Dental hygiene education about patients with special needs: a survey of U.S. programs.

The objective of this study was to explore how dental hygiene programs in the United States educate their students about treating patients with special needs. Data were collected from 102 U.S. dental hygiene programs (response rate=49 percent) with a web-based survey. Nearly all programs (98 percent) reported that they present this material in lectures. However, only 42 percent of the programs required students to gain clinical experiences with patients with special needs. Most programs covered the treatment of patients with physical/sensory impairments such as hearing impairments (93.1 percent), psychopathologies (89.2 percent), and adult onset neurological disorders (89.2 percent). Outcome assessments were usually done in a written exam (97.1 percent), while objective structured clinical examinations (OSCEs) (9.8 percent) and standardized patient experiences (4.9 percent) were less frequently used. Respondents identified "curriculum overload" as the biggest challenge to addressing special patient needs. Nevertheless, 29.4 percent of the respondents indicated that they support an increase in clinical experiences for students to give them increased opportunities to work with patients with special needs. Recent changes in accreditation standards require graduating dental hygiene students to be competent in assessing the treatment needs of special needs patients. Based on the program directors' responses, recommendations can be made to increase the opportunities for students to have clinical experiences with patients with special needs and to address the needs of patients with special needs more comprehensively in dental hygiene curricula.

Dental Hygiene Students' Perceptions of Importance and Confidence in Applying Motivational Interviewing During Patient Care.

Purpose: Motivational Interviewing (MI) is an evidence-based, patient-centered counseling approach for eliciting behavior change. In 2012, the University of Michigan (U-M) Dental Hygiene Program significantly enhanced their behavior change curriculum by reinforcing and building upon the Motivational Interviewing segment. The purpose of this study was to examine students' perceptions of the importance of MI and their confidence in applying it during patient care.Methods: A convenience sample of 22 U-M Class of 2015 dental hygiene students who had received an enhanced curriculum participated in this study, utilizing a retrospective, pre-test/post-test design.Results: A Wilcoxon signed rank test was used to compare the differences in average ranks between T1 (Retrospective Pre-Test) and T4 (Post-Test 3) for the importance and confidence questions at each time point for the Class of 2015. Students' perceptions of importance increased with statistical significance in five out of eight MI strategies. Perceptions in confidence increased in seven out of eight strategies. Effect size ranged from .00 to .55. Assessment of qualitative data provided additional insight on student experiences.Conclusion: Student perceptions of importance of using MI and their confidence in applying MI increased in a majority of the strategy categories. Successes with patient health behavior change and challenges with time to integrate this in practice were noted. Research on the longitudinal impact and faculty feedback calibration is recommended.

Integration of oral health care and mental health services: Dental hygienists' readiness and capacity for secondary prevention of eating disorders.

Often the first to observe overt health effects of eating disorders, dentists and dental hygienists play a fundamental role in the secondary prevention of eating disorders. The purpose of this study was to explore readiness and capacity for integration of oral health and mental health services. Employing a randomized cross-sectional study based upon the Transtheoretical and Health Belief Models, data were collected from 378 dental hygienists. Results reveal that the majority do not currently engage in secondary prevention practices. Only 18% of respondents indicated referring patients exhibiting oral manifestations of eating disorders to treatment. Significantly increasing the likelihood of assessment, referral, and case management included modifying factors regarding greater perceived self-efficacy, and knowledge of oral cues of disordered eating, as well as the individual's perception pertaining to severity of eating disorders. Implications for bridging dental care to mental health services include increasing behavioral capacity among dental hygienists via consciousness raising and improved self-efficacy.

Knowledge of oral and physical manifestations of anorexia and bulimia nervosa among dentists and dental hygienists.

Despite the crucial role oral health care providers can have in the early identification of eating disorders and the referral and case management of patients with these disorders, little is known concerning their knowledge of oral complications of these disorders. The purpose of this study was to determine the knowledge among dentists and dental hygienists concerning the oral and physical manifestations of eating disorders. Employing a randomized cross-sectional study, data were collected from 576 dentists and dental hygienists randomly selected from the American Dental Association and the American Dental Hygienists' Association. Results indicated low scores concerning knowledge of oral cues, physical cues of anorexia, and physical cues of bulimia among study participants. More dental hygienists than dentists correctly identified oral manifestations of eating disorders (p=.001) and physical cues of anorexia (p=.010) and bulimia (p=.002). As the first health professional to identify oral symptoms of eating disorders, the most important task of the dental care provider when identifying oro-dental signs of eating disorders is to ensure that the patient receives treatment. Implications for education include the addition of conceptual, procedural, and skill-based curricula objectives addressing etiologic assessment and patient communication--thus increasing behavioral capacity for delivery of restorative care and patient referral.

Radiographic detection of approximal caries: a comparison between senior dental students and senior dental hygiene students.

PURPOSE: Dental hygienists do not legally (or definitively) diagnose caries, but they often are responsible for preliminary interpretation of bitewing (BW) radiographs taken during prophylaxis appointments. Given this custom of practice, it is important to understand whether there is a difference between the capabilities of dental hygienists and dentists in interpreting BWs based on education and clinical experience. This study compared proximal carious lesion classification from BWs by senior dental students and senior dental hygiene students. METHODS AND MATERIALS: Volunteers (40 dental [D] and 54 dental hygiene [DH] students) classified proximal carious lesions from BWs of 96 extracted teeth, which were mounted in wax to simulate quadrants of the mouth. A soft tissue equivalent was placed in front of the mounted teeth before x-ray exposure. Films were developed automatically and mounted into six sets point scale. The teeth were sectioned vertically and evaluated clinically at 5x magnification with an explorer. The "gold standard" of carious lesion classification was then compared to the students' classifications. RESULTS: All students detected 54% of the carious lesions and correctly identified lack of caries 80.5% of the time. There were no differences between the two groups of students in terms of sensitivity, but dental students showed higher specificity (p = 0.0006). CONCLUSION: Permitting dental hygienists to make preliminary interpretations of caries from BWs in the dental office appears to be an acceptable practice.

ePortfolio: developing a catalyst for critical self-assessment and evaluation of learning outcomes.

There is a growing trend among college accreditation bodies, especially in professional schools, to incorporate self-assessment in the curriculum and deliver evidence of students' learning outcomes. Both as product and process, reflective ePortfolios have the potential to promote learning and transfer of knowledge by fostering the ability to make connections between learning outcomes and leaning experiences. This article describes a model for a program-wide integrated reflective ePortfolio developed by the University of Michigan Dental Hygiene Degree Completion E-Learning (online) Program. This systematic approach to developing a successful portfolio program can be utilized in many areas of professional health care education. Applying these strategies can result in an ePortfolio that has a positive impact on student learning, develops reflective practitioners, and provides valuable programmatic outcomes data.

Using multiple methods to assess learning and outcomes in an online degree-granting dental hygiene program.

Program evaluation is a necessary component of curricular change and innovation. It ascertains whether an innovation has met benchmarks and contributes to the body of knowledge about educational methodologies and supports the use of evidence-based practice in teaching. Education researchers argue that rigorous program evaluation should utilize a mixed-method approach, triangulating both qualitative and quantitative methods to understand program effectiveness. This approach was used to evaluate the University of Michigan Dental Hygiene Degree Completion E-Learning (online) Program. Quantitative data included time spent on coursework, grades, publications, course evaluation results, and survey responses. Qualitative data included student and faculty responses in focus groups and on surveys as well as students' portfolio reflections. The results showed the program was academically rigorous, fostering students' ability to connect theory with practice and apply evidence-based practice principles. These results also demonstrated that the students had learned to critically reflect on their practice and develop expanded professional identities; going beyond the role of clinician, they began to see themselves as educators, advocates, and researchers. This evaluation model is easily adaptable and is applicable to any health science or other professional degree program. This study also raised important questions regarding the effect of meta-reflection on student confidence and professional behavior.

Using online program development to foster curricular change and innovation.

Distance education offers an opportunity to catalyze sweeping curricular change. Faculty members of the University of Michigan Dental Hygiene Program spent eighteen months researching best practices, planning outcomes and courses, and implementing an e-learning (online) dental hygiene degree completion program. The result is a collaborative and portfolio-integrated program that focuses on the development of reflective practitioners and leaders in the profession. A team-based, systems-oriented model for production, implementation, and evaluation has been critical to the program's success. The models and best practices on which this program was founded are described. Also provided is a framework of strategies for development, including the utilization of backward course design, which can be used in many areas of professional education.

Online directed journaling in dental hygiene clinical education.

Reflecting upon and sharing of clinical experiences in dental hygiene education is a strategy used to support the application of didactic material to patient care. The promotion of interactive, clinically focused discussions creates opportunities for students to foster critical thinking and socialization skills in dental hygiene practice. Twenty-eight dental hygiene students in their first semester of patient care utilized online directed journaling via blogging software, as a reflection and sharing strategy. Journal entries found critical thinking and socialization themes including connection of didactic material to clinical experience, student-patient interaction, student-student collaboration, and a vision of the professional role of the dental hygienist. A 7 item evaluation instrument provided data that the online journaling strategy was perceived as effective and valuable by the students. Online directed journaling is a strategy that has the potential to enhance critical thinking and socialization skills in dental hygiene clinical education.

The utilization of Computer Mediated Communication for case study collaboration.

Computer Mediated Communication (CMC) can be used as an effective tool for student communication and collaboration. First-year, first-semester dental hygiene students self-selected groups to develop dental hygiene process of care treatment plans, written reports, and oral case presentations based on assigned clinical cases. In consultation with the University of Michigan (UM) Digital Media Commons Collaborative Technologies Teams, CMC options were identified. Two chat rooms were established within the UM's Course Management System (CTools) to provide opportunities for synchronous (simultaneous, real-time) communication. One course blog site and 8 case blog sites were developed to provide students and instructors with electronic asynchronous (nonsimultaneous) communication formats. The purpose of this study was to evaluate the effectiveness of these technologies during group case study projects. CMC has the potential to provide an effective means of collaboration and communication when the technologies align with the purpose of the project and compliment the dynamics of student groups.