Assessment in a global context: An international perspective on dental education.

Assessments are widely used in dental education to record the academic progress of students and ultimately determine whether they are ready to begin independent dental practice. Whilst some would consider this a "rite-of-passage" of learning, the concept of assessments in education is being challenged to allow the evolution of "assessment for learning." This serves as an economical use of learning resources whilst allowing our learners to prove their knowledge and skills and demonstrating competence. The Association for Dental Education in Europe and the American Dental Education Association held a joint international meeting in London in May 2017 allowing experts in dental education to come together for the purposes of Shaping the Future of Dental Education. Assessment in a Global Context was one topic in which international leaders could discuss different methods of assessment, identifying the positives, the pitfalls and critiquing the method of implementation to determine the optimum assessment for a learner studying to be a healthcare professional. A post-workshop survey identified that educators were thinking differently about assessment, instead of working as individuals providing isolated assessments; the general consensus was that a longitudinally orientated systematic and programmatic approach to assessment provide greater reliability and improved the ability to demonstrate learning.

A review of the oral health-related quality of life (OHRQL) model for dental hygiene: Eighteen years later.

PURPOSE: The purpose of this paper is to review available evidence to determine the impact of the oral health-related quality of life (OHRQL) Model for Dental Hygiene on education, research, and practice. METHODS: A search was conducted in PubMed using the search terms oral health-related quality of life, OHRQL, and dental hygiene and limited to publications between 1998 and 2016. Google Scholar was also used to identify citations for the two original OHRQL model papers to capture the literature widely read by practicing dental hygienists but not indexed in PubMed. A total of 40 publications met the predetermined search strategy. Full publications were obtained and reviewed to determine how this research is being used in education, research, and practice. FINDINGS: The OHRQL is being utilized to a very limited degree in education, research, and practice. The literature shows how the OHRQL is actively being used in the school where the model originated in addition to a dental hygiene programme in Japan. Studies have been conducted on a variety of research instruments, including the OHRQL, designed to capture OHRQL outcomes. Japanese researchers have used the OHRQL in studies designed to determine the impact of oral healthcare delivery on patients' oral health-related quality of life. CONCLUSION: Eighteen years of the literature confirms that the OHRQL is being used minimally in education, research, and practice. Greater emphasis is needed around the collection and assessment of oral health-related quality of life measures for providing patient-centred care.

Exploration of the relationship between parent/guardian sociodemographics, intention, and knowledge and the oral health status of their children/wards enrolled in a Central Florida Head Start Program.

OBJECTIVE: The purpose of this study was to identify possible relationships between parent/guardian sociodemographics, intention, knowledge, and the oral health status of their child/ward. Intention includes three factors as defined in the Theory of Planned Behavior: attitudes, subjective norms and perceived control, and oral health status was measured by decayed, missing and filled teeth (dmft) scores. METHODS: A convenience sample of parent/guardian with child/ward with age of three to five (n = 181 dyads) enrolled in a Head Start program in the state of Florida participated. A cross-sectional observational study comprised of two components, parent/guardian questionnaire and an oral health status form for recording dmft scores of participating child/ward was employed. RESULTS: Parent/guardian race/ethnicity and years of education were significantly related to dmft of child/ward. The highest rates of severe early childhood caries (ECC) were found in child/ward whose parent/guardian is Hispanic and parent/guardian with less than a high school education. Multivariate regression analysis found that increased education level of parent/guardian was significantly associated with lower dmft in this population. No significant relationship was found between parent/guardian self-reported intention (attitudes, subjective norms and perceived control), knowledge and dmft scores of the child/ward. CONCLUSION: Researchers have called for greater attention to the impact of parental influences in the aetiology of ECC. Results from this study were consistent with current studies where parent/guardian race/ethnicity and educational level served as predictors of oral health status of children. In this study population, parent/guardian intention and knowledge were not shown to significantly impact the oral health status of their child/ward.

Measuring the short-term effects of incorporating academic service learning throughout a dental hygiene curriculum.

OBJECTIVES: Academic service learning (ASL) provides the venue for dental hygiene education to take oral healthcare services directly into communities while at the same time promoting professional responsibility within the student bodies. The purpose of this study was to quantitatively examine the change in pre-existing attitudes and behaviours of dental hygiene students following the incorporation of ASL activities throughout a five-semester dental hygiene curriculum. METHODS: Seventy-seven first-year dental hygiene students who participated in ASL from the graduating classes of 2008-2010 participated in the study. A survey instrument developed by Shiarella, based on Schwartz's Helping Behaviors Model, was used to assess students' attitudes towards community service. Additionally, questions were developed using Shinnamon's Methods and Strategies for Assessing Service-Learning in the Health Professions. RESULTS: Internal estimates of reliability for scales (Cronbach's α) were all >0.8. The results revealed statistically significant improvements over time in enhanced learning (P = 0.0001), self-awareness (P = 0.0001), sense of volunteerism (P = 0.013), impact on career choices (P = 0.001) and decrease in personal costs (P = 0.0001). There were no significant changes in other subscales over time. Further investigating these domains revealed minimal to no changes in attributes of service learning. CONCLUSION: Service learning integrated into the dental hygiene curriculum can enhance learning and improve students' self-awareness, sense of volunteerism, career choices and perception of personal costs. In concert with the literature on ASL, these experiences throughout the curriculum have potential for increasing students' awareness of community need and their roles as oral health professionals.

The global network on dental education: a new vision for IFDEA.

The advent of globalization has changed our perspectives radically. It presents increased understanding of world affairs, new challenges and exciting opportunities. The inequitable distribution and use of finite energy resources and global warming are just two examples of challenges that can only be addressed by concerted international collaboration. Globalization has become an increasingly important influence on dentistry and dental education. The International Federation for Dental Educators and Associations (IFDEA) welcomes the challenges it now faces as a player in a complex multifaceted global community. This report addresses the new circumstances in which IFDEA must operate, taking account of the recommendations made by other working groups. The report reviews the background and evolution of IFDEA and describes the extensive developments that have taken place in IFDEA over the past year with the introductions of a new Constitution and Bylaws overseen by a newly established Board of Directors. These were the consequence of a new mission, goals and objectives for IFDEA. An expanded organization is planned using http://www.IFDEA.org as the primary instrument to facilitate the exchange of knowledge, programmes and expertise between colleagues and federated associations throughout the world, thereby promoting higher standards in oral health through education in low-, middle- and high-income countries of the world. Such aspirations are modified by the reality and enormity of poverty-related global ill health.

Advanced degree seeking students' satisfaction with online courses at UMKC--an early investigation.

UNLABELLED: The use of online instruction is becoming more prevalent and transcends many disciplines. Nursing has been at the forefront of health professions utilizing distance education. Nearly half of all predoctoral dental programs report use of web-based or distance delivery. Comparatively, 22% of dental hygiene programs report use of this somewhat new approach to teaching. Distance learning provides a means for increasing access to and enrollment in dental hygiene programs. Individuals who cannot physically attend courses in dental hygiene benefit from the institutions that offer web-based classes. In today's environment, more individuals seek to advance their educational needs. Advanced dental hygiene degree programs may benefit by providing distance learning. Since 2000, the University of Missouri - Kansas City (UMKC), Division of Dental Hygiene has offered its degree completion program online. Its master's degree online program has been offered since 2001. PURPOSE: The purpose of this study is to describe the pre- and post-course graduate and degree completion students' perceptions of web-based courses offered at UMKC. METHOD: Over the course of 3 years, all students enrolled in required fall semester online classes were selected and agreed to participate in the study. Students were asked to fill out questionnaires prior to and at the completion of required online courses. There were no identifiers on the questionnaires. The surveys used in the study were derived from an instrument used by Wills and Stommel who examined graduate nursing students' perceptions of web-based courses. RESULTS: Results indicate that students enjoy this method of learning. All students reported they would enroll in another online course if given the opportunity. CONCLUSION: Based on favorable student perceptions, UMKC will continue to provide this method of learning to students seeking advanced degrees in dental hygiene.

Effect of magnification lenses on student operator posture.

A distinct body of literature supports the association between clinical postures of the dental practitioner and work-related musculoskeletal disorders (WRMD). Several aids or devices have been tested to improve clinical posture in the interest of decreasing WRMD. The use of magnification lenses while performing dental procedures may increase the quality of work and decrease the likelihood of musculoskeletal problems. To date, only anecdotal and personal opinions had existed regarding the benefits of using magnification lenses, and no empirical evidence had authenticated the contention that use of magnification lenses exerts a positive change in operator posture. The objective of this study was to assess the effect magnification lenses had on the posture of dental hygiene students. Using a randomized crossover design, researchers videotaped nineteen senior dental hygiene students performing an intra-oral procedure with and without the use of magnification lenses. The tapes were then evaluated by a panel of five dental hygiene educators calibrated in the use of Branson's Posture Assessment Instrument (PAI). Results of a paired t-test indicate that the posture of the students while wearing magnification lenses was more acceptable (p=.019) than when wearing traditional safety glasses. Results of this study indicate a quantifiable change in acceptability of posture for clinicians wearing magnification lenses and suggest that the use of such lenses in dental education may be warranted.

Dental hygiene fear: gender and age differences.

Studies aimed at examining gender and age differences as they relate to dental anxiety have begun to appear in the literature. The purpose of this investigation was to explore fear and anxiety in a dental hygiene setting and evaluate gender and age differences among four sub-scales of dental hygiene fear. The Dental Hygiene Fear Survey (DHFS) was developed to address patient reaction to dental hygiene treatment. The University of Washington Dental Fears Model was the theoretical model used for it identifies four domains of dental fear: fear of specific stimuli, generalized anxiety, fear of catastrophe, and distrust. Males and females respond differently to dental hygiene treatment with women reporting significantly (p<.05) greater fear overall than males. Examination of the four dental hygiene fear sub-scales show that females report greater fear (p<.05) in relation to specific fear and generalized anxiety. There were no significant differences across age categories on total fear scores or within any of the sub-scales. Characterization of the dental hygiene fear patient along with knowledge of procedures that elicit anxiety can assist the practitioner in recognizing dental hygiene-related fear. With this foundation, the practitioner can then develop management strategies specific to this phenomenon.

Validity and reliability of the oral health-related quality of life instrument for dental hygiene.

PURPOSE: The purpose of this study was to examine reliability, construct validity, and produce a concise instrument for assessing Oral Health-Related Quality of Life (OHRQL). METHOD: The OHRQL model for dental hygiene served as the theoretical basis in the development of this instrument. The survey utilized five-point Likert scale items, designed to assess the domains of symptom status, functional status, and health perceptions. The instrument was administered to 321 functionally independent older adults from six Area Agency on Aging nutrition centers and three retirement communities in the Kansas City and St. Louis areas in Missouri. Scale reliability was demonstrated by calculating the coefficient alpha for each subscale. Item analysis was subsequently conducted to provide additional supportive evidence for reliability. Construct validity was assessed using a one-way multivariate analysis of variance MANOVA to examine the effect of known subgroups. Analysis of variances (ANOVA) for groups on each subscale was conducted as a follow-up test to the MANOVA. RESULTS: Coefficient for the seven subscales ranged from 0.74 to 0.89. No significant difference was found among males and females. However, there were significant differences in patterns of subscale means (p < .05) for subgroups reporting 'good' versus 'poor' denture fit; 'presence' or 'absence' of recent toothache; 'presence' or 'absence' of loose teeth; 'presence' or 'absence' of gingival recession; 'presence' or 'absence' of dentures interfering with eating; and self-report of 'good' versus 'poor' general health. CONCLUSION: These preliminary results provided initial supportive evidence of the OHRQL's reliability and validity. Future studies are needed to confirm this preliminary conclusion.

Oral health-related quality of life: a model for dental hygiene.

During the past decade, dental hygiene has been challenged to develop conceptual models to define the discipline. Such models can provide a common language and infrastructure for the discipline to define the process of care. Health-Related Quality of Life conceptual models have been adopted by many health professions to assist in planning health-related interventions and assessing outcomes to care. Based on the Natural History of Disease Schema, the Wilson & Cleary model, and Neuman's Systems Model, a new conceptual model for dental hygiene is proposed. The Oral Health-Related Quality of Life Model, composed of six primary domains: Health/Preclinical Disease, Biological/Clinical Disease, Symptom Status, Functional Status, Health Perceptions, and General Quality of Life. This model proposes a dynamic relationship among these domains and characteristics unique to individual clients or populations, and may have utility for interdisciplinary communication. As an integrated model, it may serve as a foundation for assessing, planning, implementing, and evaluating outcomes to dental hygiene care. This paper reviews possible application of the model for clinical practice, research, and education.

Comparison of the plaque removal efficacy of a new flossing aid (Quik Floss) to finger flossing.

The purpose of this clinical trial was to compare the effectiveness and safety of a new dental flossing device (Quik Floss) to finger flossing in plaque removal, reduction of gingival inflammation and patient preference. 30 healthy, non-flossing adults with 20 natural teeth, a plaque index (PI) of at least 1.8 and a gingival index (GI) of 1.3 or greater participated in this two-phase crossover design study. Patients were randomly assigned to use either the new flossing device or finger flossing first in the sequence. At baseline, data were collected and patients were given flossing method instructions. The Silness & Löe GI, Quigley-Hein PI, Eastman Bleeding Index (BI) and trauma were assessed at baseline, 15 and 30 days for each treatment period. After the initial 30-day treatment phase, patients were instructed to cease all flossing during a 14-day "washout" period. Subjects were then assigned to the opposite treatment group during the 2nd treatment phase. A 3-factor repeated measures ANOVA analyzed data for differences within and between groups over time. Results revealed statistically significant (p < 0.01) within group improvement in PI, GI, and BI for both treatment groups over time. No statistically significant between group differences were found for either group at any time period. In addition, no significant gingival trauma was recorded and no differences were found between groups. Quik Floss was as effective as finger flossing. Subjects preferred (55%) Quik Floss over finger flossing. In conclusion, Quik Floss is a safe and effective oral hygiene measure for reducing plaque, inflammation and bleeding over time.

An investigation of dental hygiene treatment fear.

PURPOSE: The purpose of this study was to develop and test the psychometric properties of a dental hygiene fear survey in a convenience sample population from a Midwestern metropolitan area. METHODS: A convenience sample of 300 subjects from two sites, a suburban general dental practice and a dental school intramural faculty practice located in a metropolitan area, was utilized. A 16-item instrument was developed that incorporated the University of Washington Fears Clinic four subtypes of dental fear: fear of specific stimuli, generalized anxiety, distrust, and catastrophe. The survey was administered prior to dental hygiene treatment. Scores were summed and patients were classified as experiencing dental hygiene fear if their scores were greater than one standard deviation above the mean. Reliability was estimated by Cronbach's alpha. Validity was examined by correlating the revised instrument with measures of conceptually related variables. RESULTS: Cronbach's alpha coefficient was .85 for specific dental hygiene stimuli, .79 for generalized anxiety, .75 for distrust, and .68 for fear of catastrophe while receiving dental hygiene treatment. Overall reliability of all 16 items was estimated at .92. A significantly positive correlation (.58) was found between dental hygiene patients who reported high fear and avoidance (> 2 years) of dental hygiene treatment (p < .05). Dental hygiene fear correlated negatively (-.12) with age (p < .05). Females reported dental hygiene fear more frequently than males. CONCLUSIONS: Further revisions of the Dental Hygiene Fear Survey are needed; however, this survey shows promise in evaluating dental hygiene fear.

The effect of personal protective equipment on high-and low-dental fear patients.

PURPOSE: This investigation was designed to examine both high- and low-dental-fear patients' perceptions about and anxiety responses to personal protective equipment (PPE) as presented in a videotaped, simulated interaction between oral healthcare worker and patient. METHODS: Sixty-two individuals representing a convenience sample presented at the University of Missouri-Kansas City (UMKC) Dental School and were screened for eligibility. The Dental Fears Survey was administered to participants to assess level of dental fear. Subjects were then matched according to fear level, gender, and age, and randomly assigned to an experimental or control group. Subjects viewed a videotaped vignette of a male dentist conducting a new patient interview. The control group viewed a tape in which the provider did not utilize PPE. The experimental group viewed the provider putting on PPE at completion of the interview. Subjects were instructed to complete a semantic differential scale at completion of the tape in order for the researchers to assess their attitude toward the scene. Paired adjectives in the semantic scale were scored from 1 to 7, with low scores reflecting negative evaluations and high scores reflecting positive evaluations. Heart rate and skin conductance were measured prior to and during the viewing of the videotapes by means of a photoplethysmograph and an electrodermograph, respectively. RESULTS: A two-factor ANOVA found the main effect of fear to be significant (p < .05), with subjects exhibiting high levels of dental fear rating both videotapes (PPE & NO PPE) more negatively than subjects exhibiting low levels of dental fear. A repeated measure ANOVA was used for analysis of heart rate and skin conductance. The Dunn's Multiple Means Comparison Test showed that skin conductance increased significantly (p < .05) in both groups from baseline to presentation of the oral healthcare environment. CONCLUSIONS: A videotaped presentation of the dental environment produced significantly more negative evaluations from patients with high fear than from patients with low fear. Both groups experienced a significant increase in skin conductance (perspiration) upon presentation of the oral healthcare environment. However, presence of PPE did not adversely affect patient perceptions of the oral healthcare provider.

How personal protective equipment affects perceptions of dentists.

In this study, 248 college-educated young adults completed the Dental Fears Survey. Subjects then viewed one of two slides of a dentist. In one slide, the dentist wore no PPE at all; in the other, the dentist wore gloves, mask, glasses, face shield and lab coat. Subjects completed a 20-item semantic differential scale to assess their attitudes toward the dentist portrayed in the slide they saw.