100 Years of Dental Hygiene Research: Progress and possibilities.

During the last century, the role of dental hygienists as leaders in the recognition, prevention, and treatment of oral diseases has grown, reflecting the ever-evolving knowledge base of the profession. The American Dental Hygienists' Association (ADHA) has contributed to and supported research that has formulated the scientific basis for the profession to inform education and practice. Progress has been made across multiple priority areas identified on the National Dental Hygiene Research Agenda, including educational research examining the impact of curriculum models on teaching and learning; health services research projects documenting workforce issues and cost-effectiveness of practice models; and public health initiatives expanding access to care to provide oral health care services for diverse patient populations. The Journal of Dental Hygiene, established in 1927, has played a significant role in disseminating scientific evidence to the global dental hygiene and professional communities. Collaborative efforts both within dental hygiene and externally with interprofessional partners and key stakeholders have positively contributed towards building the research infrastructure to support the profession. The number of dental hygienists who are actively engaged in research has increased, as has the value for research as part of the research culture. Focused research priorities and training efforts have encouraged collaborations across the globe to conduct and promote the science supporting dental hygiene education and practice. Development, testing and validation of theoretical frameworks is essential to drive all professional activities. Building a community of scholars who will continue to define the dental hygiene discipline through scholarship is critical to promote a scholarly identity for the profession.

Training Dental Hygiene Students to Care for Patients with Disabilities.

Purpose The purpose of this study was to evaluate the impact of a novel training program on dental hygiene students' knowledge, attitudes and beliefs about caring for individuals with disabilities.Methods A mixed methods approach was used. Students from five dental hygiene programs based at community colleges completed a two-hour didactic training session to supplement their existing special care dentistry coursework. Students completed an original 14-item pretest and posttest before and after the training that assessed attitudes and beliefs, and two validated posttests that assessed knowledge. Afterwards, students completed a clinical rotation in an advanced care dental clinic at a local academic institution gaining hands-on experience with equipment and patient treatment. Descriptive statistics were used to report training scores, types of services rendered and modifications to treatment. Student comments about their experiences were assessed using thematic analysis.Results Two hundred and ninety-four students completed didactic training and 261 completed clinical rotations. Posttest scores indicated positive improvements in knowledge, attitudes and beliefs. All students provided direct patient care. Sixty-nine percent treated patients with intellectual and developmental disabilities; 75% placed silver diamine fluoride or fluoride varnish. Altered patient positioning was used by 70.5%. Most students (95.4%) reported that their experience positively changed their attitudes towards caring for patients with disabilities in the future. Eight themes emerged, notably increased comfort and confidence, a willingness and desire to treat patients, the acquisition of new skills, and clinician behaviors of empathy and compassion towards others.Conclusion Training can help prepare dental hygiene students with the confidence and skills to address the oral health needs of individuals with disabilities.

Sampling Methods: A guide for researchers.

Sampling is a critical element of research design. Different methods can be used for sample selection to ensure that members of the study population reflect both the source and target populations, including probability and non-probability sampling. Power and sample size are used to determine the number of subjects needed to answer the research question. Characteristics of individuals included in the sample population should be clearly defined to determine eligibility for study participation and improve power. Sample selection methods differ based on study design. The purpose of this short report is to review common sampling considerations and related errors.

Training dental hygiene students to care for patients with disabilities.

OBJECTIVE: The purpose of this study was to evaluate the impact of a novel training programme on dental hygiene students' knowledge, attitudes, and beliefs about caring for individuals with disabilities. METHODS: A mixed methods approach was used. Students from five dental hygiene programmes based at community colleges completed a two-hour didactic training session to supplement their existing special care dentistry coursework. Students completed an original 14-item pretest and posttest before and after the training that assessed attitudes and beliefs, and two validated posttests that assessed knowledge. Afterwards, students completed a clinical rotation in an advanced care dental clinic at a local academic institution, gaining hands-on experience with equipment and patient treatment. Descriptive statistics were used to report training scores, types of services rendered, and modifications to treatment. Student comments about their experiences were assessed using thematic analysis. RESULTS: Two hundred and ninety-four students completed didactic training, and 261 completed clinical rotations. Posttest scores indicated positive improvements in knowledge, attitudes, and beliefs. All students provided direct patient care. Sixty-nine percent treated patients with intellectual and developmental disabilities; 75% placed silver diamine fluoride or fluoride varnish. Altered patient positioning was used by 70.5%. Most students (95.4%) reported that their experience positively changed their attitudes towards caring for patients with disabilities in the future. Eight themes emerged, notably increased comfort and confidence, a willingness and desire to treat patients, the acquisition of new skills, and clinician behaviours of empathy and compassion towards others. CONCLUSION: Training can help prepare dental hygiene students with the confidence and skills to address the oral health needs of individuals with disabilities.

The Doctoral Degree in Dental Hygiene: Creating New Oral Healthcare Paradigms.

UNLABELLED: Doctoral dental hygiene education would prepare scholars and leaders to improve population health through changes in oral health policy and delivery. BACKGROUND: Discussions about doctoral education in dental hygiene have centered on the need to create a cadre of dental hygiene researchers and scholars who will expand the body of knowledge for the profession. It has been proposed that scholars are needed to lead the development of theory and disseminate knowledge unique to the discipline of dental hygiene. Transformation to doctoral education is not a new trend as many other health care disciplines have already implemented curricular models, establishing the doctoral degree for entry level into practice. The Institute of Medicine has called for the exploration of new models for care delivery. Dental hygienists need to be prepared with leadership skills enabling them to participate and lead interprofessional teams and develop policies designed to improve the delivery of oral health care services to enhance population health. Current educational models do not adequately prepare dental hygienists to serve in this capacity. METHODS: The purpose of this article is to present 2 models of doctoral education for dental hygiene that will illustrate how dental hygienists can be better prepared as scholars and leaders for the profession. CONCLUSION: These proposed models of doctoral education in dental hygiene present a paradigm shift in dental hygiene education. As with other disciplines that have evolved, both academically and professionally, dental hygiene will be positioned to achieve the hallmark of professional status with this terminal degree.

A Comprehensive Oral Preventive Care Protocol for Caring for the Renal Transplant Population.

PURPOSE: Candidates and recipients of kidney transplants are at high risk for oral infections due to systemic co-morbidities, and disease and drug-induced immunosuppression. Developing oral infections while on the waiting list can jeopardize candidacy for receiving a kidney, and post-operatively increases the chance for organ rejection. Therefore, it is imperative to minimize oral disease risks in this population. A comprehensive, oral preventive care protocol is presented to guide dental professionals with patient management throughout the process of care. Proper dental and dental hygiene care can help to prevent oral infections, optimize oral health, and enhance overall health and quality of life for the renal transplant population.

A Dental Radiography Checklist as a Tool for Quality Improvement.

Purpose: A checklist intervention was applied to the dental radiographic acquisition process to determine its effectiveness in improving the diagnostic value of bitewing images and reducing patient exposure to unnecessary radiation.Methods: A mixed-method, nonrandomized research design using two dental hygiene program cohorts (n=33) as control and intervention groups was used to assess the effect of a radiographic checklist on the number and type of radiographic imaging errors. The relationship between perceived value of the checklist and willingness to continue its use was examined and analyzed using descriptive statistics. The effect of previous radiography experience, type and number of acquisition errors, and number of retake exposures were analyzed using Fisher's Exact test, chi-square analysis, Spearman's rho, ANOVA, Cronbach's alpha, Breslow-Day, and Pearson correlation coefficient test.Results: Checklist use did not contribute to an improvement in the diagnostic value of radiographs, nor did the intervention reduce patient exposure to unnecessary radiation. Additionally, analysis did not reveal a statistically significant difference between types of radiographic errors and previous radiography experience. A positive correlation was found between perceived value and willingness to continue checklist use.Conclusion: Similarities between the professions of medicine and dentistry suggest that dental procedures may also benefit from application of checklists. Although a positive association between checklist use and error and retake rate was not realized in this study, checklist use may help to improve the quality of radiographic exposures, thereby impacting patient safety by limiting unnecessary exposure to radiation. Additional research is needed to continue to evaluate the effects of checklist use on dental radiographs. As the body of knowledge related to checklist development and use continues to grow, dental hygienists can look for additional ways to incorporate checklists into practice.

Oral surgery in a patient with cirrhosis and thrombocytopenia: a case report.

PURPOSE: While most oral surgical procedures can be safely performed in an outpatient setting, certain medical conditions may present a higher chance of postoperative complications. In particular, those predisposing the patient to bleeding abnormalities pose a potential risk when performing such treatments. The authors report a case involving full-mouth extractions in a patient with cirrhosis and thrombocytopenia after obtaining a platelet transfusion. METHODS/CASE: A 62-year-old Caucasian female presented to a university special care dental clinic requiring extractions. Her pertinent medical history was remarkable for cirrhosis and thrombocytopenia, with a platelet count of 32,000/uL. Upon medical consultation, the patient was appointed for a prophylactic platelet transfusion. The surgery was rendered uneventfully, and the patient achieved adequate hemostasis without hospitalization. CONCLUSION/CLINICAL RELEVANCE: Patients with cirrhosis pose a potential bleeding risk with dental surgical procedures. Pre-operative medical consultation, review of pertinent laboratory values, and prophylactic platelet transfusion allow these patients to be managed safely in an outpatient setting.

A survey of attitudes, behaviors, and needs of team dentists.

Elite athletes strive to attain superior levels of health and fitness; however, many have high levels of oral disease. Oral screenings detect disease and need for treatment and identify opportunities for preventive interventions. Many dentists volunteer their time with sports organizations, but their scope of practice and needs are unknown. The purposes of this study were to gather baseline data about attitudes, practice behaviors, and needs of team dentists and to assess dental services provided, including the type and frequency of oral screenings conducted on athletes and any associated barriers to those screenings. This descriptive study utilized an original online survey, comprising 37 supplied-response questions, that was pilot tested for face and content validity. All dentist members of the Academy for Sports Dentistry were invited to participate (n = 491), and 150 responded, yielding a 31% response rate. The survey format allowed respondents to skip questions, and some respondents chose not to answer some questions. Quantitative data collected included level of athletes, league affiliation, scope of services provided, and types of oral screening performed. Dentists' attitudes regarding athletes' treatment and preventive needs, practice behaviors, and self-identified needs were assessed. Descriptive statistics were used to analyze the data. Results revealed that 116 of 146 respondents (80%) had a league affiliation. Among 112 dentists who reported providing services to athletes, the most frequently provided services were emergency treatment (96%), mouthguards (96%), restorative treatment (79%), oral hygiene instruction (63%), prophylaxis (61%), periodontal charting (61%), and dental charting (60%). Most team dentists (80%; n = 90/112) performed oral screenings for the athletes. Among 87 respondents who performed screenings and reported the type of screening they provided, 36 (41%) screened all athletes prior to the season and then provided individualized follow-up examinations as needed. The most commonly cited barrier to screenings was lack of awareness of the importance of oral health. Additional education for athletes, coaches, owners, schools, and leagues is needed to increase the value placed on oral health.

Risk management strategies for reducing oral adverse drug events.

UNLABELLED: Oral adverse drug effects negatively impact oral health, comfort and function. BACKGROUND: Patients treated in the oral health care environment take multiple medications, many of which cause oral complications. Dental professionals are challenged with making recommendations to prevent or minimize drug-induced oral disease risks, while reducing symptoms to improve oral health quality of life. METHODS: This paper presents a critical analysis of current evidence regarding common oral adverse drug events, and reviews existing clinical practice guidelines based upon findings from published systematic reviews. RESULTS: There is a lack of sufficient, high quality evidence to support most recommendations for interventions to relieve signs and symptoms of drug-induced oral adverse events. Existing recommendations are largely based on data obtained from observational studies and case reports, and from randomized controlled clinical trials with significant design flaws and potential reporting bias. Outcome measures, especially those related to symptom relief and long-range benefits, are either insufficient or lacking. CONCLUSIONS: Oral adverse drug effects are a common problem, and additional data is needed to support best practices for product recommendations to improve oral health in medicated patients.

Advancing the profession through doctoral education.

Doctoral education in dental hygiene is necessary to create a cadre of dental hygiene researchers and scholars, and to develop educators who will expand the body of knowledge for the profession. Dental hygienists with advanced degrees will require skill sets that parallel those of other professionals if they are to function productively as credible, equal members of interprofessional teams. Doctorally-prepared dental hygienists will be working as leaders, administrators and researchers, and will be influential in creating models that increase access to care, developing collaborative health care teams and improving health outcomes. The doctorate of philosophy is the terminal graduate degree for any discipline, and is the pinnacle for the profession. This paper explores the development of doctoral degrees for dental hygiene, and encourages educators to develop models for graduate programs based upon considerations presented here.

A Delphi study to update the American Dental Hygienists' National Dental Hygiene Research Agenda.

OBJECTIVE: The American Dental Hygienists' Association (ADHA) National Dental Hygiene Research Agenda (NDHRA) is a working document that guides research efforts of the dental hygiene profession. The purpose of this study was to update the NDHRA to reflect current research priorities aimed at meeting national health objectives and to systematically advance dental hygiene's unique body of knowledge. METHODS: Forty-nine dental hygiene experts and key opinion leaders representing all domains of the profession, participated in the Delphi study to update and gain consensus on the NDHRA. The study was carried out electronically in 3 phases: a development phase, 2 rounds of mailed questionnaires to gain consensus on topics during the second phase, and a third phase to prioritize topics. Responses were analyzed using descriptive statistics and instrument reliability was analyzed using the Pearson Product Moment Correlation Coefficient and Cronbach's Alpha for internal consistency. RESULTS: One hundred twelve topics reflecting the research agenda categories were identified during Phase I. Through Phase II, 36 topics were eliminated and consensus was reached on 42 of the remaining 76 topics. Return rates of 95% and 100% were achieved for the 2 survey rounds. Instrument reliability was established at .76 and internal consistency at .87. During Phase III participants attempted to rank the 42 topics as to their level of priority, however results of this phase were not usable. OUTCOMES: Each category comprising the NDHRA was represented by the 42 topics. Thus, consensus on the national agenda was achieved. Ideally, identified priorities on the revised NDHRA will be used to direct future research efforts, identify research funding initiatives, and guide education and practice.