Dental hygienists in Europe: trends towards harmonization of education and practice since 2003

The employment of dental hygienists in European countries: Report of a European Dental Hygienists Federation/European Association of Dental Public Health Survey in 2021

AIM

This survey aimed to investigate a range of topics relating to the employment of dental hygienists in European countries, whose National Dental Hygienists Associations (NDHAs) were members of the EDHF.

METHODS

During 2020/2021, an online questionnaire and participant information leaflet were distributed by email in each of the 24 countries, whose NDHA is a member of the EFDH or to an EADPH member who was likely to respond.

RESULTS

The broad term employment of dental hygienists was taken to include current numbers, place of work (public or private clinics and other locations), whether they were currently working as dental hygienists, their pay, any planned changes in their employment and their participation in continuing education. Twenty-four countries (92%) responded. Hungary and Poland reported that fewer than 35% of their qualified dental hygienists were working as dental hygienists. In 10 countries, often for family reasons, over 40% worked part-time. In 14 countries, over 70% worked in private clinics. Average annual pay ranged from €8400 in public clinics in Poland to €106,000 in dental hygienist-owned clinics in Denmark Regular participation in continuing education was mandatory in only nine countries.

CONCLUSIONS

Dental hygienists play a different role within the oral healthcare system in each European country. There is a wide variation in their education, places of employment, annual pay and continuing education requirements.

Developing a reliable and valid competency model for assistant dentists in China

BACKGROUND

The shortage of dentists is one of the various medical-resource problems found around the world. More and more countries are improving the provision of oral services by training dental therapists and hygienists. In China, they are called assistant dentists, and they supplement dental services, but thus far, no research has been conducted on the competence of this group.

OBJECTIVE

The purpose of this study was to establish a competency model for Chinese assistant dentists. This model can provide a more scientific basis for the education, training, and evaluation of these professionals, as well as provide a reference for the capacity of dental therapists in various countries.

METHODS

We established a system of competency characteristics using theoretical analysis and focus group discussions, after which we established an initial competency model by consulting a Delphi panel of 29 experts. Finally, we collected data from 1389 assistant dentists from 14 provinces in China, and the reliability and validity of the model were confirmed by factor analysis of this data.

RESULTS

After three rounds of Delphi panels, the competency model came to include seven ability levels and 50 indicators. In exploratory-factor analysis, three indicators were eliminated, and the questionnaire could explain 68.41 % of total variance. In confirmatory-factor analysis, the established model and data fit well (goodness-of-fit index [GFI] = 0.914, root mean square error of approximation [RMSEA] = 0.047). The results showed that the entire model has good reliability and validity.

CONCLUSIONS

Our competency model for dental assistants in China includes seven elements. This is consistent with the current health situation in China, and it has distinct Chinese characteristics. Some of our findings, like those reported in other countries with dental therapists, offer ideas for other developing countries.

O-HEALTH-EDU: A scoping review on the reporting of oral health professional education in Europe

INTRODUCTION

The variability in oral health professional education is likely to impact on the management of oral health needs across Europe. This scoping review forms the initial part of a larger EU-funded collaborative Erasmus + project, 'O-Health-Edu'. The aim of this scoping review is to investigate how oral health professional education in Europe is reported.

METHODS

The PRISMA and Arksey & O'Malley methodological frameworks for scoping reviews were used to guide reviewers in answering the research question "How is oral health professional education reported in Europe?". The search strategy encompassed published literature searches, internet searches and further searching of relevant documents from educational organisations, regulators and professional bodies. Once the search strategy was developed, it was sent to key stakeholders for consultation. Sources were reviewed by two authors (JD, JF) and included in the review if they reported on oral health professional education in Europe.

RESULTS

A total of 508 sources were retrieved from all of the searches. A total of 405 sources were excluded as they did not report on the topic of interest, leaving 103 sources that reported on oral health professional education in Europe. Handsearching the references of published sources lead to a further 41 sources being screened, of which, 15 were included. In total, 33 duplications were removed and the final number of included sources was 85. The average year of publication for the included sources was 2007, with sources most commonly published in journals dedicated to dental education. Surveys represented the most common form of reporting. From the data obtained, four broad themes of reporting were evident: dental education at a programme level, dental education at a discipline level, other oral health professional education, and postgraduate education and continuous professional development.

CONCLUSION

The reporting of dental and oral health professional education in Europe is limited. Whilst there are many useful documents that provide guidelines on dental education, there is limited knowledge on how education is implemented and delivered. There is a greater need for comprehensive educationally driven programme-level data on oral health professional education across Europe.

Stakeholder Perception of the Professional Role and Competence of Swedish Dental Hygienists: A Questionnaire and Interview Study

Objectives:

This study investigated stakeholder opinions on the competence and role of dental hygienists in Sweden.

Materials and Methods:

A questionnaire was sent by e–mail to 94 stakeholders in eight Swedish counties. The survey queried the competence of recently graduated dental hygienists in skills in collaboration, communication, and problem–solving, and in clinical skills. In addition, 10 stakeholders from different Swedish dental organizations agreed to one–on–one deep interviews. Open–ended questions focused on dental hygienist competence to perform dental hygienist skills and tasks and to collaborate with other dental professionals and health–care professionals. Further topics concerning the dental hygienist included their future role and working in other European countries. The interviews were transcribed and then coded using qualitative conventional content analysis methods.

Results:

The stakeholder consensus in both the questionnaires and the interviews was that the dental hygienist profession is essential to modern dental care. The professional knowledge possessed by dental hygienists is unique and their role has developed and broadened over the years. Furthermore, the qualitative content analysis of the deep interviews identified a core category: The dental hygienist is an important profession for good oral health.

Conclusion:

Dental hygienists, responsible for prevention and oral health promotion, are an important members of the modern dental team. The need for dental hygienists to collaborate with other dental and general health–care professionals to meet the future demands of society will increase.

The Dental Hygienists in Sweden and Portugal: A Comparative Study

Aims and Objectives:

The aim of the present study was to identify the dental hygienists (DHs)’ working areas and compare these findings between Sweden and Portugal.

Materials and Methods:

A web-based questionnaire was sent by E-mail to all 2943 members of the Swedish DH Association and 381 members of the Portuguese DH Association. The questionnaire contained questions about; number of years of work, which patient groups they worked with, if they had got sufficient knowledge from the education and what different tasks they worked with. Independent sample t-test, relative risk, and logistic regression analysis were used as statistical methods.

Results:

The response rate for Sweden was 31% (n = 923) and the corresponding figure for Portugal was 53.5% (n = 204). The most common tasks for the DHs, in both countries, were to diagnose and treat patients with periodontitis and to diagnose and perform caries prevention. In Portugal, 86.5% worked with orthodontic patients compared to 32.3% in Sweden (P = 0.001). The logistic regression analysis showed that there was a 25% (P = 0.02) higher probability that Swedish DHs took more X-rays and 38% (P = 0.042) probability that they had more communications skills compared to the Portuguese DHs.

Conclusion:

The DH profession in Sweden and Portugal was overall quite similar. Despite a few local differences, both the academic education and scope of practice corresponded well between the countries. The few discrepancies could be explained by differences in legislations in each country.

Factors associated with the inclusion of oral health technicians into the public health service in Brazil

BACKGROUND

The number of oral health technicians (OHT) in the public health service in Brazil is lower than the number of training school graduates. Thus, the objective of this study was to investigate possible factors associated with the inclusion of OHT in the public health service in Minas Gerais, Brazil, and its implications on oral health indicators.

METHODS

This cross-sectional ecological study used a database (Excel) composed of 122 municipalities that participated in an OHT training course that took place between 2012 and 2013. Municipal contextual variables, including oral health indicators and sociodemographic indicators, related to the organization of health services were incorporated before and after the course. The dependent variable was the entry of graduates into the public health service according to a self-report survey conducted in 2015. A descriptive analysis of the variables was carried out, followed by bivariate analyses between the independent variables and the dependent variable using Pearson's chi-square test. The independent variables selected for multivariate logistic regression were statistically significant at p <  0.20. In the final model, significant effects were identified for variables with p <  0.05. The statistical software SPSS 18.0 for Windows was used.

RESULTS

After the course, the variable of the public service organization and the two variables of oral health indicators were associated with the outcome. The organization services variable "presence of oral health team modality II" and the variable "indicator of coverage of first dental programmatic consultation" presented an association tendency with the entry of OHT in the multivariate logistic regression model, but these associations were not statistically significant because they had significance levels of p = 0.075 and p = 0.191, respectively. The variable "collective action indicator supervised dental brushing" was associated with the entry of egress (p = 0.045) remaining in the final model.

CONCLUSION

The model of organization of the oral health service formed through the implementation of modality II oral health teams positively influenced the inclusion of OHT in the public health service in Minas Gerais, with improvement in the oral health indicators of the municipalities.

Willingness to Work and the Working Environment of Japanese Dental Hygienists

Japanese dental hygienists' employment rate is low. The environment factors and daily job contents that contribute to willingness to work of Japanese dental hygienists and their structures were investigated. A cross-sectional survey was conducted using a self-administered postal questionnaire distributed for one thousand and twenty-three members of Japan Dental Hygienist Association registered in Iwate prefecture affiliation. Three items concerning willingness to work, satisfaction for the 9 items about working environment, anxiety for work, and 106 daily job contents were used for analysis. Structural equation modeling, decision analysis, and correspondence analysis were carried out. The present study found that working environment such as interpersonal relationship was more important than social environment such as salary for the regular employee of Japanese dental hygienist working at private dental office. However, salary was only the determinant for the dental hygienist who strongly disliked their work. And daily job contents affected the willingness to work. Especially, jobs concerned with prosthodontic treatments were of major concern. Improving the working environment and avoiding assignment of tasks that require lower level of skill may improve dental hygienists' willingness to work and may assist to improve the employment rate of dental hygienist in Japan.

Professional competencies and work-related support in relation to periodontal therapy and work satisfaction: A questionnaire study among Swedish Dental Hygienists

OBJECTIVES

To analyse dental hygienists' (DHs) views on professional competencies and behavioural interventions in the treatment of periodontitis patients, perceived work-related support and work satisfaction.

METHODS

A Web-based questionnaire was distributed to all DHs employed at the public dental service in the county of Västra Götaland, Sweden. 302 (83%) responded to the questionnaire; 291 of these DHs stated that they on regular basis treated periodontitis patients and thus constituted the sample for analyses. Based on initial correlation and bivariate analyses of the questionnaire data, multiple logistic regression models were formulated to estimate perceived competencies to treat patients with periodontitis and work satisfaction.

RESULTS

The multiple analyses revealed that DHs who worked with specific methods for behavioural intervention, like motivational interviewing, were more likely to rate themselves as "definitely possessing the competencies required to treat patients with periodontitis" (OR 4.0). Likewise, this group of DHs did not consider it more difficult to charge their patients the financial costs for such a behavioural intervention than for scaling therapy (OR 3.1). The perception that one's professional competencies were utilized well in daily practice was associated with high work satisfaction (OR 4.1). More years in the profession (OR 1.03) and a good support by colleagues (OR 1.9) had also a positive impact on work satisfaction.

CONCLUSIONS

Dental hygienists' considered that competencies in the treatment of periodontitis patients were related to the practice of behavioural interventions as part of therapy. A stimulating and supportive work environment, with opportunities for professional development, is important for work satisfaction.

Dental hygiene education in Germany: Between economics and emotions

OBJECTIVES

To date, there is still no IFDH approved dental hygienist (DH) education model in Germany. Nevertheless, opportunities to complete vocational DH education courses have substantially increased within the last two decades. However, the content and quality of these courses vary greatly and are difficult to survey. The purpose of this article therefore was to present an overview of the education programmes offered in Germany as of March 2017.

METHODS

A formal request was sent to all education establishments for details of such courses, and a systematic internet search was performed covering the DH education topic in Germany.

RESULTS

Ten vocational education programmes were found, most of them organized by local dental chambers. One private provider offers a Bachelor Degree in Dental Hygiene on completion of a course which runs over 2 or 3 ys. Details of contents, objectives and concise ratings or comparisons of the various courses are scarce, although in principle all should meet the same quality standards.

CONCLUSION

For dental hygiene students, patients and dentists, it is hard and unsatisfactory to get a clear overview of the types and the quality of DH education which can be achieved in Germany. A solution for this dilemma would appear to be essential. However, due to the peculiarities of German legislation as well as the complex sphere of vested interests, it is impossible to predict if or when the situation will change for the better.

Does dental hygienist professional education meet the needs of working life? Educators' views

OBJECTIVE

The aim of this study was to describe the compatibility of dental hygienist education with working life from the perspective of their educators.

METHODS

We conducted a qualitative study among principal educators of dental hygienists in Finland in 2012-2013. The participants were leading educators of dental hygienists (n = 13) from the four Finnish education units. We used semi-structured interviews based on previous Nordic studies to collect the data and analysed them using inductive content analysis.

RESULTS

According to the educators, dental hygienists' skills at work are neither fully nor effectively utilized, even though their education meets the needs of working life quite well. The educators felt that hygienists' professional competence would prove more useful in health promotion and orthodontic measures and that the division of labour should be clearer. Clarifying this distinction in periodontal therapy could be improved.

CONCLUSION

Fully utilizing dental hygienists' competence in clinical work would benefit from further development. The content of dental hygienists' clinical work should be reassessed so as to utilize their skills more fully. The compatibility of dental hygienist education corresponds largely to the needs of future working life.

COMPETÊNCIAS DE AUXILIARES E TÉCNICOS DE SAÚDE BUCAL E O VÍNCULO COM O SISTEMA ÚNICO DE SAÚDE

Resumo O estudo teve por objetivo descrever o perfil sociodemográfico, de trabalho e formação de auxiliares e técnicos em saúde bucal com atuação no estado do Rio Grande do Sul. Foram analisadas as informações relatadas por 255 auxiliares e técnicos de saúde bucal que participaram do Congresso Rio-Grandense de Odontologia realizado em 2010 e 2012. A pesquisa utilizou-se de um questionário escrito, estruturado e autoaplicável, organizado em três blocos temáticos com as seguintes categorias: identificação (sexo, idade, estado civil, estado/cidade, renda, habilitação, vínculo e inscrição conselho/sindicato), formação (estabelecimento, duração, incentivo/dificuldades de atualização/formação) e processo de trabalho (competências e atribuições profissionais). Os resultados encontrados demonstraram que diferenças no processo de trabalho entre os auxiliares e técnicos de saúde bucal determinadas pelo vínculo de trabalho com o Sistema Único de Saúde estavam concentradas nas atribuições das competências de promoção e prevenção de saúde. Também se verificou que as atribuições das competências de organização do ambiente de trabalho e de atendimento clínico de saúde bucal conferem maior identidade ao trabalho desses profissionais, independentemente do vínculo. O estudo alerta para a sobreposição das competências e atribuições realizadas pelos auxiliares e técnicos de saúde bucal.

Health workforce governance and oral health: Diversity and challenges in Europe

Throughout the life course, oral diseases are some of the most common non-communicable diseases globally, and in Europe. Human resources for oral health are fundamental to healthcare systems in general and dentistry is no exception. As political and healthcare systems change, so do forms of governance. The aim of this paper is to examine human resources for oral health in Europe, against a workforce governance framework, using England as a case study. The findings suggest that neo-liberalist philosophies are leading to multiple forms of soft governance at professional, system, organisational and individual levels, most notably in England, where there is no longer professional self-regulation. Benefits include professional regulation of a wider cadre of human resources for oral health, reorientation of care towards evidence-informed practice including prevention, and consideration of care pathways for patients. Across Europe there has been significant professional collaboration in relation to quality standards in the education of dentists, following transnational policies permitting freedom of movement of health professionals; however, the distribution of dentists is inequitable. Challenges include facilitating employment of graduates to serve the needs and demands of the population in certain countries, together with governance of workforce production and migration across Europe. Integrated trans-European approaches to monitoring mobility and governance are urgently required.

Oral health status and dental care behaviours of head and neck cancer patients: a cross-sectional study in an Austrian tertiary hospital

OBJECTIVES

This study aimed to assess the oral health status and dental care behaviours of patients treated for head and neck squamous cell carcinoma (HNSCC) in an Austrian tertiary hospital.

MATERIALS AND METHODS

Dental care behaviours, oral hygiene level, caries, and periodontal parameters were assessed in 48 patients treated for HNSCC >6 months ago.

RESULTS

Only 52 % requested a dental check-up after HNSCC diagnosis and prior to treatment, and of those, 80 % received some type of dental treatment. At time-point of clinical examination, 69 % of the patients had consulted a dentist within the last year, but 88 % still needed dental treatment; 75 % had at least one tooth with caries and 78 % had moderate to severe periodontitis.

CONCLUSION

Although it was recommended, only half of the patients did consult a dentist prior to HNSCC treatment and oral health appeared, in general, low prioritized.

CLINICAL RELEVANCE

About 90 % of the current group of head and neck squamous cell carcinoma cancer patients presented large treatment needs, both in regard with caries and periodontal disease, about 20 months after cancer treatment.

Dental sealant knowledge, opinion, values and practice of Spanish dental hygienists

OBJECTIVES

Dental sealants have proved to be an effective approach to prevent pit and fissure caries. This study examines the knowledge, opinion, values and practice (KOVP) of dental hygienists concerning sealant use in the southwest region of Andalusia, Spain.

METHODS

Spanish dental hygienists (n = 400) volunteered to complete a 31-item, self-administered, pretested questionnaire to assess their knowledge, opinion, values and practice regarding pit and fissure sealants. Wilcoxon matched-pairs signed ranks test, the Friedman nonparametric repeated-measures anova and Spearman's correlation were used to analyse the data.

RESULTS

The mean scores for knowledge, opinion, values and practice were 3.57 ± 0.41; 2.17 ± 0.42; 2.58 ± 0.77 and 3.56 ± 0.46, respectively. Knowledge differed by years of experience (P < 0.01) and place of work (P < 0.01); opinion differed by years of experience (P = 0.03) and sector (P < 0.01). Similarly, practice about sealants differed by years of experience (P < 0.01). Conversely, values around sealant placement did not statistically differ by sex, years of experience, practice sector or place of work. Statistically, significant correlations were found between knowledge, opinion and value, while it was found no significant correlation between practice and the other variables (P > 0.05).

CONCLUSIONS

Most dental hygienists have sufficient knowledge about pit and fissure sealants. They also acknowledge the importance of use of dental sealants and have positive opinion/attitude about using sealants. Practice of dental sealants in clinics was found adequate. However, they were not following the specific guidelines and standardized procedures.

Introducing dental hygienists in general practice to research - an in-practice evaluation programme in the United Kingdom

AIM

To introduce dental hygienists (DHs) in the UK to the principles of research through a practice-based product evaluation programme.

METHODS

The programme consisted of an initial training and orientation day with presentations on evidence-based practice, research methods and the structure of research papers. The programme and its aims were explained in detail, and participants were briefed on the methods to be used. Participants then recruited seven to ten patients from their practices (offices), carried out a baseline assessment of: plaque, gingival health, calculus and staining at anterior teeth, and gave the patients a questionnaire asking about their teeth and then provided a 3-month supply of a test toothpaste. About 10 weeks later, a follow-up assessment of the same variables was performed and the questionnaire was repeated. A second training day followed during which the DHs provided feedback of their experiences and received training in literature searching and critical appraisal of literature including interpretation of results.

RESULTS

Sixty-five DHs attended the first training day; 31 were able to recruit sufficient patients and attend the second training day. The DHs recruited 168 patients who received baseline and follow-up assessments. All the variables improved overall. Feedback from the DHs was very positive, and patients expressed delight with the care they had received.

CONCLUSIONS

Qualitative feedback for participating DHs suggests the programme met its aim and could be used in the future as a mechanism for helping DHs who want to increase their understanding of research methodology.

Social vulnerability in paediatric dentistry: an overview of ethical considerations of therapeutic patient education

Dental caries is a multifactorial condition that remains a major public health issue in high income countries. The prevalence of dental caries in children has markedly declined in most countries over the past 30 years. However, the disease continues to affect a vulnerable population defined as a high-risk group. As many public health policies are inefficient in dealing with this underprivileged group, it is necessary to find other strategies to decrease the incidence and the burden of dental caries. Defining dental caries as a chronic disease enables us to develop the concept of 'therapeutic patient education.' It is meant to train patients to self-manage or adapt treatment to their particular chronic disease and to cope with new processes and skills. The purpose of this paper is to propose a new approach to dental caries, in particular to early childhood caries. That should decrease the gravity and prevalence of the disease in this specific population. As a result, this new approach could increase the quality of life of many children both in terms of function and aesthetics.

Comparison of clinical practice education in dental hygiene schools in eight countries

OBJECTIVES

The profession of dental hygienist is one of the few in which the primary function of the practitioner is to prevent oral disease and to promote the well-being of patients. The aim of this study was to investigate clinical training conditions in schools of dental hygiene in eight countries (the USA, Canada, the UK, Sweden, Denmark, Thailand, South Korea and Japan).

METHODS

In 2006, we sent out a questionnaire in which we asked dental hygiene schools about how they educate dental hygiene students.

RESULTS

The techniques taught to students in schools in Western industrialised nations, such as the USA, Canada, Denmark, the UK and Sweden, were mainly related to dental preventive measures and dental health guidance. By contrast, training schools in South Korea and Japan placed less emphasis on dental preventive measures and dental health guidance. Dental hygienists in Thailand are trained to perform local anaesthesia and to fill and extract deciduous teeth although the country does not have a specific qualification system.

CONCLUSIONS

The contents of clinical training and education in schools of dental hygiene differ greatly among countries.