Patient orientation and professional orientation of Dutch dentists

By providing dental health care, dentists dedicate themselves to the preservation and/or improvement of oral health in their patients. By adequately carrying out this care providers' role, dentists will gain recognition, esteem and respect from both patients and colleagues. This analysis aims to assess the patient and professional orientation of dentists and investigate which of their personal and practice characteristics can be regarded determining for these two aspects of their role as care providers. In the year 2000, data was collected via a written questionnaire sent to a random, stratified sample of 790 dentists, of whom 607 (77%) responded. Multivariate regression analysis shows that the preventive treatment concept, professional satisfaction and the number of hours per week that household tasks are performed are positive determinants for dentists' patient orientation. Also, the longer dentists are active in their profession, the more patient oriented they will be, and with more hours per week support from oral hygienists they are less patient oriented. As for professional orientation, dentists' preventive treatment concept and their professional satisfaction can also be considered positive determinants. Furthermore, dentists are more profession oriented when their partner works in the practice, with more hours per week support from oral hygienist(s) and with more collaboration contacts with other care providers. Compared to men, women are on average less profession oriented. Among Dutch dentists, there exist clear differences in the way they take on their role as care providers with regard to patient orientation and professional orientation.     

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.     

Factors Associated with Fissure Sealant Delegation: Dentist Characteristics and Office Staffing Patterns

The purpose of this research was to identify dentist characteristics and dental office staffing patterns related to delegation of sealant applications. Results from a 1989 ma/led survey were used to characterize Michigan general dentists (N =300) who did or did not delegate sealant applications to auxiliaries and to identify factors associated with delegation. Nearly 50 percent of respondents were applying all sealants themselves. In offices that delegated the procedure, the mean proportion of sealants being applied by dentists was 39.9 percent. Registered dental hygienists were applying 51 percent, while registered dental assistants were applying 6.5 percent. Delegating dentists were more knowledgeable about sealant procedures, held more favorable attitudes, treated more young patients, placed more sealants, and were better informed about the legality of delegation according to the state practice act. Logistic regression analysis found that employing a registered dental hygienist was the most significant factor associated with sealant delegation, followed by employing a registered dental assistant. Findings suggest that dental auxiliaries, and particularly registered dental assistants, are underutilized for applying sealants. Approaches to increasing delegation of sealants may include changing dentists' traditional hiring patterns, highlighting the skills of auxiliaries such as the registered dental hygienist (RDH) and the registered dental assistant (RDA), and increasing awareness of legally allowable procedures that RDHs and RDAs can perform.     

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

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

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.     

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.     

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.     

Aspects of Quality of Dental Hygiene Care in Supervised and Unsupervised Practices

Objective : The purpose of this study was to assess aspects of the quality of care provided by dental hygienists in a California demonstration project in which hygienists treated patients independent of dentists' supervision. Methods : The structure and process of care were evaluated in nine independent practices using site visits and reviews of 25 records at each practice. The findings were compared to evaluations of six general dentist practices reviewed for a government agency and insurance company during the same time period. Patient satisfaction was assessed by a questionnaire. Results : The structural aspects of the unsupervised hygienist practices were generally acceptable and surpassed the dentist practices in most areas, including infection control. For process, the hygienist practices had high percentages of acceptable care and were significantly better than the dentist practices in several areas, including follow-up to medical findings, updating the medical history at recall, and documenting the evaluation of the periodontal status and soft tissues. Ninety-eight percent of patients expressed satisfaction with their care in hygienist practices. Conclusion : Under the circumstances of the demonstration project and the methods used to assess the quality of care, the study showed that independent dental hygienist practice did not increase the risk to the health and safety of the public.     

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.     

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.     

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.     

Smoking Cessation Practices in Dental Offices

We have surveyed the health promotion efforts of dentists and dental hygienists in general dental practice in Chittenden County, Vermont, in relation to smoking. The response rate was 61 percent. Smoking issues were addressed by 76 percent of dentists and 81 percent of dental hygienists in approximately one quarter of their smoking patients. Although the majority of both dentists and dental hygienists advised their patients to change their smoking behavior, their advice was usually to cut down rather than to quit. Most of the respondents--78 percent of dentists and 93 percent of dental hygienists--considered it appropriate to give advice about smoking during visits for routine dental care and 68 percent and 89 percent, respectively, were willing to learn brief methods of advising their patients about smoking. Experience with giving advice about smoking and agreement that it was appropriate to give such advice were both strongly related to willingness to learn brief methods of giving such advice. In individual dental practices, there were virtually no correlations between the dentist's and the dental hygienist's behaviors as far as the proportion of patients from whom a smoking history was taken, the proportion of smokers advised about smoking, the content of the advice, or the nature of the advice. Only nine percent of dentists and 11 percent of dental hygienists were current smokers.     

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.     

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?     

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     

The attitudes of New Zealand dentists and dental hygienists towards toothbrushes and toothbrushing

The purpose of this study was to survey the attitudes of dentists and dental hygienists who practise in New Zealand, with respect to their personal habits, and the recommendations they give to their patients about toothbrush use. A questionnaire was mailed to 800 dentists and 74 dental hygienists with a response rate of 58% and 66% respectively. The results indicate that 76.6% of dentists and 89.1% of dental hygienists recommend toothbrush replacement every two to three months to their patients and generally follow this recommendation themselves. Both groups feel patients should replace their toothbrushes more often than they currently do and the majority tell their patients when to replace brushes. Dentists and dental hygienists have identified bristles that "no longer remove plaque" and "bent, splayed bristles" as the two most important indicators of when a new toothbrush is needed. Soft, compact head brushes are most often recommended by both groups. Most offices give toothbrushing instruction and distribute complimentary brushes. Dentists most often assume this task, but when a hygienist is employed, this duty is typically their responsibility. Oral B and Colgate toothbrushes are the brands most often recommended by both dentist and dental hygienists.     

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.     

Service mix in general dental practices employing and not employing dental hygienists

Abstract Service mix studies conducted in Australia have indicated a low provision of periodontal services. The service mix in Australian general dental practices employing dental hygienists has not been studied. This study compares the service mix between 18 practices employing hygienists and 29 practices not employing hygienists in Adelaide. Practices employing hygienists tended to be larger group practices, with younger dentists seeing a younger set of patients. Practices employing dental hygienists provided a mean of 97.9 services to 57.2 patients over 2 days, significantly higher than the mean of 68.8 procedures to 39.1 patients in practices not employing dental hygienists. Comparing the % of procedures provided in treatment categories as a ratio of total procedures, practices employing dental hygienists provided significantly more periodontal procedures and less oral surgery, prosthetic and restorative procedures. Periodontally-related services accounted for an average of 37.7% of procedures in practices employing dental hygienists compared with 18.9% in practices not employing dental hygienists (p(0.05). Periodontal and preventive treatment of 50.7%) of patients in practices employing hygienists was delegated to a hygienist, and the level of delegation of periodontally-related procedures was 77.2%. Over 90% of procedures performed by hygienists were periodontally-related, with the removal of subgingival calculus accounting for 57.7% of all procedures provided by dental hygienists. In conclusion, practices employing hygienists had a more periodontally-orientated service mix, with hygienists acting to complement the services of dentists in the provision of periodontal services, rather than as a substitute for the dentist.     

Dental hygienists' attitudes towards dental care for people with a mental handicap and their perceptions of the adequacy of their training

A survey was undertaken among a group of dental hygienists to investigate potential barriers to providing dental care to people with mental handicap. Barriers similar to those indicated in studies on dentists were shown to be experienced by hygienists. Concerns were mainly related to perceived problems with communication and lack of understanding of the client group, rather than lack of cooperation of the patient. Degrees of concern in treating handicapped patients were shown to be related to type of handicap. Twenty-five (73.5%) of the hygienists surveyed (n = 34) felt that the training they had received, in relation to preparing them to work with mentally handicapped people, was inadequate; 28 (82%) felt that special training was necessary, over and above general hygienist training. However, most hygienists (73.5%) felt more positive about treating people with mental handicaps after a period of post-qualification work experience.