Are adults with autism receiving regular preventive dental services?

PURPOSE/AIM: To investigate the frequency of preventive dental care among adults with autism and explore factors associated with receiving regular preventive care. MATERIALS AND METHODS: De-identified data was collected from electronic health records of 18-year-old or older patients with autism that had at least one preventive dental procedure recorded. The data was then analyzed to describe the frequency of preventive dental procedures provided for this population and investigate what variables are associated with regular care. RESULTS: Sample size was 119, 67% were males, average age was 30.8 years, and 58% had Medicaid. Average BMI was 42.8, the prevalence of diabetes and heart disease were 16% and 34%, respectively, and 86% reported mental health problems. Recreational drug use was 6.8%, alcohol use was 19%, and tobacco use 16%. Xerostomia was reported by 32%, and the average number of medications was 7.2 ± 5.5. The average number of preventive dental visits was 7.9 ± 10.6, and 35% of the patients had at least one preventive dental visit per year. Only number of medications had a statistically significant association with number of preventive dental visits. CONCLUSIONS: Only one in every three adults with autism had at least one preventive dental visit per year.

Fidelity of motivational interviewing training for dental hygiene students.

Use of Motivational Interviewing (MI), a patient centered counseling strategy in the health professions, has demonstrated efficacy. Given the varied training associated with the delivery of health interventions, it is essential adherence and competence are equivocally assured. Motivational Interviewing Treatment Integrity (MITI) coding evaluated our recorded standardized patient oral assessment and planning sessions to identify the skills in which MI-trained students (n = 26) performed compared to student counterparts (n = 24) not trained in the MI curriculum. The full integration of MI in those receiving the MI curriculum resulted in the dental hygiene students with higher ratings for all global ratings, behavioral counts, and summary scores. MI-trained mean scores for evocation, collaboration, autonomy support, empathy, and direction ranged from 4.16(±0.43) to 3.85 (±0.67). All students receiving MI training reached competence in all 5 of the referenced MITI global variables: evocation, collaboration, autonomy support, empathy, and direction. The most substantial improvements for MITI behavioral and summary variables were in Giving Information, MI Adherence, and proportion of Open-Ended Questions. Complex Reflections, and subsequently Ratios of Complex Reflections to Open-Ended Questions were notably below proficiency in the MI group. Knowing which elements were adhered to well and which were lacking helps inform student MI learning outcomes. Results inform the design of MI training curricula to address areas of weakness and maximize performance across all MI fidelity domains.

Dental Hygienists' Experiences with Motivational Interviewing: A Qualitative Study.

The effectiveness of Motivational Interviewing (MI) to change health behaviors is well documented. Previous studies support use of MI to change oral health behaviors in the areas of early childhood caries and periodontal diseases, but research is limited due to the sparse number of oral health care providers with training in MI. The University of Missouri-Kansas City (UMKC) formally integrated MI training into its dental hygiene curriculum five years ago. Summative program evaluation of UMKC's MI training shows that it effectively equips graduates with MI skills. The aim of this qualitative study was to use semi-structured interviews with nine program alumni to provide insight into the experiences of MI-trained dental hygienists in clinical practice. All interviews were captured with a digital voice recorder, were transcribed, and were resubmitted to the interviewees for checking. Five themes emerged from the data analysis: salience, best practices, barriers, facilitators, and lessons learned. These dental hygienists strongly valued and embraced the spirit of MI. They reported feeling strongly that it should be part of all dental hygiene curricula, and they upheld MI as a best practice. The participants approved of their MI instruction as a whole but felt it was difficult and sometimes not viable in practice. They reported that MI training had improved their communication skills and increased treatment acceptance. Time, difficulty, and managing patient resistance were the most often cited barriers, while a supportive climate and creating a routine were the most often cited facilitators.

Fifteen years of portfolio assessment of dental hygiene student competency: lessons learned.

PURPOSE: Adoption of portfolio assessment in the educational environment is gaining attention as a means to incorporate self-assessment into the curriculum and to use evidence to support learning outcomes and to demonstrate competency. Portfolios provide a medium for students to demonstrate and document their personal and professional growth across the curriculum. The purpose of this literature review is to discuss the drivers for portfolio education, the benefits to both students and program faculty/administrators, the barriers associated with portfolio use, and suggested solutions that have been determined through several years of "lessons learned." The University of Missouri Kansas City School of Dentistry, Division of Dental Hygiene department has been utilizing portfolio assessment for over 15 years and has collected data related to portfolio performance since 2001. Results from correlational statistics calculated on the 312 dental hygiene students that graduated from 2001 to 2013 demonstrate a positive and significant relationship between portfolio performance and overall GPA as well as portfolio performance and NBDHE scores.

Motivational interviewing in dental hygiene education: curriculum modification and evaluation.

Motivational interviewing (MI) is a person-centered, goal-directed method of communication for eliciting and strengthening intrinsic motivation for behavior change. Originally developed in the field of addiction therapy, MI has been increasing applied in the health professions with a growing body of successful outcomes for tobacco cessation and diabetic control, which can significantly impact oral health. MI has shown preliminary value for impacting oral behaviors that reduce early childhood caries, plaque, and gingival inflammation. While the training in and use of MI by oral health providers is emerging, full integration into dental and dental hygiene curricula has yet to be explored. Therefore, the purpose of this project was to evaluate the full implementation of MI in the classroom and clinic of a dental hygiene curriculum.

A qualitative case study of the legislative process of the hygienist-therapist bill in a large Midwestern state.

PURPOSE: Inequitable access to dental care contributes to oral health disparities. Midlevel dental provider models are utilized across the globe as a way to bridge the gap between preventive and restorative dental professionals and increase access to dental care. The purpose of this study was threefold: to examine lessons learned from the state legislative process related to creation of the hygienist-therapist in a Midwestern state, to improve understanding of the relationship between alternative oral health delivery models and public policy and to inform the development and passage of future policies aimed at addressing the unmet dental needs of the public. METHODS: This research investigation utilized a qualitative research methodology to examine the process of legislation relating to an alternative oral health delivery model (hygienist-therapist) through the eyes of key stakeholders. Interview data was analyzed and then triangulated with 3 data sources: interviews with key stakeholders, documents and researcher participant field notes. RESULTS: Data analysis resulted in consensus on 3 emergent themes with accompanying categories. The themes that emerged included social justice, partnerships and coalitions, and the legislative process. CONCLUSION: This qualitative case study suggests that the creation of a new oral health workforce model was a long and arduous process involving multiple stakeholders and negotiation between the parties involved. The creation of this new workforce model was recognized as a necessary step to increasing access to dental care at the state and national level. The research in this case study may serve to inform advocates of access to oral health care as other states pursue their own workforce models.

Massachusetts dental public health program directors practice behaviors and perceptions of infection control.

PURPOSE: The objective of this exploratory study was to deter mine the current infection control practices used in Massachusetts dental public health programs and assess the perceived compliance and challenges with infection control standards as outlined in the 2003 Centers for Disease Control and Prevention (CDC) infection control guidelines. METHODS: A convenience sample of program directors of dental public health programs in Massachusetts (n=82) were invited to participate. The directors were identified through the Massachusetts Department of Public Health, Massachusetts League of Community Health Centers, local dental/dental hygiene schools and key stakeholders in dental public health. The electronic questionnaire-based survey consisted of 26 open/closed-ended and Likert scale questions. Statistical analysis included frequency distribution and factor analysis. RESULTS: The overall response rate was 43%. The majority of responders to the survey were from public health settings using fixed/mobile dental equipment (82.9%), compared to settings using portable equipment (17.1%). Perceived lapses in the guidelines were attributed to lack of finances (r=0.938), lack of personnel (r=0.874) and lack of space (r=0.763). The only significant correlation between the program directors perceived adherence to the CDC guidelines was having access to necessary supplies and equipment (r=0.914). Program directors indicated that the CDC guidelines are hard to apply (r=0.895) and guide lines specific to settings using portable equipment would be helpful (r=0.925). CONCLUSION: Within the limitations of the sample size and response rate, directors from public health settings using both fixed/mobile and portable equipment reported being able to apply the current 2003 CDC infection control guidelines with few compliance challenges. However, respondents indicated that the guidelines were hard to apply and that infection control guidelines for settings using portable equipment would be useful.

Comparing the risk identification and management behaviors between oral health providers for patients with diabetes.

PURPOSE: Evidence supporting the link between periodontal disease and systemic disease continues to grow. To date, little is known about how dental professionals incorporate this information into managing diabetic patients. This study examines the risk identification and practice behaviors regarding diabetic patients among dentists, hygienists and specialists. METHODS: Responses were received from 383 currently practicing oral health professionals in Arkansas. The electronic survey consisted of 35 open and closed-ended or Likert-type items. Principal components factor analysis using varimax rotation was used to explore underlying dimensions of the questionnaire in order to provide a more parsimonious view of the outcomes. Logistic models were fitted to determine best practice outcome as a function of knowledge and professional and social norms. RESULTS: Neither knowledge about diabetes (p<0.285) nor provider type (p<0.186) was a predictor of practice behavior. Professional and social norms (p<0.001) identified those practitioners who felt modifying their management strategies for their patients with diabetes was a necessary component of their practice behavior. CONCLUSION: In general, risk assessment was lacking, irrespective of whether a clinician was a dentist or dental hygienist. Results indicate oral health professionals in Arkansas need to improve the treatment and management of patients with diabetes and periodontal disease.

Student self-assessment in dental hygiene education: a cornerstone of critical thinking and problem-solving.

Self-assessment is an integral component of learning and developing decision making and critical thinking skills in the practice of dental hygiene. Dental hygienists must think critically and develop problem-solving strategies during their formal education to ensure lifelong quality and ongoing development of their personal knowledge and skill as related to providing comprehensive, evidence-based patient care. The primary focus of this qualitative investigation was to obtain undergraduate dental hygiene students' perceptions of and experiences with self-assessment. The sample consisted of an intact undergraduate dental hygiene class of seventeen students in their final semester of a two-year, entry-level dental hygiene program at a community college in the southeast United States. Data for this research were obtained from three sources: 1) a program-designed self-assessment survey assignment, 2) in-depth interviews with four second-year dental hygiene students, and 3) program-designed clinical competence evaluation forms. Inductive data analysis revealed that the majority of students perceived that they had no prior experience with self-assessment in any prerequisite coursework and thus felt unprepared for its use in the dental hygiene program. As they matriculated in the program, students began to see the advantages of self-assessment in clinical practice. Programmatic orientation to self-assessment may therefore be beneficial due to the varying backgrounds of students entering dental hygiene programs.

Examining clinical assessment practices in U.S. dental hygiene programs.

Competency-based education (CBE) in dental hygiene education is intended to measure learned skills that prepare students to independently provide services for the public. A variety of standardized clinical assessment techniques (SCATs) are available to substantiate the competence of health care professionals, including, but not limited to, objective structured clinical examinations (OSCEs), triple jump exams, standardized patients, and simulations. Standardized clinical examinations test students' abilities to treat diverse patients in a consistent, controlled setting. SCATs help prepare clinicians to safely treat patients of various complexities. The objectives of this study were to examine the variety of techniques used to assess clinical competence in U.S. accredited dental hygiene programs and to obtain program directors' attitudes regarding clinic assessment, with a focus on how SCATs are used. An online survey collected data from 125 directors (48 percent response rate). Approximately 97 percent of the responding programs used observation-type assessments followed by case studies (90 percent), self-assessment (85 percent), and mock boards (75 percent), with SCATs being the least used. The majority of responding directors (74 percent) indicated an interest in learning more about these SCATs. A chi-square test identified no significant difference between the use of SCATs by associate and baccalaureate degree programs, with program location also being irrelevant.

Examining the role of collaborative assessment in a didactic dental hygiene course.

The purpose of this study was to evaluate a technique known as collaborative assessment considering students' and faculty members' perceptions of the value and utility of this approach. Twenty-eight dental hygiene students took eight individual assessments (quizzes) immediately followed by completion of the same assessment in a five-member peer group as part of a didactic dental hygiene course. At the end of the semester, student perceptions and course performance were examined. Faculty perceptions were also collected. A paired samples t-test was conducted to compare student performance on individual and group assessments. Students reported that this collaborative assessment approach enhanced their learning, provided them with experience in defending their answers, and decreased stress. Concerns for fairness and individual accountability were noted by both students and faculty. The mean group score for all quizzes combined (M=91 percent, SD=2 percent) was significantly higher by 16 percentage points (91 percent versus 75 percent) than the mean individual score for all quizzes combined (M=75 percent, SD=8 percent), t(27)=11.61, alpha =.05, p<.0005. This study suggests that additional measures are needed to ensure individual preparation and accountability when using the collaborative assessment process as a learning strategy with dental hygiene students.

Utilizing public health clinics for service-learning rotations in dental hygiene: a four-year retrospective study.

National reports outlining disparities in oral health care in the United States have focused attention on ways to encourage health care providers to become more involved in the public health arena. Utilization of service-learning in professional health education programs is one method being explored. The purpose of this study was to conduct a retrospective review of a service-learning rotation within a dental hygiene public health course. The study utilized data sources generated by students as part of a course evaluation. These sources included student journals (qualitative/quantitative) and Likert-scaled (quantitative) and open-ended (qualitative) student satisfaction survey items. Mixed methodology data analysis techniques were used to analyze and triangulate data in order to form conclusions related to the effectiveness of service-learning as a teaching strategy in dental hygiene. This investigation suggests that service-learning is an effective learning strategy for increasing student awareness of underserved populations, cultural diversity, and ethical patient care. The study also suggests that service-learning helped students to determine their level of interest in public health as a career choice by giving them a real-world experience in public health patient care.

Evaluation of an academic service-learning course on special needs patients for dental hygiene students: a qualitative study.

The purpose of this study was to evaluate the outcomes of a service-learning course on special needs patients for dental hygiene students by considering student reflections, community site coordinators' feedback, and faculty reflections in a qualitative analysis. Twenty-three female dental hygiene students beginning their fourth semester in the program provided preventive oral health services at eight community sites serving six diverse groups of people having special health care needs. Students reflected on the experience via commentaries written in self-reflection journals. The investigators applied the constant comparative method to analyze and unitize the data, ultimately reaching consensus on three category topics: awareness, higher order thinking, and professionalism. End of course project assessments provided additional data that was used to triangulate with data from the reflective journals. Telephone interviews with the site coordinators and personal interviews with the course faculty provided data from multiple perspectives. The outcomes of this study suggest that service-learning pedagogy can facilitate a deeper understanding of the subject matter and provide an opportunity for students to use critical thinking strategies in addition to becoming aware of complex social and professional issues related to the oral health care of individuals with special needs.

Predictive validity of dental hygiene competency assessment measures on one-shot clinical licensure examinations.

The purpose of this study was to examine the predictive validity of traditional and nontraditional dental hygiene competency assessment measures on one-shot clinical licensure examinations in a baccalaureate dental hygiene program. Traditional assessment data including overall grade point average (GPA), Clinical GPA, National Board Dental Hygiene Examination (NBDHE) scores, and Central Regional Dental Testing Service (CRDTS) scores along with nontraditional assessment data in the form of Portfolio scores were collected from seventy-four students. Factor analysis and subsequent linear regression modeling were used to explore the ability of four variables (Overall GPA, NBDHE, Portfolios, and Clinical GPA) to predict one-shot clinical licensure examination (CRDTS) scores. A two-factor solution was obtained with one factor defined as dental hygiene cognition and the second factor defined as dental hygiene clinical performance. Factor scores were subsequently used in a linear predictive model to assess the shared and unique contribution of factors to the one-shot clinical licensure examination score. The shared contribution of both factors only accounted for 13.9 percent of variance in the outcome measure of one-shot clinical licensure examination scores. The lack of concordance between previously validated measures of dental hygiene student competency or predictors of student success (Overall GPA, NBDHE, and Portfolios) and a one-shot clinical licensure examination (CRDTS) raises serious concern about the validity of our current dental hygiene licensing procedure which uses the CRDTS clinical examination to make decisions about granting licenses to practice.

Early childhood caries in an urban health department: an exploratory study.

PURPOSE: The purpose of this investigation was to assess the prevalence of early childhood caries (ECC) as a function of various ECC case definitions, in a population of children ages one to five, attending a Women, Infants, and Children (WIC) or well-child clinic at an urban health department. Additionally, the study examines the association of sociodemographic factors, caregiver's oral health perceptions, resources, feeding and oral care behaviors, and prenatal and perinatal histories as risk factors for early childhood caries. METHOD: A convenience sample of 74 children ages one to five years and their parent(s) or guardian(s) enrolled in the WIC and Well Child Services Program at the Kansas City Health Department participated in this study. Caries experience and developmental enamel defects of children were assessed utilizing the deft and linear enamel hypoplasia (LEH) indices. Additionally, the children's parents of guardians were asked to complete a questionnaire to collect data on predisposing risk factors. RESULTS: The proportion of all children with evidence of Type I ECC was high (31.5%), with all ethnic minority groups having a large proportion with caries. Four of the predisposing risk factor variables were related (p < 0.05) to presence of ECC-child's age, gender, age at weaning, and frequency of sweet drinks. Child's age and age at weaning were related to a significant increase in risk for caries when these effects were adjusted by the effect of other risk factor variables. The odds of having caries were increased by 2.3 times (95%, CI 1.4, 3.9) for each increase in child's age by year, and by 2.8 times (95%, CI 1.5, 5.2) for each incremental increase in age category for the child at weaning. CONCLUSION: This investigation lends further support to the contention that quantifying the occurrence of ECC is likely dependent and complicated by diverse case definitions. Caregiver's perceptions of their child's oral health were generally accurate, thereby supporting proponents for educational and preventive strategies aimed at the parent/guardian.

Validity and reliability of a dental operator posture assessment instrument (PAI).

PURPOSE: Basic operating posture is considered an important occupational health issue for oral health care clinicians. It is generally agreed that the physical posture of the operator, while providing care, should be such that all muscles are in a relaxed, well-balanced, and neutral position. Postures outside of this neutral position are likely to cause musculoskeletal discomfort. To date, the range of the neutral operator position has not been well-defined; nor have any specific instruments been identified that can quantitatively or semi-quantitatively assess dental operator posture. This paper reports on the development of an instrument that can be used to semi-quantitatively evaluate postural components. METHODS: During the first phase of the study, an expert panel defined the basic parameters for acceptable, compromised, and harmful operator postures and established face validity of a posture assessment instrument (PAI). During the second phase, the PAI was tested for reliability using generalizability theory. Four raters tested the instrument for reliability. RESULTS: Overall, total PAI scores were similar amongst three of the raters, with the fourth rater's scores being slightly greater than the other three. The main effect of the rater on individual postural components was moderate, indicating that rater variance contributed to 11.9% of total variance. CONCLUSIONS: The PAI measures posture as it occurs and will have numerous applications when evaluating operator performance in the dental and dental hygiene education setting. Also, the PAI will prove useful when examining the effects of operator posture and musculoskeletal disorders.