The Impact of Community Rotations on the Cultural Competence of Dental Hygiene Students in the State of Texas.

Purpose: Culturally competent health care providers understand cultural attitudes, values, beliefs and practices and are able to use this knowledge to guide patient care. Rising oral health disparities among racial and ethnic minorities require that dental educators emphasize the attainment of cultural competence in order to prepare students to effectively care for patients with backgrounds different from their own. This study investigated the role of community rotations on the cultural competence of second-year Texas dental hygiene students.Methods: A modified version of the validated self-assessing Clinical Cultural Competency Questionnaire (CCCQ) was given to students at twelve Texas dental hygiene programs with a 100% response rate (239/239). Data analysis was performed using the Kendall tau correlation for associations and Kruskal-Wallis and Mann-Whitney U tests for differences among and between groups.Results: Students scored highest in attitude (86th percentile). Time spent in community rotations (p=0.009), number of community rotations (p=0.028), racial/ethnic diversity of program clinic patients (p=0.042), and training hours (p=0.044) were associated with increased cultural competence scores. Students with over 50 community rotation hours (p=0.006) scored significantly higher than students with less than 50 hours. Generally, those with four rotations (p=0.002) scored highest. Those with public clinic (p=0.049) and school (p=0.044) rotations scored significantly higher than those without these experiences. Those with nursing home (p=0.009) and hospital (p=0.026) experience scored lower than those without these experiences. Students seeing the most racially/ethnically diverse patients in program clinics scored higher (p=0.014) than students seeing less diverse patients. Those with 6-10 training hours scored higher (p=0.013) than those with other training levels. Hispanics scored significantly higher than whites in skill and overall cultural competence (p≤ 0.005).Conclusion: Dental hygiene programs should invest time in cultural competence training and choose a robust program of community rotations, while considering the diversity of the student body and clinic patient pool to enhance graduates' cultural competence.

Current prescribing Practices for Antibiotic Prophylaxis: A Survey of Dental Practitioners.

AIM: Antibiotic prophylaxis guidelines have been developed for health care and dentistry. The authors examined whether dentists were following the 2007 American Heart Association (AHA) and the 2012 American Association of Orthopaedic Surgeons (AAOS) recommendations for antibiotic prophylaxis. MATERIALS AND METHODS: A survey was sent to 600 dentists in the south-central region of the United States. The survey examined dentists' prescribing practices for patients with cardiac and prosthetic joint replacements, antibiotic regimen prescribed, confidence in their prescription decisions, and dentistry's contribution to antibiotic resistance. RESULTS: The response rate was 28.7% (n = 172). Dentists followed the 2007 AHA guidelines for patients with a history of infective endocarditis (95%), and cardiac valves repaired with prosthetic materials (76%) or animal/donor tissue (61%). For prosthetic joint replacement, 72% prescribed antibiotic prophylaxis within the first 2 years after placement and 58% continued to prescribe after 2 years. Amoxicillin was the most frequently prescribed antibiotic for cardiac conditions (92%) and prosthetic joint replacements (77%). No significant differences were found in relation to dentists' gender (p = 0.75), year of graduation (p = 0.71), scope of practice (p = 0.30), and their confidence in their prescription decisions; 73% believed taking multiple doses of antibiotics leads to antibiotic resistance. CONCLUSION: The majority of dentists were following the 2007 AHA guidelines. Confusion regarding the 2012 AAOS guidelines for prosthetic joint replacement was evident. CLINICAL SIGNIFICANCE: Keeping current with changing antibiotic prophylaxis guidelines ensures dentists are providing the best evidence-based dentistry for their patients.

Attitudes towards students who plagiarize: a dental hygiene faculty perspective.

The purpose of this study was to examine baccalaureate dental hygiene faculty members' attitudes and practices regarding student plagiarism. An email containing a link to a thirty-two-item survey was sent to fifty-two baccalaureate dental hygiene program directors in the United States; thirty of those agreed for their faculty members to participate. Of the 257 faculty members who received the survey link, 106 completed the survey, for a response rate of 41.2 percent. The responding faculty members reported thinking plagiarism is a rising concern in their dental hygiene programs (54.5 percent, 54/99). The majority said they check for plagiarism on student class assignment/projects (67.1 percent, 53/79). For those who did not check for plagiarism, 45.8 percent (11/24) stated it took "too much time to check" or it was "too hard to prove" (16.6 percent, 4/24). The most frequent form of student plagiarism observed by the respondents was "copying directly from a source electronically" (78.0 percent, 39/50). Most respondents reported checking for plagiarism through visual inspection (without technological assistance) (73.0 percent, 38/52). Of those who said they use plagiarism detection software/services, 44.4 percent (16/36) always recommended their students use plagiarism detection software/services to detect unintentional plagiarism. For those faculty members who caught students plagiarizing, 52.9 percent (27/51) reported they "always or often" handled the incident within their dental hygiene department, and 76.5 percent (39/51) said they had never reported the student's violation to an academic review board.

The ethics of live patient use in dental hygiene clinical licensure examinations: a national survey.

A national survey of dental hygienists was conducted to explore ethical issues arising from the use of live patients for dental hygiene clinical licensure examinations. Data were collected regarding respondents' demographics, additional costs they incurred associated with their examination beyond the examination fees, delays in patients' treatment resulting from the examination, unethical candidate and/or patient behaviors they experienced, and provisions they made for patients' follow-up care related to the examination. Five hundred surveys were mailed to dental hygienists from two states in each of the five licensure examination regions. The response rate was 40.6 percent (n=203). Descriptive statistics were used to analyze the data. The results showed that the majority of the respondents spent additional money on examination-related expenses (69.2 percent). Sixty-one percent of the respondents reported paying their patients; however, only 50.5 percent felt such a practice was acceptable. More than half (53.1 percent) reported believing it was appropriate to delay treatment in order to have a patient participate in the examination, although only 16.4 percent reported actually delaying treatment. Informed consent was said to be obtained by 94.9 percent of the respondents. The majority (86.6 percent) said they referred patients for follow-up dental hygiene care. When asked if they felt the examination was an accurate assessment of their clinical skills, 78.7 percent of the respondents agreed that it was.

Dimensions of oral care management in Texas hospitals.

PURPOSE: There is a growing body of evidence that suggests improved oral health can help patient outcomes in hospitals. Yet there are indicators that oral care in hospitals is less than ideal. This study was conducted to quantify and qualify the dimensions of oral care in Texas hospitals with a focus on the dental knowledge, attitudes and practices of nurses and barriers to providing such care. METHODS: A random sample of 582 registered nurses, licensed and employed in Texas, was surveyed about oral care attitudes, practices and knowledge. Frequencies and Spearman correlations were used to describe and analyze the data with SPSS. RESULTS: Ninety-eight respondents returned surveys for a 16.8% response rate. Of these, 52% reported their nursing education did not ("minimally/not at all") prepare them for oral care management. However, they felt oral health was important (95%), felt responsible for oral care (79%) and assessed the oral cavity of their patients (78.6%). Although they reported being "knowledgeable" or "very knowledgeable" about oral health management (67%), their score on the knowledge questions was low (mean=51%, sd=0.132). There was not a significant correlation between the knowledge scores and education levels (ρ=0.136, p>0.05) or knowledge scores and work areas (ρ=-0.080, p>0.05). They also reported such barriers as low priority for oral care, lack of time, no mandate and the need for more resources. CONCLUSION: This study revealed that nurses experienced a disconnect between feeling responsible yet somewhat incapable and/or ill-prepared to provide adequate oral care for their patients. This suggests a possible need for revising nurse education, hospital requirements and protocols for performing oral care and employing dental professionals in hospitals.

The nonmedical use of prescription stimulants among dental and dental hygiene students.

The purpose of this study was to determine the nonmedical use of prescription attention deficit disorder (ADD) stimulant medication among dental and dental hygiene students. A questionnaire was used to examine demographic information, student experiences, and perceptions of prescription stimulant medication and to determine if students used a prescription stimulant nonmedically. In 2008, 401 surveys were mailed to dental education institutions in the south-central region of the United States, and 243 surveys (61 percent) were returned. The survey found that 12.4 percent of these students used a prescription stimulant nonmedically and, of those, 70 percent took it to improve attention and/or concentration. The most commonly reported stimulant medication used nonmedically was Adderall (77 percent). The majority (87 percent) of the students obtained the medication through friends, and 90 percent began using the drug in college. Even though 74 percent of the students reported being stressed, chi-square analysis found no significant association between nonmedical use of ADD stimulant medication and stress level (p=0.585). Sixteen percent of the students surveyed felt it was easy to obtain stimulant medication for nonmedical use at their school, and 17 percent thought it was a problem within their institution. These results may help administrators and faculty members become aware of potential problems with the misuse of ADD stimulant medication.

Factors affecting the performance of oral cancer screenings by Texas dental hygienists.

PURPOSE: The 5 year survival rates for oral cancer have not changed in the last 50 years. A simple intra- and extra-oral examination provided by health care professionals could help to reduce morbidity and mortality of oral cancer. This study focused on Texas dental hygienists' performance of oral cancer screenings (OCS) and factors that influenced their performance of this examination. METHODS: A 33 question survey of 608 randomly selected Texas dental hygienists was conducted. Frequency, chi-square and Spearman correlation tests were performed. RESULTS: Three hundred and six hygienists replied and provided the data for this study. The data indicated that 45.8% "always" performed OCS, 23.5% performed OCS at the initial appointment and 47.4% at the recall appointment. Experience and comfort level were the greatest influences on OCS performance. Dental hygienists practicing for 16 or more years performed OCS 51.2% of the time, while those with only 0 to 5 years of experience performed OCS 25.5% of the time. A statistically significant correlation (ρ=0.15, p<0.007) was found be tween years of experience and performance of OCS. A significant correlation (ρ=0.18, p<0.001) was found between the identification of a suspicious lesion and the performance of OCS. Forty-nine percent of dental hygienists reported feeling "very comfortable" with intra-oral examinations, but only 26.5% felt "very comfortable" with extra-oral examinations. A statistically significant correlation (ρ=0.16, p<0.001) was found between comfort level in the performance of an OCS and reported frequency of OCS. The majority of subjects performed poorly on the knowledge portion of the survey (mean=53%). There was a significant correlation (ρ=0.22, p<0.001) between attendance at OCS continuing education courses and the performance of OCS. CONCLUSION: Dental hygienists' knowledge about oral cancer was not current and comfort levels with performing OCS were low. These indicate a need for a stronger emphasis on the importance of OCS for students during dental hygiene education and a more thorough continuing education for practicing dental hygienists.

Allied dental and dental educators' perceptions of and reporting practices on academic dishonesty.

Highly publicized reports and current research on cheating in dental schools and dental hygiene programs have created a resurgence of proactive measures in the deterrence of academic dishonesty. A majority of administrators and faculty members are of the opinion that cheating does occur at their schools and may have been personally involved with incidents of cheating through observation or student reporting. With the information age and the diverse makeup of today's student body, there may be differences in what is considered academic dishonesty between students and educators. The purpose of this study was to elicit perceptions on those differences, ascertain the number of cheating incidents that educators personally witnessed or about which they received information, and determine how they resolved those incidents. Another aim of this study was to determine if having an honor code, adequate ethics training, honor pledges, dialogue in the classroom, and formal due process policy were related to the number of cheating incidents. Surveys were distributed at the educational program of the American Dental Education Association (ADEA) Section on Dental Hygiene Education at the 2009 ADEA Annual Session & Exhibition. Results show the majority of these educators had had experience with cheating occurrences and believe that there are disparities between students and educators and among cultural groups in defining academic dishonesty. No differences or patterns emerged between academic integrity characteristics and occurrences or reports of cheating.

What victims of domestic violence need from the dental profession.

Most dental schools teach students about domestic abuse, but it is unknown if this information is ever applied in practice. This study was conducted to determine whether domestic violence victims 1) visited dental offices when signs of abuse were present; 2) were asked about their injuries; 3) were given referrals or assistance; and 4) want the abuse recognized by and discussed with the dental professional. A survey was developed and mailed to fifteen shelters. Eleven (73.3 percent) shelters participated, with a total of 112 out of 165 (67.8 percent) surveys returned. Descriptive statistics were analyzed, and an ANOVA test was conducted to determine if a relationship existed between the incidence of abuse and ethnicity. Seventy-six percent of respondents had suffered physical abuse in the head and neck area. Over half of the participants had seen a dentist when signs of abuse were present, yet 88.6 percent were not asked about their injuries. In addition, 69.2 percent responded that they would have liked to have been asked about their injuries. It appears that the dental profession needs to take a more active role in the recognition of domestic violence in their patient populations. Raising dentists and dental hygienists' awareness of the problem and potentially increasing the number of referrals may help more victims.

The prevalence of academic dishonesty in Texas dental hygiene programs.

The media has given much attention to the academic cheating crisis in America. A majority of college students believe that, in today's global environment, it is necessary to cheat in order to get ahead and to compete with their peers. The prevalence and attitudes concerning academic dishonesty of health professions students, including those in medical, dental, and nursing schools, have been extensively researched. No such studies exist in the discipline of dental hygiene. The purpose of this study was to investigate the prevalence of cheating in Texas dental hygiene programs. Four hundred surveys were mailed to twenty Texas dental hygiene schools for graduating students to complete. A total of 289 usable surveys was returned for a response rate of 72.25 percent. Data were analyzed using SPSS with frequencies and chi-square tests. Findings from this study reveal that 86.5 percent of graduating Texas dental hygiene students have cheated a minimum of one time during matriculation. Students identified the demands of what they considered academic overload as the primary justification for cheating behavior.

Disciplinary actions associated with the administration of local anesthetics against dentists and dental hygienists.

PURPOSE: Research studies have demonstrated the need for and the ability of dental hygienists to provide local anesthetics for pain control and reduction of patient anxiety. Although two-thirds of state dental practice laws allow these services to be performed by dental hygienists, controversy exists between organized dentistry and dental hygiene regarding the administration of local anesthetics by dental hygienists. Some dentists believe the quality of care would be compromised and patient safety jeopardized because dental hygienists do not have adequate background knowledge to prevent complications and recognize emergencies caused by anesthetics. The purpose of this study was to collect quantitative data addressing safety when dental hygienists administer local anesthetics. RESULTS: Eighteen responses were received, for a response rate of 69%. These data showed, over a 10-year period, no reports of disciplinary actions against dental hygienists for the administration of local anesthetics. CONCLUSION: This study affirmed public safety, which should be helpful to states considering statutes to allow the administration of local anesthetics by dental hygienists. Results suggest that properly educated dental hygienists in the states surveyed have administered local anesthetics to patients without harm.

How well prepared are Texas dental hygienists to recognize and report elderly abuse?

The elderly are the nation's fastest-growing population, and the number of elder abuse victims has reached epidemic proportions. In Texas, dentists and dental hygienists are mandated by law to report suspected abuse. This study surveyed Texas dental hygienists regarding elder abuse education received in dental hygiene school and post-graduation. Respondents were also asked to self-assess their knowledge level in recognizing the six types of elder abuse and to answer questions regarding Texas law and mandatory reporting of abuse. A survey designed for this study was mailed to 780 Texas licensed dental hygienists, representing 10 percent of the Texas dental hygiene population. Respondents were selected using a computer-generated random sample. A second mailing was sent to nonrespondents to prevent response bias. Results were analyzed using Statistical Programs for Social Scientists (SPSS). Over one-half of the respondents (56 percent) stated that abuse education was not part of their dental hygiene school curriculum. Only 46 percent of the respondents who replied that abuse education had been included in the curriculum were educated on elder abuse. A majority of respondents stated they lacked knowledge in recognizing the six types of elder abuse, and 81 percent of respondents reported being unknowledgeable about reporting elder abuse. The current status of elder abuse education in dental hygiene programs and post-graduation is insufficient. Dental hygienists have an obligation to become knowledgeable in recognizing and reporting elder abuse in order to provide complete care for their patients.