Development and evaluation of the Jönköping Dental Fear Coping Model: a health professional perspective.

OBJECTIVE: The purpose of this study was to design a structured treatment model focusing on all levels of adult's dental fear, the Jönköping Dental Fear Coping Model (DFCM). The aim was to study the DFCM from a dental health professional perspective. MATERIAL AND METHODS: The DFCM was studied by means of quantitative and qualitative analyses. Nine dental clinics participated in Period I (pre-intervention/standard care), and 133 dental health professionals (dentists, dental hygienists, dental assistants) and 3088 patients were included. After completion of Period I, four of the clinics were randomized to Period II (intervention), beginning with the professionals undergoing DFCM training. Following that, 51 dental health professionals treated 1417 patients according to the DFCM. The other five clinics served as controls. RESULTS: Half or more of the dental health professionals assessed the model as better than standard care, regarding anamnesis and diagnostics, communication and contact, and understanding of patients and dental fear. The dental health professionals reported higher tension in their fearful patients in Period II compared with Period I, possibly due to their increased awareness of dental fear. CONCLUSIONS: The qualitative data suggest that dental health professionals find the DFCM beneficial in routine dental care. The model promotes a holistic approach to the treatment of adult patients. However, stress among the professionals was not reduced when measured, neither quantitatively nor qualitatively. It is important to evaluate the model in further studies to make it possible to draw generalizable conclusions.

An analysis of dental patient safety incidents in a patient complaint and healthcare supervisory database in Finland.

OBJECTIVE: Few studies of patient harm and harm-prevention methods in dentistry exist. This study aimed to identify and characterize dental patient safety incidents (PSIs) in a national sample of closed dental cases reported to the Regional State Administrative Agencies (AVIs) and the National Supervisory Authority for Welfare and Health (Valvira) in Finland. MATERIALS AND METHODS: The sample included all available fully resolved dental cases (n = 948) during 2000-2012 (initiated by the end of 2011). Cases included both patient and next of kin complaints and notifications from other authorities, employers, pharmacies, etc. The cases analyzed concerned both public and private dentistry and included incident reports lodged against dentists and other dental-care professionals. Data also include the most severe cases since these are reported to Valvira. PSIs were categorized according to common incident types and preventability and severity assessments were based on expert opinions in the decisions from closed cases. RESULTS: Most alleged PSIs were proven valid and evaluated as potentially preventable. PSIs were most often related to different dental treatment procedures or diagnostics. More than half of all PSIs were assessed as severe, posing severe risk or as causing permanent or long-lasting harm to patients. The risk for PSI was highest among male general dental practitioners with recurring complaints and notifications. CONCLUSIONS: Despite some limitations, this register-based study identifies new perspectives on improving safety in dental care. Many PSIs could be prevented through the proper and more systematic use of already available error-prevention methods.

Dental therapists/hygienists working in remote-rural primary care: a structured review of effectiveness, efficiency, sustainability, acceptability and affordability.

AIM: To examine the use of dental therapist/hygienists to provide primary dental treatment in remote-rural areas with regard to their effectiveness, efficiency, sustainability, acceptability and costs (affordability). METHOD: The structured literature review of studies indexed in Medline, Embase and CinAHL was conducted using search terms relevant to 'dental therapists' and 'remote-rural'. Remote-rural was defined as 'those (individuals) with a greater than 30-minute drive time to the nearest settlement with a population of greater than 10,000'. RESULTS: From 1,175 publications screened, 21 studies from 19 publications were initially included. Only seven studies were included that explicitly focused on remote-rural areas. Four were surveys and three were qualitative studies. All of the included studies were reported within the last 7 years. The methodological quality of the surveys varied, particularly with regard to their response rates. All three of the qualitative studies were assessed as potentially weak methodologies. Regarding the research question, none of the studies included provided data relevant to understanding efficiency, cost issues or the acceptability of dental therapists. The available empirical evidence contained only indirect indicators about the sustainability of dental therapy in rural areas. CONCLUSIONS: The available data indicates that dental therapist/hygienists have suitable skills and could constitute a valuable asset to meet the dental demands in remote-rural areas. However, the evidence base is limited and of a poor quality. There is a need to put in place 'well-designed interventions with robust evaluation to examine cost-effectiveness and benefits to patients and the health workforce'.

Factor analysis on implementation of domiciliary dental care in Metropolitan Tokyo.

The need for domiciliary dental care has increased with the aging of Japanese society. The Tokyo Metropolitan Government and Tokyo Dental Association conducted a survey of dental institutions within Tokyo in order to clarify which factors influenced implementation of domiciliary dental care by dental institutions. The proportion was significantly higher in (1) dentists in their 50s or older, (2) those working in cooperation with primary care physicians, (3) those providing dysphagia rehabilitation, (4) those who give information on prevention of aspiration pneumonia, (5) those who attended training on medical or domiciliary dental care for the elderly in need of nursing care, and (6) those who attended training workshops and seminars provided by the Tokyo Dental Association in 2010. In the logistic regression analysis, a significant odds ratio was obtained for the same items, excluding age. Attendance at training on medical or domiciliary dental care for the elderly in need of nursing care had the highest odds ratio. Those who attended any kind of training course implemented domiciliary dental care significantly more often. Training conducted by the Tokyo Metropolitan Center for Oral Health of Persons with Disabilities, Tokyo Dental Association, and local dental associations showed a significant odds ratio, with the highest by the Tokyo Dental Association. Traditionally, education on domiciliary dental care in the elderly is not provided at the college level. The present results indicate the importance of educating students with regard to the unique challenges such work poses. Attending seminars hosted by the Tokyo Dental Association also significantly influenced implementation of domiciliary dental care. This seems to be an important result, suggesting the effectiveness of training provided by dental associations with regard to the promotion of domiciliary dental care. This indicates the need for dental associations to provide such training throughout Japan.

What factors need to be addressed to support dental hygienists to assist their patients to quit smoking?

INTRODUCTION: Dental hygienists are well placed to assist their patients to quit smoking. Smoking affects oral health and dental treatments, and hygienists report greater time with patients than dentists with more focus on prevention. However, there has been little research into the extent to which hygienists assist patients to quit smoking and strategies to support them in this role. METHODS: A 2-stage survey of Australian dental hygienists was conducted. The first survey measured potential predictors of asking patients about smoking and assisting patients to quit smoking using the Theory of Planned Behavior as a framework. The second survey measured these behaviors in the past week. Structural equation modeling was used to examine predictors of the two behaviors. RESULTS: A total of 362 hygienists returned the first questionnaire. Intentions to ask and assist patients were high. The 273 hygienists who returned the second questionnaire assisted an estimated total of 1,394 patients to quit smoking in 1 week. Predictors within the Theory of Planned Behavior framework explained significant variance in asking (11%) and assisting (29%) behaviors, with self-efficacy the most critical predictor in both cases (ß = .27 and .32, respectively). CONCLUSIONS: Dental hygienists may be a viable and willing avenue for addressing smoking. Hygienists may be best supported in this role through increasing skills and confidence around asking sensitively about smoking, building rapport, and assisting patients to quit smoking. Incorporation of smoking status into general history taking and adoption of organizational policies on assisting patients to quit smoking could also be encouraged.

Tobacco cessation efforts in dentistry: a rural state study.

The U.S. Department of Health and Human Services published Treating tobacco use and dependence: 2008 update to provide guidelines for treating tobacco use and dependence. These guidelines were developed based on a literature review with the goal of assisting clinicians in treating patients who use tobacco products. In 2010, the authors conducted a survey of dentists and dental hygienists in a rural state with a high rate of tobacco use to determine dental providers' tobacco cessation efforts. The study found that the majority of clinicians surveyed ask about their patients' tobacco use at their initial examination and educate patients about the consequences of tobacco use. Still, improvements are possible with regard to identifying and documenting tobacco use. In addition, this research suggests that providers can become more confident in their cessation approach with patients and that additional referrals can be made for alternative cessation services.

Improving oral health in Pakistan using dental hygienists.

This paper reviews the healthcare system, available dental care, and oral health status of people in Pakistan. Considering the enormous unmet oral health needs, the insufficient supply of dental professionals and the current unstructured dental hygiene curriculum in Pakistan, a mission, vision, and goals for professional dental hygiene in Pakistan is recommended. The authors offer recommendations for competency-based dental hygiene education and practice, professional credentialing, a practice act, and a dental hygiene scope of practice to promote the health, welfare, and quality of life of the Pakistani people. Specifically, the authors recommend increasing the number of quality dental hygiene programs, establishing the dental hygienist as a primary care provider of oral health services, enhancing current dental hygiene curriculum, and establishing a dental hygiene council with responsibility for educational requirements and regulation of dental hygienists in Pakistan.

The use of dental sealants in adults: a long-neglected preventive measure.

The consensus among the general public appears to be that dental sealants are intended to be used primarily with children whose teeth are in the early developmental stage, yet little attention is given to the preventive long-term aspects when applying them to adult permanent dentition. This article explores the rationale and substantiates the use of dental sealants among the adult population in reducing occlusal pit-and-fissure caries while accentuating a beneficial oral health lifestyle.

General dentists and periodontal referrals.

Questionnaire data were collected from 160 MDA members. The data showed that 16 percent of the respondents had not made a periodontal referral during the last month, 67 percent had made one to five referrals, 7 percent between six and 10 referrals, and 10 percent referred more than 10 patients. The number of referrals did not differ as a function of patients' disease characteristics or dentists' periodontal treatment patterns. They were affected by considerations of practice characteristics and patient's oral hygiene efforts. In conclusion, general dentists differ greatly in the number of periodontal referrals they make. Referral frequencies were not affected by diagnostic considerations or treatment patterns.

Dental hygiene education in Nepal.

AIM: This article provides information about the history, recent curriculum changes and the legal status of the dental hygiene education in Nepal. It also intends to show, how, even in a poor developing nation, the personal drive of a native Nepalese citizen with a vision and the proper connections can lead to the establishment of a new profession, until then unknown. METHOD: Data were obtained from the founder of the first dental hygiene school in Nepal through qualitative interviews, and through personal visits to two Nepalese dental hygiene schools in Kathmandu and in Pokhara. Since 2006, the first author serves as curricular advisor, allowing him access and input to drafts of the development of current curricular changes. RESULTS: In 2000, the first dental hygiene course started in Kathmandu. Since then, dental hygiene education has been going through different stages of development and professionalization. In 2005, the programme was changed to 3 years in length in order for students to obtain an academic Certificate in Dental Hygiene. In 2006, the Nepalese Dental Hygienists Association was founded, resulting in greater recognition of the profession, especially by the powerful Nepalese Dental Association. Obscure rules and legislation results in eclectic specifications governing dental hygiene practice. Future challenges for the schools and the dental hygienists association are issues of quality insurance and scope of practice suitable for a developing country. Currently, Nepal is the only country worldwide with an almost equal gender distribution in the dental hygiene profession.

Educational and career pathways of dental hygienists: comparing graduates of associate and baccalaureate degree programs.

The purpose of this study was to compare the educational and career pathways of graduates from associate degree (A.S./A.A.) and baccalaureate degree (B.S./B.A.) entry-level dental hygiene (DH) programs. A thirty-item, closed-ended questionnaire was mailed to a random sample of 1,352 dental hygienists who were educated and licensed in California between 1990 and 2000. The response rate was 76 percent. Approximately half of the respondents had a degree prior to entering the DH program, and the elapsed time between degrees was greater for A.S./A.A. graduates (p=0.05). More B.S./B.A. graduates had earned or were seeking master's and other more advanced degrees: 11.9 percent versus 4.3 percent. Graduates from both types of programs were involved in professional and community organizations and held leadership positions. Most were currently practicing in the traditional clinical setting, with means of 3.6 and 3.3 days/week for the A.S./A.A. and B.S./B.A. graduates, respectively (p<0.05). More B.S./B.A. graduates held DH faculty positions (30.3 percent versus 4.3 percent, p<0.05) and other non-DH teaching positions (14.9 percent versus 8.6 percent, p<0.05) and had greater involvement with research (8.0 percent versus 3.6 percent, p<0.05). The two groups did not differ in regard to other dental and DH-related positions. In conclusion, graduates from B.S./B.A. programs are more likely to have positions in nontraditional settings.

Emerging allied dental workforce models: considerations for academic dental institutions.

The U.S. surgeon general defined the national oral health care crisis in 2001 in Oral Health in America: A Report of the Surgeon General. The report concluded that the public infrastructure for oral health is not sufficient to meet the needs of disadvantaged groups and is disproportionately available depending upon certain racial, ethnic, and socioeconomic factors within the U.S. population. Now, several new workforce models are emerging that attempt to address shortcomings in the oral health care workforce. Access to oral health care is the most critical issue driving these new workforce models. Currently, three midlevel dental workforce models dominate the debate. The purpose of this report is to describe these models and their stage of development to assist the dental education community in preparing for the education of these new providers. The models are 1) the advanced dental hygiene practitioner; 2) the community dental health coordinator; and 3) the dental health aide therapist.

Dental Group Practice and the Need for Dentists.

This study compared the number of patients treated per year by general dentists and dental hygienists in solo practice and by those employed by a large group practice. Information on the annual number of patient visits to solo general dental practitioners comes from the 2013 American Dental Association (ADA) Survey of Dental Practice. Patient visits were divided by 2.5 to estimate the number of patients treated annually. The data on group practices come from HealthPartners (HP) of Minnesota, a large not-for-profit medical and dental Health Maintenance Organization that accepts insurance contracts based on global budgets and is financially at risk. In 2013, solo general dentists averaged 1,350 patients, while the average HP general dentist treated 2,052 patients. HP general dentists thus treated over 700 more patients annually than did solo practitioners. This large difference has major implications for the future of the dental delivery system and dental education. This article was written as part of the project "Advancing Dental Education in the 21st Century."

The prevalence of mentoring programs in the transition from student to practitioner among U.S. dental hygiene programs.

Mentoring of students to assist them in the transition to clinical practice has been utilized in a number of health professions but has only been recently introduced in dental and dental hygiene education. A survey was sent to all U.S. dental hygiene program directors to determine the prevalence of mentoring programs in the dental hygiene curriculum that utilize practicing dental hygienists as mentors to facilitate the transition from student to practitioner. Results showed that less than 30 percent of dental hygiene programs are using this type of student mentoring. Dental hygiene program directors reported that the main benefit mentoring provided was "real world" experiences to their students. Lack of formal structure to the mentoring program was the most frequently cited weakness of existing programs. Programs not utilizing mentoring programs listed inadequate time in the existing dental hygiene curriculum as the main obstacle for not implementing a mentoring program. Student mentorship in other health professions has been shown to not only enhance personal and professional growth, but also to increase job satisfaction and retention. Further research, however, is needed on student mentoring programs in the dental and allied dental fields.

Child abuse and neglect: dental and dental hygiene students' educational experiences and knowledge.

The objective of this study was to explore dental and dental hygiene students' educational experiences and knowledge concerning child abuse/neglect. Questionnaire data were collected from 233 dental (116 male/117 female; response rate=54.82 percent) and seventy-six dental hygiene students (all female; response rate=76.77 percent). Of those surveyed, 94.7 percent of the dental hygiene and 70.5 percent of the dental students reported having learned about child abuse/neglect in classroom settings, and 15.8 percent of the dental hygiene and 29.3 percent of the dental students reported having learned about it in clinical settings. Dental students reported more minutes of instruction about this topic than dental hygiene students (184.48 vs. 112.90 minutes; p=.006). Only 5.5 percent of the dental and 16.7 percent of the dental hygiene students defined child abuse correctly; 32.2 percent of the dental and 13.2 percent of the dental hygiene students did not know their legal responsibility concerning reporting child abuse; and 82.4 percent of the dental and 78.9 percent of the dental hygiene students did not know where to report child abuse. Dental care providers are likely to encounter child abuse and neglect in their professional lives and are legally required to respond to these matters. Dental and dental hygiene curricula should be revisited to ensure that students are adequately prepared for this professional task.

An analysis of preventive dental visits by provider type, 1996.

BACKGROUND: Understanding preventive dental visit utilization patterns facilitates planning of the dental health services delivery system. The authors examine these patterns by analyzing the receipt of preventive dental services in the United States by type of dental provider. METHODS: The authors analyzed data from the 1996 Medical Expenditure Panel Survey (MEPS) for the U.S. community-based population. They developed national estimates for the population with preventive dental visits by provider type, including the population with a preventive dental visit and mean number of preventive dental visits per person for socioeconomic and demographic categories. RESULTS: Respondents who are white, are older, are female, have dental insurance, are from higher income and education backgrounds, and reside in small metropolitan areas were more likely (P < .05) to receive preventive care from a dental hygienist than from a dentist. CONCLUSION: MEPS data showed that people's socioeconomic background and other demographic factors were associated with having a preventive dental visit with a dentist or dental hygienist. These factors also influence the per-person number of preventive visits by type of dental practitioner. These elements must be considered when planning for future dental work force needs. PRACTICE IMPLICATIONS: Estimating future dental work force needs through this analysis assists dentists in meeting patient demand and maximizing the productive output of all services rendered in their practices, including preventive services.

The dental safety net in Connecticut.

BACKGROUND: Many poor, medically disabled and geographically isolated populations have difficulty accessing private-sector dental care and are considered underserved. To address this problem, public- and voluntary-sector organizations have established clinics and provide care to the underserved. Collectively, these clinics are known as "the dental safety net." The authors describe the dental safety net in Connecticut and examine the capacity and efficiency of this system to provide care to the noninstitutionalized underserved population of the state. METHODS: The authors describe Connecticut's dental safety net in terms of dentists, allied health staff members, operatories, patient visits and patients treated per dentist per year. The authors compare the productivity of safety-net dentists with that of private practitioners. They also estimate the capacity of the safety net to treat people enrolled in Medicaid and the State Children's Health Insurance Program. RESULTS: The safety net is made up of dental clinics in community health centers, hospitals, the dental school and public schools. One hundred eleven dentists, 38 hygienists and 95 dental assistants staff the clinics. Safety-net dentists have fewer patient visits and patients than do private practitioners. The Connecticut safety-net system has the capacity to treat about 28.2 percent of publicly insured patients. CONCLUSIONS: The dental safety net is an important community resource, and greater use of allied dental personnel could substantially improve the capacity of the system to care for the poor and other underserved populations.

How Swedish dental hygienists apply their training program in the field.

The purpose of this study was to evaluate how clinical practice by Swedish dental hygienists was related to type of dental delivery system, period of training, educational institution attended and patient category. Dental hygienists from 14 different dental hygiene schools were represented. Of these schools, 11 are still in operation. A specially designed questionnaire was posted to all dental hygienists in Sweden (n = 1857). A total of 1399 questionnaire (75.3%) were completed and returned, providing data on 15,546 dental appointments. 37.2% of the Swedish dental hygienists are presently working in private practices, 45.8% in the public dental health service and 6.2% in both. Of the patients treated by hygienists, 88.7% were adults: 99.5% in private practice and 78.4% in the public dental health service. 42.0% of all dental hygienists were trained in 1980-84. The mean treatment time per appointment in private practice was 49.7 min and 45 min in the public dental health service. Scaling, root-planning and removal of overhangs took 27 min per visit in private practice and 22 min in the public dental health service. However, there were no significant differences in methods in the two delivery systems with respect to examinations, self-care training, professional mechanical toothcleaning (PMTC), topical fluoride application, or salivary and oral microbiology tests. The adult patient categories were periodontal risk (45.1%), caries risk (9.1%) and hygiene (34.6%). In periodontal risk patients, scaling, root-planning and removal of overhangs took 28 min per appointment and 14 min in caries risk patients.

Use of dental hygienists and returns to scale in child dental care in Norway.

The purpose of this study was to investigate, in the provision of dental care for children, technically and economically efficient combinations of dentists and dental hygienists and to study returns to scale by analyzing production functions. Data from 137 dental health clinics were analyzed. Output was registered as the number of 3-18-yr-old children to whom the clinic delivered complete dental care. Resource input was registered as hours spent by dentists, dental hygienists and dental assistants to deliver care to the children. The average clinic that employed dental hygienists used one hygienist hour per three dentist hours for child dental care. It would save dentist time, but not costs, to extent the use of hygienists. Increased use of dental hygienists might be economically efficient if the work distribution between the personnel groups were changed, for example, by delegating more examinations and preventive care to hygienists. There were technical opportunities for further substitution of dental hygienists for dentists both by introducing dental hygienists in the clinics that only used dentists in child dental care and by extending use of hygienists in clinics that already employed hygienists. This study found no productivity gain from centralizing treatment of children in large dental clinics.