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 of the Victorian oral health workforce to the employment and scope of practice of dental hygienists

BACKGROUND: Increasing the number of dental hygienists and expanding their scope of practice are two policy directions that are currently being explored to increase the supply of dental services in the context of projected oral health workforce shortages in Australia. Understanding factors relating to the employment of hygienists and the attitudes of the oral health workforce to dental hygiene practice are important in this policy debate. METHODS: A postal survey of a random sample of Victorian dentists, periodontists, orthodontists and hygienists was undertaken in 2006. Dentists and specialists were grouped into those whose practice employed or did not employ a hygienist. Data on the attitudes of dentists, specialists and hygienists towards various aspects of dental hygiene practice were explored. RESULTS: A response rate of 65.3 per cent was achieved. Hygienists believed that their employment made dental care more affordable (53.7 per cent) and improved access to dental care (88.1 per cent), while few dentists believed hygienists made care more affordable. Most hygienists believed they were capable of diagnosing periodontal disease and dental caries and formulating a treatment plan, but there was less support from employers and non-employers. Dentists were strongly opposed to independent practice for dental hygienists, although there was qualified support from employers for increasing the scope of practice for hygienists. CONCLUSIONS: Dentists who worked with hygienists acknowledged their contribution to increasing practice profitability, efficiency and accessibility of dental services to patients. Hygienists and employers supported increasing the scope of dental hygiene practice, however the majority of non-employers opposed any expansion.     

Is there a shortage of dental hygienists?

Dental hygiene faculty from the Ohio State University, working under a grant from the Ohio Dental Association, surveyed licensed dentists and dental hygienists in Ohio in order to determine work-related concerns and possible solutions to perceived shortages of hygienists. There were 585 respondents from those selected through stratified systematic sampling based on state dental district for a 69% rate of dentist return and a 73% rate of hygienist return. The joint surveys assessed attitudes and documented experiences in several categories: practice background, opinion about hygiene employment shortage, compensation, aspects of hygiene satisfaction, reasons for ever terminating hygiene practice and future conditions persuading a return to hygiene practice. This article, the first in a series, presents findings from the survey of dentists relative to a perceived shortage of clinical dental hygienists. Forty-eight percent of dentist respondents believe that there is a shortage, while 52% are either not sure or believe there is no shortage. Those sensing a shortage have either tried to find a hygienist and could not believe there is a smaller pool to choose from, or have heard that colleagues have been unable to find a hygienist. Solutions to the shortage focus on better recruitment of qualified students, encouraging reentry of non-practicing hygienists, and promoting retention of hygienists in existing practices. Less frequently, dentists suggest starting new hygiene programs or training hygienists by preceptorship.     

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.     

A qualitative study of limited access permit dental hygienists in Oregon

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

International profiles of dental hygiene 1987 to 2001: a 19-nation comparative study

AIM: The purpose of this international longitudinal study is to examine patterns and monitor trends and changes in dental hygiene. METHOD: Information was collected from national dental hygienists' associations through surveys conducted in 1987, 1992, 1998 and 2001. Sample size increased from 13 countries in 1987 to 22 by 2001--of which 19 were included in the analysis. RESULTS: Overall, characteristics of the profession were remarkably similar; most noteworthy was the scope of dental hygiene clinical practice. Regarding historical development, educational programmes and professional organisation, the profession was more similar than dissimilar. Greater variation was evident regarding numbers, distribution, regulation, workforce behaviour, predominant work setting, and remuneration. Over the relatively short 14-year period, several observations were of particular interest: marked increase in the supply of dental hygienists, accompanied by a decline in their ratio to populations and to dentists and a high workforce participation rate; increase in baccalaureate dental hygiene programmes, with a gradual shift from the diploma as the entry-level qualification; and increase in scope of practice and professional autonomy, including for Europe and North America in particular, a decline in mandated level of work supervision and a slight but gradual increase in independent practice. CONCLUSION: By 2001, the profiles reflected the vast majority of the world's population of dental hygienists. Rate of change varied across the countries examined; however, the nature of the change overall was consistent, resulting in a continuing homogeneity in the profession worldwide. Observed trends, changes and persistent issues have implications for service accessibility and technical efficiency and should continue to be monitored.     

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.     

Oral health in pregnancy: educational needs of dental professionals and office staff

Objective: Dental care during pregnancy is important for pregnant women and their children. Comprehensive guidelines for the provision of dental services for pregnant patients were published in 2006, but there is relatively little information about their use in actual practice. The aim of this study was to examine differences in knowledge and attitudes regarding dental care in pregnancy among dentists, dental hygienists, dental assistants, and nonclinical office staff. A secondary aim was to identify sources of influence on attitudes and knowledge regarding the guidelines. Methods: A survey was used to collect information from 766 employees of a Dental Care Organization based in Oregon; responses from 546 were included in the analyses reported here. Results: Statistically significant differences in knowledge were found among the professional‐role groups. Dentists and hygienists consistently answered more items correctly than did other respondents. Within all professional‐role groups, knowledge gaps existed and were most pronounced regarding provision of routine and emergency services. Positive perceptions of providing dental care during pregnancy were associated with higher knowledge scores (z = 4.16, P < 0.001). Conclusions: Updated dental education and continuing education for all dental office personnel are needed to promote the diffusion of current evidence‐based guidelines for dental care during pregnancy.     

Accuracy of dental hygienists in diagnosing dental decay

Abstract During recent decades, the duties and care rendered by Swedish dental hygienists have continuously expanded, and since 1991 they are licensed to practice dental hygiene independently. The aim of the present study was to investigate the accuracy of dental hygienists in examining and recording dental caries in comparison with dentists performing identical examinations. The study included two parts: A) Registration of carious lesions from radiographs of 100 extracted teeth, where the correct diagnosis could be verified, and B) clinical examination and registration of carious lesions in 213 patients. No statistically significant differences could be found between the dental hygienists” and their control dentists' accuracy to diagnose and record dental decay, with the exception of the number of initial lesions (white spot lesions) registered clinically, where the dental hygienists recorded more buccal and lingual lesions. Irrespective of the group of examiners (dental hygienists or dentists), however, the inter-examiner variation was wide. The variation decreased with the size of the lesion and increased with the age of the patient. This study suggests that no patient with a restorative treatment need would have been neglected if the dental hygienists had performed the examination, and, possibly, a more accurate non-restorative treatment need would have been addressed.     

Utilisation of dental auxiliaries--attitudinal review from six developed countries

OBJECTIVE: To identify reasons for the development of dental auxiliaries across six developed countries and to explore attitudes towards them. DESIGN: Literature review; semistructured interviews with key informants. SETTING: Interviews in each selected country; Belgium, Greece, Finland, U.K., Canada and New Zealand. MATERIALS AND METHODS: For each country, representatives of key informants were interviewed. RESULTS: The introduction of dental auxiliaries in many countries was as a result of workforce shortages. There has been no development of dental auxiliaries in Belgium or Greece largely because of perceived lack of need by the representative respondents. In Canada, Finland, New Zealand and the U.K. the introduction of clinical dental auxiliaries was a result of shortages of workforce and high levels of disease. Concerns amongst dentists were about the pace of the increased scope of practice for auxiliaries and by auxiliaries about lack of career development. CONCLUSIONS: Two distinct professional attitudes towards dental auxiliaries were found--in Belgium and Greece, there is little or no support compared with the other countries, where, in general, professional attitudes support the use of dental hygienists but are less supportive of therapists and denturists.     

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.     

Working relationship between dentists and dental hygienists: their perceptions

The purpose of this study was to reexamine the working relationship between the dentist and the dental hygienist with regard to delegation and professional interaction. A questionnaire was mailed to Michigan dentists and dental hygienists to acquire data regarding dental hygiene practice, office procedures, and employer/employee interaction. Of the 500 dentists surveyed, 289 (58%) returned questionnaires, and of the 360 hygienists surveyed, 298 (83%) returned questionnaires. The dental hygienists' perception of their practice is significantly different from the dentists' in several major areas. More than half of the dentists reported checking the hygienist's work all of the time, whereas only one third of the hygienists reported always being checked. Assessment of patient needs by a clinical caries examination is perceived differently. Most of the hygienists reported they perform clinical caries examinations all of the time, whereas only two thirds of the dentists reported the hygienist always performs an examination. Delegation of auxiliary procedures is viewed similarly by both dentists and hygienists, but procedures which can be performed are not being delegated. With respect to professional communications, half of the dentists perceive that they provide feedback to the hygienist all of the time, while only one third of the hygienists feel they receive feedback all of the time. In determining the recall interval, most of the dentists reported establishing it in consultation with the hygienist, whereas half of the hygienists reported setting it alone. Data suggest that the dentists' perceptions are inconsistent with the hygienists' in role delineation and patient care.     

The professional role of the dental hygienist as viewed by accreditation commissioners and consultants.

Members of the Commission on Accreditation of Dental and Dental Auxiliary Educational Programs and of its associated Committee D (Committee on Dental Hygiene) were asked a series of questions designed to elicit their positions on (1) the occupational status of dental hygiene in society at large and in the social prestige hierarchy of the dental profession, (2) reference groups for dental hygienists, (3) ethical norms for the hygienist role, (4) revivalism movements within dental hygiene, and (5) images of the "ideal dental hygienist." Results indicate that commissioners and consultants see dental hygienists as (1) ranking 7.1 on a ten-point scale of professional status in the community-at-large, (2) somewhat lower than dentists but higher than other auxiliaries in the social hierarchy of the dental profession, (3) socially referenced to dentists rather than hygienists, (4) primarily oral health educators with strong clinical skills, (5) better educated and more skilled now than they have ever been before, (6) bound to essentially the same ethics as dentists, except for self-regulation, and (7) much too aggressive at the national level for their own good. The ideal dental hygienist was seen as a behavioral change specialist with (1) clinical skills, (2) an attitude of service to patients (3) a willingness to work with dentists to increase the scope of dental hygiene duties in the preventive and periodontal areas, and (4) a willingness to leave the decisions regarding the profession of dental hygiene to dentists.     

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.     

Preceptorship: the impact on Georgia dental hygiene education

The perceived imbalance between the supply of and demand for practicing dental hygienists has encouraged organized dentistry to pressure legislators for revisions in state practice acts. Georgia's recent experience with this type of legislation has required dental hygiene educators to develop, implement, and evaluate strategies that would increase the pool of available dental hygienists. The purpose of this paper is to present a review of strategies that were developed by Georgia dental hygiene educators to meet the recommendations spurred by proposed legislation in the General Assembly of Georgia. Dental hygiene program directors were charged by the chancellor of the University System of Georgia to improve student recruitment and retention, to explore the feasibility of new programs in areas of need, and to examine innovative ways to improve access to dental hygiene education. Dental hygiene faculties united with their professional association to activate alumni and registered hygienists, to improve public awareness by accentuating positive aspects of dental hygiene careers, and to organize a communication network whereby legislative information could be disseminated rapidly. Student recruitment was strengthened through individual and joint programs organized by dentists and dental hygienists. In response to these efforts, program enrollments were increased substantially, and a new program was established in an area of need. Nationally, dental hygienists are facing many challenges and problems that threaten to weaken or eliminate their status as educated and competent health professionals. Recently, dental and dental hygiene educators' attention was drawn to legislative activity in Georgia.     

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.     

Impact of faculty and work role models on the professional socialization of dental hygienists

The purpose of this study was to identify and assess the degree of influence dental hygiene role models in education and practice have on the professional socialization of recent dental hygiene graduates. Professional socialization was measured by two constructs: attitudes toward professionalism and interpersonal values. This study compared responses on attitudes and values scales of 1985 dental hygiene graduates who indicated they did or did not identify with a dental hygiene role model in school and at work. A comparison of responses on five other control variables also was assessed in relation to attitudes and values. Results showed that those respondents who identified with a role model in school held significantly stronger attitudes on the professional organization as major referent variable. However, graduates who did not identify with a faculty role model held stronger values on independence. Respondents who identified with a dental hygiene role model in practice held stronger values on benevolence but those who did not have a role model at work held stronger values on independence. There were no statistically significant differences between groups with or without a work role model on the attitudes scales.     

Research utilization among dental hygienists in Sweden--a national survey

Over the last decade evidence-based practice has become increasingly important in health care as an approach to improve patient outcomes. It is vital that dental hygienists, like other health professionals, use research findings to inform clinical practice. The objective of the present study was to investigate the extent of research utilization among dental hygienists in Sweden and to investigate the relationship between level of education and factors related to research utilization. A random sample of 261 dental hygienists in Sweden, 113 with 1 year and 148 with 2-year education, responded to a postal questionnaire covering various aspects of research utilization, i.e. their attitudes towards research, availability and support for the implementation of research findings, use of research in daily practice, their activity in seeking new research findings and their participation in a range of research-related activities. Dental hygienists with 2-year education had a more positive attitude towards research, used research to a greater extent and were more active in seeking new research findings than dental hygienists with 1-year education. Overall, relatively few dental hygienists reported that they implemented research findings in practice; the most frequently reported activity concerned reading research articles in professional journals. The conclusions are that the length of dental hygiene education is a key factor influencing the application of research findings to practice. One-year education appears to be inadequate to achieve evidence-based practice. Moreover, not even two years of formal education guarantees necessary competence in research for evidence-based dental hygiene practice.     

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?     

Tobacco use cessation curricula in the U.S. dental schools and dental hygiene programs

Tobacco-related health problems are the most preventable forms of illness in the United States. By assuming proactive tobacco use cessation counseling roles, dentists and dental hygienists can help reduce the number of people who currently use tobacco. The literature reports that many oral health professionals feel unprepared to assume such roles. To help combat the problem of tobacco-related illness and to help prepare dentists and dental hygienists to assume tobacco use cessation counseling roles, dental schools and dental hygiene programs need to develop appropriate didactic and clinical tobacco use cessation curriculum content. To date, there are limited national data addressing the extent of tobacco use cessation education in dental schools and dental hygiene programs. Studies of medical schools have revealed a need for increased curriculum content on tobacco use prevention and cessation. Further, tobacco use cessation training programs for medical students, practicing dentists, and dental hygienists have resulted in increased student and provider confidence when tobacco use cessation counseling roles were assumed. This study surveyed all dental schools and dental hygiene programs in the U.S. to determine if tobacco-related curriculum content exists, and if so, to what extent. Variables addressed included allocated hours, subject content, scope, department responsible, workplace smoking policy, importance, and future curricular directions. Questionnaires were mailed to all dental hygiene program directors and dental school academic deans. Study findings suggest that dental and dental hygiene students receive limited tobacco use cessation education, and respondent schools have no immediate plans for curriculum change in this area.(ABSTRACT TRUNCATED AT 250 WORDS)