Attitudes among dentists and dental hygienists towards extended scope and independent practice of dental hygienists

Aims: Attitudes of dentists and dental hygienists towards extended scope and independent dental hygiene practice are described in several studies, but the results are heterogenous. The purpose of this systematic review was to compare the attitudes of dentists and dental hygienists towards extended scope and independent dental hygiene practice. Methods: PubMed, AMED and CINAHL were screened by two independent assessors to identify relevant studies. Only quantitative studies that reported the percentages of dentists'' and dental hygienists'' attitude towards extended scope and independent dental hygiene practice were included. The random-effects model was used to synthesise possible heterogenous influences. Results: Meta proportions with regard to a positive attitude towards extended scope of practice are 0.54 for dentists and 0.81 for dental hygienists. Meta proportions of a positive attitude towards independent practice are 0.14 for dentists and 0.59 for dental hygienists. A meta analysis with regard to negative attitudes could only be performed on extended scope of practice and did not reveal a difference between the two professions. We obtained homogeneous outcomes of the studies included regarding negative attitudes of dentists . A minority of dentists hold negative attitudes towards extended scope of dental hygiene practice. Study outcomes regarding negative attitudes of dental hygienists were heterogeneous. Conclusions: Positive attitudes are present among a majority of dentists and dental hygienists with regard to extended scope of dental hygiene practice, while for independent dental hygiene practice this holds for a minority of dentists and a majority of dental hygienists.Key words: Dental practice, general dental practice, hygienist, oral health policy, primary oral health care     

Attitudes to independent dental hygiene practice: dentists and dental hygienists in Ontario

This study examined Ontario dentists' and dental hygienists' attitudes to independent dental hygiene practice and changing the scope of practice. Data were collected from a mail survey of a systematic, stratified sample of Ontario dentists (483 respondents) and dental hygienists (437 respondents) conducted in the winter and spring of 2002 to assess what practising dentists and dental hygienists think about independent practice and other professional issues. Contrary to previous research, this study found that male and female dentists did not differ in their attitudes to independent dental hygiene practice and university education for dental hygienists: both strongly opposed the former and tended to support the latter. Similarly, few differences in attitude amongst dentists by specialty were found. Dental hygienists were generally supportive of independent practice and of expanding their scope of practice. On some measures, however, sex and age differences in attitudes were evident: at times dental hygienists who were older or male seemed to be stronger advocates for professional change than others.     

Supervision and practice of dental hygienists: report of ADHA survey

In 1986, the American Dental Hygienists' Association (ADHA) funded a study to examine demographic and practice data concerning the dental hygiene profession. The purpose of this survey was to establish a data base for the current practice of licensed dental hygienists in the United States. Information was collected on the type of supervision under which hygienists worked and the type of supervision they would prefer. Using a stratified random sampling technique, questionnaires were sent to licensed member and nonmember dental hygienists residing in the United States. A total of 9,110 hygienists received surveys and after a second mailing to nonrespondents, a total of 4,522 completed surveys were received, for a response rate of 49.6%. This survey indicates that hygienists' attitudes toward supervision are changing. Although the majority of hygienists still work in a private practice where a dentist is present and usually examines the patient, over half of the respondents prefer that the dentist's presence in the facility not be required. In examining practice behaviors, a collaborative relationship appears to exist between the hygienist and dentist when treating both new and recall patients. The collaborative relationship decreases with the dental hygienist demonstrating an increase in responsibility and independent decision making for recall patients. Traditional practice behaviors are also changing to include more comprehensive dental hygiene services, particularly by baccalaureate degree hygienists.     

A survey of Canadian pediatric dentists: practice characteristics and views on dental education

The success of caries prevention in the developed countries has resulted in a marked decline in dental disease, especially in pediatric divisions of dental faculties, where an acute problem is finding patients to provide students with the clinical experience they will require in practice. It has become apparent that this changing disease pattern should be accompanied by a re-thinking of educational strategies and objectives to mirror the times and projected trends. While changes in educational strategies will likely be initiated from within the dental faculties, debate and discussion should include those in private practice as well as the academic field. With this in mind, 85 pediatric dentists nation-wide were surveyed regarding their views on educational matters as well as characteristics of their practice and their general profiles. There was widespread agreement on the need for changes in educational strategies and suggestions were made regarding the directions these changes should take.     

Disinfection and sterilisation: the duties and responsibilities of dentists and dental hygienists.

Disinfection and sterilisation have received a considerable amount of attention due to the spread of AIDS in the past few years. There appears to be a low risk of occupational transmission of HIV, but this is not the case with other transmissible diseases. There are about 40 infection hazards for the patient and dental personnel in the dental surgery. Disinfection and cleaning are important in disease containment and cross-infection control, and all members of the dental team must bear responsibility for this. Disinfection of hands, surfaces, instruments, impression materials, radiographic units and suction systems are discussed. In addition, sterilisation and hygiene management of the reception area are considered. The duties and responsibilities of the dental team are emphasised.     

Disaster response in Illinois: the role for dentists and dental hygienists

Taking a leadership role, the Illinois Department of Public Health's Division of Oral Health has helped to successfully integrate oral health professionals into the emergency medical response system in Illinois by raising awareness, building needed partnerships, identifying and garnering resources, and facilitating training, policy development, surveillance, and evaluation. Applying the same principals and standards to the integration of oral health and disaster preparedness and response as it does to all facets of dental public health, the division has partnered with the Disaster Emergency Medicine Readiness Training Center at the University of Illinois at Chicago and many other key stakeholders to cement oral health as an integral component to the public health response system in Illinois.     

Attitudes of Ohio dentists and dental hygienists on the use of automated external defibrillators

The American Heart Association reports that approximately 220,000 people die each year of sudden cardiac arrest. In ventricular fibrillation (VF), the most common abnormal heart rhythm that causes cardiac arrest, the heart's electrical impulses suddenly become chaotic, often without warning. Death will follow within minutes if the victim is not treated appropriately, and the only known treatment is defibrillation. An automated external defibrillator (AED) can restore a victim's normal heart rhythm by providing defibrillation. The purpose of this study was to gather data from dentists and dental hygienists in Ohio on their use of and attitudes toward using AEDs in dental offices. Six percent of Ohio dentists and dental hygienists were randomly selected to receive a twenty-three question survey related to their use of and attitudes toward their use of AEDs in dental offices. Thirty-three percent (244) of the surveys were returned; 41 percent of the respondents were dentists, and 59 percent were dental hygienists. Six percent said they have had to administer nitroglycerin to a patient during a dental visit; 5 percent have performed CPR on a patient in the dental office; and 78 percent said their last CPR training course included training on an AED. Eleven percent said there was an AED at their dental office. With the increased likelihood of dealing with a cardiac emergency in the dental office setting and the willingness of dental professionals to use an AED, all dental offices should consider obtaining an AED. Dental educators should become familiar with current protocols for handling cardiac medical emergencies in the dental office and prepare dental and dental hygiene students with the skills necessary to manage patients with cardiac emergencies. Graduating dental students entering private practice may want to consider the AED as part of their medical emergency office protocol.     

Medical emergencies in dental practice and choice of emergency drugs and equipment: A survey of Australian dentists

This is a report of a postal questionnaire survey of 1250 general dental practitioners regarding occurrence of medical emergencies and their choice of emergency drugs and equipment. The response rate was 65 per cent and the results showed that about one in seven practitioners had had to resuscitate a patient. The most common medical emergencies were adverse reactions to local anaesthetics, grand mal seizures, angina pectoris and hypoglycaemia (insulin shock). Nearly all respondents (96 per cent) believed that dentists need to be competent in cardiopulmonary resuscitation, just over a half (55 per cent) felt they were competent in CPR on graduation and a similar, figure (57 per cent) felt they could perform effective single person CPR for five minutes. Almost twothirds (64 per cent) had undertaken CPR courses since graduation. Additionally, the most commonly kept emergency drugs were oxygen (63 per cent) and adrenaline (22 per cent), while the most commonly kept emergency equipment was a manual resuscitator (recoil bag-valve-mask type) which was kept by 27 per cent of the practitioners.     

A national survey of dental hygienists: working patterns and job satisfaction

OBJECTIVE: To describe the working practices and level of job satisfaction of dental hygienists in the United Kingdom. DESIGN: Postal questionnaire survey of 3,955 dental hygienists registered with the General Dental Council. Replies were received from 2,533 (64%). RESULTS: At the time of the survey only a small proportion of respondents (11%) were not working as dental hygienists, the most common reason for a current career break being child rearing. The majority of dental hygienists (78%) were employed in general dental practices, and most worked in more than one practice (64%). Approximately half worked part-time (fewer than 30 hours per week), and part-time working was more common amongst those respondents with childcare responsibilities. In the region of 60% of respondents had taken one or more career breaks during their working life, and the average total duration of career breaks was 11 months, the most common reason for all career breaks was child rearing. Additional qualifications had been gained by 35% of the sample, a high proportion (75%) had attended training courses in the previous year. The respondents expressed a high degree of job satisfaction, those who were older and who had childcare responsibilities expressed higher levels of job satisfaction. CONCLUSIONS: Dental hygienists express a high level of job satisfaction. A proportion take breaks in their career, most commonly for pregnancy and child rearing. The majority return to part-time employment after their career break. Planning of future requirements for the training of professionals complementary to dentistry should be informed by a consideration of the working patterns of dental hygienists.