Publications

Vulnerable populations are more likely to access medical care than visit a dentist. We introduced a dental team into a student-faculty collaborative clinic that serves a low-income Latino population. Documentation of oral exam findings rose from 11.88% to 50.50% in the year following integration of dental students into the clinic.

Globalization, along with the increasing prevalence of non-communicable diseases, their risk factors, and poor oral health, demands global approaches to oral health care. Trained health care workers' providing volunteer services abroad is one model used for improving access to dental services for some communities. Currently, little is known about U.S. dental student involvement in international clinical service volunteerism. The aim of this exploratory study was to capture national survey data from predoctoral dental students about their interest in and experience with global health service trips. The survey sought to assess students' past experiences and current and future interest in programs providing dental and/or medical services in order to lay the foundation for further research. A 12-question web-based survey was distributed in May 2017 to 22,930 students enrolled in U.S. dental schools. A total of 1,555 students responded, for a response rate of 7%. Respondents were evenly distributed across the four academic years. Approximately 22% (n=342) of the respondents had already participated in a service trip experience, 83% reported interest in a service trip while in school, and 92% were interested after graduation. Reported motivations for international trips included the desire to care for the underserved and to obtain a more global view of health and disease. Concerns were expressed regarding costs and time constraints. This study provided preliminary, exploratory data on dental student engagement with international service trips. Both interest and participation in international service trips among responding students were high, reflecting current trends in both dentistry and medicine. Dental education may have an opportunity to guide student engagement in more sustainable and ethical volunteering in the U.S. and abroad.

Studies have shown a relationship between maternal periodontal diseases (PDs) and premature delivery. PDs are commonly encountered oral diseases which cause progressive damage to the periodontal ligament and alveolar bones, leading to loss of teeth and oral disabilities. PDs also adversely affect general health by worsening of cardiovascular and metabolic diseases. Moreover, maternal PDs are thought to be related to increasing the frequency of preterm-birth with low birth weight (PBLBW) in new-borns. Prematurity and immaturity are the leading causes of prenatal and infant mortality and is a major public health problem around the world. Inflamed periodontal tissues generate significantly high levels of proinflammatory cytokines that may have systemic effects on the host mother and the fetus. In addition, the bacteria that cause PDs produce endotoxins which can harm the fetus. Furthermore, studies have shown that microorganisms causing PDs can get access to the bloodstream, invading uterine tissues, to induce PBLBW. Another likely mechanism that connects PDs with adverse pregnancy outcome is maternal vitamin D status. A role of inadequate vitamin D status in the genesis of PDs has been reported. Administration of vitamin D supplementation during pregnancy could reduce the risk of maternal infections and adverse pregnancy outcomes. As maternal PDs are significant risk factors for adverse pregnancy outcome, preventive antenatal care for pregnant women in collaboration with the obstetric and dental professions are required.

In this article, we briefly summarized evidence that cellular phosphate burden from phosphate toxicity is a pathophysiological determinant of cancer cell growth. Tumor cells express more phosphate cotransporters and store more inorganic phosphate than normal cells, and dysregulated phosphate homeostasis is associated with the genesis of various human tumors. High dietary phosphate consumption causes the growth of lung and skin tumors in experimental animal models. Additional studies show that excessive phosphate burden induces growth-promoting cell signaling, stimulates neovascularization, and is associated with chromosome instability and metastasis. Studies have also shown phosphate is a mitogenic factor that affects various tumor cell growth. Among epidemiological evidence linking phosphate and tumor formation, the Health Professionals Follow-Up Study found that high dietary phosphate levels were independently associated with lethal and high-grade prostate cancer. Further research is needed to determine how excessive dietary phosphate consumption influences initiation and promotion of tumorigenesis, and to elucidate prognostic benefits of reducing phosphate burden to decrease tumor cell growth and delay metastatic progression. The results of such studies could provide the basis for therapeutic modulation of phosphate metabolism for improved patient outcome.

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.

Nutrients usually act in a coordinated manner in the body. Intestinal absorption and subsequent metabolism of a particular nutrient, to a certain extent, is dependent on the availability of other nutrients. Magnesium and vitamin D are 2 essential nutrients that are necessary for the physiologic functions of various organs. Magnesium assists in the activation of vitamin D, which helps regulate calcium and phosphate homeostasis to influence the growth and maintenance of bones. All of the enzymes that metabolize vitamin D seem to require magnesium, which acts as a cofactor in the enzymatic reactions in the liver and kidneys. Deficiency in either of these nutrients is reported to be associated with various disorders, such as skeletal deformities, cardiovascular diseases, and metabolic syndrome. It is therefore essential to ensure that the recommended amount of magnesium is consumed to obtain the optimal benefits of vitamin D.

People who are incarcerated or have a history of incarceration have high rates of dental disease, but access to dental treatment is often a challenge during and after incarceration. Dental students' exposure to this population is unknown: no data exist regarding the number of schools that provide didactic and clinical training in correctional dentistry. The aim of this study was to assess the extent of instruction in correctional dentistry and clinical opportunities at correctional facilities for dental students in the U.S. A survey was distributed to the academic deans at all 66 U.S. dental schools in 2017. Respondents were asked if their institutions had curricular content on correctional health and if they provided clinical opportunities in the correctional setting. Respondents from 30 schools completed the survey, for a response rate of 45%. Nearly two-thirds of the respondents said their institutions offered didactic instruction on the impact of incarceration on health, and eight schools offered a clinical experience at a correctional facility. The most common format was a community-based dental externship involving fourth-year dental students. Oral exams, prophylaxis, and extractions were the most common procedures performed. Respondents from schools that offered a clinical experience agreed more strongly than those that did not that exposure to correctional health care was important and that their students believed incarceration to be a social determinant of health. This study found that a substantial proportion of dental schools offered didactic education on correctional health, but a much smaller number offered student rotations in correctional facilities.

AIMS: This article analyzes the digital childhood vaccination information network for vaccine-hesitant parents. The goal of this study was to explore the structure and influence of vaccine-hesitant content online by generating a database and network analysis of vaccine-relevant content. METHOD: We used Media Cloud, a searchable big-data platform of over 550 million stories from 50,000 media sources, for quantitative and qualitative study of an online media sample based on keyword selection. We generated a hyperlink network map and measured indegree centrality of the sources and vaccine sentiment for a random sample of 450 stories. RESULTS: 28,122 publications from 4,817 sources met inclusion criteria. Clustered communities formed based on shared hyperlinks; communities tended to link within, not among, each other. The plurality of information was provaccine (46.44%, 95% confidence interval [39.86%, 53.20%]). The most influential sources were in the health community (National Institutes of Health, Centers for Disease Control and Prevention) or mainstream media ( New York Times); some user-generated sources also had strong influence and were provaccine (Wikipedia). The vaccine-hesitant community rarely interacted with provaccine content and simultaneously used primary provaccine content within vaccine-hesitant narratives. CONCLUSION: The sentiment of the overall conversation was consistent with scientific evidence. These findings demonstrate an online environment where scientific evidence online drives vaccine information outside of the vaccine-hesitant community but is also prominently used and misused within the robust vaccine-hesitant community. Future communication efforts should take current context into account; more information may not prevent vaccine hesitancy.

A consortium of 22 U.S. academic institutions is currently participating in the Rwanda Human Resources for Health Program (HRH Program). Led by the Rwandan Ministry of Health and funded by both the U.S. Government and the Global Fund to Fight AIDS, Tuberculosis and Malaria, the primary goal of this seven-year initiative is to help Rwanda train the number of health professionals necessary to reach the country's health workforce targets. Since 2012, the participating U.S. academic institutions have deployed faculty from a variety of health-related disciplines and clinical specialties to Rwanda. In this Article, the authors describe how U.S. academic institutions (focusing on the seven Harvard-affiliated institutions participating in the HRH Program-Harvard Medical School, Brigham and Women's Hospital, Harvard School of Dental Medicine, Boston Children's Hospital, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, and Massachusetts Eye and Ear Infirmary) have also benefited: (1) by providing opportunities to their faculty and trainees to engage in global health activities; (2) by establishing long-term, academic partnerships and collaborations with Rwandan academic institutions; and (3) by building the administrative and mentorship capacity to support global health initiatives beyond the HRH Program. In doing this, the authors describe the seven Harvard-affiliated institutions' contributions to the HRH Program, summarize the benefits accrued by these institutions as a result of their participation in the program, describe the challenges they encountered in implementing the program, and outline potential solutions to these challenges that may inform similar future health professional training initiatives.

Scientists and health communication professionals expressed frustration over the relationship between misinformation circulating on the Internet and global public perceptions of and responses to the Ebola epidemic originating in West Africa. Using the big data platform Media Cloud, we analyzed all English-language stories about keyword "Ebola" published from 1 July 2014 to 17 November 2014 from the media sets U.S. Mainstream Media, U.S. Regional Media, U.S. Political Blogs, U.S. Popular Blogs, Europe Media Monitor, and Global Voices to understand how social network theory and models of the networked global public may have contributed to health communication efforts. 109,400 stories met our inclusion criteria. The CDC and WHO were the two media sources with the most inlinks (hyperlinks directed to their sites). Twitter was fourth Significantly more public engagement on social media globally was directed toward stories about risks of U.S. domestic Ebola infections than toward stories focused on Ebola infections in West Africa or on science-based information. Corresponding public sentiments about Ebola were reflected in the policy responses of the international community, including violations of the International Health Regulations and the treatment of potentially exposed individuals. The digitally networked global public may have influenced the discourse, sentiment, and response to the Ebola epidemic.

Malnutrition and dental caries in early childhood remain persistent and intertwined global health challenges, particularly for indigenous and geographically-remote populations. To examine the prevalence and associations between early childhood dental caries, parent-reported mouth pain and malnutrition in the Amazonian region of Ecuador, we conducted a cross-sectional study of the oral health and nutrition status of 1407 children from birth through age 6 in the "Alli Kiru" program (2011-2013). We used multivariate regression analysis to examine relationships between severe caries, parent-reported mouth pain measures, and nutritional status. The prevalence of dental caries was 65.4%, with 44.7% of children having deep or severe caries, and 33.8% reporting mouth pain. The number of decayed, missing and filled teeth (dmft) increased dramatically with age. Malnutrition was prevalent, with 35.9% of children stunted, 1.1% wasted, 7.4% underweight, and 6.8% overweight. As mouth pain increased in frequency, odds for severe caries increased. For each unit increase in mouth pain frequency interfering with sleeping, children had increased odds for being underweight (Adjusted Odds Ratio (AOR): 1.27; 95% CI: 1.02-1.54) and decreased odds for being overweight (AOR: 0.76; 95% CI: 0.58-0.97). This relationship was most pronounced among 3-6 year-olds. Early childhood caries, mouth pain and malnutrition were prevalent in this sample of young children. Parent-reported mouth pain was associated with severe caries, and mouth pain interfering with sleeping was predictive of poor nutritional status. We demonstrate the utility of a parsimonious parent-reported measure of mouth pain to predict young children's risk for severe early childhood caries and malnutrition, which has implications for community health interventions.

The Global Oral Health Interest Group of the Consortium of Universities for Global Health (GOHIG-CUGH) published recommended competencies to support development of competency-based global health education in dental schools. However, there has been no comprehensive, systematically derived, or broadly accepted framework for creating and delivering competency-based global health education to dental students. This article describes the results of a collaborative workshop held at the 2016 American Dental Education Association (ADEA) Annual Session & Exhibition designed to build on the GOHIG-CUGH competencies and start to develop systematic approaches for their practical application. Workshop organizers developed a preliminary theoretical framework for guiding the development of global health in dental education, grounded in published research. Collectively, workshop participants developed detailed outcomes for the theoretical framework with a focus on three educational practices: didactic, experiential, and research learning and how each can meet the competencies. Participants discussed learning objectives, keys to implementation, ethical considerations, challenges, and examples of success. Outcomes demonstrated that no educational practice on its own meets all 33 recommended competencies for dental students; however, the three educational practices combined may potentially cover all 33. Participants emphasized the significance of sustainable approaches to student learning for both students and communities, with identified partners in the communities to collaborate on the development, implementation, evaluation, and long-term maintenance of any student global health activity. These findings may represent early steps toward professional consensus and best practices for global health in dental education in the United States.

We have integrated preventive oral health measures into preventive care visits for children at a federally qualified health center in Boston, Massachusetts. The program, started in 2015, covers 3400 children and has increased universal caries risk screening in primary care to 85%, fluoride varnish application rates to 80%, and referrals to a dental home to 35%. We accomplished this by minimizing pressures on providers' workflow, empowering medical assistants to lead the initiative, and utilizing data-driven improvement strategies, alongside colocated coordinated care.

PURPOSE: Physician assistants (PA) are health care team members who often work in primary care. Providing oral health education to PAs during training could improve oral health for vulnerable patients who seek treatment in the primary care setting and who are less able to access dental care. The purpose of this study was to assess the effectiveness of a peer-to-peer oral health curriculum taught by dental students to their PA student colleagues. METHODS: Dental students presented an interactive, case-based curriculum, followed by a hands-on oral examination training session. PA student feedback was obtained, and results were analyzed. RESULTS: Students found the content to be highly relevant and well presented. Conveying oral health competencies to future primary care providers may reduce oral health disparities. CONCLUSIONS: PA students reported improved understanding of oral health and indicated they would incorporate what they had learned into their future clinical practice.

Legal protections in the United States mandate that individuals with limited English proficiency (LEP) have equal access to health care. However, LEP populations are at higher risk of poor health. Dental school clinics offer lower cost care by supervised dental students and often provide care for LEP patients. The aims of this study were to survey dental students about their clinical experience with LEP patients, the interpreter resources available at their dental school clinics, and the extent of instruction on these topics. Academic deans at 19 dental schools (30.6% of 62 invited schools) distributed the survey to their students, and the survey was completed by 325 students (4.2% of students at the 19 participating schools). Among the responding students, 44% reported their dental school clinic lacked formal interpreter services, and most of the respondents reported receiving minimal instruction on caring for LEP patients. Only 54% of the responding students reported feeling adequately prepared to manage LEP patients following graduation. These results suggest there is limited access to interpreter services for students while in dental school. A large proportion of these dental students thus reported feeling unprepared to treat LEP patients after graduation.

The number of Americans with limited English proficiency (LEP) is growing, and legal protections mandate that LEP individuals have equal access to health care services. The aim of this study was to determine the availability of interpretation services in U.S. dental school clinics and the kinds of instruction dental students are given regarding treatment of LEP patients. A survey was distributed to the academic deans of all U.S. dental schools; 35 completed the survey for a response rate of 58%. Respondents were asked to report on the number of LEP patients treated in their student clinics, the resources available to students working with LEP patients, and the extent of instruction offered. Descriptive statistics were calculated. The results indicated that the proportion of LEP patients treated at U.S. dental schools was perceived to be higher than that of the general population. The availability of interpreter services and the extent of student education about LEP individuals varied widely. Among the responding schools, the most common language spoken by LEP patients was Spanish, followed by Chinese (Mandarin and Cantonese) and Russian. Most of the responding dental schools reported offering fewer than two hours of instruction to their predoctoral students on treating LEP patients. Although almost 90% of the respondents indicated believing LEP patients received care equal in quality to that of non-LEP patients in their clinics, only 61.9% indicated that their students were adequately prepared to manage LEP patients following graduation. These findings suggest that dental schools should consider curricular innovations that will prepare students to work with LEP populations and improve the ability of LEP patients to receive care in the teaching clinic setting.

Since 1923, more than fifty countries have improved access to dental care by allowing midlevel providers-frequently called dental therapists-to offer preventive and restorative treatment, primarily in the public sector. A growing body of research has found that dental therapists provide high-quality, cost-effective care and improve access to care for underserved populations. This article explores the evolution of the dental therapy movement in the United States, where multiple barriers to oral health care have created persistent unmet needs. We examine developments since the 1940s that have led to the authorization of dental therapists in parts of Alaska and the states of Minnesota, Maine, and Vermont; and the approval of national accreditation standards for dental therapy training programs by dental educators. We also show how dental therapists might fit within a health care system that is being transformed.

In today's digital era, people are increasingly relying on the Internet-including social media-to access health information and inform their health decisions. This article describes an exploratory initiative to better understand and define the role of dentists in patient education in the context of e-patients and Health 2.0. This initiative consisted of four phases. In Phase I, an interdisciplinary expert advisory committee was assembled for a roundtable discussion about patients' health information-seeking behaviors online. In Phase II, a pilot case study was conducted, with methods and analysis informed by Phase I recommendations. Phase III consisted of a debriefing conference to outline future areas of research on modernizing health communication strategies. In Phase IV, the findings and working theories were presented to 75 dental students, who then took a survey regarding their perspectives with the objective of guiding potential curriculum design for predoctoral courses. The results of the survey showed that the validity of online content was often secondary to the strength of the network sharing it and that advocacy online could be more effective if it allowed for emotional connections with peers rather than preserving accuracy of the information. Students expressed high interest in learning how to harness modern health communications in their clinical care since the role of the dentist is evolving from giving information to giving personalized guidance against the backdrop of an often contradictory modern information environment. The authors recommend that the dental profession develop patient-centered health communication training for predoctoral students and professional development and continuing education for practicing professionals.