Factors Associated with Burnout among Dental Hygienists in California.

Purpose: The Maslach Burnout Inventory (MBI) quantifies the characteristics of mental and physical exhaustion caused by one's professional life. The purpose of this study was to assess the key occupational factors that may contribute to burnout among dental hygienist members of the California Dental Hygienists' Association as measured by the MBI.Methods: A 36-item electronic survey, consisting of questions assessing burnout, demographic information, clinical care and occupational environment, was sent to dental hygienist members of the California Dental Hygienists' Association (n=2211). Mean scores for each of the burnout subscales (emotional exhaustion-EE, depersonalization-DP, and personal accomplishment-PA) were computed using the MBI manual guidelines, and statistically related to the occupational factors.Results: The response rate was 20.9% (n=443). Thirty percent (30.9%) of respondents reported burnout, as identified by the MBI guidelines; 30.0% of respondents reported high emotional exhaustion (scores > 27) and 11.3% reported high depersonalization (scores > 10). Only 41.1% reported low levels of personal accomplishment. Emotional exhaustion and depersonalization decreased with increasing age categories (EE: F=5.78, p< 0.05; DP: F=9.26, p <0.05). Respondents between the ages of 35-44 had the highest levels of emotional exhaustion (EE=24.7) and depersonalization (DP=6.34). Respondents reporting higher levels of self-perceived appreciation in the workplace were more likely to have lower EE and DP scores (EE: F=5.12, p <0.05; DP: F=8.66, p <0.05).Conclusion: Approximately one-third of the dental hygienists in the sample population experienced burnout. Data indicate the importance of expressing well-deserved appreciation to colleagues and the need to develop educational programs to teach practicing dental hygienists and dental hygiene students strategies to prevent and alleviate the symptoms of stress that often lead to burnout.

Similarities and differences of international educational experiences of dental hygienists.

Purpose: Better understanding of dental hygienists' educational experiences may contribute to a more globally integrated dental hygiene (DH) profession. The purpose of this study was to assess similarities and differences of the educational experiences of dental hygienists who had completed DH programs in a broad spectrum of countries.Methods: Dental hygienists, educated in DH programs outside of the United States (US), were surveyed regarding their educational experiences in various subject areas/courses and their clinical skills. The International Federation of Dental Hygienists distributed study information, link for the informed consent, and 28-item survey to their member country House of Delegates representatives, along with a request to forward the survey information to their association members. Additionally, DH faculty at programs outside of the US were identified and invited to participate. Descriptive statistics were used to analyze the data.Results: A total of 513 dental hygienists from 22 countries outside of the US agreed to participate. More than half of all respondents, from over half of the countries, reported holding a baccalaureate degree. Nearly all respondents from all 22 countries reported having courses in periodontology and dental anatomy. Reviewing health histories, scaling using hand and/or ultrasonic instrumentation and the application of fluoride via trays or varnish, were the most common clinical skills, reported by nearly all respondents from almost all countries.Conclusion: Understanding the similarities of DH educational experiences, such as the emphasis on preventive therapy and maintenance of periodontal health, with educational content delivered at the university level, may facilitate greater global collaboration and a more unified workforce.

Nursing Administrators' Views on Oral Health in Long-Term Care Facilities: An exploratory study.

Purpose: To explore the knowledge, attitudes, and practices of supervising nurse administrators (SNAs) regarding the oral care provided to long-term care facility (LTCF) residents and the role of dental professionals in those facilities.Methods: The investigators of this study partnered with the National Association of Nursing Administrators to send this cross-sectional study consisting of a 35-item electronic survey to its members whose email addresses were in their database. Online software tabulated responses and calculated frequencies (percentages) of responses for each survey item.Results: Of the 2,359 potential participants, 171 (n=171) completed the survey for a 7% response rate. Only 25% of the respondents were familiar with the expertise of dental hygienists (DHs), however once informed, the majority were interested in having DHs perform oral health staff trainings, oral screenings, and dental referrals and initiate fluoride varnish programs. Most respondents correctly answered the oral health-related knowledge items, understood that oral health is important to general health, but reported that the LTCF residents' oral health was only "good" or "fair." Fewer than half, (48%) of the SNAs were "very satisfied" with the quality of oral care provided to the residents. While more than half reported that they had no dentist on staff or on-site dental equipment, 77% reported that they would consider on-site mobile oral care services. Oral health training for staff was provided primarily by registered nurses, however only 32% reported including identification of dental caries as part of the in-service training.Conclusion: This exploratory study lays the foundation for more extensive research investigating various strategies to improve the oral health of LTCF residents, including increased collaboration between DHs and SNAs.

Factors Influencing Dental Hygienists' Decisions to Pursue Doctoral Degrees.

Purpose: To identify the factors that have influenced dental hygienists to pursue post-graduate education opportunities, specifically dental (DDS, DMD) as compared to academic doctoral degrees, such as doctor of philosophy (PhD) or doctor of education (EdD).Methods: A convenience sample of dental hygienists with doctoral degrees were identified from multiple sources (n=140) and sent a 27-item web-based survey. Univariate logistic regression analysis was used to explore the influence of independent variables (respondents' demographic and personal characteristics, influential persons and experiences, encouraging and motivating factors) on the respondents' decision to pursue either a dental or an academic doctoral degree.Results: Of the 140 potential participants, 69 (n=69) responded (49% response rate): 17 dental degree respondents, 46 academic degree respondents. In contrast to academic degree respondents, those with dental degrees graduated from dental hygiene programs more recently (p=0.03), spent less time working as a dental hygienist (p=0.01), considered themselves mechanically inclined (p=0.03), and preferred to learn a new skill rather than read about a current research study (p=0.002). Both groups agreed that working one-on-one with people was important to career satisfaction. Dental degree respondents were more likely to have been influenced or encouraged to pursue dentistry by dentists (p=0.01) and family (p=0.004). Academic degree respondents were more likely to have had experiences with a researcher/scientist (p=0.004) or had been influenced by an educator (p=0.01). Only 40% of all respondents reported that dental hygiene instructors were instrumental in encouraging their advanced education.Conclusion: Dental hygienists possessing characteristics similar to the academic degree respondents in this study should be encouraged to pursue academic doctoral education, providing the necessary skills to advance the dental hygiene profession.

Perceptions of Registered Dental Hygienists in Alternative Practice Regarding Silver Diamine Fluoride.

Purpose: Silver diamine fluoride (SDF) is an inexpensive, non-invasive, antimicrobial liquid used to treat carious lesions and decrease sensitivity. The purpose of this study was to assess the perceptions of registered dental hygienists in alternative practice (RDHAP) regarding the use of SDF to treat dental caries.Methods: A 16-item survey designed to evaluate RDHAP's familiarity and perceptions of SDF was electronically distributed to 222 RDHAPs practicing in the state of California. A survey research software program collected and tabulated responses, calculated response frequencies for each survey item, and determined statistical relationships among variables, using cross tabulation analysis.Results: The response rate was 46% (n=103). Over half the respondents, 54%, were unfamiliar with SDF. After describing SDF's properties and uses, 78% of respondents agreed that applying SDF to treat dental caries would be within the scope of practice of a RDHAP. Respondents agreed that patients or parents of patients would be interested in using SDF because it provides an alternative to removing tooth structure with a dental drill in order to place restorative material (82%), less expensive than restorative treatment (82%), applied like a varnish and time efficient (86%), and utilized without local anesthesia (91%). Over 56% of the respondents agreed that many patients or guardians of patients would object to the permanent black staining of the carious lesion treated with SDF. The respondents' employment/practice settings were related statistically (p<0.01) to their agreement that SDF is within the RDHAP scope of practice and their disagreement the question that patients would not accept SDF treatment due to the black staining (p=0.03). Eighty-eight percent of the respondents felt that the advantages of SDF outweigh the disadvantages for their patient populations.Conclusions: SDF would be a useful therapeutic agent for the treatment of dental caries for RDHAP practitioners treating underserved populations.

Survey of Knowledge, Beliefs, and Behaviors of Migrant Vietnamese Parents Regarding Young Children's Oral Health.

Purpose: The purpose of this study was to investigate the oral health knowledge, beliefs, and behaviors of migrant Vietnamese parents of 1-5 year-olds in San Jose, California.Method: A verbally-administered survey was conducted with a convenience sample of 45 Vietnamese parents recruited at San Jose public libraries. Following preliminary screening, written informed consent was obtained from eligible individuals. A pre-tested, structured 94-item questionnaire was used to collect information regarding parent demographics, and the parent's knowledge, beliefs, and behaviors about children's oral health. Simple descriptive statistics were used to analyze the data.Results: Vietnamese parents acknowledged a number of basic concepts regarding early childhood caries (ECC), such as influences of sugar consumption, oral hygiene, and bottle use. Unlike other groups, they reported some familiarity with the role of bacteria in caries etiology. Oral health knowledge and beliefs, however, were not reflected in parental oral health behaviors such as supervision of children's brushing. Knowledge about the preventive role of fluoride was limited and varied among the population. Parental knowledge and behaviors did not vary by education level or length of residence in US.Conclusion: Vietnamese parents demonstrated reasonably good oral health knowledge, but poor behavioral guidance of their children's oral health, indicating the need for continued parental education emphasizing age-appropriate oral care and the preventative role of fluoride.

Challenges of Dental Assisting Students in Their Pursuit of Academic Success.

The aim of this study was to identify the challenges encountered by dental assisting students, especially those from underrepresented racial and ethnic groups (UREG), that affected their achieving academic success. In 2016, directors of the nine northern California dental assisting programs were contacted via email to explain the study and request an opportunity to administer the 26-item survey to their currently enrolled students. Student responses were entered into a survey research program, which tabulated the data and calculated the frequency of responses to each item. All nine programs participated, and the overall student response rate was 98%. Most (71%) of the 215 respondents agreed that they had experienced challenges in achieving academic success. Respondents reported the following challenges that made it difficult to perform well at school: financial responsibilities (41%), family responsibilities (33%), and language challenges (21%). These challenges, as well as difficulty understanding the language and vocabulary of instructional materials and cost of tuition and supplies, were statistically related to respondents' perceptions of their challenges to academic success. Most (83%) of the respondents perceived that faculty members supported their academic success. One-third of the respondents were from UREG: Hispanic, African American, and Native American. Higher percentages of UREG than non-UREG participants worked more hours/week (p=0.03) and tended to perceive financial (52%/32%) and family (42%/28%) responsibilities as challenges. Since both UREG and non-UREG respondents experienced these challenges, all students should be informed of institutional and programmatic resources that can assist them in achieving academic success.

Effects of mandatory continuing education related to infection control on the infection control practices of dental hygienists.

The infection control (IC) practices of dental hygienists, who were practicing in states with and without mandatory continuing education (CE) related to IC, were compared using a nationwide survey approach. The percentages of respondents from states with mandated IC CE, who reported compliance with 8 practices described in the current IC guidelines and acquiring more CE units and taking more recent IC CE, were greater (P < .005) than the percentages of respondents from states without the requirement.

Factors Influencing California Dental Hygienists' Involvement in School-Based Oral Health Programs.

PURPOSE: To assess the influence of community oral health experiences during entry-level dental hygiene education on participation in community oral health events after graduation and the facilitators and barriers experienced by dental hygienists in participating in these programs. METHODS: A 27-item survey, consisting of items related to community oral health experiences during and after entry-level education, was distributed by the California Dental Hygienists' Association to all dental hygienists whose email addresses were in their database. Frequencies of participants' responses to each survey item were calculated. Chi-square analysis was performed to identify significant relationships among variables. RESULTS: Response rate was 8%, with 513 out of the 6,248 contacted having responded. Additionally, 95% of the respondents had participated, as entry-level students, in community oral health experiences such as school-based oral health educational programs. Respondents agreed that participation in these programs was valuable to their professional development and encouraged them to participate after graduation; both these variables were related (p<0.01) to their participation in community experiences as a licensed dental hygienist. Most (75%) respondents reported participation in community events after graduation. The most commonly reported facilitators, encouraging participation, were an interest in helping people (89%) and professional development (59%). Barriers included conflict with work (61%), family time commitment (52%), and no knowledge of existing programs (24%). CONCLUSION: Dental hygienists' involvement in school-based oral health programs is enhanced by their community experiences as a dental hygiene student. Barriers and facilitators need to be addressed to increase the number of programs and participants so that more children can benefit.

Perceptions and Attitudes of Dental Hygiene Educators About the Establishment of Doctoral Education Programs in Dental Hygiene.

Purpose: To assess the perceptions and attitudes of dental hygiene (DH) educators at selected colleges and universities regarding the establishment of doctoral educational programs in DH in the United States.Methods: An online survey of DH educators at the 58 U.S. schools offering baccalaureate or master's degree programs was used to assess participants' perceptions and attitudes regarding the following: need to establish doctoral programs in DH, interests in supporting their development, potential barriers and facilitators, and goals/motivators of potential enrollees. Percentages of respondents selecting each response were calculated for each survey item and responses of selected items analyzed for significant differences.Results: Of 608 potential participants, 203 completed the survey for a 33% response rate. More than half the respondents strongly agreed and a quarter more agreed that a DH doctoral program was needed to relate equitably with doctoral graduates of other health-related disciplines and to expand the DH body of knowledge by conducting discipline-specific research. A majority indicated likely interest in supporting the development of both clinically oriented and research-based doctoral programs. Significantly (p<0.01) more respondents with doctorates were interested in developing doctoral programs than those with a master's degree as their terminal degree. Respondents identified shortages of qualified educators and interested enrollees as primary barriers. Facilitators included support from the American Dental Education Association and the American Dental Hygienists' Association. Becoming a better researcher and an institutional administrator were perceived as chief motivations.Conclusion: The majority of DH educators perceived that doctoral educational programs in DH are needed to advance the DH profession.

Detection of Early-Stage Oral Cancer Lesions: A Survey of California Dental Hygienists.

Purpose: To assess dental hygienists' knowledge of early-stage oral cancer lesions and their practices, attitudes, barriers, and facilitators related to early detection.Methods: A 20-item survey containing images of oral lesions and related multiple-choice questions was distributed electronically by the California Dental Hygienists' Association to all dental hygienists whose email addresses were in their database. Response frequencies were calculated per survey item. Logistic regression analysis was used to explore associations.Results: Seven hundred fifty-one dental hygienists responded, yielding a 12% response rate. Respondents' correct identification of the six images of oral lesions varied from 40%-97%. Most respondents reported conducting oral cancer examinations (OCE) at every dental hygiene appointment and performing palpation during OCE. Regions of the mouth varied regarding the frequency of palpation. Lymph node palpation was considered the most commonly omitted step. Those who conducted palpations were 3.3 (95% CI: 1.4 to 7.9, p=0.006) times more likely to report that they knew someone with oral cancer and had detected oral cancer lesions than those who did not. Knowing a person with a history of oral cancer and previously detecting a cancerous lesion were also reported as factors encouraging respondents to bring suspicious lesions to the attention of the dentist. Discouraging factors were mostly related to the dentist' behavior, such as not referring a suspicious lesion for biopsy that the respondent identified.Conclusion: Detection of early-stage oral cancer lesions by dental hygienists may be enhanced through more extensive education of visual appearances of lesions and the importance of palpation in a comprehensive OCE.

Dental Hygienists' Attitudes Toward the Obese Population.

Purpose: To explore dental hygienists' attitudes toward the obese population and to determine whether there are differences in attitudes among those with different self-reported body images.Methods: The study population was dental hygienists whose email addresses were in the database of the California Dental Hygienists' Association (CDHA). CDHA distributed the electronic message containing study information, informed consent, and a link to the survey. The survey consisted of 14 items from the Fat Phobia Scale, 13 items from the Anti-fat Attitudes Questionnaire (AFAQ), 3 demographic questions, and 1 question on body image. Frequencies of responses for each survey item were calculated, and Likert-like scale responses from the AFAQ were analyzed to determine significant differences among self-reported body images.Results: Of the 6,248 email addresses in the CDHA database, 518 hygienists or 8% responded. Mild fat phobia was indicated by 57% of the word pair scores on the Fat Phobia Scale being higher than 2.50. On the AFAQ, 84% agreed to the statement, "People who weigh too much could lose at least some part of their weight through a little exercise." Significantly (p<0.05) more respondents who self-reported as overweight than underweight agreed to "I feel disgusted with myself when I gain weight" and "I worry about becoming fat," while more in the overweight than underweight category significantly (p<0.05) disagreed with "Fat people make me somewhat uncomfortable."Conclusion: Dental hygienists exhibited mildly negative attitudes toward the obese population. Curricula specific to the role of the dental hygienist in addressing the health effects of obesity are recommended.

Senior Dental Students' Knowledge and Attitudes Toward Dental Hygienists' Contributions to Comprehensive Patient Care.

Purpose: To assess senior dental students' knowledge and attitudes toward dental hygienists' contributions to comprehensive patient care and to compare the responses of students from two dental schools, one with a dental hygiene (DH) program, and one without a DH program.Methods: Senior dental students from one school with DH (n=363) and one without DH (n=111) were requested to complete a 15-item survey assessing knowledge of clinical duties of licensed dental hygienists, attitudes regarding outcomes of collaborating with hygienists, and demographic characteristics. Responses were collated, and frequencies of responses for each item were analyzed by Qualtrics software program. The chi-square test was used to compare responses of the two groups of dental students.Results: The response rate was 27%. More respondents from the school with DH than those from the school without DH significantly agreed to these statements: "collaborating with DH students in school, has given, or would have given me, a better understanding of the value a dental hygienist brings to my future dental practice" (p=0.02) and "having a DH program at a dental school leads to patients receiving more comprehensive preventive care" (p=0.01). The likelihood of employing a dental hygienist was not significantly different between the two groups of students. The perceived high financial cost was the most frequent reason not to employ a hygienist.Conclusion: Collaboration of dental and DH students in entry-level education results in dental students' greater understanding and support of the dental hygienists' contributions to comprehensive patient care.

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.

Oral Health Knowledge, Attitudes and Behaviors of Parents of Children with Diabetes Compared to Those of Parents of Children without Diabetes.

PURPOSE: To compare the oral health knowledge, attitudes, and behaviors of parents of children, aged 6 to 13, who have type 1 (insulin-dependent) diabetes to those of parents of similarly aged children without diabetes. METHODS: The study population consisted of 46 parents of children with diabetes and 46 parents of children without diabetes from outpatient clinics, providing medical care to children with and without diabetes, respectively. After gaining permission of clinic directors, the investigator approached parents, who were waiting in the clinics' reception areas, to complete the 33-item survey. The survey included questions on socio-demographic characteristics, their child's oral hygiene practices, dental visits, dietary habits, their own oral health knowledge and attitudes, and their child's diabetic condition, when relevant. A Chi-square test was used to determine significant differences between responses of the two groups of parents. RESULTS: All parents approached completed the survey. Children with diabetes had significantly less frequent sugary drink consumption and less untreated dental caries than children without diabetes. The majority of parents of children with diabetes selected "don't know" for statements related to diabetes and oral health, whereas most parents of children without diabetes agreed with the statements, resulting in significant differences between groups. Most parents of children with diabetes considered these same statements important to them, while the importance to parents of children without diabetes was variable. CONCLUSION: To maintain their children's oral health, parents of children with diabetes must receive more education regarding the prevention and control of the oral complications of diabetes.

Assessment of pathology instruction in U.S. Dental hygiene educational programs.

PURPOSE: To assess the instruction of pathology content in entry-level and advanced practitioner dental hygiene educational programs and the program directors' perceptions whether their graduates are adequately prepared to meet the increasingly complex medical and oral health needs of the public. METHODS: A 28-question survey of instructional content and perceptions was developed and distributed using Qualtrics® software to the 340 directors of entry-level and advanced practitioner dental hygiene programs in the US. Respondents rated their level of agreement to a series of statements regarding their perceptions of graduates' preparation to perform particular dental hygiene services associated with pathology. Descriptive statistics for all 28 categorical survey questions were calculated and presented as the frequency (percentage). RESULTS: Of the 340 directors surveyed, 130 (38%) responded. Most entry-level respondents (53%) agreed or strongly agreed (29%) that their graduates were adequately prepared to meet the complex medical and oral health needs of the public, while all respondents of advanced practitioner programs strongly agreed. More respondents strongly agreed to statements related to clinical instruction than to didactic courses. While 64% of respondents agreed that their graduates were prepared to practice unsupervised, if it were legally allowed, 21% were ambivalent. The extent of pathology instruction in entry-level programs varied, but most used traditional formats of instruction, educational resources and assessments of educational outcomes. Advanced practitioner programs emphasized histological and clinical examination of oral lesions and patient case studies. CONCLUSION: Strengthening pathology instruction would ensure that future generations of dental hygienists would be adequately prepared to treat medically compromised patients.

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.

Knowledge, attitudes and practices of dental hygienists regarding caries management by risk assessment.

PURPOSE: The purpose of this study was to survey dental hygienists to determine their knowledge, attitudes and practices regarding the implementation of caries risk assessment, particularly caries management by risk assessment (CAMBRA), in private dental practices. METHODS: A 17 item survey was developed to evaluate dental hygienists' knowledge, attitudes and practices related to CAMBRA and perceived barriers to CAMBRA implementation in private dental practice. Surveys were mailed to a randomized sample of 1,000 dental hygienists licensed to practice in California. Responses were tabulated for each respondent, and the response frequency for each survey item was calculated. Respondents' comments to the open-ended question were compiled, according to themes. RESULTS: The response rate was 18%. Only 66% of the respondents were familiar with the term CAMBRA, although 89% agreed with its underlying principles of risk assessment. CAMBRA protocol had been implemented in 40% of the respondents' employment sites. Respondents disagreed that time (45%) and cost of products (68%) were barriers to implementation. Many did not know their employers' knowledge or attitudes about CAMBRA and its implementation, as evidenced by a "don't know" response range of 29 to 48% for the 4 relevant statements. Respondents' comments included both successes and barriers implementing CAMBRA. CONCLUSION: CAMBRA protocol has not been widely implemented in private practice, although the current data do not indicate insurmountable barriers. Broader dissemination may be feasible if dental hygienists would obtain more comprehensive knowledge of evidence-based risk assessment protocols and would assume a leadership role in implementing CAMBRA protocols and procedures in private dental practices.

Adjunctive use of the diode laser in non-surgical periodontal therapy: exploring the controversy.

PURPOSE: Despite the controversy regarding clinical efficacy, dental hygienists use the diode laser as an adjunct to non-surgical periodontal therapy. The technique to maximize successful laser therapy outcome is controversial as well. The purpose of this review is to explore the scientific foundation of the controversy surrounding the use of the diode laser as an adjunct to non-surgical periodontal therapy. Further, this paper addresses the weaknesses in study design, the heterogeneity of methodology in the published clinical studies, especially the laser parameters, and how these issues impact the collective clinical and microbial data, and thus conclusions regarding clinical efficacy. Evaluation of the literature identifies possible mechanisms that could contribute to the varied, often conflicting results among laser studies that are the foundation of the controversy surrounding clinical efficacy. These mechanisms include current paradigms of periodontal biofilm behavior, tissue response to laser therapy being dependent on tissue type and health, and that the successful therapeutic treatment window is specific to the target tissue, biofilm composition, laser wavelength, and laser energy delivered. Lastly, this paper discusses laser parameters used in the various clinical studies, and how their diversity contributes to the controversy. Although this review does not establish clinical efficacy, it does reveal the scientific foundation of the controversy and the need for standardized, well designed randomized controlled clinical trials to develop specific guidelines for using the laser as an adjunct to non-surgical periodontal therapy. Using evidence-based laser guidelines would allow dental hygienists to provide more effective non-surgical periodontal care.

Students from underrepresented racial and ethnic groups entering the dental hygiene profession.

African American, Hispanic/Latina, and American Indian/Alaska Native persons are markedly underrepresented racial and ethnic groups (UREG) in the dental hygiene profession. The purpose of this study was to survey UREG dental hygiene students to determine their perceptions of the barriers and facilitators that influenced their decision to enter the dental hygiene profession. Participants were eighty-four UREG students attending entry-level dental hygiene programs across the state of California. We conducted face-to-face interviews using a survey guide that consisted of forty-two mostly closed-ended questions. Most (57 percent) participants reported that they had either perceived or experienced barriers: primarily costs associated with the program and the lack of role models in their race/ethnicity. Almost all participants reported that there had been a person, mainly a dental professional, who influenced them to become a dental hygienist; 62 percent of these individuals were reported to be from a similar UREG group as the participant. Funding (57 percent) and emotional support from family and friends (87 percent) were the predominant facilitators employed by the participants to overcome barriers. Based on these results, we recommend three strategies to recruit more UREG students into the dental hygiene profession: more extensive outreach programs, enhanced mentoring by UREG dental professionals, and a modified admission process.