Knowledge of human papillomavirus among dental providers: A mixed methods study

Dental professionals are encouraged by the American Dental Association (ADA) to recommend the HPV vaccine to eligible patients. To better understand their comfort level in following this recommendation, we conducted a mixed methods study of dentists and dental hygienists. A total of 173 providers were surveyed and 8 interviewed. The majority felt they had an important role in preventing HPV-related OPC and that they should educate their patients and encourage HPV vaccination. However, most providers had low knowledge about HPV and expressed a need to obtain more information on the topic. In particular, they desired information about the HPV vaccine, its connection to cancer and where to refer patients for vaccination. They also wanted access to visual aids to help them bring up the topic. This study demonstrates the need to develop and disseminate educational programs for dental providers so they can assist with efforts to raise HPV vaccination rates.

Collaborative Skill Building in Dentistry and Dental Hygiene through Intraprofessional Education: Application of a quality improvement model

Purpose: The purpose of this study was to apply a quality improvement model in the application of an intraprofessional educational experience by improving student perceptions of collaboration and increasing the number of collaborative experiences within the dental hygiene curriculum.Methods: A quality improvement model, Plan, Do, Study, Act (PDSA) developed by the Institute for Healthcare Improvement (IHI), was used to initiate an intraprofessional education experience for dental hygiene and dental students. Faculty members utilized the PDSA worksheet to plan, implement, and analyze the educational experience. Pre- and post-session surveys were used to measure dental hygiene student perceptions of their ability to perform four Interprofessional Education Collaborative (IPEC) sub-competencies. Statistical analysis was carried out on the pre and post session surveys. Students were also given the opportunity to discuss their learning and intraprofessional experiences in a reflection assignment.Results: Dental hygiene students demonstrated positive changes from pre- to post-session survey data in in all four targeted IPEC sub-competencies. Statistical significance was noted in three of the four IPEC sub-competency rating statements. Themes from the reflection assignments indicated student learning in the areas of teamwork and communication. Dental hygiene faculty applied the information gained from the assessments as part of the IHI PDSA cycle for improvement in health care to evaluate and plan for future learning experiences.Conclusion: Meaningful intraprofessional education experiences between dental hygiene and dental students support collaborative practice skills and should be integrated into dental and dental hygiene curricula. Applying a continuous quality improvement model, such as the IHI PDSA, can assist educators in planning, implementing, and evaluating curricular changes in order to improve student learning outcomes.

Educational and Clinical Experiences in Administering Local Anesthesia: a study of dental and dental hygiene students in California

Purpose: The purpose of this study was to examine the differences in educational preparation and practical educational experiences between dental and dental hygiene students in the administration of local anesthesia (LA) and management of LA related complications in the state of California.Methods: Course instructors responsible for teaching LA or the program directors of the 6 dental schools and 29 dental hygiene programs in California (n=35) were invited to participate in this study. A computer-based descriptive survey, a comparative checklist of LA instruction requirements and semi-structured interviews were used for the data collection. Descriptive statistics were used to analyze results.Results: Eighteen LA course instructors or program directors participated in the study for a response rate of 51%. One respondent was from a dental school while 17 were from dental hygiene programs. The majority of the dental hygiene (n=16) respondents reported teaching 12 types of intraoral injections; the dental school respondent reported teaching seven injection types. Fewer student-to-student injection experiences per injection type were required by the dental school (n=7) than the dental hygiene schools (n=12) and the dental school did not indicate a minimum number of student-to-patient injection requirements for graduation. Analysis of a checklist of required elements of LA instruction and individual syllabi revealed common elements of all courses; students are expected to choose the proper local anesthetic, identify the proper injection type, and manage any LA complications. The majority of the interview participants perceived that dental hygiene students had more educational preparation in LA than their dental student cohorts and that dental hygienists were educationally prepared to administer LA safely without direct supervision.Conclusions: Dental hygiene students in California programs appear to be well prepared through their education experiences to administer and manage complications related to local anesthesia. Consideration should be given to supporting changing the supervision requirements for the administration of local anesthesia by dental hygienists licensed in the state of California.

Interprofessional Education in Dental Hygiene Programs and CODA Standards: Dental Hygiene Program Directors' Perspectives

Purpose: The Patient Protection and Affordable Care Act changed the paradigm of health care delivery by addressing interprofessional education (IPE) and care (IPC). These considerations, combined with evolving dental hygiene (DH) workforce models, challenge DH educators and clinicians alike to embrace IPE and IPC. The objectives of this study were to determine DH program directors' perceptions of the importance of IPE, to assess current and planned activities related to Commission on Dental Accreditation (CODA) standards that imply competency in IPE, and assessment of outcomes.Methods: Email addresses of the 322 entry-level, DH program directors in the United States were obtained from the American Dental Hygienists' Association and a web-based survey was developed based on the American Dental Education Association Team Study Group on Interprofessional Education. Descriptive statistics were computed for the responses to the closed ended questions and answers to open-ended questions were transcribed and thematically coded.Results: A response rate of 30% (N = 102) was obtained from the DH program directors. While the respondents indicated that they personally considered IPE to be important, one-third reported that IPE was not a priority for their academic institution. The majority of current IPE activities related to the 2014 CODA Standards 2-17, 2-26 and 2-19 were clinic-based (Standards 2-17 and 2-19: N=49; Standard 2-19: N=64). Fewer classroom-based activities were reported (N=12 vs. N=25). The respondents planned 27 clinic-based, 9 classroom-based and 51 other future IPE-related activities. Competency assessment was mostly determined with clinic-based activities (N=43) and other activities such as rubrics (N=16) and the development of IPE assessment tools (N=10). Thirty-three respondents named positive aspects of IPE and 13 saw IPE as relevant for the dental hygiene profession.Conclusion: Accountable accreditation standards have been identified as the driver of change for incorporating IPE, making an explicit IPE standard for dental hygiene education an important agenda item for the profession.

The Dental Hygiene Scholarly Identity and Roadblocks to Achieving It

Progress in the dental hygiene discipline is predicated on the development of a community of scholars with a dental hygiene scholarly identity who explore questions central to the art and science of dental hygiene and in doing so create conceptual models to expand the discipline's structural hierarchy of knowledge. Graduate dental hygiene education is challenged to develop programs that stimulate and nurture dental hygiene scholars as well as scientists. The need for the development of dental hygiene doctoral education is critical to strengthening our discipline's scholarly identity.The authors explore the tyranny of the "Queen-Bee" and the paralyzing nature of the "Imposter Syndrome," as pathologic non-productive behavior patterns that create roadblocks not only for the individual to move forward, but also for the discipline as a whole. Recognizing and eliminating these maladaptive syndromes will empower the individual as well as strengthen the collective to build a strong dental hygiene scholarly identity. The significance of dynamic "Follower-ship" as an often undervalued concept is offered as an antidote to overcome roadblocks and energize the collective's value of a scholarly identity for dental hygiene.

California Dental Hygiene Educators' Perceptions of an Application of the ADHA Advanced Dental Hygiene Practitioner (ADHP) Model in Medical Settings

PURPOSE

To assess California dental hygiene educators' perceptions of an application of the American Dental Hygienists' Association's (ADHA) advanced dental hygiene practitioner model (ADHP) in medical settings where the advanced dental hygiene practitioner collaborates in medical settings with other health professionals to meet clients' oral health needs.

METHODS

In 2014, 30 directors of California dental hygiene programs were contacted to participate in and distribute an online survey to their faculty. In order to capture non-respondents, 2 follow-up e-mails were sent. Descriptive analysis and cross-tabulations were analyzed using the online survey software program, Qualtrics™.

RESULTS

The educator response rate was 18% (70/387). Nearly 90% of respondents supported the proposed application of the ADHA ADHP model and believed it would increase access to care and reduce oral health disparities. They also agreed with most of the proposed services, target populations and workplace settings. Slightly over half believed a master's degree was the appropriate educational level needed.

CONCLUSION

Among California dental hygiene educators responding to this survey, there was strong support for the proposed application of the ADHA model in medical settings. More research is needed among a larger sample of dental hygiene educators and clinicians, as well as among other health professionals such as physicians, nurses and dentists.

Relationship of Musculoskeletal Disorder Pain to Patterns of Clinical Care in California Dental Hygienists

PURPOSE

To relate self-reported levels of musculoskeletal disorder (MSD) pain and patterns of clinical care among members of the California Dental Hygienists' Association (CDHA), using a web-based survey.

METHODS

The 24-item survey consisted of questions on patterns of clinical care, health habits, experience with MSD pain and demographic information. Recruitment information, including survey link and consent form, was emailed to the CDHA for distribution to its members. Descriptive analysis and cross tabulations were conducted using the online software program Qualtrics™. A Chi-square test determined statistical significant differences between the responses of the no/mild pain and moderate/severe pain groups.

RESULTS

The response rate was 19% (500/2,700). Ninety-six percent of all respondents reported some level of MSD pain, causing nearly 25% of the respondents to miss work. Respondents, who reported moderate/severe pain, treated more patients per day (p=0.007) and on average treated greater numbers of moderate to heavy calculus patients (p=0.017) than those respondents reporting no/mild pain. Forty percent of the respondents in the moderate/severe group treated more than 8 patients per day. A higher percentage of respondents (p=0.000) in the moderate/severe pain group than in the no/mild group reported using proper posture less than 50% of treatment time. Using proper posture more than 50% of treatment time was more frequent in respondents who had practiced more than (p=0.012), compared with less than, 5 years.

CONCLUSION

Workload and ergonomics are related to MSD pain. Educational programs need to emphasize the importance of these factors in the development and reduction of MSD pain.

The efficacy of screening for common dental diseases by hygiene-therapists: a diagnostic test accuracy study

Regularly attending adult patients are increasingly asymptomatic and not in need of treatment when attending for their routine dental examinations. As oral health improves further, using the general dental practitioner to undertake the "checkup" on regular "low-risk" patients represents a substantial and potentially unnecessary cost for state-funded systems. Given recent regulatory changes in the United Kingdom, it is now theoretically possible to delegate a range of tasks to hygiene-therapists. This has the potential to release the general dental practitioner's time and increase the capacity to care. The aim of this study is to compare the diagnostic test accuracy of hygiene-therapists when screening for dental caries and periodontal disease in regularly attending asymptomatic adults who attend for their checkup. A visual screen by hygiene-therapists acted as the index test, and the general dental practitioner acted as the reference standard. Consenting asymptomatic adult patients, who were regularly attending patients at 10 practices across the Northwest of England, entered the study. Both sets of clinicians made an assessment of dental caries and periodontal disease. The primary outcomes measured were the sensitivity and specificity values for dental caries and periodontal disease. In total, 1899 patients were screened. The summary point for sensitivity of dental care professionals when screening for caries and periodontal disease was 0.81 (95% CI, 0.74 to 0.87) and 0.89 (0.86 to 0.92), respectively. The summary point for specificity of dental care professionals when screening for caries and periodontal disease was 0.87 (0.78 to 0.92) and 0.75 (0.66 to 0.82), respectively. The results suggest that hygiene-therapists could be used to screen for dental caries and periodontal disease. This has important ramifications for service design in public-funded health systems.

Assuring dental hygiene clinical competence for licensure: a national survey of dental hygiene program directors

PURPOSE

To conduct a national survey of dental hygiene program directors to gain their opinions of alternative assessments of clinical competency, as qualifications for initial dental hygiene licensure.

METHODS

A 22 question survey, comprised of statements eliciting Likert-scale responses, was developed and distributed electronically to 341 U.S. dental hygiene program directors. Responses were tabulated and analyzed using University of California, San Francisco Qualtrics® computer software. Data were summarized as frequencies of responses to each item on the survey.

RESULTS

The response rate was 42% (n=143). The majority of respondents (65%) agreed that graduating from a Commission on Dental Accreditation (CODA)-approved dental hygiene program and passing the national board examination was the best measure to assure competence for initial licensure. The addition of "successfully completing all program's competency evaluations" to the above core qualifications yielded a similar percentage of agreement. Most (73%) agreed that "the variability of live patients as test subjects is a barrier to standardizing the state and regional examinations," while only 29% agreed that the "use of live patients as test subjects is essential to assure competence for initial licensure." The statement that the one-time state and regional examinations have "low validity in reflecting the complex responsibilities of the dental hygienist in practice" had a high (77%) level of agreement.

CONCLUSION

Most dental hygiene program directors agree that graduating from a CODA-approved dental hygiene program and passing the national board examination would ensure that a graduate has achieved clinical competence and readiness to provide comprehensive patient-centered care as a licensed dental hygienist.

Keeping current: a commitment to patient care excellence through evidence based practice

The desire to improve the oral health of clients begins with the hygienist's commitment to keeping current with useful scientific knowledge. The challenge is mastering the skills to discriminate between the many claims and what actually has been shown to be effective. One approach is through evidence-based decision-making (EBDM), which helps practitioners find relevant clinical evidence when it is needed for treatment decisions and for answering client questions. The purpose of this article is to discuss EBDM and its use in practice, potential challenges, future developments and resources that will assist in keeping current.

Developing a scholarly identity and building a community of scholars

Progress in the dental hygiene discipline is predicated on the development of a community of scholars who explore questions related to the art and science of dental hygiene and clients in need of oral health care. Graduate dental hygiene education is challenged to develop programs that stimulate and nurture dental hygiene scholars as well as scientists. The need for the development of doctoral dental hygiene education is discussed.

Advancing our profession: are higher educational standards the answer?

Educational models in health care professions have changed drastically since on-the-job training models. The purpose of this manuscript was to investigate how the professions of physical therapy, occupational therapy, physician assistant, nursing and respiratory therapy have advanced their educational models for entry into practice and to recommend how dental hygiene can integrate similar models to advance the profession. The recommendations are to create an accreditation council for dental hygiene education and to mandate articulation agreements for baccalaureate degree completion in developing and existing programs. Dental hygiene must continue on the path to advance our profession and glean lessons from other health professions.

Looking at the past to see the future: the role of the dental hygienist in collaborating with dentists to expand and improve oral health care

As dental hygiene approaches its 100th anniversary in 2013, it is clear that the profession has evolved far beyond the initial vision of Dr. Alfred Fones. Much of this evolution has been driven by changing oral health needs of the public as well as the way dentists practice, based on innovations in dentistry, to concentrate on more advanced procedures and delegate other duties to the dental hygienist. By and large, these changes have been achieved by dentists, dental hygienists, and other team members working together. We have an opportunity to overcome initial resistance and, based upon evidence of successful outcomes, further extend the reach of the dental team for the benefit of patients, especially the most vulnerable among them.

[Dissertations 25 years after date 30. Oral hygiene and dental hygienists]

In 1986 the thesis entitled 'Choosing for dental hygienists' was published in The Netherlands. It provided the scientific basis for the further development of the profession of dental hygienists in The Netherlands. Since then, the profession has developed very strongly. In the intervening years, qualified dental hygienists have come to be considered capable of taking over simple restorative treatments from dentists. As a result, treatment, especially in children, can largely be carried out by one person. Nevertheless, recent developments, such as the sharp increase in the number of new dental students, suggest that the re-allocation of responsibilities is proceeding slowly. This suggests that policy makers have not yet unambiguously opted for dental hygienists and prevention.

Development and status of the advanced dental hygiene practitioner

Advanced dental hygiene practitioners (ADHPs), members of the oral health care team, bring care to persons disenfranchised from adequate dental services. ADHPs are licensed and provide the traditional educational, preventive and therapeutic dental hygiene services, plus diagnostic, prescriptive and minimally invasive restorative services. ADHPs work in collaboration with all members of the dental team, referring patients in need of services outside of their scope directly to dentists or other health care providers.

Outcomes of dental hygiene baccalaureate degree education in Canada

There is little published literature about the outcomes of dental hygiene baccalaureate degree education, particularly in Canada. Since there are various dental hygiene entry-to-practice educational models in Canada, exploring baccalaureate dental hygiene education is becoming an increasingly important subject. The purpose of this study was to explore the personal outcomes and dental hygiene practice outcomes of dental hygiene degree-completion education in Canada from the perspectives of diploma dental hygienists who have continued their education to the bachelor's degree level. This study employed a qualitative phenomenological design, using a maximum variation purposeful sampling strategy. Data generation occurred with sixteen dental hygienists across Canada through individual semistructured interviews. Interviews were audiorecorded, transcribed verbatim, and coded for data analysis, involving pattern recognition and thematic development. Themes that emerged included changes in self-perception, values, and knowledge base. Changes in self-perception were reflected in a reported increase in self-confidence and perceived credibility. Changes in values included a greater appreciation for lifelong learning. Advancements in knowledge strengthened the development of specific abilities that ultimately influenced participants' dental hygiene practice. These abilities included an increased ability to think critically, to make evidence-based decisions, and to provide more comprehensive care. Participants also commented on having more career opportunities available to them outside of the private clinical practice setting. These results reveal important insights into the impact of earning a dental hygiene baccalaureate degree on oneself and one's dental hygiene practice.

Organisation and management of public dentistry in Sweden. Past, present and future

Professional organisations present challenges in management compared to producing companies, as control of the work lies within the professional groups themselves. Management in the Public Dental Health Service (PDHS) has an added difficulty in the two-tiered political governance in Swedish public dentistry. The aim of this thesis was to contribute to better understanding of the organisation and management of Human Service Organisations, especially the PDHS in Sweden, thereby contributing to long-term sustainability with due regard to the professionals. The aim was also to point to some future difficulties facing the PDHS and possible solutions to these. Four papers are included in the thesis. The first paper set out to define the professions in dentistry in Sweden from theories on professions. Dentists and, to a lesser degree; dental hygienists were the identified professional groups. The second paper scrutinised the external environment for dentistry in Sweden in the form of political decisions, i.e., laws and regulations. The findings were that there can be a gap between the formal objectives and the factual behaviour from the political level, and that certain politically attractive ideas might reoccur at a later time despite good scientific arguments against them. Also indicated in this paper were ways to influence the political processes, by active participation in the early stages of decision-making The third paper dealt with the heads (CDOs) of the PDHS in the counties and is based on a questionnaire to them on management. It was found that ideas on management and organisation usually were embedded in the way the respective county council was organised. A strong belief in advantages of scale was noted, both for administration and also for dental care itself. The fourth paper compared overall job satisfaction among publicly employed dentists in Denmark and Sweden. A focus on size of clinic, on professional development and on influence at the work place was found to be important. The Danish dentists were generally more satisfied with their overall job situations than the Swedish ones. One explanation might be found in the environment for the respective service, with a much stronger element of competition in Sweden. Another aspect could be that the expectations of the Danish dentists might be more realistic when they entered the public service. In an appendix the history of the Swedish Public Dental Health Service is outlined.

CONCLUSIONS

Dentists in Sweden are an established profession and dental hygienists are an emerging profession; they and society would benefit from a clearer delineation and definition of their unique competences. Political decision-making is not necessarily rational, and garbage can models or similar can give a better understanding of political processes. CDOs have a widespread belief in advantages of scale in administration as well as in care, which may pose future problems for the provision of dental care in sparsely populated areas. Overall job satisfaction, as part of Good Work, is founded in an atmosphere at the clinic that is focussed on professional values. It is noteworthy that PDHS dentists not born in Sweden had a lower job satisfaction than those born in Sweden. Perhaps a closer cooperation between the dental colleges and the PDHS might give the newly qualified dentists a more realistic view of the professional challenges in public dentistry, as well as giving the colleges access to the vast material on patients in the PDHS. The future division of tasks between the general dentists, dental hygienists and specialist care dentists has a great impact on the future need for personnel, and needs to be carefully analysed. The future diminishing numbers of dentists and the difficulty for the PDHS to retain dentists may be met by adapting the organisations to a much greater flexibility by allowing different teams to organise their own work. The possibilities to give the patients good service quality will depend on continued democratisation and less managerial control. Producer cooperatives, franchising, or similar, could be revisited and tried. However, such forms will require carefully designed contracts where the objectives and the outcomes are possible to define and to evaluate. The balance between good work for dentists, an efficient organisation and perceived good service to the public will be objects for further studies.

[Task redistribution in Dutch dental care in relation to dental hygienists' job satisfaction]

In research into a professional cross-section of dental hygienists, we studied the extent to which task redistribution has an influence on job satisfaction. The research among randomly chosen dental hygienists consisted of questions about organizational and personal characteristics, the set of assigned tasks, task characteristics and job satisfaction. The respondents were divided into 3 clusters which differed in the breadth of their sets of tasks. Although prevention and periodontology services remain the core tasks in dental hygienists' jobs, the degree of task redistribution differed strongly from cluster to cluster. Respondents with a considerable degree of task redistribution experienced the most task variation, but scored significantly lower on the task characteristics autonomy, feedback, task identity and task importance. This explains why redistribution does not directly correspond with a greater degree of job satisfaction. Moreover, it is precisely the dental hygienists with a broad set of tasks who are significantly less satisfied with their salary than those with a traditional set of tasks.

An analysis of student performance benchmarks in dental hygiene via distance education

PURPOSE

Three graduate programs, 35 undergraduate programs and 12 dental hygiene degree completion programs in the United States use varying forms of Distance Learning (DL). Relying heavily on DL leaves an unanswered question: Is learner performance on standard benchmark assessments impacted when using technology as a delivery system? A 10 year, longitudinal examination looked for student performance differences in a Distance Education (DE) dental hygiene program. The purpose of this research was to determine if there was a difference in performance between learners taught in a traditional classroom as compared to their counterparts taking classes through an alternative delivery system.

METHODS

A longitudinal, ex post facto design was used. Two hundred and sixty-six subject records were examined. Seventy-seven individuals (29%) were lost through attrition over 10 years. One hundred and eighty-nine records were used as the study sample, 117 individuals were located face-to-face and 72 were at a distance. Independent variables included time and location, while the dependent variables included course grades, grade point average (GPA) and the National Board of Dental Hygiene Examination (NBDHE). Three research questions were asked: Were there statistically significant differences in learner performance on the National Board of Dental Hygiene Examination (NBDHE)? Were there statistically significant differences in learner performance when considering GPAs? Did statistically significant differences in performance exist relating to individual course grades? T-tests were used for data analysis in answering the research questions.

RESULTS

From a cumulative perspective, no statistically significant differences were apparent for the NBDHE and GPAs or for individual courses.

CONCLUSIONS

Interactive Television (ITV), the synchronous DL system examined, was considered effective for delivering education to learners if similar performance outcomes were the evaluation criteria.

A survey of dental hygiene program directors: summary findings and conclusions

To assist the ADEA Council of Allied Dental Program Directors in focusing future goals and actions, an online survey was developed and administered to the directors of the 300 Commission on Dental Accreditation (CODA)-accredited U.S. dental hygiene programs in November 2008. The survey solicited directors' opinions about certain contemporary dental hygiene issues such as entry-level education, the use of articulation agreements, the advanced dental hygiene practitioner (ADHP) model proposed by the American Dental Hygienists' Association, and accreditation. Over three-quarters of survey respondents indicated it is "important" or "somewhat important" to advance the entry-level educational requirements for dental hygiene practice to the baccalaureate level. Educational setting (four-year versus two-year) was a significant determinant in whether a respondent thought a baccalaureate degree should result from a dental hygiene educational program. Fifty-six percent of respondents' programs either have or are in the process of developing articulation agreements with other institutions. Seventy percent of all respondents felt it was important to support advancing the ADHP model. Over 60 percent of respondents noted the importance of developing competencies for degree completion and graduate programs, and 42 percent of respondents indicated that it was important to have a separate accreditation process for graduate-level programs. Conclusions suggest advancing entry-level education for dental hygiene is desired if it can maintain a role for both four-year and two-year institutions.

Knowledge and attitude towards risk factors in oral cancer held by dental hygienists in the Autonomous Community of Murcia (Spain): A pilot study

The objective was to study the knowledge and attitude on risk factors in oral cancer held by dental hygienists working in private dental practices in the Autonomous Community of Murcia, Spain. An anonymous phone survey was made after obtaining consent from the interviewee. A simple randomized study was carried out and 240 dental hygienists were selected. The questionnaire was divided into three different parts: (1) professional data and years of practice; (2) knowledge of the risk factors in oral cancer and (3) education and training needs on oral cancer. The response rate was 58.3%. Regarding knowledge of the risk factors in oral cancer, 100% correctly identified tobacco and 90% alcohol, while only 50.7% identified sun exposure with labial cancer. Only 51.4% of the dental hygienists routinely gave advice to their patients on prevention of oral cancer. Furthermore, 57.1% did not consider themselves sufficiently well trained to discover suspected oral cancer lesions, and 84.3% recognized that their academic training on the early diagnosis and prevention of oral cancer was insufficient for their professional activity. To reduce morbidity and mortality of oral cancer it is necessary to implement training programs on oral cancer for dental hygienists, so they may acquire the necessary skills for its detection and prevention.

An argument for dental hygiene to develop as a discipline

The practice of dental hygiene was developed to provide oral health education and preventive oral health care, originally for children. It has grown to provide oral health services valued by a broad spectrum of society, but has not attained the desired respect and status accorded to other professional groups.

OBJECTIVE

Professional disciplines link actions of practitioners with the science that is the foundation of practice. The purpose of this paper is to examine whether dental hygiene practice could benefit from pursuit of development as a discipline.

METHODS

Literature on professionalization and disciplines, related to dental hygiene in general and the North American context specifically, was retrieved from databases and grey sources, such as organizational reports. Dental hygiene's current characteristics relative to a discipline were examined.

RESULTS

Dental hygiene has developed some characteristics of a discipline, such as identifying a metaparadigm that includes concepts of the client, the environment, health/oral health and dental hygiene actions, with a perspective that includes a focus on disease prevention and oral health promotion. However, research production by dental hygienists has been limited, and often not situated within theoretical or conceptual frameworks.

CONCLUSION

Dental hygiene draws its knowledge for practice from a variety of sources. Dental hygiene could strengthen its value to society by prioritizing development of highly skilled researchers to study interventions leading to improved oral outcomes, and transferring that knowledge to practitioners, strengthening links between practice and science. Intentional pursuit of knowledge for practice would lead to dental hygiene's eventual emergence as a professional discipline.

Cost effectiveness of changing health professionals' behavior: training dental hygienists in brief interventions for smokeless tobacco cessation

OBJECTIVE

Disseminating effective interventions to health care professionals is a critical step in ensuring that patients receive needed advice and materials. This cost effectiveness analysis compared two methods of disseminating an effective protocol for smokeless tobacco cessation intervention.

METHOD

Interested dental hygienists (N = 1051) were recruited in 20 Western and Midwestern U.S. communities and randomized by community to receive workshop training, self-study with mailed materials, and delayed self-study training, in 1996-98. Hygienists were surveyed about their smokeless tobacco-related activities with patients at baseline and post-intervention. Data on intervention costs were collected, and incremental costs per unit of behavior change were calculated.

RESULTS

Self-study was more cost effective than workshop training under a wide range of assumptions: change in group versus individual behavior, hygienists' time and travel costs included or excluded, and hygienist wage rates at the national median or substantially lower. However, workshops may be as cost effective in producing behavior change among hygienists earning wages substantially higher than the national median.

CONCLUSION

Self-study may be a more cost effective method than workshops to achieve behavior change among motivated health professionals.

The impact of quality assurance programming: a comparison of two canadian dental hygienist programs

Quality assurance (QA) and continuing competence (CC) programs aim to ensure acceptable levels of health care provider competence, but it is unknown which program methods most successfully achieve this goal. The objectives of the study reported in this article were to compare two distinct QA/CC programs of Canadian dental hygienists and assess the impact of these two programs on practice behavior change, a proxy measure for quality. British Columbia (BC) and Ontario (ON) were compared because the former mandates continuing education (CE) time requirements. A two-group comparison survey design using a self-administered questionnaire was implemented in randomly selected samples from two jurisdictions. No statistical differences were found in total activity, change opportunities, or change implementation, but ON study subjects participated in significantly more activities that yielded change opportunities and more activities that generated appropriate change implementation, meaning positive and correct approaches to providing care, than BC dental hygienists. Both groups reported implementing change to a similarly high degree. The findings suggest that ON dental hygienists participated in more learning activities that had relevancy to their practice and learning needs than did BC subjects. The findings indicate that the QA program in ON may allow for greater efficiency in professional learning.

[Direct access to the dental hygienist 2. Opinions of dental hygienists and dentists]

In this paper the opinions from dental hygienists and dentists are described concerning the question whether patients could visit the dental hygienist without being seen by a dentist first (access without referral). Eight of ten dental hygienists have a positive attitude towards the idea of access without referral. Dentists were much more sceptical about this idea. There are different opinions about which treatment, what kind of patients, which age groups etcetera a dental hygienist could treat without referral from the dentist. When access without referral becomes relevant, pilot studies are advised before implementing the concept of access to the dental hygienist without referral from the dentist.

Quality assurance and dental hygiene

Dental hygiene in Canada has experienced significant growth. It has shifted from an emerging occupation to a regulated health profession in several jurisdictions. Many achievements may be attributed to this growth, including self-regulation and a national code of ethics. However, the majority of Canadian dental hygienists are relying on traditional, outdated and ineffective quality assurance mechanisms, such as mandatory continuing education requirements. In the interests of public protection, dental hygiene needs to ensure that the quality assurance activities required from its members are effective, valid and reliable. Quality assurance in health care continues to undergo modifications that better reflect the public's need for competent, ethical, safe and appropriate health care. Dental hygienists and dental hygiene regulatory bodies are challenged to find valid, reliable and effective methods of quality assurance. This paper discusses some of the developments in quality assurance in health care as well as some of the key and significant achievements of dental hygiene in Canada. The use of quality assurance mechanisms currently used in dental hygiene in Canada is also discussed. The paper concludes with a discussion on the potential barriers and issues that the profession may face when attempting to incorporate suitable quality assurance activities into daily dental hygiene practice.

Quality assurance in health care: past, present and future

Quality of health care delivery is a growing concern globally given current budget restraints and increasing demands on health care providers. The variety of quality assurance and quality management activities equals the numerous ways health care practitioners of all genres provide health care. Dental hygienists around the world must be knowledgeable about quality assurance and management in health care as it is a significant factor in the evolution of the dental hygiene profession and the quality of oral health care provided by dental hygienists. The objective of this research was to conduct a literature review on quality assurance and quality management. A MEDLINE search from 1966 to 2002 was conducted. The search resulted in approximately 145 articles. Additional references from works generated by the search were also obtained. The literature revealed information on the background and history of quality assurance and quality management. Much of the literature was devoted to discussions of the validity, reliability and effectiveness of most prominent quality management activities being utilised in health care today. The investigation revealed numerous issues and barriers surrounding quality management. This article concludes with suggestions for future directions of quality assurance and quality management.

Evidence-based practice and the professionalization of dental hygiene

The application of knowledge is fundamental to human problem solving. In health disciplines, knowledge utilization commonly manifests through evidence-based decision making in practice. The purpose of this paper is to explore the development of the evidence-based practice (EBP) movement in health professions in general, and dental hygiene in particular, and to examine its relationship to the professionalization agenda of dental hygiene in Canada. EBP means integrating practitioner expertise with the best available external evidence from research. Proponents of EBP believe that it holds promise for reducing a research-practice gap by encouraging clinicians to seek current research results. Both the Canadian and American Dental Hygienists Associations support practice based on current research evidence, yet recent studies show variation in practice. Professionalization refers to the developmental stages through which an organized occupation passes as it develops traits that characterize it as a profession. The status conferred by professionalization privileges a group to make and monitor its own decisions relative to practice. Dental hygiene's success in acquiring attributes of a profession suggests that transformation to a profession is occurring. This paper compares the assumptions and challenges of both movements, and argues the need for a principal focus on the development of a culture of evidence-based dental hygiene practice.

Dental hygienists and oral cancer prevention: knowledge, attitudes and behaviors in Italy

This study explored knowledge of risk factors and diagnostic procedures for oral cancer, attitudes and behavior among dental hygienists in Italy. A random sample of 500 dental hygienists received by mail a questionnaire focusing on demographics and practice characteristics, knowledge, attitudes and behaviors regarding oral cancer assessment practices. Almost all dental hygienists correctly indicated tobacco usage and having a prior oral cancer lesion as risk factors. Although 88.8% knew that the tongue is one of the two most common sites of oral cancer, only 13.5% identified the floor of the mouth. Less than half (42.8%) recognized that an early oral lesion usually is a small, painless and red area and only 4.2% knew the examination procedures of the tongue. Results of the multiple logistic regression showed that those dental hygienists who worked a higher number of hours and treated a lower number of patients in a week were more likely to indicate tobacco and alcohol use as risk factors for oral cancer. Higher number of years in practice, scientific journals and associations as sources of information about oral cancer, and knowledge that ventral lateral border of tongue is the most common site for oral cancer, significantly predicted compliance with oral cancer examination. Dental hygienists' sex, age, and years in practice were associated with a positive attitude towards oral cancer prevention. Further educational interventions in order to early detect and prevent oral cancer are strongly needed.

Inter-professional conflict and professionalization: dentistry and dental hygiene in Ontario

In Ontario, Canada, an inter-professional struggle is occurring between the professions of dentistry and dental hygiene over who should be the primary oral health care provider for the public; that is, when someone seeks dental treatment, who should they see first? This conflict has been spurred by recent changes in the regulation of health care professions, changing markets for professional services, and the professional projects pursued by dental hygiene and dentistry. An examination of the history and dimensions of dentistry-dental hygiene relations, reveals the extent to which professionalization both provokes and is shaped by inter-professional conflict.

Effect of grade point average and enrollment in a dental hygiene National Board review course on student performance on the National Board Examination

Passing the National Board Dental Hygiene Examination is a requirement for licensure in all but one state. There are a number of preparation courses for the examination sponsored by corporations and dental hygiene programs. The purpose of this study was to determine if taking a board review course significantly affected student performance on the board examination. Students from the last six dental hygiene classes at Baylor College of Dentistry (n = 168) were divided into two groups depending on whether they took a particular review course. Mean entering college grade point averages (GPA), exiting dental hygiene program GPAs, and National Board scores were compared for the two groups using a t-test for independent samples (p < 0.05). No significant differences were found between the two groups for entering GPA and National Board scores. Exiting GPAs, however, were slightly higher for those not taking the course compared to those taking the course. In addition, a strong correlation (0.71, Pearson Correlation) was found between exiting GPA and National Board score. Exiting GPA was found to be a strong predictor of National Board performance. These results do not appear to support this program's participation in an external preparation course as a means of increasing students' performance on the National Board Dental Hygiene Examination.

Noncognitive predictors of academic performance. Going beyond the traditional measures

The purpose of this study was to examine comparatively the use of an atypical, noncognitive predictor of academic achievement, the Problem Solving Inventory (PSI), with the traditional cognitive measures of American College Testing (ACT) score and grade point average (CPA). A review of relevant literature on noncognitive variables as predictors of academic success is provided, followed by a general overview of the PSI and pertinent literature. In this study, the PSI was administered to 28 dental hygiene students, and a series of models were tested. The first model examined the relationship between the traditional cognitive predictors of academic success (ACT score and entering GPA) on academic outcomes (National Board Dental Hygiene Examination score and exit CPA). A second model examined the influence of the PSI composite score when added to the cognitive predictors. A third model examined the addition of the three PSI factor scores to the cognitive predictors. The addition of PSI scores in the second and third models increased the predictive capacity of the respective model. Bivariate correlations indicated a significant inverse relationship (p < 0.05) between the admissions variables of ACT score and entering OPA with PSI composite and factor scores. The PSI personal control factor score showed a significant (p < 0.05) inverse relationship with the outcome measures. Preliminary findings indicate that the PSI adds slightly to the predictive capacity of ACT score and entering GPA, although its usefulness in augmenting these traditional measures used in the student selection process requires further investigation. The PSI factor score of personal control may provide insight into a student's coping skills, potentially having implications on academic achievement.

[Oral hygienist with extended competencies]

The multidisciplinary team approach could be the answer to increase the available manpower in oral care in the Netherlands. After additional education the dental hygienist within the dental team could provide more extensive preventive care including restorative dental treatment. Implications for the future role, the future education and for the number of dental hygienists required are presented.

Utilization of local anesthesia by Arkansas dental hygienists, and dentists' delegation/satisfaction relative to this function

PURPOSE

Given the legalization of administration of local anesthesia as an expanded function for dental hygienists in Arkansas, the purpose of this study was to 1) describe the utilization of local anesthesia in dental hygiene care; 2) compare the utilization of local anesthesia by dental hygienists certified in the administration of local anesthesia and those who were not; 3) determine if there was a difference in attitude toward the use of local anesthesia for dental hygiene procedures between dental hygienists certified in the expanded function versus those not certified; 4) determine if and to what degree employers delegate this procedure to certified employees; and 5) compare employer satisfaction with this expanded function for those who employed a certified dental hygienist and those who did not.

METHODS

Surveys were sent to all Arkansas dental hygienists certified, as of June 1998, to administer local anesthesia as well as an equal random sample of Arkansas dental hygienists not certified in the expanded function. The dentist employers of these dental hygienists also were asked to complete a companion survey. These surveys included demographic items as well as questions about the demand for and utilization of local anesthesia by dental hygienists. Additionally, the surveys included an opinionnaire section concerning attitudes toward and perceptions of the administration of local anesthesia by dental hygienists.

RESULTS

An overall response rate of 31% (n = 182) was achieved for the survey of the dental hygienist sample (n = 580). Forty-one percent of the surveys (n = 118) were returned by the dental hygienists certified in the administration of local anesthesia, while 22% (n = 64) of the surveys were returned by those not certified in the function. An approximate response rate of 25% (n = 146) was achieved for the surveys of the dentist employers. Findings indicate that the respondents perceived local anesthesia as beneficial for both dental hygiene patients and clinicians. Arkansas dental hygienists and dentists reported that this function had a positive impact on scheduling, production, patient satisfaction and comfort, and quality of care. Furthermore, more than nine out of 10 of the dentist respondents were satisfied with their dental hygienists local anesthesia skills and/or would encourage their uncertified dental hygienists to become certified. Dental hygienists certified in the function reported utilizing this technique moderately to fully for patient care, particularly for those in practices with greater numbers of periodontally involved patients. Certified dental hygienists also viewed local anesthesia as contributing to the quality of patient care and necessary for dental hygiene procedures.

CONCLUSIONS

Results of this study provide evidence that local anesthesia benefits dental hygiene patients and clinicians. Both Arkansas dental hygienists and dentists viewed this expanded function as necessary for provision of quality dental hygiene care. The dentist employers of certified dental hygienists reported that the function had a positive impact on scheduling, production, patient satisfaction and comfort, and quality of care.

Dental public health for the 21st century: implications for specialty education and practice

A panel of public health practitioners sponsored by the Health Resources and Services Administration met December 6-8, 1994, to examine current roles and responsibilities for dental public health workers and to recommend changes in education and training to meet challenges posed by an evolving health care system. Overall, at least the same number, if not more, dental public health personnel will be needed in the future. While some new roles were identified, the panel felt that only small numbers of personnel will be needed to fill these new roles. Not all of these roles necessarily require a dental degree. The panel felt that a need exists for more academicians for dental schools, schools of public health, dental public health residencies, and dental hygiene programs; oral epidemiologists and health services researchers; health educators; and specialists in utilization review/outcomes assessment, dental informatics, nutrition, program evaluation, and prevention. To meet these personnel needs: (1) dental public health residency programs should be structured to meet the educational needs of working public health dentists with MPH degrees through on-the-job residency programs; (2) the standards for advanced specialty education programs in dental public health should be made sufficiently flexible to include dentists who have advanced education and the requisite core public health courses; (3) flexible MPH degree programs must be available because of the rising debt of dental students and the decreased numbers of graduating dentists; (4) loan repayment should be available for dentists who have pursued public health training and are working in state or local health departments; and (5) standards for advanced education in dental public health should be developed for dental hygienists.

U.S. dental hygienists' knowledge and opinions related to providing oral cancer examinations

BACKGROUND

Because U.S. dental hygienists play a significant role in providing prevention and early-detection services, it is important to describe and evaluate their oral cancer knowledge and opinions.

METHODS

A pretested survey, cover letter, and prepaid return envelope were mailed to 960 dental hygienists, followed by three complete follow-up mailings.

RESULTS

The respondents were not as knowledgeable about oral cancer risk factors and diagnostic procedures as hypothesized. Although the respondents were well informed about certain key aspects of oral cancer risk factors and diagnostic procedures, there were many aspects of these topics in which they were deficient and in some cases misinformed.

CONCLUSIONS

Dental hygiene curricula should be updated and continuing education coursesabout oral cancer should be developed and implemented.

A survey of hygienists qualifying from the Liverpool School of Dental Hygiene 1977-1998

OBJECTIVES

To analyse the working patterns of all those who qualified from the Liverpool School of Dental Hygiene over a 20-year period. To assess the proportion who give up practice, the degree of part-time work, career breaks, job satisfaction, availability of continuing professional education etc.

METHOD

A questionnaire sent to all 226 hygienists who qualified from the School between 1997 and 1998, whether still enrolled as dental hygienists or not.

RESULTS

Responses were received from 83% of whom 89% were still working as hygienists, the majority in general practice. 46% had taken an employment break, mostly for maternity reasons but a significant number for other reasons. Around 80% expressed good job satisfaction. Although there is a high level of part-time work, especially after career breaks, few had experienced difficulty in finding employment. One third of respondents considered that the availability of continuing professional education was 'poor' or 'very poor'.

CONCLUSIONS

The great majority of hygienists enjoy good job satisfaction and work in more than one general dental practice. Comparisons suggest that they continue to work in their chosen career at least as much as female dentists do in theirs. The reasons for this are thought to be that hygienists tend to be recruited from the ranks of highly motivated, mature dental nurses and that the profession lends itself to part-time work which can be combined with family commitments. There are perceived deficiencies in the availability of continuing professional education, which may be remedied by the development of distance learning packages and Section 63 type courses designed specifically for them.

Outcomes assessment in dental hygiene programs

In 1996, the American Dental Association's Commission on Dental Accreditation instituted a revised accreditation standard for dental hygiene educational programs entitled Standard 12-Outcomes Assessment. As a result of this standard, all dental hygiene programs were required to assess the attainment of goals through a formal outcomes assessment process. This study examined and analyzed the implementation process used by dental hygiene programs. Twenty-two dental hygiene program directors were interviewed to collect information regarding their experiences. The directors indicated that their programs routinely and effectively assess student outcomes and use the acquired information to make needed program improvements and to demonstrate accountability to groups having a vested interest in the program. Several factors, such as the policy itself, as well as gaining faculty and administrative support, were viewed as important to implementation. Time constraints were identified as a major barrier. Outcomes assessment data have also been used by dental hygiene programs as leverage for funding requests that resulted in significant program enhancement.