Examining the mental health of university students: A quantitative and qualitative approach to identifying prevalence, associations, stressors, and interventions

ObjectiveTo identify the prevalence of anxiety, depression, and suicidal ideation that would place university students at risk for mental health disorders. To explore the source of stressors and possible interventions that may benefit student mental health in a university setting.

PARTICIPANTS

University students (n = 483) who had been learning remotely due to the COVID-19 pandemic.

METHODS

A mixed-methods cross-sectional survey was administered in 2020.

RESULTS

Students were at an increased rate of depression, anxiety and suicidal ideation as compared to the general population. Female gender, lack of social support, living alone, being a first-generation college student and COVID-19 were significantly associated with mental health disorders. Stressors were identified and categorized into themes and interventions were recognized that may improve student well-being.

CONCLUSION

Students enrolled in university programs appear to experience significant amounts of anxiety, depression, and suicidal ideation. Additional mental health education, resources, and support is needed.

A review of the oral health-related quality of life (OHRQL) model for dental hygiene: Eighteen years later

PURPOSE

The purpose of this paper is to review available evidence to determine the impact of the oral health-related quality of life (OHRQL) Model for Dental Hygiene on education, research, and practice.

METHODS

A search was conducted in PubMed using the search terms oral health-related quality of life, OHRQL, and dental hygiene and limited to publications between 1998 and 2016. Google Scholar was also used to identify citations for the two original OHRQL model papers to capture the literature widely read by practicing dental hygienists but not indexed in PubMed. A total of 40 publications met the predetermined search strategy. Full publications were obtained and reviewed to determine how this research is being used in education, research, and practice.

FINDINGS

The OHRQL is being utilized to a very limited degree in education, research, and practice. The literature shows how the OHRQL is actively being used in the school where the model originated in addition to a dental hygiene programme in Japan. Studies have been conducted on a variety of research instruments, including the OHRQL, designed to capture OHRQL outcomes. Japanese researchers have used the OHRQL in studies designed to determine the impact of oral healthcare delivery on patients' oral health-related quality of life.

CONCLUSION

Eighteen years of the literature confirms that the OHRQL is being used minimally in education, research, and practice. Greater emphasis is needed around the collection and assessment of oral health-related quality of life measures for providing patient-centred care.

Using Registered Dental Hygienists to Promote a School-Based Approach to Dental Public Health

We examine a strategy for improving oral health in the United States by focusing on low-income children in school-based settings. Vulnerable children often experience cultural, social, economic, structural, and geographic barriers when trying to access dental services in traditional dental office settings. These disparities have been discussed for more than a decade in multiple US Department of Health and Human Services publications. One solution is to revise dental practice acts to allow registered dental hygienists increased scope of services, expanded public health delivery opportunities, and decreased dentist supervision. We provide examples of how federally qualified health centers have implemented successful school-based dental models within the parameters of two state policies that allow registered dental hygienists varying levels of dentist supervision. Changes to dental practice acts at the state level allowing registered dental hygienists to practice with limited supervision in community settings, such as schools, may provide vulnerable populations greater access to screening and preventive services. We derive our recommendations from expert opinion.

Assessing the Effectiveness of a School-Based Dental Clinic on the Oral Health of Children Who Lack Access to Dental Care

This program evaluation examines the effectiveness of a school-based dental clinic. A repeated-measures design was used to longitudinally examine secondary data from participants ( N = 293). Encounter intensity was developed to normalize data. Multivariate analysis of variance and Kruskal-Wallis test were used to investigate the effect of encounter intensity on the change in decay, restorations, and treatment urgency. A Pearson's correlation was used to measure the strengths of association. Encounter intensity had a statistically significant effect on change in decay ( p = .005), restorations ( p = .000), and treatment urgency ( p = .001). As encounter intensity increased, there was a significant association with the decrease in decay (-.167), increase in restorations (.221), and reduction in referral urgency (-.188). Incorporating dental care into a school-based health center resulted in improved oral health in underserved children while overcoming barriers that typically restrict access. The collaboration of school nurses with the school-based dental clinic was an important element for maximizing student access to dental care.

Effectiveness of an Alternative Dental Workforce Model on the Oral Health of Low-Income Children in a School-Based Setting

OBJECTIVES

We evaluated the effect of an alternative dental workforce program-Kansas's Extended Care Permit (ECP) program--as a function of changes in oral health.

METHODS

We examined data from the 2008 to 2012 electronic medical records of children (n = 295) in a Midwestern US suburb who participated in a school-based oral health program in which preventive oral health care was delivered by ECP dental hygienists. We examined changes in oral health status as a function of sealants, caries, restorations, and treatment urgency with descriptive statistics, multivariate analysis of variance, Kruskal-Wallis test, and Pearson correlations.

RESULTS

The number of encounters with the ECP dental hygienist had a statistically significant effect on changes in decay (P = .014), restorations (P = .002), and treatment urgency (P = .038). Based on Pearson correlations, as encounters increased, there was a significant decrease in decay (-0.12), increase in restorations (0.21), and decrease in treatment urgency (-0.15).

CONCLUSIONS

Increasing numbers of encounters with alternative providers (ECP dental hygienists), such as with school-based oral health programs, can improve the oral health status of low-income children who would not otherwise have received oral health services.

A qualitative analysis of oral health care needs in arkansas nursing facilities: the professional role of the dental hygienist

PURPOSE

Frail elders and nursing home residents are vulnerable to poor oral health and frequently lack access to dental care. The purpose of this study was to determine why residents in Arkansas skilled nursing facilities have limited access to oral health care.

METHODS

This study utilized qualitative research methodology. Data was collected from oral health care personnel through open-ended responses in a written survey (n=23) and through telephone interviews (n=21). The investigators applied the constant comparative method to analyze and unitize the data and ultimately reach consensus.

RESULTS

Data analysis resulted in consensus on 2 emergent themes: policy and access.

CONCLUSION

This qualitative case study suggests access to oral health care for residents living in both long-term care (LTC) and assisted living I and II facilities in Arkansas is affected by public and facility policies and access to oral health care as a function of the patient's health status and availability of oral health care providers. Access for residents residing in assisted living I and II facilities is also limited by the residents' inability to assume responsibility for accessing oral health care. The outcomes from this study may serve to inform policymakers and advocates for access to oral health care as they develop new policies to address this growing need.

Preventive services program: a model engaging volunteers to expand community-based oral health services for children

PURPOSE

This paper describes the Preventive Services Program (PSP), a community based oral health program model which engages volunteers to provide preventive services and education for underserved children in Missouri. In 2006, the Missouri Department of Health and Senior Services created a program for children designed to use a systems approach for population-based prevention of oral disease. Currently, 5 part-time dental hygienists serve as Oral Health Program Consultants to work with the citizens of a community to engage dentists, dental hygienists, parents and other interested stakeholders in the activities of the program. Dental volunteers evaluate oral health and disease in the community's children and facilitate referrals for dental care. Other volunteers apply fluoride varnish and provide educational services to the children.

PROGRAM OUTCOMES

In 2006, 273 volunteer dentists and dental hygienists and 415 community volunteers provided oral screenings, oral health education, 2 fluoride varnish applications and referral for unmet dental care for 8,529 children. In 2011, 775 volunteer dentists and dental hygienists and 1,837 other community volunteers provided by PSP services to nearly 65,000 children.

CONCLUSION

It has been demonstrated that when the local citizens take responsibility for their own needs that a sustainable and evidence-based program like PSP is possible. Guidelines which provide criteria for matching models with the specific community characteristics need to be generated. Furthermore, a national review of successful program models would be helpful to those endeavoring to implement community oral health program.

Preliminary findings on the correlation of saliva pH, buffering capacity, flow, Consistency and Streptococcus mutans in relation to cigarette smoking

PURPOSE

The purpose of this preliminary study was to examine the relationship of caries risk, salivary buffering capacity, salivary pH, salivary quality (flow, consistency) and levels of Streptococcus mutans in relation to cigarette smoking.

METHODS

This clinical trial consisted of 53 volunteer patients receiving care in a university based dental hygiene clinic. Participants completed a questionnaire specific to their social history in regards to tobacco use, oral health and dietary history. Measurements of unstimulated saliva were collected followed by collection of stimulated saliva samples. These samples were used to measure salivary pH, buffering capacity and Streptococcus mutans levels.

RESULTS

The subject's smoking status was significantly associated with caries risk (p= 0.001), with 25% of the variability of caries risk attributed to smoking. The smoking status was significantly associated with buffering capacity (p=0.025), with 9% of the variability of buffering status attributed to the smoking. Associations between smoking status and salivary pH were not statistically significant. The subject's caries risk was significantly associated with buffering capacity (p= 0.001), with 25% of the variability of caries risk attributed to the buffering capacity. The subject's caries risk was significantly associated with salivary pH (p= 0.031), with 9% of the variability of caries risk attributed to the salivary pH. The Streptococcus mutans test showed no statistical significance (p>0.05) possibly due to the number and low variance in the subjects.

CONCLUSION

A relationship between caries risk and smoking, buffering capacity and smoking, and stimulated salivary pH and smoking were concluded. No significance difference (p>0.05) between caries risk and salivary pH, salivary quality and smoking, S. mutans and smoking were noted from the preliminary results.

Extending oral health care services to underserved children through a school-based collaboration: part 2: the student experience

PURPOSE

The purpose of this study was to examine the experiences of dental hygiene students providing services to unserved and underserved children in a school-based collaboration between a dental school, school district and Extended Care Permit I (ECP-I) dental hygienist in Kansas.

METHODS

Following comprehensive preventive oral health care services to children in 4 schools supervised by an ECP-I dental hygienist, 26 senior dental hygiene students enrolled in the dental hygiene program at the University of Missouri-Kansas City submitted rotation data records and self-reflection journals describing the experience. Using the constant comparative method, 3 faculty researchers unitized the data by identifying key themes.

RESULTS

Data from student reflections was aggregated into 5 categories: skill development (46%), awareness (19%), type of experience (15%), description of environment/setting (13%) and role model (7%).

CONCLUSION

Participation in well-designed service learning programs is rewarding for students providing the services and works toward developing the skills needed to competently care for the changing needs of society. New models of oral health care and expanded roles for dental hygienists are providing greater access to preventive oral health care in Kansas.

Extending oral health care services to underserved children through a school-based collaboration: part 1: a descriptive overview

PURPOSE

The purpose of this report is to describe the process and outcomes of a collaborative, comprehensive preventive oral health program between the University of Missouri-Kansas City School of Dentistry, the Olathe School District and an Extended Care Permit I dental hygienist. The report describes the programs collectively working to provide school-based services to disadvantaged children in 4 Title I schools using the community collaborative practice oral health model and tele-dentistry.

METHODS

The "Miles of Smiles" clinic was assembled in 4 elementary schools using portable dental equipment. Dental hygiene students, supervised by a dental hygiene faculty member with an extended care permit, provided comprehensive preventive oral health care to unserved and underserved children.

RESULTS

Twenty-eight dental hygiene students provided prophylaxis, radiographs, sealants, fluoride varnish, oral health education and nutritional counseling to 339 children in the Miles of Smiles clinic during the 2008 to 2009 academic year. Sixty-three percent of children had decay and were referred to a dentist. Upon re-evaluating at the end of the school year, 11% had begun the transition process of seeking restorative care at a safety net clinic or from a local dentist.

CONCLUSION

School based oral health models, using dental hygienists with expanded scopes of practice to provide preventive oral health services and referrals, can serve as one approach to overcoming barriers and reaching vulnerable children that desperately need oral health care. However, transitioning children outside of their school to a safety net clinic or local dentist to receive restorative care was found to be problematic.

Evaluation of social interaction, task management, and trust among dental hygiene students in a collaborative learning environment

The purpose of this study was to evaluate the impact of collaborative learning on the development of social interaction, task management, and trust in dental hygiene students. These three traits were assessed with the Teamwork Assessment Scale in two different learning environments (traditional lecture/lab and collaborative learning environment). A convenience sample of fifty-six entry-level dental hygiene students taking an introductory/preclinic course at two metropolitan area dental hygiene programs provided comparable experimental and control groups. Factor scores were computed for the three traits, and comparisons were conducted using the Ryan-Einot-Gabriel-Welsh multiple comparison procedure among specific cell comparisons generated from a two-factor repeated measures ANOVA. The results indicate that the collaborative learning environment influenced dental hygiene students positively regarding the traits of social interaction, task management, and trust. However, comparing dental hygiene students to undergraduate students overall indicates that dental hygiene students already possess somewhat higher levels of these traits. Future studies on active learning strategies should examine factors such as student achievement and explore other possible active learning methodologies.

An evidence-based review of ergonomic features of dental hygiene instruments

OBJECTIVES

The purpose of this paper is to describe the research identifying dental hygiene risk factors, outline the structural characteristics of the various tools that dental hygienists use and discuss the evidence to support ergonomic tool re-designs.

METHODS

Two databases, Medline and Cinahl, were used to identify epidemiological research studies from 1998--2008 that describe the prevalence of musculoskeletal disorders in dental hygienists. The length, diameter, mass and padding of twenty-one (n=21) dental instruments and instrument grip combinations and twenty-two (n=22) mirrors and mirror grip combinations are described.

RESULTS

The length, mass and diameter of dental instruments and dental mirrors ranged from 16.3 cm to 17.5 cm and 15.9 cm to 18.5 cm, from 10.0 g to 25.0 g and 5.0 g to 30.0 g, and from 6.5 mm to 11 mm and 6 mm to 14 mm, respectively. Padding instruments and mirrors increased the mass by approximately 5.0 g. The literature does not suggest an optimal length for dental instruments or dental mirrors. The literature suggests that the optimal diameter for dental instruments and mirrors is at least 10 mm, the optimal weight is 15.0 g or less, and padding decreases muscle activity.

CONCLUSIONS

Dental hygienists should be educated to select a variety of instrument handles based upon the parameters described above.

Examining the effect of the Flextend Orthotic Device on grip strength: a pilot study

Strengthening exercises like those used to treat carpal tunnel syndrome have been recommended for prevention however their effectiveness when used in this manner are not known. The purpose of this study was to determine the effects of the Flextend Orthotic Device on grip strength of dental hygiene students. This study used a convenience sample of 24 (n=24) first year dental hygiene students. Students were randomly assigned to either the Flextend Orthotic Exercise glove group or a control group. A series of grip strength measurements were taken periodically throughout the study using a hydraulic hand dynamometer. In a repeated measures analysis of covariance there were no significant effects for study group (p=0.812) time (p=0.954), nor was there a significant interaction between group and time (p=0.858). Use of the Flextend Orthotic Device did not additionally increase grip strength among dental hygiene students over the eight week time period. In none of the weeks post baseline was there a significant difference between the Flextend Orthotic Device group and control groups.

Examining the role of collaborative assessment in a didactic dental hygiene course

The purpose of this study was to evaluate a technique known as collaborative assessment considering students' and faculty members' perceptions of the value and utility of this approach. Twenty-eight dental hygiene students took eight individual assessments (quizzes) immediately followed by completion of the same assessment in a five-member peer group as part of a didactic dental hygiene course. At the end of the semester, student perceptions and course performance were examined. Faculty perceptions were also collected. A paired samples t-test was conducted to compare student performance on individual and group assessments. Students reported that this collaborative assessment approach enhanced their learning, provided them with experience in defending their answers, and decreased stress. Concerns for fairness and individual accountability were noted by both students and faculty. The mean group score for all quizzes combined (M=91 percent, SD=2 percent) was significantly higher by 16 percentage points (91 percent versus 75 percent) than the mean individual score for all quizzes combined (M=75 percent, SD=8 percent), t(27)=11.61, alpha =.05, p<.0005. This study suggests that additional measures are needed to ensure individual preparation and accountability when using the collaborative assessment process as a learning strategy with dental hygiene students.

Comparison of tactile discrimination associated with varying weights of explorers

The prevalence of work-related musculoskeletal disorders in dental hygienists is significantly higher than that of the general population. The purpose of this study was to evaluate the effect of explorer weight on dental and dental hygiene students' tactile discrimination when exploring. A randomized controlled clinical trial utilizing a dual dependent statistical design was used to collect data on a convenience sample of forty-eight (n=48) dental hygiene students beginning their senior year of their curriculum. Tactile discrimination was measured by having twenty-four experimental subjects (using a lightweight 0.4 ounce explorer) and twenty-four control subjects (using a heavier 1.0 ounce explorer) delineate the coarseness of varying textures of sandpaper in an apparatus that provided a blinded environment. Data were analyzed using SPSS. Descriptive statistics, chi square tests, and independent sample t-test were computed. Results did not display statistically significant differences between groups. Descriptive statistics illustrated that students using lightweight explorers were better able to delineate between textures. One exception to this finding was with very similar textures, where heavier explorers provided superior tactile discrimination. Overall, the weight of the explorer does not affect students' tactile discrimination abilities.

Evaluation of an academic service-learning course on special needs patients for dental hygiene students: a qualitative study

The purpose of this study was to evaluate the outcomes of a service-learning course on special needs patients for dental hygiene students by considering student reflections, community site coordinators' feedback, and faculty reflections in a qualitative analysis. Twenty-three female dental hygiene students beginning their fourth semester in the program provided preventive oral health services at eight community sites serving six diverse groups of people having special health care needs. Students reflected on the experience via commentaries written in self-reflection journals. The investigators applied the constant comparative method to analyze and unitize the data, ultimately reaching consensus on three category topics: awareness, higher order thinking, and professionalism. End of course project assessments provided additional data that was used to triangulate with data from the reflective journals. Telephone interviews with the site coordinators and personal interviews with the course faculty provided data from multiple perspectives. The outcomes of this study suggest that service-learning pedagogy can facilitate a deeper understanding of the subject matter and provide an opportunity for students to use critical thinking strategies in addition to becoming aware of complex social and professional issues related to the oral health care of individuals with special needs.

Advanced degree seeking students' satisfaction with online courses at UMKC--an early investigation

The use of online instruction is becoming more prevalent and transcends many disciplines. Nursing has been at the forefront of health professions utilizing distance education. Nearly half of all predoctoral dental programs report use of web-based or distance delivery. Comparatively, 22% of dental hygiene programs report use of this somewhat new approach to teaching. Distance learning provides a means for increasing access to and enrollment in dental hygiene programs. Individuals who cannot physically attend courses in dental hygiene benefit from the institutions that offer web-based classes. In today's environment, more individuals seek to advance their educational needs. Advanced dental hygiene degree programs may benefit by providing distance learning. Since 2000, the University of Missouri - Kansas City (UMKC), Division of Dental Hygiene has offered its degree completion program online. Its master's degree online program has been offered since 2001.

PURPOSE

The purpose of this study is to describe the pre- and post-course graduate and degree completion students' perceptions of web-based courses offered at UMKC.

METHOD

Over the course of 3 years, all students enrolled in required fall semester online classes were selected and agreed to participate in the study. Students were asked to fill out questionnaires prior to and at the completion of required online courses. There were no identifiers on the questionnaires. The surveys used in the study were derived from an instrument used by Wills and Stommel who examined graduate nursing students' perceptions of web-based courses.

RESULTS

Results indicate that students enjoy this method of learning. All students reported they would enroll in another online course if given the opportunity.

CONCLUSION

Based on favorable student perceptions, UMKC will continue to provide this method of learning to students seeking advanced degrees in dental hygiene.

Using a multifaceted approach including community-based service-learning to enrich formal ethics instruction in a dental school setting

The purpose of this investigation was to examine the degree to which a multifaceted approach to formal ethics instruction including community-based service-learning can enrich the learning environment and how it influences students' attitudes and perceptions about their role as oral health care providers, access to care, disparity, and working in a diverse community. Students' attitudes were evaluated prior to and following the seven-week course to determine if community-based service-learning had any impact on their perceptions. Factor analysis was conducted; and based on the identified factor structure, subscales were computed and used for subsequent analyses of change in attitude over time (pre- and post-test results) and to compare assessment of experience between discipline groups (dental and dental hygiene) as well as gender. There was a statistically significant difference in student attitudes from the beginning of the course to the end about volunteering in the community (p=.036). Additionally, there was a statistically significant difference (p<.01) between male and female students related to course impact on career choice and personal ability. Female students reported the course had a greater impact on their career choice and personal ability than did males. Students were required to complete a reflection paper on their service-learning experience. Reflective papers were analyzed using the qualitative constant comparative method. Reflective papers served as a rich source of information for understanding student perceptions related to their role as oral health care providers, access to oral health care, disparity, and cultural competence. Both dental and dental hygiene students indicated a desire for additional opportunities to participate in community-based service-learning activities and a desire for addressing the current access to care issues in their curricula. We found that a multifaceted approach to ethics instruction incorporating a community-based service-learning component provided an enriched environment for the discussion of several ethical issues facing oral health care providers today.

Comparison of muscle activity associated with structural differences in dental hygiene mirrors

PURPOSE

Ergonomic studies suggest that the commonly used pinch grasp, held in a static position, is a contributing factor for dental Hygienists' development of work-related musculoskeletal disorders (WMSDs) such as carpal tunnel syndrome (CTS), Trigger Thumb, de Quervain's stenosing tenosynovitis, and carpometacarpal (CMC) osteoarthritis. The pinch grasp is commonly used by the dental hygienist while holding the dental mirror in the non-dominant hand. In response to this concern, manufacturers are redesigning dental mirror handles. The value of these re-designed products is based solely on anecdotal evidence. To date, minimal research has been done to examine the non-dominant mirror hand. The purpose of this study was to objectively evaluate dental mirror handle design using surface electromyography (sEMG) to compare muscle activity associated with grasping the mirror.

METHODS

This randomized controlled clinical trial utilized a two-by-two repeated measures statistical design. Data was collected on a convenience sample of 19 (N=19) healthy dental hygiene students in their last year of study. Data collection was divided into two phases to maintain a balanced study. The independent variables in phase I were diameter and weight. The independent variables in phase II were weight and padding. Muscle activity was measured while grasping various dental hygiene mirrors in 30-second increments using sEMG. Following data collection subjects designated which mirror felt most and least comfortable to compare subjective data with objective data.

RESULTS

Three statistically significant results occurred. In phase II, padding (p=.01) demonstrated the largest reduction of muscle activity in the flexor pollicis brevis, by decreasing mean muscle activity by 3.7 microv. The interaction of diameter and weight (p=.01) in phase I reduced the mean muscle activity in the extensor digitorum by .8 microV and weight (p=.02) in phase II decreased the muscle activity in the extensor digitorum by .62 microV. Self-reports of comfort reported by the subjects in this study were not consistent with the measurements of muscle activity using sEMG.

CONCLUSION

Ergonomic adaptations to dental hygiene mirror handles were associated with increases and decreases in muscle activity. The clinical impact of this is amplified as force is exerted. Furthermore, it may be possible to reduce WMSDs for dental hygienists by using instrument designs during the workday. Self-reports of comfort by the subjects in this study did not calibrate with the measurements of muscle activity using sEMG. Additional research is needed to further isolate the external variables of the study and to determine what actual reduction in muscle activity is significant for maintaining musculoskeletal health.