Publications

The Lancet Commission on Education of Health Professionals for the 21(st) Century calls for enhancing health education for the needs and challenges of the 21st century to improve health status globally. To complement the Lancet report, this article makes recommendations for including core global health competencies in the education of health care professionals and specific groups of the public who are relevant to oral health in a global context in order to tackle the burden of oral diseases. Experts from various professional backgrounds developed global oral health competencies for four target groups: Group 1 was defined as dental students, residents/trainee specialists (or equivalent), and dentists; Group 2 was community health workers, dental hygienists, and dental therapists (or the equivalent); Group 3 was health professionals such as physicians, physician assistants, nurses, nurse practitioners, and pharmacists; and Group 4 was non-health professionals in the public arena such as parents, teachers, decision makers, key opinion leaders, and health and consumer advocates. Key competencies for members of each of the four target groups are presented in a matrix. The suggested competency matrix shows that many other health professions and groups in society have potentially crucial roles in the prevention, control, and management of oral diseases globally. Workforce models including a wider range of professionals working together as a team will be needed to tackle the burden of oral diseases in an integrated way in the broader context of non-communicable diseases. Further discussion and research should be conducted to validate or improve the competencies proposed here with regard to their relevance, appropriateness, and completeness.

SETTING: While some studies have reported the prevalence of dental caries in sub-Saharan Africa, little is known about care-seeking behavior or how dental caries are managed, particularly at rural district hospitals. OBJECTIVE: To describe the management of patients seeking care for dental caries at Butaro District Hospital (BDH) in rural Rwanda. DESIGN: This cross-sectional descriptive study was conducted in BDH, in northern Rwanda. A sample of 287 patient encounters for dental caries between January and December 2013 was randomly selected and stratified by age group (⩽5 years, 6-21 years and >21 years). We estimated the treatment received with 95% confidence intervals in each age group, and differences between age groups were assessed using Fisher's exact test. RESULTS: Nearly all patients (97.6%) underwent tooth extraction, and this did not vary significantly by age group (P = 0.558). In addition to dental caries, most patients also had chronic pulpitis (74.9%). CONCLUSION: Caries prevention and care should be prioritized through a developed community program on oral health. We recommend introducing advanced training, equipment and materials for dental caries management other than tooth extraction, and increasing the number of qualified dentists.

BACKGROUND: At the 2008 inaugural meeting of the Consortium of Universities for Global Health (CUGH), participants discussed the rapid expansion of global health programs and the lack of standardized competencies and curricula to guide these programs. In 2013, CUGH appointed a Global Health Competency Subcommittee and charged this subcommittee with identifying broad global health core competencies applicable across disciplines. OBJECTIVES: The purpose of this paper is to describe the Subcommittee's work and proposed list of interprofessional global health competencies. METHODS: After agreeing on a definition of global health to guide the Subcommittee's work, members conducted an extensive literature review to identify existing competencies in all fields relevant to global health. Subcommittee members initially identified 82 competencies in 12 separate domains, and proposed four different competency levels. The proposed competencies and domains were discussed during multiple conference calls, and subcommittee members voted to determine the final competencies to be included in two of the four proposed competency levels (global citizen and basic operational level - program oriented). FINDINGS: The final proposed list included a total of 13 competencies across 8 domains for the Global Citizen Level and 39 competencies across 11 domains for the Basic Operational Program-Oriented Level. CONCLUSIONS: There is a need for continued debate and dialog to validate the proposed set of competencies, and a need for further research to identify best strategies for incorporating these competencies into global health educational programs. Future research should focus on implementation and evaluation of these competencies across a range of educational programs, and further delineating the competencies needed across all four proposed competency levels.

PURPOSE: The correlation between insurance status and edentulism has not previously been reported in a population with known access to a dentist, and little is known about patient demographics in corporate dental settings. This study investigated patient demographics of a former dental franchise in Chicopee, Massachusetts, and examined a correlation between dental insurance and edentulism in this group. The correlation of edentulism with age, gender, and dental risk factors (diabetes, temporomandibular disorder, trouble with previous dental work, or oral sores and ulcers) was also examined. MATERIALS AND METHODS: This was a retrospective case study. Age, gender, and presence of dental risk factors were recorded from the patient medical history intake form. Dentate status was recorded from patient odontograms. Dental insurance status was obtained from billing records. Data was aggregated and deidentified. Descriptive and bivariate statistics and logistic regression models were used to identify associations (p-value ≤ 0.05 significance). RESULTS: Of 1,123 records meeting inclusion criteria, 52.54 percent of patients had dental insurance, 26.27 percent had at least one dental risk factor, and 18.17 percent were edentulous. Age and insurance status were significantly correlated with edentulism. Correcting for age, individuals without insurance were 1.56 times as likely to be edentulous. CONCLUSION: This case study provides insight into patient demographics that might seek care in a corporate setting and suggests that access to a dentist alone may not be adequate in preserving the adult dentition; dental insurance may also be important to health. As the corporate dental practice model continues to grow, these topics deserve further study.

OBJECTIVES: In an antifluoridation case study, we explored digital pandemics and the social spread of scientifically inaccurate health information across the Web, and we considered the potential health effects. METHODS: Using the social networking site Facebook and the open source applications Netvizz and Gephi, we analyzed the connectedness of antifluoride networks as a measure of social influence, the social diffusion of information based on conversations about a sample scientific publication as a measure of spread, and the engagement and sentiment about the publication as a measure of attitudes and behaviors. RESULTS: Our study sample was significantly more connected than was the social networking site overall (P<.001). Social diffusion was evident; users were forced to navigate multiple pages or never reached the sample publication being discussed 60% and 12% of the time, respectively. Users had a 1 in 2 chance of encountering negative and nonempirical content about fluoride unrelated to the sample publication. CONCLUSIONS: Network sociology may be as influential as the information content and scientific validity of a particular health topic discussed using social media. Public health must employ social strategies for improved communication management.

Through a case example of fluoride, this paper examines why dental caries and other 21st century challenges require collaborative practice toward improved health that begins with interprofessional education (IPE). We suggest a theoretical framework for expanding the thinking around IPE for global health and recommend beginning at the undergraduate, or "pre-interprofessional," level where students are still undifferentiated by profession. Our theoretical framework can assist in providing a foundation for curriculum alignment and calibration moving forward to the graduate and professional training levels.

OBJECTIVE: Rwanda's Ministry of Health, with the Clinton Health Access Initiative, implemented the Human Resources for Health (HRH) Program. The purpose of the program is to train and retain high-quality health care professionals to improve and sustain health in Rwanda. DESIGN: In May 2011, an oral health team from Rwanda and the United States proposed that oral health be included in the HRH Program, due to its important links to health, in a recommendation to the Rwandan Ministry of Health. The proposal outlined a diagonal approach to curriculum design that supports the principles of global health through interconnected training for both treatment and collaborative prevention, rather than discipline-based fragmented training focused on isolated risk factors. It combined 'vertical' direct patient care training with 'horizontal' interdisciplinary training to address common underlying risk factors and associations for disease through primary care, program retention, and sustainability. RESULTS: The proposal was accepted by the Ministry of Health and was approved for funding by the US Government and The Global Fund. Rwanda's first Bachelor of Dental Surgery program, which is in the planning phase, is being developed. CONCLUSIONS: Competencies, the training curriculum, insurance and payment schemes, licensure, and other challenges are currently being addressed. With the Ministry of Health supporting the dental HRH efforts and fully appreciating the importance of oral health, all are hopeful that these developments will ultimately lead to more robust oral health data collection, a well-trained and well-retained dental profession, and vastly improved oral health and overall health for the people of Rwanda in the decades to come.

To channel students' interest in global oral health and prepare them to respond adequately to the health effects of globalization as future practitioners, new courses in dental curricula may be needed. This article documents the results of Harvard School of Dental Medicine (HSDM)'s new course, Global Oral Health: Interdisciplinary Approaches. To the authors' knowledge, this is the first course of its kind in dental education. HSDM developed learning objectives for the course based on the literature, the training and experience of HSDM global health faculty, and the mission of the HSDM Global Health Initiative. Dental residents and public health students enrolled, and some dental students audited. The discussion-based critical thinking course examined the extensive relationship between oral health and global health, and concept development was determined by in-class participation. After taking the course, students' assessments of their global oral health knowledge increased on average 100 percent. Nearly all students reported that they were very likely to use the concepts of global oral health in their careers and that they would definitely recommend the course to others. This course model seems to have met the expectations of students and faculty, and its fundamentals appear to be readily transferrable to other dental schools.

Harvard School of Dental Medicine (HSDM) estimates that nearly 25 percent of its predoctoral dental students have expressed an interest in global health, including traveling abroad to conduct research or to volunteer in a project. This article addresses the important differences between "voluntourism" (combined volunteering and tourism) and responsible engagement in global health, reports on a pilot workshop at HSDM to promote responsible volunteering, and provides a recommendation on how to address these issues in the context of a dental curriculum. The pilot Workshop for Ethical Volunteering in Global Health was designed as a discussion-based, interactive program that included lectures, small-group activities, and personal reflection. The aim of the workshop was to provide students with a systematic approach to ethical volunteering, critically reflecting on their motivation and attitudes related to conventional models of volunteering and facilitating alignment with principles of global health. Students participated in an anonymous written survey at the start and the close of the workshop. After the workshop, survey results demonstrated a significant increase in understanding the value of applying principles of global health when volunteering in order to avoid negative and unintended impacts on communities. All of the students reported that the workshop influenced the way they view volunteering in dentistry.

We evaluated the Oral Physician Program, a dental residency sponsored by Harvard Medical School, Harvard School of Dental Medicine, and the Cambridge Health Alliance that offers an innovative model for training dentists to provide limited primary care. The didactic and clinical experiences increased residents' medical knowledge and interviewing skills, and faculty assessments supported their role as oral physicians. Oral physicians could increase patients'-especially patients from underserved groups-access to integrated oral and primary care services.