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.

Perceptions Related to Use of Electronic Cigarettes among California College Students.

Purpose: To assess electronic cigarette (e-cigarette) use, factors associated with use, and exposure to e-cigarette-related information from health professionals in a sample of college students attending a public university in northern California, using a web-based survey.Methods: In this quantitative cross-sectional study, survey items assessed e-cigarette use, perceived risks and benefits, and exposure to e-cigarette-related information from health professionals and were pilot tested for feasibility and acceptability. Participants were recruited from three courses taught at a northern California public university and were given an electronic link to the survey with informed consent information. Frequency distributions and cross-tabulations were calculated for survey responses. The Mann-Whitney U-test was used to compare differences in perceived risks, benefits, and social consequences between ever-users and never-users.Results: Ninety-one individuals completed the web-based survey. Among respondents, 89% were aware of e-cigarettes, 49% were ever-users, and 10% were current (past-30 day) e-cigarette users. Compared to e-cigarette ever-users, never-users perceived a higher chance of experiencing 5 out of 8 physical and social risks from e-cigarette use (P<0.05). E-cigarettes, marijuana, and hookah were perceived to be less harmful to health than cigarettes. Few participants reported receiving counseling regarding e-cigarettes from health professionals, including dental hygienists. Counseling about the adverse health effects of cigarettes was more common in this study population.Conclusion: Dental hygienists must stay current with the scientific evidence related to e-cigarette use and incorporate such information into their client tobacco-related counseling. Addressing the perceived physical and social risks associated with e-cigarette use when counseling college students may deter them from initiating or continuing e-cigarette use.

ST product characteristics and relationships with perceptions and behaviors among rural adolescent males: a qualitative study.

Although smoking declines in the United States, the prevalence of male adolescent smokeless tobacco (ST; moist snuff and chewing tobacco) use remains unchanged. ST product characteristics, such as flavoring, packaging, and branding, could influence adolescents' ST initiation and continued use. This qualitative study examines the potential role of product characteristics in shaping ST-related perceptions and behaviors among rural adolescent males. Semi-structured individual interviews were conducted at three California rural high schools. ST users were asked about their experiences and perceptions related to product characteristics. Interviews were transcribed, coded, and analyzed using a general inductive approach. Participants associated flavored ST with appealing non-tobacco products, such as chewing gum and alcohol. Availability of different varieties and flavors stimulated interest and curiosity in sampling or switching between ST products. Time-limited promotional flavors and packaging also enhanced product appeal. Adolescent ST users preferred certain brands based on perceived brand features and perceived nicotine content, associating higher-strength brands as better suited for experienced ST users. Brand preferences frequently reflected perceived ST brand popularity within peer groups. Based on these observations, potential ST regulation and health education campaigns to address misconceptions about ST characteristics could influence adolescents' ST-related perceptions and reduce ST use among this vulnerable population.

Smokeless Tobacco Decision-Making Among Rural Adolescent Males in California.

Smokeless tobacco (ST) use among US high school males living in rural areas exceeds national levels. Subgroups at heightened risk of ST use have been identified, but less is known regarding ST decision-making within high-risk groups. The study objective was to describe rural adolescent males' perceived ST acceptability, health risks, and social implications and how those perceptions differ between ST users and never-users. Semi-structured individual interviews were conducted with a purposeful sample of 55 male students (32 ST ever-users) at three rural California high schools. Interviews were audio recorded and professionally transcribed. Investigators collaboratively developed a codebook based on thematic content and then independently coded transcripts, reconvening frequently to achieve consensus. Coded text was systematically organized into themes following a general inductive approach. ST users and non-users shared multiple ST-related perceptions, including: that ST is a common, normative way of life in rural "country" culture among certain groups; that ST use conveys oral health risks; and that the decision to use (or not to use) is rooted in personal choice. ST users' and never-users' perceptions differed regarding the immediacy, severity, and inevitability of health risks, particularly relative to cigarette smoking. Other differences included perceived parental permissiveness and the expected social benefits of ST use, such as peer acceptance and conveying maturity. Within this population of rural male adolescents, ST users emphasized the social benefits of ST use, while acknowledging but discounting health risks. Differences and similarities in tobacco perceptions among adolescents living in similar environments may inform effective health communication.

The changing tobacco landscape: What dental professionals need to know.

BACKGROUND: Tobacco products in the United States and the patterns of tobacco use are changing. Although cigarette smoking prevalence has declined, dental professionals are likely to encounter substantial numbers of patients who have tried and are continuing to use new and alternative tobacco products, including cigars, water pipes (hookahs), and electronic cigarettes, as well as conventional and new smokeless tobacco products. METHODS: The authors reviewed conventional and new tobacco products in the United States, their adverse oral and systemic health effects, and their prevalence of use. RESULTS: Tobacco products other than cigarettes account for a substantial portion of tobacco use. For this reason, tobacco-use prevention and cessation counseling provided by dental health care professionals must address all tobacco products, including cigarettes, cigars, water pipes, and electronic cigarettes, as well as conventional and new smokeless tobacco products. Cigarette smoking and smokeless tobacco use are associated with immediate and long-term adverse health effects, including nicotine addiction, oral and systemic disease, and death. Novel products may attract new tobacco users, potentially leading to addiction that results in enduring tobacco product use and associated adverse health effects. CONCLUSIONS: This critical review of conventional, new, and emerging tobacco products presents information that dental professionals can use in providing tobacco-related counseling to patients who use or who are at risk for using tobacco products. PRACTICAL IMPLICATIONS: It is essential that dental professionals are knowledgeable about tobacco products and are able to answer patients' questions and provide them with evidence-based tobacco-related counseling. This information may prevent patients from initiating use or help reduce or cease use to avoid immediate and long-term adverse health effects, including nicotine addiction, oral and systemic disease, and death.

Oral Health Prevention and Toddler Well-Child Care: Routine Integration in a Safety Net System.

BACKGROUND AND OBJECTIVE: Applying topical fluoride varnish (FV) to young children's teeth is an effective therapeutic strategy for preventing early childhood caries (ECC). In 2008, the pediatricians at Contra Costa Regional Medical Center and Health Centers became concerned that our low-income pediatric patients had high rates of ECC and very limited access to dental care. We formed an interdisciplinary safety net-academic partnership with the University of California San Francisco to implement routine FV applications, along with oral health education, screening, and referral during well-child exams for children aged 1 to 5 years. METHODS: Over 3 years, the team developed clinical policies, educational materials, billing, and support systems to facilitate implementation in the primary care setting. A pilot study was performed in 2 health centers; improvements to the implementation plan were made. A team of local providers and academic partners performed system-wide didactic and hands-on trainings and spread this intervention to the remaining 6 health centers. Continued improvement strategies and provider feedback were pursued with each measurement cycle. RESULTS: In August 2012, 95% of all children aged 1 to 5 years who were seen for well-child checkups received a FV application and oral health education during their primary care well visit. Repeat measurement in April 2014 showed a sustained rate of 97% application of FV for children in this age group seen for well-child visits. CONCLUSIONS: With institutional commitment and an academic partnership, a safety net institution can integrate routine FV applications and oral health interventions into well-child visits to reduce ECC.

Conditional risk assessment of adolescents' electronic cigarette perceptions.

OBJECTIVES: To adapt an established instrument for measuring adolescents' cigarette-related perceptions for new application with electronic cigarettes (e-cigarettes). METHODS: In this exploratory study, 104 male high school students (40% tobacco ever-users) estimated the probability of potential e-cigarette risks (eg, lung cancer) or benefits (eg, look cool). We calculated associations between risk/benefit composite scores, ever-use, and use intention for e-cigarettes, and analogously, for combustible cigarettes. RESULTS: E-cigarette ever-use was associated with lower perceived risks, with adjusted differences versus never-users greater for e-cigarettes than for cigarettes. Risk composite score was inversely associated, and benefit score positively associated, with e-cigarette ever-use and use intention. CONCLUSION: Conditional risk assessment characterized adolescents' perceived e-cigarette risk/benefit profile, with potential utility for risk-perception measurement in future studies.

Effectiveness of a Screening and Brief Intervention protocol for heavy drinkers in dental practice: A cluster-randomized trial.

Results of a cluster-randomized trial of a Screening and Brief Intervention for heavy drinkers in dental practice are reported. Data were obtained from 103 heavy drinking patients recruited from randomized intervention (7; n = 50) and control (6; n = 53) practices. Analysis of data revealed that 6-month decreases in total drinks per week were significantly (p < .05) greater for heavy drinking intervention (43%) than control patients (21%)-a 4 drink per week difference. Similar decreases were obtained for quantity and frequency among intervention patients compared to control patients. Despite power limitations, the 6-month results support the effectiveness of the Screening and Brief Intervention.

Doctoral dental hygiene education: insights from a review of nursing literature and program websites.

PURPOSE: Because dental hygiene education has had a similar trajectory as nursing education, this critical review addressed the question "What can the dental hygiene discipline learn from the nursing experience in their development of doctoral education?" Information on admission and degree requirements, modes of instruction, and program length and cost was collected from the websites associated with 112 of 125 PhD nursing programs nationally, and 174 of 184 Doctor of Nursing Practice (DNP) programs. In addition, searches of PubMed, Cumulative Index Nursing Allied Health Literature (CINAHL) and the Web of Science were utilized to identify key articles and books. The following 4 insights relevant to future dental hygiene doctoral education emerged from a review of nursing doctoral education: First, nursing doctoral education offers 2 main doctoral degrees, the research-focused PhD degree and the practice-focused DNP degree. Second, there is a well-documented need for doctoral prepared nurses to teach in nursing programs at all levels in managing client-care settings. Third, curricula quality and consistency is a priority in nursing education. Fourth, there are numerous templates on nursing doctoral education available. The historical background of nursing doctoral education was also reviewed, with the assumption that it can be used to inform the dental hygiene discipline when establishing doctoral dental hygiene education. The authors recommend that with the current changes toward medically and socially compromised patient populations, impending changes in health care policies and the available critical mass of master degree-prepared dental hygiene scholars ready to advance the discipline, now is the time for the dental hygiene discipline to establish doctoral education.

Developing a scholarly identity and building a community of scholars.

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

Influence of continuing education on dental hygienists' knowledge and behavior related to oral cancer screening and tobacco cessation.

PURPOSE: There are more than 35,000 new cases of oral and pharyngeal cancers (OPC) diagnosed each year. Most OPCs are diagnosed in advanced stages, requiring aggressive treatment and resulting in higher morbidity and mortality than when diagnosed early. The overall 5 year survival rate of OPC is about 60%. Early detection of OPC lesions are the key to survival. A major risk factor for OPC is chronic tobacco use. The purpose of this paper is to report changes in dental hygienists' knowledge, attitudes and behaviors 6 months after attending a standardized lecture format continuing education (CE) course on early OPC detection and tobacco cessation counseling compared to baseline values. METHODS: A total of 64 CE courses were given for dental professionals throughout the 10 U.S. public health districts to determine if OPC screenings and tobacco cessation counseling behaviors could be modified at 6 months post-training. Questionnaires were obtained at baseline and 6 months later using a pre-/post-test design. RESULTS: A total of 1,463 dental hygienists participated at baseline and 543 at a 6 month follow-up. Data showed a significant difference in knowledge and behavior compared to baseline values. CONCLUSION: CE appeared to have a significant influence on participants' OPC and tobacco cessation knowledge and behavior, and could potentially make a difference on prevention, early detection and ultimately on OPC control.

Oral health perceptions of paediatric palliative care nursing staff.

Systematic oral care reduces oral complications among children in paediatric palliative care (PPC), yet little is known about the oral health perceptions of PPC nursing staff. This qualitative cross-sectional study used semi-structured interviews based on phenomenography to explore PPC nursing staff's perceptions of oral health and the relationship of oral care to comfort and quality of life. A purposive sample of nine nursing staff employed at a California PPC facility participated. Five themes emerged from the analysis of the interviews: signs of oral health, reasons for oral care, adaptation of oral care on a case-by-case basis, barriers to providing oral care, and facilitators of improving oral care. The perceived importance of oral health was the underlining similarity between the themes. A need for further research in the area of oral PPC is indicated. Collaboration with dental professionals may be needed to create oral PPC guidelines that fit the complex needs of children with life-limiting illnesses.

A brief motivational intervention for heavy alcohol use in dental practice settings: rationale and development.

Although brief alcohol interventions have proven effective in a variety of health care settings, the present article describes the development of the first brief intervention for heavy drinkers in dental practice. Elements of motivational interviewing and personalized normative feedback were incorporated in a 3- to 5-minute intervention delivered by dental hygienists. The intervention is guided by a one-page feedback report providing personalized normative feedback regarding the patient's current oral health practices, their drinking in comparison to others, and oral cancer risk associated with current smoking and drinking. Future publications will present data regarding intervention effectiveness from an ongoing randomized trial.

Dentists' attitudes, behaviors, and barriers related to tobacco-use cessation in the dental setting.

OBJECTIVE: This study assessed attitudes, behaviors, and barriers among general dentists in California, Pennsylvania, and West Virginia, related to patient tobacco cessation counseling. METHODS: From 2004 to 2008, a baseline survey was mailed to 271 study dentists randomly selected from a master Delta Dental Insurance Company provider list in each state who had agreed to participate in a tobacco cessation randomized clinical trial. Four backward logistic regression models assessed correlates of the five As related to tobacco cessation: Asking about tobacco use, Advising users to quit, Assessing readiness to quit, Assisting with quitting, and Arranging follow-up. RESULTS: Most respondents (n=265) were male, had practiced dentistry for over 15 years, asked about tobacco use (74%), and advised tobacco users to quit (78%). Only 19% assessed readiness to quit; 39% assisted with quitting; 4% arranged follow-up; and 42% had formal training in tobacco cessation. Believing that tobacco cessation counseling was an important professional responsibility, practicing <15 years, and asking about tobacco use significantly related to advising users to quit. Providing cessation advice and feeling effective intervening related to assessing readiness to quit. Advising users to quit, assessing readiness to quit, feeling effective intervening, and having had formal tobacco cessation training related to assisting with quitting. Barriers to cessation counseling were perceived patient resistance (66%), lack of insurance reimbursement (56%), not knowing where to refer (49%), and lack of time (32%). CONCLUSION: Study dentists reported not fully performing the five As. Advising, assessing, having formal training, and feeling effective increased the likelihood of cessation counseling.

The effect of training on the use of tobacco-use cessation guidelines in dental settings.

BACKGROUND: An increase in the number of dentists conducting tobacco-use cessation treatment is needed. The authors assessed the effects of high-intensity training (HIT) or low-intensity training (LIT) and reimbursement on general dentists' tobacco-use-related attitudes and treatment behaviors. METHODS: The authors randomly selected 265 dentists in three states and assigned them to one of five groups: HIT workshop groups with and without tobacco-use cessation counseling reimbursement, LIT mailed self-study groups with and without reimbursement or a control group. Outcomes at follow-up were dentists' self-reported tobacco-use-related attitudes and behaviors and patients' reports of dentists' behaviors. RESULTS: Significantly more dentists in the intervention groups reported having positive attitudes and behaviors at follow-up than did dentists in the control group. Dentists in the HIT groups, however, reported assessing patients' willingness to quit and assisting them with the quitting process significantly more often than did dentists in the LIT groups. Significantly more patients of dentists in the intervention groups who used tobacco reported receiving advice and assistance from their dentists than did patients of dentists in the control group. Adding reimbursement to HIT or LIT conditions did not provide additional intervention effect. CONCLUSION: Dentists trained by means of a workshop or self-study program used components of a recommended guideline more frequently and felt more positive toward tobacco-use cessation counseling than did dentists in the control group. CLINICAL IMPLICATIONS: Although the workshop training was more successful than the self-study training, the latter's reach among dentists could have a more significant public health impact. The effect of reimbursement needs further study.

Smokeless tobacco cessation cluster randomized trial with rural high school males: intervention interaction with baseline smoking.

INTRODUCTION: Adolescent males in rural areas use smokeless tobacco (ST). We assessed the efficacy of a school-based nurse-directed ST intervention among rural high school males. METHODS: Study high schools were randomly selected from a public high school list of California rural counties. Consenting high schools were stratified by school size and randomly assigned within strata to intervention or no-intervention groups. After gaining parental consent, male students completed baseline and 1-year follow-up questionnaires. The intervention included peer-led educational sessions and an oral exam by the school nurse who also provided brief tobacco cessation counseling. We used binary generalized estimating equation (GEE) models accounting for clustering within schools to test no difference between groups after adjusting for year in high school using both completers only and multiple imputation for those lost to follow-up. Subgroup analyses assessed Baseline Factor x Group interaction in GEE models. RESULTS: Twenty-one rural counties (72%), 41 randomly selected high schools (56%), and 4,731 male students (50%) participated with 65% retention. Nonsmoking ST users in the intervention group were significantly more likely to stop using ST at follow-up than those in the no-intervention group; there was no intervention effect among baseline ST users who also smoked. A higher percentage of baseline nonsmoking ST users reported smoking at follow-up than baseline non-ST-using smokers who reported using ST. DISCUSSION: A school-based nurse-directed ST cessation program was efficacious among rural nonsmoking ST-using high school males. The potential program reach holds significant public health value. Baseline ST use facilitated smoking at follow-up.

Dentists' attitudes and practices related to diabetes in the dental setting.

OBJECTIVE: The objective of this study was to determine general dentists' attitudes and practices related to patients with diabetes, a major public health issue with oral complications. METHODS: This study was a cross-sectional survey of 265 randomly selected general dentists who were Delta Dental providers in California, West Virginia, and Pennsylvania. RESULTS: Sixty-one percent of respondents believed that addressing diabetes was important to their role as a dentist, 86 percent advised patients with diabetes about periodontal risks, 18 percent provided diabetic-related services, 47 percent reported they knew how to assess for diabetes, and 42 percent felt well prepared to intervene with patients with diabetes. Adjusting for number of patients with diabetes and adult patients seen in the past month, dentists' formal training in diabetes assessment and management [odds ratio (OR) = 4.0, P = 0.000, confidence interval (CI) = 1.9, 8.5], and belief in the importance of their role as a dentist to intervene with patients with diabetes (OR = 1.6, P = 0.011, CI = 1.1,2.3) were both significant factors in providing services for patients with diabetes. Similarly, dentists' formal training (OR = 3.0, P = 0.02, CI = 1.2, 7.3) and belief in the importance of their role (OR = 1.9, P = 0.00, CI = 1.3, 2.6) were both significant factors in advising patients with diabetes about periodontal risk associated with diabetes. CONCLUSIONS: Formal training and personal beliefs are important factors related to dentists' behavior toward patients with diabetes in the dental setting.