Factors associated with the inclusion of oral health technicians into the public health service in Brazil.

BACKGROUND: The number of oral health technicians (OHT) in the public health service in Brazil is lower than the number of training school graduates. Thus, the objective of this study was to investigate possible factors associated with the inclusion of OHT in the public health service in Minas Gerais, Brazil, and its implications on oral health indicators. METHODS: This cross-sectional ecological study used a database (Excel) composed of 122 municipalities that participated in an OHT training course that took place between 2012 and 2013. Municipal contextual variables, including oral health indicators and sociodemographic indicators, related to the organization of health services were incorporated before and after the course. The dependent variable was the entry of graduates into the public health service according to a self-report survey conducted in 2015. A descriptive analysis of the variables was carried out, followed by bivariate analyses between the independent variables and the dependent variable using Pearson's chi-square test. The independent variables selected for multivariate logistic regression were statistically significant at p <  0.20. In the final model, significant effects were identified for variables with p <  0.05. The statistical software SPSS 18.0 for Windows was used. RESULTS: After the course, the variable of the public service organization and the two variables of oral health indicators were associated with the outcome. The organization services variable "presence of oral health team modality II" and the variable "indicator of coverage of first dental programmatic consultation" presented an association tendency with the entry of OHT in the multivariate logistic regression model, but these associations were not statistically significant because they had significance levels of p = 0.075 and p = 0.191, respectively. The variable "collective action indicator supervised dental brushing" was associated with the entry of egress (p = 0.045) remaining in the final model. CONCLUSION: The model of organization of the oral health service formed through the implementation of modality II oral health teams positively influenced the inclusion of OHT in the public health service in Minas Gerais, with improvement in the oral health indicators of the municipalities.

President's Message.

This is the last Editorial for me as President of IFDH. It has been an unforgettable time during the last 6 years on the Board and I am very grateful for all the support from colleagues around the world and from my Executive team. Corrie Jongbloed, our President Elect from the Netherlands will be assuming the role and I wish her the very best in her future endeavour.I recently read an article "The 100-year evolution of the science and practice of dental hygiene"1 which caused me to investigate and reflect on where our profession has come from and what will be the future. This article is protected by copyright. All rights reserved.

Empowerment through mentorship and leadership.

UNLABELLED: Leadership is vital to future growth and change in the dental hygiene profession. BACKGROUND AND PURPOSE: As health care reform emerges, state practice acts expand and new models of dental hygiene practice are created and implemented, dental hygienists will assume leadership positions that may be quite different from the more traditional leadership roles they assume today. These dental hygienist leaders will envision, creatively design and implement oral health care programs to improve the oral health of the public. Mentoring, a vital component of leadership development, is critical for dental hygienists to acquire knowledge, guidance, and growth. METHODS: This paper provides a literature-supported overview of leadership and mentoring principles applicable to dental hygienists in their personal and professional lives. Opportunities for dental hygienists to assume leadership roles are also described. CONCLUSIONS: Dental hygienists are poised to become leaders and vital members of the professional team promoting and integrating oral health care as a part of general health. Consequently, the dental hygienist's leadership roles are likely to expand and can be strengthened through mentoring relationships and mentoring teams. Ultimately, this can increase professional growth and career satisfaction for the dental hygienist as well as improve oral health care for the public.

Increasing productivity in dental practice: the role of ancillary personnel.

Dentistry has achieved substantial improvements in productivity which have the effect of making more care available at reasonable cost. Data are presented documenting trends in productivity. These are analyzed with respect to number of dentists, hours worked by dentists, and the use of ancillary personal in dental offices. There is strong evidence linking increased productivity to the use of ancillary personnel. The history of creation, recognition, and integration of ancillary personnel into dental practice is also presented.

Summary of the International Federation of Dental Hygienists house of delegates workshop.

OBJECTIVES: The 2007 International Federation of Dental Hygienists (IFDH) House of Delegates participated in a two day forum to discuss professional topics of interest and to provide a focus for the direction of the profession and the IFDH. MATERIALS AND METHODS: Delegates were asked to select a work group of interest based on four main topics: promoting evidence-based dental hygiene practice, procedures, and products; disease prevention and health promotion for primary health care; promoting interprofessional collaboration; and, reframing dental hygiene education. Each work group was challenged to address key questions and create a summary statement with recommendations to the IFDH. RESULTS: Each work group identified numerous areas for professional growth and development and created a list of aspirations for the profession and the association to achieve. CONCLUSION: The IFDH has made a commitment to the HOD to incorporate proposed recommendations and future aspirations.

Assessing the viability of the independent practice of dental hygiene--a brief communication.

BACKGROUND: This paper deals with the economics of the independent dental hygiene practice. METHODS: Using historical data from dental practices in Cincinnati, Ohio, we developed a business model for an independent hygiene practice. We tested the sensitivity of the model to variations in key assumptions (initial capitalization, interest, employee salary, and owner's draw). We described the profitability on the basis of the breakeven point. RESULTS: Under the most permissive regulatory and financial environment, the practice would breakeven after 26 months. However, the owner would not equal the earnings of a salaried hygienist until the initial loan is paid off after 7 years. The model was not sensitive to 20 percent changes in the key assumptions. CONCLUSIONS: Under ideal circumstances, an independent hygiene practice could be profitable.

Disaster response in Illinois: the role for dentists and dental hygienists.

Taking a leadership role, the Illinois Department of Public Health's Division of Oral Health has helped to successfully integrate oral health professionals into the emergency medical response system in Illinois by raising awareness, building needed partnerships, identifying and garnering resources, and facilitating training, policy development, surveillance, and evaluation. Applying the same principals and standards to the integration of oral health and disaster preparedness and response as it does to all facets of dental public health, the division has partnered with the Disaster Emergency Medicine Readiness Training Center at the University of Illinois at Chicago and many other key stakeholders to cement oral health as an integral component to the public health response system in Illinois.

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.

Education About Dental Hygienists' Roles in Public Dental Prevention Programs: Dental and Dental Hygiene Students' and Faculty Members' and Dental Hygienists' Perspectives.

In 2005, Public Act No. 161 (PA 161) was passed in Michigan, allowing dental hygienists to practice in approved public dental prevention programs to provide services for underserved populations while utilizing a collaborative agreement with a supervising dentist. The aims of this study were to assess how well dental and dental hygiene students and faculty members and practicing dental hygienists have been educated about PA 161, what attitudes and knowledge about the act they have, and how interested they are in additional education about it. University of Michigan dental and dental hygiene students and faculty members, students in other Michigan dental hygiene programs, and dental hygienists in the state were surveyed. Respondents (response rate) were 160 dental students (50%), 63 dental hygiene students (82%), 30 dental faculty members (26%), and 12 dental hygiene faculty members (52%) at the University of Michigan; 143 dental hygiene students in other programs (20%); and 95 members of the Michigan Dental Hygienists' Association (10%). The results showed that the dental students were less educated about PA 161 than the dental hygiene students, and the dental faculty members were less informed than the dental hygiene faculty members and dental hygienists. Responding dental hygiene faculty members and dental hygienists had more positive attitudes about PA 161 than did the students and dental faculty members. Most of the dental hygiene faculty members and dental hygienists knew a person providing services in a PA 161 program. Most dental hygiene students, faculty members, and dental hygienists wanted more education about PA 161. Overall, the better educated about the program the respondents were, the more positive their attitudes, and the more interested they were in learning more.

Evaluating the Impact of Expanded Practice Dental Hygienists in Oregon: An Outcomes Assessment.

PURPOSE: Currently the dental hygiene practice model in Oregon includes the Expanded Practice Dental Hygienist (EPDH), which allows dental hygienists with an Expanded Practice Permit (EPP) to provide care to limited access populations without the supervision of a dentist. The number and types of services provided by EPDH practitioners is thus far undocumented. The purpose of this study is to conduct an outcomes assessment of EPDH practitioners in order to quantify the impact, defined by count of services, on the access to care crisis in Oregon. METHODS: A 16 question confidential survey was developed and approved by the Pacific University institutional review board. The mail-based survey was sent to 181 EPDHs in Oregon in November 2011 (all EPDHs except pilot testers and one author). A second mailing was sent to non-respondents. Data were analyzed using descriptive statistics and chi-square analysis in SPSS. RESULTS: The response rate was 39% (n=71). Approximately 41% (n=29) of the respondents were currently using their EPP to provide care to limited access patients with an additional 21% (n=15) planning to start their own expanded practice. The majority of practicing EPDHs provide care in residential care facilities (n=21) and in school settings (n=13). Of the current practicing EPP holders, 76% practice ≤10 hours per week, and 66% make <$10,000 per year. Total services reported in an average month from all responding EPDH practitioners were: 254 adult prophylaxes, 1,003 child prophylaxes, 106 adult fluorides, 901 child fluorides and 1,994 fluoride varnishes, among many other preventive procedures. CONCLUSION: To a limited extent, the amount and type of services provided by EPDHs has now been quantified, and EPDHs are making an impact on the access to care crisis in Oregon. Continued outcomes assessment is needed to further quantify the impact of EPDHs.

Hiring staff 101.

For the graduating dentist or the dentist in practice for only a few years, the best investment you can make in your future is to hire and keep the highest-quality staff. Dentists new to the role of employer have neither the HR training to attract, interview, and hire quality staff, nor the experience in dealing with what may just be the most important factor in the success of your practice: the people you hire.

Expanding the physician-substitute concept to oral health care practitioners.

This position paper proposes the development of an intermediate level practitioner to increase access to primary oral health care and to maximize cost benefit factors. The proposal is built upon research which has demonstrated the feasibility of preparing baccalaureate hygienists to serve as the counterpart to the physician assistant or nurse practitioner. The role of the primary oral health care practitioner would involve locating underserved or non-user groups, assessing oral health needs, referring to appropriate care providers, and providing primary care traditionally provided by dentists. Promotion of the intermediate oral practitioner would require policy to halt erosion of the infrastructure of university-based dental hygiene education, the allocation of nationally funded financial incentives, and specified modifications in the current health care system.

Dental hygienists in Poland.

The activities of dental hygienists in Poland since 1974 are described. About 600 dental hygienists graduated in Poland up to 1977 but only 32% of them are still working in the profession. Their main activities are: dental health education, fluoride prophylaxis and assisting in dental clinics. Although the work of about 50% of the hygienists is poorly organized, they are regarded as useful in dental care by 23 Heads of district dental clinics who employ dental hygienists.

Fee-paying systems and service patterns in a Hong Kong dental clinic.

OBJECTIVE: This study aimed to describe and compare patients' consumption of dental services and dentists' productivity in a university campus clinic before and after changing from a time-based to an item-based fee-paying system. METHOD: Data were collected from the University of Hong Kong dental clinic which serves all university students and staff. A time-based fee-paying system had been in use up to February 1999 when it was switched to an item-based system. Computerised records of all patients in two 1-year periods starting from February 1996 and February 1999 were analysed. RESULTS: The percentages of eligible users who attended the University dental clinic were similar in the two study periods (30% in 96/97 vs 29% in 99/00). However, on average, patients consumed more dental service items in a year after the switch in fee-paying system (3.2 vs 4.1). There was also an increase in the mean number of dental service items provided by a dentist per working week after the change in fee-paying system (71.5 vs 99.4). CONCLUSION: On switching from a time-based to an item-based fee-paying system, dentists in the UHS dental clinic became more productive and the consumption of dental services per patient also increased.

Attitudes to independent dental hygiene practice: dentists and dental hygienists in Ontario.

This study examined Ontario dentists' and dental hygienists' attitudes to independent dental hygiene practice and changing the scope of practice. Data were collected from a mail survey of a systematic, stratified sample of Ontario dentists (483 respondents) and dental hygienists (437 respondents) conducted in the winter and spring of 2002 to assess what practising dentists and dental hygienists think about independent practice and other professional issues. Contrary to previous research, this study found that male and female dentists did not differ in their attitudes to independent dental hygiene practice and university education for dental hygienists: both strongly opposed the former and tended to support the latter. Similarly, few differences in attitude amongst dentists by specialty were found. Dental hygienists were generally supportive of independent practice and of expanding their scope of practice. On some measures, however, sex and age differences in attitudes were evident: at times dental hygienists who were older or male seemed to be stronger advocates for professional change than others.