Imbalances in the oral health workforce: a Canadian population-based study.

BACKGROUND: In Canada, a new federal public dental insurance plan, being phased in over 2022-2025, may help enhance financial access to dental services. However, as in many other countries, evidence is limited on the supply and distribution of human resources for oral health (HROH) to meet increasing population needs. This national observational study aimed to quantify occupational, geographical, institutional, and gender imbalances in the Canadian dental workforce to help inform benchmarking of HROH capacity for improving service coverage. METHODS: Sourcing microdata from the 2021 Canadian population census, we described workforce imbalances for three groups of postsecondary-qualified dental professionals: dentists, dental hygienists and therapists, and dental assistants. To assess geographic maldistribution relative to population, we linked the person-level census data to the geocoded Index of Remoteness for all inhabited communities. To assess gender-based inequities in the dental labour market, we performed Blinder-Oaxaca decompositions for examining differences in professional earnings of women and men. RESULTS: The census data tallied 3.4 active dentists aged 25-54 per 10,000 population, supported by an allied workforce of 1.7 dental hygienists/therapists and 1.6 dental assistants for every dentist. All three professional groups were overrepresented in heavily urbanized communities compared with more rural and remote areas. Almost all dental service providers worked in ambulatory care settings, except for male dental assistants. The dentistry workforce was found to have achieved gender parity numerically, but women dentists still earned 21% less on average than men, adjusting for other characteristics. Despite women representing 97% of dental hygienists/therapists, they earned 26% less on average than men, a significant difference that was largely unexplained in the decomposition analysis. CONCLUSIONS: Accelerating universal coverage of oral healthcare services is increasingly advocated as an integral, but often neglected, component toward achieving the health-related Sustainable Development Goals. In the Canadian context of universal coverage for medical (but not dentistry) services, the oral health workforce was found to be demarcated by considerable geographic and gendered imbalances. More cross-nationally comparable research is needed to inform innovative approaches for equity-oriented HROH planning and financing, often critically overlooked in public policy for health systems strengthening.

Dental and dental hygienist trainee satisfaction with their veterans affairs clinical training experiences during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic rapidly altered dental practice, training, and education. This study investigates the pandemic's impacts on the clinical training experiences of dental and dental hygienist trainees at the US Department of Veterans Affairs (VA). METHODS: Using data from post-doctoral general practice dentists, dental specialists, and dental hygienist trainees who completed the VA Trainee Satisfaction Survey before and during COVID-19, we performed logistic regression and thematic content analyses to determine whether COVID-19 was associated with training satisfaction and likelihood of considering future VA employment. RESULTS: While post-doctoral dentist and dental specialty trainees did not report significant differences, dental hygienist trainees reported increased overall satisfaction and an increased likelihood to consider future VA employment during the pandemic compared to before the pandemic. Similar reasons for dissatisfaction were identified for both the pre-pandemic and pandemic groups. CONCLUSIONS: Research outside VA indicates the pandemic's association with trainees' intentions to leave health profession education programs. Our results suggest the likely existence of factors that could lead to positive changes for at least some portion of the dental workforce. Future studies should explore those potential factors as some may be replicable in other settings or may apply to other health professions.

Dental care professionals' awareness of oral dryness and its clinical management: a questionnaire-based study.

BACKGROUND: Despite the high prevalence of oral dryness and awareness of its complications, there is limited research on the clinical management of patients with oral dryness in general dental care. PURPOSE: To (1) describe and compare awareness among dental care professionals regarding saliva functions, potential causes and complications of oral dryness, and patient management (2) Investigate if the length of professional experience influences these aspects. METHODS: A digital self-administrated survey was sent to 2668 dental care professionals working in the general dental care, Public Dental Service, in Sweden. Twelve dental care professionals reviewed the questionnaire prior to its distribution. The questionnaire comprised 32 questions about patient management, awareness of saliva functions, causes and complications of oral dryness, and self-assessment queries. RESULTS: The response rate was 18.6% (241 dentists and 257 dental hygienists). Older adults (65+) were asked more often about dry mouth (93.0%) compared to those aged 18-23 years (50.0%) and those under 18 years (24.9%). Dental hygienists encountered individuals with oral dryness more frequently (61.1%) than dentists (48.5%) (p < 0.01), and more often asked individuals in the age groups 18-23 years (p = 0.003), 24-40 years (p = 0.045), and 41-65 years (p = 0.031) about dry mouth. A higher proportion of dental hygienists (88.3%) than dentists (51.0%) had measured salivary secretion rate, (p < 0.001) and more often suggested preventive dental care 3-4 times a year, (42.5% vs. 30.5%) (p < 0.007). Dentists had a higher awareness of saliva functions, while dental hygienists had a higher awareness about causes and complications of oral dryness. Higher proportions of dentists and dental hygienists with over 10 years of professional experience had measured salivary secretion rate (69.1% vs. 95.7%) compared to their counterparts with less than 10 years of professional experience (35.9% vs. 79.5%) (p < 0.001 for both). CONCLUSION: Compared to dentists, dental hygienists were more attentive to patients with oral dryness as they encountered these individuals more often, asked more age-groups, suggested frequent preventive measures, and had higher awareness of the causes and complications of oral dryness. Length of professional experience could improve both the management of patients with oral dryness and awareness of its causes, particularly for dental hygienists.

O-HEALTH-EDU: A viewpoint into the current state of Oral Health Professional education in Europe: Part 1: Programme-level data.

INTRODUCTION: Current legislation leaves Oral Health Professional (OHP) education open to wide interpretation and may result in significant variation in educational practice and resultant professional attributes across Europe. Data regarding the current state of OHP education across Europe is limited. The aim of Part 1 of this series is to provide programme-level data for Primary Dental Degree Programmes, Dental Hygiene and Postgraduate Education. METHODS: A 91-item questionnaire was developed following the Delphi method. The questionnaire and the Articulate glossary of OHP education terms were developed concurrently to facilitate a common understanding of language. Piloting was performed in multiple stages and included institutions internal and external to the research group. The questionnaire was uploaded online and converted to a data hub, allowing dental schools to control their own data and update the data provided whenever they wish. All ADEE member schools (n = 144) were invited to provide data. Forty questions relating to school details, Primary Dental Degree Programmes, Dental Hygiene and Postgraduate Education were included in this part of the series. RESULTS: Seventy-one institutions from 25 European countries provided data between June 2021 and April 2023, which represents a response rate of 49.3% of ADEE members. Programme-level data for Primary Dental Degree Programmes, Dental Hygiene and Postgraduate Education is presented including programme length, funding, languages and fees, student numbers and demographics, student admission and selection processes and permission to practice after graduation. CONCLUSION: This series of papers, as far as the authors are aware, are the first attempts to build a comprehensive picture of the current state of OHP education in Europe. A comprehensive view of the state of OHP education in Europe is not yet available but the O-Health-Edu data hub provides a means for all education providers in Europe to contribute data to reach this goal. It is anticipated that the data hub will be updated and built upon over time to continually establish a clearer picture of the state of OHP education in Europe.

O-Health-Edu: A viewpoint into the current state of oral health professional education in Europe: Part 2: Curriculum structure, facilities, staffing and quality assurance.

INTRODUCTION: Oral health professional (OHP) education is likely to vary across Europe in accordance with an EU directive that is open to broad interpretation. It is not clear how OHP curricula are structured or delivered across Europe. The objectives of Part 2 of this paper series are: (i) to provide an overview of common practices in curriculum structure, the availability of facilities, staffing (faculty) and quality assurance processes and (ii) to consider how the existing programme structures align to stakeholder guidance documents. METHODS: A total of 27 questions from a 91-item questionnaire were used for this manuscript. The questionnaire was developed following the Delphi method to establish consensus from a group of experts. Members of the research team and colleagues from other countries in Europe completed a multi-step piloting process. An online data hub was created to allow the respondents to be data controllers and respond to the questionnaire. ADEE member schools (n = 144) were invited to provide data. RESULTS: Totally, 71 institutions from 25 European countries provided data between June 2021 and April 2023, which represents a response rate of 49.3% of ADEE members. Data on curriculum approaches, teaching methods, integration of topics of interest, clinical education, staff-student ratios, access to facilities and new technologies, teaching staff (faculty) and quality assurance processes are presented for Primary Dental Degree Programmes. CONCLUSION: To the best of our knowledge, this series of papers are the first attempts to provide a comprehensive overview of OHP education in Europe. Results showed that the majority of European dental programmes are engaged in providing innovative and scientifically grounded education in order to develop quality future OHPs. Nevertheless, significant variability in the delivery of clinical education across the European OHP schools was notable in this dataset. A comprehensive view of the state of OHP education in Europe is not yet available but the O-Health-Edu data hub provides a means for all education providers in Europe to contribute data to reach this goal. It is anticipated that the data hub will be updated and built upon over time to continually establish a clearer picture of the state of OHP education in Europe.

Environmental Sustainability in Oral Health Professional Education: Approaches, Challenges, and Drivers-ADEE Special-Interest Group Report.

INTRODUCTION: This paper reports on the scholarship activity of the 'Sustainability in Dentistry' Special-interest Group (SiG), which met at the Association for Dental Education in Europe (ADEE) annual conference in Liverpool on 25 August 2023. The aim of this study was to (i) identify current teaching practices and approaches to embedding Environmental Sustainability (ES) in the curriculum in ADEE attendee schools and (ii) explore existing barriers/challenges to incorporating ES in dental education and consider potential solutions. METHODOLOGY: A mixed-methods approach was used to fulfil the aims of this study. A pre-workshop questionnaire was used to explore current teaching practices, challenges and drivers of embedding ES in the curriculum. An interactive workshop at the in-person meeting in Liverpool was used to propose key strategies to overcome the most frequent challenges to embedding ES in the curriculum. RESULTS: The majority of respondents (56%) reported that their institutions do not currently teach ES. Traditional didactic forms of teaching were mostly reported to teach ES in non-clinical environments, and a transition to more environmentally sustainable materials and instruments was the most popular response for clinical teaching. Key barriers to embedding ES in the curriculum were identified, including time constraints and the overloaded curriculum, a lack of expertise/knowledge to teach and lack of practical guidance to support educators, limited learning resources for staff and students and resistance from colleagues regarding the relevance of ES in dentistry. The special-interest group participants proposed strategies to overcome these challenges that centred around 14 themes. CONCLUSION: This paper reports recent scholarship activity by ADEE's 'Sustainability in Dentistry' SiG. Key strategies for overcoming the most common challenges to embedding ES in the curriculum are also discussed.

Common practices of dental implant maintenance among dental hygienists working in the Netherlands - A survey.

BACKGROUND: Dental implant maintenance is crucial to obtain and maintain a healthy peri-implant situation. Although it is part of a dental hygienists (DH) scope of practice, the knowledge and common practices among DHs in the Netherlands are unclear. MATERIALS AND METHODS: A web-based survey was distributed by the Dutch Association of DHs, by spreading survey QR codes and snowballing. The role of the different DH curricula 2- or 3-year diploma and a 4-year bachelor's degree is evaluated. RESULTS: In total, 165 (diploma: 73, bachelor: 92) DHs responded. Peri-implant diseases were well known (98%), indices and clinical symptoms were used to assess peri-implant tissues. A periodontal probe (97%) was used and bone loss was evaluated on radiographs (89%). Treatment was performed supra- and subgingivally (69%), mostly by titanium (45%) or plastic hand instruments (42%). Ultrasonic (52%) and air-abrasive (52%) devices were often used. The recall interval for maintenance was based on a risk-adjusted protocol (70%). DHs with a bachelor's received significantly more training compared to DHs with a diploma during primary education (p < 0.001). Diploma DHs mainly obtained their knowledge from continuing education (p = 0.04). In general, there was no significant difference in knowledge or common practices. CONCLUSIONS: The primary education of DHs with a 2- or 3-year diploma and a 4-year bachelor's varies. Due to the continuing education of diploma DHs, knowledge and common practices generally do not differ. Most DHs in the Netherlands perform implant maintenance. A periodontal probe and radiographs are used for examination. Instrumentation is performed supra- and subgingivally, usually with titanium or plastic hand instruments. The recall interval is based on a patient's risk assessment.

The role of self-compassion in mediating the effect of perfectionism on personal growth initiative in dental hygienists.

OBJECTIVE: This study explored perfectionism, self-compassion and personal growth initiative in clinical dental hygienists. METHODS: Cross-sectional survey research was conducted with a non-probability sample of clinical dental hygienists (n = 877). The survey had 55 items and consisted of three validated instruments: Frost's Multidimensional Perfectionism Scale-Brief (including evaluative concerns and perfectionistic striving subscales), Neff's Self-Compassion Scale and Robitschek's Personal Growth Initiative Scale. Descriptive, correlation, t-test, ANOVA and logistic regression analyses were used to evaluate the relationships among variables. Mediation analysis was conducted to determine the presence of a mediated moderation effect of self-compassion on perfectionism and personal growth initiative. RESULTS: The completion rate for the survey was 89% (n = 788). Evaluative concerns (M = 11.83) and perfectionistic strivings (M = 15.44) among dental hygienists were high, levels of self-compassion (SC) were moderate (M = 2.87) and levels of personal growth initiative (PGI) were low (M = 38.07) compared to others not in the dental field. The mediation analysis found that SC mediates the relationship between perfectionistic evaluative concerns and PGI. It was also determined that SC mediates the relationship between perfectionistic strivings and PGI. CONCLUSION: Dental hygienists have high levels of perfectionism and may lack necessary levels of self-compassion to counteract those perfectionistic tendencies resulting in a decrease in taking the initiative to engage in opportunities for growth. This suggests the importance of dental hygienists developing a more adaptive perfectionism to balance self-criticism along with not having unrealistic expectations for perfection while engaging in self-compassion that includes self-kindness and mindfulness to support their continued growth.

Professional use of social media platforms by independent dental hygienists in the Netherlands: A quantitative study.

AIM: This study examines the prevalence of the professional use of social media platforms by independent DHs in the Netherlands and assesses the associated personal and demographic factors. METHODS: In this exploratory, observational, cross-sectional study, independent DHs who were members of the Dutch Dental Hygienist Association (Nederlandse Vereniging voor Mondhygiënisten: NVM) were included. Data were collected from the DH practices' websites. Statistics included frequency distributions, percentages, chi-square tests for the relationship between the parameters, and multiple logistic regression for the associations between social media use and the personal and demographic factors. RESULTS: A total of 830 independent DHs from 670 different practices were included in the study. Of these DHs, 34.4% had a link to a social media platform on their website. DHs with practices in the west or south of the Netherlands were more likely to use Facebook (p = 0.035 and p = 0.002, respectively) than those in the east or north. The likelihood of DHs with 4 years of training using Facebook was 1.910 greater than those with 2 years of training (p = 0.002). Furthermore, DHs who graduated in Utrecht were more likely to use Instagram (p < 0.001). CONCLUSION: Over a third of the independent DHs in the Netherlands used social media for professional purposes. DHs who trained in Utrecht for 4 years and who had a practice in the west or south of the Netherlands were more likely to use social media for professional purposes.

Survey on Patient Perception of At-Home Bacterial Biofilm Control in Relation to Peri-Implant Soft Tissue Health.

OBJECTIVE: Bacterial biofilm control around dental implants is critical for the health of the peri-implant soft tissue and longevity of dental implants. The patient's role in regular biofilm removal around dental implants is just as important as that of the dental hygienist. The purpose of this study is to identify the relationship between at-home dental implant care and patients' perceptions of peri-implant soft tissue health. METHODS: A 15-item paper survey was distributed to adult patients undergoing professional dental hygiene maintenance at a specialty dental practice within a 3-month period and had at least one dental implant. Survey items included participant demographics, patient-reported adjunctive aids for dental implants and patient perceptions of dental implant oral hygiene practices and peri-implant soft tissue health. RESULTS: There was a statistical difference between time spent cleaning dental implants and peri-implant soft tissue health. An association was found between patients who reported spending more time cleaning their dental implants and less bleeding (p = 0.046/54%), gingival inflammation (p = 0.026/58%) and gingival tissue redness (p = 0.036/53%). Additionally, patients who more frequently underwent professional dental hygiene maintenance perceived less gingival inflammation (p = 0.001/66%). CONCLUSION: To promote peri-implant soft tissue health and reduce oral biological complications, best practice guidelines should be implemented, including optimal at-home dental implant care and regular professional dental hygiene maintenance.

Implicit racial bias among dental hygienists practicing in the United States.

PURPOSE: Provider bias has been shown to be a contributing factor to racial and ethnic disparities observed in health care settings. The purpose of this study was to examine implicit racial bias among dental hygienists. METHODS: A convenience sample of licensed and practicing dental hygienists within the United States was recruited through email and national dental hygiene social media groups via snowball sampling. A two-part survey design was used for data collection. Participants completed a 10-item demographic survey through an online platform and were then routed to the Race Implicit Association Test (IAT). Descriptive statistics and linear regression analyses were used to compare demographic data and implicit racial preference scores (d-scores). RESULTS: Data from 404 licensed dental hygienists were included in this study. Over two-thirds (67.8%) of participants showed a preference for European Americans over African Americans. A significant difference was found between implicit racial preference scores and participant age (Estimate: 0.01, 95% CI: 0.00, 0.01), years worked comparing <5 years to 21 or more years (Estimate: 0.19, 95% CI: -0.30, -0.09) and race comparing non-White to White (Estimate: -0.17, 95% CI: -0.27, -0.07). No difference was found with task order, previous Race IAT experience, or previous self-reported implicit bias training. CONCLUSIONS: Findings suggest that dental hygienists may harbor implicit racial preferences for European Americans over African Americans. Non-White participants had more positive implicit preferences toward African Americans compared to White participants. Further research is needed to determine the extent to which implicit racial biases contribute to disparities in oral health.

Knowledge of the monkeypox 2022 outbreak among dental hygienists and students in Saudi Arabia: A cross-sectional study.

OBJECTIVE: This study aimed to assess the knowledge of monkeypox infection among dental hygiene professionals and students in Saudi Arabia. METHODS: A cross-sectional study was conducted among a convenience sample of dental hygiene professionals (n = 259). The questionnaire was developed based on previous literature, and descriptive analysis and a Chi-square test were performed. RESULTS: A total of 159 dental hygienists responded to the questionnaire. Results indicated that only 1.7% had good knowledge, 7.7% had moderate knowledge and 90.6% had low knowledge of the monkeypox outbreak. The mean knowledge scores varied among dental hygiene students, practitioners and faculty members. Significant group differences were observed for some questions (p < 0.05). CONCLUSION: Our study concludes that dental hygienists had moderate to low level of knowledge of the monkeypox infection and its implications for oral health and patient care, indicating a need for more education on the subject.

Knowledge, attitude, and practice in oral cancer: A national survey on 150 dental hygienists.

OBJECTIVE: The aim of this study is to explore knowledge, practice, and attitude on oral cancer (OC) among a cohort of Italian dental hygienists, in consideration of their role in the field of early diagnosis. MATERIALS AND METHODS: A cross-sectional study of 150 Italian dental hygienists was performed to assess the participant's knowledge, practice, and attitude on OC. Data were collected using a structured self-administered questionnaire (through Google Forms). The questionnaire included four sections: sociodemographic information, disease knowledge, answers related to attitudes toward OC, and a questionnaire assessing the practice of dental hygienists on oral screening. RESULTS: Responses were received from 137 participants (83 women and 54 men). Overall, there is a good knowledge of the real risk factors among the participants (98.5%, 98.5%, and 94.2% regard smoking, alcohol, and HPV, respectively). The analysis related to the knowledge of non-risk factors, oral potentially malignant disorders, and clinical features of OC showed more heterogeneous results. Only 60% considered university education to be adequate. The totality of dental hygienists considered continuing education necessary, but despite this, only half took updating courses. Finally, 90% performed intraoral screening visits, and 95% and 69% investigated smoking and alcohol consumption, respectively. CONCLUSIONS: Our data showed the need to implement OC training courses by re-evaluating pre- and post-graduate training programs.

Factors affecting the infection control behaviours of Korean dental hygienists in response to the coronavirus disease 2019 pandemic.

OBJECTIVES: This study aimed to identify the factors affecting the prevention of cross-infection with coronavirus disease-19 (COVID-19) among Korean dental hygienists. METHODS: The level of knowledge about COVID-19 (KNWCO ), level of awareness of infection control (AWRIC ), degree of performance for infection control (PRFIC ), and organizational factors for infection control (OFWIC ) of clinical dental hygienists in Korea to prevent COVID-19 transmission were investigated. A self-written online questionnaire was administered to dental hygienists currently working in dental clinics or hospitals, and the survey results of 263 participants were analysed. Pearson's correlation coefficients were calculated for relationships between the KNWCO , AWRIC , PRFIC , and OFWIC . Multiple linear regression analysis was performed to identify the factors affecting the PRFIC . Statistical significance was set at p < 0.05. RESULTS: Knowledge about COVID-19, AWRIC , PRFIC , and OFWIC were significantly correlated with each other. OFWIC (ß = 0.491, p < 0.001), followed by AWRIC (ß = 0.428, p < 0.001) and KNWCO (ß = 0.095, p = 0.013), had the greatest impact on PRFIC with regard to the prevention of COVID-19 transmission. CONCLUSIONS: Organizational factors for infection control and AWRIC should be strengthened to improve PRFIC and prevent COVID-19 transmission during dental care.

Training dental hygiene students to care for patients with disabilities.

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

Response to the coronavirus disease 2019 pandemic of dental hygienists in South Korea-Part II: Fear and anxiety.

OBJECTIVES: The purpose of this cross-sectional study was to evaluate the mental fear and anxiety about coronavirus disease 2019 (COVID-19) among Korean clinical dental hygienists and to investigate factors influencing the anxiety felt after the outbreak of COVID-19. METHODS: A questionnaire on mental fear (Fear-C) and anxiety for COVID-19 was conducted among 500 clinical dental hygienists in South Korea. Fear-C was identified with eight questions. The General Anxiety Disorder-7 (GAD-7) questionnaire was scored for the pre-COVID-19 situation (GADBefore ) and the current situation going through the pandemic (GADAfter ). The scores for the responses to the questionnaire were 0 points for strong negative and 3 points for strong positive. Higher scores indicate higher levels of fear and anxiety. All data were analysed using IBM SPSS Statistics, and the statistical significance was set at α = 0.05. RESULTS: The average Fear-C was 16.11 ± 3.89 out of 24.00. There were significant differences in Fear-C when the type of work organization and symptoms related to COVID-19 (Sx-C) differed. Significant differences were confirmed in GADBefore according to age range, systemic diseases, and Sx-C (p < 0.05). There was no difference in GADAfter for all general characteristics, except Sx-C (p > 0.05). In the regression model of GADAfter , Sx-C (ß = 0.526), Fear-C (ß = 0.358), and GADBefore (ß = 0.515) were positively related to GADAfter (p < 0.001), respectively. CONCLUSIONS: Most dental hygienists complained of Fear-C. GADAfter was significantly higher than GADBefore . The factor that had the greatest impact on GADAfter was Sx-C.

The preventive care of medication-related osteonecrosis of the jaw (MRONJ): a position paper by Italian experts for dental hygienists.

PURPOSE: The prevention and early diagnosis of medication-related osteonecrosis of the jaw (MRONJ) is fundamental to reducing the incidence and progression of MRONJ. Many in the field believe that dental hygienists should play an integral role in primary and secondary MRONJ prevention. However, to date, very few publications in the literature have proposed standardised MRONJ protocols, which are dedicated to dental hygienists. The aim of this study was to provide guidance to the health care providers managing MRONJ. METHODS: The expert opinion in this study was developed by dental hygienists from the main Italian technical-scientific associations (Italian Dental Hygienists Association, AIDI and National Union of Dental Hygienists, UNID) and authors of the latest Italian recommendations regarding MRONJ from the field of dentistry and maxillofacial surgery. RESULTS: The oral care protocol outlined in this position paper is focused on the role of dental hygienist in patients at risk or affected by MRONJ, and it regards 3 main issues: primary prevention, secondary prevention and supporting the treatment of MRONJ. Each issue contains easy-to-apply indications and procedures, as described by the authors, regarding the role of the dental hygienist. CONCLUSION: Referring to the main issues under consideration (primary prevention, secondary prevention and the treatment of MRONJ), a clinical examination of periodontal tissue is critical in preventing MRONJ. It is the opinion of the authors of this study that the application of a periodontal screening score is fundamental in defining personalised strategies for patients at risk of MRONJ. By means of these basic procedures, a protocol for assisting the health care provider and the presentation of a practical approach for patients at risk or affected by MRONJ are described in this study.

Canadian dental hygienists' experiences and perceptions of regulatory guidelines during the COVID-19 pandemic: a qualitative descriptive analysis.

BACKGROUND: In Spring of 2020, due to the COVID-19 pandemic, Canadian provincial dental hygiene regulatory bodies implemented new practice guidelines. Reports of stress, anxiety and conflict experienced by dental hygienists have been linked to miscommunication between oral health regulators at this time. Limited data exists on the perceptions and experiences of dental hygienists navigating new guidelines for dental hygiene care during the pandemic. Therefore, the objective of our study was to explore via descriptive thematic analysis how dental hygienists experienced and perceived: i) dental hygiene practice during the COVID-19 pandemic, and ii) their regulatory body's COVID-19 guidelines. METHODS: Participants were identified through provincial dental hygiene licensing bodies. Online bi-monthly questionnaires were administered to participants (n = 876) from December 2021 to January 2022. Two open-ended questions were asked in the questionnaire. A qualitative descriptive thematic analysis was applied to these two questions. RESULTS: Major themes at baseline relayed challenges related to workplace compliance, patient treatment and communication of practice protocols. Across responses, hygienists confirmed conflicting messaging from regulators and guideline interpretations as stressors impacting their professional practice and satisfaction within the profession. Participant responses at endpoint cited increased satisfaction with regulatory guidelines as the pandemic evolved, yet inconsistencies in regulators' messaging was noted as a prevailing issue. CONCLUSION: Inconsistent guideline messaging reflects an increased need for collaboration amongst oral health care regulators to streamline protocols for practice and reduce interprofessional conflict in pandemic circumstances. A national unified approach is warranted in establishing guidelines for dental hygiene practice in Canada.

Collaboration between general dental practitioners and dental hygienists: a qualitative study.

BACKGROUND: Influenced by governmental measures, collaboration in oral health care practices in the Netherlands has increased in recent decades. Previous studies on this subject have mainly concerned the composition of the staff or have been normative rather than descriptive. Based on the existing literature, four aspects were expected to be of significant influence on the collaboration on oral health care practices: goals, leadership, the allocation of tasks and responsibilities and formalization. METHODS: The aim of this study was to describe a classification of collaboration between general dental practitioners and dental hygienists within oral health care practices in the Netherlands. Eighteen semi-structured face-to-face interviews were conducted in nine oral health care practices, which differed with regard to both practice characteristics and characteristics of the principal general dental practitioner. In all practices, the principal general dental practitioner and one dental hygienist were consulted. The interviews were conducted in the practices of the respondents and were held between October 2019 and July 2020. The interviews were analyzed through theoretical thematic analysis using Microsoft Word 2010 and Atlas.ti 8. Three researchers coded and analyzed three practices, and discussed their results. Based on their mutual conclusions, one researcher analysed all practices. The final results were reviewed and approved by the other two researchers. RESULTS: Different factors influencing the collaboration between general dental practitioners and dental hygienist in the Netherlands were found. The most important factors seemed to be leadership style and goals for collaboration. Leadership style varied from very directive to very supportive and seemed to be connected to the allocation of responsibilities. Goals for collaboration varied from predominantly patient-related to mostly practice-related. Formalization appeared to be more present in larger practices and practices that are affiliated to a dental chain. CONCLUSIONS: Based on leadership style and goals for collaboration, a classification was identified. This classification is recommended as a starting point for further research on directive and supportive leadership in oral health care practices.

Pneumonia incidence and oral health management by dental hygienists in long-term care facilities: A 1-year prospective multicentre cohort study.

OBJECTIVE: To investigate the association between oral health management (OHM) by dental hygienists and the occurrence of pneumonia, and determine the effectiveness of OHM in pneumonia prevention. BACKGROUND: In long-term care facilities in Japan, the need for professional OHM is increasing with an increase in the number of severely debilitated residents. MATERIALS AND METHODS: A 1-year prospective multicentre cohort study was conducted using data from 504 residents (63 men; mean age: 87.4 ± 7.8 years) in Japanese long-term care facilities. Basic information, medical history, willingness to engage in oral hygiene behaviour, need for OHM and oral conditions were investigated at baseline. In addition, information on the occurrence of pneumonia was collected using a follow-up survey after one year. A Poisson regression analysis with robust standard errors was conducted, with pneumonia as the dependent variable, and factors associated with OHM and pneumonia occurrence as explanatory variables. RESULTS: Overall, 349 (69.2%) residents required OHM by dental hygienists during that year of follow-up. Of those, 238 (68.2%) were provided with OHM, and 18 (7.5%) developed pneumonia. Among the 111 patients (31.8%) who were not provided with OHM, 21 (18.9%) developed pneumonia. The OHM group had lower pneumonia rates than the non-OHM group (prevalence rate ratio: 0.374; 95% CI: 0.210-0.665). CONCLUSION: Oral health management by dental hygienists was associated with a lower incidence of pneumonia among residents of long-term care facilities, underlining the importance of professional OHM for such individuals. It is recommended that OHM be practised routinely in long-term care facilities.