Advancing Oral Health Equity through Medical-Dental Integration: Dental hygienists as catalysts for change in an evolving health care system.

This report explores the changing landscape of oral health care delivery in the United States, highlighting the evolving role of dental hygienists. The 2021 National Institutes of Health report "Oral Health in America: Advances and Challenges" has become a key milestone in addressing oral health inequities, acknowledging the important role that dental hygienists could play in expanding innovative care models, and promoting medical-dental integration (MDI). The Rainbow Model of Integrated Care offers a framework to examine facilitators of MDI care models, revealing supportive policies, interprofessional collaborative practice, incremental change, and local leadership as some of the crucial components needed for success. Dental hygienists emerge as catalysts for change, as such, the overarching aim of this report is to contribute to the broader conversation about optimizing oral health care accessibility through integrated care models led by dental hygienists.

Implicit racial bias among dental hygienists practicing in the United States.

PURPOSE: Provider bias has been shown to be a contributing factor to racial and ethnic disparities observed in health care settings. The purpose of this study was to examine implicit racial bias among dental hygienists. METHODS: A convenience sample of licensed and practicing dental hygienists within the United States was recruited through email and national dental hygiene social media groups via snowball sampling. A two-part survey design was used for data collection. Participants completed a 10-item demographic survey through an online platform and were then routed to the Race Implicit Association Test (IAT). Descriptive statistics and linear regression analyses were used to compare demographic data and implicit racial preference scores (d-scores). RESULTS: Data from 404 licensed dental hygienists were included in this study. Over two-thirds (67.8%) of participants showed a preference for European Americans over African Americans. A significant difference was found between implicit racial preference scores and participant age (Estimate: 0.01, 95% CI: 0.00, 0.01), years worked comparing <5 years to 21 or more years (Estimate: 0.19, 95% CI: -0.30, -0.09) and race comparing non-White to White (Estimate: -0.17, 95% CI: -0.27, -0.07). No difference was found with task order, previous Race IAT experience, or previous self-reported implicit bias training. CONCLUSIONS: Findings suggest that dental hygienists may harbor implicit racial preferences for European Americans over African Americans. Non-White participants had more positive implicit preferences toward African Americans compared to White participants. Further research is needed to determine the extent to which implicit racial biases contribute to disparities in oral health.

Implicit Racial Bias Among Dental Hygienists Practicing in the United States.

Purpose Provider bias has been shown to be a contributing factor to racial and ethnic disparities observed in health care settings. The purpose of this study was to examine implicit racial bias among dental hygienists.Methods A convenience sample of licensed and practicing dental hygienists within the United States was recruited through email and national dental hygiene social media groups via snowball sampling. A two-part survey design was used for data collection. Participants completed a 10-item demographic survey through an online platform and were then routed to the Race Implicit Association Test (IAT). Descriptive statistics and linear regression analyses were used to compare demographic data and implicit racial preference scores (d-scores).Results Data from 404 licensed dental hygienists were included in this study. Over two-thirds (67.8%) of participants showed a preference for European Americans over African Americans. A significant difference was found between implicit racial preference scores and participant age (Estimate: 0.01, 95% CI: 0.00, 0.01), years worked comparing <5 years to 21 or more years (Estimate: 0.19, 95% CI: -0.30, -0.09), and race comparing non-White to White (Estimate: -0.17, 95% CI: -0.27, -0.07). No difference was found with task order, previous Race IAT experience, or previous self-reported implicit bias training.Conclusion Findings suggest that dental hygienists may harbor implicit racial preferences for European Americans over African Americans. Non-White participants had more positive implicit preferences toward African Americans compared to White participants. Further research is needed to determine the extent to which implicit racial biases contribute to disparities in oral health.

Medical Dental Integration in Wisconsin: Integrating dental hygienists into pediatric well child visits and prenatal care.

Disparities exist in access to early oral health care, disproportionately impacting minority ethnic groups and populations with low socio-economic status. Medical dental integration provides an opportunity to create a new dental access point for early prevention and intervention as well as care coordination. The Wisconsin Medical Dental Integration (WI-MDI) model expanded early access to preventive oral health services by integrating dental hygienists (DHs) into pediatric primary care and prenatal care teams to address oral health inequities with the goal of reducing dental disease. This case study will describe how DHs were incorporated into the medical care teams in Wisconsin and how legislation expanding scope of practice made this possible. Since 2019, five federally qualified health systems, one non-profit clinic, and two large health systems have enrolled in the WI-MDI project. Thirteen DHs have worked across nine clinics in the WI-MDI project and over 15,000 patient visits to a medical provider included oral health services provided by DHs from 2019 to 2023. Dental hygienists working in alternative practice models such as those demonstrated in the innovative WI-MDI approach are positioned to reduce oral health disparities through the provision of early and frequent dental prevention, intervention, and care coordination.

Pneumonia incidence and oral health management by dental hygienists in long-term care facilities: A 1-year prospective multicentre cohort study.

OBJECTIVE: To investigate the association between oral health management (OHM) by dental hygienists and the occurrence of pneumonia, and determine the effectiveness of OHM in pneumonia prevention. BACKGROUND: In long-term care facilities in Japan, the need for professional OHM is increasing with an increase in the number of severely debilitated residents. MATERIALS AND METHODS: A 1-year prospective multicentre cohort study was conducted using data from 504 residents (63 men; mean age: 87.4 ± 7.8 years) in Japanese long-term care facilities. Basic information, medical history, willingness to engage in oral hygiene behaviour, need for OHM and oral conditions were investigated at baseline. In addition, information on the occurrence of pneumonia was collected using a follow-up survey after one year. A Poisson regression analysis with robust standard errors was conducted, with pneumonia as the dependent variable, and factors associated with OHM and pneumonia occurrence as explanatory variables. RESULTS: Overall, 349 (69.2%) residents required OHM by dental hygienists during that year of follow-up. Of those, 238 (68.2%) were provided with OHM, and 18 (7.5%) developed pneumonia. Among the 111 patients (31.8%) who were not provided with OHM, 21 (18.9%) developed pneumonia. The OHM group had lower pneumonia rates than the non-OHM group (prevalence rate ratio: 0.374; 95% CI: 0.210-0.665). CONCLUSION: Oral health management by dental hygienists was associated with a lower incidence of pneumonia among residents of long-term care facilities, underlining the importance of professional OHM for such individuals. It is recommended that OHM be practised routinely in long-term care facilities.

Dental Hygienists' Attitudes and Experiences with Public Health Supervision in Iowa.

Purpose: Iowa is one of 42 states with a direct access dental hygiene workforce model. Public health supervision (PHS) in Iowa allows dental hygienists (DH) to provide services in community settings without a prior examination from a dentist. The purpose of this study was to assess the current PHS workforce in Iowa and add to the body of evidence on direct access DH care.Methods: A 40-item mixed-mode survey was administered to all DH working under PHS in Iowa (n=126). Consent letters were mailed with directions to an online survey. Follow-up letters were sent to non-responders with an enclosed paper copy of the survey. Univariate analyses were performed to analyze the data.Results: The response rate was 52% (n=62), with 69% (n=42) of participants currently providing services under PHS. The most common employer categories were local public health agencies (59%), community health centers (CHCs) (20%), and nonprofit clinics (10%). The most common types of services provided under PHS were dental screenings (95%), fluoride varnish (91%), and sealants (50%). The majority of supervising dentists worked in private practice (61%) and CHCs (27%). Most supervising dentists (71%) accepted some referrals; however, a majority of PHS participants (71%) reported that it was somewhat or very difficult to find dentists to accept patient referrals.Conclusion: Most PHS DHs were employed by government agencies, however the majority of supervising dentists worked in private settings. Although most supervising dentists accepted at least some patient referrals, PHS DHs still experienced a high degree of difficulty referring patients for care.

A standardized protocol for the comprehensive assessment of dental hygiene work.

BACKGROUND: Work-related musculoskeletal disorders are prevalent in dental hygienists. Although engineering controls and ergonomic training is available, it is unclear why this intransigent problem continues. One possible barrier is that a comprehensive, standardized protocol for evaluating dental hygiene work does not exist. OBJECTIVE: This study aimed to generate a valid and reliable observational protocol for the assessment of dental hygiene work. METHODS: An iterative process was used to establish and refine an ecologically valid video acquisition and observation protocol to assess key activities, tasks, and performance components of dental hygiene work. RESULTS: Good inter-rater reliability was achieved across all variables when the final coding scheme was completed by three independent raters. CONCLUSIONS: This work provides an exemplar of the process required to generate a comprehensive protocol for evaluating the work components of a particular job, and provides standardized nomenclature for use by scientists and practitioners interested in understanding and addressing the pervasive issue of work-related disorders in dental hygienists.

Investigation of the Cultural Competence of Dental Hygienists Practicing in a Region of Low Diversity.

Purpose: The profession of dental hygiene is lacking in racial and ethnic diversity, a contributory factor to providing culturally competent patient care. The purpose of the study was to determine the cultural competence (CC) of licensed dental hygienists (DHs) in a region of low racial and ethnic diversity and explore the contributory factors.Methods: modified version of the Cultural Competency Assessment (CCA), a survey developed using the 3-D Model of Culturally Congruent Care was used to identify the levels of (CC) of DHs practicing in a area of low diversity. Utah was identified as a region of low racial and ethnic diversity. DHs holding a license to practice in the state of Utah were invited to participate in the 35-item, electronically delivered survey. Multiple regression was used to analyze associations between cultural competence and salient participant characteristics.Results: Of the 3,231 RDHs invited to participate, 673 responses were included for analysis, for a 20% response rate. The mean score was 10.153 (SD=1.3), indicating moderate cultural competence, unequally distributed between cultural awareness and sensitivity and culturally competent behavior scores. Possessing a graduate degree, cultural education during dental hygiene school, cultural continuing education, and employment in public health, significantly predicted CC. The regression model was significant F(8,664)=8.616 (p<0.0005) with a small effect size (R 2=0.094).Conclusion: Education and types of practice experiences were predictors of CC. Specific educational interventions that may influence the various components of cultural competency were not determined. Dental hygiene providers possessed moderate CC however there was a disconnect in translating awareness into behavior, possibly reinforced by environments lacking racial and ethnic diversity with limited opportunities to develop and exercise CC.

Reducing the Risks for Musculoskeletal Disorders Utilizing Self-Assessment and Photography among Dentists and Dental Hygienists.

Purpose: Prolonged muscle strain and repetitive movements in the dental workforce may lead to work-related musculoskeletal disorders (WMSDs). The purpose of this study was to determine whether feedback involving photography and self-assessments would improve the postures and the accuracy of ergonomic self-assessment among practicing dentists and dental hygienists.Methods: convenience sample of dentists and dental hygienists was used for this randomized control design study (n=50). The Modified-Dental Operator Posture Assessment Instrument (M-DOPAI) was used for ergonomic evaluations of the randomly assigned control and experimental (training) groups over a four-week period. All participants were photographed and completed a M-DOPAI without viewing the photographs or receiving feedback at baseline. Participants in the control group independently completed a M-DOPAI without any additional photographs or feedback during weeks two and three. The experimental group had additional photographs taken and completed a M-DOPAI along with the principal investigator. Mixed-design ANOVAs were used to evaluate improvements in ergonomic scores and the accuracy of ergonomic self-assessments.Results: The training group utilizing photography resulted in improvements in ergonomic scores as compared to the control group. Improvements in the accuracy of ergonomic self-assessments was demonstrated among practicing dental hygienists. All participants strongly agreed that it was important to understand and properly apply ergonomics, and to develop accurate ergonomic self-assessment skills for clinical practice.Conclusions: Improving self-awareness for ergonomics through self-assessment can help reduce the risk of developing WMSDs among practicing dentists and dental hygienists.

Utilization of Periodontal Risk Assessment Tools in the Clinical Setting: Knowledge, attitudes and practice behaviors of dental hygienists.

Purpose: Identifying individuals at risk for developing periodontal disease helps to prevent, treat, and manage this condition. The purpose of this study was to explore the knowledge, attitudes, and practice behaviors of dental hygienists regarding the use of periodontal risk assessment tools.Methods: This cross-sectional survey study used a convenience sample of dental hygienists recruited through social media and snowball sampling. The validated electronic survey included items related to demographics, knowledge, attitude, and practice behaviors regarding the use of periodontal risk assessment tools in the clinical setting. Descriptive statistics were used to analyze the data and outcomes were represented through frequencies and percentiles.Results: Two-hundred eighty-two of the respondents (n=282) (n=530) met the inclusion criteria, for a participation rate of 53%. A majority (88%) "agreed" or "strongly agreed" that periodontal risk assessment tools improve communication and increase educational opportunities with patients and 50% reported completing periodontal risk assessments during a patient's scheduled appointment. Significant relationships existed between "frequently" or "always" reviewing periodontal risk assessment outcomes and the participants age, place of employment and number of continuing education (CE) hours completed (p=0.004). Participants who were members of the American Dental Hygienists' Association (ADHA) were more likely to correctly answer three or more knowledge questions (p=0.01), and more likely to measure and record pocket depths in a periodontal risk assessment tool (p=0.005).Conclusion: Although dental hygienists reported periodontal risk assessment tools were helpful for patient communication and education, only 50% reported regular completion while providing patient care. Continuing education on the value of periodontal risk assessment tools and better understanding of the barriers to routine implementation, could expand their use.

Impact of an Interprofessional Education Intervention and Collaborative Practice Agreements of Expanded Practice Dental Hygienists in Oregon.

Purpose: The state of Oregon developed the expanded practice dental hygienist (EPDH), to address oral health care disparities. The establishment of collaborative practice agreements between dental hygienists (DH) and physician assistants (PA), has created a need for interprofessional education (IPE) for future interprofessional collaboration with EPDHs. The purpose of this study was to assess the impact of an IPE intervention on future interest in collaborative practice agreements.Methods: Current and former DH and PA students from Pacific University Oregon (n=420) were invited to participate in an electronic survey. The 39-item survey included questions related to an annual IPE activity and questions related to collaborative practice agreements between PAs and EPDHs. Descriptive statistics were used to analyze the data.Results: A total of 80 DHs and PAs completed the survey for a response rate of 19%. There were high levels of agreement between DHs and PAs in regards to valuing the expertise of other health care providers, teamworking skills and interprofessional collaboration for a better understanding of a patient's condition. Only 18.9% (n=7) of the DH respondents and 25.6% of the PA respondents (n=11) were aware of the collaborative practice agreements for Oregon EPDHs.Conclusion: Participants from DH and PA disciplines agreed patient care is improved by collaborative practice fostered through interprofessional education activities. Multiple approaches may be needed to increase knowledge on the EPDH collaborative practice agreements with PAs in Oregon.

Types of Perception of Home Visiting Oral Health Care Services for Korean Older Persons: A Q Methodology Study.

This study was conducted using the Q methodology to categorize Korean older persons' subjective perceptions of home visiting oral health care services. Various opinions regarding home visiting oral health care services were collected based on related literature, and by conducting in-depth interviews with 12 people. Thirty-two statements were finally selected, and Q classification was applied. Based on data analysis with the PC-QUANL program, six factors (seven types) were derived, which accounted for 49.6% of the total variance. By comprehensive analysis of the types of subjective perceptions of home visiting oral health care services, the following two characteristics were identified. Korean older persons were expected to promote their own oral health activities, or improved access to expert health care services, through the home visiting oral health care services. Additionally, they had a need for social, economic, emotional, and informational support. Therefore, home visiting dental personnel should be able to provide customized visiting oral health care services based on evaluation of the need and type of perception of older persons. Thus, it is essential for visiting dental personnel to be trained in the knowledge of social welfare, and to develop diverse competencies.

Creating Awareness for the Social Determinants of Health: Dental hygiene and nursing student interprofessional service-learning experiences.

Purpose: The purpose of this study was to evaluate whether a service-learning interprofessional education (IPE) experience with dental hygiene students and undergraduate nursing students could reinforce learning related to Interprofessional Education Collaborative (IPEC) sub-competencies.Methods: Dental hygiene students were provided an IPE experience document to guide group discussion and written reflection prior to a school-based service-learning activity with nursing students. Dental hygiene students were responsible for conducting oral exams and providing oral hygiene instruction while nursing students were responsible for taking blood pressure, calculating body mass index, and classifying risk for obesity. The dental hygiene students completed individual written reflection assignments following the activity and the narrative responses were independently analyzed for themes related to the IPEC sub-competencies and for learning beyond the targeted sub-competencies.Results: Student reflection assignments confirmed that the learning outcomes were met. Themes from the written reflections indicated that students recognized social barriers related to health and the need for multiple professions to promote health. Responses also suggested the potential formation of negative bias.Conclusion: Service-learning activities enhance IPE and learning outcomes on the topic of social determinants of health. Group discussion and individual reflection are essential components to consider when designing a service-learning IPE experience.

Inter-rater reliability of the Oral Assessment Guide for oral cancer patients between nurses and dental hygienists: the difficulties in objectively assessing oral health.

PURPOSE: Perioperative oral care is effective for the prevention and reduction of complications following surgery. However, oral cancer patients' oral health is often poor. During hospitalization, oral cancer patients frequently receive oral care from ward nurses as well as professional oral care from dental hygienists. Maintenance of good oral hygiene in these patients ideally requires cooperation between nurses and dental hygienists. Consequently, communication tools used to share information about the status of patients' oral health are needed. One such tool is the Oral Assessment Guide (OAG). However, the inter-rater reliability of the OAG has not been consistently reported; therefore, we examined this between nurses and dental hygienists. METHODS: Participants comprised 76 patients hospitalized for oral cancer treatment. After surgery, a nurse and a dental hygienist performed oral assessments using the OAG. Comparative statistical analyses were conducted to examine differences and consistencies in the scores of nurses and dental hygienists. RESULTS: Although almost all patients' oral health status was poor, none were given the worst score in the mucous membrane or gingiva categories. Further, the tongue, saliva, mucous membrane, gingiva, and teeth/denture categories had low κ coefficients, indicating poor nurse-dental hygienist inter-rater reliability. In contrast, the κ coefficients and agreement rates for voice and swallowing were high. Dental hygienists' scores were significantly higher for the tongue, gingiva, and teeth/denture categories than were nurses' scores. CONCLUSIONS: This study showed low nurse-dental hygienist inter-rater reliability for the OAG and highlighted the difficulties in objectively assessing patients' symptoms and oral health conditions. Therefore, rather than only relying on an objective assessment of symptoms by a clinician, assessments should also include patients' subjective reporting of symptoms. OAG will likely be used until a new assessment tool is developed. Objective assessment training and/or user manual development may be required to improve the reliability of OAG. The present training of one lesson a year is insufficient, and efforts should be made to improve this to get more reliable outcomes.

Synergy in Social Action: A Dental Hygiene Theory.

Purpose: The intent of this qualitative study was to construct a new theory for the discipline of dental hygiene. Dental hygienists' experiences while participating in legislative efforts to expand their scope of practice and the provision of direct access to oral care were explored as social action experiences.Methods: A grounded theory approach was used to collect and analyze data. Using semi-structured interviews, data were collected from eight practitioners in three states, who met the inclusion criteria. Data analysis consisted of three separate coding procedures: initial, focused and theoretical. Critical theory was used as the theoretical lens, which focused on the struggle to improve access to care.Results: The learning process was categorized into actions: Committing to Social Action, Challenging the Status Quo to Improve Access to Care, Surviving in Social Action and Envisioning the Future The education process involved: Raising Critical Awareness of Underserved Populations' Oral Health Needs, Building Support for Improving Access to Care, Sustaining Support for Social Action and Building the Next Generation of Dental Hygiene Practitioners The resulting theory, Synergy in Social Action, is composed of three key elements which provide energy to sustain momentum for social action through the interaction both within and among these elements. The identified elements are: learning and educating process, critical awareness and empowerment, and individual and collective action.Conclusion: The Synergy in Social Action Theory provides the means to understand the challenge of improving access to oral health care from a new vantage point and advances dental hygiene as a discipline with its own theories.

Assessment of Michigan Dentists' and Dental Hygienists' Perceptions Toward Obtaining Continuing Education Credits for Volunteering in Community-Based Clinics.

Purpose: The purpose of this study was to assess dentists' and dental hygienists' current motivation, attitudes, and knowledge regarding volunteering in a non-profit dental setting and the opportunity for earning continuing education (CE) credits.Methods: This cross-sectional study surveyed a convenience sample of dental and dental hygiene professionals from the state of Michigan. A 20-question paper survey was developed and pilot tested. The survey was disseminated to attendees at various component meetings of the dental and dental hygienists' associations in southeastern Michigan.Results: Out of the 274 surveys that were distributed, 182 (n=182) were completed, yielding a 66% response rate. Eighty percent of the participants were unaware of the opportunity for earning CE by volunteering and 79% were unaware of the volunteering site approval requirement by the Michigan Board of Dentistry. Thirty percent of participants were unable to determine how many unpaid days per year they were willing to volunteer and a similar percentage, (28%), were unable to determine how many paid days. The most common motivating factor to volunteer was to give back to the community (60%) while the greatest barrier was lack of time (62%).Conclusion: The opportunity to earn CE credit for volunteerism is seen as a benefit, however, it needs to be better promoted to potential volunteers, through dissemination of information by professional associations and in educational settings. Community-based clinics also need to be made aware of how to become a CE provider. Further research on the longitudinal impact of CE for volunteerism in community-based clinics is warranted.

The dental therapist movement in the United States: A critique of current trends.

Dental therapists are members of the oral health workforce in over 50 countries in the world typically caring for children in publically funded school-based programs. A movement has developed in the United States to introduce dental therapists to the oral health workforce in an attempt to improve access to care and to reduce disparities in oral health. This article critiques trends in the United States movement in the context of the history and success of dental therapists practicing internationally. While supporting the dental therapist movement, we challenge: a) the use of dental therapists treating adults, versus focusing on children; b) the use of dental therapists in the private versus the public/not-for-profit sector; and c) requirements that a dental therapist must also be credentialed as a dental hygienist.

Public Health Dental Hygienists in Massachusetts: A Qualitative Study.

Purpose: The aim of this qualitative, phenomenological study was to explore the attitudes and perceptions of public health dental hygienists on providing preventive care to underserved populations in Massachusetts.Methods: Non-probability purposive sampling was used for initial participant recruitment, and snowball sampling occurred thereafter. Data collection occurred through semi-structured interviews. Qualitative analysis was conducted using Pitney and Parker's eight-step CREATIVE process.Results: Data saturation occurred with 10 participants (n=10), one-third of the public health dental hygienists who are practicing in Massachusetts. The majority of practice settings included school-based programs (70%), while programs for children with special needs (10%) were the least common. Two major themes emerged from the data; (a) the opportunity to be an oral health change agent and (b) barriers to practice. Six subcategories emerged from the data and are reviewed within the context of their associated themes. Additionally, career satisfaction emerged as an unintended theme, and was reported as the driving force for the majority of participants.Conclusion: This study revealed a better understanding of the public health dental hygiene workforce model in Massachusetts. Public health dental hygienists in Massachusetts perceive themselves as change agents within the health care profession, and although barriers to practice are plentiful, these oral health care professionals are committed to improving access to dental care.

Exploring Interprofessional Relationships Between Dental Hygienists and Health Professionals in Rural Canadian Communities.

Purpose: For most Canadians living in rural communities, limited access to dental care can negatively impact oral and general health. This narrative, tertiary review of the literature explores the outcomes of interprofessional relationships between dental hygienists and other health professionals on individuals residing in rural communities in Canada. Themes addressed include: implementing interprofessional education experiences in entry-to-practice health programs, interprofessional dynamics in primary health care teams, health perceptions in rural communities, and barriers and enablers to interprofessional relationships.Conclusion: Findings from this review suggest that the development of interprofessional relationships between health care professionals is complex and dynamic. Interprofessional collaboration should first be implemented at the educational level to help develop trust and understanding of each profession's role in health care. Alternative models of health care delivery, such as interprofessional collaborative practice, have the potential to reduce overall health care costs and improve access of comprehensive health care services to Canadians residing in rural communities.

Patients' Willingness to Participate in Rapid HIV Testing: A pilot study in three New York City dental hygiene clinics.

Purpose: One in eight people living with an HIV infection in the United States is unaware of their status. Rapid HIV testing (RHT) is an easily used and accepted screening tool that has been introduced in a limited number of clinical settings. The purpose of this study was to investigate patient acceptability, certainty of their decision, and willingness to pay for screening if RHT was offered in university-based dental hygiene clinics.Methods: A cross-sectional survey was administered to 426 patients at three dental hygiene clinics in New York City over a period of four months. The survey questionnaire was based on the decisional conflict scale measuring personal perceptions; with zero indicating extremely high conflict to four indicating no conflict. Patients were assessed for their acceptance of RHT, provider preference for administration of the test and their willingness to pay for RHT.Results: Over half (72.2%) indicated acceptance of HIV testing in a dental hygiene clinic setting; with 85.3% choosing oral RHT, 4.9% fingerstick RHT, and 8.8% venipuncture. Respondents were amenable to testing when offered by dental hygienists (71.7%) and dentists (72.4%). Over 30% indicated their willingness to receive HIV testing in the dental setting when offered at no additional cost. The mean decisional conflict score was 3.42/4.0 indicating no decisional conflict.Conclusions: Patients are willing to undergo oral RHT when offered as a service and provided by dental hygienists in the dental setting. Patients appear to be aware of the benefits and risks associated with RHT. Further research is needed to evaluate the public health benefits and logistical challenges facing the delivery of RHT within in the dental setting.