Caries preventive methods in child dental care reported by dental hygienists,Norway, 1995 and 2004

Dental hygienists are used as first-line personnel in child dental care in Norway, and have an increasing influence on the delivery of preventive dental services. The purpose of this study was to describe: (1) preventive methods reported by hygienists in child dental care in Norway and (2) changes in preventive care during the 9-year period 1995 to 2004. Questionnaires were sent to all dental hygienists in the public dental services in Norway in 1995 and 2004; 70% (199 of 286) were returned in 1995 and 71% (210 of 297) in 2004. The hygienists considered one-third of children to be at risk of caries and spent 45 min of preventive care on these children every 16th month, while the remaining children were given 15 min of prevention every 20th month. One-third of the hygienists provided fluoride varnish for all children and one-fourth placed sealants routinely. Ninety percent of the hygienists reported that all children were given information on diet, hygiene, and fluoride. Most of the preventive practices of dental hygienists reflected limited changes in the period 1995 to 2004. However, the hygienists had reduced the use of fluoride varnishes and less often recommended fluoride tablets. The majority of hygienists reported that they individualized clinical prevention, while individual oral health information was standardized and given to all children. The results indicate that in 2004 a preventive approach combining individual information for all with intensified clinical prevention for children considered at risk was followed in child dental care.     

Use of dental hygienists and returns to scale in child dental care in Norway

Abstract The purpose of this study was to investigate, in the provision of dental care for children, technically and economically efficient combinations of dentists and dental hygienists and to study returns to scale by analyzing production functions. Data from 137 dental health clinics were analyzed. Output was registered as the number of 3–18-yr-old children to whom the clinic delivered complete dental care. Resource input was registered as hours spent by dentists, denial hygienists and dental assistants to deliver care to the children. The average clinic that employed dental hygienists used one hygienist hour per three dentist hours for child dental care. It would save dentist time, but not costs, to extend the use of hygienists. Increased use of dental hygienists might be economically efficient if the work distribution between the personnel groups were changed, for example, by delegating more examinations and preventive care to hygienists. There were technical opportunities for further substitution of dental hygienists for dentists both by introducing dental hygienists in the clinics that only used dentists in child dental care and by extending use of hygienists in clinics that already employed hygienists. This study found no productivity gain from centralizing treatment of children in large dental clinics.     

Recall intervals, dental hygienists and quality in child dental care

Abstract Decline in dental disease and the need to provide dental care efficiently suggest changes in clinical and administrative routines in public dental care provision for children. A field project in Norway demonstrated productivity gains after the introduction of individualized recall intervals and using dental hygienists to conduct recall examinations. The purpose of the present study was to assess changes in the quality of dental health outcome and changes in the quality of the process of dental care provision. Recall intervals were increased from a target of 12 months to 16 and 18 months in two districts. Dental hygienists undertook all recall examinations and referred to dentists those patients who required operative care. Bitewing radiographs were inspected for all 18-yr-olds who were examined in 1989, 1990 and 1991 (n=956) and for those who were examined before the changes were implemented in 1987 (n=300). For each child, approximal caries on 24 surfaces was scored according to a 4-point severity scale. Clinical records were examined to determine what treatment had been provided. For each year after the changes were implemented, the quality of health outcome was assessed by comparing the radiographic caries prevalence and the number of sound surfaces with 1987 data. Quality in the process of care provision was indicated by the treatment decisions for approximal caries and by the proportion of uninterpretable surfaces on radiographs for each study year. The mean number of sound surfaces increased over time. A declining proportion of sound surfaces was restored over the study period, and almost all caries lesions extending deep into dentine were restored. Radiographic quality improved during the project period. The overall finding was that the changes to clinical and administrative routines were not associated with major changes in the quality of care provided in the short run.     

Task division between dentists and dental hygienists in Norway

Abstract – Objective: The aim of the study was to investigate the attitudes among dentists and dental hygienists to the policy objective in Norway of delegating more dental work from dentists to dental hygienists. Method: A questionnaire was mailed to a random sample of 1111 dentists and 268 dental hygienists in 2005. The response rates were 45% (504) among the dentists and 42% (112) among the dental hygienists. The survey sought to explore any discrepancies between current and preferred mix of different work tasks, as well as attitudes to the idea of substituting dentists with dental hygienists for certain work tasks. Logistic regression was used to analyse how answers differed by respondent characteristics. Results: Dentists spent only half of their total working hours on complex dental services, i.e. tasks that only dentists are skilled to undertake. Nearly 40% of their time was spent on tasks that dental hygienists are qualified to perform; examinations, screening and basic treatments. Still, the mix of work tasks that dentists preferred would involve slight changes: on average only 2% points more complex treatment and 3–4% points less of those tasks that dental hygienists are permitted to provide. Seemingly contrary, as many as 60% of dentists answered that it was ‘desirable to delegate’ more tasks to dental hygienist. However, only 21% of the dentists agreed that dental hygienists should be the entry point for dental services. Dental hygienists would prefer to do relatively more basic treatments and fewer examinations and screening, and the vast majority among them supported the idea that they could be the entry point for dental services. Conclusion: The results suggest that there will not be major changes in the division of labour between dentists and dental hygienists in Norway, if dentists are to be held responsible for taking such initiatives. Although dentists agree that more of their current work could– in principle – be delegated to dental hygienists, they do not prefer to reduce much of their own current activity of those work tasks that dental hygienists are qualified to perform.     

Answers from dentists, dental hygienists and dental assistants to questions asked by patients concerning preventive dental matters

142 dentists, 21 dental hygienists and 35 dental assistants were asked lo fill in a questionnaire which consisted of 40 questions about preventive dental matters regularly asked by Dutch dental patients. The 40 questions were submitted to experts in the field of preventive dentistry. The experts were in agreement on 26 questions. It was decided to use these questions for analysis. The average percentage of correctly answered questions was: for the dentists 53%, for the dental hygienists 58% and for the dental assistants 37%. The group of 142 dentists was further analyzed. It appears that the knowledge about preventive dental matters increases subsequently with each year of gradual ion. Analysis of the dentists who graduated from Dutch dental schools in their capacity as private practitioner, as faculty member or in the school dental service, revealed that there was no difference in knowledge between these groups. With some reservations the conclusion can be stated that an obvious necessity exists for post-academic courses in preventive dentistry in the groups concerned. Greater uniformity is needed between the views of the experts and the dental professionals who treat patients daily.     

Attitude of dental hygienists,general practitioners and periodontists towards preventive oral care: an exploratory study

Introduction: Promoting oral hygiene and stimulating patient''s responsibility for his/her personal health remain challenging objectives. The presence of dental hygienists has led to delegation of preventive tasks. However, in some countries, such as Belgium, this profession is not yet legalized. The aim of this exploratory study was to compare the attitude towards oral-hygiene instructions and patient motivational actions by dental hygienists and by general practitioners/periodontists in a context without dental hygienists. Materials and Methods: A questionnaire on demographics (six items), oral-hygiene instructions (eight items) and patient motivational actions (six items) was distributed to 241 Dutch dental hygienists, 692 general practitioners and 32 periodontists in Flanders/Belgium. Statistical analysis included Fisher''s exact-test, Pearson''s chi-square test and multiple (multinomial) logistic regression analysis to observe the influence of profession, age, workload, practice area and chair-assistance. Results: Significant variance was found between general practitioners and dental hygienists (in 13 of 14 items), between general practitioners and periodontists (in nine of 14 items) and between dental hygienists and periodontists (in five of 14 items). In addition to qualification, chair-assistance was also identified as affecting the attitude towards preventive oral care. Conclusion: The present study identified divergence in the application of, and experienced barriers and opinions about, oral-hygiene instructions and patient motivational actions between dental hygienists and general practitioners/periodontists in a context without dental hygienists. In response to the barriers reported it is suggested that preventive oriented care may benefit from the deployment of dental hygienists to increase access to qualified preventive oral care.Key words: Dental hygienists, general practitioners, periodontists, oral-hygiene instruction, patient motivation, questionnaire study     

Caries experience among publicly-funded dental patients in Australia, 1995-96: type of care and geographic location

Health card holders are a financially disadvantaged group and are the target population eligible for publicly-funded dental care. While their health status is generally worse compared with other Australians, there is also considerable variation among card holders. The aims of this study were to describe the oral health status of publicly-funded dental patients by type of care, geographic location and age, and to compare trends over time against other Australian studies. Patients were sampled randomly, based on date of birth, by State/Territory dental services in 1995-96. Dentists recorded oral health measures at the initial visit of a course of care using written instructions, but there was no formal calibration. The 6109 patients sampled were weighted in proportion to the numbers of publicly-funded dental patients for each State/Territory. Multiple linear regression analysis indicated that caries experience measured by the DMFT index increased across older age groups (p < 0.05). For rural compared with urban patients, mean numbers of decayed and filled teeth tended to be higher. For emergency compared with non-emergency care, mean numbers of decayed and missing teeth were higher, and filled teeth lower. The findings of this monitoring survey document high levels of previous disease and treatment and indicate variation between subgroups of users of publicly-funded dental care. This included an uneven geographic distribution of oral health and disease, and variation in unmet treatment needs by type of course of care. Temporal comparisons indicate publicly-funded patients have experienced the population trend towards lower levels of tooth loss over time but have higher levels of untreated decayed teeth compared with the general population.     

Working profiles of dental hygienists in public and private practice in Finland and Norway

Abstract: Aim: The aim was to compare the working profiles of Finnish and Norwegian dental hygienists in public and private practice. To this end, we compared the procedures performed, the type of patients and the time devoted to different tasks. Subjects and methods: A questionnaire survey was originally conducted among a representative sample of dental hygienists in Finland (n = 595) and all authorized dental hygienists in Norway (n = 1 138) in 2004. The questionnaires collected data on the dental hygienists’ age, gender, year of graduation, working experience, work sector (private or public), working time spent on different activities and patient groups. The questionnaire also assessed how frequently the dental hygienists performed 25 different treatment measures. Results: The Norwegian dental hygienists spent 45.4% of their clinical time on check‐ups, whereas the Finns spent 49.9% of their time scaling. Dental hygienists in Finland and Norway working in the public sector spent 42.9% and 74.6% of their working time dealing with children and youth respectively. Conclusions: The working profiles of dental hygienists in Finland and Norway were quite similar, although differences in distribution by activities, type of patients and treatment measures do exist. The main activity of the dental hygienists was clinical work. The most commonly practised clinical activity among Finnish dental hygienists was scaling, and among Norwegians, check‐ups. Public dental hygienists in both countries dealt mainly with children and youths. Oral hygiene instruction was the most commonly reported treatment measure among both Finns and Norwegians.     

Caries risk assessment, prevention, and management in pediatric dental care

The recent increase in the prevalence of dental caries among young children has highlighted the need for a new approach to prevent caries in children at a younger age. New disease prevention management models call for children to have their first visit to the dentist at age 1 or when their first tooth erupts. This article addresses early childhood caries risk assessment, prevention, and management strategies in young children using the concept of the "dental home" and a simple six-step protocol to conduct an effective and comprehensive infant oral care visit.     

Caries increment in children aged 3-5 years in relation to parents' dental attitudes: Oslo, Norway 2002 to 2004

Abstract – Objectives: To assess the relationship between parents’ dental attitudes and the caries increment in their children from the age of 3 to 5 years. Methods: Data based on parental questionnaires and dental examinations were collected from children participating in a follow‐up study from age 3 years (n = 354) in 2002 to 5 years (n = 304) in 2004. The children were categorized as western‐native (WN) and immigrants (IM). The items used were significantly related to caries experience in a multicentre study [ 1 Community Dent Health, vol. 21, pp. 121–30]. The responses to attitudinal items were weighted as positive if they would promote good dental health, and negative if not. Composite attitudinal variables relating to hygiene, diet and indulgence were calculated as a summation of the weighted responses to selected items. Regression analyses (bivariate and multiple) were performed to assess associations during the period between the attitudinal predictors/other control variables and caries increment (Δd_3‐5mfs). Results: Bivariate logistic regression analyses revealed that ‘Attitude to Diet’ and ‘Parental Indulgence’ were clearly related to caries increment. The more exposed children were to negative parental attitudes, the higher the OR. ‘Attitude to Diet’ also persisted in a multiple logistic regression model, showing a higher OR value than caries experience. ‘Immigrant Status’ was the most potent predictor of caries increment. Parents were found to be more indulgent among IM than among WN groups. Conclusion: Parental dental attitudes are clearly shown to be associated with caries increment in early childhood. The relationship is of such strength that it deserves to be taken into account in future preventive dental strategies.     

Relationship between age, dental status and regular dental care in Norway illustrated by a model

The purpose of this paper was to describe the relationship between age, dental status, and patterns of dental visits. Data from a national health survey of 11,014 persons in Norway 1975 were used. The model shows that though the absolute number of regular attenders decreased with increasing age their relative number among dentate persons increased with increasing age. Different examples of how the model may be used are described. Finally three explanations are given of the dental attendance pattern among Norwegian adults.     

Utilizing dental hygienists to undertake dental examination and referral in residential aged care facilities

Hopcraft MS, Morgan MV, Satur JG, Wright FAC. Utilizing dental hygienists to undertake dental examination and referral in residential aged care facilities. Community Dent Oral Epidemiol 2011; 39: 378–384. © 2011 John Wiley & Sons A/S Abstract – Objective: The Australian population is ageing, and a growing proportion of elderly Australians are now living in residential aged care facilities (RACFs). These residents are commonly dependent on others for their daily oral hygiene care and often display high levels of plaque and calculus. With declining edentulism rates, periodontal disease is becoming more prevalent in this population. The aim of this study was to investigate the ability of a dental hygienist to undertake a dental examination for residents of aged care facilities, devise a periodontal and preventive treatment plan and refer patients appropriately to a dentist. Methods: A total of 510 residents from 31 Victorian RACFs were examined, with 275 dentate residents included in this study. Between May 2005 and June 2006, residents were examined by a single experienced dental epidemiologist and one of four dental hygienists using a plane mouth mirror and periodontal probe. Results: A total of 510 residents from 31 RACFs had a dental examination from a dentist and one of four dental hygienists. The treatment needs of residents examined were high, with nearly all of the 275 dentate residents requiring preventive and periodontal treatment, and three‐quarters requiring referral to a dentist for treatment. There was excellent agreement between the dentist and hygienists regarding the decision to refer residents to a dentist for treatment, with high sensitivity (99.6%) and specificity (82.9%). Only 8.0% of residents were referred by a hygienist to a dentist when the dentist considered that no referral was required. Conclusions: Dental hygienists have the skills and knowledge necessary for undertaking a dental examination for residents, correctly identifying the majority of residents who require a referral to a dentist. They are capable of formulating appropriate dental hygiene treatment plans for residents of aged care facilities. It is recommended that there should be greater utilization of hygienists in the provision of dental care to residents of aged care facilities, as a safe, efficient and effective use of health resources.     

Professional oral health care by dental hygienists reduced respiratory infections in elderly persons requiring nursing care

Abstract:  Objectives:  Respiratory infection is a major cause of death in the elderly. We have evaluated the role of professional oral health care (POHC) by dental hygienists in reducing respiratory infections in elderly persons requiring nursing care. Methods:  Two populations of elderly persons, one receiving POHC and one not, were examined to determine numbers of microorganisms, potent pathogens of respiratory infection, enzymatic activity in saliva, fevers, prevalence of fatal aspiration pneumonia and prevalence of influenza. Results:  In the first population, we found a high prevalence of potent respiratory pathogens such as Staphylococcus species, Pseudomonas aeruginosa and Candida albicans. Patients who received POHC showed a lower prevalence for these pathogens than those who did not. The ratio of fatal aspiration pneumonia in POHC patients was significantly lower than that in patients without POHC (non-POHC) over a 24-month period ( P  < 0.05). The prevalence of a fever of 37.8°C or more in POHC patients was significantly lower than that in the non-POHC group ( P  < 0.05). In the second study population, we investigated the effects of POHC on infection with influenza over a 6-month period. In the POHC group, neuraminidase and trypsin-like protease activities decreased, and one of 98 patients was diagnosed with influenza; whereas, in the non-POHC group, nine of 92 patients were diagnosed with influenza. The relative risk of developing influenza while under POHC was 0.1 (95% CI 0.01–0.81, P  = 0.008). Conclusion:  These results suggest that POHC by dental hygienists is effective in preventing respiratory infections in elderly persons requiring nursing care.     

Caries preventive services for children and adolescents in Denmark, Iceland, Norway and Sweden: strategies and resource allocation

Abstract– According to the dental acts of Denmark, Iceland, Norway and Sweden, emphasis is placed on preventive dental care. The purpose of this study was to describe and compare two aspects of the caries preventive services: the strategies and the resource allocation for preventive dental care of children and adolescents in Denmark, Iceland, Norway and Sweden. Questionnaires were sent to samples of dentists and other dental personnel who provided preventive care to children during 1995 and 1996. Comparisons between the countries showed significant differences in recall routines and in implementation of risk-based and population-based preventive strategies. Multivariate analyses showed that the time used for preventive care varied by country and was not associated with the DMFT of the children. More time was allocated for prevention when more operating dental auxiliaries were available at the clinic, when the recall interval was shorter, when the time used for routine examination was longer and when the clinician was an auxiliary rather than a dentist. In conclusion, resource allocation and strategies used for prevention were not consistent between the countries.     

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.