Implementing a Prenatal Oral Health Program for Dental Students: Lessons Learned.

The Prenatal Oral Health Program (pOHP) was developed to educate dental students on prenatal oral health and promote access to dental care for pregnant women. Program advancement has occurred in support of quality improvement. This mixed-methods design combined quantitative data from fourth-year dental students who participated the pOHP (N = 81) and qualitative data from a student-faculty-staff focus group discussion (N = 7). Different clinical structures, appropriate leveling in the curriculum, management with a patient care coordinator, and inclusion of interprofessional learning experiences (IPE) were compared. The survey response rate was 96.4% (N = 81). Trends were noted between students who provided clinical care for a pregnant patient (31%) versus those who did not. Results indicated that an integrated clinic was preferred, though students who had treated a pOHP patient showed greater support for a standalone clinic model. Survey and focus group data agreed that pOHP should occur during the third-year dental school training; however, students with patient experience favored second-year placement. Survey and focus group data emphasize the importance of a patient care coordinator for clinical management and IPE as an essential learning element. Innovating new clinical models requires a period of evolution to determine preferred and sustainable infrastructure. Results reveal the advantages and disadvantages of various program implementation models and demonstrate that student perceptions were influenced by their clinical experiences. Study findings will inform implementation and guide other programs as they create and modify existing curricula to enhance prenatal oral health.

Trends in dental hygiene academic leadership development: Influencers, barriers, and enabling mechanisms.

PURPOSE: This quantitative exploratory study was designed to learn about trends and forces impacting leadership development (LD) opportunities for dental hygiene (DH) program directors. METHODS: A 10-item electronic survey was created and disseminated using Qualtrics system to directors of all accredited DH programs in the United States (N = 325). Surveys included closed and open-ended response items to capture quantitative and qualitative data. The analysis included descriptive statistics and thematic categorization of free responses. RESULTS: Eight-two surveys were returned (25% response rate). Leadership development training experiences varied among participants; 79% (n = 65) reported completing some form of LD training. Institutional support was variable among the DH program directors, yet most (76%, N = 62) indicated some level of school support for LD training opportunities for DH program directors. Feedback indicated that most options included campus-sponsored courses or events (28%, N = 47), professional association courses or events (24%, N = 40), and programs within the school, department, or division (24%, N = 40). CONCLUSION: Study findings support positive perceptions of the need, demand, and value of LD. Respondents shared beliefs in the benefits of LD and the value of placing resources to support these opportunities, yet also acknowledged substantial challenges including time, funding, and workforce needs. By addressing barriers and capitalizing on driving forces, programs can create systemic approaches to fostering LD for current and future DH program directors.

Interprofessional Collaboration Among Dental Hygiene and Nursing Students on the Oral Health of Cancer Patients.

ABSTRACT: One third of patients diagnosed with cancer develop oral complications during cancer treatment. Health care professionals play an important role in the management of patients undergoing cancer therapies; however, optimal oral care for cancer patients is often missing from nursing and dental hygiene curricula. A quasi-experimental mixed-methods study was conducted with accelerated bachelor of nursing and dental hygiene students following a presentation and small-group case review. Pre/post surveys and findings from a debriefing session showed increased confidence to screen, counsel, and refer patients between disciplines compared to a control group.

Trends in Dental Hygiene Academic Leadership Development: Influencers, barriers, and enabling mechanisms.

Purpose This quantitative exploratory study was designed to learn about trends and forces impacting leadership development (LD) opportunities for dental hygiene (DH) program directors.Methods A 10-item electronic survey was created and disseminated using Qualtrics system to directors of all accredited DH programs in the United States (n=325). Surveys included closed and open-ended response items to capture quantitative and qualitative data. Analysis included descriptive statistics and thematic categorization of free responses.Results Eight-two surveys were returned (25% response rate). Leadership development training experiences varied among participants; 79% (n=65) reported completing some form of LD training. Institutional support was variable amongst the DH program directors, yet most (76%, n=62) indicated some level of school support for LD training opportunities for DH program directors. Feedback indicated that most options included campus-sponsored courses or events (28%, n=47), professional association courses or events (24%, n=40), and programs within the school, department, or division (24%, n=40).Conclusion Study findings support positive perceptions of the need, demand, and value of LD. Respondents shared beliefs in the benefits of LD and the value of placing resources to support these opportunities, yet also acknowledged substantial challenges including time, funding, and workforce needs. By addressing barriers and capitalizing on driving forces, programs can create systemic approaches to fostering LD for current and future DH program directors.

Academic Leadership Development for Health Professions Programs.

AIMS: This study explored perceptions of leadership development in U.S. higher education health professions programs. Emphasis was placed on identifying value and need, key factors, trends, and personal experiences with leadership development programs. METHODS: This qualitative phenomenological study employed triangulation of data sourced from a survey, semi-structured interviews, and a focus group. Purposeful sampling included academic leaders who serve as the professional development directors, or an equivalent role, in health profession programs at one institution. RESULTS: Data supported the emergence a major theme of the value of leadership development as influential factors to determine the positive perceptions of leadership development in health professions programs. Resource allocation and opportunities varied greatly by school, exposing a need for best practices for leadership development. Much of the data focused on the critical need for leadership development and the belief in the value for such programs. Participants agreed that development should be continual and longitudinal, include faculty at varying career levels, and offer multiple focus points for knowledge, confidence, and behavioral aspects of leadership. CONCLUSION: Data from the current study substantiate a need for leadership development for academic leaders in health professions programs to support development and enhancement of skills needed to achieve professional success.

Safe to speak: Fostering psychological safety among incoming predoctoral dental students.

PURPOSE: To describe the implementation and impact of an introductory session on psychological safety for incoming first-year Doctor of Dental Surgery (DDS) learners. METHODS: In August 2020, first-year DDS students participated in a 2-h online instructional session focused on defining psychological safety, the behaviors that promote and disrupt it, and setting expectations for learner and faculty behavior to foster it. Learners worked in small groups to discuss the various components of psychological safety and document their discussion in a collaborative workspace before a large group debriefs. Participants were requested to complete an electronic survey before and after the session to evaluate their change in knowledge, confidence in performing tasks to foster psychological safety, and perceptions about their level of control. Six months after the session, learners were requested to participate in a focus group for additional feedback and reflections. RESULTS: Seventy-four participants completed the before and after experience survey. There was a statistically significant increase in knowledge of the components of psychological safety and perceptions of control. In addition, self-reported measures of confidence to perform the tasks increased from an average rating of 36% confident before the session to 86% confident afterward. In the experience, learners were active in their discussion and generated many ideas about behaviors that promote and disrupt psychological safety, which informed the creation of learner and faculty classroom expectations. CONCLUSION: Engaging learners in discussions about psychological safety can be a useful activity to establish expectations and create group norms that may support collaborative learning environments.

Transition to a Competency-informed Dental Hygiene Clinical Evaluation System.

Purpose: Competency-informed clinical education includes rigorous and specific performance outcomes with an emphasis on demonstrated outcomes. The purpose of this study was to assess faculty and dental hygiene (DH) student perceptions and elicit feedback regarding the transition to a competency-informed clinical evaluation model in the DH program at the University of North Carolina Adams School of Dentistry for the purpose of continuous quality improvement.Methods: A mixed-methods approach was utilized to survey senior DH student (n = 36) and clinical DH faculty (n = 15) during the 2018 -19 academic year. Cohort-specific surveys included demographics, Likert-scale questions, and open-ended questions to gauge perceptions of the new system. Two debriefing sessions were held, one for faculty and one for students, to provide open feedback and expand discussions. Survey responses were compared using descriptive statistics. Open-ended responses and debriefing comments were reviewed to identify common themes.Results: All senior DH students (n=36) and two-thirds of the faculty (67%, n=10) completed the survey. Findings revealed an overall preference to the new evaluation system and indicated that it was a more accurate reflection of clinical performance. Open-ended and debriefing comments revealed an increased quantity and quality of faculty feedback with an emphasis on patient-centered care, rather than a grade-based focus. Students reported decreased stress levels regarding asking clinical care questions and grade outcomes. While improvement in faculty calibration was reported, students also noted a need for continued calibration.Conclusion: Surveys and debriefing sessions revealed areas of strengths and challenges in a competency-informed clinical evaluation system. Transitioning to a competency-based system provided an environment that is conducive to learning and patient-centered care rather than focused on grades.

Piloting a first-year resident-as-teacher workshop to foster evidence-based teaching.

PURPOSE: Residents function as important educators of dental students; however, they often have limited training in educational best-practices. Resident-as-teacher programs have been designed and implemented in other health professions to prepare residents to teach in clinic and classroom settings. In this research, we describe the design, implementation, and evaluation of a 2-day workshop for first-year advanced dental residents. METHODS: The program engaged residents in techniques to: (1) foster psychological safety, (2) use the cognitive apprenticeship framework, (3) deliver quality feedback, and (4) conduct effective didactic instruction. Nineteen first-year residents attended 2 four-hour workshops in July 2019. The impact of the program was evaluated using Kirkpatrick's model, which included participant reactions, learning, and self-reported behaviors. RESULTS: Most residents (at least 83.3%) reported the value and quality of the workshop was high or very high. With regard to knowledge, residents had statistically significant higher scores after the workshop on knowledge questions about cognitive apprenticeship (P < 0.01), feedback strategies (P < 0.05), and classroom instruction techniques (P < 0.05). Resident reported self-efficacy had a statistically significantly increase (P < 0.05) after the workshop in psychological safety, cognitive apprenticeship, and most items related to providing feedback; there were few changes in self-efficacy on classroom instruction strategies. CONCLUSION: Overall, a workshop to prepare residents as teachers can improve knowledge and self-efficacy in evidence-based educational practices.

Teledentistry: Dental hygiene students' knowledge, attitudes, and curriculum recommendations.

Purpose: Research has shown an increase in dental hygiene (DH) students' knowledge and attitudes toward teledentistry (TD) after TD training in states with permissive but not restrictive DH scope of practice policies. The purpose of this study was to identify self-reported knowledge and attitudes regarding TD among the DH students at the University of North Carolina (UNC) at Chapel Hill before and after an educational intervention and student recommendations for TD curriculum placement.Methods: A faculty presentation and video demonstration, followed by small group discussions and a large group debriefing session were conducted at the UNC Adams School of Dentistry in March 2019. Participants were invited to complete a survey before and after the educational session. McNemar's matched pair test was used to compare the proportion of the participants' pre- and post-test responses.Results: Survey participants (n=30) included first year and second year DH students. There was significant difference (p<0.001) between pre and post self-reported knowledge of TD as well as a significant difference in participant's response (p= 0.012) about facilitating consultation with health care specialists through TD in NC. There was a significant difference in favorable responses (p=0.0394) that TD could increase reimbursement to dentists to enhance the provision of more services in NC. Students identified didactic courses (43%), simulated cases (47%), and integration into the DH community rotations (66%) as potential ways to incorporate TD into curriculum. Most students (93%) identified DH restricted scope of practice as a barrier to TD implementation in NC.Conclusion: The educational session resulted in increased self-reported knowledge and demonstrated positive attitudes toward the adoption of TD into multiple facets of DH curriculum. A major barrier to its adoption into practice is the DH restricted scope of practice in NC.

Implementing a Prenatal Oral Health Program in Dental Hygiene Curriculum.

Purpose: Inadequate prenatal oral health education in dental hygiene (DH) curricula can negatively impact patient care by graduating clinicians lacking competence in the provision of care for this population. The purpose of this study was to assess the knowledge, opinions, and willingness of DH students to provide oral care services to pregnant patients before and after participating in a prenatal oral health educational program (pOHP).Methods: Senior DH students were invited to complete a baseline and post-program survey to evaluate their experiences in the pOHP at the University of North Carolina, Chapel Hill. All senior DH students attended a one-hour lecture on prenatal oral health guidelines and practices prior to their clinical rotation in the pOHP. Each survey consisted of items on knowledge, confidence, and attitudes related to screening, counseling, and willingness to provide oral care services to pregnant patients.Results: Over a period of three years, 93 DH students (n=93) completed both the baseline and post-program surveys for a 96.8% response rate. Participants reported gains in knowledge and confidence for screening and counseling pregnant patients. Post-program survey respondents agreed that dental providers should deliver oral health counselling to pregnant women (99%, n=93) and perform an oral health examination during prenatal care (99%, n=92). Nearly all of the respondents, (98%; n=90) reported they are likely to take care of pregnant women upon graduation and deliver preventive oral health messaging to this population (98%, n=91).Conclusion: Dental hygiene student participants in a prenatal oral health program (pHOP) demonstrated positive trends in increasing knowledge and confidence in screening and counseling pregnant patients in the dental setting. Inclusion of a clinical experience played an influential role in changes in knowledge regarding the safety of care during pregnancy, indicating a need for both didactic and clinical immersion opportunities to enhance cognitive and affective transformations.

Teledentistry Knowledge and Attitudes: Perspectives on the role of dental hygienists.

Purpose. The first statewide teledentistry (TD) Summit in North Carolina (NC) was convened by the University of North Carolina (UNC) at Chapel Hill in 2018. The purpose of this analysis is to compare Summit participants' understanding of TD, its benefits, challenges, solutions and the role of dental hygienists, pre- and post-Summit.Methods. Summit invitees included leaders in related policy, education, advocacy, legislation, technology and UNC dental hygiene and dental students. Descriptive analyses and exact McNemar's matched pair tests compared proportions of participants' responses to pre- and post-Summit surveys.Results. Response rates were pre-Summit 75.3% (n= 58) and post-Summit 70.1% (n= 47); matched pre-post survey pairs (n=42). Pre-Summit respondents reported their primary role in administration (48.0%), teaching and mentoring (21.0%), patient care (12.0%) or as a student (19.0%). Among respondents, overall self-reported TD knowledge increased from 38.1% to 92.9%, p< 0.001. Their reported extent TD should be developed in NC increased from 78.6% to 95.2%, p = 0.07; the extent hygienists should have a role in TD services increased from 83.3% to 88.1%, p = 0.73. The most frequently mentioned challenge was state practice acts requiring direct supervision of dental hygienists, limiting their TD use in community settings, which increased in the pre- to post-surveys from 33.3% to 59.5% respectively, p = 0.01.Conclusion. Among attendees at the statewide TD Summit, self-reported knowledge was high and attitudes favorable for moving forward with TD in NC. However, state dental practice act barriers restricting dental hygienist participation in TD was the first challenge respondents thought needed to be addressed.

Audiology and oral health professional students: An interprofessional education collaboration.

OBJECTIVES: Audiology knowledge is important for oral health professionals because patients may present with hearing loss or temporomandibular joint dysfunction with referred pain to the ear. Additionally, their occupational environment may negatively affect their own hearing. An interprofessional learning experience for dental (DDS), dental hygiene (DH), and audiology students was created to increase DDS and DH students' knowledge of the audiology profession, risks to their own hearing, and communication with hearing-impaired patients. This study's purpose was to evaluate this new educational experience. METHODS: In 2018, audiology students presented information to DH and DDS students about audiology and offered optional supervised hearing screenings. DDS and DH students were surveyed to assess their self-rated knowledge level on audiology topics (e.g., audiology profession, hearing assessment, noise-induced hearing loss, and communicating with hearing impaired patients) before and after the educational sessions, as well as to evaluate their learning experience. Audiology students received didactic and hands-on instruction by DDS and DH students and faculty on performing a head and neck exam and making appropriate referrals. RESULTS: The response rate was 48% (n = 57). Students' reported knowledge on all topics significantly improved (P < 0.05) after the educational program. The majority, 86%, agreed that this experience should be added to the curriculum, and 92% reported it increased their understanding of the importance of collaborating with other health professionals. CONCLUSIONS: This experience increased students' knowledge of the audiology profession and understanding of hearing loss, while also increasing their appreciation of interprofessional education.

Collaborative Educational Experiences of Dental Hygiene and Audiology Students.

Purpose: An innovative, collaborative interprofessional experience for dental hygiene and audiology students that included hearing assessments and a class lecture/discussion session was developed and implemented at the University of North Carolina, Chapel Hill. The purpose of this study was to evaluate whether the objectives were met for the initial educational experience and to identify areas for improvement.Methods: Audiology students, under faculty supervision, provided hearing screenings for 33 senior dental hygiene (DH) students and 4 graduate (DHE) students. In a subsequent didactic session for the DH and DHE students, an audiology doctoral student presented on the following topics: overview of the audiology profession, interprofessional collaboration with audiologists, principles of noise-induced hearing loss, protective measures for hearing health, and techniques for communicating with patients with hearing loss. Class discussion followed the lecture presentation. Surveys on the screening and education session were completed by the students and changes in their perception of knowledge were assessed.Results: Nearly half (49%) of the students indicated that this was their first hearing assessment. The vast majority (97-100%) agreed or strongly agreed that the experience was well-organized, contained important information for dental practice, and increased their understanding of the importance of collaboration and their comfort level in working with audiologists. Nearly all of the students (94%) recommended this experience be included in future curriculum. Significant changes were reported in students' knowledge of hearing assessments, noise induced hearing loss, and communication with patients with hearing loss (Wilcoxon Signed Rank Test, p < 0.05).Conclusion: The educational objectives of this initial interprofessional collaborative experience were met. Participants reported that the didactic and experiential education was a valuable learning experience and it increased their knowledge about the audiology profession and hearing health for themselves and their patients.

Use of a Self-Instructional Radiographic Anatomy Module for Dental Hygiene Faculty Calibration.

Purpose: Dental hygiene educators often provide inconsistent instruction in clinical settings and various attempts to address the lack of consistency have been reported in the literature. The purpose of this pilot study was to determine if the use of a use of a self-instructional, radiographic anatomy (SIRA) module improved DH faculty calibration regarding the identifica-tion of normal intraoral and extraoral radiographic anatomy and whether its effect could be sustained over a period of four months.Methods: A convenience sample consisting of all dental hygiene faculty members involved in clinical instruction (N=23) at the University of North Carolina (UNC) was invited to complete the four parts of this online pilot study: a pre-test, review of the SIRA module, an immediate post-test, and a four-month follow-up post-test. Descriptive analyses, the Friedman's ANOVA, and the exact form of the Wilcoxon-Signed-Rank test were used to an-alyze the data. Level of significance was set at 0.05. Participants who did not complete all parts of the study were omitted from data analysis comparing the pre to post-test performance.Results: The pre-test response rate was 73.9% (N=17), and 88.2% (N=15) of those initial participants completed both the immediate and follow-up post-tests. Faculty completing all parts of the study consisted of: 5 full-time faculty, 5 part-time faculty, and 5 graduate teaching assistants. The Friedman's ANOVA revealed no statistically significant difference (P=0.179) in percentages of correct responses between the three tests (pre, post and follow-up). The exact form of the Wilcoxon-Signed-Rank test revealed marginal significance when comparing percent of correct responses at pre-test and immediate post-test (P=0.054), and no statistically significant difference when comparing percent of correct responses at immediate post-test and the follow-up post-test four months later (P=0.106).Conclusions: Use of a SIRA module did not significantly affect DH faculty test performance. Lack of statistical significance in the percentages of correct responses between the three tests may have been affected by the small number of participants completing all four parts of the study (N=15). Additional research is needed to identify and improve methods for faculty calibration.

Obstructive Sleep Apnea and the Role of Dental Hygienists.

PURPOSE: Obstructive Sleep Apnea (OSA) is the most commonly undiagnosed sleep disorder and is gaining more recognition in dentistry. Dental hygienists are at a pivotal position to discuss risks, characteristics, medical referrals and treatment options for OSA, as well as detect if an individual has OSA through questionnaires and other tools that can be done during an examination. Dental hygienists need to receive appropriate education about OSA and should be well versed in their knowledge to educate patients. The purpose of this literature review is to identify the role of the dental hygienist in detecting the risk of OSA and gain knowledge on the topic in order to educate patients.

Dental and allied dental students' attitudes towards and perceptions of intraprofessional education.

Interprofessional and intraprofessional learning opportunities in health professions education are vital to emphasize evidence-based practice, quality improvement, and cost-effectiveness in patients' oral health care. The aim of this study was to assess dental, dental hygiene, and dental assisting students' readiness for intraprofessional education and to evaluate their attitudes towards and perceptions of intraprofessional teamwork, communication, respect, and understanding of professional roles. In 2013, students at one dental school (N=247) were surveyed, and focus groups were conducted for this convergent parallel mixed-methods study. Survey response rates were as follows: senior dental students 54.4% (N=43), senior dental hygiene students 100% (N=32), dental assisting students 95% (N=19), junior dental students 51.8% (N=42), and junior dental hygiene students 100% (N=33). The results showed that the dental hygiene students had more positive responses about intraprofessional education than the dental and dental assisting students (p<0.05). Most (94%, N=160) of the respondents in the combined groups agreed that intraprofessional learning would help them become more effective members of the oral health care team. The three focus group sessions (N=17) revealed consistency among the groups regarding the value of an integrated clinical design and intraprofessional education. These students were eager and positive about intraprofessional learning and agreed that a shared learning model can improve communication and respect among team members, provide a better understanding of roles, and ultimately enhance patient care.

Practicum Experiences: Effects on Clinical Self-Confidence of Senior Dental Hygiene Students.

PURPOSE: The purpose of this study was to determine the effects of a 3-week practicum experience on the clinical self-confidence of University of North Carolina (UNC) senior dental hygiene students. METHODS: A mixed methods approach was utilized. Before and after a 3-week practicum experience, UNC senior dental hygiene students (n=32) were asked to complete a 20-statement clinical self-confidence survey based on the dental hygiene process of care. Statements were Likert-scaled, ranging from "not at all confident" to "totally confident." The stratified Mantel Haenszel row mean score test with the subject as strata as a repeated approach was used to assess whether on average across subjects, the pre- and post-surveys had the same mean score. Students were also asked to submit reflective journal entries discussing critical incidents during their practicum experience. Representative comments from students' journal entries were selected as qualitative data to support survey results. RESULTS: Pre- and post-practicum surveys (31 and 32, respectively) were completed, and all 32 students submitted journal entries. The differences in the row mean scores from pre- to post-practicum survey were statistically significant (p<0.05), indicating an overall positive gain in clinical self-confidence from the practicum experience. Students' journal entries provided comments that supported the quantitative results. CONCLUSION: The results suggest that a 3-week practicum experience in dental hygiene students' final semester increased UNC dental hygiene students' clinical self-confidence in the dental hygiene process of care. Dental hygiene administrators may want to consider the benefits of requiring students to participate in a practicum experience if they do not already do so.

Obstructive sleep apnea in association with periodontitis: a case-control study.

PURPOSE: Periodontitis is associated with several cardio-metabolic disorders that are co-morbid with sleep-disordered breathing. A relationship between periodontitis and obstructive sleep apnea (OSA) is plausible, but has received little attention. This study investigated the strength of association between periodontitis and risk for OSA. METHODS: In this case-control study, cases had moderate or severe periodontitis (n = 50, 32.5%) and controls had gingivitis or slight periodontitis (n = 104, 67.5%). Sixty-one males (39.6%) and 93 females (60.4%) with a mean age of 61 years were sampled from the dental hygiene preventive care clinic in the School of Dentistry at the University of North Carolina at Chapel Hill between February and April 2011. Patients received a full mouth periodontal examination that included probing pocket depths and clinical attachment levels at 6 sites per tooth. The case definition for moderate or severe periodontitis was that of the American Dental Association (ADA). Risk for OSA was determined by the 4 item "STOP" OSA screening questionnaire, which assesses self-reported snoring, excessive daytime sleepiness, witnessed apnea during sleep and history of hypertension. Demographic, general health and orofacial characteristics were recorded that were considered putative predictors of either periodontitis or OSA. A multivariate binary logistic regression assessed odds of moderate or severe periodontitis according to OSA risk with adjustment for potential confounders. RESULTS: In all, 59 patients (38.3%) screened at high risk for OSA by providing 2 or more affirmative responses on the STOP questionnaire. Sixty percent of periodontitis cases (n = 30) screened high risk of OSA compared with only 28% of controls (n = 29). Cases were 4.1 times more likely (95% CI: 1.9, 11.4) to be at high risk for OSA than controls (p = 0.007) after adjustment for potential confounders. CONCLUSION: A significant association was observed between moderate or severe periodontitis and risk for OSA.