US Dental Research Articles

Variation in response to the coronavirus disease 2019 (COVID-19) at US dental school clinics.

Although the threat of coronavirus disease 2019 (COVID-19) was the same at different US dental schools, the response wasn't. There is no study that documents the variation in mitigation strategies, COVID-19 transmission, and clinical educational changes at US Dental schools during the ongoing pandemic that began in 2020 in the US. The current study was approved as exempt research (project number HUM00199261). Our survey of Associate Dean's of Clinical Operations was individually emailed in July 2021. There were no reminders and descriptive statistics were calculated using Microsoft Excel. We received 46 completed surveys from the 68 sent out. Note that 65.2% of respondents reported requiring N95 masks for aerosol-generating procedures. Note that 38.9% of respondents said they required student partnering as chairside dental assistants for aerosol-generating procedures. Note that 37.7% of respondents began using alternate cubicles. A total of 6.52% of schools reported a transmission of the severe acute respiratory syndrome coronavirus 2 virus from patient to provider. There were no reported transmissions from provider to patient or from patient to patient. In our study, we found a lot of similarities between the approach taken by Dental School Clinics across the US to mitigate the risks of COVID-19, however, we also observed many differences.

Prescription Opioid Pain Medication Use among Patients Attending a US Dental College Clinic: Prevalence and Implications

Purpose: Due to the increased opioids abuse in US during the past several decades, efforts have been made to counter this trend through regulation of use of prescription opioid pain medications. This study assesses the use of these medications by adult dental patients attending a US dental college clinic during February 2017 to October 2021. Methods: A self-administered anonymous questionnaire was used to gather data from patients on demographics and patterns of utilization of medications. Results: Among the patients included in the study, the majority were 51 to 70 years of ages, females, Caucasians, and with minimum high school education. Nine prescription opioid medications were used, and of these, hydrocodone and oxycodone were more common. Most patients used single medications, of which the majority were utilized for a few days up to 4 weeks. Nearly all medications were prescribed by 10 different health profession specialists, and the majority comprised emergency medicine physicians, primary health care practitioners and dentists. Most patients used their medications as intended, without sharing with others, and also expressed their satisfactions with the medications they used. Conclusions: The study suggests that the recently reported opioid epidemic in US is less related to use of prescription medication, but to other external factors, including the non-medical use of potent synthetic compounds, such as fentanyl, as widely reported in the literature. Such a recognition, while warranting further studies on the topic, provides additional justifications for enhanced focus on this aspect of opioid abuse.

Evaluation of Comprehensive COVID-19 Testing Program Outcomes in a US Dental Clinical Care Academic Setting

Although many academic institutions have implemented infection control and prevention protocols, including regular asymptomatic self-testing, in response to the COVID-19 pandemic, the outcomes of mandatory surveillance testing programs at academic dental institutions that offer direct patient-facing clinical care has not yet been reported. To report the findings of a comprehensive surveillance COVID-19 testing program at an academic dental institution by assessing SARS-CoV-2 positivity rates and the potential association of test positivity with individual-level characteristics such as age, sex, and role. A retrospective cohort study was conducted using SARS-CoV-2 self-testing data from a mandatory surveillance program at the Harvard School of Dental Medicine. Test results obtained between August 24, 2020, and February 28, 2022, from students, faculty, and staff members were analyzed. Testing cadence varied from 1 to 3 times per week depending on risk status. The association of individual characteristics with test positivity was evaluated with univariate analyses and a bayesian multilevel logistic regression model. Age by decade, sex, and role or position category (staff members, faculty, and students stratified by their involvement in clinical care activities), testing cadence, and testing date. Positive results from SARS-CoV-2 real-time reverse transcription-polymerase chain reaction self-tests were assessed. Of the 390 study participants, 210 (53.8%) were women. Participants were grouped by age as follows: 20 to 29 years (190 [48.7%]), 30 to 39 years (88 [22.6%]), 40 to 49 years (44 [11.3%]), 50 to 59 years (42 [10.8%]), and 60 years or older (26 [6.7%]). Test results demonstrated an overall 0.27% positivity rate (61 test-positive cases), with a peak weekly positivity rate of 5.12% in the first week of January 2022. The mean (SD) test positivity rate among those involved in clinical activities was 0.25% (0.04) compared with 0.36% (0.09) among nonclinical participants. When adjusting for all considered covariates, test positivity was significantly associated with testing frequency (3 times vs 1 time per week: odds ratio [OR], 1.51 [95% credible interval (CrI), 1.07-3.69]) and timing of the test (after vs during the Alpha wave: OR, 0.33 [95% CrI, 0.11-0.88]; and Omicron vs Alpha: OR, 11.59 [95% CrI, 6.49-22.21]) but not with individual characteristics (age, sex, and role). These findings suggest that implementing an adaptive testing cadence based on the risk status of individuals may be effective in reducing the risk of SARS-CoV-2 infection within an institution. In this study, involvement in clinical activities did not pose additional risk of SARS-CoV-2 infection compared with other in-person activities in the presence of these control measures.

The US Dental Insurance System Prevents Care for the Whole Person

The US Dental Insurance System Prevents Care for the Whole Person

Introduction to this special issue.

Introduction to this special issue.

Current Implementation of Digital Dentistry for Removable Prosthodontics in US Dental Schools.

Objectives Although digital technology has been widely integrated into dental education, there is limited literature investigating the extent of the integration of computer-aided design and computer-aided manufacturing (CAD-CAM) for removable systems in the dental curriculum. The purpose of this study was to assess the current implementation of CAD-CAM complete and partial dentures in predoctoral (PP) and advanced graduate prosthodontic (AGP) education in US dental schools. The study also aimed to identify potential barriers to its implementation in the dental curriculum. Methods An online survey with 15 questions was created using online survey software. The survey was distributed to the directors of predoctoral prosthodontics in 56 schools and advanced graduate programs of prosthodontics in 52 schools listed in the 2018–19 American Dental Education Association (ADEA) Directory. Results The percentage of programs (PP and AGP) implementing CAD-CAM complete dentures (CAD-CAM CDs) and CAD-CAM removable partial dentures (CAD-CAM RPDs) in their didactic, preclinical, and clinical curricula was recorded. CAD-CAM CDs are taught in didactic courses in 54.2% of PP and 65.2% of AGP. However, CAD-CAM RPDs are only taught in 37.5% of PP and 47.8% of AGP. Programs are largely limited by a lack of funds, resources, time, and faculty members. Conclusion While digital technologies have indeed become more prevalent in dental education, many institutions face barriers to implementation. More research must be conducted in order to support the continued incorporation of digital technologies into dental education.

Alcohol use among US dental students: Results of a nationwide survey.

Substance use may be a consequence of dental student stress. Studies have examined the alcohol use among medical students, but there are fewer studies among dental students. The purpose of this study was to examine alcohol use in a large geographically diverse sample of US Dental Students. An anonymous web-based survey instrument was modeled after well-known surveys of college student substance use. Survey data collection used best practices for web-based surveys when possible. 2019 responses were collected with the cooperation of fifteen US dental schools (potential sample size: 6029; RR: 7.6%, n=463). 2021 responses were collected using the American Student Dental Association email list (potential sample size: 18,722; RR: 2.2%, n=424). Respondents came from all regions of the US. Thirty-day alcohol usage and binge drinking rates were somewhat higher among dental students than college-age students from other surveys. Women's 30-day prevalence of alcohol use was slightly higher than men, but binge drinking prevalence was greater among men. Prevalence of binge drinking was higher among white students, as was mean drinks per drinking occasion. Students who self-reported below average academic performance were more likely to report drinking to get away from problems and had a higher prevalence of some alcohol-related problems (ARPs). Despite the limitations of this study, the results are consistent with that of other studies. This study has provided some valuable insight into the prevalence of alcohol usage and ARPs among US dental students. Of special concern are the reasons for drinking as mechanisms for relieving tension and stress, which may continue into dental practice.

Oral Health Advocacy Education Impacts Future Engagement: Exploration at a Midwestern US Dental School.

Purpose: With the emergence of COVID-19, and the potential inclusion of dental benefits in Medicare, it is critical that dentists are able to engage in legislative advocacy to support public oral health. Dental education has an opportunity to teach advocacy skills to future dentists, although advocacy training in predoctoral dental education has been largely ignored. The purpose of this study was to evaluate fourth-year dental student's attitudes toward advocacy, identify the type and extent of advocacy experiences during dental school, and assess their future intentions to engage in advocacy.Methods: An electronic questionnaire was administered to fourth-year dental students enrolled in their final semester at Ohio State University.Results: Forty-seven students completed the survey (43% response rate). Most (84%) respondents agreed that advocacy training should be a required experience in accreditation standards for predoctoral dental education. Over half (58%) reported seldom or no exposure to legislative and regulatory processes in oral health policy development in the curriculum. Students who participated in grassroots advocacy efforts while in dental school were more likely to contact legislators regarding dental issues (p = 0.005) or public insurance (p = 0.037), and participate in future lobbying efforts (p = 0.019). Students who contributed to PAC while in dental school were more likely to express intentions to contribute in future (p = 0.005).Conclusions: There is limited exposure to legislative advocacy in predoctoral dental education. Dental students with advocacy experience are more likely to report intentions to participate in advocacy as dentists. Dental education has a critical role in preparing future dentist-advocates.

Opioid Prescription Trends in a US Dental School Clinic, 2014-2018: A Retrospective Study Using Electronic Health Record Data.

Opioid misuse and abuse continues to be a grave public health concern in the United States. The aim of this study was to use electronic health records (EHRs) from a US dental school clinic to retrospectively analyze trends in opioid prescription frequencies. A database review was conducted using EHR data from 20 patient care clinics in a dental school over a 5-year period during which local, state, and national policies and guidelines to mitigate harm from opioid misuse were introduced. University of Michigan School of Dentistry, state of Michigan. Descriptive statistics using measures of frequency and distribution of opioid prescriptions written were compared over a 5-year period by dental school clinic specialty, CDT (Code on Dental Procedures and Nomenclature) procedure, drug type, and patient age/gender. From 2014 to 2018, a total of 12 401 opioid-based prescriptions were written by dental providers in the school's patient care clinics. An ARIMA (autoregressive integrated moving average) model time trend analysis demonstrated a significant decrease in the number of prescribed opioids after 2016. While causal relationships cannot be drawn between drug abuse and prescription trends alone, this exploratory study provided a better understanding of prescription frequency patterns that can help monitor distribution of opioids and identify areas where future public health interventions may be needed. Dental education institutions have an obligation to ensure a competent health care workforce as well as unique opportunities to support regional and national public health strategies aimed at reducing misuse of opioids.

Assessing Campus Climate at a US Dental School

Purpose: A US dental school assessed its campus climate to improve diversity and inclusion as well as meet an accreditation mandate. Methods: Climate surveys for faculty (n=277), staff (n=351) and students (n=595) were developed and validated by the college IDEA committee. They were pilot-tested and administered in spring 2017. Findings: Response rates ranged from 50%-52%. Onequarter to one-third viewed themselves as a member of an underrepresented group. A consistent proportion of staff members (10-20%) disagreed that diversity was valued. All three groups reported having too much work to do (10-23%) and being overly stressed (18-29%), particularly students. Ten percent or more of the staff disagreed that they had interactions with college people. Faculty and students reported they frequently observed (5-10 times or more) the inappropriate expression of political beliefs. Only the staff (≥ 10%) reported uncivil and ostracizing behaviors occurring often. The majority of all three groups (≥ 60%) reported their physical health and emotional well-being as good or excellent. The majority of faculty and staff reported being satisfied with their job (≥ 78%) and liking to work at the College (≥ 83%). The majority of students reported being satisfied with their educational program (85%) and glad they attended the College (86%). Some sub-groups reported significantly lower health and satisfaction levels. A qualitative analysis of comments revealed that the primary theme for faculty and students was the campus climate was inclusive and positive. The primary theme for staff was the current climate was not inclusive, and they experienced inappropriate behaviors. Conclusion: This 2017 culture assessment revealed that the majority of College personnel and students believed the climate was inclusive and diversity was valued, with the staff being the least satisfied. A new Diversity and Inclusion Plan has been developed to address the problems identified.

The NIH’s Funding to US Dental Institutions from 2005 to 2014

This study examines funding from the National Institutes of Health (NIH) to US dental institutions between 2005 and 2014 based on publicly available data from the NIH Research Portfolio Online Reporting Tools. Over the 10-y span, 56 US dental institutions received approximately $2.2 billion from 20 Institutes, Centers, and Offices at the NIH. The National Institute of Dental and Craniofacial Research (NIDCR) is the largest NIH supporter of dental institutions, having invested 70% of the NIH total, about $1.5 billion. The NIDCR is also the primary supporter of research training and career development, as it has invested $177 million, which represents 92% of the total NIH investment of $192 million. Over the past 10 y, about half of the NIDCR’s extramural award dollars have gone to dental schools, while the NIH has invested about 1%. There has been an approximately 10% net decrease in extramural dollars awarded to dental institutions over the past decade; however, given the year-to-year variability in support to dental institutions, it is unclear if this net decline reflects a long-term trend. In addition, there was an overall reduction in the extramural dollars awarded by the NIDCR and by the NIH. For example, from 2005 to 2014, the total NIDCR budget for extramural research decreased by roughly 4%, which represents a decrease of $20 million to dental institutions. After adjusting for inflation, the decline in funding to dental institutions from the NIDCR and NIH was approximately 30%. Although the NIDCR and NIH continue to invest in dental institutions, if the current decline were to continue, it could negatively affect the research conducted at dental institutions. Therefore, we discuss opportunities for dental institutions to increase NIDCR and NIH support and improve their capacity for research, research training, and career development.

Data Collection for Adverse Events Reporting by US Dental Schools.

Accreditation of US dental schools requires a formal system of quality assessment of clinical adverse events (AE). There is no universal system to collect, record, interpret, or release findings or trends pertaining to AEs. The objective of this study was to compare similarities and differences among the AE reporting forms used at US dental schools. Sixteen (24%) dental schools responded to a query to provide copies of their AE forms. The forms were analyzed to identify unique AE items. A total of 69 unique AE items were identified, grouped, and ranked according to frequency. Methods of AE data collection were also noted. The forms were different in organization, form, and content. The 69 AE items represented a wide variety of information, with no standardization of the type of information, how it was collected, or by whom. We identified 9 most requested AE items and 4 least requested AE items. The schools differed in how the information was obtained: 2 schools used a menu, 8 schools used free response, and 6 schools used a hybrid of both methods. We found that dental school clinic AE reporting forms are not standardized in structure, organization, or content. We conclude that a hybrid form containing both guided responses and free responses would ensure that proper information is being reported to fully understand why/how an AE occurred. In addition, dental schools need to develop a standardized method of collecting and assessing AE data which will allow for quality improvement and increased patient safety.

Is There Uniformity and Satisfaction Among Clinical Practice Models and Faculty Compensation Plans in US Dental School-Based Oral and Maxillofacial Surgery Departments?

There is a lack of information regarding clinical practice models and faculty compensation plans used by dental school-based departments of oral and maxillofacial surgery (OMS) and their effectiveness. The purpose of this study was to examine 1) the level of uniformity in clinical practice models and faculty compensation plans for US dental school-based OMS departments and 2) the level of satisfaction expressed by faculty with their current compensation plan. A survey was sent to the chairs of the 40 US dental school-based OMS departments asking them specific information regarding their current practice model, the faculty compensation plan, and their satisfaction with their current plan. Twenty-four of the 40 department chairs returned the survey, for a 60% response rate. The OMS practice was part of the dental school faculty practice in 50% of the departments and a separate entity in 33%. The most common faculty compensation plan consisted of an academic salary plus a faculty practice salary based on a collection-based incentive (38%), but in 25% it was based on production. Fifty-seven percent of the responding chairs stated they were not satisfied with their current practice and compensation plans. There is considerable variation in the practice models and compensation plans in US dental school-based OMS departments. More than half the department chairs expressed a general dissatisfaction with their current compensation plans. The survey data indicate a need for alternative models, and this report presents one such model.

A Survey of Radiation Safety Practices at US Dental Schools

A Survey of Radiation Safety Practices at US Dental Schools

Sleep Medicine Education in US and Canadian Dental Schools: A Report of the Inaugural Dental Educators Conference at the University of North Carolina School of Dentistry

Sleep Medicine Education in US and Canadian Dental Schools: A Report of the Inaugural Dental Educators Conference at the University of North Carolina School of Dentistry

Faculty Positions

Faculty Positions

A Survey of US Dental Practices’ use of Social Media

Social media is becoming the way for businesses, including health care professionals, to communicate with consumers. The study examines the use of social media by dental practices in the US. An electronic survey was sent to 22,682 dentists in the United States. The survey consisted of questions related to the use of social media in the dental practice. Data was analyzed using descriptive statistics and comparisons were made using a Fisher's exact test. A total of 573 responses were received. Social media was used in 52% of dental practices, the most common being Facebook. The use of social media was most commonly for marketing purposes (91%). Dentists younger than 45 years old were more likely to use social media in their practice than dentists 45 years or older (p > 0.001). Dental practices actively use social media for marketing and communication. Many dentists are unsure how to measure the success of social media in their practice. Additional research is needed to measure the success of social media in a dental practice. Social media is a common way practices market and interact with their patients. There are some difficulties in determining what appropriate content for social media is and how to evaluate the success.

Total NIH Support to US Dental Schools, 2005-2009

This study compared total NIH research funding across US dental institutions from 2005 to 2009. Utilizing the online NIH RePORT, we obtained comprehensive award data for US dental schools by funding NIH Institutes/Centers (ICs). Fifty dental schools were awarded a total of $974.393 million, 69.3% from NIDCR and 30.7% from 21 other ICs. These provided the majority of support to 12 schools. Greater than 50% of non-NIDCR support came from 4 ICs. The median dental school NIH portfolio was $14.572 million, with a minimum of $0.241 million and a maximum of $88.609 million. Forty-six schools received $544.899 million for R01 awards. Thirty-five schools were awarded $100 million in research training and career development grants. Several dramatic differences are found for dental schools’ rankings based on total NIH dollars compared with NIDCR-only support. Dollars from ICs other than NIDCR increased 34.6% between 2005 and 2009. Grants to US dental institutions comprised 50% or less of total NIDCR awards globally from 2005 through 2009. Funds received from all NIH ICs are an objective metric for evaluation of the research performance of dental schools. NIDCR has played a diminishing role in funding research at US dental schools between 2005 and 2009.

Variability of Mechanical Torque‐Limiting Devices in Clinical Service at a US Dental School

The purpose of this study was to measure the variability of torque produced by a population of mechanical torque-limiting devices in clinical service in a US dental school. The torque-limiting devices were divided into two categories according to their mode of action: toggle-type and beam wrenches. Proper action of these devices is essential for calibrated delivery of preload to implant prosthetic screws. Seventeen torque-limiting devices (35 Ncm) were obtained from graduate prosthodontic, predoctoral, and faculty practice clinics. Nine of these were toggle-type devices, and eight were beam-type wrenches. Torque from each wrench was measured using an MGT electronic torque meter. Wrenches were tested in two modes, slow (over 4 seconds) and fast (over 1 second). Toggle-type torque wrenches produced a mean (+/- SD) torque of 38.1 +/- 16.0 Ncm; beam-type wrenches produced 32.8 +/- 1.1 Ncm. These results were not significantly different. When tested in fast mode (1 second), toggle-type wrenches produced 28.0 +/- 9.6 Ncm; in the slow mode (4 seconds) they produced significantly more force, 36.6 +/- 14.0 Ncm (p < 0.001). Beam-type wrenches produced 33.2 +/- 1.1 Ncm and 32.8 +/- 1.1 Ncm in fast and slow modes, respectively. Both types of wrenches tested were capable of producing accurate torque values; however, variability was higher in the toggle-type group. Some toggle-type torque wrenches in clinical service delivered unacceptably high torque values. It is recommended that clinicians calibrate toggle-type wrenches frequently. Torque wrenches should be activated slowly, over 4 seconds, when using a correctly calibrated toggle-type wrench.

Who Is Teaching Undergraduate Prosthodontics in US Dental Schools, 2007?

The shortage of full-time dental school faculty along with a slow steady increase in student enrollment is not a new phenomenon. The purpose of this study was to determine who is teaching undergraduate prosthodontics in US dental schools-what percent are full-time faculty; what percent are prosthodontists; and what percent are board-certified prosthodontists-to allow schools to make a real-time comparison of the composition of instructors they have teaching prosthodontics to the apparent status quo. A short, ten-question survey was sent via e-mail to representatives at the 55 undergraduate US dental schools. A cover letter explained the nature of the study and requested participation and electronic return of the survey. Three weeks after the initial request, an aggressive follow-up was conducted to schools that had not returned the survey. Answers were converted to percentages to compensate for differences between schools with many or few instructors. Schools were also grouped by location to see if regional differences exist. Thirty-eight (69%) of the surveys were completed and returned. In general, the division between full-time and part-time instructors is about 50%. More removable prosthodontic instructors (60%) than fixed instructors (44%) are prosthodontists, and only a small percentage of the total (18% removable and 15% fixed) have completed board certification. The South and Midwest had the highest percentage of prosthodontists involved in teaching; the South had the highest percentage with specialty board certification. This study indicated that only a few schools are fortunate enough to have sufficient full-time, specialty-trained faculty available for complete coverage of all undergraduate prosthodontic courses and clinics. The information presented serves as a baseline for future comparison to see if the percentage of full-time and/or specialty-certified prosthodontic faculty changes.