Evaluating the Quality of Multiple Choice Question in Paediatric Dentistry Postgraduate Examinations

ABSTRACT: Objectives: This study aimed to evaluate the quality of multiple choice question (MCQ) items in two postgraduate paediatric dentistry (PD) examinations by determining item writing flaws (IWFs), difficulty index (DI)and cognitive level. Methods: This study was conducted at Mohamed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE. Virtual platform-based summative versions of the general paediatric medicine (GPM) and prevention of oral diseases (POD) examinations administered during the second semester of the 2017–2018 academic year were used. Two PD faculty members independently reviewed each question to assess IWFs, DI and cognitive level. Results: A total of 185 single best answer MCQs with 4–5 options were analysed. Most of the questions (81%) required information recall, with the remainder (19%) requiring higher levels of thinking and data explanation. The most common errors among IWFs were the use of “except” or “not” in the lead-in, tricky or unfocussed stems and opportunities for students to use convergence strategies. There were more IWFs in the GPM than the POD examination, but this was not statistically significant (P = 0.105). The MCQs in the GPM and POD examination were considered easy since the mean DIs (89.1% ± 8.9% and 76.5% ± 7.9%, respectively) were more than 70%. Conclusion: Training is an essential element of adequate MCQ writing. A general comprehensive review of all programme’s MCQs is needed to emphasise the importance of avoiding IWFs. A faculty development programme is recommended to improve question-writing skills in order to align examinations with programme learning outcomes and enhance the ability to measure student competency through questions requiring higher level thinking. Keywords: Examination Question; Student; Educational Measurement; Discriminant Analysis; Pediatric Dentistry; United Arab Emirates

The Effect of Chlorhexidine on Bacterial Contamination of Hall Technique Elastomeric Orthodontic Separators and Gingival Health: A Pilot Study

Objective: To study the effect of chlorhexidine on elastomeric orthodontic separators (EOS) bacterial-colonisation and gingival-health in Hall technique (HT) patients. Material and Methods: Prospective in-vivo pilot clinical study of EOS bacterial colonisation and primary-molar gingival health assessment in 20 patients (mean age 5.45±1.27 years) requiring bilateral HT crowns (40 teeth). One side received 1-minute 0.12% chlorhexidine-soaked-EOSs (Chx-EOSs), and the other side dry-EOSs (NoChx-EOSs). The EOSs were removed five-days later and underwent a bacterial enumeration technique. Plaque (PI) and Gingival (GI) indices were assessed pre-, five-days and three-months post-treatment. Wilcoxon-Signed-Rank/McNemar-Chi-square statistics were used (p<0.05). Results: Baseline unused/packaged EOSs’ sterility check yielded zero colony-forming-units (CFU) per millilitre, but 100% of the used EOSs became colonised by oral-microorganisms. An overall trend of lower mean CFU count in Chx-EOSs (3.415± 0.78 x105 CFU/ml) compared to NoChx-EOSs (6.157±1.48 x105 CFU/ml) was observed (p=0.009). Both NoChx-EOSs and Chx-EOSs insertion sites showed evidence of gingivitis with no difference between PI and GI indices by site over time. Conclusion:There was a lower trend of bacterial colonization in chlorhexidine treated EOSs and an occurrence of gingivitis pre/post HT-treatment regardless of EOS type. The lack of difference in the gingival health may be inconclusive due to this pilot’s low power suggesting the need for robust large scale studies

The effect of chlorhexidine on bacterial contamination of hall technique elastomeric orthodontic separators and gingival health: A pilot study

Objective: To study the effect of chlorhexidine on elastomeric orthodontic separators (EOS) bacterial-colonisation and gingival-health in Hall technique (HT) patients. Material and Methods: Prospective in-vivo pilot clinical study of EOS bacterial colonisation and primary-molar gingival health assessment in 20 patients (mean age 5.45±1.27 years) requiring bilateral HT crowns (40 teeth). One side received 1-minute 0.12% chlorhexidine-soaked-EOSs (Chx-EOSs), and the other side dry-EOSs (NoChx-EOSs). The EOSs were removed five-days later and underwent a bacterial enumeration technique. Plaque (PI) and Gingival (GI) indices were assessed pre-, five-days and three-months post-treatment. Wilcoxon-Signed-Rank/McNemar-Chi-square statistics were used (p<0.05). Results: Baseline unused/packaged EOSs’ sterility check yielded zero colony-forming-units (CFU) per millilitre, but 100% of the used EOSs became colonised by oral-microorganisms. An overall trend of lower mean CFU count in Chx-EOSs (3.415± 0.78 x105 CFU/ml) compared to NoChx-EOSs (6.157±1.48 x105 CFU/ml) was observed (p=0.009). Both NoChx-EOSs and Chx-EOSs insertion sites showed evidence of gingivitis with no difference between PI and GI indices by site over time. Conclusion: There was a lower trend of bacterial colonization in chlorhexidine treated EOSs and an occurrence of gingivitis pre/post HT-treatment regardless of EOS type. The lack of difference in the gingival health may be inconclusive due to this pilot’s low power suggesting the need for robust large scale studies

Use of the Hall technique by specialist paediatric dentists: a global perspective.

Background The Hall technique (HT) is popular with UK paediatric dentists (PDs). Global PDs perception/use of HT is unknown.Aim To investigate global PDs opinions/use of HT.Materials and methods A cross-sectional questionnaire of 26 questions was sent to specialist PDs across the globe.Results Responses of 709 PDs from six continents were obtained. The majority (n = 654, 92.32%) had heard about HT but only 50.6% (n = 358) used it, with wide country variations. Respectively, 37.5%, 31.5% and 31% were neutral, against or supportive of HT when they initially heard about it. Only 17% of HT users said it was always the treatment of choice for non-pulpal asymptomatic carious primary molars (NPACPMs), 62% would take a pre-operative radiograph, 65% would consider using high speed drills before HT, 63% would never consider HT under general anaesthesia, 56% would use HT under N2O sedation. Finally, in a clinical scenario of a NPACPM in a cooperative 6-year-old, 75% of PDs would choose conventional restorative methods over the HT.Conclusion The HT is recognised, but not used, by an outright majority of PDs across the globe. Identifiable barriers such as lack of training, perception as substandard dentistry and perceived lack of evidence reduced its use

The Epidemiology and Outcome of Biliary Atresia: Saudi Arabian National Study (2000–2018)

BackgroundThe epidemiology and outcomes of biliary atresia (BA) have been well-documented in national cohorts from two main ethnicities, namely, the Asian Orientals and Caucasians, with incidence ranging from 1 in 5,000 to 1 in 9,000 live births in East Asia and 1 in 15,000 to 19,000 live births in Europe and North America.ObjectiveWe report the first nationwide BA study outside North America, Europe, and East Asia to describe the epidemiology and outcomes of BA in Saudi Arabia.MethodsA national database of BA cases diagnosed between 2000 and 2018 was analyzed. We assessed clearance of jaundice (bilirubin &lt;20 μmol/L) in all cases that underwent Kasai portoenterostomy (KPE). We then estimated survival using the Kaplan–Meier method with endpoints of liver transplantation (LT), death, or survival with native liver (SNL).ResultsBA was diagnosed in 204 infants (106 females; 10% pre-term). The incidence of BA was 1 in 44,365, or 2.254 in 100,000 live births (range, 0.5–4 in 100,000). Polysplenia was diagnosed in 22 cases (11%). The median age at referral was 65 days. A total of 146 children (71.5%) underwent KPE at a median age of 70 days. Clearance of jaundice was achieved in 66 of the 146 (45%) infants. The 10-year SNL after KPE was 25.5%, and the overall 10-year estimated survival was 72.5%. The Kaplan–Meier survival curves for patients undergoing KPE at the age of &lt;60, 61–90, and &gt;90 days showed a SNL rate at 51.6, 33, and 12.5%, respectively, at 5 years (P &lt; 0.001). The 2-, 5-, and 10-year post-LT survival rates were 92.5, 90.6, and 90%, respectively. Undergoing an initial KPE did not impact negatively on the overall LT survival rate when compared to BA cases that underwent primary LT (P = 0.88).ConclusionThe incidence rate of BA in Saudi Arabia is lower than the incidence reported elsewhere. Late referral of BA cases remains a problem in Saudi Arabia; as a result, the SNL rate was lower than reported by other national registries. Hence, national policies devoted to timely referral and earlier age at KPE are needed

Assessment of Paediatricians’ Oral Health Knowledge, Behaviour, and Attitude in the United Arab Emirates

Aim. Paediatricians’ oral health knowledge is essential for early detection of disease, appropriate advice, and proper referral. Therefore, this study aimed to evaluate the knowledge, behaviour, and attitude of paediatricians practicing in the United Arab Emirates (UAE) regarding children’s oral health. Study Design. Cross-sectional survey. Methods. A questionnaire consisting of 16 questions was completed after piloting by a sample of randomly selected registered UAE paediatricians. Scores of knowledge (out of 9), behaviour (out of 4), and attitude (out of 3) were calculated. Statistical analysis was performed using Shapiro–Wilk, Mann–Whitney U, and Kruskal–Wallis tests. Statistical significance was set as P<0.05. Results. A total of 185 surveys were completed. Nearly half of the paediatricians (95 (51.4%)) identified the appropriate age for child’s first dental visit; while 88 (47.6%) believed that the appropriate age to start brushing was after the eruption of the primary molars (2-3 yrs), and 132 (71.4%) believed that the ideal time to give sugary snacks is in between meals. 123 (66.5%) participants said that they would prescribe antibiotics to treat local dental sepsis without fever. Experienced paediatricians and those trained in Western countries had significantly better knowledge about oral health (P values 0.040 and 0.031 consecutively). The scores of attitude, behaviour, and knowledge were correlated, and a positive relationship between the scores of knowledge and behaviour was found (r = 0.241, P=0.001) and between scores of attitude and behaviour (r = 0.197, P=0.007). Conclusions. The results demonstrated a general lack of knowledge of oral health aspects by UAE paediatricians. Furthermore, continuous education in the subject is recommended

Self-reported adaptability among postgraduate dental learners and their instructors: Accelerated change induced by COVID-19.

It is forecasted that the skills and competencies necessary for post-pandemic success in higher education need to be founded upon adaptability, coping, and Self- Regulated Learning (SRL). It is worth investigating how stakeholders perceived their adaptability and coping with the accelerated change accompanying Coronavirus Disease of 2019 (COVID-19). Accordingly, the purpose of this study was to assess the self-reported adaptability of postgraduate dental learners and their instructors in the context of abrupt transition to distance learning induced by the pandemic. This study utilized a convergent mixed methods study design. The quantitative and qualitative data were concurrently collected from instructors and learners, using a tailor-made survey of items measured with a Likert-type scale, complemented with open-ended questions. The collected datasets were independently analyzed. Descriptive and inferential analysis were conducted using the quantitative data. Qualitatively, the researchers underwent a multi-staged thematic analysis. The generated information was then integrated using a joint model analysis. The percentage of the total average of self-reported adaptability for both groups of stakeholders was 81.15%. The instructors, with a mean of satisfaction of 17.94 (±1.76), rated their adaptability significantly higher than the learners, with a mean of satisfaction of 15.66 (±2.77) (p = 0.002). The thematic analysis resulted in two interrelated themes: Self and Environment. Within the Self theme, three subthemes surfaced: Cognitions, Emotions, and Behaviors. As for the Environment theme, it encapsulated two subthemes: Enablers and Impediments. The stakeholders perceived themselves to have adapted well to the transition, and SRL appeared as a cornerstone in the adaptation to the accelerated change accompanying COVID-19. There appeared to be an interplay between the cognitions, emotions, and behaviors on the level of the self as part of the adaptation process. Also, building upon existent models of SRL, this study uncovered that the stakeholders considered the environment to play a crucial role in their adaptation process. This highlights the importance of developing a climate that remains, despite external pressures, conducive to attaining learning and teaching goals. It is also crucial for university-level mental health promotion activities to proactively foster, among learners and instructors, adaptability, building 'academic resilience'

Rapid transition to distance learning due to COVID-19: Perceptions of postgraduate dental learners and instructors.

The outbreak of Coronavirus disease 2019(COVID-19) necessitated an abrupt transition from on campus, face-to-face sessions to online, distance learning in higher education institutions. The purpose of this study was to investigate the perceptions of postgraduate dental learners and instructors about the transition to distance learning, including the changes to the learning and teaching and its efficaciousness. A convergent mixed methods approach to research was utilized. All the instructors and postgraduate learners in a dental college were invited to participate in an online survey. Quantitative data was analyzed using descriptive and inferential analyses on SPSS for Windows version 25.0, and for the responses to the open-ended questions, multi-staged thematic analysis was utilized. Both groups of stakeholders: learners and instructors, were satisfied with the rapid transition to distance learning due to COVID-19. Instructors were significantly more satisfied than the learners. The stakeholders adapted well to the change. The perception of the stakeholders regarding the case-based scenarios significantly influenced their level of satisfaction. As perceived by the stakeholders, the transition to distance learning entailed advantages and challenges. Going through the experience enabled the stakeholders to develop informed opinions of how best to sustain learning and teaching irrespective of how matters unfold in relation to the pandemic. In conclusion, the worldwide dental education community faced unprecedented challenges due to the onset of COVID-19. From a macro perspective, decision-makers must not miss out on the valuable opportunities, inherent in the experience, to reinforce curriculums, and maximize learning and teaching

Enamel defects and caries prevalence in preterm children aged 5-10 years in Dubai

Background: Enamel defects (EDs) are commonly reported dental findings in preterm/low birthweight children. EDs potentially increase caries susceptibility. Aim: To assess the prevalence of EDs and dental caries in a group of preterm children (aged 5–10 years) in Dubai, United Arab Emirates (UAE). Methodology: A retrospective cohort study of medical records of 62 preterm children (mean age 8.1 ± 1.54) and 62 full-term children (mean age 8.1 ± 1.73) of both genders born in a UAE children’s hospital were studied. These children were dentally assessed for EDs and caries by a calibrated examiner. Results: EDs were 4.34 times more prevalent among preterm children [odd ratio (OR) = 4.338, CI 95% [2.010–9.366]. The prevalence of EDs in the pre-term group was 58.15%, significantly higher (P &lt; 0.01) than the full-term control group (24.2%). Birth weight, intubation and type of delivery were statistically significant factors contributing to EDs. In the primary dentition, the mean dmft was 4.61 ± 4.30, while in the permanent dentition DMFT was 0.38 ± 0.99. There was a statistically significant difference in permanent teeth caries experience amongst pre-term children compared to the full-term control as measured by DMFT (P = 0.008). Conclusion: EDs and dental caries in permanent dentition in the pre-term group were significantly higher than the full-term group