Experiences of the Kansas Extended Care Permit Providers: A descriptive study.

Purpose: A total of 40 states to date have expanded the role of dental hygienists with the goal of improving access to basic oral health services for underserved populations. In Kansas, legislative changes have resulted in the Extended Care Permit (ECP) designation. The purpose of this study is to describe the experiences of registered dental hygienists in Kansas holding ECP certificates (ECP RDH) as of July of 2014.Methods: Secondary data analysis was performed utilizing data collected from a survey conducted in 2014 by Oral Health Kansas. All registered ECP RDH's were sent the 32-item survey via Survey Monkey®. Descriptive statistical analyses consisted of frequency distributions, and measures of central tendency. Inferential analyses using t-tests and ANOVA were conducted to compare groups.Results: A total of 73 responses were received from the (n= 176) surveys that were e-mailed for a 41% response rate. Of the clinicians who responded, 80%, worked at least part-time and in school settings. The most consistent barriers to providing care were the inability to directly bill insurance (52%), financial sustainability (42%) and physical requirements (42%). Follow-up tests found significant differencs between clinician groups when examining barriers.Conclusion: Although the ECP legislation appears to be expanding access to care for citizens in Kansas, significant barriers still exist in making this a viable model for oral healthcare delivery.

Effectiveness of an Alternative Dental Workforce Model on the Oral Health of Low-Income Children in a School-Based Setting.

OBJECTIVES: We evaluated the effect of an alternative dental workforce program-Kansas's Extended Care Permit (ECP) program--as a function of changes in oral health. METHODS: We examined data from the 2008 to 2012 electronic medical records of children (n = 295) in a Midwestern US suburb who participated in a school-based oral health program in which preventive oral health care was delivered by ECP dental hygienists. We examined changes in oral health status as a function of sealants, caries, restorations, and treatment urgency with descriptive statistics, multivariate analysis of variance, Kruskal-Wallis test, and Pearson correlations. RESULTS: The number of encounters with the ECP dental hygienist had a statistically significant effect on changes in decay (P = .014), restorations (P = .002), and treatment urgency (P = .038). Based on Pearson correlations, as encounters increased, there was a significant decrease in decay (-0.12), increase in restorations (0.21), and decrease in treatment urgency (-0.15). CONCLUSIONS: Increasing numbers of encounters with alternative providers (ECP dental hygienists), such as with school-based oral health programs, can improve the oral health status of low-income children who would not otherwise have received oral health services.

Preventive services program: a model engaging volunteers to expand community-based oral health services for children.

PURPOSE: This paper describes the Preventive Services Program (PSP), a community based oral health program model which engages volunteers to provide preventive services and education for underserved children in Missouri. In 2006, the Missouri Department of Health and Senior Services created a program for children designed to use a systems approach for population-based prevention of oral disease. Currently, 5 part-time dental hygienists serve as Oral Health Program Consultants to work with the citizens of a community to engage dentists, dental hygienists, parents and other interested stakeholders in the activities of the program. Dental volunteers evaluate oral health and disease in the community's children and facilitate referrals for dental care. Other volunteers apply fluoride varnish and provide educational services to the children. PROGRAM OUTCOMES: In 2006, 273 volunteer dentists and dental hygienists and 415 community volunteers provided oral screenings, oral health education, 2 fluoride varnish applications and referral for unmet dental care for 8,529 children. In 2011, 775 volunteer dentists and dental hygienists and 1,837 other community volunteers provided by PSP services to nearly 65,000 children. CONCLUSION: It has been demonstrated that when the local citizens take responsibility for their own needs that a sustainable and evidence-based program like PSP is possible. Guidelines which provide criteria for matching models with the specific community characteristics need to be generated. Furthermore, a national review of successful program models would be helpful to those endeavoring to implement community oral health program.

Factors associated with clinical skill remediation in dental hygiene education programs.

PURPOSE: The purpose of this study was to examine the challenges related to formal clinical remediation in dental hygiene programs, which include timing of student identification, policy development, and the issues of methodology and scheduling. METHODS: A 23 item investigator-designed survey was electronically distributed to all 303 U.S. entry-level dental hygiene program directors. This questionnaire included 23 forced-choice questions with the options to add comments to 8 of the questions. A total of 111 surveys were returned yielding a response rate of 36%. Descriptive statistics and Chi-square analyses were utilized to analyze relationships between responses and the degree earned from the dental hygiene program. RESULTS: All schools reported having a remediation policy; however, 13.6% of the respondents revealed this information was not readily available to students. The majority of respondents (67.8%) reported identifying students with clinical deficiencies in the preclinical semester, and 15.5% identified students in the second year, second clinical semester. Instrumentation technique was identified as the area in greatest need of remediation (81%), followed by critical thinking and problem solving skills (12%). Coordination of faculty and student schedules to conduct remediation was identified as one of the greatest challenges by respondents (25.2%). Results of this study suggest that challenges exist with the process of remediation. Some of these challenges include involving the student in remedial plan development, the academic consequences associated with remediation and scheduling time and space for remedial activities. CONCLUSION: These findings indicate that respondents are well aware of the need for remediation policies in dental hygiene programs. The point in time varies when students in need of remediation are identified. Therefore, further research needs to be conducted to determine the reasons for this difference. Some reasons may include inability to grasp the foundational skills and/or the complexity of advanced instrumentation in the second year. Also, it is suggested that investigation regarding methods used to address the challenge of faculty and student scheduling for remediation sessions would be useful.

Effects of dental magnification lenses on indirect vision: a pilot study.

PURPOSE: The purpose of this pilot study was to evaluate the effect of magnification lenses on the indirect vision skills of dental hygiene students. METHODS: This pilot study examined the accuracy and efficiency of dental hygiene students' indirect vision skills while using traditional safety lenses and magnification lenses. The sample was comprised of 14 students in their final semester of a dental hygiene program. A crossover study approach was utilized, with each participant randomly assigned to a specific order of eyewear. The study included evaluation of each participant taking part in 2 separate clinical sessions. During the first session, each participant completed a clinical exercise on a dental manikin marked with 15 dots throughout the oral cavity while wearing the randomly as signed eyewear, and then completed a similar exercise on a differently marked dental manikin while wearing the randomly assigned eyewear. This procedure was repeated at a second clinical session, however, the dental manikin and eyewear pairings were reversed. Accuracy was measured on the number of correctly identified dots and efficiency was measured by the time it took to identify the dots. Perceptions of the participants' use of magnification lenses and the participants' opinion of the use of magnification lenses in a dental hygiene curriculum were evaluated using a questionnaire. RESULTS: Comparing the mean of the efficiency scores, students are more efficient at identifying indirect vision points with the use of magnification lenses (3 minutes, 36 seconds) than with traditional safety lenses (3 minutes, 56 seconds). Comparing the measurement of accuracy, students are more accurate at identifying indirect vision points with traditional safety lenses (84%) as com pared to magnification lenses (79%). Overall, the students report ed an increased quality of dental hygiene treatment provided in the clinical setting and an improved clinical posture while treating patients with the use of magnification lenses. CONCLUSION: This study did not produce statistically significant data to support the use of magnification lenses to enhance indirect vision skills among dental hygiene students, however, students perceived that their indirect vision skills were enhanced by the use of magnification lenses.

Changes in posture: a case study of a dental hygienist's use of magnification loupes.

PURPOSE: Evidence suggests that using magnification loupes will improve the posture of dental clinicians, thus decreasing work-related musculoskeletal disorders. The purpose of this case study was to document the experiences of a dental hygienist during a four week acclimatization period. METHODS: Documentation was comprised of self-reports from the dental hygienist's reflective journaling and postural measurements made by a trained observer using Branson's Posture Assessment Instrument (BPAI), a validated posture assessment instrument. Journal reports and postural measurements were made prior to the use of the magnification loupes and over the subsequent three week trial. CONCLUSION: Use of the magnification loupes was a positive experience. The BPAI results indicated a positive change in neck and low back posture. Further trials of the effectiveness of magnification loupes in reducing musculoskeletal disorders with this occupational group are recommended.

An evidence-based review of ergonomic features of dental hygiene instruments.

OBJECTIVES: The purpose of this paper is to describe the research identifying dental hygiene risk factors, outline the structural characteristics of the various tools that dental hygienists use and discuss the evidence to support ergonomic tool re-designs. METHODS: Two databases, Medline and Cinahl, were used to identify epidemiological research studies from 1998--2008 that describe the prevalence of musculoskeletal disorders in dental hygienists. The length, diameter, mass and padding of twenty-one (n=21) dental instruments and instrument grip combinations and twenty-two (n=22) mirrors and mirror grip combinations are described. RESULTS: The length, mass and diameter of dental instruments and dental mirrors ranged from 16.3 cm to 17.5 cm and 15.9 cm to 18.5 cm, from 10.0 g to 25.0 g and 5.0 g to 30.0 g, and from 6.5 mm to 11 mm and 6 mm to 14 mm, respectively. Padding instruments and mirrors increased the mass by approximately 5.0 g. The literature does not suggest an optimal length for dental instruments or dental mirrors. The literature suggests that the optimal diameter for dental instruments and mirrors is at least 10 mm, the optimal weight is 15.0 g or less, and padding decreases muscle activity. CONCLUSIONS: Dental hygienists should be educated to select a variety of instrument handles based upon the parameters described above.

Examining the effect of the Flextend Orthotic Device on grip strength: a pilot study.

Strengthening exercises like those used to treat carpal tunnel syndrome have been recommended for prevention however their effectiveness when used in this manner are not known. The purpose of this study was to determine the effects of the Flextend Orthotic Device on grip strength of dental hygiene students. This study used a convenience sample of 24 (n=24) first year dental hygiene students. Students were randomly assigned to either the Flextend Orthotic Exercise glove group or a control group. A series of grip strength measurements were taken periodically throughout the study using a hydraulic hand dynamometer. In a repeated measures analysis of covariance there were no significant effects for study group (p=0.812) time (p=0.954), nor was there a significant interaction between group and time (p=0.858). Use of the Flextend Orthotic Device did not additionally increase grip strength among dental hygiene students over the eight week time period. In none of the weeks post baseline was there a significant difference between the Flextend Orthotic Device group and control groups.

Utilizing public health clinics for service-learning rotations in dental hygiene: a four-year retrospective study.

National reports outlining disparities in oral health care in the United States have focused attention on ways to encourage health care providers to become more involved in the public health arena. Utilization of service-learning in professional health education programs is one method being explored. The purpose of this study was to conduct a retrospective review of a service-learning rotation within a dental hygiene public health course. The study utilized data sources generated by students as part of a course evaluation. These sources included student journals (qualitative/quantitative) and Likert-scaled (quantitative) and open-ended (qualitative) student satisfaction survey items. Mixed methodology data analysis techniques were used to analyze and triangulate data in order to form conclusions related to the effectiveness of service-learning as a teaching strategy in dental hygiene. This investigation suggests that service-learning is an effective learning strategy for increasing student awareness of underserved populations, cultural diversity, and ethical patient care. The study also suggests that service-learning helped students to determine their level of interest in public health as a career choice by giving them a real-world experience in public health patient care.

Comparison of tactile discrimination associated with varying weights of explorers.

The prevalence of work-related musculoskeletal disorders in dental hygienists is significantly higher than that of the general population. The purpose of this study was to evaluate the effect of explorer weight on dental and dental hygiene students' tactile discrimination when exploring. A randomized controlled clinical trial utilizing a dual dependent statistical design was used to collect data on a convenience sample of forty-eight (n=48) dental hygiene students beginning their senior year of their curriculum. Tactile discrimination was measured by having twenty-four experimental subjects (using a lightweight 0.4 ounce explorer) and twenty-four control subjects (using a heavier 1.0 ounce explorer) delineate the coarseness of varying textures of sandpaper in an apparatus that provided a blinded environment. Data were analyzed using SPSS. Descriptive statistics, chi square tests, and independent sample t-test were computed. Results did not display statistically significant differences between groups. Descriptive statistics illustrated that students using lightweight explorers were better able to delineate between textures. One exception to this finding was with very similar textures, where heavier explorers provided superior tactile discrimination. Overall, the weight of the explorer does not affect students' tactile discrimination abilities.

Increasing access to oral health care in underserved areas of Missouri: dental hygiene students in AHEC rotations.

In 2004 personnel from the Missouri Area Health Education Centers and faculty from the University of Missouri-Kansas City, School of Dentistry, Division of Dental Hygiene, joined forces to develop dental hygiene student rotations to rural and underserved areas. Twenty-six students participated in a two week rotation to Federally Qualifed Health Centers throughout Missouri. The rotations included objectives which focused on student familiarity with 1) the similarities and differences between private practice and public health clinics, 2) assessing, planning, implementing and evaluating an oral health education program, 3) working with a diverse population; and 4) an understanding of the ethics of delivering healthcare to a whole community versus individual patients. Additionally, the rotation sought to continue to develop the students' clinical skills under supervised instruction. The rotation was evaluated using various qualitative and quantitative measurements, including journals, task records and post-program surveys. This article reports on the results of the qualitative and quantitative measures used for evaluating the objectives of the project.

Comparison of muscle activity associated with structural differences in dental hygiene mirrors.

PURPOSE: Ergonomic studies suggest that the commonly used pinch grasp, held in a static position, is a contributing factor for dental Hygienists' development of work-related musculoskeletal disorders (WMSDs) such as carpal tunnel syndrome (CTS), Trigger Thumb, de Quervain's stenosing tenosynovitis, and carpometacarpal (CMC) osteoarthritis. The pinch grasp is commonly used by the dental hygienist while holding the dental mirror in the non-dominant hand. In response to this concern, manufacturers are redesigning dental mirror handles. The value of these re-designed products is based solely on anecdotal evidence. To date, minimal research has been done to examine the non-dominant mirror hand. The purpose of this study was to objectively evaluate dental mirror handle design using surface electromyography (sEMG) to compare muscle activity associated with grasping the mirror. METHODS: This randomized controlled clinical trial utilized a two-by-two repeated measures statistical design. Data was collected on a convenience sample of 19 (N=19) healthy dental hygiene students in their last year of study. Data collection was divided into two phases to maintain a balanced study. The independent variables in phase I were diameter and weight. The independent variables in phase II were weight and padding. Muscle activity was measured while grasping various dental hygiene mirrors in 30-second increments using sEMG. Following data collection subjects designated which mirror felt most and least comfortable to compare subjective data with objective data. RESULTS: Three statistically significant results occurred. In phase II, padding (p=.01) demonstrated the largest reduction of muscle activity in the flexor pollicis brevis, by decreasing mean muscle activity by 3.7 microv. The interaction of diameter and weight (p=.01) in phase I reduced the mean muscle activity in the extensor digitorum by .8 microV and weight (p=.02) in phase II decreased the muscle activity in the extensor digitorum by .62 microV. Self-reports of comfort reported by the subjects in this study were not consistent with the measurements of muscle activity using sEMG. CONCLUSION: Ergonomic adaptations to dental hygiene mirror handles were associated with increases and decreases in muscle activity. The clinical impact of this is amplified as force is exerted. Furthermore, it may be possible to reduce WMSDs for dental hygienists by using instrument designs during the workday. Self-reports of comfort by the subjects in this study did not calibrate with the measurements of muscle activity using sEMG. Additional research is needed to further isolate the external variables of the study and to determine what actual reduction in muscle activity is significant for maintaining musculoskeletal health.

Predictive validity of dental hygiene competency assessment measures on one-shot clinical licensure examinations.

The purpose of this study was to examine the predictive validity of traditional and nontraditional dental hygiene competency assessment measures on one-shot clinical licensure examinations in a baccalaureate dental hygiene program. Traditional assessment data including overall grade point average (GPA), Clinical GPA, National Board Dental Hygiene Examination (NBDHE) scores, and Central Regional Dental Testing Service (CRDTS) scores along with nontraditional assessment data in the form of Portfolio scores were collected from seventy-four students. Factor analysis and subsequent linear regression modeling were used to explore the ability of four variables (Overall GPA, NBDHE, Portfolios, and Clinical GPA) to predict one-shot clinical licensure examination (CRDTS) scores. A two-factor solution was obtained with one factor defined as dental hygiene cognition and the second factor defined as dental hygiene clinical performance. Factor scores were subsequently used in a linear predictive model to assess the shared and unique contribution of factors to the one-shot clinical licensure examination score. The shared contribution of both factors only accounted for 13.9 percent of variance in the outcome measure of one-shot clinical licensure examination scores. The lack of concordance between previously validated measures of dental hygiene student competency or predictors of student success (Overall GPA, NBDHE, and Portfolios) and a one-shot clinical licensure examination (CRDTS) raises serious concern about the validity of our current dental hygiene licensing procedure which uses the CRDTS clinical examination to make decisions about granting licenses to practice.

Early childhood caries in an urban health department: an exploratory study.

PURPOSE: The purpose of this investigation was to assess the prevalence of early childhood caries (ECC) as a function of various ECC case definitions, in a population of children ages one to five, attending a Women, Infants, and Children (WIC) or well-child clinic at an urban health department. Additionally, the study examines the association of sociodemographic factors, caregiver's oral health perceptions, resources, feeding and oral care behaviors, and prenatal and perinatal histories as risk factors for early childhood caries. METHOD: A convenience sample of 74 children ages one to five years and their parent(s) or guardian(s) enrolled in the WIC and Well Child Services Program at the Kansas City Health Department participated in this study. Caries experience and developmental enamel defects of children were assessed utilizing the deft and linear enamel hypoplasia (LEH) indices. Additionally, the children's parents of guardians were asked to complete a questionnaire to collect data on predisposing risk factors. RESULTS: The proportion of all children with evidence of Type I ECC was high (31.5%), with all ethnic minority groups having a large proportion with caries. Four of the predisposing risk factor variables were related (p < 0.05) to presence of ECC-child's age, gender, age at weaning, and frequency of sweet drinks. Child's age and age at weaning were related to a significant increase in risk for caries when these effects were adjusted by the effect of other risk factor variables. The odds of having caries were increased by 2.3 times (95%, CI 1.4, 3.9) for each increase in child's age by year, and by 2.8 times (95%, CI 1.5, 5.2) for each incremental increase in age category for the child at weaning. CONCLUSION: This investigation lends further support to the contention that quantifying the occurrence of ECC is likely dependent and complicated by diverse case definitions. Caregiver's perceptions of their child's oral health were generally accurate, thereby supporting proponents for educational and preventive strategies aimed at the parent/guardian.

Validity and reliability of a dental operator posture assessment instrument (PAI).

PURPOSE: Basic operating posture is considered an important occupational health issue for oral health care clinicians. It is generally agreed that the physical posture of the operator, while providing care, should be such that all muscles are in a relaxed, well-balanced, and neutral position. Postures outside of this neutral position are likely to cause musculoskeletal discomfort. To date, the range of the neutral operator position has not been well-defined; nor have any specific instruments been identified that can quantitatively or semi-quantitatively assess dental operator posture. This paper reports on the development of an instrument that can be used to semi-quantitatively evaluate postural components. METHODS: During the first phase of the study, an expert panel defined the basic parameters for acceptable, compromised, and harmful operator postures and established face validity of a posture assessment instrument (PAI). During the second phase, the PAI was tested for reliability using generalizability theory. Four raters tested the instrument for reliability. RESULTS: Overall, total PAI scores were similar amongst three of the raters, with the fourth rater's scores being slightly greater than the other three. The main effect of the rater on individual postural components was moderate, indicating that rater variance contributed to 11.9% of total variance. CONCLUSIONS: The PAI measures posture as it occurs and will have numerous applications when evaluating operator performance in the dental and dental hygiene education setting. Also, the PAI will prove useful when examining the effects of operator posture and musculoskeletal disorders.