A review of the global literature on dental therapists.

OBJECTIVE: Access to adequate oral health care is deficient in many parts of the world. Many countries are now using dental therapists to increase access, particularly for children. To inform the discussion on dental therapists in the workforce, particularly in the United States, the W.K. Kellogg Foundation funded a review of the global literature to identify as many documents as possible related to the practice of dental therapists since the establishment of the School Dental Service in New Zealand in 1921. METHODS: Consultants in each of the countries considered to have a substantive literature on dental therapists were asked to participate in the research; seventeen in total. In addition to identifying and reviewing published articles, a focus of the research was on identifying 'gray' documents. Standard databases were searched for key words associated with dental therapists. In addition, searches were conducted of the governmental and dental association websites of all countries known to have dental therapists in their oral health workforce. RESULTS: Fifty-four countries, both developing and developed, were identified where dental therapists are members of the workforce. Eleven hundred documents were identified from 26 of these countries, with over 2/3 of them cited in the published monograph. Reliable evidence from the related literature and verbal communication confirmed the utilization of dental therapists in an additional 28 countries. Thirty-three of the countries were members of the Commonwealth of Nations, suggesting a mechanism of spread from New Zealand. Variable lengths of training/education existed for dental therapists with the tradition being 2 years postsecondary. In a few countries, the training of therapists and hygienists is now being combined in a three academic year program. Historically, dental therapists have been employed by government agencies caring for children, typically in school-based programs. Initiatives in some countries allow limited care for adults by dental therapists with additional training. CONCLUSIONS: The evidence indicates that dental therapists provide effective, quality, and safe care for children in an economical manner and are generally accepted both by the public and where their use is established, by the dental profession.

A randomized controlled trial of home tooth-whitening products.

PURPOSE: To evaluate the effectiveness of two marketed home tooth-whitening products. METHODS: A randomized controlled clinical trial involving 87 adults who were randomly allocated into one of three groups: (1) 6% hydrogen peroxide whitening strips, (2) 18% carbamide peroxide whitening gel, and (3) a placebo (fluoride toothpaste) control group. Subjects were instructed individually and then used the given product daily for 2 consecutive weeks. Color was determined in brightness (L*), yellowness (b*) and redness (a*) [color space] at baseline and 8 weeks after dispensing the product by employing a high resolution digital camera (Fuji HC1000 CCD) to image the subject's anterior maxillary teeth under standard polarized lighting conditions. The subjects also completed a questionnaire on self-satisfaction with the treatment outcome. RESULTS: One-way ANOVA (Bonferroni test) demonstrated significant differences in color between the three groups with changes in brightness (L*, P< 0.001), yellowness (b*, P< 0.001) and redness (a*, P < 0.001). Changes in L* a* b* was greatest among those who used the 6% hydrogen peroxide whitening strips. Subjects in the whitening strip group also rated that product significantly (P < 0.01) more favorably than other groups with respect to the amount of whiteness improvement, as well as whitening satisfaction and overall impression while there is no significant difference between the whitening gel and the placebo groups.

Developing a short form of Oral Health Impact Profile (OHIP) for dental aesthetics: OHIP-aesthetic.

OBJECTIVES: To develop and evaluate shortened forms of the Oral Health Impact Profile (OHIP) for discriminating dental aesthetics problems and evaluating dental aesthetic outcomes. METHODS: Eighty-seven subjects self-completed the 49-item OHIP at baseline and 63 at follow up (8 weeks later), with the intervention of applying an array of tooth-whitening products. Expert-based approach and regression analysis (on baseline data) were undertaken to derive two subset questionnaires (OHIP-conceptual and OHIP-regression). Their discriminatory ability for dental aesthetics and their responsiveness to tooth whitening were compared with the original OHIP-49, Slade's OHIP-14 and a Chinese short-form version of OHIP. RESULTS: The measures developed were strongly associated with self-rating of dental aesthetics (P < 0.001) unlike OHIP-49 (P = 0.03) or other OHIP short forms (P > 0.05). The measures were also reliable (Cronbach's alpha 0.86) and comparable with the other OHIP forms. In terms of effect size, OHIP-conceptual was more effective in measuring changes than the one based on the regression analysis, the original OHIP-49, OHIP-14 and the Chinese version of the short-form OHIP. It also exhibited a less susceptibility to floor effects than other OHIP forms. CONCLUSION: A modified short form of the OHIP derived (OHIP-conceptual) was the most favorable in discriminating dental aesthetics, was reliable and most sensitive to the dental aesthetics intervention - tooth whitening.