Dental Hygiene Students' Knowledge, Understanding and Intended Use of Caries Preventive Regimens and Community Water Fluoridation.

Purpose The purpose of this study was to determine dental hygiene students' perspectives regarding their knowledge and understanding about caries prevention strategies and their intention to use these regimens in clinical practice. Dental hygienists' knowledge and understanding of caries prevention is critical because they are the primary providers of these regimens and the relevant education.Methods This 2019 national cross-sectional online survey was designed by the University of Maryland (UMD), structured by the ADA staff for online administration, distributed and collected by the American Dental Hygienists' Association (ADHA) to 9533 email addresses, and de-identified response data were analyzed by UMD. The survey included questions on three caries preventive regimens: fluoride varnish, dental sealants, and silver diamine fluoride (SDF), and items on community water fluoridation (CWF), respondent's demographics and intent to use the regimens. Statistical analyses included descriptive statistics and analysis of variance. Significance was set at p<0.05.Results Of the 235 surveys returned (response rate 2.5%) the majority were female, White and born in the United States. Over half were in associate degree programs; nearly a third were in baccalaureate programs. Respondents reported greater knowledge/understanding and intention to use fluoride varnish and dental sealants than SDF. Less than half (44.7%) reported knowledge/understanding of SDF and only 22.6% had a high level of confidence regarding applying it. Additionally, only 31.1% indicated they were extremely likely to use SDF upon graduation.Conclusions To reduce the prevalence of caries, dental hygiene graduates must be well-versed with the latest science-based preventive procedures, including non-invasive caries prevention and control therapies. The results of this survey, albeit non representative of the general population of dental hygiene students, suggest a need for a more extensive review of the caries preventive regimen content, especially for silver diamine fluoride, of dental hygiene curricular programs.

How health literacy is taught and evaluated in dentistry, medicine, nursing, law, pharmacy, public health, and social work: a narrative review.

BACKGROUND: This narrative review examined the published peer-reviewed literature on how health literacy is taught and evaluated in seven health professional and adjacent disciplines: dentistry, medicine, nursing, law, pharmacy, public health, and social work. The study objectives were to assess how students are educated about health literacy and how their health literacy education and skills are evaluated. METHODS: Study selection followed guidelines outlined in PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). We searched PubMed, CINAHL, SocINDEX (EBSCOhost), Lexis Advance and Public Health (ProQuest) for English-language publications of health literacy education studies across seven disciplines at U.S.-based institutions. Inclusion criteria included: 1) methods describing a primary health literacy educational intervention, 2) professional education in one or more of the seven disciplines, 3) educational institutions in the United States, and 4) articles published in peer-reviewed journals between 2000 and 2020. RESULTS: The searches yielded 44 articles. Health literacy education is evident in six of the seven studied disciplines, and varies widely in the quality, quantity, timing and mode of education and evaluation. Despite the presence of health literacy accreditation requirements, none of the seven disciplines has developed and implemented a standard, rigorous health literacy education program for students. CONCLUSIONS: Graduating institutions and professional accreditation organizations that set the standards for education must lead the way by implementing upstream changes in health literacy professional education. Teaching health literacy to students in health professions is one strategy to help close gaps in patient/client professional communication for graduates and those they serve.

Knowledge, Attitudes, Behaviors of Women Related to Pregnancy, and Early Childhood Caries Prevention: A Cross-Sectional Pilot Study.

OBJECTIVE: Health education interventions during pregnancy can influence maternal oral health (OH), maternal OH-behaviors and children's OH. Interventions that can be delivered at anytime and anywhere, for example mobile-health (mHealth) provides an opportunity to address challenges of health education and support activation of women in underserved and rural communities to modify their health behavior. This pilot study was undertaken as a part of a mHealth initiative to determine knowledge, attitudes, and behaviors related to pregnancy and ECC prevention among women attending obstetrics/gynecology (OB/GYN) practices at a large rurally-based clinic. METHODS: A cross-sectional survey study was voluntarily engaged by women (n = 191) aged 18 to 59 years attending OB/GYN visits, over a 3-week period from 12/2019 to 1/2020. Survey results were analyzed applying descriptive statistics, X2 and Fisher's Exact tests. The significance level was set at P < .0001 for all analyses. RESULTS: Approximately half of respondents were between 18 and 29 years (53%), had a college degree (55%), and 100% reported cell phone use. Whereas 53% and 31%, respectively, indicated that they were "somewhat" or "very" sure of how to prevent ECC in their children, only 9% recognized evidence of early decay and 30% did not know the purpose of fluoride. Overall, only 27% of participants correctly answered the knowledge-based questions. Further, only 57% reported their provider explained things in a way that was easy to understand. Only 24% reported seeing a dentist during their current pregnancy. CONCLUSIONS: Study results suggested potential gaps in knowledge and behaviors related to ECC prevention and provided baseline data to inform future interventions to improve ECC prevention practices. Notably, majority of participants used their cell phones for making medical/dental appointments and reported using their phones to look up health-related information. This demographic represents a potentially receptive target for mHealth approaches to improve understanding of oral health maintenance during pregnancy and ECC prevention.

Seeking community water fluoridation information on state health department websites.

Community water fluoridation (CWF) is the most effective and equitable approach to preventing dental caries (tooth decay). Yet millions of Americans, especially those at highest risk of caries, do not know what CWF is or its preventive benefits. State health departments are responsible for educating their respective populations. Thus, this study assessed health department websites (N = 50) to determine if CWF content existed, the ease of finding it, and if it was written in plain language and for a consumer audience. We used the web component of the HLE2: The Health Literacy Environment of Hospitals and Health Centers (HLE2) to assess how easy or difficult it was to the navigate a website and find information. Forty-one websites had CWF information; 37 states had content written for a consumer audience. HLE2 scores ranged from 0 to 54 points (60 possible). Only five states had websites with a HLE2 score of 50 or higher. SHDs with higher HLE2 scores were easy to navigate and their content was written for a consumer audience. Study findings suggest most SHDs should improve their website's CWF content and its accessibility to better promote the role of fluoridated water in preventing dental caries.

Obstetric Providers' Role in Prenatal Oral Health Counseling and Referral.

Objectives: In this study, we explored what Maryland obstetric (OB) residents and certified nurse-midwives (CNMs) know, understand, and counsel pregnant women about oral health. We also examined the frequency with which they refer patients to dentists and their perspectives on barriers to prenatal dental care. Methods: This qualitative descriptive study used one-on-one phone interviews to identify providers' perspectives about the need for prenatal dental care, reasons low-income pregnant women do not receive care, and recommendations for increasing dental care. We interviewed 32 providers between June 2017 and March 2018. Results: Most providers were unaware of the importance of and need for prenatal dental care. Most did not discuss dental care with their patients and some admitted being inadequately trained to do so. Both provider groups were positive about actions they could take to increase pregnant patients' dental care-seeking. Conclusions: For OB residents and CNMs to play an important role in improving pregnant patients' oral health they must have adequate oral health literacy, receive appropriate training in medical and nursing school, possess oral health educational materials for their patients, and have a list of dental providers who accept their insurance.

Oral Health Literacy and Dental Care among Low-Income Pregnant Women.

Objectives: In this study, we sought to determine the impact of oral health literacy (OHL) on use of prenatal dental care and knowledge, understanding, and practices related to preventing dental caries (tooth decay) among low-income pregnant women in Maryland. Methods: We conducted a mixed methods study using a survey and a structured guide for one-on-one interviews or focus groups. The study included 117 pregnant women and was conducted between July 2016 and April 2018 in Maryland. Results: Respondents had a low level of OHL. Maryland Medicaid covers prenatal dental care, but only 53% of participants reported seeing a dentist during their pregnancy. Most women were unaware of the Medicaid dental program for pregnant women and the importance of prenatal dental care. They could not afford care if there was an associated cost and had difficulty finding a Medicaid dental provider. Importantly, they lacked understanding of how to prevent caries and did not practice behaviors to prevent this disease. Conclusions: To decrease caries rates, policies and programs must be implemented to increase the OHL of low-income pregnant women because the OHL of caregivers is associated with their children's oral health status.

Perceptions of Dental Hygienists and Dentists about Preventing Early Childhood Caries: A Qualitative Study.

Purpose: The objective of this qualitative pilot study was to gain an in-depth understanding of dental hygienists and dentists perspectives regarding children's oral health and what needs to be done to prevent early childhood caries (ECC), the most frequent chronic disease of childhood.Methods: A skilled facilitator conducted four focus groups and four phone interviews with 20 dental hygienists and 17 dentists practicing in a variety of locations within the state of Maryland. The interview guide was based on results from previous state-wide surveys of dental hygienists and dentists. Sessions were recorded, transcribed, and reviewed by the PI and facilitator. Qualitative content analysis was used to identify and manually code themes.Results: Focus groups and interviews provided rich and insightful information for strategies to help solve the ECC problem in Maryland, which supplemented the earlier quantitative mail survey data. Three key themes emerged: challenges to preventing ECC among low-income families; necessary educational methods and practices; and, the need for inter-professional collaboration. Discussions focused on issues related to educating parents with low oral health literacy about how to prevent ECC and the value of including non-dental health care providers, such as pediatricians and school nurses, in the caries prevention process.Conclusions: Current approaches to educating low-income adults about caries prevention are insufficient to prevent ECC and dental care providers cannot accomplish this goal alone. Ensuring that all dental care providers have a science-based understanding of caries prevention is critical. Integrating science-based oral health preventive care into medical and nursing undergraduate programs could increase providers' knowledge and confidence towards incorporating oral health into patient care plans; improve the oral health literacy of providers and patients; and improve patient oral health outcomes.

Perspectives of Maryland adults regarding caries prevention.

OBJECTIVES: We obtained in-depth information from low-income parents and caregivers of young children about their knowledge and understanding of and practices related to the prevention and control of dental caries (tooth decay). METHODS: In 2010, we conducted 4 focus groups in Maryland communities with low-income, English-speaking parents and caregivers who had at least 1 child aged 6 years or younger or who were pregnant. We developed a focus group guide based on findings of a previous statewide random telephone survey of adults with young children. RESULTS: Most participants had limited understanding of and extensive misinformation about how to prevent dental caries. They were confused about the use of juice and its impact on their child's teeth and had limited understanding of the use of fluorides to prevent caries. Most did not drink tap water and did not give it to their children; rather, they used bottled water. CONCLUSIONS: These results and those of the statewide telephone survey strongly suggest the need for educational interventions designed for those with limited levels of education.

Health literacy environmental scans of community-based dental clinics in Maryland.

OBJECTIVES: We conducted health literacy environmental scans in 26 Maryland community-based dental clinics to identify institutional characteristics and provider practices that affect dental services access and dental caries education. METHODS: In 2011-2012 we assessed user friendliness of the clinics including accessibility, signage, facility navigation, educational materials, and patient forms. We interviewed patients and surveyed dental providers about their knowledge and use of communication techniques. RESULTS: Of 32 clinics, 26 participated. Implementation of the health literacy environmental scan tools was acceptable to the dental directors and provided clinic directors with information to enhance care and outreach. We found considerable variation among clinic facilities, operations, and content of educational materials. There was less variation in types of insurance accepted, no-show rates, methods of communicating with patients, and electronic health records use. Providers who had taken a communication skills course were more likely than those who had not to use recommended communication techniques. CONCLUSIONS: Our findings provide insight into the use of health literacy environmental scan tools to identify clinic and provider characteristics and practices that can be used to make dental environments more user friendly and health literate.

Use of communication techniques by Maryland dentists.

BACKGROUND: Health care providers' use of recommended communication techniques can increase patients' adherence to prevention and treatment regimens and improve patient health outcomes. The authors conducted a survey of Maryland dentists to determine the number and type of communication techniques they use on a routine basis. METHODS: The authors mailed a 30-item questionnaire to a random sample of 1,393 general practice dentists and all 169 members of the Maryland chapter of the American Academy of Pediatric Dentistry. The overall response rate was 38.4 percent. Analysis included descriptive statistics, analysis of variance and ordinary least squares regression analysis to examine the association of dentists' characteristics with the number of communication techniques used. They set the significance level at P < .05. RESULTS: General dentists reported routinely using a mean of 7.9 of the 18 communication techniques and 3.6 of the seven basic techniques, whereas pediatric dentists reported using a mean of 8.4 and 3.8 of those techniques, respectively. General dentists who had taken a communication course outside of dental school were more likely than those who had not to use the 18 techniques (P < .01) but not the seven basic techniques (P < .05). Pediatric dentists who had taken a communication course outside of dental school were more likely than those who had not to use the 18 techniques (P < .05) and the seven basic techniques (P < .01). CONCLUSIONS: The number of communication techniques that dentists used routinely varied across the 18 techniques and was low for most techniques. Practical Implications. Professional education is needed both in dental school curricula and continuing education courses to increase use of recommended communication techniques. Specifically, dentists and their team members should consider taking communication skills courses and conducting an overall evaluation of their practices for user friendliness.

Oral health literacy: at the intersection of K-12 education and public health.

The link between a student's health and their ability to learn is well-established. Schools are the intersection of public health programs, dental care, and self-care. This position affords them a unique role and opportunity to enhance health literacy, including oral health literacy. This paper explores the potential of K-12 school programs and the dental profession to address oral health literacy, and, in so doing, provide future participants with essential skills to promote their oral health.

Maryland dentists' knowledge of oral cancer prevention and early detection.

To reduce the morbidity and mortality associated with oral cancers, dentists must have accurate knowledge and skills to detect and diagnose oral cancers at early stages. The authors' study found gaps in dentists' knowledge of risk factors and procedures for diagnosing oral cancers. Increasing health literacy for oral cancers among dental professionals may lead to increased health literacy for oral cancers among the public because dental professionals are a key source of oral health information for the public.

Outcomes of oral cancer early detection and prevention statewide model in Maryland.

A high oral cancer mortality rate and a moderately high oral cancer incidence rate prompted Maryland to develop a statewide approach to oral cancer early detection and prevention. This approach can serve as a model for other states. Key lessons learned include the need to: develop a comprehensive plan that focuses on actions to increase awareness, education and training for the public, dental and non-dental providers and policy makers; include oral cancer in the state's comprehensive cancer control plan to keep attention focused on this disease; and maintain high vigilance among stakeholders to keep oral cancer prevention and early detection a high priority within the state. Future efforts will focus on: requiring all dental and dental hygiene students to perform a set number of supervised oral cancer examinations for licensure to ensure a dental workforce that is competent and predisposed to providing routine oral cancer examinations; training health care providers such as doctors, nurse practitioners, and physician assistants to perform oral cancer examinations as part of a comprehensive cancer screening exam to expand the number of individuals that receive oral cancer examinations; and continuing to educate the public about oral cancer risk factors, its symptoms, and ways to prevent it.