Improving oral health in Pakistan using dental hygienists.

This paper reviews the healthcare system, available dental care, and oral health status of people in Pakistan. Considering the enormous unmet oral health needs, the insufficient supply of dental professionals and the current unstructured dental hygiene curriculum in Pakistan, a mission, vision, and goals for professional dental hygiene in Pakistan is recommended. The authors offer recommendations for competency-based dental hygiene education and practice, professional credentialing, a practice act, and a dental hygiene scope of practice to promote the health, welfare, and quality of life of the Pakistani people. Specifically, the authors recommend increasing the number of quality dental hygiene programs, establishing the dental hygienist as a primary care provider of oral health services, enhancing current dental hygiene curriculum, and establishing a dental hygiene council with responsibility for educational requirements and regulation of dental hygienists in Pakistan.

New discoveries and directions for medical, dental and dental hygiene research: low temperature atmospheric pressure plasma.

The study of plasma integrates physics, chemistry, biology, and engineering, and has recently engaged medicine and dental hygiene in research efforts. The study of plasma holds promise for a myriad of applications ranging from lasers and electronics, hazardous waste management, decontamination, sterilization and disinfection of foods, soil, water, instruments, to medical uses in wound healing and treating certain types of tumours and cancers. Plasma represents a new state-of-the-art sterilization and disinfection treatment for certain oral and enviornmental pathogens, heat-sensitive materials, contaminated medical waste, hard and soft surfaces, and ventilation systems may assist health care facilities in the management of various health concerns. The role that Low Temperature Atmospheric Pressure Plasma (LTAPP) could play in the inactivation of pathogenic microorganisms might prove to be a new, faster, noncorrosive, more economical alternative, as well as support green healthcare.

Use of miswak versus toothbrushes: oral health beliefs and behaviours among a sample of Jordanian adults.

OBJECTIVE: This descriptive survey aimed at determining the perceived relationship among miswak, the toothbrush, and toothbrush-plus-miswak usage on oral health beliefs and behaviours of Jordanian adults, 18-60 years old, seeking dental care in the city of Irbid, northern Jordan. METHODS: Patients (n = 138) voluntarily completed a self-designed questionnaire prior to their dental appointments at public and private clinics. RESULTS: Overall, the level of oral health knowledge was low; of 71 people who attempted to define dental plaque, only 26% knew the meaning of dental plaque. While 12% have never been to a dentist, and 12% visit the dentist on a regular basis, the majority (63.2%) of the respondents reported that they visit the dentist only when they have pain. The majority (72%) use the toothbrush, 20.5% use the toothbrush-plus-miswak and only 3% use miswak alone. Toothbrush users believe that using the toothbrush-plus-miswak is most effective in reducing mouth debris (chi2 = 32.069, d.f. = 16, P = 0.01); and level of education is significantly associated with the type of oral cleaning device used (chi2 = 25.817, d.f. = 12, P = 0.05). There was no significant difference between toothbrush users and toothbrush-plus-miswak users in terms of how they perceive their oral health status. About 19% of the study participants use dental floss, 60.9% use mouth rinses and 8.3% use inter-dental brushes. Educated people (baccalaureate or associate degrees) tended to use toothbrushes and toothbrush-plus-miswak. The toothbrush-plus-miswak users are most likely to spend 1-2 min each day cleaning their teeth (chi2 = 34.9, d.f. = 20, P = 0.02) than those using other devices. Respondents who use the toothbrush are most likely to visit the dentist when they have pain (chi2 = 34.02, d.f. = 12, P = 0.00) than those using other devices. CONCLUSION: The oral health awareness level among Jordanian adults is poor and needs to be improved. Evidence-based and community-based dental health education and a philosophical change from disease-oriented and pain management care to primary preventive care are highly recommended for the Jordanian population.

The cultural adaptability of health sciences faculty.

PURPOSE: Health care educators have a major responsibility to prepare future health care practitioners to provide services for culturally diverse clients. As a starting point, prior to making any curricular changes, the cultural adaptability of the faculty needs to be measured; therefore, this study was conducted to determine the cultural adaptability of the faculty within a College of Health Sciences of an urban regional university in Southeastern Virginia. METHODS: The sample consisted of 40 health sciences faculty representing dental hygiene, medical laboratory sciences, nursing and physical therapy. The principal investigator personally administered the Cross-Cultural Adaptability Inventory (CCAI), a 50-item instrument that contains questions to measure the construct cultural adaptability and its four dimensions: emotional resilience, flexibility/openness, perceptual acuity, and personal autonomy. The CCAI is not targeted to one particular culture, but rather is designed to be culture general. RESULTS: Overall, all four faculty groups exhibited higher average CCAI scores than the CCAI norm group which consisted of individuals with cross-cultural experience and training. Analysis of variance revealed no statistically significant difference, at the 0.05 level, in the overall CCAI scores among the health sciences faculty. Analysis of CCAI scores among the health sciences faculty, using analysis of variance revealed no statistically significant difference, at the 0.05 level, in emotional resilience, perceptual acuity, and personal autonomy. In the dimension flexibility/openness, a significant difference was exhibited between the physical therapy and medical laboratory sciences faculty. CONCLUSIONS: These qualities should provide a strong foundation for the development of additional competence in cross-cultural health care and for preparing practitioners who can provide culturally sensitive health care. Further exploration to determine whether a cross culturally adaptable faculty can impart this attribute to students might be to administer the CCAI to entering and exiting students.

Behavioral management instruction of anxious clients in the dental hygiene curricula.

PURPOSE: This study sought to determine the type and amount of instruction on behavioral management of anxious clients in dental hygiene curricula, the instructional differences between associate and baccalaureate programs, and the opinions of educators regarding behavioral management. METHODS: A 19-item questionnaire was mailed to the directors of 210 dental hygiene programs who were asked to furnish information pertaining to behavioral instruction in their curricula and to express their opinions by use of a Likert scale. Data were analyzed using descriptive statistics and the chi-square and Z hypothesis tests. RESULTS: Two mailings resulted in an overall response rate of 81%, with 170 questionnaires returned. Results revealed that 86% of programs surveyed taught behavioral management of anxious clients to their students. Types of strategies taught and percentage of programs teaching them were: information provision (96%), distraction (51%), modeling (51%), relaxation (62%), and hypnosis (7%). No significant relationships were found between associate and baccalaureate degree programs relating to the type of behavioral instruction; however, baccalaureate degree programs devoted significantly more curricular hours to this instruction. In general, the sample of dental hygiene educators held positive opinions regarding the use of behavioral management, with only 28% having had formal education in this area. CONCLUSION: Results suggest that comprehensive instruction on behavioral management of client anxiety is not provided to students in all dental hygiene programs, even though dental hygiene educators consider this modality effective during oral health care.

Application of the human needs conceptual model to dental hygiene practice.

The Human Needs Conceptual Model is relevant to dental hygiene because of the need for dental hygienists to be client focused, humanistic, and accountable in practice. Application of the Human Needs Conceptual Model provides a formal framework for identifying and understanding the unique needs of the client that can be met through dental hygiene care. Practitioners find that the Human Needs Conceptual Model can not only help them in assessment and diagnosis, but also in client education, decision-making, care implementation, and the evaluation of treatment outcomes. By using the model, the dental hygienist is able to manage client care humanistically and holistically, and ensure that care is client-centered rather than task-oriented. With the model, a professional practice can be made operational.

The oral health status of individuals on renal dialysis.

The primary purpose of this investigation was to determine the oral health status of individual's undergoing renal dialysis in southeastern Virginia. A sample was identified for this cross-sectional study via a local health maintenance organization. Three subgroups of the population were studied: 1) those who have been on renal dialysis for less than a year; 2) those on renal dialysis for 1 to 3 years; and 3) those on renal dialysis for longer than 3 years. Three dental indices the Periodontal Disease Index; the Decayed, Missing. Filled index; and the Simplified Oral Hygiene Index--were used to identify periodontal disease, dental caries activity, and oral hygiene status. Data were compiled and analyzed by using the parametric test, 1-way analysis of variance. Results suggested that 100% (n = 45) of the individuals undergoing renal dialysis presented with some form of periodontal disease (X = 3.15, SD = 1.41). The majority (64%) of the sample displayed either severe gingivitis (28%) or early periodontitis (36%). Sixty-four percent of the sample displayed a high DMF index (X = 11.77, SD = 7.55), while 98% of the sample accumulated calculus. Oral debris was present in 100% of the sample, resulting in a high Simplified Oral Hygiene Index score (X = 3.24, SD = 1.26), suggesting an increased need for oral care instruction. Findings led to the conclusion that the renal dialysis population in southeastern Virginia, regardless of length of time on dialysis, is in need of comprehensive professional oral care and self-care instruction. Oral disease was present and is a source of active infection in these medically compromised individuals and, as such, has dire implication for morbidity and mortality.

Factors influencing dental hygiene retention in private practice.

PURPOSE: The objective of this study was to identity specific factors that contribute to dental hygienists remaining in the same private practice employment setting for five or more years. Working conditions, the employer and the organizational structure of the employment setting, scope of practice, and personal factors were assessed. METHODS: In 1992, a self-designed questionnaire was sent to a sample of 1,200 licensed dental hygienists. One state was randomly chosen from each of the 12 American Dental Hygienists' Association (ADHA) regions of the United States, and 100 licensed dental hygienists were randomly selected from each of these twelve states. Data were analyzed using univariate analysis (frequency distribution) and multivariate analyses (factor analyses). RESULTS: A 62.9% (n = 755) response rate was obtained from the 1200 questionnaires mailed. Of those dental hygienists, 14.3% (n = 108) were not practicing, and 85.7% (n = 647) were currently practicing. Nearly two-thirds (63.3%; n = 480) of the total number of respondents had been practicing five or more years in the same practice setting. Six major factors were identified by dental hygienists as reasons for remaining in one private practice setting for at least five years (1) quality/safe work environment, (2) time management for high-quality dental hygiene services, (3) effective employer office policies/procedures and personnel management, (4) employer support of professional career, (5) supportive work environment, and (6) variety in scope of practice. CONCLUSIONS: Factors identified in this study as influential in dental hygienists' retention in private practice are similar to those identified as reasons for leaving the profession in previous attrition and reentry studies. To increase retention and job satisfaction of dental hygienists in the private practice setting, strategies for effectively working with employers should be emphasized in dental hygiene and dental curriculums and in continuing education programs.

Self-report of oral health services provided by nurses'aides in nursing homes.

PURPOSE: The purpose of this investigation was to identify the oral healthcare role of nurses' aides in nursing homes. Nurses' aides were asked to report what preventive and referral oral health services they provided, factors that encourage and discourage performance of these services, and their perceived knowledge of oral hygiene care procedures. METHODS: A random sample of 40% (n = 14) of nursing home facilities in southeastern Virginia was selected. A 14-item questionnaire was administered to 121 nurses' aides employed at 11 of these nursing home facilities during April, May, and June of 1991. Frequency and percentages were analyzed for discrete, nominally, and ordinally scaled data. RESULTS: Eleven of the 14 nursing homes selected agreed to participate, representing 32% of the nursing homes in the southeastern region of Virginia. Ninety-eight out of 121 questionnaires were completed and analyzed. Nurses' aides in nursing home facilities typically reported providing preventive oral health services such as mouthrinsing (71%), toothbrushing (63%), and denture cleaning procedures (37%) for nursing home residents. The majority of nurses' aides indicated that patient cooperativeness was a major factor that encouraged (71%) or discouraged (88%) the performance of oral health services. Aides typically reported suspicious and abnormal findings detected in residents' mouths to the nurse in charge of the shift (97 5). The majority of nurses' aides rated their knowledge of mouthrinses for residents with teeth (99%), denture cleaning (99%), toothbrushing (97%), fluoride mouthrinses for residences with teeth (90%), mouth checks for residents with teeth (91%), and flossing (61%) as adequate or excellent. However, a large percentage of nurses' aides rated their knowledge of saliva substitutes (45%) and flossing (39%) as poor. CONCLUSION: This study indicated that nurses' aides generally provide daily oral hygiene services to nursing home residents. Thus, the role of the dental hygienist should be to outline specific educational and curricular guidelines and conduct training programs for nurses' aides and to develop instructional materials to be used in nursing homes. Future dental hygiene graduates must be prepared to meet the needs of oral hygiene education for nurses' aides.

A proposed human needs conceptual model for dental hygiene: part I.

To date, research and theory development in dental hygiene have been largely sporadic and lacking in focus. Dental hygiene has begun to develop its body of knowledge by adopting a definition of the discipline and a structural hierarchy of knowledge that includes a global paradigm, conceptual model(s), and theory. By identifying major concepts and linking theory to an expanding knowledge base, dental hygiene can begin to evolve as a scientific discipline. Conceptual models and theories will characterize the uniqueness of dental hygiene and move it into collegiality with other professional disciplines. In the future, practitioners, educators, and researchers may adopt an organizational framework for dental hygiene. Doing so will enhance dental hygiene research, teaching, and client care. Most importantly, it will enhance dental hygiene's view of itself. This in turn will facilitate dental hygiene's continuing evolution toward professionalization.

Continuing education.

A large, representative sample of licensed dental hygienists practicing in the United States was surveyed by ADHA regarding dental hygiene demographics, office characteristics, supervision and practice behavior, infection control practices, utilization of medical and dental histories, and continuing education. This paper presents the continuing education portion of this survey and specifically explores relationships among descriptive variables such as dental hygienists' ages, types of practice, membership in ADHA, continuing education courses attended, and interest versus need in continuing education course attendance. Results indicate that continuing education participation is most likely for dental hygienists under 25 years of age and who are working over 30 hours per week in a speciality office which employs seven or more staff members. Comparisons among dentist, dental hygienist, and dental assistant participation were made for selected continuing education topics. According to the respondents, more dental hygienists than dentists or dental assistants have participated in continuing education courses on blood pressure measurement, aseptic technique, AIDs, and cardiopulmonary resuscitation. Dental hygienists perceived a need for attendance by all dental personnel in selected continuing education programs.