Sexual Dimorphism in Periodontitis is Regulated by the miR-141/200c Cluster

Objective:  Sexual dimorphism in periodontitis reflects intrinsic molecular regulation of host responses, mediated by microRNAs that act on immune, inflammatory, and hormonal pathways. We aimed to elucidate how the autosomal miR-141/200c cluster impacts sex-specific susceptibility to experimental periodontitis and its underlying mechanisms.
Methods:  To determine sex-specific influences of the miR- 141/200c  cluster on the oral microbiome and inflammation, oral microbiota and serum inflammatory cytokines were analyzed in miR-141/200c  knockout (KO) mice of both sexes using 16S rRNA sequencing and an inflammatory cytokine array. We further analyzed sex-specific functions of the miR-141/200c  cluster on gingival inflammation and bone metabolism in a mouse model of periodontitis by gingival transcriptomic profiling and micro-CT analysis. Key molecular mechanisms identified from transcriptomic data were validated in primary human gingival fibroblasts.
Results:  Oral microbiome composition showed higher alpha diversity and more distinct beta diversity clustering in females than in males. Notably, while it has limited effects in males, knocking out the miR-141/200c  cluster significantly affected females and eliminated sex differences. KO mice also showed enrichment of more gingival inflammatory pathways than wild-type (WT) mice. In ligature-induced periodontitis, while KO had limited effects in males, KO females exhibited significantly less bone loss than WT and eliminated the differences compared to males. Correspondingly, KO females had reduced serum proinflammatory cytokines. KO females also reversed the enrichment of inflammation-related pathways, restored estrogen signaling, and upregulated angiotensin-converting enzyme 2 (Ace2) , a periodontal inflammatory mediator located on the X-chromosome. While circulating estrogen levels were unchanged, KO females had an upregulated estrogen receptor (Esr) 1  and Esr2  in the gingival tissues. The increased expression of Esr1  and Ace2  in the KOs was confirmed in primary human gingival fibroblasts treated with a miR-200c  inhibitor.
Conclusion:  The miR-141/200c  cluster regulates sexual dimorphism in periodontitis through modulation of oral microbiome composition, inflammation, and estrogen signaling.
Supported by: NIDCR R56 DE026433

Assessing the Practice Management Curriculum in U.S. Dental Schools

Objective:  Practice management (PM) skills are critical for safe, sustainable dental practice, yet their integration in U.S. dental curricula is inconsistently documented. This study aimed to describe PM course structure, instructional hours, content emphasis, teaching methods, and implementation challenges.
Methods:  PM syllabi were first collected from course directors and academic deans to inform survey design. A national Qualtrics survey was then distributed to academic deans of all U.S. dental schools. Data included institutional characteristics, course format, hours by year (D1–D4), topic-specific allocation, teaching strategies, assessment practices, and ranked challenges.
Results:  Fourteen schools completed the survey; 71% were public institutions. PM courses were required in nearly all programs. Delivery formats varied: 43% offered standalone courses, 43% combined standalone and integrated formats, and 14% used only integrated approaches. Schools reported a median of three distinct PM courses (range 1–10). Instructional time increased in D3/D4 years, with median hours of 2.25 (D1), 6 (D2), 18 (D3), and 32 (D4). Ethics/professionalism received the highest median allocation (6 hours), followed by technology/digital tools (4), interprofessional collaboration (3.25), and leadership/ team building (3). Core business and regulatory topics averaged 2–2.75 hours, while artificial intelligence was rarely covered. Teaching methods included lectures, case- based learning, simulations, standardized patients, guest experts, and online modules; approximately 77% aligned objectives with Bloom’s taxonomy. Major challenges were faculty workload and competing priorities (mean rank ~2.79) and limited curriculum time (~3.07).
Conclusion:  PM education in U.S. dental schools is widely required, concentrated in later years, and delivered through diverse didactic and experiential methods. However, faculty capacity and time constraints limit depth, particularly for emerging topics. Enhancing simulation resources, expanding hands-on learning, and sharing instructional assets may help standardize and strengthen PM training nationally.
Supported by: University of Iowa College of Dentistry Student Research Program Posters 23
 

Comparing D1 Versus D4 Students’ Willingness to Treat Underserved Populations

Objective:  This longitudinal study assessed how dental students’ willingness to treat underserved populations changed from the first-year (D1) to the fourth-year (D4).
Methods:  A 21-item questionnaire was administered annually to all D1 and D4 students (D1: 2008–2020; D4: 2011–2025; N=1,120). Participants indicated their anticipated willingness to treat 14 underserved populations five years post-graduation. Responses were dichotomized as "yes" versus "yes, but a limited number of patients," "unsure," or "no." Corresponding D1 and D4 surveys were matched. Means and frequencies were calculated. McNemar’s tests evaluated changes in participants’ willingness to treat each population. Fisher’s exact tests assessed which participant demographic variables were associated with willingness to treat each population. (a=0.05)
Results:  643 surveys were matched (response rate=57%). Except for known drug users and patients with HIV/ AIDs, fewer D4 than D1 respondents were willing to treat each underserved population (i.e. "yes"). However, when considering the change by proportions, a larger percentage of respondents became more positive than more negative for 6 populations (e.g. medically complex), while a larger percentage of respondents became more negative than more positive for 7 populations (e.g. Medicaid). Participants who identified as Hispanic, Black/African American, Asian/ Pacific Islander, or other/mixed demonstrated greater willingness to treat 6 populations compared to non-Hispanic, Caucasians. Participants whose mothers or fathers had < high school education were more likely to treat 3 or 1 population, respectively. Females were more likely to treat 2 populations, while participants from higher socioeconomic backgrounds were more willing to treat 1 population.
Conclusion:  This study suggests that changes in dental students’ willingness to treat underserved populations are population specific. Overall, there was a general decline in willingness; however, approximately half of the populations saw a greater proportional shift from more negative to more positive. With the exception of race and ethnicity, participants’ demographic variables were rarely associated with willingness to treat.
Supported by: University of Iowa College of Dentistry Student Research Program
 

Critical Thinking: Symbiotic Network of Skillsets, Outcomes, and Learning Moments

Objective:  Although critical thinking is widely recognized as essential in education, there are few structured ways to develop and assess it. This study aimed to help students build critical thinking skills by creating a set of exercises across multiple departments. These exercises formed a connected, or "symbiotic," network where students can learn from the expertise of the clinician’s skillsets with the goal of students applying these skills in outcome-based assessments and then explore deeper insights to what we call "learning moments."
Methods:  Third year dental students (n=80) were provided with a standardized PowerPoint template and a learning guide. After conducting comprehensive medical and dental examinations, students entered patient data into the template and responded to guided critical thinking questions designed to simulate expert clinical reasoning.
Results:  Two factors were seen to contribute to the symbiosis of learning guides among different departments: use of standardized learning guide and outcomes-based assessment. The use of a learning guide based on a designated thought process combined with use of a common outcomes-based assessment were also associated with subsequent rich and varied learning moments distinctive for each exercise.
Conclusion: This emulation-based approach fostered the development of critical thinking and encouraged deeper outcome driven learning experiences. With little literature on learning outcomes for critical thinking, the emulation learning model based on the thought processes of the master clinician led to development initially of multiple critical thinking skillsets followed by interactions of exercises. The result was a symbiotic network with rigorous demonstration of a skillset followed by a rich exploration of nuances.
Supported by: University of Iowa College of Dentistry Student Research Program
 

Dental Care Access for Adults With Disabilities: Barriers and Facilitators

Objective:  Adults with disabilities face barriers to accessing dental care and experience poorer oral health outcomes compared to the general population. This study aimed to identify the main barriers and facilitators for this population to access dental services as seen from the perspectives of patients, caregivers, patient advocacy organizations, and dental providers.
Methods:  A mixed-methods approach was employed. Participants were recruited through patient advocacy organizations and healthcare organizations in Iowa, and the University of Iowa College of Dentistry.  Qualitative data were collected from patients (n=5), caregivers (n=12), individuals working for patient advocacy organizations (n=15) and providers (n=6) through seven focus groups and four 1:1 interviews conducted from June-October 2025. Quantitative data were collected from responses to an electronic survey (n=36). Deductive thematic analyses were conducted, guided by the five dimensions of access to healthcare (Penchansky and Thomas, 1981).
Results:  The main barriers to accessing dental care included: difficulties in finding providers who accept Medicaid and are willing to treat individuals with disabilities, long distances to receive care, extensive wait times to obtain appointments, issues with patient-provider communication, and lack of various accommodations. Increasing Medicaid reimbursement rates, additional training for providers, and greater flexibility regarding appointment scheduling were highlighted as potential facilitators.
Conclusion:  This study identified the main barriers to accessing dental care for this vulnerable population as seen from the perspectives of multiple stakeholders. In addition, the findings identified several policy-level changes and educational interventions that could improve access.
Supported by: Delta Dental of Iowa Foundation
 

Dental Implications of Nutritional Profiles of Protein Powders and Shakes

Objective:  High-protein diets are a popular dietary trend, and consumers often turn to protein powders, which are generally mixed with a milk product, or protein shakes to increase protein intake. These protein drinks have the potential to affect oral health. We hypothesize that plant-based products will have fewer nutrients and be more likely to adversely impact the oral environment than traditional animal-based products. The objective was to examine the nutrient profiles of plant- and animal-based protein shakes, protein powders, and milk products and to consider how the nutrient profiles might impact oral health.
Methods:  Nutritionix.com was used to identify the top ten commonly used products for each of the following categories: plant-based protein powders, animal-based protein powders, plant-based protein shakes, animal-based protein shakes, plant-based milk alternatives,  and  animal- based milks. The products’ nutrient composition (i.e., protein, added sugars, starches, micronutrients) and ingredient list (i.e., non-nutritive sweeteners and acids) were identified.
Results:  All protein products contained whole proteins; the protein density of plant-based products was lower than that of animal-based products. Ten percent of protein powders contained added sugars and starches, while all plant-based protein shakes and one animal-based shake contained added sugars. Most plant-based milks contained added sugars, although unsweetened versions were available. Seventy-two percent of products contained non-nutritive sweeteners, including stevia, acesulfame potassium, and sucralose. There were no acidic ingredients except in one protein powder. The nutrient composition of products varied considerably. All plant-milks were fortified with calcium; the majority had vitamin D.
Conclusion:  Fortification of plant-based products (i.e., calcium, vitamin D) normalized these micronutrient concentrations to animal-based products; however, protein concentrations were generally lower in plant- based products.  Most protein powders and shakes do not increase caries or erosion risk, although some products are potentially cariogenic.
Supported by: University of Iowa College of Dentistry Student Research Program
 

Dental Insurance Literacy Varies by Role Within a Dental School

Objective:  The aim of this study was to determine the dental insurance literacy of dental students, residents, faculty, and staff at the University of Iowa College of Dentistry.
Methods:  A survey was created in Qualtrics, and IRB approval was obtained. The survey assessed individuals’ knowledge of dental insurance terminology (10 questions), their ability to calculate out-of-pocket treatment costs (5 questions), and their perceptions of selecting and using dental insurance, rated as 1=not very confident to 7=very confident. The survey was sent four times via email to all members of the College between June-September 2025. Descriptive and bivariate analyses were performed. (alpha=0.05)
Results:  N=131. The majority of responses were from staff (39.7%), students (31.3%), and faculty (25.2%). Knowledge scores ranged from 2 (0.8%) to 10 (47.3%), and calculation scores ranged from 0 (16.8%) to 5 (11.5%). Students had significantly lower mean knowledge scores (8.1) compared to faculty (9.2), residents (9.6), and staff (9.4; p<0.05). Similarly, students were less likely to correctly calculate out-of-pocket costs (2.4) compared to faculty (3.3; p=0.02); however, students’ scores were not significantly different from residents (3.2) and staff (2.8). Nearly 1/3 of respondents reported they understand dental insurance "very well." In contrast, 50.4% reported understanding it "somewhat," and 18.3% reported "not very well." Overall, respondents reported moderate confidence choosing (mean=4.54) and using (mean=4.67) dental insurance.
Conclusion:  Although all mean knowledge scores were high, students possessed significantly lower knowledge of dental insurance terminology compared to others. Respondents were less knowledgeable about calculating out-of-pocket costs, and more than 2/3s of respondents indicated a lack of understanding about dental insurance. Dental schools could benefit by providing dental insurance literacy training to all providers and staff who interact with patients.
Supported by: University of Iowa College of Dentistry Student Research Program

Dental Student Professionalism: Identifying Education Gaps and Developing Assessment Strategies

Objective:  The need to teach and assess professionalism has increased in recent years, as standards of conduct have notably declined, both in society at large and among dental students. The purpose of this study is to describe the multi-year efforts of the University of Iowa College of Dentistry to develop a common understanding of professionalism, identify gaps in professionalism among students, consider ways to cultivate professionalism, and develop more consistent assessment across classroom, laboratory, and clinical contexts.
Methods:  This case analysis includes qualitative data collected at the September, 2021, faculty retreat addressing faculty perceptions of the elements of professionalism and faculty examples of unprofessional student behavior. These data were analyzed and presented at the September, 2023, faculty retreat, where quantitative survey data were collected addressing current professionalism assessment practices and desired support.
Results:  Twelve themes emerged in faculty definitions of professionalism. Four themes have exact counterparts in ADEA’s 6 values defining professionalism, but competence and service-mindedness were not emphasized by faculty. Examples of unprofessional student behavior were offered by 62 faculty, several offering multiple and egregious examples in contexts ranging from the classroom to the lab to the clinic. Quantitative survey data indicated 45% had experienced "critical" levels of unprofessional student behavior, significantly undermining patient care or working relationships. Faculty most commonly reported unprofessional behavior occurred monthly (35%) or once a semester (32%). Although significant majorities advocated formal professionalism assessment, only 25% were comfortable confronting student behavior. Majorities requested more education on assessment (61%) and a professionalism rubric (53%), which subsequently was developed.
Conclusion:  Faculty conceptualizations of professionalism may differ from more formal definitions. Although faculty regularly encounter unprofessional student behavior in a range of contexts, they are uncomfortable addressing it and prefer education and rubrics to better assess professionalism and provide useful feedback to students.
 

Food Insecurity Among WIC-Enrolled Pregnant Women

Objective:  Food insecurity, defined as limited access to adequate and nutritious food, affects approximately 1 in 10 pregnant women due to increased caloric needs and financial strain. Early childhood nutritional challenges have been associated with adverse oral health outcomes, underscoring the importance of maternal nutrition during pregnancy.
Methods:  This secondary analysis included 634 survey responses from WIC-enrolled pregnant women participating in the longitudinal Birth to Three – Cavity Free  study, a trial of an intervention to improve care behaviors and reduce ECC. Food insecurity was assessed using a validated questionnaire. Baseline demographics and maternal behaviors were compared by food insecurity status using two-sample t-tests for continuous variables and chi-square or Fisher’s exact tests for categorical variables. All tests were two-sided, and p-values are reported for descriptive purposes only.
Results:  Participants had a mean age of 26.98 years (SD = 5.67). Overall, 43.3% reported worrying about food not lasting through the month, and 35.0% reported that food did not last. Compared to those who never experienced food insecurity, participants reporting food insecurity were significantly more likely to be pregnant for the first time (49.1% vs. 31.9%, p < 0.001), unemployed (31.4% vs. 23.0%), have very low income (<$5,000: 25.6% vs. 17.6%, p = 0.005), exhibit less predictable eating patterns (75.1% vs. 66.1%, p = 0.027), consume fewer daily meals (≥3 meals/ day: 52.9% vs. 65.8%, p = 0.001), and eat breakfast less frequently (≥5 times/week: 39.3% vs. 58.1%, p = 0.004).
Conclusion:  Food insecurity among WIC-enrolled pregnant women was common and associated with socioeconomic disadvantage and suboptimal eating behaviors. These findings highlight the need for targeted interventions that address food access, promote consistent meal patterns, and integrate oral health support during pregnancy to benefit both mothers and their infants.
Supported by: NIDCR UH3 DE029443

Food Noise and Behaviors Associated with Dental Caries Risk

Objective:  Food noise, defined as persistent thoughts about food, may influence eating behaviors that contribute to dental caries risk. Dietary patterns and food-related behaviors are established risk factors for caries. Our objective was to examine the relationship between food noise and caries risk behaviors. 26
Methods:  An online Qualtrics® survey was distributed to adults (18+ years) via the University of Iowa’s listserve and posted on social media. The survey queried demographics, diet-related caries risk behaviors, and food noise. Diet- related caries behaviors included eating frequency, meal structure, sugar-sweetened beverage (SSB) behaviors, and candy/lozenge frequency. Food noise was measured using a validated five-item assessment questionnaire with scores ranging from 5 to 25; higher scores indicate greater food noise. Statistical significance was set at p<0.05.
Results:  Of 887 respondents, 834 were included in the final analysis after excluding 53 surveys with <25% completion. Respondents were predominantly female (n=644), aged 18-24 years (n=342), and non-Hispanic White (n=704), with some college education (n=237), and full-time employment (n=421). The mean (standard deviation) food noise score was 13.8 (5.1) and ranged from 5-25. Food noise scores were associated with caries risk behaviors. Individuals with higher food noise scores were more likely to consume only one meal/day (p=0.049), snack more than three times/day (p <0.001), have unstructured meal patterns (p<0.001), consume more SSBs (p<0.001), consume SSBs over longer time periods (p<0.001), and consume sugared candy/lozenges more frequently (p<0.001) than individuals with lower food noise scores.
Conclusion:  These findings suggest that higher food noise is associated with behaviors increasing risk of dental caries. Consideration of food noise may be relevant when evaluating behavioral contributors to caries risk in dental populations.
Supported by: Finkelstein Professorship
 

Front-Line Staff Attitudes and Experiences with Teledentistry Scheduling in Academics

Objective:  This qualitative study’s objective was to examine front-line staff attitudes and experiences with scheduling teledentistry visits. It explores coordination challenges, perceptions of teledentistry as a care model, and factors affecting scheduling efficiency, as well as its impact on patient care and satisfaction. Feedback from staff will guide recommendations to improve scheduling processes and inform the future of teledentistry as a method of dental care delivery.
Methods:  The methods involved interview front-line staff from the COD Admissions Clinic about their experiences scheduling teledentistry visits. Approximately fifteen staff were invited to participate via email, with consent indicated by their response. Interview questions were developed from existing telehealth literature and refined with supervisor input. Data were analyzed thematically, with both researchers independently coding transcripts and collaboratively identifying final themes.
Results:  Resulting participants included one supervisor from the call center and three front-line schedulers. All described positive experiences implementing and scheduling teledentistry appointments. They agreed that teledentistry positively impacts patient care, particularly by reducing travel time for those living farther away. The most common challenge involved creating and managing Zoom, which participants suggested could be better automated. Two participants also proposed offering a patient self-scheduling option.
Conclusion:  In conclusion, teledentistry appointments are an effective way to expand access to care. Schedulers unanimously shared the sentiment that any extra steps are minor and well worth the effort to help more patients. While small improvements could increase efficiency, these issues do not substantially add to workload or diminish enthusiasm for continuing teledentistry.
Supported by: University of Iowa College of Dentistry Student Research Program
 

HPV Vaccine Referrals in Dentistry: A Qualitative Study

Objective:  Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and causes over 70% of oropharyngeal cancers (OPC). Iowa has the highest OPC rate in the nation alongside lower-than-average HPV vaccination rates, indicating a critical gap in prevention efforts that dental professionals could help address. This study assessed changes in dental staff knowledge, attitudes, and practices following implementation of an HPV vaccine education and referral training program.
Methods:  A three-hour training program was developed and delivered to staff at two dental offices, focusing on HPV epidemiology, OPC prevention, strategies for vaccine education, recommendation, and referral. Over a six-month implementation period, staff educated patients about HPV and OPC, recommended the HPV vaccine to eligible individuals, and provided referrals to vaccination sites. Materials including patient brochures, educational flipcharts, and referral pads facilitated integration into practice workflows. Following the intervention, staff participated in semi- structured interviews exploring changes in their knowledge, attitudes, and clinical behaviors. Interview transcripts were analyzed qualitatively using thematic analysis.
Results:  Twelve staff members completed post-intervention interviews. Nearly all participants (92%, n=11) reported improved understanding of HPV, OPC, and HPV vaccination. Initial concerns about discussing a sexually transmitted infection with patients decreased substantially, with four staff (33%) expressing pre-training hesitation compared to zero after training. Staff found patients highly receptive to these conversations: “I would just say how receptive the parents were and how grateful so many of them were that we were discussing this .” Participants successfully integrated the intervention into existing practice through collaborative approaches, as one dentist explained: “The hygienist would plant a seed and talk about HPV and oropharyngeal cancer and [ . . .] I would come in and talk about the vaccine and the recommendation.”
Conclusion:  Training dental staff in HPV vaccine education and referrals is feasible, acceptable, and may contribute to reducing Iowa’s OPC burden.
Supported by: NCI P30 CA086862; NCCDPHP U48 DP006389; Roy J. Carver Charitable Trust 24-5779; University of Iowa College of Dentistry Student Research Program

Long-Term Effects of Chlorinated Pools on the Oral Cavity

Objective:  Competitive swimmers spend extensive time in chlorinated water, which may alter enamel integrity and the oral microbiome. However, evidence on whether swimming frequency correlates with increased tooth sensitivity or microbial shifts remains limited. This study assessed whether there is a higher prevalence of tooth sensitivity in competitive swimmers versus non-swimmers.
Methods:  55 participants (29 swimmers, 26 non-swimmers) aged 18-25 were surveyed on tooth sensitivity using a Likert- scale questionnaire as part of a cross-sectional study. Two sample permutation t-tests were used to compare sensitivity measures between groups, and ordinal logistic regression models were used to analyze whether years of swimming or weekly hours of pool exposure predicted responses among swimmers alone. Salivary samples (n=31) were cultured on SB-20 and blood agar plates to quantify S . mutans  and total microflora colony counts (CFU/ mL) respectively, for swimmers and non-swimmers.
Results:  Swimmers reported lower anxiety about tooth sensitivity (p=0.029) and were less likely to modify eating behavior due to discomfort (p=0.011) than non- swimmers. No significant differences were observed for overall sensitivity or avoidance of specific foods (p>0.05). Within swimmers, neither years of experience nor hours of weekly exposure significantly predicted sensitivity outcomes (all 95% confidence intervals contained 0). Mean S . mutans  counts and total microflora colony counts did not significantly differ between swimmers and non- swimmers on either blood (p=0.54) or SB-20 agar (p=0.44).
Conclusion:  Contrary to our hypotheses, competitive swimmers did not exhibit greater tooth sensitivity or lower S . mutans  concentrations than non-swimmers. In fact, swimmers appeared less reactive to sensitivity-related discomfort, suggesting potential enamel adaptation or behavioral desensitization. While the sample size was small, these findings highlight the need for longitudinal studies to clarify the long-term oral effects of chlorinated pool exposure.
Supported by: University of Iowa College of Dentistry Student Research Program

Obesity Stereotypes, Biases, and Prejudices Amongst Academic Dental Professionals

Objective:  Shaped by societal emphasis on thinness, individuals with obesity frequently encounter stereotypes, bias, and prejudice (SBP), which has been documented among healthcare professionals. This study examined obesity-related SBP among dental professionals in an academic setting, hypothesizing patterns similar to other healthcare workers.
Methods:  Faculty, staff, graduate students/residents, and students affiliated with the University of Iowa College of Dentistry in Fall 2024 were invited. A 37-item QualtricsÆ survey collected demographic information and assess obesity-related SBP using the validated Antifat Attitudes Questionnaire and Fat Phobia Scale. Chi-square or Fisher’s exact tests were used for categorical bivariate analyses, and a two-sample t-tests or ANOVA with Tukey-Kramer post-hoc tests for group comparisons (a=0.05).
Results:  A total of 230 responses were received (70.3% female, 83.0% White; 44.8% <30 years). Most disagreed with, "I tend to think that people who are obese are a little untrustworthy" (90.4%) and "Although some obese people are surely smart, in general, I think they tend not to be quite as bright as normal weight people" (88.5%). Conversely, 58.1% agreed, "People who weigh too much could lose at least some part of their weight through a little exercise." Responses were mixed for, "One of the worst things that could happen to me would be if I gained 25 pounds" (disagree=29.5%; neutral=24.2%; agree=46.1%). Mean Fat Phobia Score was 3.53±0.56; participants <30 years had the highest scores compared to those 40-59 and 60+ (3.71±0.50 vs. 3.37±0.60 and 3.29±0.54; p<0.001), with no significant difference from form participants 30-39.
Conclusion:  Obesity-related SBP are present among dental professionals, consistent with other healthcare fields. While most rejected associations between obesity and dishonesty or lack of intelligence, substantial agreement remained with negative obesity stereotypes and weight-related concerns, particularly anxiety about personal weight gain.
Supported by: University of Iowa College of Dentistry Student Research Program
 

Oral Health Knowledge among WIC-Enrolled Pregnant Women

Objective:  The purpose of this study is to assess expecting mothers’ baseline knowledge about their oral health and their future baby’s oral health. The objective is to reduce ECC incidence by ensuring that mothers, particularly those from underserved populations, are equipped with the knowledge and resources necessary to foster oral health from the earliest stages of their child’s life.
Methods:  This secondary analysis included 634 baseline survey responses from WIC-enrolled pregnant women in longitudinal the Birth to Three – Cavity Free study, a trial of an intervention to improve care behaviors and reduce ECC. Maternal oral health knowledge was assessed using a 32-item questionnaire scored from –2 (strongly incorrect) to +2 (strongly correct), summed to create a total score. Univariable linear regressions examined associations between total knowledge score and demographics (age, education, employment, income, marital status, dental insurance, ethnicity). Regression coefficients, 95% confidence intervals (CI), and p-values are reported. 28
Results:  Participants had a mean age of 27 years (SD = 5.7); most held a high school diploma/GED (63.9%), and nearly half were single (46.9%). Income was low, with 21.1% reporting $0–5,000 annually; 67.4% had Medicaid coverage. Higher total knowledge scores were associated with age [+0.383 points/year (95% CI: 0.24–0.53; p < 0.001)]; education [two-year college (+11.703; p = 0.004), four-year college (+13.315; p = 0.001) vs. ≤8th grade]; employment [full-time (+5.325; p < 0.001), part-time (+2.489; p = 0.031), and homemaker (+7.883; p < 0.001) vs. unemployed]; dental insurance [Medicaid (+4.589; p < 0.001) and private (+6.756; p < 0.001) vs. no insurance], income [≥$30,000 (+7.710; p < 0.001) vs. $0–5,000]. Single mothers had lower scores than married (–4.003; p < 0.001). Hispanic ethnicity and student status were not significant. Item-level analyses revealed persistent misconceptions about fluoride toothpaste and bedtime brushing, even among higher knowledge groups.
Conclusion:  Maternal oral health knowledge is strongly linked to socioeconomic factors. Targeted education strategies for single, low-income, and less-educated mothers is critical to reduce ECC disparities.
Supported by: NIDCR UH3 DE029443

Oral Health Perceptions and Behaviors Among Low-Income Pregnant Women

Objective:  Describe baseline demographics, self-reported oral health perceptions, and dietary and oral hygiene behaviors of pregnant participants enrolled in the Birth to Three – Cavity Free  UH3 study through Iowa’s WIC program.
Methods:  Secondary analysis utilized baseline data from Iowa WIC-enrolled pregnant women enrolled in a randomized clinical trial evaluating the efficacy of autonomy-supportive oral health messages based on self-determination theory compared to control in preventing early childhood caries in their future children. Participants completed comprehensive questionnaires capturing demographic information, oral health perceptions, and dietary and oral hygiene behaviors. Univariate analyses were conducted to generate an overall profile of the study population.
Results:  To date, 602 participants (94% of the final sample size of 634) have completed the initial visit. The mean age was 27±5.71 years; 73% identified as Caucasian, 48% were single, 23% reported annual incomes below $5,000, and 19% identified as Hispanic. The largest percentages rated their natural teeth as being in good condition (31%), did not believe they had gum problems (40%) or cavities (32%), and had not visited a dental provider since becoming pregnant (65%). Dietary behaviors included consuming three meals (58%) and more than three snacks (45%) daily, with 69% reporting unstructured eating patterns. Beverage consumption between meals included regular soda (42%), 100% juice (47%), and water (94%). Oral hygiene behaviors performed daily included toothbrushing (90%), fluoride toothpaste use (80%), and flossing (29%).
Conclusion:  The oral health perceptions and behaviors reported by these pregnant women suggest potential risks for their future children’s oral health. Understanding and addressing these behaviors during pregnancy is critical, as maternal habits and knowledge significantly influence early childhood caries outcomes.
Supported by: NIDCR UH3 DE029443; University of Iowa College of Dentistry Student Research Program
 

Patient Characteristics Associated with Dental Fear: A Retrospective EHR Study

Objective:  This study examined variables associated with dental fear (DF) by comparing patients who reported fear-related avoidance of dental appointments with those who did not.
Methods:  Deidentified electronic health record data from over 50,000 patients at the University of Iowa College of Dentistry (2010–present) were analyzed. Variables related to demographics, dental history, and medical history were assessed. Descriptive and bivariate statistics compared patients with and without self-reported DF. Multivariable logistic regression was conducted to identify factors associated with self-reported dental fear.
Results:  Dental fear was reported by 20.5% of patients. Bivariate analysis revealed that patients reporting dental fear had a significantly higher mean number of untreated carious teeth (DF: 4.06 ± 4.08, No DF: 2.38 ± 2.75, p<0.001). Additionally, patients with dental fear had fewer filled teeth on average than those not reporting dental fear (DF: 4.74 ± 4.26; No DF: 5.60 ± 5.16, p<0.001). Diastolic blood pressure was positively associated with dental fear, while systolic blood pressure showed no significant association. Eight binary variables were significantly associated with DF with adjusted odds ratio ([AOR] ≥ 1.50): history of previous problems with dental treatment (AOR = 3.75, CI: 3.50–4.03), dissatisfaction with smile (AOR = 2.25, CI: 2.14–2.37), general anxiety (AOR = 1.77, CI: 1.67–1.88), current dental pain (AOR = 1.71, CI: 1.62–1.81), generalized tooth sensitivity (AOR = 1.67, CI: 1.57–1.77), tobacco use (AOR = 1.60, CI: 1.51–1.69), female gender (AOR = 1.54, CI: 1.46–1.63), and history of recreational drug use (AOR = 1.50, CI: 1.40–1.61).
Conclusion:  Dental fear is associated with many psychological, behavioral, and clinical factors. These findings support the development of targeted screening tools and interventions to reduce oral health disparities among patients reporting dental fear.
Supported by: University of Iowa College of Dentistry Student Research Program

Pregnant Women’s Knowledge and Use of Fluoridated Tap Water

Objective:  Community water fluoridation (CWF) is an effective and equitable strategy for preventing caries. Many individuals, particularly those from socioeconomically disadvantaged groups, avoid tap water due to safety concerns or limited fluoride knowledge. Pregnant women’s water choices may influence early childhood caries risk. This study examined demographic factors associated with tap water use, concern about tap water safety, and fluoride knowledge among pregnant participants in the Birth to Three – Cavity Free  study.
Methods:  This secondary analysis included survey responses from pregnant women enrolled in the Birth to Three – Cavity Free  study (n=614), a trial of an intervention to improve care behaviors and reduce early childhood caries. Descriptive statistics summarize demographics and drinking water behaviors. Group differences were evaluated using chi-square tests. Associations were examined across three domains: drinking water source, concern about tap water safety, and fluoride knowledge, with significance set at p<0.05.
Results:  Tap water was the primary drinking source for 34.0% of participants, while 66.0% primarily consumed non-tap water. Tap water use was significantly associated with household income (p<0.001), education level (p<0.001), marital status (p=0.016), Hispanic ethnicity (p=0.020), and race (p<0.001). Tap water users more often reported higher incomes (≥$35,000: 35.8% vs. 18.9%) and identified as White (75.6% vs. 56.0%) Tap water safety concern was associated with lower income (p=0.015); 28.1% vs. 19.2% reported incomes <$5,000. Fluoride knowledge revealed misconceptions, including the belief that bottled water contains ideal fluoride levels.
Conclusion:  Pregnant women’s avoidance of tap water and limited understanding of fluoride benefits may undermine CWF’s effectiveness and exacerbate oral health disparities. Targeted educational interventions addressing fluoride misconceptions and tap water safety concerns are essential, particularly for socioeconomically disadvantaged and minority populations. Enhancing CWF awareness among expectant mothers can improve oral health outcomes for both mothers and children.
Supported by: NIDCR UH3 DE029443
 

Socioeconomic Indicators of Caries Incidence in an Iowa Pediatric Cohort

Objective:  This study seeks to investigate the relationship between parental stress and children's diet, sugary beverage consumption, hygiene, and DMFT scores.
Methods:  Our study population included children aged 2-6 undergoing elective surgeries under general anesthesia at the University of lowa Stead Family Children's Hospital and a primary caregiver. Caregivers of eligible participants completed a questionnaire collecting data on demographics, oral hygiene habits, diet, systemic health, socioeconomic status, safety, and psychological distress. Intraoperative dental examinations were conducted on the children to assess participants' dmft/DMFT scores.
Results:  Higher levels of parental stress were significantly associated with poorer dietary patterns (p = 0.034) and increased sugary beverage consumption (p = 0.0413). No statistically significant associations were observed between parental stress and DMFT scores. Additionally, parental stress was not significantly associated with children's oral hygiene practices.
Conclusion:  Parental stress appears to influence children's dietary behaviors, particularly increasing sugary beverage intake, but was not linked to oral hygiene or caries experience. These findings highlight the need to address psychosocial factors in promoting healthy dietary habits. Given the small sample size and qualitative nature of the data, further research with larger cohorts is warranted to clarify the pathways through which parental stress impacts pediatric oral health.
Supported by: Colgate Award for Research Excellence; University of Iowa College of Dentistry Seed Grant
 

Flexure Strength Comparison: 3Y, 4Y, 5Y TZP and Lithium Disilicate

Objective:  1: flexural strength of 3Y, 4Y, and 5Y-TZP zirconia, and lithium disilicate using standardized testing methods 2: effect of elemental composition of 3Y, 4Y, and 5Y-TZP zirconia, and lithium disilicate on mechanical properties such as flexural strength and translucency
Methods:  A digital STL file will be generated using digital software, incorporating dimensions of 25×4×3  mm. This file will be 3D designed with the aid of Exocad  software. A total of 10 samples per group  will be acquired. This methodology facilitates a comparative analysis of the mechanical properties among the four groups. Flexure strength evaluations of conventionally milled zirconia (Y-TZP)  material: Flexural strength and flexural modulus will be determined by three-point bend testing. 3-point-bending test specimens, measuring 25×4×3mm  (ISO 6872) . 30 Scanning Electron Microscope (SEM) : samples will be subjected to SEM for evaluation of surface characterization and elemental composition analysis. A total of 10 samples per group will be acquired to evaluate the structural analysis using SEM (Scanning Electron Microscopy). By biostatistics and computational biology within the University of Iowa College of Dentistry: The Shapiro-Wilk test , with a significance level of 0.05 , will be employed to assess the normal distribution of the data. This test will be conducted separately for each group, and a sample size of 48  will be used.
Results:  Results show that the milled 3Y TZP  has the highest flexural strength, followed by 4Y, 5Y, and lithium disilicate. In addition, elemental composition and structural analyses support the degree of compactness of particles and yttria composition available in each group, both being contributing factors to flexural strength and esthetics (translucency).
Conclusion:  The 3% yttria-stabilized  zirconia provides the ideal outcome when it comes to the flexural strength of the material. The yttria content available plays an important role in the degree of strength development, post- sintering consolidation of the TZP particles, and different degrees of translucency. Lithium disilicate provides the most translucency due to its elemental composition (glass matrix with embedded crystalline particles).
Supported by: University of Iowa College of Dentistry Student Research Program

Impact of Designed Porosity on SBS of 3D-Printed Y-TZP

Objective:  This study aims to evaluate the influence of designed porosity on the mechanical properties and dimensional accuracy of 3D-printed yttria-stabilized tetragonal zirconia polycrystal (Y-TZP). The aim of this study is to determine how variations in pore design affect the diameter, thickness, and shear bond strength (SBS) of printed zirconia specimens, providing insight into how porosity influences the precision and reproducibility of additive manufacturing processes
Methods:  Digital STL file was generated using a software, incorporating dimensions of 12 diameter x 5 mm. For the experimental phase, the test disks (n=20) consisted of two distinct groups (n=10). Groups were separated by no surface treatment (Control) and design pores of 50X50 microns 200 µm apart (G1:50). The designs were exported as a standard tessellation language (STL) file and used to additively manufacture (AM) the disks with different surface textures using an SLA 3D printer and a zirconia material (3DMix ZrO2 paste, 3DCeram Co). The diameter and thickness of all AM specimens were measured with digital calipers. A bond strength testing machine measured SBS of all AM specimens. Microstructural surface characterization was evaluated using a Scanning Electron Microscope (SEM). Mean standard deviation was calculated for each group regarding the volumetric changes (diameter and thickness). Data presented a normal distribution (Shapiro-Wilk test, p>0.05). The groups were compared using an independent-sample t-test. The significance level adopted was p<0.05 for all tests.
Results:  There was a significant difference in diameter (t= -4.546; p<0.001) with higher mean values for the porosity group, and no statistical difference for thickness (t= 0.470; p=0.644).
Conclusion:  Although additive manufacturing offers a promising alternative to conventional subtractive techniques for producing zirconia crowns, optimizing design parameters and maintaining strict process control are essential to achieve dimensional accuracy, preserve material integrity, and enhance clinical outcomes.
Supported by: University of Iowa College of Dentistry Student Research Program

pH of Nano-Hydroxyapatite Containing Oral Care Products in Simulated Saliva

Objective:  This study evaluated the pH of commercially available nHAp oral care products after dilution in artificial saliva, with implications for oral pH homeostasis and remineralization potential.
Methods:  Fourteen oral care products including toothpaste gels (BOKA, Fygg, Ollie, Dr. Jen, Great Oral Health, Mouthology, Davids Hydroxi Fluoride Free) and tablets (WhiteBite Pro, NoBS, Boka, Huppy, Bite, Duo) were dissolved in artificial saliva (BioChemazone BZ323, pH = 6.8). Each sample was mixed at a ratio of 1 mL of artificial saliva per unit of toothpaste (1 tablet or 250 mg of gel, simulating a pea-sized amount) to reflect typical oral dilution. Triplicate samples were prepared for each product. pH measurements were recorded at 1 and 5 minutes post-mixing using a calibrated pH meter. Mean pH values and standard deviations were calculated for each product.
Results:  pH values ranged from 6.46 to 8.73 across all products. The lowest mean pH was observed in NoBS Tablets (6.46 ± 0.05 at 1 min; 6.59 ± 0.06 at 5 min), while the highest was found in Davids Hydroxi Fluoride Free toothpaste (8.70 ± 0.10 at 1 min; 8.74 ± 0.11 at 5 min). Most products maintained a neutral to slightly alkaline pH, with tablets generally showing greater variability than paste formulations.
Conclusion:  The pH of nHAp-containing oral care products varies significantly by formulation after mixing with artificial saliva. Our findings support further investigation into formulation-dependent effects on oral health outcomes of nHAp-containing oral care products.
Supported by: University of Iowa College of Dentistry Student Research Program

Remineralization Efficacy of Desensitizing Agents Following Dentinal Erosion

Objective:  Dentin demineralization occurs when acids from dietary, bacterial, or intrinsic sources dissolve tooth minerals, leading to hypersensitivity and reduced structural strength.  Remineralization (formation of a new mineralized layer on exposed dentin) can reduce patient pain and restore dentinal properties. This study investigated the efficacy of three desensitizing materials (Teethmate (calcium phosphate slurry), Predicta (10% nanohydroxyapatite paste), and ClinPro (2.1% NaF varnish)) in restoring mineralization and mechanical properties of eroded dentin using x-ray diffraction and microhardness testing.
Methods:  28 extracted premolars had buccal dentin surfaces exposed and underwent erosive cycling with citric acid (pH2.4, 5 min, 3x/day, for 5 days) and simulated body fluid (pH7.0). Pre- and post-erosion microhardness were measured to standardize erosion. Baseline (eroded) values were measured prior to desensitizing agent application. Samples were treated with Predicta, Teethmate, ClinPro varnish, or control (deionized water), then immersed in remineralization media (1 hour in both 1M CaCl2 and 1M KH2PO4 solution). X-ray diffraction and Knoop microhardness testing assessed hydroxyapatite formation and mechanical recovery. Microhardness of the specimens before (eroded) and after desensitizing agent and remineralization was analyzed using repeated measures ANOVA (α=0.05), and one-way ANOVA was used to compare fold-change between groups (α=0.05).
Results:  ClinPro produced a statistically significant increase in microhardness between eroded and remineralized specimens (p=0.036). Predicta (p=0.36) and Teethmate (p=0.22) showed numerical, though non-significant increases. Fold-change analysis indicated hardness recovery of 1.3- fold for Predicta, 1.1-fold for Teethmate, and 0.94-fold for control (p=0.075). All treated groups showed restoration of sharp distraction peaks in hydroxyapatite ranges compared to blunted x-ray diffraction peaks in eroded specimens.
Conclusion:  All desensitizing agents promoted dentin remineralization, evidenced by increased microhardness and hydroxyapatite formation. ClinPro 2.1% NaF varnish demonstrated the greatest improvement in mechanical properties, suggesting superior efficacy in restoring eroded dentin strength.
Supported by: University of Iowa College of Dentistry Student Research Program

The Novelty of Dental Ceramic: New Advances in Lithium Disilicate

Objective:  Specific Aim 1: This aim seeks to understand the influence of 10-MDP on bonding efficacy, which is critical for the durability and longevity of the restorations. Specific Aim 2: Assess the flexural strength and modulus of elasticity of the newly available CAD/CAM lithium disilicate glass-ceramic block CEREC Tessera. Specific Aim 3: Evaluate the marginal fit discrepancy of the new CAD/CAM lithium disilicate glass-ceramic block CEREC Tessera.
Methods:  Standardized CAD/CAM blocks (CEREC Tessera, IPS e.max CAD, Celtra Duo, GC Initial LiSi) were sectioned into specimens for Notchless Triangular Prism fracture toughness testing and three-point bending for flexural strength and modulus evaluation. Specimens were bonded with a 10-MDP resin cement system (Panavia V5) and stored in 37 ∞C water for either 24 h or 90 days. Digital scanning and dual-scan superimposition were used to measure marginal fit via Geomagic Control software. Statistical analysis will include two-way ANOVA and Weibull analysis (a = 0.05).
Results:  Preliminary results indicate consistent specimen preparation and bonding standardization across all groups. Early observations suggest that CEREC Tessera exhibits clinically acceptable marginal gaps comparable to IPS e.max CAD. Initial mechanical testing trends indicate favorable handling and crack resistance in Tessera specimens, aligning with reported high biaxial flexural strength values. Final fracture toughness and flexural strength data are currently under processing and will be presented at the meeting.
Conclusion:  CEREC Tessera demonstrates promising marginal adaptation and mechanical behavior consistent with established lithium disilicate ceramics. Although full mechanical data analysis is ongoing, preliminary trends indicate comparable performance to current clinical gold standards. These findings support the potential clinical adoption of advanced lithium disilicate materials for esthetic and functional restorations.
Supported by: University of Iowa College of Dentistry Student Research Program
 

Associations Between Weight Loss Medications and Oral Health

Objective:  Use of pharmacological treatments for weight loss has increased in recent years, yet their effects on oral health remain unclear. This study aimed to address this gap by examining associations between weight loss medication (WLM) use and oral health outcomes. 32
Methods:  A cross-sectional study was conducted among adult patients (18+ years old) who received comprehensive examinations at the University of Iowa College of Dentistry between January 2017 and December 2024. Participants were categorized as either WLM users with self-reported use of at least one WLM at the time of their exam or nonusers who reported no WLM use. WLM users were matched 1:1 to nonusers based on gender, age (±1 year), and exam date (≤365 days). Demographic, socioeconomic, systemic health, and dental variables were collected from electronic dental records. Associations between WLM use and oral health were assessed using Pearson’s chi-square and Wilcoxon rank-sum tests (alpha=0.05).
Results:  Among the 381 matched pairs of WLM users and nonusers, the average age was 52.6±13.7 years, and 66.7% of participants were female. Compared to nonusers, WLM users had significantly higher BMIs (p=0.001) and a greater prevalence of Type 2 diabetes (p=0.002). Heart disease (p=0.014) and alcohol use (p=0.004) were also more common among WLM users. Additionally, WLM users reported higher candy consumption (p=0.042), were more likely to run out of food (p=0.042), and experienced greater difficulty maintaining a sufficient food supply (p=0.023) compared to non-users. No significant differences were observed between groups in caries experience (DMFT) or dental erosion. However, WLM users had fewer teeth than nonusers (p=0.041). The prevalence of periodontal disease, denture use, and dry mouth did not differ significantly between groups.
Conclusion:  These findings do not support an association between WLM use and increased risk of caries, erosion, or periodontal disease.
Supported by: University of Iowa College of Dentistry Student Research Program

Clinical Survival of Band and Loops Versus Crown and Loops

Objective:  This study compared clinical survival rates of band & loop (B&L) and crown & loop (C&L) space maintainers placed at the University of Iowa College of Dentistry.
Methods:  A retrospective cohort study was conducted using electronic health records between July 1, 2014, and June 30, 2024. A convenience sample of the first 200 pediatric patients was selected from all patients that received a space maintainer during that time period. Outcomes were categorized as success (appliance intact until eruption of the permanent successor or no evidence of failure at follow- up appointments) or failure (premature dislodgement, loss, or need for replacement). Univariate data is reported.
Results:  A total of 285 unilateral space maintainers were placed in our sample of 200 pediatric patients. 220 of them were B&Ls and 65 were C&Ls.  Out of 220 B&Ls, 92 were successful, 65 failed, and 63 were lost to follow-up, for a survival rate of 42%. Out of 65 C&Ls, 28 were successful, 11 failed, and 27 were lost to follow-up, for a survival rate of 43%.
Conclusion:  Band & loop and crown & loop space maintainers have similar survival rates when used in the primary and mixed dentitions in a college of dentistry setting.
Supported by: University of Iowa College of Dentistry Student Research Program
 

Comparative analysis of AI-based mandibular segmentation software for CBCT -derived 3D reconstruction of edentulous mandibles

Objective:  Accurate jaw segmentation of cone beam computed tomography (CBCT) data is fundamental to three-dimensional (3D) modeling in digital dental implant workflows. Artificial intelligence (AI)–based jaw segmentation has emerged as a promising alternative; however, evidence regarding its performance remains limited. The objective of this study was to compare 3D reconstructions generated by commercially available AI-based mandibular segmentation software.
Methods:  Forty de-identified Cone Beam Computed Tomography (CBCT) datasets of completely edentulous mandibles were selected from an institutional database after screening 250 datasets, adhering to strict inclusion criteria that excluded the presence of teeth, implants, fractures, or artifacts. These DICOM files were segmented using four different software platforms: BlueSky Bio, RealGuide, CoDiagnostix, and ReLu. The segmented models were then exported as STL files and imported into Geomagic Design X, where a best-fit global and fine registration algorithm was utilized to align all models. Global surface-to-surface deviation was quantified through root mean square (RMS) error assessments for the entire mandible and specifically for the anterior region mesial to the mental foramen. Additional parameters analyzed included surface area, volume, number of vertices, and resolution density. Statistical analysis was conducted using a linear mixed-effects model with restricted maximum likelihood estimation to determine if clinically significant differences exist among the AI segmentation platforms regarding mandibular reconstruction, with linear measurements taken at a midline cross-section (height and width) and between bilateral gonial angles. Furthermore, color deviation maps were generated for qualitative assessment of the results.
Results:  The surface characteristics and reconstructed areas of the 3D models varied depending on the segmentation software used. The global surface-to-surface deviation results indicated that CoDiagnostix exhibited the greatest variation relative to the other software programs, both for the entire mandible and for the anterior segment. In the measurement of intergonial linear distance, Blue Sky Bio showed significantly larger values, whereas no statistically significant differences were found among ReLu, CoDiagnostix, and RealGuide. A similar tendency was observed in the 2D linear measurements of bone height and width in the anterior region.
Conclusion:  The 3D geometric modeling of the edentulous mandible was influenced by commercially available AI-based jaw segmentation software; however, the deviations among the software programs remained within the clinically acceptable range. 

Cross-System Patient Matching Between Epic and Axium Using Transformer-Based Embeddings

Objective:  Integrating general hospital and dental records across heterogeneous electronic health record (EHR) systems remains challenging due to differences in data sources, coding standards, and documentation practices. This study evaluates BERT-based language models for research-oriented patient matching between Epic (hospital EHR) and Axium (dental EHR), focusing on performance across multiple clinical data channels.
Methods:  Patient representations were constructed from Epic and Axium using structured and semi-structured clinical data, including diagnoses, procedures, medications, and questionnaire-derived text. Record-level embeddings were generated using pretrained transformer models, including MiniLM, MPNet, Bio_ClinicalBERT, and SapBERT. Patients were represented using Epic-only, Axium-only, or combined cross-system embeddings. Evaluation was conducted in two stages. First, patient self-matching was assessed by computing cosine similarity between Epic- and Axium- derived embeddings and ranking all pairwise matches. Performance was summarized using top-k accuracy, defined as the proportion of patients whose true cross-system match appeared among the top-k candidates. Second, channel- wise analyses quantified the contribution of individual data sources, followed by development of a weighted multi- channel fusion framework integrating medication and contextual embeddings. All analyses were conducted strictly for research and methodological evaluation and were not intended for clinical or operational identity resolution.
Results:  General-purpose sentence embedding models demonstrated more stable cross-system matching performance than domain-specific clinical models. SapBERT and MiniLM achieved the highest top-k accuracy across multiple data combinations, while several clinical- domain models were less robust to heterogeneous record structures. Channel-wise analyses showed that medication and contextual information contributed disproportionately to matching accuracy. The weighted fusion framework further improved performance and reduced case-level mismatches compared to single-channel representations.
Conclusion:  These findings emphasize the importance of systematic benchmarking for cross-system EHR integration. Lightweight general-purpose embeddings combined with targeted multi-channel fusion may provide a more robust and scalable approach for patient-level matching between hospital and dental EHR systems than reliance on domain-specific clinical models alone.
Supported by: University of Iowa Strategic Initiatives Fund P3; University of Iowa CTSA Award; University of Iowa College of Dentistry CRISP Grant

Dentist Reports of Patient Dental Anxiety and Procedural Pain Management

Objective:  This study aimed to assess dentists’ perceptions and experiences regarding patient-reported procedural pain and anxiety.
Methods:  A 23-item electronic survey was distributed through the University of Iowa College of Dentistry’s alumni email list. Questions addressed patient anxiety and anesthesia challenges, including prevalence, provider confidence, interventions, training sources, and documentation practices. Descriptive and bivariate analyses were conducted by gender, years in practice, and provider attitudes toward patient pain tolerance (alpha=0.05).
Results:  Ninety-seven dentists completed the survey (56.7% males, mean years in practice: 21.1±13.7). The most anxiety- inducing aspects for patients were fear of injections (57.9%) and pain during the procedure (31.6%). Overall, 62.9% of respondents agreed that patients should tolerate mild procedural discomfort. The median estimated percentage of difficult-to-numb patients was 10% (mean±SD:14.5%± 12.2%). Commonly reported management strategies included changing injection sites (92.8%), PDLs injections (84.5%), and switching anesthetic agents (74.2%). More than 60% reported "often" or "always" providing additional anesthetic routes. Sources of knowledge most often cited were personal trial-and-error (42.6%), followed by dental school  training (24.5%) and continuing education courses (16.0%). Only one-third felt well prepared by their dental school education. Confidence in anesthetizing difficult-to-numb patients was generally high (74.2%), but varied by gender and experience. Male dentists were more likely than females to report high confidence (83.5% vs. 63.4%, p=0.024). Confidence also increased with years of practice (<10 years: 60.0%, 10-25 years: 68.7%, >25 years: 86.8%, p=0.015).  Similarly, reports that dental injections were "often" or "always" perceived as painless increased with experience (<10 years: 44.0%, 10-25 years: 59.4%, >25 years: 78.9%, p=0.005).
Conclusion:  Dentists varied in their assessment of dental fear, procedural pain, and patient pain tolerance, with less variability in their applied management strategies. Strengthened educational and clinical efforts are warranted to better address the persistent prevalence of dental fear and anxiety.
Supported by: University of Iowa College of Dentistry Student Research Program