A national survey of dental hygiene faculty perspectives on diversity, equity, and inclusion.

PURPOSE/OBJECTIVES: To investigate potential unconscious bias among dental hygiene educators and identify baseline perceptions of race and racism. METHODS: Dental hygiene programs in the USA were clustered into 4 geographic regions from which 2 programs were sampled from each region. The 20-item, Color-Blind Racial Attitudes Scale (CoBRAS) electronic survey was sent to educators from each of the selected programs in 2022. The CoBRAS instrument measures contemporary racism and stereotyping in 3 subcategories: Unawareness of Racial Privilege, Institutional Discrimination, and Blatant Racial Issues. Scores range from 20-120, with higher scores indicating elevated levels of denial of racism. Descriptive statistics and one-way ANOVA were performed. The level of significance was set to α = 0.05. RESULTS: Of the 172 potential respondents, 89 (52%) completed all of the survey questions. The majority of the respondents were White, female and from the Northeast (74.2%, 93.3%, and 61.8% respectively). The mean CoBRAS score (55.73) indicated moderate levels of color-blind racial attitudes. Race was a significant variable in perceptions of racial dynamics and racism with statistically significant differences between groups by race and ethnicity as demonstrated by one-way ANOVA (F[6,82] = 3.469, p = 0.004). CONCLUSIONS: Moderate levels of color-blind racial attitudes among dental hygiene educators were found, indicating a presence of cognitive aspects of stereotyping related to race. The demographic data collected adds to the existing evidence of a lack of diversity among dental hygiene faculty.

A qualitative assessment of dental hygiene educators' COVID-19 related burnout.

PURPOSE: The purpose of this study was to elicit ideas or concerns influencing dental hygiene educators' experiences of personal and professional burnout, burnout working with students, and teaching efficacy in an online/hybrid environment as a result of the COVID-19 pandemic. METHODS: A qualitative, content-analysis study included a convenience sample of dental hygiene educators emails. An invitation to participate in an August 2021 or October 2021 focus group was sent via Qualtricsxm with informed consent, and focus groups were held over Zoom. Conversations were audio recorded, transcribed, and de-identified. Consensus on a codebook by two coders achieved an 88% agreement. RESULTS: Fifty-three were invited to the August 2021 focus groups for a 26% (n = 14) response rate, and 116 were invited to the October 2021 focus groups for an 11% (n = 13) response rate. Contributing factors to experiences of burnout expressed were: (1) work-life balance (n = 59), including (a) overwork, (b) pressure to be available, and (c) lack of boundaries; (2) change (n = 34) involving (a) developing new protocols, (b) constant uncertainty, (c) COVID-19 requirements, and (d) new platforms; and (3) negative interactions (n = 32) with (a) students and (b) faculty. CONCLUSION: A lack of work-life balance from overwork, pressure to be available at all times, no boundaries with students, and an absence of a sense of connection for workplace vitality were contributors to burnout. Work-from-home flexibility, a work environment that supported wellness and mental well-being, and the ability to leave the workplace for periods of time were reported as helpful solutions to combatting burnout.

Relationship Between Job Satisfaction and Health of Hygienists in Lithuania.

OBJECTIVES: This study aimed to determine the perceived musculoskeletal and psychological symptoms and job satisfaction of Lithuanian dental hygienists. Second, the study aimed to examine the relationships between job satisfaction and musculoskeletal and psychological symptoms amongst dental hygienists in Lithuania. METHODS: A 41-item survey was sent by email to all members of the Lithuanian Dental Hygienists Association (N = 328) up to 3 times. The questionnaire comprised 5-point Likert scale structured questions, which were developed according to 3 existing questionnaires. RESULTS: The final response rate was 52.4% (N = 172). The level of overall work-related physical health was 3.76 ± 0.65, and the most common physical health symptom was upper back pain; the level of overall work-related psychological health was 3.84 ± 0.64, and the most common symptom was stress. The level of overall job satisfaction was 3.87 ± 0.62, and the most satisfying areas were their relationships with colleagues, relationships with dentists, and working conditions (equipment, work environment); the least satisfying practice areas were income, work-related physical and psychological health, and social security. CONCLUSIONS: According to the results of this study, Lithuanian dental hygienists were quite satisfied with their job but sometimes experienced work-related musculoskeletal and psychological disorders. Their physical health score and the total psychological health score were significantly correlated with all job satisfaction criteria. The better the self-evaluation of physical and psychological health, the higher the job satisfaction reported.

Assessing Dental Hygiene Students' Test Anxiety in Examiner-Administered vs. Camera-Supervised OSCEs: A Pilot Study.

The aim of this pilot study was to measure and compare dental hygiene students' level of text anxiety and performance when being tested on an objective structured clinical examination (OSCE) using camera supervision versus direct examiner observation. This randomized, controlled trial, conducted in October 2016, assessed students' anxiety levels and performance using the Zung Self-Rating Anxiety Scale and performance on an OSCE. All 32 first-year students in one U.S. dental hygiene program were invited to participate, and all 32 participated for a 100% response rate. Participants were randomly assigned to the direct observation (N=16) and camera-supervised (N=16) groups. The comparison of pre-OSCE anxiety levels and performance scores evaluated with direct observation (36.4 and 20.4) versus camera-supervised (37.5 and 20.9) found no statistically significant difference between the two groups (p=0.496, p=0.403). The difference in post-OSCE anxiety levels between the direct observation and camera-supervised groups (33.8 and 37.8) approached significance (p=0.051). This study found that student anxiety levels were similar between the two groups except for the post-OSCE direct observation anxiety levels, which were lower. No significant difference was found between the two groups' performance scores. Due to similar performance scores and anxiety levels for the direct examiner and camera-supervised methods, the camera-supervised OSCE warrants further exploration as an alternative approach to direct observation for evaluation of students' performance.

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.

Interest in Dental Hygiene Therapy: a study of dental hygienists in Maine.

Purpose: The purpose of this study was to assess the awareness of registered dental hygienists (RDHs), licensed in the state of Maine, regarding the midlevel dental hygiene therapist (DHT) provider model and to gather data regarding the degree of interest in enrolling in a DHT program.Methods: A quantitative cross-sectional study design with a non-probability purposive sampling of actively practicing RDHs in the state of Maine (n=1,284) was utilized for the web-based survey. Survey questions included awareness in the passage of DHT legislation, level of interest pursuing education and licensure in this midlevel provider model. Data was collected over a three-week period. Descriptive statistics and thematic analysis were used for data analysis.Results: Response rate was 21% (n=268). Sixty-five percent of respondents expressed interest in enrolling in a DHT program and 40% of those respondents stated a willingness to enroll in a DHT program within the coming year. Although willing to travel 25-50 miles, a majority of respondents preferred programs incorporating online components combined with clinical training completed in nearby communities. Themes emerging from the open-ended question regarding DHT program feasibility and appeal included: convenience, flexibility, cost/affordability, and independent or collaborative practice.Conclusion: Study outcomes indicated interest exists among Maine RDHs regarding the DHT provider role and enrollment in a DHT program. Although there are no DHT programs currently being offered in the New England states, results suggest further investigation is warranted regarding the development of a DHT program in the Northeastern United States.

Treatment of a Culturally Diverse Refugee Population: Dental hygiene students' perceptions and experiences.

Purpose: Dental hygiene professionals need to be prepared as part of their entry level education process, to treat the wide range of culturally diverse patients they may encounter in the United States. The purpose of this qualitative study was to explore the perceptions and experiences of a cohort of senior dental hygiene students in regards to their preparedness to treat a culturally diverse patient.Methods: A purposeful sample of second year dental hygiene students (n=18) participated in semi-structured group interviews before and after the treatment of a culturally diverse patient. Data was gathered and analyzed using a thematic analysis. Demographics were enumerated using frequency percentiles, means, and summary statistics.Results: Prior to the dental hygiene care appointment, the participants reported feeling confident and prepared to treat culturally diverse patients. Following the dental hygiene care appointment, participants reported feeling that more education and an increased number of clinical experiences were needed with culturally diverse patients.Conclusion: Exposing dental hygiene students to diverse patients in a clinical setting as part of the curriculum was an effective method towards building cultural preparedness.

Perceptions and attitudes toward performing risk assessment for periodontal disease: a focus group exploration.

BACKGROUND: Currently, many risk assessment tools are available for clinicians to assess a patient's periodontal disease risk. Numerous studies demonstrate the potential of these tools to promote preventive management and reduce morbidity due to periodontal disease. Despite these promising results, solo and small group dental practices, where most people receive care, have not adopted risk assessment tools widely, primarily due to lack of studies in these settings. The objective of this study was to explore the knowledge, attitudes, and beliefs of dental providers in these settings toward risk-based care through focus groups. METHODS: We conducted six focus group sessions with 52 dentists and dental hygienists practicing in solo and small group practices in Pittsburgh, PA and New York City (NYC), NY. An experienced moderator and a note-taker conducted the six sessions, each including 8-10 participants and lasting approximately 90 min. All sessions were audio-recorded and transcribed verbatim. Two researchers coded the focus group transcripts. Using a thematic analysis approach, they reviewed the coding results to identify important themes and selected representative excerpts that best described each theme. RESULTS: Providers strongly believed identifying risk factors could predict periodontal disease and use this information to change their patients' behavior. A successful risk assessment tool could assist them in educating and changing their patient's behaviors to adopt a healthy lifestyle, thus enabling them to play a major role in their patients' overall health. However, to achieve this goal, it is essential to educate all dental providers and not just dentists on performing risk assessment and translating the results into actionable recommendations for patients. According to study participants, the research community has focused more on translating research findings into a risk assessment tool, and less on how clinicians would use these tools during patient encounters and if it affects a patients' risk or outcome. CONCLUSIONS: Dental practitioners were open to performing risk assessment as routine care and playing a bigger role in their patients' overall health. Recommendations to overcome major barriers included educating dental providers at all levels, conducting more research about their adoption and use in real-world settings and developing appropriate reimbursement models.

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.

Experiences of the Kansas Extended Care Permit Providers: A descriptive study.

Purpose: A total of 40 states to date have expanded the role of dental hygienists with the goal of improving access to basic oral health services for underserved populations. In Kansas, legislative changes have resulted in the Extended Care Permit (ECP) designation. The purpose of this study is to describe the experiences of registered dental hygienists in Kansas holding ECP certificates (ECP RDH) as of July of 2014.Methods: Secondary data analysis was performed utilizing data collected from a survey conducted in 2014 by Oral Health Kansas. All registered ECP RDH's were sent the 32-item survey via Survey Monkey®. Descriptive statistical analyses consisted of frequency distributions, and measures of central tendency. Inferential analyses using t-tests and ANOVA were conducted to compare groups.Results: A total of 73 responses were received from the (n= 176) surveys that were e-mailed for a 41% response rate. Of the clinicians who responded, 80%, worked at least part-time and in school settings. The most consistent barriers to providing care were the inability to directly bill insurance (52%), financial sustainability (42%) and physical requirements (42%). Follow-up tests found significant differencs between clinician groups when examining barriers.Conclusion: Although the ECP legislation appears to be expanding access to care for citizens in Kansas, significant barriers still exist in making this a viable model for oral healthcare delivery.

A Mid-Level Dental Provider in Oregon: Dental hygienists' perceptions.

Purpose: Many states are exploring alternative provider models and examining the role of the dental hygienist to address access to care challenges as the United States continues to face increasing demands for oral healthcare services. The purpose of this study was to assess dental hygienists' opinions in the state of Oregon regarding the current limitations of dental hygienists' scope of practice, perceived need for a mid-level provider in Oregon, and personal interest in becoming a mid-level provider.Methods: In December 2013 a survey was mailed to a sample of 1,231 dental hygienists registered in Oregon representing 30% of the licentiates. All licentiates holding expanded practice permits (EPP) were included in the sample (n=351). The following categories were included in the 32-question survey: scope of practice, mid-level provider, current practice, and demographics.Results: A total of 440 surveys were returned for a response rate of 36%. Of the EPP holders, 51% responded to the survey. Over half of respondents (59%) believe that a mid-level provider is needed in the state. Respondents holding membership in the American Dental Hygienists' Association, as well as EPP holders, were significantly more likely to respond that a mid-level dental provider was needed in the state (p<0.0001). Ninety-one percent (n=400) of respondents agreed or strongly agreed that if a mid-level provider was introduced in Oregon, the new provider should be a registered dental hygienist model. Forty-three percent (n=186) of respondents were interested in becoming mid-level providers and 47% (n=203) of respondents believed that the minimum education for a mid-level provider should be a bachelor's degree. The majority, 74% (n=137), of those interested in becoming a mid-level provider indicated a preference in completing their education through online teaching combined with a clinical internship.Conclusion: There is strong support from dental hygienists in Oregon that a need exists for a mid-level dental provider and that this provider model should be dental hygiene based. Individuals interested in developing a curriculum for a mid-level provider should consider including online teaching components with a clinical internship component.

Factors Associated with the Economic Sustainability of the Registered Dental Hygienist in Alternative Practice.

Purpose: The purpose of this study was to investigate key factors associated with the economic sustainability of the Registered Dental Hygienist in Alternative Practice (RDHAP).Methods: An invitation to participate in a 38-question electronic survey was sent via postal mail to 440 RDHAP licentiate addressees obtained through the Dental Hygiene Committee of California (DHCC). Legal restrictions did not allow for obtaining the RDHAP licentiate email addresses from the DHCC. The survey was disseminated via email to the 254 RDHAPs who were members of the California Dental Hygienists' Association. Additional invitations to participate were made via flyer distribution at an RDHAP symposium, and on RDHAP only social media sites.Results: The response rate was an estimated 16%. While 44% of the RDHAPs reported some employment in a traditional dental practice, given the opportunity, 61% of these respondents indicated that they would practice exclusively as an RDHAP. With regard to practice strategic planning and alliances, 31% felt that dentists lacked knowledge of the RDHAP, and 25% indicated dentists were resistant to this workforce model. Regarding RDHAP practice staffing patterns, 75% indicated not having any employees. When asked about business systems, 64% had solo, portable practices and 16% had standalone practices. Economic sustainability challenges included practice business/equipment expenses (29%), insurance/reimbursement issues (21%), patient flow (19%) and RDHAP visibility (14%).Conclusions: RDHAP practices face challenges including the need for strategic planning and intra- and inter-professional alliances, efficient and effective patient flow, optimal staffing patterns and effective business systems. Focus on enhancing RDHAP visibility within the dental and medical communities should be a priority. In addition, further research should explore RDHAPs aligning with community-based clinics, Federally Qualified Health Centers and Dental Support Organizations (DSOs) with a commitment to disease prevention in addition to the financial resources and staff to manage practice business systems.

Attitudes of Dental Hygienists towards Independent Practice and Professional Autonomy.

PURPOSE: The purpose of this cross-sectional, quantitative research was to examine if registered dental hygienists feel competent to work independently based on regulations of dental supervision. METHODS: A stratified sample of 360 dental hygienists from 8 states completed the Dempster Practice Behaviors Scale survey. ANOVA and MANOVA analyses revealed how state dentist supervision level, age, degree of education, employment status, gender and years of clinical experience affect the perceived autonomy of professional dental hygienists. RESULTS: The response rate included 360 dental hygienists from 8 states. According to the findings age, education level and gender affected the hygienist's level of autonomy. In all 8 states, the registered dental hygienists have a high level of autonomy and feel competent to work independently. CONCLUSION: The DPBS scores of the sample registered dental hygienists suggest that they feel prepared and competent to perform preventive dental hygiene services without dentist supervision. The attitudes of the dental hygienist sample from each of the 4 state dentist supervision levels supports a move toward achieving professional jurisdiction of preventive dental care within the U.S.

Assessment of Prognosis and Periodontal Treatment Goals Among General Dental Practitioners and Dental Hygienists.

PURPOSE: To evaluate general dental practitioners' (GDPs) and dental hygienists' (DHs) assessment of prognosis, suggested treatment goals, and estimated number of treatment sessions in patients with varying severity of periodontal disease. MATERIALS AND METHODS: Seventy-seven GDPs and fifty DHs in a Swedish county participated in a questionnaire study, based on three patient cases: a patient with generalised bone loss but no clinical signs of inflammation (well-maintained); a patient with clinical signs of inflammation and generalised bone loss (periodontitis); and a patient with clinical signs of inflammation but no bone loss (gingivitis). In open-ended questions, the clinicians assessed the prognosis in case of no treatment and proposed treatment goals. Furthermore, based on given fixed-alternative options, they estimated the number of treatment sessions needed for successful management of the condition. RESULTS: Based on a response rate of 94%, the majority of clinicians expected a worsening of the periodontal condition in all three patients (well-maintained: 80%; periodontitis: 94%; gingivitis: 60%). The most common treatment goal in all 3 cases was to improve oral health awareness. The majority of clinicians estimated that the periodontitis case needed slightly more treatment sessions (mean: 3.04, 95% CI: 2.83-3.24) compared to the gingivitis (mean: 1.93, 95% CI: 1.75-2.11) or well-maintained patient case (mean: 1.84, 95% CI: 1.60-2.07). CONCLUSIONS: The majority of included clinicians did not perform an individualised risk assessment and did not individually match the number of appointments to the actual periodontal treatment needs of the patient. This may result in overtreatment in some cases and in undertreatment in others, and possibly in suboptimal use of resources.

Assessment of Students' Sense of Community in Distance Education Classrooms of U.S. Dental Hygiene Programs.

The aim of this study was to examine the association between distance education (DE) and students' sense of classroom community (SCC) in U.S. dental hygiene programs. The concept of SCC is recognized to have an influence on students' educational outcomes. With the goal of increasing diversity among future dental professionals, there comes a need to accommodate students of various backgrounds through the use of DE. The impact of DE on students' SCC has not been studied in previous research. This 2014 cross-sectional survey study looked at a convenience sample of dental hygiene students finishing their first or second clinical year to assess their SCC. Participating programs had both host and satellite campuses and utilized DE for didactic course delivery at the remote sites. To calculate the students' sense of community, Rovai's Classroom Community Scale (CCS) was utilized, and demographic information was collected. Six of the 13 eligible programs agreed to participate; the overall response rate for individual students was 25%. When evaluated on their sense of community, the satellite college-based students scored 26.47 CCS units and 14.51 learning subscale units lower than the host college-based students. These results suggested a negative association between the students' sense of community and their affiliation with satellite campuses when controlled for demographic variables. The findings suggest a negative trend in the SCC for dental hygiene students on remote campuses and utilizing DE for a portion of their curriculum. This trend can potentially decrease students' educational success and satisfaction and should be addressed.

Knowledge, attitudes and practices of dental hygienists regarding caries management by risk assessment.

PURPOSE: The purpose of this study was to survey dental hygienists to determine their knowledge, attitudes and practices regarding the implementation of caries risk assessment, particularly caries management by risk assessment (CAMBRA), in private dental practices. METHODS: A 17 item survey was developed to evaluate dental hygienists' knowledge, attitudes and practices related to CAMBRA and perceived barriers to CAMBRA implementation in private dental practice. Surveys were mailed to a randomized sample of 1,000 dental hygienists licensed to practice in California. Responses were tabulated for each respondent, and the response frequency for each survey item was calculated. Respondents' comments to the open-ended question were compiled, according to themes. RESULTS: The response rate was 18%. Only 66% of the respondents were familiar with the term CAMBRA, although 89% agreed with its underlying principles of risk assessment. CAMBRA protocol had been implemented in 40% of the respondents' employment sites. Respondents disagreed that time (45%) and cost of products (68%) were barriers to implementation. Many did not know their employers' knowledge or attitudes about CAMBRA and its implementation, as evidenced by a "don't know" response range of 29 to 48% for the 4 relevant statements. Respondents' comments included both successes and barriers implementing CAMBRA. CONCLUSION: CAMBRA protocol has not been widely implemented in private practice, although the current data do not indicate insurmountable barriers. Broader dissemination may be feasible if dental hygienists would obtain more comprehensive knowledge of evidence-based risk assessment protocols and would assume a leadership role in implementing CAMBRA protocols and procedures in private dental practices.

Disparity in perception of the working condition of dental hygienists between dentists and dental hygiene students in Japan.

OBJECTIVES: In Japan, there continues to be a shortage of active dental hygienists. The scope of dental hygienists' practice is also considered to be unclear. One of the reasons for this is that dental hygienists find the working conditions during dental hygiene education different from those in reality. The purpose of this study was to clarify the actual working condition of dental hygienists in dental clinics, as well as evaluate the awareness of dental hygiene students and dentists regarding the working condition of dental hygienists. METHODS: Questionnaires were sent by post to 481 dentists and were distributed to 89 dental hygiene students. The awareness about the working condition of dental hygienists was compared between dentists and dental hygiene students. RESULTS: Two hundred twenty-two dentists and 89 dental hygiene students responded to questionnaires. Dental hygiene students considered the team of 'dental hygienist, dental technician and clerk' to be more effective in providing dental care than dentists (P < 0.001). Among the dentists, 37.1% did not find any clear distinction between hygienists and assistants in their clinics. However, 97.4% of dental hygiene students answered that dental team members should clearly inform patients of the distinction between hygienists and assistants. CONCLUSIONS: This study indicated that there was disparity between dentists' and dental hygiene students' perception of dental hygienists' working conditions, and dental team work was not always effective. For training high quality dental hygienists, all educational institutions related to dentistry must educate students regarding the more realistic dental hygienists' working condition, as well as benefits.

Perceptions of Kansas Extended Care Permit dental hygienists' impact on dental care.

PURPOSE: In 2003, Kansas addressed their access to oral health care needs with amended state dental practice act for registered dental hygienists. The Extended Care Permits (ECP) I, II and III have expanded the dental hygiene scope of practice, allowing dental hygienists to provide oral care to Kansans in different settings beyond the dental office. The purpoase of this study was to examine the perceptions of Kansas ECP dental hygienists on change to oral care in Kansas. METHODS: A questionnaire was mailed to all ECP dental hygienists (n=158) registered with the Kansas Dental Board. Questions were open-ended, close-ended and Likert scale. Information was sought regarding demographics, areas of employment, work related activities and impact to oral health care. Study exclusions included ECP providers no longer practicing in Kansas, practice more than 50% in another state or no longer practice dental hygiene at all. RESULTS: A total of 69 surveys were returned, with 9 surveys excluded for exclusion criteria. Most respondents (92%) agreed the ECP is a solution to oral health care access issues in Kansas. Barriers to utilizing their permits fully included: difficulty locating a sponsoring dentist (12%), locating start up finances (22%), limited work space (14%) and difficulty with facility administrators (39%). Many respondents (62%) agreed the proposed registered dental practitioner would improve access to oral health care to Kansans. CONCLUSION: The Extended Care Permit providers in Kansas appear to be satisfied with their current employment situations and feel oral health care has improved for their patients served but they are unable to utilize their permits fully for various reasons.

Use of restorative procedures by allied dental health professionals in Minnesota.

BACKGROUND: In 2003, the Minnesota legislature revised the Dental Practice Act to include restorative procedures in the scope of practice for registered dental assistants (RDAs) and registered dental hygienists (RDHs). The authors examined these practitioners' characteristics and made comparisons on the basis of their use of restorative function (RF) training and their practices' locations. They also examined practice type, models of implementation and perceived outcomes. METHODS: The authors mailed a survey to all RF-certified RDAs and RDHs in Minnesota (N = 387). They used descriptive statistics to summarize the data and t tests and Fisher exact tests (P <.0001) to make comparisons between groups. RESULTS: The authors received 243 surveys (63 percent). Less than one-half (38 percent) of the RF-certified practitioners performed RFs. Of these, 29 percent were RDHs and 71 percent were RDAs. These practitioners performed RFs most often by working with a dentist or when time allowed. They perceived increased access to dental care and an increase in the number of patients treated to be outcomes of performing RFs. CONCLUSIONS: The results of this survey indicated use of restorative procedures varied greatly by practitioner type. The perceptions of those who performed RFs indicated they had a positive effect on dental practice. PRACTICAL IMPLICATIONS: The addition of RF-certified personnel to the dental team has the potential to increase the number of patients seen in practice and the job satisfaction of team members.

The acceptability of care delegation in skill-mix: the salience of trust.

The aim of this research was to explore the acceptability of care delegation in skill-mix, using the views and experiences of patients and parents of children treated by dental therapists as a case study. A purposive sample of 15 adults whose care, or that of their children, had been delegated to dental therapists in English dental practices was interviewed using narrative and ethnographic techniques (July 2011 - May 2012). Experiences were overwhelmingly positive with the need for trust in clinicians and the health system emerging as a key factor in its acceptability. Perceptions of general and dental health services ranged from them being a collectivist public service to a more consumerist marketised service, with the former seemingly associated with notions of dentistry as a trusted system working for the social good. Interpersonal trust appeared built, sustained (and undermined) by the affective behaviour, perceived competence, and continuity of care with clinicians providing care, and contributed to trust in the system. It also appeared to compensate for gaps in knowledge needed for patient decision-making. Overall, where trust existed, delegation of care was acceptable. An increasingly marketised health system, and emphasis on the patient as a consumer, may challenge trust and acceptability of delegation, and undermine the notion of patient-centred health care.