The Effects of Dental Hygiene Instrument Handles on Muscle Activity Production.

Purpose The objective of this study was to compare the effects of ten commercially available instrument handle designs' mass and diameter on forearm muscle activity during a simulated periodontal scaling experience.Methods A convenience sample of 25 registered dental hygienists were recruited for this IRB-approved study. Ten commercially available instruments were categorized into four groups based on their masses and diameters: large diameter/light mass, small diameter/light mass, large diameter/heavy mass, and small diameter/heavy mass. Participants were randomized to four instruments with one from each group. Participants scaled with each instrument in a simulated oral environment while muscle activity was collected using surface electromyography. Muscle activity was compared among the four instrument group types.Results Muscle activity of the flexor digitorum superficialis was not significantly influenced by instrument mass (p=0.60) or diameter (p=0.15). Flexor pollicis longus muscle activity was not significantly influenced by instrument mass (p=0.81); diameter had a significant effect (p=0.001) with smaller diameter instruments producing more muscle activity. For the extensor digitorum communis and extensor carpi radialis brevis, instrument mass did not significantly affect muscle activity (p=0.64, p=0.43), while diameter narrowly failed to reach significance for both muscles (p=0.08, p=0.08); muscle activity for both muscles increased with smaller diameter instruments.Conclusion Results from this study indicate instrument diameter is more influential than mass on muscle activity generation; small diameter instruments increased muscle activity generation when compared to large diameter instruments. Future research in real-world settings is needed to determine the clinical impact of these findings.

Color-Blind Racial Attitudes in Entry-Level Dental Hygiene Students in Virginia.

Purpose Subscribing to color-blind racial attitudes may contribute to inequities in the delivery of oral care and affect treatment of diverse patients. The purpose of this study was to survey all entry-level dental hygiene students in one state to determine color-blind racial attitudes.Methods After IRB approval, a convenience sample of 220 dental hygiene students in all entry-level programs in Virginia were invited to participate in this cross-sectional study. The Color-Blind Racial Attitudes Scale (CoBRAS), an effective, validated measuring instrument, was used to quantify unawareness of contemporary racist ideals. Three subscales (Racial Privilege, Institutional Discrimination, and Blatant Racial Issues) were also measured by the survey. Descriptive statistics, separate one-way between-subjects ANOVA, and independent samples t-tests were used to analyze the data.Results One hundred and sixty (n=160) dental hygiene students completed the survey. Independent samples t-tests revealed statistically significant differences when comparing year in program and program type. Participants in their second year of dental hygiene education had significantly lower overall CoBRAS scores compared to those in their first year of education (M=50.76, M=59.13, respectively; p=0.004). Participants enrolled in a baccalaureate dental hygiene (B.S.) program had significantly lower overall CoBRAS scores compared to those enrolled in an associate (A.S.) program (M=50.53, M=59.54, respectively; p=0.002).Conclusion Participants possessed moderate levels of color-blindness suggesting a need for more awareness and training early in dental hygiene education to increase delivery of culturally competent oral healthcare.

The effects of dental hygiene instrument handles on muscle activity production.

OBJECTIVE: The objective of this study was to compare the effects of 10 commercially available instrument handle designs' mass and diameter on forearm muscle activity during a simulated periodontal scaling experience. METHODS: A convenience sample of 25 registered dental hygienists was recruited for this IRB-approved study. Ten commercially available instruments were categorized into four groups based on their masses and diameters: large diameter/light mass, small diameter/light mass, large diameter/heavy mass and small diameter/heavy mass. Participants were randomized to four instruments, one from each group. Participants scaled with each instrument in a simulated oral environment while muscle activity was collected using surface electromyography. Muscle activity was compared among the four instrument group types. RESULTS: Muscle activity of the flexor digitorum superficialis was not significantly influenced by instrument mass (p = 0.60) or diameter (p = 0.15). Flexor pollicis longus muscle activity was not significantly influenced by instrument mass (p = 0.81); diameter had a significant effect (p = 0.001), with smaller diameter instruments producing more muscle activity. For the extensor digitorum communis and extensor carpi radialis brevis, instrument mass did not significantly affect muscle activity (p = 0.64, p = 0.43), while diameter narrowly failed to reach significance for both muscles (p = 0.08, p = 0.08); muscle activity for both muscles increased with smaller diameter instruments. CONCLUSION: Results from this study indicate instrument diameter is more influential than mass on muscle activity generation; small diameter instruments increased muscle activity generation when compared to large diameter instruments. Future research in real-world settings is needed to determine the clinical impact of these findings.

Pinch force generation during scaling by dental professionals: A systematic review.

OBJECTIVE: The objective of this review was to examine the impact of instrument designs on pinch force generation during scaling by dental professionals. METHODS: Three databases were utilized from September 2019 to November 2021 in addition to hand-searching specific journals and reference lists. Research articles that examined pinch force generation in dental professionals during scaling with manual instruments only were included. Bias was assessed in the individual articles. RESULTS: Six research articles were included with sample populations that varied from 12 to 24 participants. Four articles evaluated instrument designs in relation to pinch force generation during scaling by dental professionals. Two articles evaluated the clinicians' experience levels and the impact on pinch force generation. Results of three articles revealed instruments with large diameters and low weights produced the least amount of pinch force (p < 0.05). Additionally, two articles found instruments with a round, tapered shape produced less pinch force and instrument handles made of silicone produced higher pinch strength post-scaling (p < 0.05). One study indicated instrument designs associated with modified scaling techniques may reduce thumb and index finger pinch force (p < 0.05). CONCLUSION: The findings from this review indicate weak evidence for instrument choices to reduce pinch force during scaling. Dental professionals should consider lightweight and large diameter instruments for manual scaling. Clinicians may also want to consider round, tapered handles and instrument designs with modified scaling techniques. This systematic review further identified the need for clinical research studies with rigorous research designs that examine the ergonomic impacts of instrument designs.

Color-Blind Racial Attitudes in Practicing Dental Hygienists.

Purpose: Individuals who subscribe to a color-blind racial ideology may not be aware of differences or differential treatment based on race which may be related to racial inequality in the delivery of oral health care. The purpose of this study was to determine color-blind racial attitudes in a convenience sample of clinical dental hygienists.Methods: A convenience sample of practicing dental hygienists recruited through social media via snowball sampling was invited to participate in this cross-sectional survey study. The Color-Blind Racial Attitudes Scale (CoBRAS), a valid and reliable measuring instrument, was used to determine unawareness of racial attitudes and stereotyping. Three subscales (Racial Privilege, Institutional Discrimination, and Blatant Racial Issues) were measured by the survey. Descriptive statistics and separate one-way between-subjects ANOVA were used to analyze the data.Results: Two-hundred and thirty-three (n = 233) dental hygienists in clinical practice completed the survey. ANOVA revealed statistically significant differences in overall CoBRAS scores when comparing age groups and ethnicities. Participants aged 18-29 had significantly lower overall CoBRAS scores compared to participants aged 60 and over (x = 49.41, x = 59.17, respectively; p = .019). African American participants scored significantly lower on overall CoBRAS scores compared only to those in the Other ethnicity category (x = 42.27, x = 62.08, respectively; p = .029).Conclusion: Participants possessed moderate levels of color-blindness, suggesting unawareness of racism and a need to understand the implications of racism as a means of promoting equity and improve oral health care delivery. Findings emphasize a need for more research examining color-blind ideology and how it affects oral health care delivery to diverse patient populations.

Attitudes of Virginia Dental Hygienists Toward Dental Therapists.

Purpose: The state of Virginia faces a reported dental health professional shortage affecting approximately half of its residents.The purpose of this study was to assess the opinions and attitudes of dental hygienists in Virginia toward a mid-level dental provider model, dental therapists (DTs), and to determine whether current education level and years of practice affected opinions regarding the education requirements for DTs.Methods: A 22-item questionnaire was distributed online to a convenience sample of Virginia dental hygienists (n=910). Items assessed attitudes of participants toward the DT using a seven-point Likert-type scale ranging from 1 (strongly disagree) to 7 (strongly agree). Participants were asked to provide demographic information and to respond to open-ended questions regarding potential advantages and/or disadvantages to DTs. Independent samples t-tests and chi-square analyses were used to analyze the data.Results: A response rate of 22% was obtained (n=200). Most respondents agreed a DT was needed in Virginia (M=5.78, p<0.001) and supported the concept that dental therapy could be a solution to the problem of access to care issues in Virginia (M=5.97, p<0.001). While most respondents agreed it was important for Virginia to adopt legislation for a dental therapy model (M=5.89, p<0.001), most disagreed that DTs' practice should be restricted to acknowledged underserved areas in the state (M=3.19, p<0.001). No significant association was found between years of practice and opinions toward education requirements for DTs; however, a significant association was found between current education level and opinions toward education requirements for DTs (Fisher's Exact Test=34.17, df=9, p=.000, Cramer's V=.28).Conclusion: Results revealed Virginia dental hygienists had overwhelmingly positive attitudes toward DTs. Research with a larger sample could provide more insight into opinions of the Virginia dental hygienist population regarding this mid-level oral health care provider.

Attitudes of Virginia Dentists Toward Dental Therapists: A pilot study.

Purpose: The purpose of this pilot study was to determine perceptions of Virginia (VA) dentists toward mid-level dental providers, specifically dental therapists (DT), and determine whether membership in the American Dental Association (ADA) membership affected attitudes.Methods: A convenience sample of 1208 dentists in the state of VA were invited to participate in an electronic survey. The instrument consisted of 11 Likert type scale questions assessing attitudes toward DTs. Additional items included the appropriate level of education and supervision of a DT, and five demographic questions. Descriptive statistics were used to analyze the data. A one-sample t-test was used to determine statistical significance for the Likert scale items.Results: An overall response rate of 12% was obtained (n=145). Most respondents were male (73%), members of the ADA (84%), and over the age of 40 (65%). Results suggest that most participants did not perceive (M=1.90, p<0.001) that a DT was needed in VA, and did not support (M=2.08, p<0.001) a DT model provider. Most participants (M=2.01, p<0.001) were not comfortable having a DT perform authorized procedures or ever employing one in their practice (M=1.82, p<0.001). Comfort having a DT perform authorized procedures (b=.63, p<0.001), but not years of practice (b=-.09, p=0.18), was significantly associated with support for this mid-level provider. Additionally, a lower tolerance towards DTs was associated with an increased likelihood of membership in the ADA (b=.14, p=0.04).Conclusion: Virginia dentists surveyed did not perceive a need for DTs and generally reported unfavorable attitudes towards this mid-level provider. Findings support the need for more research with a larger, more diverse sample population.

The Prevalence of Burnout Among Entry-Level Dental Hygiene Program Directors.

Purpose: Workplace burnout in academia is a problem that affects career satisfaction and longevity. The purpose of this study was to determine the prevalence of burnout among entry-level dental hygiene program directors.Methods: The Copenhagen Burnout Inventory (CBI) survey was used to determine prevalence of burnout in 325 dental hygiene program directors from across the United States. The survey was disseminated electronically. The CBI contains 19 questions that measure overall, personal, work-related, and client/student-related burnout on a five-point Likert type scale. The survey also included nine demographic and three open-ended questions related to burnout. Descriptive statistics, one sample t-tests, and one-way ANOVA tests were used to analyze the data.Results: One hundred twenty-seven dental hygiene program directors completed the survey for a 39.1% response rate. Most participants (62.2%, n=79) indicated moderate to high burnout on the personal burnout subscale, approximately one half (51.2%, n=65) on the work-related burnout subscale, and one third (33.1%, n=42) on the client/student-related burnout subscale. No statistically significant differences were found when comparing mean scores between directors of two-year and four-year program or between participants under age 50 and those 50 years of age and older (p-values>0.05). Program directors with teaching workloads of 51-60% had significantly lower burnout on the work-related burnout subscale when compared to participants with teaching workloads of 31-40% (p=0.045). Participants with the lowest workload allocations for administrative duties had higher overall mean burnout scores.Conclusion: Results from this study suggest one out of two dental hygiene program directors have symptoms of some type of burnout with the highest prevalence rate in the personal burnout subscale. Findings underscore the need for further research to identify stressors that lead to burnout as well as identify prevention strategies that promote a healthier work climate for dental hygiene program administrators.

The effects of static seated and standing positions on posture in dental hygiene students: a pilot study.

Background: Musculoskeletal disorders (MSDs) are highly prevalent among dental hygiene professionals. The purpose of this pilot study was to evaluate and compare seated and standing postures during simulated dental hygiene practice to determine ergonomic risks associated with each posture. Methods: A convenience sample of 35 female second-year dental hygiene students with no history of musculoskeletal disorders was enrolled in this IRB-approved study. In 2 separate sessions, 1 seated and 1 standing, participants instrumented 1 quadrant of the mouth in a simulated oral environment. Two images per session, per participant, were taken to evaluate biomechanical demands of each posture using the Rapid Upper Limb Assessment (RULA) tool. The same 4 calibrated researchers scored all images independently and mean scores for each posture were analysed. Results: Thirty-four students completed the study. Results revealed statistically significant (p = 0.001) differences in mean RULA scores between seated (M = 3.91, SD = 0.77) and standing (M = 4.50, SD = 1.00) postures, although these differences may not be clinically relevant. Discussion: When postures were independently assessed, seated postures were more acceptable on average compared to standing postures, yet both were in the unacceptable range. Lack of training in standing postures may have impacted the results. Conclusion: Results support the need for additional ergonomic training in dental hygiene curricula. Less than ideal posture when seated or standing could increase MSD risk. Future research should examine biomechanical loads of seated and standing postures, as well as the combination of these postures, for more insight into their ergonomic benefits and associated MSD risks.

Contexte: Les troubles musculosquelettiques (TMS) sont très répandus parmi les professionnels de l'hygiène dentaire. Cette étude pilote visait à évaluer et à comparer les postures assise et debout dans le cadre de simulations de la pratique de l'hygiène dentaire afin de définir les risques sur le plan de l'ergonomie liés à chacune de ces postures. Méthodes: Dans le cadre de cette étude approuvée par un comité d'examen institutionnel, on a examiné un échantillon de commodité réunissant 35 étudiantes en hygiène dentaire de 2e année sans antécédents de troubles musculosquelettiques. À l'occasion de 2 séances distinctes, une effectuée en position assise et une effectuée en position debout, les participantes ont travaillé sur un quadrant de la bouche dans un environnement oral simulé. On a pris 2 images par séance et par participante pour évaluer les exigences biomécaniques de chacune des postures à l'aide de l'outil d'évaluation rapide des membres supérieurs (RULA). Les 4 mêmes chercheurs calibrés ont attribué une note à toutes les images de façon indépendante. On a ensuite analysé la moyenne de ces notes pour chacune des postures. Résultats: Trente-quatre étudiantes ont participé à l'étude jusqu'à son terme. Les résultats ont révélé des différences statistiquement significatives (p = 0,001) dans les moyennes des notes de l'outil RULA entre les postures assise (M = 3,91, ET = 0,77) et debout (M = 4,50, ET = 1,00). Toutefois, ces différences pourraient ne pas être pertinentes sur le plan clinique. Discussion: Dans le cadre de l'évaluation indépendante des postures, en moyenne, la position assise était plus acceptable que la position debout. Cependant, les 2 postures se trouvaient dans la fourchette de valeurs inacceptables. Il est possible que le manque de formation en position debout ait une incidence sur les résultats. Conclusion: Les résultats confirment la nécessité d'une formation supplémentaire sur l'ergonomie dans les programmes d'hygiène dentaire. Une posture non idéale en position assise ou debout pourrait entraîner une hausse du risque de TMS. À l'avenir, des études devraient examiner les charges biomécaniques des postures assise et debout, ainsi que la combinaison de ces postures, afin de renforcer la compréhension de leurs avantages ergonomiques et des risques de TMS connexes.

Magnification loupes influence on neck and trunk flexion of dental hygienists while scaling-A pilot study.

OBJECTIVE: Work-related musculoskeletal disorders (MSDs) are common in the dental hygiene profession. Awkward postures contribute to MSDs and magnification loupes have been suggested to reduce this risk factor and minimize MSDs. METHODS: After IRB approval, 24 hygienists were enrolled in the study: twelve hygienists wearing loupes with a standard manufacturer determined declination angle (control) and 12 hygienists wearing loupes with a custom measured declination angle (experimental). To measure changes in neck and trunk flexion, accelerometers were placed on the occipital region of head, cervical vertebrae C5, and thoracic vertebrae T5 and baseline posture was recorded. Typodonts with artificial calculus simulated the oral environment. Participants were randomly assigned to wear their designated loupes during the first or second trial of the experiment and scaled in each quadrant (UR, LR, UL, LL) of the mouth for two minutes. Participants completed the scaling task twice: in the loupes and no loupes condition in a counterbalanced order. Three-way mixed design ANOVA was used to determine posture differences in neck and trunk posture. RESULTS: Those wearing custom loupes (M = 16.52, SD = 6.40) had significantly less trunk flexion while scaling compared to hygienists wearing standard loupes (M = 22.27, SD = 6.40), F(1, 22) = 7.14, P = .01. Neck flexion was not significantly affected while scaling between loupes vs no loupes or loupes type condition, (P's > .05). CONCLUSION: Posture was partially impacted by loupes type. Custom loupes resulted in less trunk flexion. Neck flexion was not affected by either loupes type.

The Additive Effects of Cell Phone Use and Dental Hygiene Practice on Finger Muscle Strength: A Pilot Study.

Purpose: The purpose of this study was to determine strength of muscles involved with instrumentation (scaling) by dental hygienists and the additive effects of cellular (mobile) phone usage, as indicated by measurements of muscular force generation.Methods: A convenience sample of licensed dental hygienists currently in clinical practice (n=16) and an equal number of individuals not currently using devices/tools repetitively for work (n=16), agreed to participate in this pilot study. All participants completed a modified cell phone usage questionnaire to determine their use pattern and frequency. Upon completion of the questionnaire, participants' force production in six muscle groups was measured using a hand-held dynamometer. Descriptive statistics were used to analyze the data.Results: A total of 16 licensed dental hygienists (n=16) and 16 participants with no history of using tools/devices repetitively for work (n=16), comprised the experimental and control groups, repectively. The control group generated greater muscle force than the experimental group for the abductor pollicis longus (p=0.045). Significant differences were identified when comparing the low mobile phone users in the experimental group to the control group for the flexor pollicis brevis (p=0.031), abductor pollicis longus (p=0.031), and flexor digitorum (p=0.006), with the control group demonstrating higher muscle force. Years in clinical practice and mobile phone use was shown to have a significant effect on muscular force generation for the flexor pollicis brevis (F=3.645, df=3, p=0.020) and flexor digitorum (F=3.560, df=3, p=0.022); subjects who practiced dental hygiene the longest produced the least amount of muscle force.Conclusion: Results from this pilot study indicate there are no significant additive effects of cell phone use and dental hygiene practice on finger muscles used for instrumentation. However, results indicate that dental hygiene practice demonstrated significant effects on muscular strength as compared to individuals who do not use tools/devices repetitively for work. The small sample size may have impacted results and the study should be repeated with a larger sample.

Color-Blind Racial Attitudes in Dental Hygiene Students: A pilot study.

Purpose: Color-blind racial attitudes and biases have been linked to racial prejudice which may potentially affect dental hygiene care to diverse patients. The purpose of this pilot study was to determine the color-blind racial attitudes of dental hygiene students.Methods: A 20-item, Color-Blind Racial Attitudes Scale (CoBRAS) electronic survey was sent to a convenience sample of 41 first-year and 30 second-year dental hygiene students (n=71) in a dental hygiene program in Virginia. The CoBRAS instrument measures contemporary racial attitudes and stereotyping in three subcategories: Unawareness of Racial Privilege, Institutional Discrimination, and Blatant Racial Issues. CoBRAS scores range from 20-120, with higher scores indicating elevated levels of denial of racism. Descriptive statistics were used to analyze the data.Results: Of the 71 students invited to participate, 70 completed the survey (n=70) for a 98.6% response rate. The majority of respondents were White females (70%, 98% respectively), aged 18-29 (90%). Results indicated an overall average CoBRAS score of 64.89. No statistically significant findings were identified between the two groups in regards to overall scores (p>0.05).Conclusion: A majority of the participants in this pilot study possessed moderate levels of color-blind racial attitudes, suggesting rejection of the concept of racism. Color-blind racial attitudes and biases have been linked to a lack of awareness of White privilege. Further education in this area may foster improved interactions with diverse patient populations.

The Effect of Magnification Loupes on Dental Hygienists' Posture while Exploring.

Purpose: The purpose of this study was to determine the effects of dental magnification loupes on posture during instrumentation.Methods: A convenience sample of 27 right-handed dental hygienists, with no prior history of injuries or disabilities of the head, neck, or trunk region, enrolled in the study. Baseline posture calibration was taken and tri-axial accelerometers were placed on four locations of the head and trunk (occipital region of head; cervical vertebrae C5; thoracic vertebrae T5; lumbar vertebrae L1) to measure acceleration and the orientation of the body to gravity. Participants were randomly assigned to wear self-supplied magnification loupes during either the first or second half of the session. Dental chair mounted typodonts, prepared with artificial calculus, were used to represent a simulated oral environment. Participants were asked to explore all areas of the mouth using an ODU 11/12 explorer. Mean accelerations of the three axes were used to compute average forward/backward (AP) and side to side (ML) tilt of each accelerometer recorded during the instrumentation sessions. An end-user opinion survey was completed by each participant at the conclusion of the session.Results: No statistically significant differences in posture were revealed between the sessions with the participants wearing their loupes and not wearing loupes. However, data from the end-user survey indicate that 74% of all the participants strongly agreed that magnification loupes made exploring easier and 67% strongly agreed that they felt that magnification loupes improved their posture.Conclusion: While the majority of participants perceived that their magnification loupes enhanced their posture and made exploring easier, data from this study provided little evidence to suggest that wearing loupes leads to improved body orientation. Future research needs to examine the declination angle of ergonomic loupes and its relationship to neck and trunk flexion.