A Survey of Senior Dental Students ’ Experiences with Young Dental Patients in Pennsylvania
INTRODUCTION According to the Third National Health and Nutrition Examination Survey ( NHANES III ), although the incidence of dental caries is concentrated among 20-25 percent of children , dental caries remains one of the more prevalent childhood diseases . For most Americans , oral health status has improved during the period of 1988-1994 and 1999-2004 . However , for youths 2-5 years of age , dental caries in primary teeth has increased . 1 A study in 2002 concluded that a substantial number of children in this country do not receive professionally recommended preventive care , particularly dental care . 2 In response to pediatric dentistry ’ s move away from a surgical model of treatment and toward a model concentrated on preventive medicine , the American Academy of Pediatric Dentistry recommended in 1985 that the first visit for every child occur no later than 12 months of age .
The goals of this first visit are to assess the risk for dental disease , initiate a preventive program , provide anticipatory guidance and decide on the periodicity of subsequent visits . 3 In spite of these recommendations , several studies have indicated that there is a misunderstanding or disagreement among general practitioners about these guidelines . 4-8 In a 2001 random survey of general practitioners representative of the 9 regions of the U . S ., only slightly more than half ( 53 percent ) of the respondents were aware of the ADA and AAPD recommendation that a child ’ s first dental visit should be no later than 12 months . 5 General dentists will often be asked to see children for their initial dental visits , as the current shortage of pediatric dentists makes it impossible for all age one dental visits to be performed by pediatric dentists . Although general dentists may be available in areas of shortage of pediatric dentists , studies have shown a general lack of willingness of general dentists to treat young pediatric patients under the age of two years . 6 , 9 , 10 Several studies have explored possible reasons for this , including lack of training or exposure to
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young pediatric dentistry patients while in dental school . There is a strong association between a dentist ’ s willingness to perform certain dental procedures and their dental school training . 13 , 14 Studies have shown that when dental students were provided with a program directed toward more exposure to young pediatric patients , they were more prepared to provide care to these patients after graduation . 4 , 14-17 A survey sent to 3,559 randomly selected general dentists in Texas found that the level of dental school training was significantly associated with the dentists ’ attitudes toward providing dental care to Medicaid-enrolled preschool-aged children . 4 Pre-doctoral clinical infant oral health programs were established at the University of Michigan School of Dentistry 15 and the University of North Carolina at Chapel Hill . 16 Surveys were distributed and respondents who had attended these programs felt better prepared to conduct oral examinations in children aged 0 to 36 months than those who had not participated in the programs . Similarly , dental students who rotated through a public health based “ Infant Oral Health Program ” in Iowa were reported being more willing to see very young children when compared to dentists who did not rotate through such a program . 14
Academic and clinical training in pediatric dentistry pose a similar challenge . Faculty shortages nationwide have impacted the pediatric dental workforce . As discussed by Seale and Casamassimo , 11 the educational system has a shortage of faculty trained in the care of children and increasingly relies on general dentists to teach pediatric dentistry . As a result , the teaching pool becomes limited to manageable children with a low level of disease . They further suggested that a relative lack of hands on experience treating young children in predoctoral pediatric dentistry programs might negatively affect access to care in the U . S . Most schools are teaching the first dental visit at 12 months or younger , but only half provide actual experiences with infants . 18
The purpose of this study is to survey graduating dental students from the three dental schools in Pennsylvania on their perceptions on training in infant oral health ( IOH ), examining young pediatric patients and their perceived willingness to do so upon graduation in their own practices .
The primary hypothesis tested is that there is an association between performance of a clinical exam on a young child , desire for additional training in pediatric dentistry , enjoyment of clinical and didactic training in pediatric dentistry and willingness to see children younger than 2 years of age in practice .
The second hypothesis that will be tested is that there is a difference between exposure to the clinical exam of a young child in a lecture setting versus a clinical setting and subject ’ s perceived comfort to do an exam in a young child . The third hypothesis to be tested is that there is a difference between observing an operative procedure on a child younger than 5 years of age versus performing the procedure , and subject ’ s perceived comfort with an oral exam in a young child . The purpose of the analysis is to observe if the “ intensity ” of exposure has any influence on the sub-
September / October 2010 • Pennsylvania Dental Journal
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