Embedding Dental Hygienists into Medical Care Teams: Implementation and evaluation of a medical-dental integration approach in Colorado.

This case report describes the implementation approach and evaluation of a medical-dental integration (MDI) project in Colorado that embedded dental hygienists (DHs) into 10 medical practice settings. Through the MDI Learning Collaborative, DHs were integrated into primary care medical care practices to provide full-scope dental hygiene care to patients. Dental hygienists were trained to collect quality-improvement metrics on all encounters, including untreated tooth decay, and referred patients with restorative needs to partnering dentists. Cross-sectional, aggregated clinic-level oral health metrics were submitted monthly from 2019-2022. Descriptive statistics were used to describe the population receiving MDI care and interviews were conducted with MDI staff to describe their perspectives on this approach to comprehensive care. A logistic regression model, adjusted for time and practice, compared untreated dental caries in established vs new MDI patient-visits. From 2019-2021, integrated DHs completed 13,458 visits to low-income patients, Medicaid (70%, n=9,421), uninsured (24%, n=3,230), SCHIP (3%, n=404), private (3%, n=404), of various ages: 0-5 (29%, n=3,838), 6-18 (17%, n=2,266), 18-64 (51%, n=6,825), >65 (4%, n=529). A total of 912 visits were provided to pregnant patients. Services included caries risk assessment (n=9,329), fluoride varnish (n=6,722), dental sealants (n=1,391), silver diamine fluoride (n=382), x-rays (n=5,465) and scaling/root-planing (n=2,882). Improvement was found in untreated decay of established vs. new patient-visits in four of the practices. Dental hygienists integrated into medical teams provided full-scope dental hygiene care to patients and expanded access to dental services. Medical-dental integration (MDI) care was variably associated with reduction in untreated decay. Integrating dental hygienists into primary care medical practices has potential to improve oral health-related outcomes, however access to restorative dental care remains a challenge.

Quality of life in dental hygienists using complementary alternative medicine approaches for work-related musculoskeletal disorders.

OBJECTIVES: The use of conventional treatment for work-related musculoskeletal disorders (WRMSDs) reduces the prevalence of pain, but with popularity of complementary alternative medicine (CAM) therapies for treatment, it is important to explore their use and impact on dental hygienists (DHs) quality of life (QoL). METHODS: A cross-sectional survey research design was used with a non-probability sample of dental hygienists (n = 85) with WRMSDs who used CAM therapies. The WHOQOL-BREF was used to assess quality of life and compared with CAM use and frequency. Analysis included descriptive, t-tests, correlation and chi-square tests of independence. RESULTS: The most commonly used CAM types were massage (81%) and chiropractic manipulation (67%) with 66% of respondents using two or more CAM therapies. Participants using five or less different CAMs (n = 46), compared with those using more than five CAM types (n = 35, M = 2.3, SD = 1.5), t (79) = 2.7, p = 0.01, had a higher average number of years before they noticed their WRMSD (M = 3.3, SD = 1.9). Participants reporting use of a higher number of CAM types also had lower QoL physical health domain scores (rho = -0.2, p = 0.03). CONCLUSIONS: Dental hygienists used a variety of CAM approaches to manage WRMSDs and had a lower QoL across all domains (physical health, psychological health, social relationships and environment) than the normative mean. More research is needed to explore the use of CAM approaches, such as yoga, for prevention and management of WRMSDs to improve QoL.

Musculoskeletal Disorders among Italian Dentists and Dental Hygienists.

Dental professionals often perform physically and mentally demanding therapeutical procedures. They work maintaining muscular imbalance and asymmetrical positions for a long time. The aim of the study was to describe the prevalence and the factors associated to work-related musculoskeletal disorders (WMSD) among Italian dental professionals and the most affected body regions. A cross-sectional observational study was conducted between March 2019 and February 2020. The Nordic Musculoskeletal questionnaire (NMQ) was implemented with questions related to working habits (dental occupation, working hours per week and per days, years of work) and lifestyle (practiced physical activity, including frequency and duration, mobilization activities, and knowledge of ergonomic guidelines) was used. The-chi square test was carried out to detect any statistically significant difference (p < 0.05). Logistic regression was carried out to detect the most significant factors associated to WMSD occurrence. A total of 284 questionnaires have been used for the analysis. A high proportion of dental professionals (84.6%) were affected by WMSD in the last 12 months. A higher prevalence was found in females (87%) when compared to males (80%). The prevalence of WMSD was correlated to the working hours/day and hour/week, with a higher risk for operators working >5 h/day and >30 h/week. In addition, a high prevalence was found in operators working for 2-5 years after graduation. Most of the surveyed dental professionals practiced physical activity (70.1%) but only a few had satisfactorily knowledge of ergonomic guidelines (12.7%). Interestingly, participants who practiced yoga or stretching as physical activities demonstrated lower WMSD (77%) when compared to other physical activities (84%). We can highlight that generic physical activities have no functional effect on WMSD for dental professionals. The most affected body areas were neck (59.9%), shoulders (43.3%), lumbar region (52.1%), dorsal region (37.7%) and wrists (30.6%). Considering the magnitude of the problem, there is an urgent need to implement the education in ergonomics among dental professionals, that may be achieved by teaching biomechanics, posturology and integrative functional therapies (such as yoga) during the university education and by promoting holistic health of dental operators.

Condition of mineralized tooth tissue in a population of 15-year-old adolescents living in a region of Ukraine with slightly exceeded fluorine concentration in the water.

INTRODUCTION: Fluorine is a common element in nature; however, the difference between a beneficial dose and a toxic dose for the organisms is small. The main source of fluoride for humans is water in addition to food. OBJECTIVE: The aim of this study was to estimate the degree of severity of pathological changes, namely, caries or fluorosis, in the mineralized tooth tissue of 15-year-old adolescents with respect to their hygienic and nutritional habits, and the content of fluorine in drinking water, soil and plant products. MATERIAL AND METHODS: 100 adolescents aged 15 from schools in Sosnilka, L'viv region, were examined. The condition of mineralized tooth tissue was evaluated by the caries severity, expressed by the mean number D3MFT, caries frequency and value of the SIC index. Fluorine in plant material and soil were determined according to the PN-G-04543:1982 standard, and water according to the PN-EN ISO 10304 - 1: 2009+ AC: 2012 standard. RESULTS: Severity of caries disease expressed by the D3MFT number in the examined group of 15-year-olds was 3.39; in the group of girls - 3.08, and in the group of boys - 3.76. In the examined group, the average number of teeth with fluorosis was 7.59. Value of the SIC index among the examined population of students (n-31) was 6.26: 5.89 (n-18) for girls and 7.31 (n-13) for boys. Fluorine concentration in the water was 0.78 - 1.25(mg·dm-3). In the soil, it also did not vary across the sampled areas and amounted, on average, to 176 mg·dm-3. The biggest fluorine content noted in the dry mass of beetroots was 3.50 (mg F· kg), and the lowest - 3.34 (mg F· kg). CONCLUSIONS: Close to optimal fluorine content lowers caries severity and frequency of fluorosis. Optimal fluorine content in drinking water and food does not require additional diet supplementation.

Patients' Perspective Regarding the Administration of Local Anesthesia by Dental Hygienists.

Purpose: Local anesthetics have been used in dentistry to aid patients in pain control during a wide range of surgical and non-surgical procedures. The purpose of this study was to explore the perspectives of patients regarding the administration of local anesthesia (LA) by dental hygienists.Methods: This qualitative study used an exploratory, online, focus group design. Four online focus groups were held with 18 participants recruited through purposive sampling. Pseudonyms were used to protect participants' confidentiality. A questioning route was established for the groups and validated by focus group experts and pilot testing procedures. Each focus group session was recorded and transcribed. Themes were analyzed using classic analysis strategy. Validity was established using investigator triangulation, saturation and member checks.Results: Three major themes were identified regarding the administration of local anesthesia by dental hygienists. The first theme identified was the patients' experience and the value participants placed on patient-centered care. The second theme was the participants' unclear perceptions regarding the dental hygienists' educational qualifications to administer LA and complete a dental hygiene diagnosis. The third theme revealed future suggestions for dentists and legislators from the participants.Conclusion: This qualitative study offers insight into the patient's perspective of dental hygienists administering LA. Participants supported dental hygienists administering LA and appreciated the aspects of patient-centered care that this practice provided. Patient participants were unclear on educational requirements and training, but supported legislation allowing dental hygienists to administer LA.

Knowledge of malocclusion supports comprehensive dental hygiene care.

Occlusal assessments are often missed or neglected by dentists and dental hygienists. This short communication discusses how these assessments can be implemented through 4 planes of space: anterior-posterior/anteroposterior, vertical, transverse, and perimeter. Expanded occlusal knowledge can improve the referral process for early preventive care. A chairside guide has been defined for dental hygienists to conduct a systematic occlusal exam.

Il arrive souvent que les évaluations occlusales ne soient pas effectuées ou soient négligées par les dentistes et les hygiénistes dentaires. Ce bref article traite de la façon dont ces évaluations peuvent être effectuées au moyen de 4 dimensions de l'espace : antérieure-postérieure/ antéropostérieure, verticale, transverse et périmètre. Une connaissance approfondie de l'occlusion peut améliorer le processus de renvoi pour l'obtention de soins préventifs précoces. Un guide au fauteuil a été préparé à l'intention des hygiénistes dentaires pour leur permettre d'effectuer un examen occlusal systématique.

HPV and Oral Cancer: The Need to Integrate Oral Health Practices Into Nursing Education.

BACKGROUND: Human papillomavirus (HPV)-associated oropharyngeal cancer has increased in recent decades. With a shortage of dental professionals, nurses may be key in detecting oral cancer and educating patients. OBJECTIVES: The aim of this study is to assess students in nursing and dental programs for their oral and oropharyngeal cancer knowledge and perceptions of responsibility and capability of performing oral screenings and HPV counseling. METHODS: 158 surveys were completed by students attending nursing and dental programs at a midwestern university. The chi-squared test and analysis of variance were used to calculate differences in frequencies of categorical and interval data. FINDINGS: Many students across programs were unaware of the potential effectiveness of the HPV vaccination in reducing oropharyngeal cancer. Nursing and nurse practitioner students were less likely to believe they could perform an examination or that it was within their perceived scope of practice.

Educational and Clinical Experiences in Administering Local Anesthesia: a study of dental and dental hygiene students in California.

Purpose: The purpose of this study was to examine the differences in educational preparation and practical educational experiences between dental and dental hygiene students in the administration of local anesthesia (LA) and management of LA related complications in the state of California.Methods: Course instructors responsible for teaching LA or the program directors of the 6 dental schools and 29 dental hygiene programs in California (n=35) were invited to participate in this study. A computer-based descriptive survey, a comparative checklist of LA instruction requirements and semi-structured interviews were used for the data collection. Descriptive statistics were used to analyze results.Results: Eighteen LA course instructors or program directors participated in the study for a response rate of 51%. One respondent was from a dental school while 17 were from dental hygiene programs. The majority of the dental hygiene (n=16) respondents reported teaching 12 types of intraoral injections; the dental school respondent reported teaching seven injection types. Fewer student-to-student injection experiences per injection type were required by the dental school (n=7) than the dental hygiene schools (n=12) and the dental school did not indicate a minimum number of student-to-patient injection requirements for graduation. Analysis of a checklist of required elements of LA instruction and individual syllabi revealed common elements of all courses; students are expected to choose the proper local anesthetic, identify the proper injection type, and manage any LA complications. The majority of the interview participants perceived that dental hygiene students had more educational preparation in LA than their dental student cohorts and that dental hygienists were educationally prepared to administer LA safely without direct supervision.Conclusions: Dental hygiene students in California programs appear to be well prepared through their education experiences to administer and manage complications related to local anesthesia. Consideration should be given to supporting changing the supervision requirements for the administration of local anesthesia by dental hygienists licensed in the state of California.

Effects of a Training Needle on Dental Hygiene Student Anxiety.

Purpose: The purpose of this pilot study was to assess whether practicing with a cotton-tipped applicator as compared to a new training device had an effect on the anxiety levels of dental hygiene students prior to administering and receiving their first intraoral injection for local anesthesia.Methods: This pilot study used a convenience sample of senior dental hygiene students from an entry-level Bachelor degree dental hygiene program. Participants completed a pre-test survey after watching a video demonstrating the inferior alveolar nerve block (IANB) injection technique to determine anxiety levels regarding administering and receiving an intraoral injection. Test and control groups were randomly assigned; and participants either received a dental syringe with an attached training needle device (test) or a cotton tip applicator (control). Both groups completed a post-test survey following a 15 minute practice session. Descriptive statistics were performed and Chi-square tests were used to determine significance.Results: Pre-test results showed that 91% of the participants (n=23) reported having anxiety regarding administering or receiving an intraoral injection in one or multiple areas. Chi-square tests determined no statistical significance (p =0.125) between the test and control groups in the post-test surveys.Conclusion: Dental hygiene students demonstrated decreased anxiety levels regarding administering and receiving an intraoral injection regardless of the assigned practice device in this pilot study. While use of a training needle was not shown to be superior at reducing anxiety in novice student operators when compared to a cotton tipped applicator, it may be a useful device for teaching local anesthesia administration techniques.

Development and evaluation of the Jönköping Dental Fear Coping Model: a health professional perspective.

OBJECTIVE: The purpose of this study was to design a structured treatment model focusing on all levels of adult's dental fear, the Jönköping Dental Fear Coping Model (DFCM). The aim was to study the DFCM from a dental health professional perspective. MATERIAL AND METHODS: The DFCM was studied by means of quantitative and qualitative analyses. Nine dental clinics participated in Period I (pre-intervention/standard care), and 133 dental health professionals (dentists, dental hygienists, dental assistants) and 3088 patients were included. After completion of Period I, four of the clinics were randomized to Period II (intervention), beginning with the professionals undergoing DFCM training. Following that, 51 dental health professionals treated 1417 patients according to the DFCM. The other five clinics served as controls. RESULTS: Half or more of the dental health professionals assessed the model as better than standard care, regarding anamnesis and diagnostics, communication and contact, and understanding of patients and dental fear. The dental health professionals reported higher tension in their fearful patients in Period II compared with Period I, possibly due to their increased awareness of dental fear. CONCLUSIONS: The qualitative data suggest that dental health professionals find the DFCM beneficial in routine dental care. The model promotes a holistic approach to the treatment of adult patients. However, stress among the professionals was not reduced when measured, neither quantitatively nor qualitatively. It is important to evaluate the model in further studies to make it possible to draw generalizable conclusions.

Change in oral health status associated with menopause in Japanese dental hygienists.

OBJECTIVES: Oral symptoms such as xerostomia and burning mouth syndrome have been recognized to increase associated with menopause. The purpose of this study was to clarify the changes in oral health as well as systemic health due to menopause and their relations with hormonal change and mental status. METHODS: Ninety-seven female dental hygienists aged 40-59 years were assigned to premenopausal, menopausal and post-menopausal groups based on self-reported menstrual condition. Subjective health statuses were evaluated by questionnaire, and objective holistic and oral statuses were evaluated by measuring serum 17ß-estradiol (E2), salivary flow rate, α-amylase and secretory IgA (SIgA) and taste sensitivity. RESULTS: A significant difference among the three groups was observed in the self-rating questionnaire of depression (SRQ-D) score and serum E2 level as well as unstimulated salivary flow rate, whereas no significant difference was observed in Simplified menopausal index, Short-Form 36-Item Health Survey, General Oral Health Assessment Index, salivary α-amylase activity, salivary SIgA concentration and taste threshold. Serum E2 levels positively correlated with unstimulated salivary flow rates and negatively correlated with SRQ-D scores and α-amylase activities. CONCLUSIONS: The results demonstrated a negative correlation between E2 levels and SRQ-D scores as well as salivary α-amylase activities, suggesting an influence of E2 on mental condition. Furthermore, E2 decrease may result in reduction of salivary flow which in turn causes various problems of oral health. Since the participants were graduates from several dental hygienist schools and working at various places, these results can be generalized to Japanese dental hygienists to some extent.

Effects of Yoga on Musculoskeletal Pain.

Purpose: Musculoskeletal pain has been associated with work stress and a shortened career in the dental hygiene profession. The purpose of this study was to determine if participating in two yoga sessions per week would reduce the musculoskeletal pain reported by dental hygiene students and or impact body composition.Methods: A convenience sample of 77 dental hygiene students self-selected into treatment (yoga) and control groups. Students in the yoga group participated in bi-weekly, 60-minute yoga sessions for 13 consecutive weeks. Students completed a questionnaire and a Comparative Pain Scale evaluation prior to and immediately following the study period to assess musculoskeletal pain. Additionally, the Omron HBF-514C Full Body Composition Sensing Monitor and Scale was used to measure body mass index (BMI), body fat, and muscle prior to and upon completion of the study. Paired sample t-tests and independent t-tests were used to analyze the data.Results: Thirty-eight dental hygiene students, with an average age of 23.9 years, participated in the yoga group and 39 were assigned to the control group. The majority of the participants were Caucasian (63.6%) females (90.9%). Participants in both groups were of similar age, ethnicity, and had comparable pre-study Harich Comparative Pain Scale scores. After participating in the yoga sessions, the treatment group reported a significant decrease in musculoskeletal pain (p<0.001), while the control group reported no significant decrease in musculoskeletal pain (p=0.881). The yoga sessions did not significantly impact the BMI scores for the yoga treatment group (p=.984) or the control group (p=.901).Conclusion: This research supports the practice of bi-weekly yoga sessions as beneficial in decreasing musculoskeletal pain in dental hygiene students. Yoga can be considered a viable complementary health approach to incorporate into student schedules as a means of increasing the health and longevity of a dental hygiene career.

Dietary analysis and nutritional counselling for caries prevention in dental practise: a pilot study.

BACKGROUND: Dental practitioners agree that dietary counselling is essential for caries prevention; however, they provide advice infrequently due to a lack of confidence and competence. This study aimed to improve practises through an online training module exploring the use of a brief counselling method, and a diet assessment of caries risk form. METHODS: Dental practitioners (N = 41) completed a survey on current practises and confidence in providing dietary advice, followed by an online training module. Ten practitioners were involved in recruiting patients, eliciting a diet assessment of caries risk, and using brief counselling techniques with these patients. Patients were followed up at 6 months for a risk assessment review. Dental practitioners also completed a 6-month follow-up survey exploring changes in confidence and perceived barriers. RESULTS: Dental hygienists' confidence improved significantly following the intervention (P < 0.025). Patients showed a significant reduction in high-risk behaviour pertaining to quantity and timing of sugar intake, and significant trends in improvement of behaviours relating to frequency, exposure time and drinking style (P < 0.05). CONCLUSIONS: It appears that a simple online learning module can improve hygienists' confidence in dietary advice provision, and have a positive impact on patient behaviour change, within a relatively short time-frame.

An Evaluation of Permit L Local Anesthesia within Dental Hygiene Practice in Massachusetts.

PURPOSE: The purpose of this descriptive study was to assess data pertinent to the Permit L local anesthesia license among practicing dental hygienists in Massachusetts, providing an overview of characteristics, practice behaviors, barriers for obtaining the permit and self-perceived competency. METHODS: A convenience sample of dental hygienists (n=6,167) identified through a publically available data base were invited to participate in a web-based survey. The survey consisted of demographic and Permit L specific questions. Items regarding opinions were rated using a 5-point Likert scale while frequencies and percentiles were used to evaluate demographics and practice-based information. Spearman's Rank correlation was performed to determine association between variables. RESULTS: A 10% (n=615) response rate was attained with (n=245) non-Permit L holders and (n=370) Permit L holders. Respondents reported significant differences in demographics and opinions between non-Permit L holders and Permit L holders (p<0.01) and between those certified through continuing education or curriculum based programs (p<0.01). Significant relationships were found in demographics (p<0.01) and practice (p<0.05) items in relation to the length of time the Permit L has been held. Themes from the data and comments indicate multiple factors influencing obtaining or not obtaining the Permit L. CONCLUSION: The results of this study provide an overview of Permit L local anesthesia administration that is generally comparable to previous studies and offers new insights into why some Massachusetts dental hygienists choose not to pursue certification. This study highlights the potential to increase the prevalence of the Permit L, address barriers to pursuing the Permit L, and further evaluate self-perceived barriers.

Periodontal diseases as a source of halitosis: a review of the evidence and treatment approaches for dentists and dental hygienists.

Bad breath (halitosis) is an important social complaint. In most cases (≥90%), the cause of halitosis can be found within the oral cavity. Under this circumstance, the term oral malodor applies. It affects both healthy and periodontally diseased individuals. Oral malodor is mainly caused by a microbial degradation of both sulfur-containing and nonsulfur-containing amino acids into volatile, bad-smelling gases. Anaerobic gram-negative bacteria, the same species that have been linked to periodontal diseases, are especially involved in this process, explaining why clinicians often associate oral malodor with periodontitis. Some volatile organic compounds render patients more susceptible to periodontitis and this supports the malodor-periodontitis link. This review investigates the interaction between oral malodor and periodontal diseases. Pro and con arguments regarding the mechanisms of halitosis and clinical implications will be presented. In general, however, the impact of tongue coatings has been found to be the dominant factor, besides gingivitis and periodontitis. The last part of this review discusses the treatment of bad breath, with different options.

Evaluation of Oral Health Promotion Program Connected with Hypertension and Diabetes Management Programs: Use of a Logical Model / 치위생과학회지

This study aimed to design and operate a complementary integrated health management program based on the connection between the hypertension and diabetes management programs and the oral health programs at a public health center. It also proposed to suggest the phased evaluation indicators. In this study, 48 adults registered in the hypertension and diabetes management program were selected from the Gangneung public health center. The clinic-specific programs were led by dental hygienists and operated for visitors twice every two weeks. The programs were designed based on the logical model, and indicators for evaluating the structure, process, and outcome were presented and applied to the input, process, output, and outcome. The evaluation indices consisted of quantitative and qualitative indicators, and the planning and operation, goal achievement, and effect of each program were assessed. The process evaluations were assessed by the appropriateness of the managers and the operating fidelity of the programs. Indicators for evaluating the outcomes were gingival bleeding, oral health knowledge, oral health awareness, and the satisfaction of the participant and the manager. The clinic-specific programs resulted in positive changes in the evaluated outcomes. The integrated health management of visitors to the hypertension and diabetes management program is important as the general and oral health has common risk factors. Furthermore, long-term operation and continuous monitoring of oral health programs are necessary to evaluate the common factors in chronic disease management.

Dental hygiene students' perceptions of a cultural competence component in a tobacco dependence education curriculum: a pilot study.

First Nations and Inuit peoples have tobacco use rates three times that of the Canadian national average. Providing tobacco dependence education (TDE) requires an understanding of the factors surrounding tobacco use that are culturally specific to this population. The aim of this pilot study was to evaluate the effectiveness of a new cultural competence component for Canadian First Nations and Inuit peoples in a TDE curriculum at Dalhousie University School of Dental Hygiene, Halifax, Nova Scotia, Canada. In 2011, the TDE curriculum was revised to include a First Nations and Inuit people's cultural component. A 32-question survey was developed for the study, with questions divided into four subscales regarding students' perceived knowledge, skills, comfort level, and attitudes about working with this population. Responses from students in two succeeding years were compared: the first cohort had not participated in the revised curriculum (56% response rate), and the second cohort had (63% response rate). The results showed an overall improvement in the subscales evaluated and a significant (p=0.002) improvement in the knowledge subscale of the students who received the new TDE curriculum, specifically regarding knowledge about sociocultural characteristics, health risks, and cultural healing traditions of First Nations and Inuit people. Although the results indicated an increase in the knowledge of the culture of First Nations and Inuit peoples, it is unclear whether the students felt better prepared to provide TDE to this population. For future research, the investigators would examine what learning experiences and further changes to the curriculum could be provided to facilitate the level of preparedness to successfully deliver TDE.