Identifying Needs to Ensure a Humanistic Academic Dental Environment: A Multi-Site Survey of Dental Students' Perspectives

Dental school academic environments, whether the overall environment or the smaller environments of the classroom, lab, clinic, or community, are critical to student learning and professional development. The aims of this study were to assess dental students' experiences in the overall academic environment related to discrimination, destructive communication, belittlement, and isolation and to explore the relationships between students' emotional health and such experiences. Dental students in all four years at five U.S. dental schools were invited to participate in an electronic survey in April 2017. A total of 358 students responded for a 19.4% response rate. These students reported a total of five cases of discrimination that had been formally reported to their schools. Among these respondents, 24% had experienced destructive communication, 33% had experienced belittlement, and 33% reported feeling a sense of isolation. Non-males and students with disabilities were more likely to experience belittlement and isolation. Both destructive communication and feeling belittled increased with program year (relative to year 1)-spiking in year 3. Destructive communication and isolation were associated with behavior changes such as weight change, increased alcohol or over-the-counter medication use, and consultation with a health professional. To improve overall academic environments, dental educators should create learning environments to foster development of professional relationships, and schools should continue to provide student support services. Identifying and acknowledging shared issues across dental education might stimulate a national discussion that could lead to concerted approaches to address these issues. Identifying the proportions of students with feelings of isolation or loneliness along with experiences of belittlement and destructive communication could provide schools with a useful picture of their academic environment.

Student Preparation for the National Board Dental Hygiene Examination: A national survey of dental hygiene program directors

Purpose: Dental hygiene students nearing completion of their educational programs are required to take written and clinical examinations in order to be eligible for licensure. The written licensure exam, the National Board Dental Hygiene Examination (NBDHE), is administered by the Joint Commission of National Dental Examinations (JCNDE). Failing a licensing examination is a costly experience for students and has the potential for a negative impact on a program's accreditation status. Nursing programs have published extensively on strategies used to prepare students for licensure examinations. However, there appears to be a gap in the literature as to how dental hygiene programs prepare their students to take the NBDHE. The purpose of this study was to conduct a national survey of U.S. dental hygiene program directors to determine what strategies their programs employ to prepare students to take the NBDHE and to explore the viewpoints of dental hygiene program directors regarding student preparation methods for the NBDHE.Methods: An survey instrument was developed, pilot tested, revised and mailed to directors of the 335 CODA accredited U.S. dental hygiene programs. The survey consisted of a combination of response formats including forced choice, multiple allowable answered, and open-ended written comments.Results: A total of 154 surveys were returned, yielding an overall response rate of 45% (154/341). The vast majority of directors (93%) reported they use specific methods and practices to prepare students for the NBDHE. The top two strategies identified were dental hygiene review texts (84%) and a board review course (83%). The majority of directors (84%) reported supporting student participation in non-mandatory, commercial review courses. In regard to mock board exams, directors "agreed/strongly agreed" (75%) that the mock board exam is a useful coaching tool in the overall process of NBDHE preparations. A majority (65%) indicated they were not concerned with failure rates, and 43% reported failure rates do reflect on the program.Conclusion: These results suggest that the majority of dental hygiene programs are utilizing strategies to prepare students for the NBDHE with board review textbooks and board review courses named as the top two strategies.

Program Evaluation of a Distance Master's Degree Dental Hygiene Program: A Program Effectiveness Study

Purpose: The purpose of this study was to conduct a program evaluation of the University of Missouri-Kansas City Master of Science in Dental Hygiene Education Program (MSDH). This evaluation examined long-term outcomes in the context of stakeholders (the profession, the student, and the degree-granting institution).Methods: A mixed-methods approach was used to gather data from the 28 graduates from the MSDH program. An electronic questionnaire included both open- and closed-ended questions including demographic and practice data, and data related to alumni preparedness to reach their career goals. Virtual focus groups provided valuable insight into whether the program has achieved its goals, and prepared the graduates to meet their program competencies and future goals.Results: Out of a total of 28 individuals who have successfully completed the distance program (2001-2011), 19 participated in an online survey (67.8%). The majority of the participants (73.7%) participated in one of 3 focus groups. Sixty-three percent of the graduates are currently employed in dental hygiene education. Eighty-four percent of the respondents have published their research conducted while in the program, thereby contributing to the dental hygiene body of knowledge. Sixty-eight percent indicated that had the distance option not existed, they would not have been able to obtain their advanced degree in dental hygiene. Twenty-one percent of the respondents report either being currently enrolled in a doctoral program, or having completed a doctoral degree.Conclusion: These results suggest that the University of Missouri-Kansas City Master of Science in Dental Hygiene Education Program is meeting its goals from the perspective of all stakeholders and providing its graduates with access to education and educational resources to meet the program competencies and ultimately achieve their career goals.

Which Way to Lean? A National Study of Women Dental Faculty Members' Career Aspirations and Choices

The aim of this first national study of women in academic dentistry was to explore factors and perceived barriers for why administrative/leadership positions were or were not sought via data collected from full-time women dental faculty members in the U.S. In fall 2015, the researchers conducted a survey that employed a combination of response formats: forced choice from a menu, multiple allowable answers, and open-ended written comments. The overall response rate for the survey was 35.6% (537/1504). Respondents were from 48 of the 65 U.S. dental schools. Half of the respondents indicated their primary appointment was in clinical sciences, 22.9% were in administration, 7.3% in research, 7.1% in basic science, and 2.5% in behavioral science. While a quarter of the respondents indicated administration as their primary appointment, over half reported holding administrative positions, and nearly all (92.4%) reported currently holding leadership roles at their institutions. For those not currently in administrative/leadership roles, 52.6% indicated a desire for an administrative role and 70.7% a leadership role. Of those in administrative/leadership roles, 62.1% indicated not receiving extra remuneration for those responsibilities. Half of the respondents perceived that they were paid less in their current position than men doing the same work. The most dominant theme emerging from qualitative analysis of barriers the respondents experienced was the difficulty women in dental education have in a traditionally male-dominated profession. The results confirmed that women faculty members are "leaning in" to seek administrative/leadership roles in academic dentistry. However, pay equity remains an issue, and faculty development and mentoring are needed for the advancement of academic dentistry and ultimately the dental profession.

Faculty Development at One Midwestern Dental School: A Program Evaluation

Most dental school faculty members arrive on campus with a wealth of clinical experience but little to no teacher training. For the past two decades, there has been a call for schools to educate their faculty on a wide variety of topics including educational methodology and cutting-edge educational techniques through faculty development programs. Drawing on theories of general program evaluation as well as evaluation specific to educational programming, the aim of this study was to investigate outcomes of the Faculty Development Program at the University of Missouri-Kansas City School of Dentistry between 2007 and 2014. A mixed-methods research design gathered quantitative data via email survey sent to all eligible teaching faculty members; it received an overall response rate of 54% (N=51). Qualitative data came from open-ended survey questions and a focus group with seven volunteer faculty participants. The survey data suggested that the stated outcomes of faculty development were being met for all stakeholder groups with varying degrees of success. Focus group results indicated a need for a more formal new faculty orientation and better communication with all about the specific charge of faculty development within the school. Evaluation of faculty development activities in academic dental institutions is a necessary component of the ongoing improvement of dental education. Suggestions for future evaluations include the idea of collaborating with other dental schools to increase sample sizes, which would increase participants' perception of the level of confidentiality and make statistical analyses more robust.

ADEA/AAL Institute for Allied Health Educators: Program Evaluation

Revised accreditation standards for dental and dental hygiene education programs have increased emphasis on faculty development that can improve teaching and learning, foster curricular change including use of teaching and learning technologies, and enhance retention and satisfaction of faculty. The American Dental Education Association (ADEA) and Academy for Academic Leadership (AAL) established the Institute for Allied Health Educators (IAHE) in 2007 to address faculty development needs for allied dental and allied health educators. In 2009, it was transitioned to an online program, which resulted in increased enrollment and diversity of participants. After seven years, a comprehensive program evaluation was warranted. The authors developed an online questionnaire based on Kirkpatrick's four-level model of training evaluation; for this study, levels one (satisfaction), two (knowledge and skill acquisition), and three (behavior change) were examined. Of the 400 program participants invited to take part in the study, a 38% response rate was achieved, with the majority indicating full-time faculty status. Nearly all (95-97%) of the respondents agreed or strongly agreed the program contributed to their teaching effectiveness, and 88-96% agreed or strongly agreed it enhanced their knowledge of educational concepts and strategies. In addition, 83% agreed or strongly agreed the program helped them develop new skills and confidence with technology, with 69% agreeing or strongly agreeing that it helped them incorporate technology into their own educational setting. Nearly 90% were highly positive or positive in their overall assessment of the program; 95% indicated they would recommend it to a colleague; and 80% agreed or strongly agreed they had discussed what they learned with faculty colleagues at their home institutions who had not attended the program. Positive findings from this evaluation provide evidence that the IAHE has been able to meet its goals.

Development and implementation of online National Board Dental Examination Review Courses

Failure on the National Board Dental Examination (NBDE) Parts I and II has troubling consequences for dental students, faculty members, and school administrators. Since the NBDE is a high-stakes exam for all involved, it is important to determine effective strategies to help students prepare. The purpose of this article is to describe the development and implementation of online NBDE Parts I and II Review Courses by the faculty and administration at the University of Missouri-Kansas City School of Dentistry. The courses are taught by faculty members who are content experts. By utilizing distance technology, students in any geographic location can review the material at the time, place, and pace that are most convenient. Early outcomes show that 592 students from thirty-two states have participated in the courses since they were first offered in 2010-11. In post-course evaluations, students report that participation in the courses encouraged them to spend more time preparing for the exam and that the associated PowerPoint slides/handouts provided structure for their review. The literature suggests that multiple modalities are most effective in preparing for the NBDE. These online review courses can serve as a beneficial component of a student's preparation regimen.

Teaching with technology: learning outcomes for a combined dental and dental hygiene online hybrid oral histology course

Among the challenges leaders in dental and allied dental education have faced in recent years is a shortage of well-qualified faculty members, especially in some specialty areas of dentistry. One proposed solution has been the use of technology. At the University of Missouri-Kansas City School of Dentistry, the departure of a faculty member who taught the highly specialized content in oral histology and embryology provided the opportunity to implement distance delivery of that course. The course is taught once a year to a combined group of dental and dental hygiene students. Previous to spring semester of 2009, the course was taught using traditional face-to-face, in-class lectures and multiple-choice examinations. During the spring semesters of 2009, 2010, and 2011, the course was taught using synchronous and asynchronous distance delivery technology. Outcomes for these courses (including course grades and performance on the National Board Dental Examination Part I) were compared to those from the 2006, 2007, and 2008 courses. Students participating in the online hybrid course were also given an author-designed survey, and the perceptions of the faculty member who made the transition from teaching the course in a traditional face-to-face format to teaching in an online hybrid format were solicited. Overall, student and faculty perceptions and student outcomes and course reviews have been positive. The results of this study can provide guidance to those seeking to use technology as one method of curricular delivery.

Academic integrity violations: a national study of dental hygiene students

The purpose of this study was to identify the prevalence of academic integrity violations reported by a national sample of dental hygiene students as compared to general undergraduate students. This study also examined the influence of student variables such as gender, age, and level of education, along with honor codes and other contextual factors, on academic integrity. A total of 2,050 surveys were mailed to a random selection of the schools with dental hygiene degree programs in each of the twelve American Dental Hygienists' Association (ADHA) districts. A total of 794 usable surveys were returned for an overall response rate of 39 percent. The respondents were predominantly twenty to twenty-nine years of age (85 percent), and 97.7 percent were female. The largest percentage of respondents (38.5 percent) had completed four or more years of undergraduate education at the time of the survey, with the majority of the coursework taken in a community college setting (39 percent). Approximately 53 percent were from associate programs and 47 percent from baccalaureate programs. Of those responding, 11.3 percent reported cheating during their dental hygiene program, and 30.2 percent were aware of someone cheating in their program. A comparison of academic violations for dental hygiene students to students in other undergraduate programs reveals that a smaller proportion of dental hygiene students report violations.

Examining clinical assessment practices in U.S. dental hygiene programs

Competency-based education (CBE) in dental hygiene education is intended to measure learned skills that prepare students to independently provide services for the public. A variety of standardized clinical assessment techniques (SCATs) are available to substantiate the competence of health care professionals, including, but not limited to, objective structured clinical examinations (OSCEs), triple jump exams, standardized patients, and simulations. Standardized clinical examinations test students' abilities to treat diverse patients in a consistent, controlled setting. SCATs help prepare clinicians to safely treat patients of various complexities. The objectives of this study were to examine the variety of techniques used to assess clinical competence in U.S. accredited dental hygiene programs and to obtain program directors' attitudes regarding clinic assessment, with a focus on how SCATs are used. An online survey collected data from 125 directors (48 percent response rate). Approximately 97 percent of the responding programs used observation-type assessments followed by case studies (90 percent), self-assessment (85 percent), and mock boards (75 percent), with SCATs being the least used. The majority of responding directors (74 percent) indicated an interest in learning more about these SCATs. A chi-square test identified no significant difference between the use of SCATs by associate and baccalaureate degree programs, with program location also being irrelevant.

The development and implementation of an online applied biochemistry bridge course for a dental hygiene curriculum

This article describes a curricular change project designed to improve instruction in biochemistry. After years of unsatisfactory outcomes from a dental hygiene biochemistry course, a decision was made to change the traditional lecture-based course to an online format. Using online technology and principles of educational pedagogy, a course was developed that fosters application of biomaterials principles to dental hygiene practice and provides a bridge between prerequisite chemistry coursework and biochemistry in a health professions program. Members of the dental hygiene graduating Classes of 2007 and 2008 participated in the revised course. The outcome measures used to assess the effectiveness of the revised course were student end-of-semester course evaluations, graduating senior survey results, student course performance, and National Board examination performance. While the results are based on only two classes, the positive outcomes suggest that the revision was a worthwhile endeavor. The use of technology in teaching holds the potential for solving many of the curriculum and instruction issues currently under discussion: overcrowding of the curriculum, lack of active learning methods, and basic sciences taught in isolation from the rest of the curriculum. It is hoped that the results of this change will be helpful to other faculty members seeking curricular change and innovation.

A qualitative study of limited access permit dental hygienists in Oregon

Many states have adopted alternative oral health care delivery systems that include expanded roles for dental hygienists. This qualitative study was designed to evaluate the impact of the Limited Access Permit (LAP) legislation in Oregon and to understand the relationship between dental hygienists and dentists within this delivery system. The snowball sampling technique was used to identify LAP dental hygienists and collaborating dentists. The snowball sampling technique begins with the identification of a known expert in the field who serves as the initial "sampling unit." Subsequent individuals are then recommended, or nominated, to the investigator by the initial study participant and are selected based upon the need to fill in or extend information. The final sample consisted of seven LAP dental hygienists and two collaborating dentists. Interviews, field observations, and document analysis were utilized for data collection. Factors that led to the creation of LAP dental hygiene practice, current LAP practice, personal characteristics, relationships between LAP dental hygienists and dentists, and the impact that LAP dental hygienists have had on access to oral health care were explored. Data revealed that the Oregon legislature twice expanded the LAP scope of practice to increase access to oral health care services. LAP dental hygienists practice in community and school-based settings. Common characteristics of LAP dental hygienists include entrepreneurship, lifelong learning, and a commitment to underserved populations. The findings from this study indicate that LAP dental hygienists and collaborating dentists have positive relationships. No evidence of lower quality of care in unsupervised dental hygiene practices was found. However, the impact of the LAP legislation is still unknown due to the limited numbers of LAP dental hygienists and the early nature of the LAP practice.

Articaine: a new alternative in dental hygiene pain control

PURPOSE

Local anesthesia administration is integral to pain control in dental hygiene. As of 2006, 40 licensing jurisdictions in the United States include local anesthesia administration in the scope of dental hygiene practice. While the risks associated with use of intraoral local anesthesia are not great, careful attention to recommended practices helps foster patient safety. As new products are introduced, it is important to study their advantages and limitations to see where they fit into dental hygiene practice. An amide local anesthetic agent, articaine, that has been available in Europe for over 20 years, was approved for US distribution in 2000.

METHODS

The purpose of this article is to review the current peer reviewed literature on the characteristics of articaine so it can be incorporated into dental hygiene practice when indicated.

RESULTS

Rather than simply using one agent for all procedures, patient care is enhanced when local anesthetics are selected based on the unique needs of the procedure, the patient and with safety and effectiveness in mind.

Access to care and the allied oral health care workforce in Kansas: perceptions of Kansas dental hygienists and scaling dental assistants

Access to oral health care continues to be a problem in the United States. Research has called for innovative approaches to improve access to oral health care and reduce oral health care disparities. Successful alternate approaches have been reported. In 1998 the Kansas Legislature passed a proposal to enhance access to care and manpower needs by allowing dental assistants to provide supragingival scaling, a service traditionally assigned to dental hygienists. In 2000, Mitchell et al. investigated the perceptions of Kansas dental hygienists and scaling dental assistants in relation to House Bill 2724 (HB 2724), which allows dental assistants to perform coronal scaling. The intent of the study was to collect baseline data in relation to HB 2724. The purpose of the present study was to follow up on the impact of HB 2724 six years after legislation. Both groups report satisfaction with their professions: scaling dental assistants believe the delivery of care in Kansas has changed, and areas of Kansas previously noted as dental health professional shortage areas are now served by either a registered dental hygienist or scaling dental assistant.

Validity and reliability of portfolio assessment of competency in a baccalaureate dental hygiene program

This study examined the validity and reliability of portfolio assessment using Messick's unified framework of construct validity. Theoretical and empirical evidence was sought for six aspects of construct validity. Seven faculty raters evaluated twenty student portfolios using a primary trait analysis scoring rubric. A significant relationship (r = .81-.95; p < .01) between the seven subscales in the scoring rubric demonstrates measurement of a common construct. There was a significant relationship between portfolios and GPA (r = .70; p < .01) and the NBDHE (r = .60; p < .01). The relationship between portfolios and the Central Regional Dental Testing Service (CRDTS) examination was both weak and nonsignificant (r = .19; p > .05). A fully crossed, two-facet generalizability (G) study design was used to examine reliability. ANOVA demonstrated that the greatest source of variance was the scoring rubric itself, accounting for 78 percent of the total variance. The smallest source of variance was the interaction between portfolio and rubric (1.15 percent). Faculty rater variance accounted for only 1.28 percent of total variance. A phi coefficient of .86, analogous to a reliability coefficient in classical test theory, was obtained in the decision study by increasing the subscales to fourteen and decreasing faculty raters to three. In conclusion, the pattern of findings from this study suggests that portfolios can serve as a valid and reliable measure for assessing student competency.

The impact of Kansas House Bill 2724: perceptions of Kansas dental hygienists and dental assistants

PURPOSE

Kansas House Bill 2724 (HB 2724), which allows dental assistants to perform coronal scaling, was passed by the Kansas legislature in the spring of 1998. This bill was the legislature's way of addressing access to care and manpower issues, in relation to oral health care in Kansas. The intent of this study was to collect baseline data related to HB 2724. Specific purposes of this study were to, 1) compare overall perceptions of dental hygienists and scaling assistants related to HB 2724, 2) compare perceptions of dental hygienists and scaling assistants on how HD 2724 has addressed access to care and manpower issues, and 3) examine the impact of HB 2724 on the delivery of preventive care in underserved areas in Kansas.

METHODS

This study employed a nonexperimental descriptive survey research design. Two survey instruments were developed consisting of Likert scale questions, demographic information, and closed and opened-ended questions. All registered Kansas dental hygienists, and dental assistants who had completed the training course approved by the Kansas Dental Board to perform coronal scaling of teeth, were chosen to participate.

RESULTS

A total response rate of 38% for dental hygienists, and 42% for scaling assistants was achieved. Analyses were conducted to ensure validity and reliability of the two survey instruments, including factor analysis and internal reliability measures. In relation to overall satisfaction with career choices, both dental hygienists and scaling assistants reported being happy in their professions and respected by their dentist employers. The majority of dental hygiene respondents (79%) did not see HB 2724 addressing either access to care or manpower issues in the state, while in contrast a majority (89%) of scaling assistants believed that this was the best answer for Kansas in relation to access to care and manpower. In examining the impact of HB 2724 on delivery of preventive care in underserved areas of Kansas, this study found that the majority of scaling assistants reported practicing in metropolitan areas, as opposed to identified oral health care shortage areas in the state.

CONCLUSIONS

While both dental hygienists and scaling assistants are satisfied with their career choices, this legislation does not appear to be addressing its main objectives-access to care and increased manpower in dentally underserved areas in Kansas.

Information-seeking behaviors of U.S. practicing dental hygienists and full-time dental hygiene educators

PURPOSE

This study compared the frequency and variety of information-seeking behaviors used by dental hygiene practitioners and dental hygiene educators to answer practice-related questions. Personal demographic characteristics also were compared between the two groups to determine the characteristics of those with a high level of computer-based information-seeking behaviors.

METHODS

A self-administered questionnaire was sent to a national computer generated random sample of 300 practicing dental hygienists and 300 dental hygiene educators. Responses were received from 63% of the practicing dental hygienists and 78% of the educators.

RESULTS

Dental hygiene practitioners and dental hygiene educators both used traditional methods of seeking information. However, dental hygiene educators used a higher frequency and wider variety of sources than dental hygiene practitioners, including innovative sources such as the Internet, computer databases and online discussion groups. Dental hygiene educators almost universally reported some use of the Internet and computer databases--97% and 91%, respectively. Meanwhile, 50% of dental hygiene practitioners used the Internet and 25% used computer databases at least once for practice information. Online discussion groups were used by 50% of dental hygiene educators but by only 13% of dental hygiene practitioners. Level of education was the demographic characteristic that was most associated with use of computers to answer practice-related questions.

CONCLUSIONS

Since use of computer sources for information were defined as innovative, more dental hygiene educators were classified in early adopter categories, while greater numbers of dental hygiene practitioners were classified in later adopter categories. Group demographics were examined to determine variables that predicted adoption. Level of education predicted the majority of variation and as a whole, showed the strongest statistical differentiation between adopter categories.

Biofilm: a new view of plaque

Dental researchers have attempted to understand the microbial nature of oral diseases over the past 120 years. Their view of plaque and its constituent microorganisms has shifted from a specific plaque hypothesis to a non-specific plaque hypothesis and back again to a theory of specific periodontal pathogens in plaque. Changes in the way plaque and its microorganisms are viewed affect the strategies used to prevent and control periodontal diseases. In recent years, dental researchers have begun to view plaque as a biofilm. This shifting view of plaque has important implications for future efforts in prevention and treatment. This article describes the various ways that dental professionals have viewed plaque throughout the years highlighting the current view of plaque as a biofilm and the ramifications for periodontal therapy.

An investigation of dental hygiene treatment fear

PURPOSE

The purpose of this study was to develop and test the psychometric properties of a dental hygiene fear survey in a convenience sample population from a Midwestern metropolitan area.

METHODS

A convenience sample of 300 subjects from two sites, a suburban general dental practice and a dental school intramural faculty practice located in a metropolitan area, was utilized. A 16-item instrument was developed that incorporated the University of Washington Fears Clinic four subtypes of dental fear: fear of specific stimuli, generalized anxiety, distrust, and catastrophe. The survey was administered prior to dental hygiene treatment. Scores were summed and patients were classified as experiencing dental hygiene fear if their scores were greater than one standard deviation above the mean. Reliability was estimated by Cronbach's alpha. Validity was examined by correlating the revised instrument with measures of conceptually related variables.

RESULTS

Cronbach's alpha coefficient was .85 for specific dental hygiene stimuli, .79 for generalized anxiety, .75 for distrust, and .68 for fear of catastrophe while receiving dental hygiene treatment. Overall reliability of all 16 items was estimated at .92. A significantly positive correlation (.58) was found between dental hygiene patients who reported high fear and avoidance (> 2 years) of dental hygiene treatment (p < .05). Dental hygiene fear correlated negatively (-.12) with age (p < .05). Females reported dental hygiene fear more frequently than males.

CONCLUSIONS

Further revisions of the Dental Hygiene Fear Survey are needed; however, this survey shows promise in evaluating dental hygiene fear.

The effect of personal protective equipment on high-and low-dental fear patients

PURPOSE

This investigation was designed to examine both high- and low-dental-fear patients' perceptions about and anxiety responses to personal protective equipment (PPE) as presented in a videotaped, simulated interaction between oral healthcare worker and patient.

METHODS

Sixty-two individuals representing a convenience sample presented at the University of Missouri-Kansas City (UMKC) Dental School and were screened for eligibility. The Dental Fears Survey was administered to participants to assess level of dental fear. Subjects were then matched according to fear level, gender, and age, and randomly assigned to an experimental or control group. Subjects viewed a videotaped vignette of a male dentist conducting a new patient interview. The control group viewed a tape in which the provider did not utilize PPE. The experimental group viewed the provider putting on PPE at completion of the interview. Subjects were instructed to complete a semantic differential scale at completion of the tape in order for the researchers to assess their attitude toward the scene. Paired adjectives in the semantic scale were scored from 1 to 7, with low scores reflecting negative evaluations and high scores reflecting positive evaluations. Heart rate and skin conductance were measured prior to and during the viewing of the videotapes by means of a photoplethysmograph and an electrodermograph, respectively.

RESULTS

A two-factor ANOVA found the main effect of fear to be significant (p < .05), with subjects exhibiting high levels of dental fear rating both videotapes (PPE & NO PPE) more negatively than subjects exhibiting low levels of dental fear. A repeated measure ANOVA was used for analysis of heart rate and skin conductance. The Dunn's Multiple Means Comparison Test showed that skin conductance increased significantly (p < .05) in both groups from baseline to presentation of the oral healthcare environment.

CONCLUSIONS

A videotaped presentation of the dental environment produced significantly more negative evaluations from patients with high fear than from patients with low fear. Both groups experienced a significant increase in skin conductance (perspiration) upon presentation of the oral healthcare environment. However, presence of PPE did not adversely affect patient perceptions of the oral healthcare provider.

Effectiveness of antimicrobial mouthrinses on aerosols produced by an air polisher

PURPOSE

The purpose of this examiner-blind investigation was to study the effect of two antimicrobial mouthrinses on the quantity and potential respiratory-penetrating ability of microorganisms generated by an air-abrasive polisher.

METHODS

Forty-five adult subjects were randomly assigned to one of three groups and asked to rinse for 30 seconds with 15 ml of either a 0.12% chlorhexidine rinse, an essential oil mouthrinse, or water prior to air polishing. Prior to treatment, microbes in ambient air were collected for five minutes using an Andersen air sampler. This device simulates the human respiratory system and collects airborne microbes by means of blood agar plates stacked in a cascade impact system. Bacteria found at stages two, four, and six--representing the pharynx, bronchi, and alveoli-were collected and counted in this study. During three minutes of air-abrasive instrumentation and two minutes immediately following, airborne microbes were again collected. Agar plates removed from the sampler were incubated for 24 hours at 37 degrees C. Colony-forming units per cubic foot of air (CFUs/ft(3)) were enumerated using a Lab Line colony counter. Data were analyzed using a two-factor repeated measure ANOVA and Dunn's multiple mean comparison techniques.

RESULTS

Results showed no significant effect of prerinsing among treatment groups. An increase in CFUs/ft(3) was found at each sequential stage of the air sampler, resulting in a statistically significant within-group effect (p< or =.05). Additionally, a significant interaction was found between prerinse treatment and respiratory stage (p< or =.05) .

CONCLUSION

While the air-abrasive polisher produced significant amounts of deeply penetrating bacterial aerosol, differences in CFUs/ft(3) generated following the antimicrobial prerinsing tested are of little clinical significance.

Aerosol generation by two ultrasonic scalers and one sonic scaler. A comparative study

The purposes of this study were to compare the amount of aerosols generated from ultrasonic and sonic scalers and to measure the potential depth of respiratory tract penetration. Forty subjects were randomly assigned to receive instrumentation with the magnetostrictive, piezoelectric, or air turbine scaler. The Anderson Air Sampler collected total baseline airborne microbes for 20 minutes prior to treatment and for 20 minutes during instrumentation. This cascade impactor system measures the degree of microbial penetration in a simulated respiratory system. Blood agar plates from the sampler were incubated for 24 hours at 37 degrees C. Colony forming units per cubic foot of air (CFUs/cu. ft.) were enumerated by one blind examiner using a Lab Line Colony Counter. Data for total microbial CFUs/cu.ft. and CFUs/cu.ft. by sampler level were analyzed on the log-transformed data using ANCOVA. Baseline values of airborne bacteria served as the covariate. Results showed no significant difference in mean combined total CFUs/cu.ft. for the magnetostrictive, piezoelectric, or air turbine sonic scalers. The magnetostrictive scaler generated the lowest CFUs/cu.ft. at the deepest level of penetration; however, no significant difference in level of penetration was found among the three scalers.

Effectiveness of chlorhexidine and sodium fluoride in reducing dentin hypersensitivity

This investigation was conducted to evaluate the effect of chlorhexidine, sodium fluoride, and sequential rinses of chlorhexidine (Cx) and sodium fluoride (NaF) on dentin hypersensitivity. Forty-four adult patients with dentin hypersensitivity on three teeth were randomly assigned to receive one of four treatment rinses: (1) placebo; (2) 0.12% Cx; (3) 0.2% NaF; or (4) 0.12% Cx plus 0.2 NaF. Patients' responses to cold stimulation were recorded at baseline, two weeks, and four weeks. Pain response was quantified by applying successively decreasing temperature intervals of water (20 degrees C, 15 degrees C, 10 degrees C, 5 degrees C, and 0 degrees C) to exposed dentin. Plaque Index (Silness and Löe) was recorded at baseline only. Data on dentin sensitivity over time were analyzed using a repeated measures ANOVA. This ANOVA was conducted to generate an error term for calculation of Dunn's multiple mean comparison test. A Spearman rank order test was computed to assess correlation between plaque and hypersensitivity at baseline. Results showed the Cx and NaF rinses alone significantly reduced hypersensitivity (p less than .01) at four weeks compared to baseline. Sequential Cx and NaF rinses significantly decreased sensitivity (p less than .01) at both the two- and four-week intervals compared to baseline. At the four-week interval, the sequential Cx/NaF rinse group showed a significantly greater reduction (p less than .01) in hypersensitivity response when compared to placebo. Cx alone, or NaF alone groups. A moderate, positive correlation (r = 0.55) was demonstrated between plaque and dentin hypersensitivity. This was statistically significant at the (p less than .05) level.

The effectiveness of a patient-applied tooth desensitizing gel. A pilot study

Potassium nitrate has been found to be an effective ingredient for reducing dentinal hypersensitivity. The purpose of this study was to evaluate the effectiveness of a patient-applied 10% potassium nitrate glycerine-based gel in decreasing dentinal sensitivity on cold on teeth with exposed dentin apical to the cemento-enamel junction, 12 patients, each having 3 hypersensitive teeth, were tested. The patients were divided into 3 treatment groups: group 1 was treated with a glycerine-based 10% potassium nitrate gel: group 2 was treated with a glycerine gel without potassium nitrate; and group 3 received no gel and no treatment (control). Following brushing and flossing, groups 1 and 2 applied the gel to the test teeth using custom-made soft acrylic trays, for a period of 5 min/day for 4 weeks. Patient responses to cold water stimuli of 20 degrees C, 10 degrees C and 0 degrees C, were measured at baseline (week 0), then at 1-, 2-, 3- and 4-week intervals. Group 1 patients showed a significant decrease in sensitivity to cold at week 2 only. The group 2 patients showed a significant decrease in sensitivity to cold after 3 and 4 weeks. A statistically significant decrease in sensitivity was noted between group 2 and group 3 patients at week 3. The most sustained decrease in sensitivity to cold was found on teeth treated with plain glycerine.

Assessment of curette sharpness

Nothing to date has appeared in the literature addressing the relationship of specific bevel dimension and clinical sharpness of curette blades. This study investigated the degree of clinical sharpness of Gracey curettes following four periods of simulated root planning and, using the scanning electron microscope (SEM), determined the approximate number of strokes at which loss of clinical sharpness became apparent. Seventy-five new stainless steel curette blades were standardized and randomly assigned to one of five groups: control, 30-stroke, 50-stroke, 70-stroke, and 90-stroke. With the exception of the control group, blades underwent a simulated root-planing procedure, on extracted, periodontally involved teeth, which employed a device to standardize pressure and stroke length. Blades were then tested for clinical sharpness using light reflection, with two degrees of magnification; and plastic stick, a tactile evaluation. Blades were photographed under the SEM at a magnification of x1,000. Bevel width was measured at 10 standardized locations on the photomicrographs, and a mean was calculated. Nonparametric data were analyzed using the Kruskal-Wallis statistical test and SEM parametric data using ANOVA and post hoc Newman-Kuels tests. Results showed no significant differences among treatment groups when either tactile or magnification sharpness tests were used. Analysis of the SEM data showed no statistically significant differences among bevel dimensions for any of the five groups. A Spearman rank order correlation, used to compare the clinical data to the SEM bevel measurements, showed no correlation of clinical sharpness and SEM-determined bevel dimension.