Brushing Behavior Changes and Plaque Removal with an Electric Toothbrush: A clinical trial.

Purpose To evaluate changes in toothbrushing behavior and plaque removal performance with usage of a next generation oscillating-rotating electric toothbrush (NG-OR).Methods This exploratory clinical study had a two-treatment, three-period, single-group, sequential design. Generally healthy adults with a screening whole mouth mean Turesky modified Quigley-Hein Plaque Index (TQHPI) score of at least 1.75 on a 0-5 scale and who were primarily OR brush users were enrolled. Participants used each OR toothbrush in A-B-B order, where a currently marketed OR brush with a traditional mechanical drive system (T-OR) was used in period A and the NG-OR brush with a linear magnetic drive was used in period B. At Visit 1, qualifying participants brushed on-site with T-OR. After a 48h washout, participants returned for Visit 2 and brushed on-site with NG-OR. Participants then used NG-OR for 1 week, twice daily, at home and returned for Visit 3 to brush on-site with NG-OR again. For all on-site brushings, participants were instructed to brush for 2min without interactive features. Each toothbrush was tagged with a transmitter chip connected to a Motion Tracking System to record movements of the toothbrush and participant using infrared light transmission to determine Isochronicity (brushing time uniformly distributed across the dentition). Plaque was measured using TQHPI. Primary variables were Isochronicity and TQHPl whole mouth mean plaque reduction (pre-brushing minus post brushing).Results Overall, 41 participants enrolled and received treatment; 40 completed the trial. NG-OR showed significantly greater Isochronicity after a single brushing (p=0.043) and after a 1-week at-home use (p=0.001) versus T-OR. NG-OR showed 41% greater whole mouth plaque removal than T-OR (p<0.001) after a single brushing. Plaque reduction by region/surface was consistent with whole mouth results.Conclusion The NG-OR brush showed greater brushing uniformity and plaque removal versus the T-OR brush.

Brushing behaviour changes and plaque removal with an electric toothbrush: A clinical trial.

OBJECTIVE: To evaluate changes in toothbrushing behaviour and plaque removal performance with usage of a next generation oscillating-rotating electric toothbrush (NG-OR). METHODS: This exploratory clinical study had a two-treatment, three-period, single-group, sequential design. Generally healthy adults with a screening whole mouth mean Turesky modified Quigley-Hein Plaque Index (TQHPI) score of at least 1.75 on a 0-5 scale and who were primarily OR brush users were enrolled. Participants used each OR toothbrush in A-B-B order, where a currently marketed OR brush with a traditional mechanical drive system (T-OR) was used in period A, and the NG-OR brush with a linear magnetic drive was used in period B. At Visit 1, qualifying participants brushed on-site with T-OR. After a 48 h washout, participants returned for Visit 2 and brushed on-site with NG-OR. Participants then used NG-OR for 1 week, twice daily, at home and returned for Visit 3 to brush on-site with NG-OR again. For all on-site brushings, participants were instructed to brush for 2 min without interactive features. Each toothbrush was tagged with a transmitter chip connected to a Motion Tracking System to record movements of the toothbrush and participant using infrared light transmission to determine Isochronicity (brushing time uniformly distributed across the dentition). Plaque was measured using TQHPI. Primary variables were Isochronicity and TQHPl whole mouth mean plaque reduction (pre-brushing minus post-brushing). RESULTS: Overall, 41 participants enrolled and received treatment; 40 completed the trial. NG-OR showed significantly greater Isochronicity after a single brushing (p = 0.043) and after a 1-week at-home use (p = 0.001) versus T-OR. NG-OR showed 41% greater whole mouth plaque removal than T-OR (p < 0.001) after a single brushing. Plaque reduction by region/surface was consistent with whole mouth results. CONCLUSION: The NG-OR brush showed greater brushing uniformity and plaque removal versus the T-OR brush.

Dental hygiene student perceptions of a school-based sealant program: A qualitative review.

PURPOSE/OBJECTIVES: The purpose of this 2021 study was to explore experiences acquired from a school-based sealant program (SBSP), to improve understanding of the relationship between SBSP and dental hygiene (DH) student outcomes, and to inform institutions of the value of educational experiences aiming to reduce disparities in access to dental care. METHODS: University of Missouri Kansas City School of Dentistry Senior DH students complete a community engaged course which includes participation in community projects and clinical activities targeting Kansas City's urban and surrounding rural environments. The SBSP is a component of this course. This investigation utilized a qualitative methodology to examine SBSP experiences through the experience of the primary investigator, on-site dentist, and DH students involved in the program. RESULTS: Data analysis resulted in consensus of five synthesized conceptual models and twenty-three emergent themes. The conceptual models include: competence, roles and responsibilities, social justice, value added, and lessons learned. CONCLUSION: Based on triangulated results, SBSPs improve access to care for children, save dental costs, and provide essential experiences for DH students.

Prevalence of baseline hypocalcemia and symptomatic hypocalcemia during leukapheresis.

Symptoms of hypocalcemia are reported in up to 50% of patients undergoing leukapheresis procedures. There is no set standard of practice for administering calcium supplementation in the prevention or treatment of hypocalcemia symptoms. The goal of this descriptive, retrospective study was to determine the prevalence of baseline hypocalcemia and symptomatic hypocalcemia during leukapheresis with acid citrate dextrose solution A and to identify patient characteristics associated with symptomatic hypocalcemia. Three percent of patients were found to have hypocalcemia before leukapheresis with 35% experiencing hypocalcemia symptoms during leukapheresis. Older age, higher albumin levels, and longer procedure time were associated with increased risk of hypocalcemia symptoms.

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.

High Patient Disease Burden in a Cross-sectional, Multicenter Contact Registry Study of Eosinophilic Gastrointestinal Diseases.

OBJECTIVES: Clinical features of eosinophilic esophagitis (EoE) have been well-described in the literature, however, characterization of features experienced by patients with other eosinophilic gastrointestinal diseases (EGIDs) is lacking. Using data collected from a patient contact registry, we sought to characterize and contrast patient-reported gastrointestinal and extragastrointestinal symptoms and comorbidities in non-EoE EGIDs, including eosinophilic gastritis, gastroenteritis and colitis, relative to EoE. METHODS: We conducted a cross-sectional study of contact registry data collected from 2015 to 2018. Statistical comparisons were made using chi-square (categorical measures) and the Mann-Whitney U test (continuous measures). Multivariable analyses were used to evaluate associations between treatment and feelings of isolation. RESULTS: Of the 715 reporting an EGID diagnosis (n = 525 EoE; n = 190 non-EoE EGID), a higher proportion of those with a non-EoE EGID reported more frequent specific and nonspecific gastrointestinal symptoms, including nausea, abdominal pain, diarrhea, constipation, and bloating (P < 0.01 for all). Participants with a non-EoE EGID were more likely to report higher frequency of fatigue, isolation, and deep muscle or joint pain (P < 0.01 for all). Specific food elimination and elemental formula treatments were associated with increased odds of more frequent (at least weekly) feelings of isolation for participants with EoE (adjusted odds rtaio [aOR]: 2.4; 95% confidence interval [CI]: 1.5--4.1 for specific food elimination and adjusted OR: 1.9; 95% CI: 1.2--3.3 for elemental formula). CONCLUSIONS: Significant differences exist in the symptoms and comorbidities experienced between those with EoE versus non-EoE EGIDs. Additional investigation is needed to elucidate the factors that may contribute to the high disease burden of these poorly understood conditions.

Relationships Between Course Capture Systems and Student Performance in Dental Hygiene Education.

Purpose: The aim of this mixed-methods longitudinal study was to assess student perceptions of technology use, and to examine the relationship between technology use and performance as reflected by self-reported student grade point averages.Methods: Students (n=351) enrolled in a dental hygiene program within a dental school located in the mid-western United States were surveyed in three courses from 2008 through 2012 to gather their perceptions regarding usage of a lecture recording system (LRS). Additionally, self-reported grade point averages were collected over the same period of time. Data were analyzed using a statistical software program (IBM SPSS; Armonk, NY).Results: The response rate was 82%. Descriptive statistics demonstrated that students believed that the LRS increased their success and satisfaction in the course and would be useful in other courses. Students also reported they would not choose to miss class sessions based on the availability of the recorded lectures. Correlation statistics found no relationship between student GPA and students' perceptions regarding the LRS.Conclusion: Students reported LRS use and availability did not impact their attendance. No relationship was found between students' self-reported GPA and evaluation of the LRS use within the limits of this study.

Effectiveness of an Antigen-Specific Streptococcus mutans Chairside Test as Compared to a Culture-Based S. mutans Test.

Purpose: To compare the effectiveness of an antigen-specific Streptococcus mutans (S. mutans) chairside test to a culture based S. mutans test.Methods: Fifty-three patients receiving dental hygiene care at the University of Missouri-Kansas City, School of Dentistry were enrolled in the study. Stimulated saliva was collected from the patients and utilized for both bacteria tests. The antigen-specific test was compared to the culture-based bacteria test and to a caries risk assessment measuring sensitivity and specificity.Results: The majority of participants were male (53%) with high caries risk (60%). The culture based test results were primarily negative (62%); while the antigen-specific test had more positives (76%). The sensitivity and specificity comparing the antigen-specific test to the culture based test was high (88%, 95% CI = (78%, 97%) and low (25%, 95% CI = (13%, 37%), respectively. The sensitivity and specificity comparing the antigen-specific test to caries risk was high (83%, 95% CI = (72%, 93%) and low (38%, 95% CI = (24%, 51%) respectively.Conclusions: While the sensitivity of the antigen-specific test was high for both the culture-based test and caries risk, the specificity was low for both. These results suggest that the antigen-specific test tends to give a higher proportion of false positive results.

Improving periodontal outcomes: merging clinical and behavioral science.

New data indicate that periodontal diseases are much more prevalent than previously thought, which means that there are large numbers of patients who will need to be diagnosed and treated for periodontal disease in a general dental practice. Oral hygiene procedures performed by patients between office visits are important for gingival health. No particular type of toothbrush has consistently been shown to have superior plaque-removal ability over another. Although studies on powered brushes have shown evidence for efficacy of biofilm removal and increased patient compliance, they are of short duration, making evaluation of long-term effects difficult to achieve. Interdental cleaning with dental floss can be effective but it is technique-sensitive. Interdental brushes have been shown to be superior to floss in plaque index scores, but not in gingival inflammation reduction. A systematic review of oral irrigation reported a beneficial adjunctive effect on bleeding and gingival indices and pocket depth. Antimicrobials in mouthrinses and toothpastes have shown significant reductions in plaque and gingivitis when used correctly. Even though it is considered essential for patients to utilize biofilm-removal techniques on a frequent basis, studies on adherence show that approximately 30-60% of health information is forgotten within 1 h, and 50% of health recommendations are not followed. Incorporating psychosocial aspects of behavioral change, including well-established counseling strategies, such as motivational interviewing, may elicit improved patient outcomes.

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.

Analysis of patient factors impacting duration of periodontal maintenance appointments: an exploratory study.

PURPOSE: The periodontal maintenance (PM) appointment requires varying amounts of time and is absolutely essential for long-term successful periodontal therapy. This study assessed time requirements for PM and relative contribution of patient-level factors such as oral health status, complex medical history, maintenance compliance and demographics. METHODS: One hundred patients receiving PM in a graduate periodontal program at a dental school participated in this cross sectional, observational study and components of their PM were timed in minutes/seconds. Descriptive data were obtained for average total-time required for PM and relative time for each treatment component. Hierarchical multiple linear regression determined what patient-level factors demonstrated the greatest impact on total-time to complete PM. RESULTS: The average PM appointment interval, with radiographs, was 1 hour, 16 minutes, 23 seconds (SD 19:25 minutes). When cubicle preparation and disinfection was included, the total-time was 1 hour, 24 minutes, 31 seconds (±19:32 minutes). Multiple regression showed that BOP, dentist examinations, number of carious lesions and/or restorative defects, number of teeth/implants, taking radiographs, female gender and deposit aggregate (supragingival and subgingival calculus and stain) were significant predictors of total PM duration and explained 57% variance (p<0.05, R2=0.569). CONCLUSION: Based on the average comprehensive PM appointment time of 1:16 minutes, the typical appointment of 60 minutes is insufficient to achieve the goals of a comprehensive PM in this academic clinic setting. These findings suggest the need to utilize more customized models for scheduling PM in order to achieve time allocations that are individualized to address specific patients' needs.

Referring periodontal patients: clinical decision making by dental and dental hygiene students.

Referral of periodontal patients requires development of a complex set of decision making skills. This study was conducted to determine criteria used by dental and dental hygiene students regarding the referral of periodontal patients for specialty care. Using mixed methods, a thirteen-item survey was developed to elicit the students' perceptions of their knowledge, confidence regarding managing patients, and clinical reasoning related to periodontal patients. The instrument was administered during the summer prior to (T1) and at the end of the students' final year (T2) of training. Seventy-nine dental students (81 percent of total class) and thirty dental hygiene students (83 percent of total class) completed T1. At T2, forty-two dental (44 percent of total class) and twenty-six dental hygiene students (87 percent of total class) completed the questionnaire. While 90 percent of dental and 96 percent of dental hygiene respondents reported a willingness to refer patients with active disease to specialists, only 40 percent of dental and 36 percent of dental hygiene respondents reported confidence in diagnosing, treating, and appropriately referring such patients. The students' ability to recognize critical disease and risk factors influencing referral was good; however, clinical application of that knowledge indicated a gap between knowledge and applied reasoning. The students' attitudes about the importance of periodontal disease and their perceived competence to identify critical disease risk factors were not significantly related (p>0.05) to correct clinical decisions in the case scenarios. The study concludes that dental and dental hygiene curricula should emphasize both the acquisition and application of knowledge regarding criteria for referral of periodontal patients.

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.

Adherence and preexisting major protease inhibitor resistance mutations are associated with virologic failure of a dual-class antiretroviral regimen with inhibitors of HIV-1 viral protease and integrase.

OBJECTIVES: Novel treatment strategies are needed for treatment-experienced HIV-infected individuals. We retrospectively evaluated virologic outcomes on a dual-class, protease inhibitor (PI) plus raltegravir, antiretroviral (ARV) regimen. METHODS: Virologic success was defined by a plasma HIV-RNA level ≤200 copies/mL. Adherence was measured using pharmacy refill data. The association between adherence and virologic failure was assessed using bivariate logistic regression. RESULTS: In 39 individuals, median prior antiretroviral therapy (ART) exposure was 11 years. Of 39 individuals, 36 (92%) achieved an HIV-RNA ≤200 copies/mL. After a median follow-up of 328 days (interquartile range [IQR] 190-737 days), 74% maintained an HIV-RNA <200 copies/mL but only 44% had <50 copies/mL. Median adherence was 96.4% (IQR 83.3%-100%). For every 10% decrease in adherence, the odds of virologic failure increased by 90% (odds ratio [OR] = 1.9, 95% confidence interval [CI] 1.1-3.3). In all, 4 individuals had ≥2 preexisting major PI resistance mutations and all 4 had virologic failure. CONCLUSIONS: Most treatment-experienced individuals achieved virologic suppression on a dual-class regimen of a PI plus raltegravir. Success was limited by poor medication adherence and preexisting major PI resistance mutations.

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.