Knowledge of human papillomavirus among dental providers: A mixed methods study.

Dental professionals are encouraged by the American Dental Association (ADA) to recommend the HPV vaccine to eligible patients. To better understand their comfort level in following this recommendation, we conducted a mixed methods study of dentists and dental hygienists. A total of 173 providers were surveyed and 8 interviewed. The majority felt they had an important role in preventing HPV-related OPC and that they should educate their patients and encourage HPV vaccination. However, most providers had low knowledge about HPV and expressed a need to obtain more information on the topic. In particular, they desired information about the HPV vaccine, its connection to cancer and where to refer patients for vaccination. They also wanted access to visual aids to help them bring up the topic. This study demonstrates the need to develop and disseminate educational programs for dental providers so they can assist with efforts to raise HPV vaccination rates.

Evaluation of the Jönköping dental fear coping model: a patient perspective.

OBJECTIVE: This study is a part of a project with the aim to construct and evaluate a structured treatment model (the Jönköping Dental Fear Coping Model, DFCM) for the treatment of dental patients. The aim of the present study was to evaluate the DFCM from a patient perspective. MATERIAL AND METHODS: The study was performed at four Public Dental Clinics, with the same 13 dentists and 14 dental hygienists participating in two treatment periods. In Period I, 1351 patients were included and in Period II, 1417. Standard care was used in Period I, and in Period II the professionals had been trained in and worked according to the DFCM. In the evaluation, the outcome measures were self-rated discomfort, pain and tension, and satisfaction with the professionals. RESULTS: In comparison with standard care, less tension was reported among patients treated according to the DFCM, (p = .041), which was also found among female patients in a subgroup analysis (p = .028). Additional subgroup analyses revealed that patients expecting dental treatment (as opposed to examination only) reported less discomfort (p = .033), pain (p = .016) and tension (p = .012) in Period II than in Period I. Patients with low to moderate dental fear reported less pain in Period II than in Period I (p = .014). CONCLUSIONS: The DFCM has several positive effects on adult patients in routine dental care. In a Swedish context, the differences between standard care and treatment according to the model were small but, in part, statistically significant. However, it is important to evaluate the model in further studies to allow generalization to other settings.

Collaborative Skill Building in Dentistry and Dental Hygiene through Intraprofessional Education: Application of a quality improvement model.

Purpose: The purpose of this study was to apply a quality improvement model in the application of an intraprofessional educational experience by improving student perceptions of collaboration and increasing the number of collaborative experiences within the dental hygiene curriculum.Methods: A quality improvement model, Plan, Do, Study, Act (PDSA) developed by the Institute for Healthcare Improvement (IHI), was used to initiate an intraprofessional education experience for dental hygiene and dental students. Faculty members utilized the PDSA worksheet to plan, implement, and analyze the educational experience. Pre- and post-session surveys were used to measure dental hygiene student perceptions of their ability to perform four Interprofessional Education Collaborative (IPEC) sub-competencies. Statistical analysis was carried out on the pre and post session surveys. Students were also given the opportunity to discuss their learning and intraprofessional experiences in a reflection assignment.Results: Dental hygiene students demonstrated positive changes from pre- to post-session survey data in in all four targeted IPEC sub-competencies. Statistical significance was noted in three of the four IPEC sub-competency rating statements. Themes from the reflection assignments indicated student learning in the areas of teamwork and communication. Dental hygiene faculty applied the information gained from the assessments as part of the IHI PDSA cycle for improvement in health care to evaluate and plan for future learning experiences.Conclusion: Meaningful intraprofessional education experiences between dental hygiene and dental students support collaborative practice skills and should be integrated into dental and dental hygiene curricula. Applying a continuous quality improvement model, such as the IHI PDSA, can assist educators in planning, implementing, and evaluating curricular changes in order to improve student learning outcomes.

Educational and Clinical Experiences in Administering Local Anesthesia: a study of dental and dental hygiene students in California.

Purpose: The purpose of this study was to examine the differences in educational preparation and practical educational experiences between dental and dental hygiene students in the administration of local anesthesia (LA) and management of LA related complications in the state of California.Methods: Course instructors responsible for teaching LA or the program directors of the 6 dental schools and 29 dental hygiene programs in California (n=35) were invited to participate in this study. A computer-based descriptive survey, a comparative checklist of LA instruction requirements and semi-structured interviews were used for the data collection. Descriptive statistics were used to analyze results.Results: Eighteen LA course instructors or program directors participated in the study for a response rate of 51%. One respondent was from a dental school while 17 were from dental hygiene programs. The majority of the dental hygiene (n=16) respondents reported teaching 12 types of intraoral injections; the dental school respondent reported teaching seven injection types. Fewer student-to-student injection experiences per injection type were required by the dental school (n=7) than the dental hygiene schools (n=12) and the dental school did not indicate a minimum number of student-to-patient injection requirements for graduation. Analysis of a checklist of required elements of LA instruction and individual syllabi revealed common elements of all courses; students are expected to choose the proper local anesthetic, identify the proper injection type, and manage any LA complications. The majority of the interview participants perceived that dental hygiene students had more educational preparation in LA than their dental student cohorts and that dental hygienists were educationally prepared to administer LA safely without direct supervision.Conclusions: Dental hygiene students in California programs appear to be well prepared through their education experiences to administer and manage complications related to local anesthesia. Consideration should be given to supporting changing the supervision requirements for the administration of local anesthesia by dental hygienists licensed in the state of California.

Improving Evaluation of Dental Hygiene Students' Cultural Competence with a Mixed-Methods Approach.

Most dental hygiene educational programs include cultural competence education, but may not evaluate student outcomes. The aim of this study was to design and implement a mixed-methods evaluation to measure dental hygiene students' progression toward cultural competence. Two cohorts consisting of consecutive classes in one U.S. dental hygiene program participated in the study. A total of 47 dental hygiene students (100% response rate) completed self-assessments to measure their attitudes and knowledge at three time points between 2014 and 2016. Mean scores were calculated for three domains: Physical Environment, Communication, and Values. Qualitative analysis of the students' cultural diversity papers was also conducted to further evaluate students' knowledge and skills. Bennett's five-level conceptual framework was used to code phrases or sentences to place students in the general categories of ethnocentric or ethno-relative. The quantitative and qualitative results yielded different outcomes for Cohort 1, but not for Cohort 2. The Cohort 1 students assessed themselves statistically significantly lower over time in one of the three measured domains. However, the Cohort 2 students assessed themselves as statistically significantly more culturally competent in all three domains. Qualitative results placed 72% of Cohort 1 students and 83% of Cohort 2 students in the more desirable ethno-relative category. Since quantitative methods consisting of student self-assessments may not adequately measure students' cultural competence, adding qualitative methods to measure skills specific to patient care in this study added a robust dimension to evaluating this complex dental hygiene student competence.

Interprofessional Education in Dental Hygiene Programs and CODA Standards: Dental Hygiene Program Directors' Perspectives.

Purpose: The Patient Protection and Affordable Care Act changed the paradigm of health care delivery by addressing interprofessional education (IPE) and care (IPC). These considerations, combined with evolving dental hygiene (DH) workforce models, challenge DH educators and clinicians alike to embrace IPE and IPC. The objectives of this study were to determine DH program directors' perceptions of the importance of IPE, to assess current and planned activities related to Commission on Dental Accreditation (CODA) standards that imply competency in IPE, and assessment of outcomes.Methods: Email addresses of the 322 entry-level, DH program directors in the United States were obtained from the American Dental Hygienists' Association and a web-based survey was developed based on the American Dental Education Association Team Study Group on Interprofessional Education. Descriptive statistics were computed for the responses to the closed ended questions and answers to open-ended questions were transcribed and thematically coded.Results: A response rate of 30% (N = 102) was obtained from the DH program directors. While the respondents indicated that they personally considered IPE to be important, one-third reported that IPE was not a priority for their academic institution. The majority of current IPE activities related to the 2014 CODA Standards 2-17, 2-26 and 2-19 were clinic-based (Standards 2-17 and 2-19: N=49; Standard 2-19: N=64). Fewer classroom-based activities were reported (N=12 vs. N=25). The respondents planned 27 clinic-based, 9 classroom-based and 51 other future IPE-related activities. Competency assessment was mostly determined with clinic-based activities (N=43) and other activities such as rubrics (N=16) and the development of IPE assessment tools (N=10). Thirty-three respondents named positive aspects of IPE and 13 saw IPE as relevant for the dental hygiene profession.Conclusion: Accountable accreditation standards have been identified as the driver of change for incorporating IPE, making an explicit IPE standard for dental hygiene education an important agenda item for the profession.

Knowledge and competence in temporomandibular disorders among Swedish general dental practitioners and dental hygienists.

OBJECTIVE: The aim of this study was to investigate knowledge and competence in temporomandibular disorders (TMD) among dentists and dental hygienists working in the public dental service (PDS) in Sweden. MATERIALS AND METHODS: The study population comprised all general dentists (n = 110) and dental hygienists (n = 80) working in the PDS in two Swedish counties: Kronoberg (K) and Blekinge (B). The participants filled out a questionnaire comprised of 15 questions. RESULTS: The results of these questions are presented. The overall response rate for the general dentists was 87%, while the rate for the dental hygienists was 71%. Statistically significant differences between the general dentists in the two counties were found regarding the following: education in the field of TMD over the last 5 years (K: 37%, B: 73%), evaluation of occlusion when examining patients with suspected TMD ('always': K: 61%, B: 82%), and a desire for consultation of the OFP (orofacial pain)/TMD specialist by telephone (K: 71%, B: 44%). Regarding the dental hygienists, there was a statistically significant difference concerning the use of the treatment modality 'reassurance' (K: 41%, B: 7%). CONCLUSIONS: The majority of the dental care providers in both counties - irrespective of professional category - had a positive attitude towards patients with TMD. Knowledge and competence in the field are sparse and require postgraduate education. There is a great need of an OFP/TMD specialist for more complicated patients and a need to implement updated knowledge and competence in the PDS in these two counties.

Changes in division of labour and tasks within public dentistry: relationship to employees work demands, health and work ability.

OBJECTIVE: By 2023, fewer dentists are expected in Sweden, at the same time as the demand for dental care is expected to increase. Older people, in particular, are expected to require more dental health than previous generations. To meet this demand, the public sector dentistry in Sweden is moving towards changes in division of labour among dental professionals, including dentists, dental hygienists and dental nurses. However, the impact of this reallocation on the physical and psychosocial wellbeing of employees is unknown. The aim of this study was to compare workplaces with an equal or larger proportion of dental hygienists than dentists (HDH) with workplaces with a larger proportion of dentists than dental hygienists (HD) on the physical and psychosocial work load, musculoskeletal and psychosomatic disorders and sickness presence. MATERIAL: A total of 298 persons employed in the Public Dental Service in a Swedish County Council participated in this study. CONCLUSION: The medium large clinics HDH reported 85% of employee's with considerably more high psychosocial demands compared to employees in medium HD (53%) and large HD (57%). Employees in medium large clinics HDH also reported sleep problems due to work (25%) compared with employees in medium large clinics HD (6%), large clinics HD (11%) and small clinics HDH (3%). Clinic size does not seem to influence the outcome of the HD and HD clinics to any great extent. Of all employees, about 94-100% reported high precision demands and 78-91% poor work postures.

The Dental Hygiene Scholarly Identity and Roadblocks to Achieving It.

PURPOSE: Progress in the dental hygiene discipline is predicated on the development of a community of scholars with a dental hygiene scholarly identity who explore questions central to the art and science of dental hygiene and in doing so create conceptual models to expand the discipline's structural hierarchy of knowledge. Graduate dental hygiene education is challenged to develop programs that stimulate and nurture dental hygiene scholars as well as scientists. The need for the development of dental hygiene doctoral education is critical to strengthening our discipline's scholarly identity.The authors explore the tyranny of the "Queen-Bee" and the paralyzing nature of the "Imposter Syndrome," as pathologic non-productive behavior patterns that create roadblocks not only for the individual to move forward, but also for the discipline as a whole. Recognizing and eliminating these maladaptive syndromes will empower the individual as well as strengthen the collective to build a strong dental hygiene scholarly identity. The significance of dynamic "Follower-ship" as an often undervalued concept is offered as an antidote to overcome roadblocks and energize the collective's value of a scholarly identity for dental hygiene.

California Dental Hygiene Educators' Perceptions of an Application of the ADHA Advanced Dental Hygiene Practitioner (ADHP) Model in Medical Settings.

PURPOSE: To assess California dental hygiene educators' perceptions of an application of the American Dental Hygienists' Association's (ADHA) advanced dental hygiene practitioner model (ADHP) in medical settings where the advanced dental hygiene practitioner collaborates in medical settings with other health professionals to meet clients' oral health needs. METHODS: In 2014, 30 directors of California dental hygiene programs were contacted to participate in and distribute an online survey to their faculty. In order to capture non-respondents, 2 follow-up e-mails were sent. Descriptive analysis and cross-tabulations were analyzed using the online survey software program, Qualtrics™. RESULTS: The educator response rate was 18% (70/387). Nearly 90% of respondents supported the proposed application of the ADHA ADHP model and believed it would increase access to care and reduce oral health disparities. They also agreed with most of the proposed services, target populations and workplace settings. Slightly over half believed a master's degree was the appropriate educational level needed. CONCLUSION: Among California dental hygiene educators responding to this survey, there was strong support for the proposed application of the ADHA model in medical settings. More research is needed among a larger sample of dental hygiene educators and clinicians, as well as among other health professionals such as physicians, nurses and dentists.

Relationship of Musculoskeletal Disorder Pain to Patterns of Clinical Care in California Dental Hygienists.

PURPOSE: To relate self-reported levels of musculoskeletal disorder (MSD) pain and patterns of clinical care among members of the California Dental Hygienists' Association (CDHA), using a web-based survey. METHODS: The 24-item survey consisted of questions on patterns of clinical care, health habits, experience with MSD pain and demographic information. Recruitment information, including survey link and consent form, was emailed to the CDHA for distribution to its members. Descriptive analysis and cross tabulations were conducted using the online software program Qualtrics™. A Chi-square test determined statistical significant differences between the responses of the no/mild pain and moderate/severe pain groups. RESULTS: The response rate was 19% (500/2,700). Ninety-six percent of all respondents reported some level of MSD pain, causing nearly 25% of the respondents to miss work. Respondents, who reported moderate/severe pain, treated more patients per day (p=0.007) and on average treated greater numbers of moderate to heavy calculus patients (p=0.017) than those respondents reporting no/mild pain. Forty percent of the respondents in the moderate/severe group treated more than 8 patients per day. A higher percentage of respondents (p=0.000) in the moderate/severe pain group than in the no/mild group reported using proper posture less than 50% of treatment time. Using proper posture more than 50% of treatment time was more frequent in respondents who had practiced more than (p=0.012), compared with less than, 5 years. CONCLUSION: Workload and ergonomics are related to MSD pain. Educational programs need to emphasize the importance of these factors in the development and reduction of MSD pain.

Assuring dental hygiene clinical competence for licensure: a national survey of dental hygiene program directors.

PURPOSE: To conduct a national survey of dental hygiene program directors to gain their opinions of alternative assessments of clinical competency, as qualifications for initial dental hygiene licensure. METHODS: A 22 question survey, comprised of statements eliciting Likert-scale responses, was developed and distributed electronically to 341 U.S. dental hygiene program directors. Responses were tabulated and analyzed using University of California, San Francisco Qualtrics® computer software. Data were summarized as frequencies of responses to each item on the survey. RESULTS: The response rate was 42% (n=143). The majority of respondents (65%) agreed that graduating from a Commission on Dental Accreditation (CODA)-approved dental hygiene program and passing the national board examination was the best measure to assure competence for initial licensure. The addition of "successfully completing all program's competency evaluations" to the above core qualifications yielded a similar percentage of agreement. Most (73%) agreed that "the variability of live patients as test subjects is a barrier to standardizing the state and regional examinations," while only 29% agreed that the "use of live patients as test subjects is essential to assure competence for initial licensure." The statement that the one-time state and regional examinations have "low validity in reflecting the complex responsibilities of the dental hygienist in practice" had a high (77%) level of agreement. CONCLUSION: Most dental hygiene program directors agree that graduating from a CODA-approved dental hygiene program and passing the national board examination would ensure that a graduate has achieved clinical competence and readiness to provide comprehensive patient-centered care as a licensed dental hygienist.

The efficacy of screening for common dental diseases by hygiene-therapists: a diagnostic test accuracy study.

Regularly attending adult patients are increasingly asymptomatic and not in need of treatment when attending for their routine dental examinations. As oral health improves further, using the general dental practitioner to undertake the "checkup" on regular "low-risk" patients represents a substantial and potentially unnecessary cost for state-funded systems. Given recent regulatory changes in the United Kingdom, it is now theoretically possible to delegate a range of tasks to hygiene-therapists. This has the potential to release the general dental practitioner's time and increase the capacity to care. The aim of this study is to compare the diagnostic test accuracy of hygiene-therapists when screening for dental caries and periodontal disease in regularly attending asymptomatic adults who attend for their checkup. A visual screen by hygiene-therapists acted as the index test, and the general dental practitioner acted as the reference standard. Consenting asymptomatic adult patients, who were regularly attending patients at 10 practices across the Northwest of England, entered the study. Both sets of clinicians made an assessment of dental caries and periodontal disease. The primary outcomes measured were the sensitivity and specificity values for dental caries and periodontal disease. In total, 1899 patients were screened. The summary point for sensitivity of dental care professionals when screening for caries and periodontal disease was 0.81 (95% CI, 0.74 to 0.87) and 0.89 (0.86 to 0.92), respectively. The summary point for specificity of dental care professionals when screening for caries and periodontal disease was 0.87 (0.78 to 0.92) and 0.75 (0.66 to 0.82), respectively. The results suggest that hygiene-therapists could be used to screen for dental caries and periodontal disease. This has important ramifications for service design in public-funded health systems.

Content validity of the National Board Dental Hygiene Examination.

This article describes a protocol that was employed to validate the content of the National Board Dental Hygiene Examination (NBDHE) using two separate practice analyses. The protocol consisted of the following phases: (1) the careful definition of the domain of knowledge and skills required for successful entry-level dental hygiene practice, (2) the conduct of a survey to gather information regarding the judgments of practicing dental hygienists on the important knowledge, abilities, and skills required of entry-level dental hygiene practice, (3) the analysis of the survey data, (4) the integration of the survey findings with the examination content using a two-dimensional matrix, (5) development of the updated specifications of the examination based on the practice analysis data, and (6) implementation of the updated specifications for subsequent item and test development. Survey data from 1,284 and 1,388 full-time practicing dental hygienists for the 2002 and 2009 practice analyses, respectively, were analyzed. A two-dimensional matrix was used to map the content of the examination to the practice of dental hygiene based on the practice analysis data. The mapping showed that the distribution of items in the content specifications reflected actual dental hygiene practice. Thus, the adequacy of the content validity of the NBDHE was confirmed.

Developing a scholarly identity and building a community of scholars.

Progress in the dental hygiene discipline is predicated on the development of a community of scholars who explore questions related to the art and science of dental hygiene and clients in need of oral health care. Graduate dental hygiene education is challenged to develop programs that stimulate and nurture dental hygiene scholars as well as scientists. The need for the development of doctoral dental hygiene education is discussed.

Keeping current: a commitment to patient care excellence through evidence based practice.

The desire to improve the oral health of clients begins with the hygienist's commitment to keeping current with useful scientific knowledge. The challenge is mastering the skills to discriminate between the many claims and what actually has been shown to be effective. One approach is through evidence-based decision-making (EBDM), which helps practitioners find relevant clinical evidence when it is needed for treatment decisions and for answering client questions. The purpose of this article is to discuss EBDM and its use in practice, potential challenges, future developments and resources that will assist in keeping current.

A qualitative study of tobacco dependence treatment in 19 US dental hygiene programs.

INTRODUCTION: The US Public Health Service calls for health professionals to provide tobacco dependence counseling for patients. The purpose of this study was to understand how dental hygiene programs make decisions about and provide training for tobacco dependence counseling to help them graduate more fully competent hygienists. METHODS: We conducted interviews (N = 32) with mainly program and clinic directors from 19 US dental hygiene education programs for this qualitative case study. We explored fluoride therapy training and tooth whitening training for comparison. Two analysts summarized the transcripts into a case study for each program. RESULTS: All programs reported a similar process of learning about and choosing a method for teaching the topics explored. The programs used a common process, ADPIE (assess, diagnose, plan, implement, evaluate), to structure students'clinical encounters. Almost all programs train students to ask about tobacco use and to advise quitting, but few programs train students to effectively help patients to quit and only 2 programs evaluated the competence of all students to provide such training. ADPIE shows promise for integrating tobacco dependence treatment more fully into the clinical training of dental hygiene students. Comparison to tooth whitening and fluoride therapy training indicated that complexity of the treatment and alignment with dental hygiene's mission were themes related to training decisions. CONCLUSION: Full implementation of tobacco dependence counseling into dental hygiene education requires a commitment by dental hygiene educators to train students and faculty in counseling techniques and their evaluation. We identified an existing clinical structure as showing promise for facilitating improvement.

Advancing our profession: are higher educational standards the answer?

PURPOSE: Educational models in health care professions have changed drastically since on-the-job training models. The purpose of this manuscript was to investigate how the professions of physical therapy, occupational therapy, physician assistant, nursing and respiratory therapy have advanced their educational models for entry into practice and to recommend how dental hygiene can integrate similar models to advance the profession. The recommendations are to create an accreditation council for dental hygiene education and to mandate articulation agreements for baccalaureate degree completion in developing and existing programs. Dental hygiene must continue on the path to advance our profession and glean lessons from other health professions.