Validity of oral health screening in field conditions: pilot study.

PURPOSE: This small pilot study examined the validity of visual dental hygiene screenings (VDHS) in conditions found in local communities. METHODS: A sample of 126 children in kindergarten through second grade was screened by 2 dental hygienists and inspected by a dentist. None of the assessors had more than minimal experience and training in epidemiological methodologies. Two dental hygienists noted teeth as decayed or not decayed using only a tongue blade and a goose-neck lamp (VDHS). The dentist noted decay by tooth and surface using a mirror, explorer, portable dental chair, as well as a goose-neck lamp; this examination is referred to as a mirror, tactile dental inspection (MTDI). The dentist's assessment (MTDI) was the "gold standard." Data were analyzed using frequency distributions, sensitivity, specificity, and kappa coefficient statistics, as well as other statistics to test the significance of differences and to investigate explanations for discrepancies between the VDHS and MTDI. RESULTS: Sensitivity and specificity for the VDHS for all teeth were 61% and 96%, with a kappa coefficient of 0.6. Analysis of the discrepancies between the VDHS and the MTDI suggest that, for primary teeth, the sensitivity of the VDHS is greater when: (1) lesions are large (i.e. multi surface) and (2) single surface lesions are located anteriorly. No statistically significant explanations were found for differences in permanent teeth. CONCLUSION: In this study, VDHS demonstrated high specificity and moderate sensitivity for caries identification.

Career promotional activities of Iowa dental hygienists.

PURPOSE: The purpose of this research was to investigate the relationship between Iowa dental hygienists' career promotional behaviors and (1) attitudes about career satisfaction, (2) beliefs about the job market, (3) membership in the American Dental Hygienists' Association, (4) demographics, and (5) employment characteristics. METHODS: In February 1993, questionnaires were mailed to a stratified random sample of 467 Iowa dental hygienists licensed and residing in the state of Iowa. Participation in four career promotional behaviors was ascertained as well as several independent variables. The data were analyzed with frequency distributions, Pearson's correlation coefficients, and chi-square statistics. RESULTS: An adjusted response rate of 92.3% was achieved (N=423 respondents). The majority of respondents (79.1%) recommended a career in dental hygiene, but fewer than 20% participated in a dental hygiene career day, gave an undesignated monetary gift to a dental hygiene education program, or donated to a dental hygiene scholarship fund. The independent variables were not related consistently to each of the career promotional activities. CONCLUSIONS: It appears that career promotional behaviors are multifaceted and require additional research to elucidate the interrelationships and enhance coordinated approaches to dental hygiene career recruitment.

The effectiveness of a low-chemical, low-protein medical glove to prevent or reduce dermatological problems.

PURPOSE: This study investigated the effectiveness of a low-chemical, low-protein, powder-free latex medical glove to reduce or prevent hand dermatitis in a group of oral healthcare workers who had a self-reported history of hand irritation from medical glove use. METHODS: Dental hygienists who had previously reported dermatological conditions from routine use of medical gloves were invited to participate in this study to test a new medical glove. All subjects completed baseline information and 85 subjects participated in the study. Subjects wore the gloves routinely for six weeks unless complications developed. Postuse questionnaires were sent to the 85 participants. Dermatological signs and symptoms were measured at both times and subjects' perceptions of change in dermatological conditions were measured postuse. Data were analyzed by frequency distributions, paired t-test, and McNemar's chi-square statistic. RESULTS: For the 85 participants, the reduction in number of dermatological signs and symptoms was statistically significant (t = 3.46; p = 0.001) from a mean of 2.5 (sd = 2.8) to a mean of 1.3 (sd = 2.6) symptoms. A statistically significantly (chi-square = 7/8; p = 0.005) greater proportion of subjects were symptom-free at postuse (61.2%) than at baseline (41.2%). Almost 90% of the oral healthcare workers perceived that the number of dermatological signs and symptoms, the intensity of signs and symptoms, and the area involved stayed the same or decreased. CONCLUSIONS: The medical gloves used in this study were effective in reducing the number of dermatological problems associated with routine medical glove use by oral healthcare workers with self-reported histories of problems with medical gloves.

Attitudes of Iowa dental hygienists regarding self-regulation and practice.

PURPOSE: This study investigated Iowa dental hygienists' perceptions about education, practice, and licensure regarding issues related to self-regulation. Furthermore, it was the purpose of the study to determine if these perceptions were statistically related to membership in the American Dental Hygienists' Association (ADHA). METHODS: In October 1992, 150 Iowa dental hygienists were randomly selected to participate in a mail survey. The questionnaire included items on self-regulation, licensure, practice, supervision, delivery systems, and independent practice. Responses were analyzed by frequency distributions and the chi-square statistic. RESULTS: Ninety responses were received, representing 80% of the 112 subjects with valid Iowa addresses, but only 60% of the selected sample. Of the 36 variables analyzed, only two were statistically significantly different by ADHA membership. Thus, data were combined and reported for all respondents. The majority of Iowa dental hygienists (71.6%) believed dental hygiene was pursuing self-regulation to improve quality of care. They wanted more dental hygiene representation on licensure boards and almost 50% wanted separate boards. The majority of respondents favored control of dental hygiene practice and 70% wanted alternatives to the current dental hygiene care delivery system. Most respondents stated general supervision and independent practice would increase access to oral healthcare without increasing patients' risk of health problems. CONCLUSIONS: The majority of Iowa dental hygienists support the dental hygiene profession's goal of self-regulation. ADHA members and nonmembers have similar attitudes and opinions about dental hygiene self-regulation, licensure, delivery systems, and practice.

Components of nonresponse in mail surveys of dental hygienists.

PURPOSE: This study was designed to investigate the reporting of nonresponse in mail survey research and to determine if nonresponse as a result of inaccurate addresses varied by sampling frame. Nonresponse bias is defined as researchers' inability to contact some members of a sample, or the refusal of some sample members to provide information. METHODS: Published survey research articles in the Journal of Dental Hygiene from 1988 through 1992 were reviewed for nonresponse information. Thirty-nine articles described studies that met the requirements of being a mail survey of dental hygiene subjects. All 39 articles included information about the population base and the number of subjects in the sample. Descriptive statistics were used to analyze the data. RESULTS: Response rates ranging from 33% to 92% were reported in 37 articles. Only 15 of the 37 articles included information on the ability to contact subjects. The percentage of subjects who could not be contacted ranged from 1.1% to 13.3%. Professional organization membership rosters provided the most accurate mailing lists, followed by school class rosters. Least accurate were licensure lists and magazine lists. CONCLUSION: More attention to research design may help dental hygiene researchers recognize the impact of nonresponse bias.

Factors related to career retention among dental hygienists.

PURPOSE: The purpose of this research was to investigate the reasons dental hygienists consider leaving or leave dental hygiene and to determine if the reasons vary by employment category. METHODS: In March 1988, mail questionnaires designed by the author were sent to a nationwide sample of 1,008 dental hygienists who graduated in 1982 and who had been surveyed every six months beginning in their senior year of dental hygiene school. Consideration of leaving dental hygiene was ascertained with an open-ended question. Responses to this question were categorized into five determinants of work change: economic, psychological, sociological, physiological, and environmental. Chi-square analysis was used to ascertain if determinants of work change were associated with employment. RESULTS: Responses were received from 812 dental hygienists--an 81% response rate overall and an 83% response rate from subjects with valid addresses. While 82% of the respondents were employed in dental hygiene, 7% were employed outside of dental hygiene, and 12% were not employed. Of the respondents, 57% had considered leaving dental hygiene within six years after graduation. Reasons for considering leaving varied by employment status. Dental hygienists currently employed in dental hygiene stated a wide variety of reasons for considering leaving, but most important were psychological factors. Environmental (family responsibility) factors were most important for unemployed dental hygienists, while economic factors were most important for dental hygienists employed outside dental hygiene. CONCLUSIONS: Factors identified in this research can be used to help understand, and to design efforts to enhance, career retention. Additional research is needed to determine whether the causative factors for job turnover and career turnover are different or essentially the same.

Examination services provided by dental hygienists.

The information presented in this paper was obtained as part of an ongoing longitudinal study of 1982 dental hygiene graduates. This paper presents information contracted by the American Dental Hygienists' Association and includes information on examination services provided to new and recall, child and adult dental hygiene patients by dental hygienists. Mail questionnaires were sent to a cohort of 1,008 dental hygienists who graduated in 1982. Data presented here were collected in September 1986. Surveys were returned from 766 subjects, 77% of those with valid addresses. Of the respondents, 455 were working in traditional clinical dental hygiene positions and provided information on patient examination services. The frequencies reported for the 15 examination services investigated by the dental hygienists varied for child and adult patients and for new and recall patients. Visual gingival examination was the most frequently provided service. In conclusion, dental hygienists need to incorporate additional patient examination services into their diagnostic workups to ensure adequate patient care and to provide adequate information to evaluate their dental hygiene care.

Passive dosimetry of dental hygienists' exposure to nitrous oxide.

This study is the first to measure exposure to waste nitrous oxide (N2O) in the dental work setting in a broad geographical region (25 states), with passive dosimeters, and for dental hygienists. Thirty-five dental hygienists who reported that they administered N2O and 20 dental hygienists who reported that they never administered N2O constituted the sample. The former (n = 35) received both a 40-hr dosimeter, which measured exposure during administration of N2O, and a 168-hr dosimeter, which measured exposure during all work hours. The latter (n = 20) received only the 168-hr dosimeter. Exposure was measured during 2 wk in April 1990. For all work hours, the mean ppm-hr was 3,636 and the mean time-weighted average (TWA) was 78 ppm. The corresponding means during administration were 2,754 ppm-hr and 842 ppm TWA. The data for dental hygienists with passive dosimeters were similar to previously reported findings for dentists as measured by infrared spectrophotometry and gas chromatography. Hygienists who worked in dental settings with scavenging equipment received higher average levels of exposure to N2O than did hygienists who worked in settings without scavenging.

Dentist involvement in care provided by the dental hygienist.

This study investigated a nationwide sample of dental hygienists to determine the extent of dentist involvement during the patient's appointment with the dental hygienist. The American Dental Hygienists' Association identified the need for additional study of dentist involvement and contracted for data to be obtained as part of the ongoing longitudinal study of 1982 dental hygiene graduates. Mail questionnaires were sent to a nationwide cohort of 1,008 dental hygienists who graduated in 1982. Responses were received from 812 subjects, an 83% response rate from subjects with valid addresses. Data indicated that, on the average, the dentist spends 10 minutes with the dental hygienist's patient at the end of the dental hygiene appointment. This time is divided almost equally among talking with the patient, performing an oral examination, and discussing diagnosis and treatment needs.

Job satisfaction among dental hygienists.

This paper presents definitions of job satisfaction from organizational theory, and a review of the dental hygiene literature on job satisfaction. Most studies of dental hygienists have used one or two global measures of satisfaction. Very few studies have used dimensional measures of satisfaction; and those that have, have not used identical measures. The studies--which measured satisfaction in a variety of ways and quantified dental hygienists' satisfaction in terms of percent satisfied--established that between 70% and 99% of dental hygienists are satisfied with their jobs.

Dental hygiene licensure specifications on pain control procedures.

State boards of dentistry of the 51 licensure jurisdictions and 51 constituent hygiene presidents were sent identical surveys to obtain current information about dental hygiene licensure specifications for nitrous oxide analgesia, and infiltration, block, and topical anesthesia. The response rate was 72% (N = 37) from boards and 90% (N = 46) from constituent presidents. Results showed that western states are more likely to allow delegation of pain control functions. Of the four functions, topical anesthesia is the most and nitrous oxide analgesia is the least delegated. Most states that allow delegation of pain control procedures did so in the 1970s and 1980s. A majority of states where pain control functions are legal specify direct or indirect supervision and certification through board-approved courses. Percentages of hygienists certified in functions ranged from a low of 0% to a high of 100%. Boards and presidents agreed closely on functions allowed, certification requirements, and year of legalization. Agreement was lower on the type of supervision required for all procedures except nitrous oxide analgesia. No reports of patient reactions to or formal complaints about pain control procedures provided by hygienists were known to state boards or constituent presidents.

Methods of charging and the fees charged for dental hygiene services in traditional and nontraditional settings.

The information presented in this paper was obtained as part of an ongoing longitudinal study of 1982 dental hygiene graduates. This portion of the study was contracted by the American Dental Hygienists' Association and investigated the methods of charging for dental hygiene services and the fees charged for these services. In September 1986, mail questionnaires were sent to a cohort of 1,008 dental hygienists who graduated in 1982. Responses were received from 766 subjects--a 76% response rate overall and a 77% response rate from subjects with valid addresses and who had received the questionnaires. Data were analyzed for clinical dental hygienists in traditional and nontraditional settings. Results showed that the methods of charging for services and the fees charged were similar in both settings. Although most hygienists provided many services, only one fee for these services was charged in most settings. The mean prophylaxis fee for child patients at traditional settings was $23.52, and $23.38 at nontraditional settings. The mean prophylaxis fee for adult patients at traditional settings was $31.23, and $32.61 at nontraditional settings.

The roles of other dental personnel in the patient care provided by dental hygienists in traditional and nontraditional settings.

The information presented in this paper was obtained as part of an ongoing longitudinal study of 1982 dental hygiene graduates. This portion of the study was contracted by the American Dental Hygienists' Association and investigated the roles of personnel other than the dental hygienist in dental hygiene patient care by collecting data on (1) the numbers of personnel by personnel category, (2) the activities that other personnel provide to assist the hygienist in providing care, (3) the frequency at which the dentist evaluates the hygienist's work and (4) the frequency at which the dentist examines the hygienist's patients. In September 1986, mail questionnaires were sent to a cohort of 1,008 dental hygienists who graduated in 1982. Responses were received from 766 subjects--a 76% response rate overall and 77% response rate from subjects with valid addresses. Data were analyzed for clinical dental hygienists working in traditional and nontraditional settings. The median numbers of personnel were similar in both traditional and nontraditional settings; however, the means and standard deviations were larger for nontraditional settings. The most common forms of assistance provided by other personnel were billing and scheduling patients; a greater percentage of hygienists in traditional settings had this type of help. Hygienists were more likely to report that dentists examined their patients rather than evaluated the hygienists' work, and hygienists in nontraditional settings reported less dentist involvement with dental hygiene patient care than did hygienists in traditional settings.

The economics of dental hygiene work in traditional and nontraditional settings.

The information presented in this paper was obtained as part of an ongoing longitudinal study of 1982 dental hygiene graduates. This portion of the study was contracted by the American Dental Hygienists' Association and provides information about method and amount of remuneration, fringe benefits, pay increases, and amount of money generated from dental hygienists' services. Data presented here were collected at two points in time: September 1985 and September 1986. The September 1985 survey was returned by 850 dental hygienists (83%) and the September 1986 survey was completed by 766 subjects (77%). Data were analyzed for clinical dental hygienists working in traditional and nontraditional settings. Results showed that most dental hygienists were salaried (80% traditional, 100% nontraditional) with a 1985 mean annual income of $19,160 for traditional and $17,197 for nontraditional hygienists. The mean daily wage in 1986 was $106.27 for traditional and $85.12 for nontraditional hygienists. Nontraditional hygienists were more likely to have received a pay increase in the previous six months and to receive fringe benefits than were traditional hygienists. Wages earned and money generated from dental hygiene services varied greatly. On the average, hygienists' wages constituted about one-third of the fees their services generated.