Evidence-based strategies for interdental cleaning: a practical decision tree and review of the literature.

Objectives: Although several studies have investigated the effectiveness of various interdental cleaning devices, there is a need for an evidence-based synopsis for clinicians to customize interdental hygiene instructions and provide specific devices for each patient. This literature review aims to establish an evidence-based decision-making tree recommending individualized approaches to interdental cleaning based on embrasure size and patient-specific conditions.
Data sources: Specific keywords related to interdental cleaning were used to search and identify the existing literature in PubMed and the Cochrane Library. Through a series of review processes, qualifying studies were identified and assessed with respect to the inclusion criteria to establish the decision tree.
Results: A total of 27 studies were included to support a decision tree. Traditional dental floss continues to remain the first choice for individuals of high motivation and good ?manual dexterity with type I closed embrasures. For individuals with closed embrasures, but lack of motivation and/or dexterity, the use of easy flossers, soft picks, oral irrigation, and small (0.6 to 0.7 mm) interdental brushes are alternatives. For individuals with type II and type III open embrasure spaces, an interdental brush has the highest evidence for its effectiveness to remove interdental plaque. However, two studies showed that residual plaque could be found over lingual embrasur?es and thus lingual approach of the interdental brush is sometimes needed. The use of gum stimulators and/or woodsticks continues to be supported when significant gingival inflammation is present.
Conclusion: Each patient should be individually assessed and given tailored oral hygiene home care instructions for the most effective outcomes. The proposed decision tree provides clinicians with an evidence-based guideline to help customize the use of interdental cleaning devices for each patient.

A survey of cariology education in U.S. dental hygiene programs: The need for a core curriculum framework.

OBJECTIVE: Dental hygienists play a key role in dental caries prevention and management. As the evidence of dental caries risk, prevention, and management becomes more complex, it is essential that dental hygiene (DH) programs have a strong cariology curriculum. This project aimed to assess current cariology content in U.S. DH programs, how content is taught, and interest in development/implementation of a common/core cariology curriculum framework. METHODS: Directors of 336 U.S. DH programs were invited to participate in a voluntary online survey using Qualtrics. The survey consisted of 41 items including demographics, details about the program's cariology content, and how it was delivered, and items related to a core cariology curriculum. RESULTS: The overall response rate used for analyses was 27.3%. Some findings include: 61.6% stated their program had a defined cariology curriculum, 35.2% did not have an individual cariology course, 61.5% had preclinical hands-on experiences in cariology, 79.7% are teaching management strategies related to salivary gland hypofunction, 68.3% are teaching use of silver diamine fluoride (SDF), and 64.2% felt cariology was adequately being taught. Only 17.7% are teaching the International Caries Detection and Assessment System (ICDAS) system. 87.3% indicated support for developing a core curriculum framework for teaching cariology in DH programs. CONCLUSIONS: This study indicated that, although DH programs reported that cariology concepts are being taught both didactically and clinically, discrepancies between concepts taught and the literature exist. Therefore, there is a need to create a more standardized curriculum framework for all U.S. DH programs.

Dental and Dental Hygiene Students' Perceptions of Status Quo, Benefits of, and Curricular Suggestions for Shared Learning: On the Road to IPE?

In 29 U.S. academic institutions, dental and dental hygiene students are educated on the same campus. The aims of this study were to explore the perceptions of dental and dental hygiene students on the same campus concerning the status quo of shared educational experiences, the benefits of shared education, and their curricular suggestions for shared education. Additionally, the study investigated whether the number of shared courses was correlated with the perceived benefits of shared learning. A survey was sent in 2016 to a chief administrator at all 29 dental school and dental hygiene programs that were on the same campus, with a request that the administrators forward the invitation email to all their students. A total of 375 dental and 117 dental hygiene students at 12 universities responded. The students reported that three of the nine dental hygiene programs and two of the six dental programs had no shared courses. The majority of dental/dental hygiene students agreed or agreed strongly that having joint classes would allow them to develop better relationships between dental and dental hygiene students (57%/57%) and gain a better understanding of each other's roles (50%/63%) and of what the other discipline "is all about" (54%/46%). Compared to dental hygiene students, dental students were less supportive of suggestions for curricular interventions such as partnering up in lab (on a five-point scale with 5=most positive: 3.99 vs. 3.56; p<0.001), using in-class time for shared group projects (3.83 vs. 3.27; p<0.001), and shadowing in clinics (4.26 vs. 3.16; p<0.001). The more courses dental and dental hygiene students jointly attended, the higher their percentage of clinic time spent on collaborative care (r=0.19; p<0.001). Having dental and dental hygiene programs on the same campus offers opportunities for shared learning, and this study's results suggest those opportunities may translate into increased shared learning.

General Dentists' Perceptions of Dental Hygienists' Professional Role: A Survey.

Purpose: Changes in dental hygienists' scope of practice in the United States (U.S.) are not independent of general dentists' attitudes and behavior related to dental hygienists' professional roles. The purpose of this study was to assess perceptions and knowledge of general dentists concerning the legally allowable duties of dental hygienists in their state versus the services they provide in their individual practices; the importance of dental hygienists' contributions to the practice; and how well dental hygienists interact with dentists and patients. The relationships between dentists' attitudes, and dental hygienists' actual behavior, the age of the dentist and the number of dental hygienists and dental assistants employed in the practice were also explored.Methods: Survey data were collected from 292 general dentists in the state of Michigan concerning their attitudes and behavior related to dental hygienists' scope of practice.Results: The average number of services dental hygienists provided in the practices surveyed were lower than the average number of services that dental hygienists are legally permitted to provide in the state of Michigan. The higher the importance dentists placed on dental hygienists' clinical and overall contributions to their practice and their patient management skills, the more diagnostic services and therapies the dental hygienists performed. The older the dentists were, the higher they rated the importance of dental hygienists' clinical contributions, their contributions for the provision of patient care, and the more often dental hygienists performed diagnostic and additional procedures.Conclusions: While dentists did not indicate delegating all of the legally allowable dental hygiene duties in their practices, they did indicate having a very high appreciation of the contributions of dental hygienists to their practice. The perceived value of dental hygienists' contributions correlated positively with the number of diagnostic and adjunctive services dentists delegated dental hygienists to perform in their practices.

Dental, Dental Hygiene, and Graduate Students' and Faculty Perspectives on Dental Hygienists' Professional Role and the Potential Contribution of a Peer Teaching Program.

The changing role of dental hygienists deserves dental and dental hygiene educators' attention. The first aim of this survey study was to assess University of Michigan dental, dental hygiene, and graduate students' and faculty members' perceptions of dental hygienists' roles; their attitudes and behaviors related to clinical interactions between dental and dental hygiene students; and perceived benefits of engaging dental hygiene students as peer teachers for dental students. The second aim was to assess whether one group of dental students' experiences with dental hygiene student peer teaching affected their perceptions of the dental hygiene profession. Survey respondents were 57 dental hygiene students in all three years of the program (response rate 60% to 100%); 476 dental students in all four years (response rate 56% to 100%); 28 dental and dental hygiene graduate students (response rate 28%); and 67 dental and dental hygiene faculty members (response rate 56%). Compared to the other groups, dental students reported the lowest average number of services dental hygienists can provide (p≤0.001) and the lowest average number of patient groups for which dental hygienists can provide periodontal care (p<0.001). Dental students also had the least positive attitudes about clinical interactions between dental hygiene and dental students (p<0.001) and perceived the fewest benefits of dental hygiene student peer teaching (p<0.001) before experiencing peer teaching. After experiencing dental hygiene student peer teaching, the dental students' perceptions of dental hygienists' roles, attitudes about clinical interactions with dental hygienists, and perceived benefits of dental hygiene student peer teachers improved and were more positive than the responses of their peers with no peer teaching experiences. These results suggest that dental hygiene student peer teaching may improve dental students' perceptions of dental hygienists' roles and attitudes about intraprofessional care.

Oral Care for Pregnant Patients: A Survey of Dental Hygienists' Knowledge, Attitudes and Practice.

PURPOSE: The purpose of this study was to examine the knowledge, attitude and practice behaviors of dental hygienists' providing oral health care to pregnant women. METHODS: Data was collected from an anonymous electronic survey administered to all Michigan Dental Hygiene Association (MDHA) members (n=1,047). The survey asked questions which assessed dental hygienists knowledge, behaviors and attitudes when providing oral care to pregnant patients. Statistical analysis was conducted correlating years in practice and years since dental hygiene degree with survey questions to identify any correlations. RESULTS: The response rate was 14.4% (n=150). Results indicated that regardless of years of experience, or level of degree, the majority of the respondents surveyed (64%) desired more education about caring for a pregnant patient. Ninety percent of respondents reported willingness to provide care for pregnant women, and 85% indicated they or their employers agreed to accept referrals to treat pregnant women. Respondents' knowledge indicated the following treatments could be provided throughout pregnancy: Prophylaxis (95.8%), emergency care (92.7%), periodontal treatment (76.3%) and restorative care (61.5%). One question. "dental hygiene services should only be provided during the second trimester," was written in the negative, with a disagree rate of 85.6% indicated a high level of knowledge about this topic. CONCLUSION: Dental hygienists are in a position to use current findings, protocols and practice guidelines to provide preventive oral health care and advocate for the pregnant patient. This study found continuing education regarding oral health care and pregnancy was desired by many dental hygienists.

Educational Deficiencies Recognized by Independent Practice Dental Hygienists and their Suggestions for Change.

PURPOSE: The purpose of this study was to determine the perceived level of preparedness Maine Independent Practice Dental Hygienists (IPDHs) received from their standard undergraduate dental hygiene education, and recognize areas necessary for further preparation in order to explore careers beyond the private practice dental model. METHODS: A convenience sample of 6 IPDHs participated in a survey exploring their educational experience in public health and alternative practice settings. The survey also asked for their recommendations to advance dental hygiene education to meet the needs of those wishing to pursue alternative practice careers. RESULTS: This study found that participants felt underprepared by their dental hygiene education with deficits in exposure to public health, business skills necessary for independent practice, communication training and understanding of situations which require referral for treatment beyond the IPDH scope of practice. CONCLUSION: As the dental hygiene profession evolves, dental hygiene education must as well. The IPDH participants' recommendations for dental hygiene programs include increased exposure to alternative settings and underserved populations as well as elective courses for those students interested in alternative practice and business ownership.

M-OSCE as a method to measure dental hygiene students' critical thinking: a pilot study.

Educators in all academic disciplines have been encouraged to utilize assessment strategies to evaluate students' critical thinking. The purpose of this study was to assess the viability of the modified objective structured clinical examination (m-OSCE) to evaluate critical thinking in dental hygiene education. This evaluation utilized a convenience sample of senior dental hygiene students. Students participated in the m-OSCE in which portions of a patient case were revealed at four stations. The exam consisted of multiple-choice questions intended to measure students' ability to utilize critical thinking skills. Additionally, there was one fill-in-the-blank question and a treatment plan that was completed at the fifth station. The results of this study revealed that the m-OSCE did not reliably measure dental hygiene students' critical thinking. Statistical analysis found no satisfactory reliability within the multiple-choice questions and moderately reliable results within the treatment planning portion of the examination. In addition, the item analysis found gaps in students' abilities to transfer clinical evidence/data to basic biomedical knowledge as demonstrated through the multiple-choice questioning results. This outcome warrants further investigation of the utility of the m-OSCE, with a focus on modifications to the evaluation questions, grading rubric, and patient case.