Richie Kohli

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University of Oxford

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Dartmouth College

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University of California, Merced

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Universiteit Utrecht

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UNL - New University of Lisbon

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Universitas Airlangga

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Papers by Richie Kohli

Randomized Controlled Trials in Dental Public Health

Springer eBooks, 2024

Randomized Controlled Trials in Periodontology and Implantology

Springer eBooks, 2024

Randomized Controlled Trials in Oral Medicine, Oral Pathology, and Oral Radiology

Springer eBooks, 2024

Randomized Controlled Trials in Endodontics

Springer eBooks, 2024

Randomized Controlled Trials in Geriatric Dentistry

Springer eBooks, 2024

Testing dental quality measures

The Journal of the American Dental Association

Launching an innovative educational model addressing substance use disorders and dental pain management (Project ECHO® in dentistry)

BMC Oral Health, Sep 15, 2022

Background: Uninformed opioid prescribing by dentists has contributed to the current opioid crisi... more Background: Uninformed opioid prescribing by dentists has contributed to the current opioid crisis. This report describes the development and implementation of an innovative, interactive, multidisciplinary, and participant-centric telementoring program "Pain Management and Substance Use Disorders Dental ECHO (Extension for Community Health Care Outcomes)". We disseminated information to dentists about appropriate opioid prescribing practices and engaged them with a focus on pain management and substance use disorders. The objective of this study was to assess the effectiveness of this program for self-reported: (1) change in knowledge and confidence related to clinical skills for dental pain management of patients with substance use disorders; (2) change in clinical behavior of dentists for safe opioids prescribing; and (3) change in clinic policies regarding safe opioids prescribing. Methods: An interdisciplinary panel of experts in medicine, pharmacy, social work, and dentistry designed and led the "Pain Management and Substance Use Disorders Dental ECHO" for invited dental care providers and dental students. Six cohorts each consisting of six, 1-h-long sessions were conducted via the Zoom videoconference platform in years 2020 and 2021. Each session included a didactic expert presentation, a participant-presented patient case and discussion. Each participant completed pre-and post-program surveys to assess the program's influence on participant knowledge, clinical confidence and behavior change. Results: The participants (N = 151) were dentists (n = 109), dental faculty (n = 15), dental residents (n = 6), dental hygienists/assistants (n = 13) and nurses and clinic administrators (n = 8). Self-reported perceived medication knowledge, confidence in identification, treatment and willingness to engage with substance use disorders patients, and reported compliance with Prescription Drug Monitoring Program (PDMP) checks increased significantly from before to after the sessions (p < 0.001). Overall, participants expressed high levels of satisfaction with the content and reported that the sessions provided high benefit. Conclusion: The Project ECHO model is effective in rapidly disseminating evidence-based information. Dentists viewed this model as having a high degree of benefit for the optimal management of dental pain and the recognition and treatment of substance use disorders.

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Racial and oral health equity in dental school curricula

Journal of Public Health Dentistry

Addressing Black men's oral health through community engaged research and workforce recruitment

Journal of Public Health Dentistry

Differential Diagnoses for Persistent Pain Following Root Canal Treatment: A Study in the National Dental PBRN

Northwest dentistry

Pain present six months following root canal treatment (RCT) may be either of odontogenic or non-... more Pain present six months following root canal treatment (RCT) may be either of odontogenic or non-odontogenic origin. This is important because treatments and prognoses are different; therefore, the aim of this study was to provide specific diagnoses of patients reporting pain six months after receiving initial orthograde RCT. We enrolled patients from the Midwest region of an existing prospective observational study of pain after RCT. Pain at six months was defined as ≥ 1 day of pain and average pain intensity of at least 1/10 over the preceding month. An endodontist and an orofacial pain practitioner independently performed clinical evaluations, which included periapical and cone-beam computed tomograph (CT) radiographs, to determine diagnoses. Thirty-eight out of the 354 eligible patients in the geographic area (11%) met the pain criteria, with 19 (50%) consenting to be clinically evaluated. As the sole reason for pain, 7 patients (37%) were given odontogenic diagnoses (4 involvin...

Faculty and dental student knowledge, attitudes, and practices concerning the prescribing of opioids: Informing curricular change

Journal of Dental Education, 2021

Training dental hygienists to place interim therapeutic restorations in a school-based teledentistry program: Oregon's virtual dental home

Journal of public health dentistry, 2021

OBJECTIVES The objectives of this study on Oregon's virtual dental home were to: 1) demonstra... more OBJECTIVES The objectives of this study on Oregon's virtual dental home were to: 1) demonstrate the feasibility of pilot project training of existing Expanded Practice Dental Hygienists (EPDHs) to perform interim therapeutic restorations (ITRs) in the community settings after diagnosis by the supervising dentist via teledentistry and 2) evaluate satisfaction of parents/guardians of children participating in a pilot program that provides school-based/on-site preventive dental care services utilizing expanded scope EPDHs to conduct dental screenings and place ITRs. METHODS This demonstration project was a 4-years longitudinal cohort study (2016-2019) in the school/community-based settings focusing on children in kindergarten to 3rd grade. EPDHs and dentists from a Dental Care Organization were trained to utilize teledentistry and EPDHs were trained to place ITRs, the latter provided onsite dental care. Data was collected regarding child's demographics and oral health status; a...

Health Education and Health Literacy in Dental Public Health

Oral health clinical training and dental referral program for nurses: An interprofessional collaborative project

Geriatric Nursing

INTRODUCTION The overall objective of this study was to establish an interprofessional oral healt... more INTRODUCTION The overall objective of this study was to establish an interprofessional oral health training program for nursing personnel at Oregon Health & Science University. METHODS Fifteen registered nurses participated in didactic and clinical training and screened the oral health of patients. Nurses completed confidence assessments and patients completed satisfaction surveys. Data analysis included descriptive statistics and non-parametric tests for comparisons of mean scores. RESULTS Pre- and post-training surveys demonstrated significant increases in nurses' knowledge, confidence in discussing dental problems, performing dental screenings, and referring patients to dentists (p < 0.05). Patient satisfaction surveys (n = 89) denoted satisfaction with oral screenings and willingness for nurses to perform them. CONCLUSIONS Nurses participating in oral health and clinical screening training programs supervised by dentists significantly increased their confidence in providing dental referrals. Longitudinal studies are needed to determine the impact of such training programs on patient health.

Dental Student to Patient Communication Analysis: A Pilot Study

Health Communication

ABSTRACT It is very crucial that dental students who comprise our future dental workforce are ade... more ABSTRACT It is very crucial that dental students who comprise our future dental workforce are adequately trained in communication skills. This training is especially important because of the increasing population of English as Second Language (ESL) patients in our community health centers, dental offices, and dental schools. The objective of this exploratory pilot study was to analyze dental student conversations about patient treatment plans to native English and ESL patients. The study recruited four dental students who spoke English as their first language and four patients, two with English as their native language and two with English as their second language from Oregon Health & Science University School of Dentistry. A Panasonic Palmcorder video camera was used to record the dental student to patient procedural conversations, which were then transcribed. Data analysis included rhetorical analysis to explore the argument structures and conversation analysis to explore the linguistic moves used in treatment plan conversations. The results showed three common errors that dental students made while dealing with ESL patients that did not exist with the native speaking patients: The consistent assumption of patient comprehension, the use of over technical jargon, and a lack of use of multi-mediated forms of communication to bridge communicative barriers. There are obvious skills to be learned by the dental students for communicating treatment plans and dealing with ESL patients. Further research and effective teaching resources are needed to better serve our patient population.

Opioid-prescribing Practices in a Graduate Endodontic Clinic before and after Implementation of the Federal Schedule II Prescribing Mandate

Journal of Endodontics

INTRODUCTION Opioid prescriptions have the potential for misuse. In October 2014, the federal sch... more INTRODUCTION Opioid prescriptions have the potential for misuse. In October 2014, the federal schedule II prescribing mandate reclassified hydrocodone combination products from schedule III to schedule II drugs that required a written prescription. The aim of this study was to evaluate the opioid-prescribing practices in a graduate endodontic clinic (GEC) before and after the mandate. METHODS Electronic health records from all patients treated in the GEC from 2010 to 2018 were reviewed retrospectively for opioid prescribing, the date of prescription, and the Current Dental Terminology code. Where opioid prescribing was documented in the electronic health record, additional data were extracted about pulpal and periapical diagnosis, pain level, opioid type, and prescription details. Prescribing rates were calculated and analyzed by using chi-square, analysis of variance, logistic regression, and multivariable analysis. Significance was set at P < .05. RESULTS Overall, 4851 patients underwent 7841 procedures; 92.2% of patients were never prescribed opioids. The remaining 380 patients underwent 420 procedures, and 509 prescriptions were provided. Prescribing rates were 7.5% (228/3021) before versus 4.0% (192/4820) after the mandate (P < .001). Hydrocodone combinations were the most prescribed opioid (77%, 392/509). Tramadol prescribing increased after the mandate (P = .023). Multivariable analysis showed significantly higher prescribing for apicoectomy procedures (P < .001). Preoperative pulpal and periapical diagnosis and pain level were not significantly associated with opioid prescribing. CONCLUSIONS An overall reduction in opioid-prescribing rates occurred coincidentally with the 2014 federal mandate. The lack of correlation between prescribing and pain level highlighted the need for evidence-based rather than habitual prescribing protocols in the GEC.

Tooth wear in patients treated with HIV anti-retroviral therapy

BMC Oral Health

Background: The objective of this study was to elucidate the relationship between HIV anti-retrov... more Background: The objective of this study was to elucidate the relationship between HIV anti-retroviral therapy and tooth wear. Methods: Assessment of tooth wear was conducted both with a survey questionnaire and clinical assessment at Russell Street Dental Clinic in Portland, Oregon. The survey questionnaire comprised of questions on study participant's gender, age, HIV status, current medications, awareness of tooth grinding or clenching, jaw soreness, tooth or gum soreness, and frequency of headaches. For the clinical evaluation, a dental provider recorded the degree of wear on each tooth using a scale of 0-3. An individual tooth-wear index was used to rank patients with regard to incisal and occlusal wear. Data analysis included descriptive analysis, tests of association and regression analysis using SPSS V.24. Results: The study sample involved 93 patients (HIV + ve = 60, HIV-ve = 33) with age range of 20-90 yrs. (mean = 49 yrs., s.d = 13.3). 92 and 67% participants of the HIV + ve and HIV-ve groups, respectively, presented with tooth wear. The mean tooth wear index was higher in HIV + ve patients than HIV-ve patients (8.2 vs. 7.8), however, this difference was not statistically significant (p > 0.05). A significant, positive correlation was found between HIV presence and tooth wear index, after accounting for age (B = 0.71, p < 0.05). The number of years on anti-retroviral therapy alone was positively correlated with tooth wear index (R 2 = 0.116, p < 0.05). After controlling for age, years of anti-retroviral therapy use was positively correlated with tooth wear index (B = 0.047, p > 0.05). Conclusions: The findings from this study suggest that HIV + ve patients, who are on anti-retroviral therapy have significant tooth wear, although more studies with larger sample size are needed to confirm this. There is a critical need to initiate a dialogue with medical providers about tooth wear as a possible side effect of antiretroviral therapy and to introduce appropriate preventive measures.

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Oral health needs, dental care utilization, and quality of life perceptions among Oregonian seniors

Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry, Jan 9, 2017

For a relevant planning process and advocate for improvement in oral health conditions of the sen... more For a relevant planning process and advocate for improvement in oral health conditions of the senior population up-to-date data are necessary. The objective of this study was to assess the oral health status, dental care utilization and quality of life perceptions of seniors in Clackamas County in Oregon. Data were collected in a cross-sectional study on institutionalized and community dwelling older adults where participants completed a self-reported oral health survey, the short-form Oral Health Impact Profile (OHIP-14 questionnaire) and had clinical screenings. Overall, the participants (n = 177) reported mean OHIP-14 score of 0.6 ± 1.1, with "physical pain" as the highest scored domain. Seniors who were white, had teeth, dental insurance, were having a regular dentist and living in the community were 4.2 to 33.1 times more likely to visit the dentist in the previous 12 months compared to those respondents who were nonwhite, edentulous, uninsured, not having a regular d...

Dental care practices and oral health training for professional caregivers in long-term care facilities: An interdisciplinary approach to address oral health disparities

Geriatric Nursing, 2017

The objectives of this study were to: 1) Assess and analyze the knowledge and attitudes of caregi... more The objectives of this study were to: 1) Assess and analyze the knowledge and attitudes of caregivers towards dental care for older adults in long-term care facilities; and 2) Train administrators, medical staff, and caregivers in the oral health competencies necessary to provide daily oral health care for residents of Assisted Living Communities in Oregon. Our results indicate that although the majority of caregivers felt comfortable with regard to their oral health background and daily activities, they expressed a need for additional training in several areas. Caregivers who participated in the training recognized the poor oral health of their residents and felt the training curriculum provided them with competencies needed to improve their daily oral health services. This innovative training demonstrates that oral health can be integrated into daily routines which could improve oral and systemic health and reduce inequities in oral health care for older adults.

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Differential Diagnoses for Persistent Pain Following Root Canal Treatment: A Study in the National Dental PBRN

Northwest dentistry