysis was limited to the 61 faculty respondents (approximately 0.5% of U.S. dental faculty members in 2015). The results showed that these dental faculty members were less confident in their colleagues' knowledge and application of copyright and fair use than they were in their own knowledge and application. Both knowledge and attitude were found to be important factors in the respondents' decision making related to copyright and fair use, although it appeared that in some contexts faculty members relied on either knowledge or attitude more strongly than the other. A large percentage (88%, n=53) said they would be open to receiving additional training in copyright from their institution. Faculty development on this topic should address attitudes about the ethics regarding application of copyright law in addition to providing factual information and should emphasize what is permissible under current copyright law rather than simply discussing actions that constitute violations.

Teaching New Materials and Techniques for Fixed Dental Prostheses in Dental Schools in the United States and Canada: A Survey.

Tooth-supported fixed dental prostheses (FDPs) remain an extensive therapeutic option, with new materials and a digital fabrication process gradually replacing traditional methods. The variety of advances calls for dental schools to expand the teaching of this field. Our aim was to examine the nature and the amount of theoretical and practical training in clinical FDP courses, and the extent to which new methods and innovations in the field are being integrated. Data were collected using an online questionnaire including theoretical and practical teaching regarding clinical courses, restorative materials, and new fabrication methods, which was sent to 58 dental schools in North America. A total of 36 schools responded to the survey for a response rate of 62.1%. All the schools teach theoretical and practical porcelain-fused-to-metal (PFM) restorations, and almost all the schools teach full-metal FDPs. In more than half (57.1%) of the schools, zirconia-based FDPs are placed by students. Students place partial veneer FDPs in less than one-fifth (17.9%) of the schools. The average number of restorations required for completion of the clinical course is 7.3 FDP units. The respondents assessed that of the total FDPs placed by students in the clinical course, tooth-color coping (zirconia/alumina/porcelain) FDPs constituted 16.2%. None of the schools produce computer-assisted design/computer-assisted manufacturing copings or crowns within the school. All North American dental schools include teaching and placement of PFM restorations in their curriculum, but only one-third teach ceramic-based crowns. The low average number of required crowns may lead to graduates not being exposed to and trained in up-to-date dental restorative materials and techniques.

Physiology Education in North American Dental Schools: The Basic Science Survey Series

As part of the Basic Science Survey Series for Dentistry, members of the American Dental Education Association (ADEA) Physiology, Pharmacology, and Therapeutics Section surveyed directors of physiology courses in North American dental schools. The survey was designed to assess, among other things, faculty affiliation and experience of course directors, teaching methods, general course content and emphasis, extent of interdisciplinary (shared) instruction, and impact of recent curricular changes. Responses were received from forty‐four of sixty‐seven (65.7 percent) U.S. and Canadian dental schools. The findings suggest the following: substantial variation exists in instructional hours, faculty affiliation, class size, and interdisciplinary nature of physiology courses; physiology course content emphasis is similar between schools; student contact hours in physiology, which have remained relatively stable in the past fifteen years, are starting to be reduced; recent curricular changes have often been directed towards enhancing the integrative and clinically relevant aspects of physiology instruction; and a trend toward innovative content delivery, such as use of computer‐assisted instruction, is evident. Data from this study may be useful to physiology course directors, curriculum committees, and other dental educators with an interest in integrative and interprofessional education.

How Neuroscience Is Taught to North American Dental Students: Results of the Basic Science Survey Series

The purpose of this study was to determine how North American dental students are taught neuroscience during their preclinical dental education. This survey represents one part of a larger research project, the Basic Science Survey Series for Dentistry, which covers all of the biomedical science coursework required of preclinical students in North American dental schools. Members of the Section on Anatomical Sciences of the American Dental Education Association assembled, distributed, and analyzed the neuroscience survey, which had a 98.5 percent response from course directors of the sixty-seven North American dental schools. The eighteen-item instrument collected demographic data on the course directors, information on the content in each course, and information on how neuroscience content is presented. Findings indicate that 1) most neuroscience instruction is conducted by non-dental school faculty members; 2) large content variability exists between programs; and 3) an increase in didactic instruction, integrated curricula, and use of computer-aided instruction is occurring. It is anticipated that the information derived from the survey will help guide neuroscience curricula in dental schools and aid in identifying appropriate content.