Sex differences among dentists regarding eating disorders and secondary prevention practices

BACKGROUND: The purpose of this cross-sectional study was to assess sex differences among dentists pertaining to current behaviors and behavioral beliefs with regard to eating disorders. METHODS: The authors collected data via a self-administered paper-and-pencil questionnaire from a randomized sample of 350 practicing male and female dentists. RESULTS: The results showed a low level of practice regarding secondary prevention (that is, measures leading to early diagnosis and prompt intervention) of eating disorders. The authors found statistically significant differences, with more female than male dentists reporting that they assessed patients for oral cues (P < .001), more female dentists reporting that they provided specific dental care instructions (P = .038) and more female dentists referring patients who have oral signs of eating disorders (P = .028). They also found sex differences with regard to mediating factors. Female dentists had greater knowledge of oral manifestations of eating disorders (P = .001), greater knowledge of physical cues of anorexia nervosa (P < .001), greater perception of the severity of anorexia nervosa (P = .007) and greater knowledge of physical cues of bulimia nervosa (P < .001). CONCLUSIONS: Although the dentist may be the first health care provider to assess oral effects of eating disorders, his or her involvement may be influenced in part by sex and sex-related health beliefs. CLINICAL IMPLICATIONS: Female dentists may be more sensitive to oral cues related to women's health issues. Further research is warranted to explore the mediating factors regarding secondary prevention of eating disorders.     

Expanding Oral Care Opportunities: Direct Access Care Provided by Dental Hygienists in the United States

Dental hygienists expand access to oral care in the United States.BackgroundMany Americans have access to oral health care in traditional dental offices however millions of Americans have unmet dental needs. For decades dental hygienists have provided opportunities for un-served and under-served Americans to receive preventive services in a variety of alternate delivery sites, and referral to licensed dentists for dental care needs.MethodsPublications, state practice acts, state public health departments, the American Dental Hygienists' Association, and personal interviews of dental hygiene practitioners were accessed for information and statistical data.ResultsDental hygienists in 36 states can legally provide direct access care. Dental hygienists are providing preventive services in a variety of settings to previously un-served and under-served Americans, with referral to dentists for dental needs.ConclusionDental hygienists have provided direct access to care in the United States for decades. The exact number of direct access providers in the United States is unknown. Limited research and anecdotal information demonstrate that direct access care has facilitated alternate entry points into the oral health systems for thousands of previously un-served and underserved Americans. Older adults, persons with special needs, children in schools, pregnant women, minority populations, rural populations, and others have benefited from the availability of many services provided by direct access dental hygienists. Legislatures and private groups are becoming increasingly aware of the impact that direct access has made on the delivery of oral health care. Many factors continue to drive the growth of direct access care. Additional research is needed to accumulate qualitative and quantitative outcome data related to direct access care provided by dental hygienists and other mid level providers of oral health services.     

Increasing dentists' capacity for secondary prevention of eating disorders: identification of training, network, and professional contingencies

The incidence of eating disorders has increased substantially over the last forty years. Primary care physicians and dentists share a parallel challenge for secondary prevention of anorexia nervosa and bulimia nervosa. The dentist, in particular, has a uniquely important and valuable role with respect to assessment of oral and physical manifestations, patient communication, referral, case management, and restorative care. Despite this crucial role, few dentists are engaged in eating disorder-specific secondary prevention. The purpose of this study was to explore beliefs, attitudes, and experiences of general dentists regarding eating disorder-specific secondary prevention behaviors using focus group methodology. Three ninety-minute focus groups were conducted with twenty-one general dentists (seventeen male, four female) recruited from the 2004 Academy of General Dentistry Leadership Conference. Data from the focus groups were analyzed to identify two over-arching themes and associated subthemes with regard to supports and barriers to eating disorder-specific secondary prevention practices. Analysis of data revealed that training, network, and dental professional contingencies emerged as places of influence for increasing capacity among dentists with regard to secondary prevention of eating disorders. This exploratory assessment identifies leverage points where strategic interventions including curriculum development, policies, and practices can be developed to support and sustain secondary preventive clinical behaviors among dentists.     

Eating disorders in the oral health curriculum

Due to the oral/systemic nature of eating disorders, this serious health issue requires comprehensive patient assessment and coordinated health treatment. The purpose of this study was to assess the breadth and depth of eating disorder and comprehensive care within the dental and dental hygiene curriculum. Survey data were collected from deans of U.S. dental programs (n=24) and dental hygiene program directors (n=94). Statistically significant differences were observed between dental programs (DP) and dental hygiene programs (DHP) as more DHP reported including anorexia nervosa (p<.001), bulimia nervosa (p<.001), and oral manifestations of eating disorders (p=.003) within their curricula. Clock hours dedicated to these topics ranged from seventeen to thirty-five minutes, with no statistically significant differences observed between DP and DHP. Only 58 percent of DP and 56 percent of DHP included patient communication skills specific to eating disorders. Moreover, DHP were observed dedicating more instruction time for this skill (p=.011). As greater emphasis is placed on oral/systemic health and the provision of comprehensive care, many oral health professionals may not be adequately trained to identify, provide education, and communicate with patients regarding the oral/systemic nature of eating disorders. The findings from this study indicate that there is a need for appropriate training to better prepare oral health professionals for comprehensive patient care.     

Eating disorder patients. Recognition and intervention

The prevalence of eating disorders is increasing, as are the chances that one or more of your patients may be suffering from anorexia nervosa, bulimia nervosa, or a combination of these disorders (bulimarexia). Although the dental profession has focused attention on the related oral and dental pathoses that occur in this population, limited information is available in the area of intervention. Recognition of these individuals is only the first step. Should a patient be suspected of having any of these disorders, intervention is the next step, to actually link the patient to medical help. This paper reviews pertinent behavioral characteristics, medical complications, and the oral, dental, and physical manifestations of these disorders in order to aid the dental hygienist in the recognition of eating disorder patients. Guidelines for conducting interventions are provided and sources for referral identified.     

The independent practice of dental hygiene

Dental hygienists are health care professionals specially trained and licensed to provide preventive oral health care and information to patients. In 49 of the 50 states, dental hygienists practice their profession under some type of supervision by a dentist. They are prohibited by state law from practicing independently in their own dental hygiene offices. The independent practice of dental hygiene and the controversial issues concerning dentists and dental hygienists are the issues examined in this article.     

Dental wear as a stomatologic manifestation of bulimia nervosa--a clinical case

The number of patients with anorexia and bulimia nervosa is increasing nowadays. The typical oral feature of these eating disorders is the dental erosion which causes sensitivity of the teeth and esthetic problems for the involved patients. This phenomenon is a characteristic feature in these cases and it may be the first sign of the mentioned disorders. The purpose of the study was to describe the generally the most characteristic oral findings of bulimia nervosa and anorexia nervosa because the dentists play a significant role in recognizing the basic problem of the patients, and they can send them for medical treatment of the serious general problems.     

Oral findings in anorexia nervosa and bulimia nervosa: a study of 47 cases

These two clinically oriented articles deal with problems dentists are seeing more frequently. One hospital dental service sees an average of four to five patients weekly with eating disorders. The first article is a research study discussing problems found in 47 study participants with the eating disorders anorexia nervosa and bulimia nervosa. The second article describes a helpful technique for oral rehabilitation.     

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.     

Preventing tobacco use in Norwegian dental practice

OBJECTIVES: To determine dentists' and dental hygienists' intervention activity towards patients who smoke or use snus (oral moist snuff), and to establish which factors impede interventions and cause variations in approach. METHODS: A questionnaire was mailed to a sample of 1500 dentists (response rate: 68%) and all dental hygienists in the country (522 in all; response rate: 61%). RESULTS: Dental hygienists conversed with patients on smoking habits on average 18 min/week, while the dentists spent 13 min doing the same. The issue of snus-use was discussed, on average, for 3 min. In eight of 10 consultations with patients suffering from tobacco-induced disorders in the oral cavity, the dentists/dental hygienists raised the subject of smoking habits with the patient. In cases without visible tobacco-induced symptoms, inquiries were made concerning smoking habits in three of 10 dentist consultations and four of 10 consultations with dental hygienists. For first-time consultations, six of 10 were queried concerning their smoking habits by their dentist, while dental hygienists enquired in seven of 10 cases. Self-reported skills, perceived barriers and attitudes explained far more of the variance in intervention impact than background variables. There were moderate differences between dentists and dental hygienists. CONCLUSIONS: There is room for improvement in smoking and snus-use prevention efforts in the dental sector. If staff is to be rid of their misconceptions regarding the efficacy of intervention, it is important to inform them about the encouraging results at the population level.     

Eating disorders: identification and intervention

Society's preoccupation with outward appearance and thinness has increased the incidence of both anorexia nervosa and bulimia nervosa, two potentially threatening diseases. Unfortunately, it is difficult to obtain accurate statistics on these eating disorders. Those with an eating disorder are often unwilling to admit they have this disorder and are reluctant to seek help. Subsequently, eating disorders have become a serious concern for medical and dental professionals. Since dental professionals see patients on a regular basis, he/she may be the person to whom the eating disorder patient confides.1 For the same reason, the oral care provider may be the first to notice oral manifestations of disease in the anoretic or bulimic person.2,3 The dental professional can serve as an important link between the person with an eating disorder and professional therapy. Knowledge of the signs and symptoms for these diseases is important because early diagnosis and treatment can result in more successful therapy.     

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 PurposeTo 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 AnalysisNew 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.ConclusionWith 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.     

Communicating with each other

Most dentists commit their professional lives to improving oral health by providing preventive and treatment services to their patients. In addition, dentists often participate in community, professional or legal activities that promote oral health. This paper describes five ways that dentists have worked with each other and with others to enhance oral health: (1) Dentists working with each other to promote oral health without the use of organized dentistry. Described as an example is the experience of all the periodontists in one city in the USA in providing community education. (2) Dental associations organizing or facilitating groups of dentists and other dental health professionals to develop and implement programmes that promote oral health. Two community-based educational efforts stimulated by the American Dental Association are described. (3) Dental specialty associations encouraging and facilitating specialists to work with other dentists to enhance their knowledge and skills in prevention, treatment and appropriate referral. The American Academy of Periodontology's efforts to teach communication skills to periodontists and diagnosis and treatment skills to general practitioners is cited as an example. (4) Dentists working with physicians and other non-dental health professionals to promote oral health. Integrating dental education into childbirth preparation classes for expectant parents is one instance of an interdisciplinary approach. (5) An individual dentist taking a leadership role to positively influence legislation to regulate a harmful substance. The efforts of one dentist to restrict the sale and promotion of smokeless tobacco are described. Working with other dentists, health care providers and legislators represent alternative ways that dentists have affected the oral health of individuals.     

The roles of other dental personnel in the patient care provided by dental hygienists in traditional and nontraditional settings

The information presented in this paper was obtained as part of an ongoing longitudinal study of 1982 dental hygiene graduates. This portion of the study was contracted by the American Dental Hygienists' Association and investigated the roles of personnel other than the dental hygienist in dental hygiene patient care by collecting data on (1) the numbers of personnel by personnel category, (2) the activities that other personnel provide to assist the hygienist in providing care, (3) the frequency at which the dentist evaluates the hygienist's work and (4) the frequency at which the dentist examines the hygienist's patients. In September 1986, mail questionnaires were sent to a cohort of 1,008 dental hygienists who graduated in 1982. Responses were received from 766 subjects--a 76% response rate overall and 77% response rate from subjects with valid addresses. Data were analyzed for clinical dental hygienists working in traditional and nontraditional settings. The median numbers of personnel were similar in both traditional and nontraditional settings; however, the means and standard deviations were larger for nontraditional settings. The most common forms of assistance provided by other personnel were billing and scheduling patients; a greater percentage of hygienists in traditional settings had this type of help. Hygienists were more likely to report that dentists examined their patients rather than evaluated the hygienists' work, and hygienists in nontraditional settings reported less dentist involvement with dental hygiene patient care than did hygienists in traditional settings.     

Dental Hygiene and Research: Irrevocably Connected

Although remarkable growth has occurred in the dental hygiene research arena, an increased emphasis on research development will facilitate the designation of dental hygiene as a true discipline.BackgroundDental hygienists have participated in research for nearly 100 years. Support for research development has increased due to contributions of the American Dental Hygienists' Association and other grant monies that have funded seminal educational endeavors to elevate the research skills of dental hygienists. Dental hygiene initiated research endeavors, the advent of doctoral degree programs in dental hygiene, expansion of the dental hygiene body of knowledge, and efforts toward interprofessional collaboration continue to elevate the profession of dental hygiene while addressing the oral health needs of the public.MethodsThe research focus in dental hygiene is reviewed. Landmark events that have supported research endeavors are described and examples of historically important global contributions made by dental hygienists are chronicled.ConclusionsFurther development of a body of dental hygiene research will help position the profession alongside other academically recognized health care disciplines. A small, dedicated group of dental hygienists have worked toward advancing the profession in this way, but additional growth is essential if dental hygiene is to be considered a true discipline. One such initiative on the near horizon is the doctoral degree in dental hygiene.     

Oral manifestations of eating disorders: a critical review

Background:  Eating disorders (ED) are a group of psychopathological disorders affecting patient relationship with food and her/his own body, which manifests through distorted or chaotic eating behavior; they include anorexia nervosa, bulimia nervosa and ED not otherwise specified and may be burdened with life-threatening complications.
As oral manifestations of ED can occur in many phases of disease progression, they play a significant role in assessment, characterization and prognosis of ED.
Methods:  Mucosal, dental, and salivary abnormalities associated with ED have been reviewed. Relations between oral menifestations and pathogenesis, management and prognosis of ED have been critically analysed.
Results:  Oral manifestations of ED include a number of signs and symptoms involving oral mucosa, teeth, periodontium, salivary glands and perioral tissues; differences exist between patients with anorexia and bulimia. Oral manifestations of ED are caused by a number of factors including nutritional deficiencies and consequent metabolic impairment, poor personal hygiene, drugs, modified nutritional habits and underlying psychological disturbances.
Conclusion:  Oral manifestations of ED can cause impairment of oral function, oral discomfort and pain, and an overall deterioration of aesthetics and quality of life. Their treatment can contribute to overall patient management and prognosis.     

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?     

Dental hygienists vital to sound oral health care

The first Dutch Dental Hygiene School was opened in 1968. Educating dental hygiene professionals with preventive qualifications was a well-considered decision. From the beginning on, the Dutch Dental Hygienists'Association has aimed at optimizing dental hygienists' role in preventive oral health care. Current developments, such as the introduction of a new national health insurance system and the rearrangement of oral health care, require reflection on the position of dental hygienists. Prevention should remain the core business of the dental hygiene profession. However, preventive oral health care has lost its social priority. Therefore, a new campaign preventing development of both old and new oral health threats should be initiated. In the opinion of the Dutch Dental Hygienists' Association, dental hygienists should be committed both to public and individual oral health prevention. The association pleads for the reinforcement of preventive oral health care for children and young adults, with a special focus on high-risk groups. Likewise, oral health care for elderly people should receive more attention.     

Dental professionals' knowledge and perceived need for education in bioterrorism preparedness

Dental professionals should be well prepared to provide care during bioterrorist events. In this study, we assessed the knowledge, opinions about playing various roles during a bioterrorist event, and perceived need for education of dental professionals (dentists and dental hygienists) from one region (Oregon) that had been exposed to bioterrorism and from another region (New England) not exposed. This cross-sectional study used an eighteen-item pretested, self-administered questionnaire distributed at the 2005 Oregon Dental Conference (n=156) and 2005 Yankee Dental Conference (n=297). Dental professionals' knowledge and perceived need for education on bioterrorist preparedness were quantified by multivariate linear and logistic modeling. More than 90 percent of the dental professionals were willing to provide care during bioterrorist events. Perceived knowledge was high; however, actual knowledge was low. Dental professionals who wanted to attend a continuing education course and who thought dental professionals should play more roles during a bioterrorist attack had higher actual knowledge. Willingness to provide care was not supported by adequate knowledge. No significant differences between New England and Oregon dental professionals were observed in terms of actual knowledge or perceived need for bioterrorism education. Integrating training and education into the predoctoral dental and dental hygiene curricula and developing continuing education courses would improve knowledge and better prepare dental professionals to effectively perform American Dental Association-recommended roles during any future bioterrorism events.     

Differences in Characteristics of California Dentists Who Employ Dental Hygienists and Those Who Do Not

BackgroundDental hygienists can increase dentists’ productivity, yet nationwide, one-third of dentists do not employ a hygienist. The profession needs more information on the characteristics of these dentists and their reasons for not employing hygienists.MethodsThe author used a 2003 survey of California dentists and a logistic regression analysis to assess factors independently associated with dentists’ employment of hygienists. These factors included dentists’ personal, practice, population, productivity and patient care characteristics. She also assessed characteristics of dentists who did not employ hygienists and their reasons for not doing so.ResultsDentists who worked full time, employed more administrative personnel, had more operatories, had longer appointments, had more income from private payers and had more elderly patients were more likely to employ hygienists than were dentists with alternative characteristics. Graduates of dental schools outside the United States and those with fewer white patients were less likely to employ hygienists. Reasons for not employing hygienists included personal choice, high costs and not having a sufficient volume of work.ConclusionsThe author's findings suggested that in employing hygienists, dentists consider preferences, practice income and patient demand, among other factors. Further examination of reasons for employing hygienists is warranted.Practice ImplicationsHiring a hygienist increases a dental practice's patient capacity, yet not all dentists can or choose to do so. Policies aimed at increasing dental workforce capacity must take into account dentists’ characteristics and preferences.