A pilot study of an HbA1c chairside screening protocol for diabetes in patients with chronic periodontitis: the dental hygienist's role.

OBJECTIVE: To assess effectiveness, convenience and cost of point-of-care diabetes screenings performed by a dental hygienist for patients with periodontitis, using a diabetes risk questionnaire, periodontal findings and a glycosylated haemoglobin (HbA1c) analyser. METHODS: A purposive sample of 50 participants with periodontitis, never diagnosed with diabetes, reporting ≥one diabetes risk factor, were administered an HbA1c test. Spearman's correlation measured relationships between HbA1c and diabetes risk test scores, numbers of missing teeth, percentage of deep pockets ≥5 mm and percentage of bleeding sites (BOP). Cost and time were assessed. Analyses used 0.05 alpha levels. RESULTS: Thirty-two per cent (n = 16) of participants presented HbA1c values indicating prediabetes; one HbA1c value indicated type 2 diabetes, totalling 34% (N = 17). No relationships existed between HbA1c values and diabetes risk scores (rs = 0.153; P = 0.144), numbers of missing teeth (r = 0.190; P = 0.093), percentage of deep pockets (rs = -0.048; P = 0.370) or percentage of BOP sites (rs = 0.066, P = 0.324). Direct cost for each HbA1c was $9US, excluding follow-up medical diagnosis. Mean screening time including patient education was 14 min (SD = 6.2). Fifty-three per cent (n = 9 of 17) of participants with elevated HbA1c values contacted their primary healthcare provider within 2 weeks as recommended. CONCLUSION: Point-of-care HbA1c screenings by dental hygienists were effective and convenient for identifying undiagnosed prediabetes and provide opportunity for interprofessional patient care; cost or lack of dental insurance may inhibit implementation. Identification of patients at risk for diabetes requires further evaluation.

Integration of the Client Self-Care Commitment Model in a dental hygiene curriculum.

OBJECTIVE: This exploratory study investigated whether integration of the Client Self-Care Commitment Model (CSCCM) Instructional Module in a dental hygiene curriculum, as an additional educational experience, would further enhance students' client-centred knowledge, values and actions. METHODS: Subjects (n = 26) were second-year students enrolled in a BS entry-level dental hygiene programme with random assignments to two groups. The experimental group participated in a 2-h didactic session, an 8-h preclinical session, an 8-h clinical session and a 1-h question and answer period. An online pretest-post-test survey administered at three time intervals (baseline, 3 and 6 weeks) was used to measure differences between the groups on three subscales (knowledge, values and actions). RESULTS: Cronbach's α for each subscale across time was above 0.90. A repeated-measures anova determined that there were no statistically significant interactions between Time and Group (experimental or control group) for the knowledge and values variables; however, there was a significant interaction between Time (P = 0.003) and Group (P = 0.033) for the actions variable. A content analysis of participants' responses to three open-ended questions reflected both positive and negative comments and revealed that students' primary barrier to implementing the model in client care was lack of time. CONCLUSIONS: Significant differences in the actions variable between the groups suggested that implementation of the CSCCM Instructional Module enhanced students' client-centred actions during client care.

Prioritization of professional issues by Idaho Dental Hygienists.

PURPOSE: The Idaho Dental Hygienists' Association (IDHA) and other constituents use surveys to establish the goals of the association and better represent members. This study was conducted to assess dental hygienists' opinions about professional issues related to dental hygiene practice and legislative activities in Idaho. METHODS: In 1998, a questionnaire was mailed to all active Idaho dental hygiene licensees (N = 652). The coded questionnaire contained two sections. Section I included items on demographic and employment characteristics, and Section II included items on legislative and professional issues. Respondents were asked to rank 14 professional issues by selecting the top five concerns about dental hygiene practice in Idaho. Research questions asked included: 1) Do entry-level baccalaureate degrees in dental hygiene affect the ranking of professional concerns of Idaho dental hygienists? 2) Does being a member of the American Dental Hygienists' Association (ADHA) affect Idaho dental hygienists' ranking of professional concerns? Data were analyzed using frequency distributions and nonparametric tests of association. RESULTS: A 74% (N = 431) response rate was obtained after two mailings. Three professional issues were ranked as important concerns by at least 50% of respondents. They were 1) the "national trend to reduce entry-level education for dental hygienists," 2) "dental assistants performing dental hygiene services," and 3) "legalizing self-regulation." CONCLUSIONS: It is incumbent upon constituent dental hygienists' associations to obtain and utilize information from members for strategic planning and legislative efforts. A statewide membership study clearly can provide direction. Idaho dental hygienists are concerned about maintaining quality education programs, reducing illegal practices, and regulating themselves. Also, the state association and regulatory agencies need to take an active role to assure that dentists, dental hygienists, and dental assistants are educated about state laws.

A proposed client self-care commitment model.

PURPOSE: Expansion of the dental hygiene body of knowledge offers options for the profession; evolving conceptual models allow practitioners to choose an approach to client care that is scientifically sound yet matches individual philosophies. Health paradigms for different approaches to client care have been developed and used in medical anthropology, psychology, and dental hygiene. Adapted from the biomedical model, the explanatory model, the empowerment model, and the human needs conceptual model, a new model for client commitment is proposed. The client self-care commitment model is composed of five domains: initiation, assessment, negotiation, commitment, and evaluation. This model proposes that the relationships among these domains, and the interaction between the client and the dental hygienist can empower clients to make decisions that will enhance their own health through commitment and compliance. This paper reviews the scientific literature from medical anthropology, psychology, and dental hygiene that focus on client care, and suggests possible applications of the model to the dental hygiene process of care, dental hygiene education, and qualitative research.

Factors influencing dental hygiene retention in private practice.

PURPOSE: The objective of this study was to identity specific factors that contribute to dental hygienists remaining in the same private practice employment setting for five or more years. Working conditions, the employer and the organizational structure of the employment setting, scope of practice, and personal factors were assessed. METHODS: In 1992, a self-designed questionnaire was sent to a sample of 1,200 licensed dental hygienists. One state was randomly chosen from each of the 12 American Dental Hygienists' Association (ADHA) regions of the United States, and 100 licensed dental hygienists were randomly selected from each of these twelve states. Data were analyzed using univariate analysis (frequency distribution) and multivariate analyses (factor analyses). RESULTS: A 62.9% (n = 755) response rate was obtained from the 1200 questionnaires mailed. Of those dental hygienists, 14.3% (n = 108) were not practicing, and 85.7% (n = 647) were currently practicing. Nearly two-thirds (63.3%; n = 480) of the total number of respondents had been practicing five or more years in the same practice setting. Six major factors were identified by dental hygienists as reasons for remaining in one private practice setting for at least five years (1) quality/safe work environment, (2) time management for high-quality dental hygiene services, (3) effective employer office policies/procedures and personnel management, (4) employer support of professional career, (5) supportive work environment, and (6) variety in scope of practice. CONCLUSIONS: Factors identified in this study as influential in dental hygienists' retention in private practice are similar to those identified as reasons for leaving the profession in previous attrition and reentry studies. To increase retention and job satisfaction of dental hygienists in the private practice setting, strategies for effectively working with employers should be emphasized in dental hygiene and dental curriculums and in continuing education programs.