Dental hygiene and direct access to care: Past and present.

The American Dental Hygienists' Association (ADHA) defines direct access as the ability of a dental hygienist to initiate treatment based on their assessment of patient's needs without the specific authorization of a dentist, treat the patient without the physical presence of a dentist and maintain a provider-patient relationship. In 2000, there were nine direct access states; currently, there are 42 states that have authorized some form of direct access. The ADHA has been instrumental in these legislative initiatives through strong advocacy efforts. While research and data support the benefits of direct preventive/therapeutic care provided by dental hygienists, many barriers remain. This paper chronicles key partnerships that have influenced and advocated for direct access and the recognition of dental hygienists as primary healthcare providers. The National Governors Association released a report in 2014 suggesting that dental hygienists be 'deployed' outside of dental offices as one strategy to increase access to oral health care along with reducing restrictive dental practice acts and increasing the scope of practice for dental hygienists. The December 2021 release of the National Institutes of Health report, Oral Health in America, further supports greater access to dental hygiene preventive/therapeutic care. This paper also reflects on opportunities and barriers as they relate to workforce policy, provides examples of effective state policies and illustrates an educational curriculum specifically created to prepare dental hygienists to provide oral health services in settings outside of the dental office. Dental hygiene education must ensure that graduates are future-ready as essential healthcare providers, prepared to deliver direct access to dental hygiene care.

Reliability of a grading rubric designed to evaluate the reflective ability of predoctoral dental students.

INTRODUCTION: Reflection and self-assessment are critical skills for healthcare providers. Identification of gaps in knowledge, skills and attitudes, along with the ability to critically think and problem solve to fill gaps, is the ultimate outcome for lifelong learning. The aims of this study were to (a) refine an instrument used for measuring reflective ability, and conduct comprehensive reliability testing, and (b) describe a process for rater calibration. MATERIALS AND METHODS: Students develop e-portfolios over a four-year span with assignments that require reflection and self-assessment. The final piece of the portfolio includes a global reflection written the last semester of the programme. Three faculty raters independently evaluated 106 dental students' global reflections using the revised grading rubric. An intraclass correlation coefficient measured the level of agreement between the three raters. RESULTS: Analysis of the 318 faculty ratings (106/rater) resulted in an intraclass correlation of .708. Based on a 5-point grading scale (0 = does not respond to the assignment to 5 = reconstructing), the ratings of the 106 global reflections ranged from 1.3 to 5.0 (M = 3.1, SD =0.66). DISCUSSION: This study provides confidence in the reliability of a grading rubric designed to assess reflective ability, along with suggestions for calibration. An overall mean of 3.1 (Level 3 = relating-includes evidence of lessons learned) illustrates the complexity of teaching reflection and self-assessment. CONCLUSION: Use of a reliable grading rubric for assessing reflective writing could assist schools interested in incorporating reflection and self-assessment into the curriculum, ultimately supporting lifelong and enhanced health care.

ASSESSMENT OF DENTAL STUDENT COMPETENCY IN THE NEW MILLENNIUM. WHAT HAS CHANGED?

The major shift in dental education in the past couple of decades has been away from process-clock-hours and number of clinical procedures-to outcomes. In order to be accredited today, schools must document that their graduates have the skills, knowledge, 8nd values required to begin independent dental practice. There has been a corresponding change in assessment methods. Graduates must demonstrate independent competency in all aspects of dental practice, and schools must provide evidence that their programs function as claimed.

Technology is a critical game changer to the practice of dental hygiene.

Dental hygienists will need to embrace 21st century technology to adapt to workplace settings. BACKGROUND AND PURPOSE: To stay relevant in the workforce, dental hygienists need mastery of new skills and technologies. The purpose of this paper is to elucidate the vast array of technological advances impacting dental practice and the consequent implications for oral health care providers. CRITICAL ANALYSIS: New technologies have provided unparalleled opportunities for degree and career advancement for dental hygienists. Advances in science and technology are providing patients with better quality and more convenient oral health care. Dental hygienists need technological skills that enable them to fully utilize technology as a strategy for consultation with dentists and other health care professionals and for other purposes. Continuing education and life-long learning factor into preparing dental hygienists for 21st century technologies. CONCLUSION: With technological advances, less adaptive professionals could potentially see a decrease in demand for their services. Possessing a high level of knowledge of dentistry and dental hygiene does not ensure a position in the workforce. Knowledge of technologies and associated skills are required for quality patient care and career and personal growth.

Women in dental education and their desire to lead: A follow-up.

The aim of this study was to provide a follow-up to the 2015 national survey of women in dental education to re-examine factors and perceived barriers to pursuing administrative and leadership roles. At the beginning of 2023, a survey was administered to full-time women faculty in predoctoral dental programs in the United States. The survey instrument employed a structured format along with open-ended questions to capture qualitative data. The overall response rate was 26% (527/1994) and included respondents from fifty-five of the sixty-seven dental schools contacted. Half of respondents indicated holding an administrative position and 20% reported administration as their primary appointment. There was a significant increase in the number of women holding a leadership role in 2023 (76%) compared to 2015 (53%). Those seeking a leadership position in 2023 were less likely to have participated in leadership training (p<0.01) and less likely to have previously sought an administrative position (p>0.01). Women in leadership and administrative roles were more likely to indicate receiving extra compensation for administrative duties (p<0.01) and a desire for higher rank (p = 0.04) compared to 2015, but perceptions persist among the majority of respondents (71%) that women are not being compensated equally to their male counterparts. Respondents highlighted the negative impact of the COVID-19 pandemic on career advancement and the positive culture changes that have contributed to greater workplace flexibility. Overall, respondents sent a resounding message that women in dental education need structural change to achieve success: pay equity, mentorship, and inclusive and supportive work environments.

Person-Centered Care in Dental Hygiene Education: Incorporation and evaluation of person-centered care in the curriculum.

Purpose Patient and person-centered care are often used interchangeably. The abbreviation PCC is used in this paper in instances where patient/person centered care reflects the definition of person-centeredness. The purpose of this study was to assess how PCC is taught and evaluated in entry-level dental hygiene education programs to prepare graduates for future collaborations with oher health care pprofessionals in a wide range of practice settings.Methods A cross-sectional study was conducted using a 10-item survey emailed to directors of 325 accredited, entry-level dental hygiene education programs in the United States in December 2021. Descriptive statistics were calculated for all variables. Associations with curriculum settings, teaching, and evaluation methods for PCC, according to program degrees granted, were tested with Chi-square and Fisher's Exact tests.Results The response rate was 23% (n=75). Seventy percent offered an associate degree (AS) and 29% offered a baccalareate degree (BS); 42% reported more than half of their curriculum is allocated to teaching PCC. Didactic lectures (100%), case presentations (97%), and clinical instruction (97%) were the most common methods used for teaching PCC. Baccalaureate programs used external rotations more than associate programs for teaching and evaluation of PCC (84.2% vs. 45.5%; p<0.01). The most common PCC terms used in Quality Assurance Plans included providing individualized care (99%) and delivering evidence-based care (91%). Ninety-three percent strongly agree-agree that teaching PCC prepares graduates for working in different settings (e.g., schools, nursing homes, etc.), and 82% strongly agree-agree that PCC prepares graduates to work with a variety of providers.Conclusion The allocation of curricula time for PCC varied widely across respondents. Conversely, the majority felt their graduates were well-prepared to work in different settings where both PCC and IPP are likely to be practiced. This study serves as a baseline for further analysis of how dental hygiene education is preparing graduates for future practice settings.

Dental Hygiene and Direct Access to Care: Past and present.

The American Dental Hygienists' Association (ADHA) defines direct access as the ability of a dental hygienist to initiate treatment based on their assessment of patient's needs without the specific authorization of a dentist, treat the patient without the physical presence of a dentist, and maintain a provider-patient relationship. In 2000 there were nine direct access states; currently there are 42 states that have authorized some form of direct access. The ADHA has been instrumental in these legislative initiatives through strong advocacy efforts. While research and data support the benefits of direct preventive/therapeutic care provided by dental hygienists, many barriers remain. This paper chronicles key partnerships which have influenced and advocated for direct access and the recognition of dental hygienists as primary health care providers. The National Governors Association (NGA) released a report in 2014 suggesting that dental hygienists be "deployed" outside of dental offices as one strategy to increase access to oral health care along with reducing restrictive dental practice acts and increasing the scope of practice for dental hygienists. The December 2021 release of the National Institutes of Health report, Oral Health in America, further supports greater access to dental hygiene preventive/therapeutic care. This paper also reflects on opportunities and barriers as they relate to workforce policy, provides examples of effective state policies, and illustrates an educational curriculum specifically created to prepare dental hygienists to provide oral health services in settings outside of the dental office. Dental hygiene education must ensure that graduates are future-ready as essential health care providers, prepared to deliver direct access to dental hygiene care.

Using learning management software data to compare students' actual and self-reported viewing of video lectures.

PURPOSE: Student engagement is typically measured by class attendance and questionnaires. Learning management systems (LMS) provide additional sources of objective data that can evaluate student performance. This study compared dental students' self-report of course video viewing with LMS data. METHODS: Dental students in a 2018 flipped pediatric dentistry course were given a questionnaire after course completion that captured self-reported course video viewing. Student data and time spent on videos were extracted from the LMS and matched to the questionnaire. McNemar's test evaluated differences between self-reported and matching LMS data. RESULTS: Of the 109 enrolled students, 99 (91%) completed the questionnaire. Most students self-reported that they watched more than half of the videos (71%), re-watched at least once (89%), and watched at times other than 8 a.m.-5 p.m. (80%). Of the 104 students with data from the LMS, 40% of students watched more than half of the videos, 49% re-watched at least one video, and 60% watched between 8 a.m.-5 p.m. LMS data showed 14 (13%) students did not watch any videos. Significant differences were found between self-reported video viewing and matched LMS video data in (1) percentage of videos watched, (2) number of times videos were re-watched, and (3) most frequent time for watching the videos (p < 0.001 for all). CONCLUSION: Technology is a tool that helps instructors more accurately track students' study habits compared to observation or self-report. When evaluating time spent watching videos via an LMS, students tend to overestimate the amount of viewing time.

Associations of Self-Reported Oral Health Quality of Life with Actual Oral Health Status in Children.

Purpose: Quality of life is considered a component of patient centered care. The purpose of this study was to examine the relationship between self-reported oral health related quality of life (OHRQoL) and the actual oral health status of children.Methods: This retrospective cohort study consisted of pediatric dental chart reviews from three clinics. Demographic and dental visit data along with the child's OHRQoL utilizing the Pediatric Oral health-related Quality of Life (POQL) instrument, were collected. Associations with untreated decay, treated decay, or POQL score were tested, using Chi-square, Fisher's exact test, 2-sample t-tests, or ANOVA. Linear regression was used to evaluate the effect of statistical confounders in the relationship between untreated decay and POQL scores. Significance level was set to 0.05.Results: Two hundred ninety-seven out of 336 children had both POQL and caries data. White children and children with untreated decay had significantly more negative POQL scores. Children rating their oral health as "excellent" or "very good" and children with sealants on molars had significantly more positive POQLs. Associations between POQL scores were significant with untreated decay, but not sealants, when considering both variables in the same model. After adjusting for having sealants, POQL scores were on average 7.5 points higher (more negative) in children with untreated decay, than in children without decay (p<0.001).Conclusions: Collecting OHRQoL data allows oral health providers to easily incorporate patient perceptions in their assessment and care and would ensure that all oral health needs of the patients are being met. This is important for children, who may have difficulty expressing their concerns, particularly in clinical environments.

Expert consensus on Didactic Clinical Skills Development for orthodontic curricula.

PURPOSE/OBJECTIVE: Competence is expected of each beginning dentist and orthodontist. However, the broad definition of competence presents a challenge to academic programs in identifying the level of cognition for students to achieve competence. This study aimed to determine the Didactic Clinical Skills Development curriculum content and competency in predoctoral and advanced education orthodontic programs. METHOD: A modified Delphi method with a consensus threshold of 70% was employed using an expert panel of academic orthodontists. RESULTS: Round One (n = 26) identified that all topics proposed by a focus group were necessary, except for predoctoral Appliances, which was at 65%. Round Two (n = 23) included subtopics of Appliances to confirm the lack of consensus, plus subtopics of all the other topics and the level of cognition required for each subtopic. The expert panel reached a consensus that all 24 subtopics, hence all topics, were necessary. In Round Three, subtopic responses in Round Two were assigned a value between 1 (remember) and 6 (create) to generate a hierarchical level-of-learning scale. Mean values were calculated for each subtopic response. For all subtopics, the mean level of cognition for predoctoral education was at understand; for advanced education, it was at evaluate. CONCLUSION: This consensus suggests that, to be deemed competent, beginning dentists must learn these topics and subtopics in the cognitive domain of understand, and beginning orthodontists in the cognitive domain of evaluate. This study showed an expert consensus on Didactic Clinical Skills Development orthodontic curriculum content and a panorama of educational objectives that could be used as a template for curriculum design.

An assessment strateqy whose time has come for documenting competency in dental education and beyond.

The Institute of Medicine report on dental education in the mid-1990s called specific attention to the need for authentic assessment of student progress and outcomes. This corresponded with the advent of competency-based dental education, resulting in recognition of the need for new methods to assess dental students knowledge, skills, and values in the context of beginning independent dental practice. The portfolio approach to assessment uses a rich collection of cumulative evidence from multiple sources in ways that address this need. Because students take some responsibility for maintaining their portfolios, the competency of reflective critical thinking can also be assessed by means of portfolios.

Scholarly Inquiry and Research: An assessment of graduate dental hygiene schools' requirements.

Purpose: Scholarly inquiry and research are core competencies for graduate dental hygiene education as defined by American Dental Education Association (ADEA). The purpose of this study was to examine how graduate dental hygiene programs in the United States (US) are meeting these competencies.Methods: The study sample consisted of the graduate programs in the US that award a terminal degree specific to dental hygiene (n=14). Graduate program directors were invited via email to participate in an electronic survey. The survey questions were developed based on the ADEA graduate dental hygiene education competency for scholarly inquiry and research. Descriptive statistics including frequencies and percentages were used to analyze the data. Exploration of relationships between variables were conducted using correlational analyses and t-tests.Results: A response rate of 71% was achieved (n=10). There was a significant difference in the minimum number of scholarly activity requirements between programs with lower student enrollments (M=4.43, SD=1.61) versus those with higher enrollments (M=2.00, SD=0; t(8)=2.51, p=.036). A negative correlation was found between the submission of a manuscript to a peer reviewed journal and the number of students accepted per year in the graduate program (r (10)= -.655, p <.05), indicating that students graduating from programs with larger enrollments were less likely to submit their scholarly work for publication.Conclusions: All program directors reported requiring students to participate in at least one scholarly activity as defined in the ADEA Core Competencies for Graduate Dental Hygiene Education. Program size was the biggest variable in relationship to the number of scholarly requirements. Schools with smaller enrollments required their students to participate in over twice the number of scholarly activities as compared to programs with larger enrollments. More research is needed to evaluate how graduate level dental hygiene programs are meeting the ADEA competencies.

ADEA-ADEE Shaping the Future of Dental Education III: Assessment in competency-based dental education: Ways forward.

Assessment in competency-based dental education continues to be a recognized area for growth and development within dental programs around the world. At the joint American Dental Education Association (ADEA) and the Association for Dental Education in Europe (ADEE) 2019 conference, Shaping the Future of Dental Education III, the workshop on assessment was designed to continue the discussion started in 2017 at the ADEA-ADEE Shaping the Future of Dental Education II.1 The focus of the 2019 conference involved examining the potential of entrustable professional activities (EPAs) and current thinking about workplace-based assessment (WBA) within competency-based education in the 21st century. Approximately 30 years ago, George Miller wrote about the assessment of competence in medical education and challenged faculty to reach for higher levels of assessment than knowledge or skill.2 Acknowledging that no one assessment method can result in a valid assessment of competence, Miller proposed a four-level framework for assessment. The lowest level involves measuring what students know ("knows"), followed by assessment of the skill with which knowledge is applied in relevant tasks or problems ("knows how"). Next is an assessment of task performance in standardized settings ("shows how"), and finally, the highest level assesses the student's performance in the unstandardized clinical workplace ("does"). The 2019 assessment workshop focused on advances in the assessment of learners in the unstandardized workplace-the highest level of Miller's assessment pyramid ("does"). Research has shown that dental education has struggled to implement assessment strategies that meet this level.3 The workshop brought together individuals from around the world, with an interest in assessment in dental education, to consider how assessment in the "does" level, specifically EPAs and WBA, factors into competence assessment in dentistry/dental education.

The development and implementation of an online applied biochemistry bridge course for a dental hygiene curriculum.

This article describes a curricular change project designed to improve instruction in biochemistry. After years of unsatisfactory outcomes from a dental hygiene biochemistry course, a decision was made to change the traditional lecture-based course to an online format. Using online technology and principles of educational pedagogy, a course was developed that fosters application of biomaterials principles to dental hygiene practice and provides a bridge between prerequisite chemistry coursework and biochemistry in a health professions program. Members of the dental hygiene graduating Classes of 2007 and 2008 participated in the revised course. The outcome measures used to assess the effectiveness of the revised course were student end-of-semester course evaluations, graduating senior survey results, student course performance, and National Board examination performance. While the results are based on only two classes, the positive outcomes suggest that the revision was a worthwhile endeavor. The use of technology in teaching holds the potential for solving many of the curriculum and instruction issues currently under discussion: overcrowding of the curriculum, lack of active learning methods, and basic sciences taught in isolation from the rest of the curriculum. It is hoped that the results of this change will be helpful to other faculty members seeking curricular change and innovation.

Predoctoral Curricular Revision for Dental Radiographic Interpretation Competence Based on OSCE Results.

Teaching radiographic interpretation skills to predoctoral dental students is challenging. The results of an objective structured clinical examination (OSCE) at one U.S. dental school failed to yield expected outcomes for students' radiographic interpretation skills. The purpose of this article is to describe the development of the radiology OSCE and subsequent curricular revisions based on the outcomes. Examples of curricular changes are a series of self-assessed radiographic interpretation cases using the university learning management system. Each case contains a set of four intraoral radiographs and a series of questions. In year 4, an OSCE and final radiographic interpretation competency exam are administered; students are required to pass both exams. OSCE outcomes over a period of six years were used to evaluate the effectiveness of the curricular revisions. A questionnaire developed to capture student perceptions of the curricular changes was administered. The pilot OSCE of 2.9% first attempt pass rates initiated curricular revision. The strongest results to date occurred in 2018 with a 73.3% first attempt pass rate. Results from the questionnaire showed that students reported greater confidence in their interpretation skills when it came to recognizing radiographic errors, dental caries, and periodontal disease/pathologies (65%, 64%, and 57%, respectively). The use of the OSCE for programmatic assessment revealed the need for curricular revision in radiology. Students' participation in the newly revised radiology curriculum resulted in improved student performance and outcomes. This article emphasizes the importance of global and programmatic assessment for assessing student competence along with analysis of how assessment and accompanying data can inform curricular decisions.

Measuring the Level of Reflective Ability of Predoctoral Dental Students: Early Outcomes in an e-Portfolio Reflection.

Learning to evaluate one's own skills through reflection and self-assessment prepares dental graduates for successfully navigating an ever-changing work environment throughout their careers, but the search continues for the most effective teaching and assessment strategies to develop students' skills in these areas. Beginning with the Class of 2017, the University of Missouri-Kansas City School of Dentistry adopted e-portfolios as a programmatic (four-year) global assessment measure in the predoctoral dental program, in large part to encourage the development of reflection. The aim of this study was twofold: to examine interrater reliability among raters when scoring reflective writing using a validated measure of reflection skill and to analyze students' level of reflective ability as fourth-year dental students. Reflections of all 102 students were independently evaluated by the three investigators using a grading rubric based on Bain's 5 Rs (reporting, responding, relating, reasoning/deconstructing, reconstructing). Intra-class correlation was used to assess interrater reliability among the three raters, resulting in a good range for agreement (ICC=0.67; 95% CI 0.54, 0.77). The results showed that the majority (70%) of the global reflections were rated at Level 2 (responding) and Level 3 (relating). Approximately 15% of the global reflections reached Level 4 (reasoning/deconstructing), and only one was rated at the highest level (Level 5, reconstructing). This study confirmed that reflection and reflective writing were difficult for students to accomplish. As a result, curricular enhancements at this school have been implemented that involve both faculty and student development. Ongoing evaluation is required to determine if those changes result in higher levels of reflective ability. The positive outcomes of reflection and writing warrant continued examination in how to improve this educational strategy across the curriculum.

Expert Consensus on Growth and Development Curricula for Predoctoral and Advanced Education Orthodontic Programs.

Dental students and orthodontic residents must demonstrate competence in various areas prior to graduation. However, the Commission on Dental Accreditation (CODA) definition of competence is broad. The aims of this study were to obtain expert consensus on Growth and Development topics and subtopics in predoctoral and advanced education programs in orthodontics and to determine the level of cognition on the subtopics necessary to demonstrate learner competence. A modified Delphi method with a consensus threshold of 70% was used. In Round One, academic orthodontists who met the expert panel inclusion criteria were surveyed to determine whether a topic was necessary to the curricula. Round Two identified the subtopics under each topic and the level of cognition necessary to demonstrate learner competence using Bloom's taxonomy, which defines the ascending levels of remember, understand, apply, analyze, evaluate, and create. Round Three involved analyses and interpretation of Round Two results. The academic orthodontists determined that six topics (n=24) and 29 subtopics (n=15) were necessary for Growth and Development curricula. For all subtopics, they determined the mean level of cognition for predoctoral education was understand; for advanced education, it was analyze. This consensus on Growth and Development curricular content suggests that these levels are necessary for a beginning dentist and a beginning orthodontist to be deemed competent. Findings from this study can serve to guide curricular development and instruction by using the identified learning objectives to build instructional and assessment measures.

A qualitative study of limited access permit dental hygienists in Oregon.

Many states have adopted alternative oral health care delivery systems that include expanded roles for dental hygienists. This qualitative study was designed to evaluate the impact of the Limited Access Permit (LAP) legislation in Oregon and to understand the relationship between dental hygienists and dentists within this delivery system. The snowball sampling technique was used to identify LAP dental hygienists and collaborating dentists. The snowball sampling technique begins with the identification of a known expert in the field who serves as the initial "sampling unit." Subsequent individuals are then recommended, or nominated, to the investigator by the initial study participant and are selected based upon the need to fill in or extend information. The final sample consisted of seven LAP dental hygienists and two collaborating dentists. Interviews, field observations, and document analysis were utilized for data collection. Factors that led to the creation of LAP dental hygiene practice, current LAP practice, personal characteristics, relationships between LAP dental hygienists and dentists, and the impact that LAP dental hygienists have had on access to oral health care were explored. Data revealed that the Oregon legislature twice expanded the LAP scope of practice to increase access to oral health care services. LAP dental hygienists practice in community and school-based settings. Common characteristics of LAP dental hygienists include entrepreneurship, lifelong learning, and a commitment to underserved populations. The findings from this study indicate that LAP dental hygienists and collaborating dentists have positive relationships. No evidence of lower quality of care in unsupervised dental hygiene practices was found. However, the impact of the LAP legislation is still unknown due to the limited numbers of LAP dental hygienists and the early nature of the LAP practice.

Dental education in a flat world: advocating for increased global collaboration and standardization.

Globalization is a broad term referring to the increasing connectivity, integration, and interdependence of economies, societies, technologies, cultures, and political and ecological spheres across the world. This position paper was developed by a working group of the 2007 American Dental Education Association (ADEA) Leadership Institute. The authors explore the effect that globalization has had on dentistry and dental education to date and hypothesize what dental education could look like in the years ahead. While the paper is written from a North American perspective, some of the authors bring international expertise and experience to the topic of global dental education in a flat world. Specific issues and barriers addressed in this position paper include variations in accreditation and licensure requirements in dental education throughout the world; the historical development of dental education models (odontology and stomatology) and the need for congruency of these models in the global environment; the competency-based model of education and its relevance to development and implementation of global dental competencies; and the slow adoption of technological advances in dental education for promoting collaborations and encouraging resource sharing among countries. These challenges are discussed as they affect the implementation of a standardized global dental education that can lead to improved access to oral health care services and better oral and overall health for the citizens of the world.