Dentistry and Culture - the unruly darlings of public ...



Dentistry and CultureDENT 1110; 3 hoursFall 2020COURSE DIRECTOR: Mieke Beth Thomeer, Ph.D.CLASS MEETS: MWF 9:00am-12:00pm, July 13 – August 7CLASSROOM:RemoteOFFICE HOURS: By appointmentOFFICE:[LOCATION]EMAIL: mthomeer@uab.eduEXAMS:Midterm: July 23; Final: August 7 Course Content & IntroductionThis course offers an introduction to the study of health and illness as a socio-cultural phenomenon. It focuses particularly on the social factors that influence dental health and healthcare. Social conditions are now understood to be fundamental causes of disease. As such, this course discusses some of the significant social ills that impact the health of society and its various subgroups. The course will be taught by sociologists with broad experience in the area of health-related sociology. The UAB Sociology Department is uniquely equipped to teach this course because it offers the only doctoral program in the country specifically in Medical Sociology. The course begins with an overview of medical sociology that looks at the basic causal mechanisms at work in the link between social structure and health. What is the impact of lifestyle differences on health? How does social structure affect health? This will be followed by a look at healthcare and specifically dental healthcare as it is structured organizationally and relationally. What are the social and medical consequences of delivering services in a marketplace? How do sociologists look at the health professions and at the relationship between provider and patient? After this introductory work, we will consider several important structural factors related to health in-depth. Disparities by class, gender, race, ethnicity and place of residence will be explored, along with their causes and consequences. In addition, the impact of certain social problems for health and health care delivery will be examined. All of these issues will be addressed in the context of the challenges facing the dentist in the ethical and socially conscious delivery of health services. The ADA’s Principles of Ethics and Code of Professional Conduct will be integrated into various discussions throughout the course. In particular, you will be asked to think about the application of the “principle of beneficence” in a complex social system affecting patients and practitioners.While the subject of Sociocultural factors in dentistry is so broad that no single course could cover its entirety, our attempt here is to examine some of the most critical social issues concerning dental health and dental care and to offer you theory, research, and real world applications. Where appropriate, in addition to course lectures, panel discussions, and guest lecturers, classes may incorporate group discussion along with reflections on the specific topic. Specifically, written reflections will be assigned at the end of each class in order to get you to think about issues discussed in class. This is a good time for you to not only highlight issues which believe are important, but to comment and reflect on their implications for your practice of dentistry.II. Course Structure & PoliciesThe course is being taught by a team of sociologists, each of whom teach and/or research the issues they will be discussing in class. Each of these presenters will be asked to contribute questions for the 2 exams. They will also grade the questions that they wrote. The course director is responsible for coordinating classes and addressing any questions students may have about the exam and/or grading. He will review the reflections handed in by students after each class. If there are any questions about a particular lecture, about examinations, or about classroom policies these questions should be directed to Dr. Thomeer. Per School of Dentistry policy attendance is expected at all lectures. Students who have one unexcused absence will receive a maximum grade of B. Students with two unexcused absences will receive a maximum grade of C. Students with 3 or more unexcused absences will receive an F for the course. Assigned readings are to be read before each class session. Students should be fully prepared to answer questions, engage the instructor and fellow classmates, and make informed comments on assigned readings. At the end of every class you will be given a specific prompt to “reflect” on the material just presented or read. These will be submitted through Canvas before the start of the next class. These “reflection” papers will consist of 1-2 paragraphs. We will not accept any assignments via e-mail. A missed assignment will be graded as a ZERO and no make-up will be scheduled unless: 1) We have personally approved prior arrangements, or 2) the absence is covered by a written excuse recognized as valid by UAB regulations. Reflections will not be accepted late for any reason. Quiz and exam questions will also address material from the reading.Remediation policy. Failure of the course may result in dismissal from the SOD, repetition of the academic year, or remediation of the course as decided by the Associate Dean for Academic Affairs after review of the student’s academic progress and consultation with the Academic Performance Committee.? If remediation is offered, the course director, in consultation with the SOD, will offer the student a one-semester course of independent study under the direction of one of the team of instructors teaching the course. After the instructor-aided self-study, the student must successfully complete an oral exam, a set of essay questions, and a research paper on a topic chosen by the instructor.III. Student Evaluation1. Reflections:10%2. Quiz Average10%3. Activities10%4. Midterm Exam35%5. Final Exam35%After every lecture/module, students will complete a short multiple choice quiz and a reflection response. Both will be due before the start of the next module (see dates below). Students will also be evaluated on their participation in class discussions and activities. The midterm and final exams will be administered online on July 23rd (midterm) and August 7th (final). Students will have 3 hours to complete each exam, but it must be completed within the 24-hour period. Each instructor will submit two questions based on their lecture material and students will be expected to answer a selection of the total questions submitted. Final grades will be based upon a standard grading scale: A = 90-100B = 80-89C = 70-79F = 69 and belowIV. Course Evaluation: This course will be evaluated by the students as per standards established by the university and administered by the Office of Academic Affairs.V. AccommodationsIf you are registered with Disability Support Services, please make an appointment with the course director, Dr. Thomeer, as soon as possible to discuss accommodations that may be necessary. If you have a disability but have not contacted Disability Support Services, please call 934-4205, email DSSOffice@uab.edu or visit the DSS offices in the Hill Student Center, Suite 409, 1400 University Blvd.VI. Course ObjectivesCompetencies. The course primarily addresses three core competencies outlined in the Dental School’s Competency Manual. These are: Competency 3.2 "Graduates must be competent to apply psychosocial and behavioral principles in patient-centered health care," 3.3 “Graduates must be competent to communicate effectively with individuals from diverse populations,” and 6.1 "Graduates must be competent to integrate and apply biomedical science knowledge to the delivery of patient care, including patients with special needs.”Objectives The primary course goal is to provide dental students with an appreciation of the social and cultural forces affecting health and health care, and to explore dentist’s professional and civic responsibilities in offering quality health care to the public. This includes the following specific objectives:Describe health disparities by class, race, ethnicity, gender and place of residence.Understand the social and cultural forces that cause these disparities.Understand the social factors influencing the profession and practice of dentistry and the delivery of health services.Understand the social and cultural factors that affect communication between dentist and patient and the dentist-patient relationship.Understand the problems and needs of special patient populations such as the poor, minorities, persons with mental health problems and drug addictions, victims of domestic violence, the homeless, etc.Understand the challenges of providing services to these special populations.Understand the ethical and social issues surrounding a market-based delivery of health services.Be familiar with local programs that offer services to populations with special needs. UAB SOD Competency Statements addressed in the course:#SOD Competency Statements1.2Utilize critical thinking skills.2.2Apply principles of professional responsibility to academics, patient care, practice management, and research.3.2 Apply psychosocial and behavioral principles in patient-centered health care.4.4Contribute to community health promotion efforts to prevent oral diseases.5.1Evaluate and apply contemporary and emerging information resources to clinical practice to promote lifelong learning. 6.2 Perform a comprehensive patient evaluation that collects diagnostic data and complete patient history (including chief complaint, medications, systemic health, behavioral, socioeconomic, and cultural information) to assess the patient’s medical, oral, and extraoral conditions.VII. Themes and Reading Assignments Power Point presentations and readings (as either PDFs or web links) may be accessed through Canvas.Unless otherwise specified, presentations for each module are pre-recorded and found on Canvas. These lectures should be viewed before the start of the next class. Questions about each lecture should be directed to the individual instructor. But some modules require students to log-on during specific time periods (between 9-11:45 am). If this is the case, the Zoom link and time can be found in the syllabus and on Canvas. When log-on, be sure to keep your microphone muted unless told otherwise. Some modules include activities. See Canvas for links and details. July 13: Dentistry: A Sociocultural PerspectiveBrief overview of sociology and culture and a sociological perspective of dentistry and health.Note for Class: Zoom meeting at 9 am, then students will review powerpoint presentation on own and complete quiz and reflection by July 15 at 9 am. Core ThemesWhat is sociology? What is culture?What is the relevance to dentistry of a sociocultural perspective?Social determinants of disease. Looking beyond the biomedical model.Readings: Nations, Marilyn K. and Sharmênia de Araújo Soares Nuto. 2002. “’Tooth Worms,’ Poverty Tattoos, and Dental Care Conflicts in Northeast Brazil.” Social Science & Medicine 54: 229-244.Jordan, Mary and Kevin Sullivan. 2017. “The Painful Truth about Teeth.” Washington Post, 15: Health Professions and the Professionalization Process: The Case of DentistryHow sociologists analyze the special work of professions; how occupations attain professional standing; turf battles within and among professions.Note for Class: View powerpoint presentation on own. Join Zoom link at 10 am for Debate. Follow directions on Debate document on Canvas. Complete quiz and reflection by July 17 at 9 am. ?Core Themes What distinguishes professions from other occupations? The importance of ethics in justifying the professional status of an occupationTurf battles among professions and new mid-level practitionersReadings: Review materials for class debate and prepare (7-15 Debate document)OPTIONAL: Adams, Tracey. 1999. “Dentistry and Medical Dominance.” Social Science & Medicine 48(3): 407-420.Adams, Tracey. 2004. “Inter-professional Conflict and Professionalization: Dentistry and Dental Hygiene in Ontario.” Social Science & Medicine 58(11): 2243-2252. July 17:?Social Class and Oral Health Socioeconomic status and why dentistry is interested in social class issues for both research and practice.? Note for Class: View powerpoint presentation on own, have case studies available to use, and join Zoom Discussion at 10:30 am to 11:30AM (link below) for case studies. There will be 4 breakout rooms, and then one person from each room will report back to the class. Complete quiz and reflection by July 20 at 9 am. Core Themes:How class matters for oral healthHow class matters in one’s practiceReading: Anja Heilmann, Georgios Tsakos, and Richard G. Watt. 2015. “Oral Health Over the Life Course”? A Life Course Perspective on Health Trajectories and Transitions, Life Course Research and Social Policies 4: 39-59.Patricia Drentea, Heith Copes, and Jessica Valles. 2020. “Hope, Dignity, and Oral Health for Women in Recovery” Contexts. 19(2): 62-64.July 20: Paying for Dental Care in the U.S. Overview of how health care is paid for in the United States, followed by a focus on unique aspects of financing dental care. Note for Class: View powerpoint presentation and Parks and Recreation episode on own, then join Zoom at 10:30 am (link below). Bring questions and comments for Dr. Jones regarding lecture and reading, then be prepared to discuss Parks & Recreation episode in breakout rooms and as a large group. Complete quiz and reflection by July 22 at 9 am. Core Themes:How have recent policy changes influenced health care spending in the U.S.?How are health care providers paid in the U.S.? – a primer on the ways we pay for health care broadly and dental care specificallyWhat drives the cost of dental care? Reading:Leake, J. L., & Birch, S. (2008). Public policy and the market for dental services. Community dentistry and oral epidemiology, 36(4), 287-295. QuickTake: The Forgotten Health Care Need: Gaps in Dental Care for Insured Adults Remain under ACA. Adele Shartzer and Genevieve M. Kenney, September 24, 2015. , M., Buchmueller, T., & Klein, R. (2016). Dental Care Presents The Highest Level Of Financial Barriers, Compared To Other Types Of Health Care Services. Health Affairs 35 (12), 2176–2182.? 22: Aging and DentistryProvide an overview of the principles, processes, and key concepts involved in the study of aging and how those may be related to dentistryNote for Class: Complete the "How Much Do You Know About Aging?" quiz and join the Zoom meeting at 9:30 am. Complete quiz and reflection by July 24 at 9 am.Core Themes:Biological, psychological and sociological factors in agingTransitions (housing, cognitive changes, physical health and death) in late lifeDentition, nutritional intake, oral hygiene, and health/illness among older adults Barrier to dental care for older minority adultsDementia and care resistance during oral care (neurobiology of threat perception)Strategies to address psychological and behavioral symptoms of dementiaReading: Davis, D.L., & Reisine, S. (2015). Barriers to Dental Care for Older Minority Adults. Special Care in Dentistry 35(4): 182-189.Jablonski-Jaudon, R. A., Kolanowski, A. M., Winstead, V., Jones-Townsend, C., & Azuero, A. (2016). Maturation of the MOUTh Intervention: From ReducingThreat to Relationship-centered Care. Journal of Gerontological Nursing 42(3): 15-23. Kohli, R., Sehgam, H.S., Nelson, S., & Schwarz, E. (2017). Oral health needs, care utilization, and quality of life perceptions among Oregonian seniors. Special Care in Dentistry 37(2): 85-92.July 23: The Mid-term Exam will be available all day, but once begin, must be submitted within 3 hours. The exam will cover material from July 13 thru July 22.July 24: Gender/Sexuality and Dentistry Understanding the role of gender and sexual orientation in dentistry, including population-specific concerns, work-life balance, and sexual harassmentNote for Class: View powerpoint presentation on own. Join Zoom discussion at 11 am. Complete quiz and reflection by July 27 at 9 am.Core Themes:Sociology of sex and gender and why matters for oral health and dentistryImportance of gender in the work place, focusing specifically on gender wage gap in dentistry, work-life balance for men and women, and sexual harassmentSexual orientation, gender identity, and oral healthReading: Tannenbaum, C., Greaves, L., & Graham, I. D. (2016). Why sex and gender matter in implementation research. BMC Medical Research Methodology, 16(1), 145. Gretchen Carlson’s Ted Talk: 27: Race/Ethnicity and DentistryImpact of race and ethnicity on dentist-patient interactions, health behaviors and beliefs, and oral health outcomesNote for Class: View powerpoint presentation on own. Complete quiz and reflection by July 29 at 9 am.Core Themes: Definitions of race, ethnicity, and racismEthnocentrism vs. cultural relativism Problems of cultural and socioeconomic disadvantage in negotiating the healthcare systemHow and why intersections of class and race shape health inequalities, particularly in regard to oral healthReadings: Pew Trusts article: “Dental Health Is Worse in Communities of Color” Hardeman, R. R., Medina, E. M., & Kozhimannil, K. B. (2016). Structural Racism and Supporting Black Lives-The Role of Health Professionals. The New England Journal of Medicine, 375(22), 2113-2115. Cottom, Tressie McMillam. 2019. I Was Pregnant and in Crisis. All the Doctors and Nurses Saw Was an Incompetent Black Woman. Time Magazine, January 8. 29: Drugs and SocietyThis lecture introduces first-year dental students to common drugs and current patterns of use in the US and addresses potential problems of abuse among patients as well as among dental professionals.Note for Class: View powerpoint presentation on own. Complete quiz and reflection by July 31 at 9 am.Core ThemesDefinitions of drugsTypes of drug use and abuseDrug use in the U.S.Drug legality and schedulingPrescription drug development and advertisingThe “war on drugs”Reading: Robinson, P.G., S. Acquah, and B. Gibson. 2005. “Drug Users: Oral Health-Related Attitudes and Behaviors.” British Dental Journal 198(4): 219-224.Shetty, V., L. J. Mooney, C. M. Zigler, T. R. Belin, D. Murphy, and R. Rawson. 2010. “The Relationship Between Methamphetamine Use and Increased DentalDisease.” The Journal of the American Dental Association 141(3): 307-318.Rosenberg, Tina. 2017. "Breaking the Opioid Habit in Dentists' Offices."?The NewYork Times, July 10.July 31: Rural/Urban Differences in Health and Health Service Delivery Health delivery problems associated with community location and size are explored.Note for Class: View powerpoint presentation on own, and join Zoom Q&A at 11 am (link below). Bring questions and comments for Dr. Davis regarding rural oral health and dental care. Complete quiz and reflection by August 3 at 9 am. Core Themes:Concentrated disadvantage Qualities and characteristics of rural versus urban places Rural oral health disparity Existing strategies for addressing disparities.Reading: Doescher M and Keppel G. 2015. Dentist Supply, Dental Care Utilization, and Oral Health Among Rural and Urban U.S. Residents. Final Report #135, Seattle, WA: WWAMI Rural Health Research Center, University of Washington. National Advisory Committee on Rural Health and Human Services. 2018. Improving Oral Health Care Services in Rural America . Green-Mcintyre, Mary, Mary Hayes Finch, and John Searcy. 2003. Smile Alabama! Initiative: Interim Results From a Program to Increase Children's Access to Dental Care. Journal of Rural Health. Vol 19. No. 5August 3: Family ViolenceProviding factual information to address common myths surrounding family violence. Mandated reporting requirements and best practices will be discussed. A panel will present community resources and survivor perspectives on the potential role for dentists in addressing family violence.Note for Class: View powerpoint presentation on own, and join Zoom Panel Q&A at 10:30 am (link below). Bring questions for panelists regarding family violence and dental care. Complete quiz and reflection by August 5 at 9 am. Core Themes:Common myths surrounding family violenceRecognizing signs and symptoms of abuse and neglect among children and adultsAlabama law and mandated reporting requirements for dentists??????????????? Best practices in identifying family violence-- RADARCommunity resources for victims Reading: Littel, Kristin. 2004. “Family Violence: An Intervention Model for Dental Professionals.”OVC Bulletin December: 1-11.August 5: Mental Health Overview of diagnostic categories of mental disorders and the problem of stigma and issues of access to care. Note for Class: View powerpoint presentation on own, and join Zoom Discussion at 11 am (link below). Complete quiz and reflection by August 7 at 9 am. Core Themes:Subjectivity & bias in diagnosis of mental illness Exploration of stereotypes, and consequences of shunning people with mental illnessThe myth and truth about the potential for violenceSerious mental illness categories recognized by community mental health centersMedical risks associated with mental illness Case examples addressing recognition and adjustments in communication style for patients with disordered language and perception. Reading: S. Brown, M. Greenwood, and J. G.?Meechan. 2010.?“General Medicine and Surgery for Dental?Practitioners. Part 5 – Psychiatry.” British Dental Journal 209: 11–16.August 7: The Final Exam will be available all day, but once begin, must be submitted within 3 hours. The exam will cover lecture material from July 24 thru August 5 only. ................
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