Characteristics of Patients Seeking Care from Independent Dental Hygienist Practices

Objectives : This study determined demographic characteristics, satisfaction with care, and likelihood of follow-up dentist visits for patients seen in office-based, independent, dental hygienist practices. Methods : New patients were surveyed after their initial visits to independent hygienist practices to assess their demographic characteristics and satisfaction with care at both the beginning of practice operations and 18 months after the start of these practices. Follow-up surveys were sent to patients 12 and 24 months after their initial visits to the independently practicing dental hygienists to determine if patients had visited a dentist. Results : Most respondents were white, female, had attended some college, and reported high family incomes. Ninety-eight percent of respondents were satisfied with their dental hygiene care. Follow-up questionnaires revealed that over 80 percent of respondents visited the dentist within 12 months of receiving dental hygiene care in independent settings. This level of follow-up care with dentists was found both for respondents who reported having a regular dentist at their initial visits with the hygienists and for those who reported not having a regular dentist. Conclusion : Independent practice by dental hygienists provided access to dental hygiene care and encouraged visits to the dentist.     

Attitudes of two groups of dentists towards dental hygienists

The purpose of the study was to assess whether cooperation with a dental hygienist was based on pursuit of financial gain or on aspirations to improve patient care. To this end a questionnaire was sent to 972 dentists. 412 dentists replied, of whom 178 had patients treated by a dental hygienist. Questions were asked regarding practice profile, preventive orientation and dentists' opinion about the material and immaterial value of cooperation with a dental hygienist. Discriminant analysis showed that the main distinguishing factor between dentists who did and dentists who did not cooperate with dental hygienists was their opinion about the quality of the dental hygienists' work in relation to the non-financial costs for patients, insurance companies, and dentists. The difference in the dentists' opinions about the direct profitability of dental hygienists was not significant. The conclusion can be drawn that the orientation of Dutch dentists towards care for their patients plays a more important role in a dentist's decision to cooperate with a dental hygienist than is usually presumed.     

Anxiety about dental hygienist treatment

Abstract – Although dental anxiety is a well investigated phenomenon in dental health care, remarkably little is known about anxiety reactions related to treatment carried out by the dental hygienist. In the present study anxiety reactions were measured among 101 patients attending the dental hygienist. General level of anxiety was assessed through the PAQ (Photo Anxiety Questionnaire; S touthard , D e J ongh & H oogstraten , 1991), whereas an additional questionnaire was used to obtain information about specific stimuli and situations that might provoke anxiety in the dental hygienist situation. The results indicated that during dental hygienist treatment only 15% of the patients experienced no feelings of anxiety. Another 15% of the patients reported that a visit to the dental hygienist was more distressing than dental treatment. The level of anxiety appeared to be strongly related to a number of stimuli and situations, with actual pain (78%) and expected pain (67%) major anxiety provoking factors. The relation between pain and anxiety was highly significant, with highly anxious patients having more fear for pain than their low anxious counterparts. Also feelings and sounds of instruments, patient's helplessness and perceived lack of control over what happens were identified as important contributors to anxiety for the dental hygienist treatment. The results of this study suggests that treatment by the dental hygienist is a distressing event for many patients.     

Ingredients in dentifrices and their effect on plaque, gingivitis and mutans streptococci

Objective: The aim of this study was to investigate attitudes and opinions of old, independently living people about their oral health and how it has affected them through life. Material and methods: A random selection of 12 individuals was made in a group of 79 individuals who earlier participated in a study about self‐reported oral health. The average age was 78.4 years. An interview guide was used as support to focus on oral health. The respondents themselves decided what was important within the topics. The respondents were encouraged to speak freely about their childhood, family, social relations, memories from early dental care, general health situation, experience from health care, life and their future. The interviews were recorded and extended from 60 to 90 min. All of them were transcribed and analysed with phenomenological method inspired by Giogi. The analysis was made by two researchers independently. After 11 interviews, no new information was found; similar opinions, answers and stories recurred. Results: Seven of 11 respondents were born and grown up in the countryside and had moved to Stockholm in the forties. Awareness about dental care was generally low. Many of them have terrible memories from early dental visits, and the dentist was authoritarian and rough. Many had no memories of brushing their teeth as a child. Most of the respondents went to dentists as adults and when they could afford to pay by themselves. After retirement, all have continuous dental care and have visited a dental hygienist during the last 20 years. Nine of 11 have regular contact with a dental hygienist. Most of them are satisfied with their oral health and want to continue being clean and healthy in the mouth. Conclusions: Most of the respondents experienced an improved oral health, information and instructions from the dental hygienist have affected their self‐care. Many tell that they have become more aware and carry out the oral hygiene more carefully after retirement. All of them experience that oral health affects the quality of life.     

Residency Training in Dental Public Health: Assessment of Status, Needs, and Issues

The opportunities for public health training have declined over the years while the need for public health skills is likely to increase. This paper reports the results of a project, sponsored by the Health Resources and Services Administration, which answers the question of "how best to invest in the dental public health education system so as to fulfill the profession's responsibilities to protect and improve the oral health of individuals and society.' An information base on dental public health education, practice, and specialization was developed from an extensive review of the literature and a survey of dentists concerning employment and practice requirements for public health dentists. An advisory group considered this information, met to discuss the issues involved in dental public health training, and provided advice to the project staff. Based on the information gathered as part of the project, recommendations were made to: (1) develop a grant program to support advanced education in dental public health; (2) increase the competencies of dentists who are working in public health positions and not eligible for board certification via off-site residencies; (3) develop model programs in areas of great need, such as general public health, management, policy, prevention, environmental health and research, that in conjunction with a basic public health core, could satisfy the eligibility requirements of the American Board of Dental Public Health; (4) develop student loan forgiveness programs for dentists and dental hygienists working in public health; and (5) develop additional credential recognition programs for dental public health workers.     

On adding a dental practice component to an ongoing longitudinal population-based study of oral health

OBJECTIVE: To determine the feasibility and effectiveness of adding a dental practice component to the Florida Dental Care Study (FDCS). METHODS: The FDCS was a study of dental health in which no treatment was provided. In-person interviews and clinical examinations were conducted at baseline, 24 months, and 48 months, with six-month telephone interviews between those times. Participants reported any dentists visited and treatment received. All but four of the 764 participants at the 24-month session gave written permission to review their dental records. Dental hygienist research assistants abstracted information on treatment that was received during the 48-month interval. RESULTS: Of the 286 practices named by FDCS subjects, all but 10 (of whom five refused) practices participated. Eight practices allowed access to records, but did not allow us to record fees. Fees were unavailable at another 13 practices. Of the 764 persons who participated for the 24-month interview, 677 ultimately reported at least one dental visit during the first 48 months of the study. Of those 677, we located dental records on 619. We also found records on four of the 111 persons who reported no dental visits, by querying practices while recording information on other participants. Charts varied in comprehensiveness; nevertheless, in conjunction with office staff consultation, all practices had adequate record of what procedures were performed. CONCLUSIONS: Although time intensive, this method of collecting data substantially increased information about dental treatment received, compared to relying on participant self-report and clinical examination.     

Child abuse and dental neglect: the dental team's role in identification and prevention

Abstract:  Health, education and social services are placing increasing emphasis on preventing abuse and neglect by early intervention to support families where children and young people may be at risk. Dental hygienist and dental assistants, like all other health professionals, can have a part in recognizing and preventing children from those who would cause them harm. They should be aware of the warning signs, recognizing what to consider as abuse or dental neglect and know how to deal with these young patients, and to fulfil their legal and ethical obligation to report suspected cases.
The purpose of this report is to review the oral and dental aspects of child abuse and dental neglect thus helping the dental team in detecting such conditions. In particular, this report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, early childhood caries and diseases that may be indicative of child abuse or neglect.
Emphasis is placed on an appropriate protocol to follow in the dental practice to best treat and protect children who may have suffered abuse, helping the team in the diagnosis and documentation.     

Improving oral health in Pakistan using dental hygienists

This paper reviews the healthcare system, available dental care, and oral health status of people in Pakistan. Considering the enormous unmet oral health needs, the insufficient supply of dental professionals and the current unstructured dental hygiene curriculum in Pakistan, a mission, vision, and goals for professional dental hygiene in Pakistan is recommended. The authors offer recommendations for competency-based dental hygiene education and practice, professional credentialing, a practice act, and a dental hygiene scope of practice to promote the health, welfare, and quality of life of the Pakistani people. Specifically, the authors recommend increasing the number of quality dental hygiene programs, establishing the dental hygienist as a primary care provider of oral health services, enhancing current dental hygiene curriculum, and establishing a dental hygiene council with responsibility for educational requirements and regulation of dental hygienists in Pakistan.     

Independent dental hygiene practice worldwide: a report of two meetings

Objectives: Following a meeting at the EUROPERIO in Berlin in 2003, a forum on Independent Practice of Dental Hygienists was held at the International Symposium on Dental Hygiene (ISDH) in Madrid July, 2004. The forum was organized and moderated by Beate Gatermann, President of the German Dental Hygiene Association. The participants were asked to address the following issues: population of country/state; population of dentists; population of state recognized dental hygienists (Canada/USA etc.); number of hygienists with ‘Diploma’ (Europe); duration of dental hygiene education; cost of education (2/3 year base approximately); when and how independent practice began in the country and who must be consulted or approve the application for an independent office (e.g. Health Department); what services are allowed? Can dental hygienists administer local anaesthesia in the dental office, and if so, must a dentist be present? Can dental hygienists purchase the necessary medication for the injection? Does the dental hygienist require additional education to provide local anaesthesia? How are the patients charged? Does the country offer a service fee list? Do insurance companies pay claims of the dental hygienist? What is the approximate average fee per hour charged (€/$)? Do dentists refer patients to you? If so, do they need a letter of referral? Are dental hygienists allowed to take radiographs in independent dental hygiene offices?     

Suitability of Krathwohl''s affective taxonomy for evaluating patient attitudes to dental care

The aims were to develop a questionnaire for dental health education based on Krathwohl's taxonomy, which measures the affective domain, and to examine correlations between the attitude determined by this questionnaire and sex, age, education, and dental behavior. The material consisted of young and middle-aged persons, 206 women and 183 men, visiting two occupational health centers in Oulu. The questionnaire comprised four questions under each of three headings: preventive dentistry, gingivitis, and dental check-up. The questions under each heading were formulated to correspond to given levels in Krathwohl's taxonomy. Factor analysis showed the questionnaire to be valid and suitable for studying different levels of the affective domain. Krathwohl's taxonomy includes the notion of cumulative adoption of a value, and Guttman scaling was used to show the cumulativeness of the scales. Groups of persons with the most and least positive attitudes were identified, 83% of the patients with the most positive attitude having visited a dentist within a year, whereas 65% of those with the least positive attitude had last done so more than 2 yr earlier. The women had a more positive attitude than the men, but education was not a decisive factor in determining attitude. All the persons with the most positive attitude were over 25 yr old. It was concluded that it was possible to formulate a questionnaire on the basis of Krathwohl's taxonomy which would measure attitudes towards dental care and that it is possible to use this questionnaire in practical situations in order to help the dentist to instruct his patients.     

Assessing anxiety in pre-school dental patients with a doll placement test

The prospect of dental treatment causes many young patients to be anxious and/or afraid. Because it is helpful to know in advance how much anxiety a child is experiencing, we have devised a test in which the child places dolls in a miniature dental office. We used this model to study 48 children, aged three to five years, who visited our paediatric dental office. We prepared a doll-house-sized model of a dental office with a dental chair, a dentist, and dental hygienist. We asked children to place two dolls, one a self-doll and the other a parent/guardian-doll at a location of their choosing in the model clinic. The positions children chose to place the dolls helped us to gauge the anxiety they were experiencing as they anticipated dental treatment. The majority of children we tested were not anxious, and they placed the self-doll in the dental chair. In contrast, we observed that many children who did not place the self-doll on the dental chair were uncooperative during subsequent dental treatment. Thus, our doll-placement test is a valuable predictor of the anxiety of children who will receive dental treatment. Although how children placed the parent/guardian-doll also provided useful information, we gained the most valuable information from whether or not the child put the self-doll on the dental chair.     

Alternative practice dental hygiene in California: past, present, and future

This study examines the development of the registered dental hygienist in alternative practice in California through an analysis of archival documents, stakeholder interviews, and two surveys of the registered dental hygienist in alternative practice. Designing, testing and implementing a new practice model for dental hygienists took 23 years. Today, registered dental hygienists in alternative practice have developed viable alternative methods for delivering preventive oral health care services in a range of settings with patients who often have no other source of access to care.     

A two-wave interview study of frequency of dental visits and dental complaints

A panel of 268 persons were interviewed twice at an interval of 2 years concerning their visits to dentists and their dental status. The answers they gave on the two occasions agreed well, except for the year of the last visit if it had taken place long ago. This was true both for the people who had gone to the dentist between the interviews and for those who had not. The panel was also asked whether they had any dental complaints. Sixteen percent of them reported complaints at one or both interviews. Complaints were more common among persons who did not often go to the dentist. The persons with complaints did not always get rid of them by going to a dentist. It is concluded that interview data be used for investigating the dental health and behavior of people who do not often go to the dentist, and that dentists are more successful in maintaining good dental health in people who have no dental complaints than in people who report having complaints.     

Dental anxiety and pain related to dental hygienist treatment

Objective. To evaluate different groups of patients’ self-reported assessments of dental anxiety and pain related to various routine dental hygienist treatment procedures, and to investigate the relationship between anxiety concerning dental and dental hygienist treatment. Material and methods. A consecutive sample of 393 patients participated in the study (59.7% F, age range 20 to 85 years, mean 47.6 years). Periodontology (PC), oral medicine (OM), student and general practice (GP) clinics were included. Each patient was asked to answer a questionnaire which included different demographic information, self-reported levels of dental anxiety, and experience of pain in relation to different dental hygienist treatments. Results. Higher dental anxiety was found in relation to gender (women), dentist treatment, and PC and OM patients. Experiences of high or extreme pain were reported by between 7.1% and 9.7% of participants for all dental hygienist procedures except polishing (0.8%). There were significant correlations between dental hygienist fear levels and reported extreme pain experiences among all five treatment procedures. Patients treated at the PC clinic scored significantly higher on pain compared with patients at the other clinics, with the exception of the OM clinic. Conclusions. Patients reported higher dental anxiety levels for dentist treatment as compared with dental hygienist treatment. Moreover, dental anxiety was significantly associated with perceived pain related to different dental hygienist treatment procedures.     

Dental hygienist attendance and its covariates in an ageing Swedish cohort

Delegation of tasks between professional groups is important to make health‐care services accessible and effective for ageing people. Focussing on a Swedish 1942 birth cohort and guided by Andersen's Behavioral Model, this study assessed dental hygienist attendance from age 50 to age 70 and identified covariates at the population‐averaged and person‐specific levels. In 1992, a census of 50‐yr‐old subjects was invited to participate in a questionnaire survey. Of the 6,346 respondents, 3,585 completed follow‐ups in 1997, 2002, 2007, and 2012. Multiple logistic regression analysis was conducted using a marginal model and a random intercept model. Cochran's Q test revealed that significantly more respondents confirmed dental hygienist attendance in 2012 than in 1992 (57.2% in 2012 vs. 26.0% in 1992). Population‐averaged ORs for dental hygienist attendance across time were 3.5 at age 70 yr compared with age 50 yr (baseline); 2.0 if being a regular rather than an irregular dental attendee; and 0.7 if being of non‐native origin compared with native origin. The corresponding person‐specific ORs were 8.9, 3.2, and 0.5. Consistent with Andersen's Behavioral Model, predisposing, enabling, and need‐related factors were associated with dental hygienist attendance at population‐averaged and person‐specific levels. This has implications for promoting dental hygienist attendance among ageing people.     

Changes in dentist and dental hygienist numbers in the European Union and economic area

Aim : To investigate the extent to which changes in the numbers of dental hygienists and dentists have occurred in the Member States of the European Union and Economic Area (EU/EEA) during the last ten years and discuss the changes in relation to the possibilities of sharing tasks between the two groups. Methods : Numbers for active dentists, registered hygienists and EU/EEA member state populations in 2007 were taken from the website of the Council of European Chief Dental Officers (CECDO) ( http:www.cecdo.org ) and from CECDO records for the EU/EEA member states in 1998 and for the new EU member states (who joined in 2004 and 2007) in 2000. From these data, population: active dentists, population: registered dental hygienist and active dentists: registered dental hygienist ratios were calculated together with percentage changes in the number of dentists and dental hygienists by member state, between 1998 and 2007 for the old and between 2000 and 2007 for the new EU member states. Results : In 2007, there were a total of 343,922 active dentists and 30,963 registered dental hygienists in the 30 EU/EEA member states plus Switzerland. The mean population to dentist ratio was about 1,500:1 and the mean population to dental hygienist ratio (in the 25 states where dental hygienists were registered) was 13,454:1. During the study period, the population of the EU/EEA plus Switzerland increased by less that 3%, the number of dentists increased by 13% and the number dental hygienists by 42%. The overall ratio of active dentists: dental hygienists changed from 18:1 to 11:1. In six of the 30 member states plus Switzerland the population to dental hygienist ratio was between 2,000:1 and 6,000:1 and the dentist: dental hygienist ratio less than 1:3. Conclusions : Although, most member states educate dental hygienists and their numbers in the EU/EEA during the last 10 years have risen more than the dentist numbers, there are still only a handful countries where the hygienist numbers are great enough to make a significant difference to the delivery of oral health care.     

A dental health education programme, including home visits, for nursery school children.

The aim of this study was to measure the effectiveness of three preventive programmes by measuring changes in oral hygiene, gingivitis and the uptake of dental care of nursery school and young primary school children living in areas of urban deprivation. The oral hygiene and gingivitis of a group of children who brushed their teeth daily at school improved during the study, but deteriorated during the summer holiday. A second group of children also brushed their teeth at school, and in addition their parents were given dental health education by a dental hygienist at home. Parents of a third group of children were given dental health education only at home. The oral hygiene and gingivitis of both the second and third groups improved and was maintained during the school holiday. The preventive programmes had little effect on the uptake of dental care in any of the study groups.     

Research defines public dental health promotion in youth

Abstract:  In the Netherlands, Dental Public Health Service workers work in the healthcare delivery system to promote dental health. Since 1994, research has been conducted in Flevoland on the condition of children's teeth. This research has shaped the content of the dental health promotion directed at children in this region. The research comprises two parts: questionnaires for parents and children above the age of 12 and a dental examination of children aged 6 and 12 in the regional primary schools. The dental examination registers the health of the children's teeth. Sound teeth are defined as being free of visible caries and/or restoration. Not sound teeth show at least one case of visible caries and/or restoration. The research results have shown great dental differences between the various schools and between municipalities. The percentage of children with sound teeth ranges between 28 and 100 per school. Based on the final results of the research, an information pack will be disseminated. In the case of high-risk schools the dental health promotion will be conducted more intensively. The Dental Public Health Service workers will give information sessions to groups of parents and children, the dentist and the dental hygienist will provide individual information and prevention. At the child health clinic (consultatiebureau), education will be provided to parents of children ranging in age from 0 to 4. This combined approach has proven to be effective on a large majority of the children. To ensure uniform dental health promotion, information protocols are used in these promotion activities within Flevoland.     

Confronting Human Papilloma Virus/Oropharyngeal Cancer: A Model for Interprofessional Collaboration

A collaborative practice model related to Human Papilloma Virus (HPV) associated oropharyngeal cancer highlights the role of the dental hygienist in addressing this condition.BackgroundThe incidence of HPV associated head and neck cancer is rising. Multiple professionals including the dental hygienist can work collaboratively to confront this growing public health concern.MethodsA critical review applies the growth and utilization of interprofessional education (IPE) and interprofessional collaboration (IPC) to multi-disciplinary models addressing the human papilloma virus and oropharyngeal cancers.ConclusionsA model related to HPV associated oropharyngeal cancer addresses an oral systemic condition that supports the inclusion of a dental hygienist on collaborative teams addressing prevention, detection, treatment and cure of OPC.