Are adults with autism receiving regular preventive dental services?

PURPOSE/AIM: To investigate the frequency of preventive dental care among adults with autism and explore factors associated with receiving regular preventive care. MATERIALS AND METHODS: De-identified data was collected from electronic health records of 18-year-old or older patients with autism that had at least one preventive dental procedure recorded. The data was then analyzed to describe the frequency of preventive dental procedures provided for this population and investigate what variables are associated with regular care. RESULTS: Sample size was 119, 67% were males, average age was 30.8 years, and 58% had Medicaid. Average BMI was 42.8, the prevalence of diabetes and heart disease were 16% and 34%, respectively, and 86% reported mental health problems. Recreational drug use was 6.8%, alcohol use was 19%, and tobacco use 16%. Xerostomia was reported by 32%, and the average number of medications was 7.2 ± 5.5. The average number of preventive dental visits was 7.9 ± 10.6, and 35% of the patients had at least one preventive dental visit per year. Only number of medications had a statistically significant association with number of preventive dental visits. CONCLUSIONS: Only one in every three adults with autism had at least one preventive dental visit per year.

Scholarly Inquiry and Research: An assessment of graduate dental hygiene schools' requirements.

Purpose: Scholarly inquiry and research are core competencies for graduate dental hygiene education as defined by American Dental Education Association (ADEA). The purpose of this study was to examine how graduate dental hygiene programs in the United States (US) are meeting these competencies.Methods: The study sample consisted of the graduate programs in the US that award a terminal degree specific to dental hygiene (n=14). Graduate program directors were invited via email to participate in an electronic survey. The survey questions were developed based on the ADEA graduate dental hygiene education competency for scholarly inquiry and research. Descriptive statistics including frequencies and percentages were used to analyze the data. Exploration of relationships between variables were conducted using correlational analyses and t-tests.Results: A response rate of 71% was achieved (n=10). There was a significant difference in the minimum number of scholarly activity requirements between programs with lower student enrollments (M=4.43, SD=1.61) versus those with higher enrollments (M=2.00, SD=0; t(8)=2.51, p=.036). A negative correlation was found between the submission of a manuscript to a peer reviewed journal and the number of students accepted per year in the graduate program (r (10)= -.655, p <.05), indicating that students graduating from programs with larger enrollments were less likely to submit their scholarly work for publication.Conclusions: All program directors reported requiring students to participate in at least one scholarly activity as defined in the ADEA Core Competencies for Graduate Dental Hygiene Education. Program size was the biggest variable in relationship to the number of scholarly requirements. Schools with smaller enrollments required their students to participate in over twice the number of scholarly activities as compared to programs with larger enrollments. More research is needed to evaluate how graduate level dental hygiene programs are meeting the ADEA competencies.

Comparison of tactile discrimination associated with varying weights of explorers.

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

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.

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.

Providing advanced degrees in dental hygiene via computer mediated distance learning: a model program.

A chief concern regarding distance education for the health professions is quality of the experience. Distance education has the potential for expanding student access, providing individualized instruction, and promoting active learning among geographically separated members of learning groups. Students and professors who have participated in distance learning platforms have expressed concerns about technical problems, inability to interact in real time with each other, and other frustrations related to this type of delivery. The Dental Hygiene program at the University of Missouri-Kansas City (UMKC) has addressed these issues and enhanced an already successful program by putting the professor, a technologist, and the student in the same space, at the same time, in real time. This enhancement has substantiated the ability of distance education to provide instruction among geographically separated members of learning groups, making it a plausible solution to the shortage of educators in healthcare professions.

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.

Predictive validity of dental hygiene competency assessment measures on one-shot clinical licensure examinations.

The purpose of this study was to examine the predictive validity of traditional and nontraditional dental hygiene competency assessment measures on one-shot clinical licensure examinations in a baccalaureate dental hygiene program. Traditional assessment data including overall grade point average (GPA), Clinical GPA, National Board Dental Hygiene Examination (NBDHE) scores, and Central Regional Dental Testing Service (CRDTS) scores along with nontraditional assessment data in the form of Portfolio scores were collected from seventy-four students. Factor analysis and subsequent linear regression modeling were used to explore the ability of four variables (Overall GPA, NBDHE, Portfolios, and Clinical GPA) to predict one-shot clinical licensure examination (CRDTS) scores. A two-factor solution was obtained with one factor defined as dental hygiene cognition and the second factor defined as dental hygiene clinical performance. Factor scores were subsequently used in a linear predictive model to assess the shared and unique contribution of factors to the one-shot clinical licensure examination score. The shared contribution of both factors only accounted for 13.9 percent of variance in the outcome measure of one-shot clinical licensure examination scores. The lack of concordance between previously validated measures of dental hygiene student competency or predictors of student success (Overall GPA, NBDHE, and Portfolios) and a one-shot clinical licensure examination (CRDTS) raises serious concern about the validity of our current dental hygiene licensing procedure which uses the CRDTS clinical examination to make decisions about granting licenses to practice.

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.

Factors influencing patients seeking oral health care in the oncology dental support clinic at an urban university dental school setting.

The purpose of this study was to identify predictors and/or factors associated with medically compromised patients seeking dental care in the oncology dental support clinic (ODSC) at the University of Missouri-Kansas City (UMKC) School of Dentistry. An 18-item survey was mailed to 2,541 patients who were new patients to the clinic from 2006 to 2011. The response rate was approximately 18% (n = 450). Analyses included descriptive statistics of percentages/frequencies as well as predictors based on correlations. Fifty percent of participants, 100 females and 119 males, identified their primary medical diagnosis as cancer. Total household income (p < .001) and the importance of receiving dental care (p < .001) were significant factors in relation to self-rated dental health. Perceived overall health (p < .001) also had a significant association with cancer status and the need for organ transplants. This study provided the ODSC at UMKC and other specialty clinics with vital information that can contribute to future planning efforts.

Factors associated with clinical skill remediation in dental hygiene education programs.

PURPOSE: The purpose of this study was to examine the challenges related to formal clinical remediation in dental hygiene programs, which include timing of student identification, policy development, and the issues of methodology and scheduling. METHODS: A 23 item investigator-designed survey was electronically distributed to all 303 U.S. entry-level dental hygiene program directors. This questionnaire included 23 forced-choice questions with the options to add comments to 8 of the questions. A total of 111 surveys were returned yielding a response rate of 36%. Descriptive statistics and Chi-square analyses were utilized to analyze relationships between responses and the degree earned from the dental hygiene program. RESULTS: All schools reported having a remediation policy; however, 13.6% of the respondents revealed this information was not readily available to students. The majority of respondents (67.8%) reported identifying students with clinical deficiencies in the preclinical semester, and 15.5% identified students in the second year, second clinical semester. Instrumentation technique was identified as the area in greatest need of remediation (81%), followed by critical thinking and problem solving skills (12%). Coordination of faculty and student schedules to conduct remediation was identified as one of the greatest challenges by respondents (25.2%). Results of this study suggest that challenges exist with the process of remediation. Some of these challenges include involving the student in remedial plan development, the academic consequences associated with remediation and scheduling time and space for remedial activities. CONCLUSION: These findings indicate that respondents are well aware of the need for remediation policies in dental hygiene programs. The point in time varies when students in need of remediation are identified. Therefore, further research needs to be conducted to determine the reasons for this difference. Some reasons may include inability to grasp the foundational skills and/or the complexity of advanced instrumentation in the second year. Also, it is suggested that investigation regarding methods used to address the challenge of faculty and student scheduling for remediation sessions would be useful.

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

PURPOSE: Frail elders and nursing home residents are vulnerable to poor oral health and frequently lack access to dental care. The purpose of this study was to determine why residents in Arkansas skilled nursing facilities have limited access to oral health care. METHODS: This study utilized qualitative research methodology. Data was collected from oral health care personnel through open-ended responses in a written survey (n=23) and through telephone interviews (n=21). The investigators applied the constant comparative method to analyze and unitize the data and ultimately reach consensus. RESULTS: Data analysis resulted in consensus on 2 emergent themes: policy and access. CONCLUSION: This qualitative case study suggests access to oral health care for residents living in both long-term care (LTC) and assisted living I and II facilities in Arkansas is affected by public and facility policies and access to oral health care as a function of the patient's health status and availability of oral health care providers. Access for residents residing in assisted living I and II facilities is also limited by the residents' inability to assume responsibility for accessing oral health care. The outcomes from this study may serve to inform policymakers and advocates for access to oral health care as they develop new policies to address this growing need.

Perceptions of Kansas Extended Care Permit dental hygienists' impact on dental care.

PURPOSE: In 2003, Kansas addressed their access to oral health care needs with amended state dental practice act for registered dental hygienists. The Extended Care Permits (ECP) I, II and III have expanded the dental hygiene scope of practice, allowing dental hygienists to provide oral care to Kansans in different settings beyond the dental office. The purpoase of this study was to examine the perceptions of Kansas ECP dental hygienists on change to oral care in Kansas. METHODS: A questionnaire was mailed to all ECP dental hygienists (n=158) registered with the Kansas Dental Board. Questions were open-ended, close-ended and Likert scale. Information was sought regarding demographics, areas of employment, work related activities and impact to oral health care. Study exclusions included ECP providers no longer practicing in Kansas, practice more than 50% in another state or no longer practice dental hygiene at all. RESULTS: A total of 69 surveys were returned, with 9 surveys excluded for exclusion criteria. Most respondents (92%) agreed the ECP is a solution to oral health care access issues in Kansas. Barriers to utilizing their permits fully included: difficulty locating a sponsoring dentist (12%), locating start up finances (22%), limited work space (14%) and difficulty with facility administrators (39%). Many respondents (62%) agreed the proposed registered dental practitioner would improve access to oral health care to Kansans. CONCLUSION: The Extended Care Permit providers in Kansas appear to be satisfied with their current employment situations and feel oral health care has improved for their patients served but they are unable to utilize their permits fully for various reasons.

A qualitative study of extended care permit dental hygienists in Kansas.

PURPOSE: Currently, 37 states allow some type of alternative practice settings for dental hygienists. This qualitative study was designed to explore the experiences of the Extended Care Permit (ECP) dental hygienist in the state of Kansas. As a first ever study of this workforce model, a qualitative research design was chosen to illuminate the education and experiences of extended dental hygiene practitioners in order to understand the impact ECP legislation has had on increasing the public's access to oral health care services and define the advantages and limitation of this model as one potential solution to access to oral care. Snowball sampling was used to identify study participants who were actively engaged in extended care practice. Nine subjects, which included one ECP consultant and eight ECP providers, participated in this study. Data obtained via personal interviews and through document analysis data were subsequently coded and thematically analyzed by three examiners. An independent audit was conducted by a fourth examiner to confirm dependability of results. Seven major categories emerged from the data analysis: entrepreneur dental hygienist, partnerships, funding, barriers, sustainability, models of care and the impact of the ECP. The findings of this study revealed that ECP hygienists are making an impact with underserved populations, primarily children, the elderly and special needs patients.

The attitudes of Ohio dentists and dental hygienists regarding the use of automated external defibrillators in the dental setting--a follow-up study.

PURPOSE: In 2004, the attitudes toward and use of automated external defibrillators (AEDs) by Ohio dental professionals were examined. While willing to use an AED, most did not have access to one. With new AED-related legislation and increased awareness of the benefits of AEDs since the initial study in 2004, the purpose of this study was to document the prevalence of and attitudes toward AED usage in the dental setting 7 years following the initial study. METHODS: A 2 page survey instrument was mailed to a random sample of 1,629 dentists and 1,801 dental hygienists in Ohio. RESULTS: A 24% overall response rate was achieved (36% dentists and 64% hygienists). Data were analyzed using SPSS. Results indicate 16% of respondents experienced a cardiac emergency in their practice that required contacting emergency personnel. AEDs are available in 48% of dental practices. Comparing the 2004 and 2011 data, statistically significant differences were found between the responses of dentists and dental hygienists. CONCLUSION: While hygienists reported more positive attitudes toward AEDs than dentists, the majority of all respondents feel AEDs should be mandated in the dental setting. These findings suggest an increase in cardiac emergencies in Ohio dental settings, an increase in the prevalence of AEDs in Ohio dental settings and that the perceptions of dental professionals are changing in favor of the use of AEDs in the dental setting since the 2004 study.

Effects of dental magnification lenses on indirect vision: a pilot study.

PURPOSE: The purpose of this pilot study was to evaluate the effect of magnification lenses on the indirect vision skills of dental hygiene students. METHODS: This pilot study examined the accuracy and efficiency of dental hygiene students' indirect vision skills while using traditional safety lenses and magnification lenses. The sample was comprised of 14 students in their final semester of a dental hygiene program. A crossover study approach was utilized, with each participant randomly assigned to a specific order of eyewear. The study included evaluation of each participant taking part in 2 separate clinical sessions. During the first session, each participant completed a clinical exercise on a dental manikin marked with 15 dots throughout the oral cavity while wearing the randomly as signed eyewear, and then completed a similar exercise on a differently marked dental manikin while wearing the randomly assigned eyewear. This procedure was repeated at a second clinical session, however, the dental manikin and eyewear pairings were reversed. Accuracy was measured on the number of correctly identified dots and efficiency was measured by the time it took to identify the dots. Perceptions of the participants' use of magnification lenses and the participants' opinion of the use of magnification lenses in a dental hygiene curriculum were evaluated using a questionnaire. RESULTS: Comparing the mean of the efficiency scores, students are more efficient at identifying indirect vision points with the use of magnification lenses (3 minutes, 36 seconds) than with traditional safety lenses (3 minutes, 56 seconds). Comparing the measurement of accuracy, students are more accurate at identifying indirect vision points with traditional safety lenses (84%) as com pared to magnification lenses (79%). Overall, the students report ed an increased quality of dental hygiene treatment provided in the clinical setting and an improved clinical posture while treating patients with the use of magnification lenses. CONCLUSION: This study did not produce statistically significant data to support the use of magnification lenses to enhance indirect vision skills among dental hygiene students, however, students perceived that their indirect vision skills were enhanced by the use of magnification lenses.

Comparing the risk identification and management behaviors between oral health providers for patients with diabetes.

PURPOSE: Evidence supporting the link between periodontal disease and systemic disease continues to grow. To date, little is known about how dental professionals incorporate this information into managing diabetic patients. This study examines the risk identification and practice behaviors regarding diabetic patients among dentists, hygienists and specialists. METHODS: Responses were received from 383 currently practicing oral health professionals in Arkansas. The electronic survey consisted of 35 open and closed-ended or Likert-type items. Principal components factor analysis using varimax rotation was used to explore underlying dimensions of the questionnaire in order to provide a more parsimonious view of the outcomes. Logistic models were fitted to determine best practice outcome as a function of knowledge and professional and social norms. RESULTS: Neither knowledge about diabetes (p<0.285) nor provider type (p<0.186) was a predictor of practice behavior. Professional and social norms (p<0.001) identified those practitioners who felt modifying their management strategies for their patients with diabetes was a necessary component of their practice behavior. CONCLUSION: In general, risk assessment was lacking, irrespective of whether a clinician was a dentist or dental hygienist. Results indicate oral health professionals in Arkansas need to improve the treatment and management of patients with diabetes and periodontal disease.

Massachusetts dental public health program directors practice behaviors and perceptions of infection control.

PURPOSE: The objective of this exploratory study was to deter mine the current infection control practices used in Massachusetts dental public health programs and assess the perceived compliance and challenges with infection control standards as outlined in the 2003 Centers for Disease Control and Prevention (CDC) infection control guidelines. METHODS: A convenience sample of program directors of dental public health programs in Massachusetts (n=82) were invited to participate. The directors were identified through the Massachusetts Department of Public Health, Massachusetts League of Community Health Centers, local dental/dental hygiene schools and key stakeholders in dental public health. The electronic questionnaire-based survey consisted of 26 open/closed-ended and Likert scale questions. Statistical analysis included frequency distribution and factor analysis. RESULTS: The overall response rate was 43%. The majority of responders to the survey were from public health settings using fixed/mobile dental equipment (82.9%), compared to settings using portable equipment (17.1%). Perceived lapses in the guidelines were attributed to lack of finances (r=0.938), lack of personnel (r=0.874) and lack of space (r=0.763). The only significant correlation between the program directors perceived adherence to the CDC guidelines was having access to necessary supplies and equipment (r=0.914). Program directors indicated that the CDC guidelines are hard to apply (r=0.895) and guide lines specific to settings using portable equipment would be helpful (r=0.925). CONCLUSION: Within the limitations of the sample size and response rate, directors from public health settings using both fixed/mobile and portable equipment reported being able to apply the current 2003 CDC infection control guidelines with few compliance challenges. However, respondents indicated that the guidelines were hard to apply and that infection control guidelines for settings using portable equipment would be useful.

California dental hygienists' knowledge, attitudes and practices regarding herbal and dietary supplements.

PURPOSE: As more Americans use dietary supplements, the potential for increased adverse effects increases. The purpose of this study was to identify the current knowledge, attitudes and practice behaviors among California dental hygienists regarding herbal and dietary supplements (HDS). METHODS: A stratified random sample of 1,203 registered California hygienists were surveyed. The survey included items about personal characteristics as well as questions regarding knowledge, attitudes and beliefs and practice behavior about HDS. Three primary outcomes were analyzed: dental hygienists' knowledge about HDS, attitudes (confidence) about HDS and behavior practices (communication) regarding HDS. Confirmatory factor analysis was performed. Personal characteristics were assessed in stepwise multiple linear regression analysis for impact on knowledge scores. RESULTS: The response rate was 21% (n=249). Dental hygienists have low levels of knowledge and confidence about HDS, as well as poor communication practices related to HDS. California dental hygienists scored a low mean of 38% on their knowledge of HDS. On the confidence scale (standardized range of 0 to 10 possible), hygienists scored 3.67±2.03. On the communication practices subscales (standardized range of 0 to 10 possible), hygienists scored 4.21±2.99 on general communication practices and 1.25±1.66 on specific communication practices. Dental hygienists who were members of the California Dental Hygienists' Association and attended a continuing education course on HDS within the last year or who personally used HDS scored significantly higher in knowledge, confidence and communication practices than their counter parts. These 3 attributes were identified as significant predicators for higher knowledge about HDS. CONCLUSION: There is a need to improve California dental hygienists' knowledge and involvement in the active management of patients who take HDS. Such actions can be expected to improve oral health outcomes. Focused training on HDS for hygienists should be designed to improve their knowledge and influence practice behaviors.