Search

INTRODUCTION Herpes Simplex Virus-1 (HSV-1) is a highly contagious virus commonly known as a cold sore or a fever blister. An estimated 90% of adults in the United States have [...], Purpose Herpes Simplex Virus type 1 (HSV-1) is a highly contagious virus that manifests as a painful lesion and recurrences can be distressing to patients. The purpose of this pilot study was to determine if the use of a 70% ethanol alcohol hand sanitizer alters the duration, size of the lesion, level of pain upon administering treatment, and overall daily discomfort during outbreak. Methods This study was a double-blind randomized controlled trial (RCT) using 70% ethanol alcohol hand sanitizer for the experiment and medical grade mineral oil for the control group. The treatment and the control were dispensed in lip gloss applicators for applying medicament. Data was collected through the initial examination, a daily journal, photographs, and a reexamination day. Descriptive statistics and the independent sample f-test were used to analyze data (p=0.05). Results A total of 20 individuals completed the research study: ten in the experimental group and ten in the control group. The mean duration of HSV-1 lesions for the control group was 10.3 days while the mean duration of the HSV-1 lesions for the experimental group was 7.6 days. The mean size of lesions for the control group was 4.87 mm; the mean size for the experimental group was 4.25 mm. The mean pain score for the control group was 1.08 and the mean pain score for the experimental group was 2.74. The mean discomfort score for the control group was 1.33 while the mean discomfort score for the experimental group was 1.72. There was no statistically significant difference between the experimental and control groups in terms of duration, size of lesions, pain, and discomfort. Conclusion Based on the results of this pilot study, 70% ethanol alcohol hand sanitizer did not demonstrate statistical significance in the treatment and management of HSV-1 lesions. Additional research is needed with a larger sample size to determine if statistical differences can be measured. Keywords herpes simplex virus, HSV-1, herpes simplex therapy, antiviral agents, novel strategies, pain management NDHRA priority area, Client level: Oral health care (new therapies and prevention modalities).

INTRODUCTION Dental anxiety (DA) is a multifaceted disorder that involves somatic, cognitive, and emotional responses triggered by thoughts and actions of dental treatment. (1 )Between 50% to 80% of adults [...], Purpose Many adults in the United States struggle with mild, moderate, or severe dental anxiety (DA). Understanding the perspectives of patients with DA may help oral health professionals gain greater insight into their needs and learn how to provide an improved experience for these patients. The purpose of this study was to identify patients' perspectives on factors that impact anxiety in a dental practice setting. Methods A qualitative, descriptive case study design was used to identify patients' perspectives on factors impacting anxiety in a dental practice setting. Potential participants were screened using the Modified Dental Anxiety Scale (MDAS) and needed a moderate DA score to qualify for the study. An interview guide focused on obtaining information about the etiology, contributing factors, management strategies, and participant experiences of DA was used for the semi-structured virtual interviews. Responses were coded using a qualitative research analytic platform (Dedoose; Los Angeles, CA, USA). The co-investigators systematically reviewed the codes using the classic qualitative analysis strategies and journal notes to identify themes and subthemes. Results Twenty-two individuals qualified for participation in this study. Most participants reported having DA beginning in early childhood and throughout their adult life. Seven themes, including Avoidance, Supportive Behaviors, Confidence in Provider, Diversion, Enduring, Adaptations, and Benevolence emerged. Participants reported their primary method for managing DA was to avoid attending their dental appointments. Conclusion Participants in this study expressed various coping mechanisms and management strategies to alleviate the symptoms of DA. Multiple opportunities exist for increasing patient-provider trust and patient comfort to reduce DA, and ultimately improve the oral health status of individuals with DA. Keywords dental anxiety, coping mechanisms, triggers, dental practice setting, communication, patient-provider relationship NDHRA priority area, Client level: Oral health care (new therapies and prevention modalities).

INTRODUCTION First identified in 2019 in Wuhan, China, severe acute respiratory syndrome coronavirus 2 (SARS-Co-V-2) emerged as the coronavirus strain responsible for the coronavirus disease (COVID-19) pandemic. (1) Although the [...], Purpose The relative newness of Post-COVID Conditions (PCC) has revealed a void in assessment protocols and treatment guidelines for dental settings. Providing oral health care practitioners with an assessment and treatment protocol could facilitate the delivery of comprehensive oral health care. The purpose of this study was to test a protocol for assessing and treating patients with PCC in dental practice settings. Methods A qualitative exploratory research design was used to conduct the study. A PCC assessment and treatment protocol (ATP) was developed and was used by dental hygienists in clinical practice in California for a period of 6 weeks. Following the use of the PCC ATP practitioners were invited to participate in individual interviews. Online individual interviews were comprised of 20 dental hygienists recruited via purposive sampling. Participant anonymity was preserved using pseudonyms. A qualitative analysis software program was used to identify codes and themes. Investigator triangulation, member checks, and saturation were used to validate responses. Results Fifty-six participants completed the six-week PCC ATP and twenty participants took part in the interview session. Four themes were identified: awareness, accessibility, resources, and complications. Within the accessibility theme, subthemes of ease of use and guidance emerged. The complications theme yielded three subthemes: time, clinician hesitation, and patient lack of cooperation. Conclusion This study demonstrated that a PCC ATP created awareness of the varied symptoms of PCC and is a useful resource for clinical practitioners. Providing dental hygienists with a treatment protocol supports efforts to provide person-centered evidence-based care. Keywords COVID-19, SARS-CoV-2, dental care, Long COVID, Post-COVID treatment protocol, oral health care providers

INTRODUCTION Incivility has been noted by researchers as an increasing problem in American culture and higher education. (1-5) Incivility is defined as 'rude or disruptive behavior that often results in [...], Purpose While incivility has been part of higher education for many years, there has been a documented increase as both students and educators have begun to recognize this behavior and its effects on student learning, faculty satisfaction and stress. The purpose of this descriptive study was to investigate the perceptions of incivility among dental hygiene students and faculty/administrators. Methods This study utilized a convenience sample of five dental hygiene programs in California. The Incivility in Higher Education-Revised survey (IHE-R) was adapted to obtain data regarding perceptions of incivility among dental hygiene students and faculty/administrators. The survey required participants to describe incivil encounters and the perceived reasons for and consequences of the incivil behavior. An online survey was used for faculty and a paper survey was administered for dental hygiene students. Data from the open-ended questions were reviewed, summarized, edited for redundancy, and analyzed using categories. Results Of the 196 participants, 81.63% were dental hygiene students (n = 160) and 18.37% were dental hygiene faculty and administrators (n = 36). Data analysis of participant responses related to the primary reason for incivil behavior in dental hygiene education revealed five categories including lack of consequences, personality traits, miscommunication, stress, and lack of professionalism. Upon data analysis of participant responses related to the most significant consequence of incivil behavior in dental hygiene education, five categories emerged including hostile environment, decreased student success, emotional distress, relationship damage, and professional damage. Conclusion Both faculty and students felt there was a lack of consequences for incivil behavior and did not feel adequately equipped to manage these situations when they arose. Dental hygiene institutions and professional organizations need to consider offering advanced training in creating a culture of civility to prevent and address incivil behaviors. Keywords dental hygiene education, incivility, dental hygiene faculty, dental hygiene administrators, dental hygiene students, unprofessional conduct NDHRA priority area, Professional development: Education (evaluation) Submitted for publication: 8/23/2023; accepted after revision: 10/30/2023

INTRODUCTION In order to receive a dental hygiene license in the United States (US), a candidate must graduate from an accredited dental hygiene program, achieve a passing score on the [...], Purpose The use of manikin testing was recently introduced for dental hygiene licensure examinations. There is currently a lack of research about the efficacy and accuracy of manikin testing for clinical licensure. The purpose of this study is to identify perceptions of dental hygiene educators regarding the use of manikins for the dental hygiene clinical licensure exam. Methods This qualitative study used an exploratory, online, focus group design with 20 dental hygiene educator participants recruited through purposive sampling. Pseudonyms were used to protect participants confidentiality. Two groups of educators were from institutions that did not use manikin testing during COVID-19, and two groups of educators were from institutions that did use manikin testing during the same time period. Themes were analyzed using the classic analysis strategy. Validity was established using investigator triangulation, member checks, and saturation. Results Lack of knowledge including preconceived assumptions regarding manikin examinations; testing considerations with benefits and concerns regarding manikins versus live patients; and perceptions regarding the value of single point in time clinical licensure examinations were the three major themes identified by the participants. Conclusion The manikin exam appeared to address ethical concerns, however, there were limitations in relation to assessing critical thinking and decision-making skills. Some participants expressed that graduation from an accredited dental hygiene program was considered sufficient for licensure. Future studies should include comparisons of recent graduates who complete a clinical licensure examination versus those who do not complete a clinical licensure examination. Keywords clinical licensure examinations, manikin testing, dental hygiene education, competency evaluation

INTRODUCTION When infection occurs at the apices of teeth, activating the inflammatory response, polymorphonuclear neutrophils and other leukocytes attempt to destroy the pathogens. (1) However if the initial inflammatory response [...], Purpose The purpose of this article is to present a case report of a periapical lesion found in a 24-year old female who presented to a university dental hygiene clinic with a chief complaint of vestibular pain around tooth #22. Radiographically, the lesion appeared radiolucent and unilocular with well-defined borders and significant bone resorption. The area of radiolucency increased in size over a period of five weeks indicating an aggressive pathosis. Given the clinical and radiographic presentations, the differential diagnosis included an odontogenic keratocystic tumor (odontogenic keratocyst), central giant cell granuloma, periapical cyst, and squamous cell carcinoma. Biopsy revealed the diagnosis of a focal abscess. The patient's presenting signs and symptoms are reviewed. Management and contributing factors are discussed. Keywords focal abscess, granuloma, periapical abscess, keratocystic odontogenic tumor, odontogenic keratocyst NDHRA priority area, Client level: Basic science (dental hygiene diagnosis)

INTRODUCTION Traditionally, higher education institutions have focused on remediation strategies to strengthen student outcomes and success when students have struggled. (1) Examples of deficit-based programs and services include directing students [...], Purpose Undergraduate dental hygiene education programs may not provide sufficient training in professional development to prepare graduates to be primary health care providers. The purpose of the year one of a two-year study was to apply the results from a strengths assessment instrument to entry-level dental hygiene students' learning experiences and faculty instruction of students. Methods An exploratory research design including quantitative and qualitative methods was used among a convenience sample of entry-level dental hygiene students. A validated assessment instrument (CliftonStrengths[R]) was used at the beginning of the academic year to determine the professional strengths of the participants. Frequencies and percentages were used to summarize the top five strengths of each participant. Focus group interviews were conducted to assess student and faculty perceptions of professional strengths based on learning experiences at the end of the first academic year. Virtual interviews were transcribed, and the codes and themes were identified. Investigator triangulation and member checks were used to validate responses. Results Thirty-two hygiene students and 28 faculty agreed to participate in the study. The top five strengths identified for both students and faculty (n=60) were in the executing, strategic and relationship building domains. All students (n=32) participated in the focus groups and the following themes were identified: awareness, application, positive approach, successful strategies, and personal growth. Of the faculty participants (n=28), 14 participated in the focus groups. Faculty themes identified were recognition, change in perspective, personalized approach, participatory environment, and empowerment. Conclusion Results this study highlight the potential benefits of a strengths- based approach to undergraduate dental hygiene education. Helping students utilize their professional strengths in a challenging educational setting may lead to increased empowerment, professional growth and development. Further study with year two data may offer an opportunity to understand how identification of professional strengths influences students' learning experiences. Keywords professional development, professional growth, dental hygiene students, dental hygiene faculty, dental hygiene education, professional strengths

INTRODUCTION Consider the following scenario. A researcher conducts a descriptive study surveying dental hygiene educators about their plans to retire from the workforce. The survey is well-designed with demographic questions, [...], Confusion exists among some researchers and educators regarding the classification of research designs. Some classify quantitative research studies as mixed methods research when using and analyzing open-ended items on a survey. Therefore, the purpose of this short report is to describe the mixed methods research design and distinguish it from other research methods. Types of mixed methods designs and key questions to consider for this approach are discussed. Keywords quantitative research, qualitative research, mixed methods research, study design

Introduction Dental hygiene education began in 1906 when Alfred C. Fones, a dentist who valued prevention, trained his assistant to scale and polish teeth. (1) By 1913, Dr. Fones had [...], Purpose: The purpose of this study was to explore the scholarship of doctoral prepared dental hygienists as it relates to advancing the dental hygiene discipline. Methods: A qualitative descriptive research design was used to determine patterns regarding dental hygienists' experiences with their doctoral education and resulting scholarly activities. Purposive and network sampling were used to identify potential participants. Interviews were audio recorded and transcribed. Data generated from the interviews were analyzed simultaneously with data collection. Open coding and axial coding were used to analyze data in a continuous comparative method to determine themes. Validity was insured through triangulation, member checks, and respondent validation. Results: Ten participants were interviewed, and data analysis revealed several themes for each research question. Themes that influenced the decision to enroll in the program included personal, professional, influencers, and situational. Experiences the PhD program provided were scholarship socialization, program requirements, and PhD program faculty. Relative to career advancement, themes included credibility and career opportunities. Scholarship activities contributing to the dental hygiene discipline revealed two themes: scholarly activities and dental hygiene is an evolving discipline. Conclusions: Although each participant's journey to a doctoral degree was unique, there were similar themes for motivation to obtain this advanced degree in addition to the preparation for engagement in scholarly activities and career advancement. While many participants had not pursued building theoretical or conceptual models, most agreed on their importance and the concept that dental hygiene is a developing discipline. Keywords: dental hygiene, doctoral education, dental hygiene education, scholarship, scholarly activities, dental hygiene discipline, career advancement

Introduction The percentage of the United States (US) population with dental implants for the replacement of missing teeth has increased significantly from 0.7% in 2000 to 5.7% in 2016 and [...], Purpose: Dental implants have become a common treatment option for the replacement of missing teeth. The purpose of this study was to identify the curriculum content used for teaching dental implant maintenance within entry-level dental hygiene programs in the United States. Methods: An electronic questionnaire was distributed via five mailings in March and April of 2020 to accredited entry-level dental hygiene program directors (n=329) in the United States. The survey instrument evaluated curriculum content related to dental implant maintenance within dental hygiene programs at both the associate and baccalaureate levels. Results were analyzed using descriptive statistics and Chi square tests of association (/>=0.01). Results: A total of 86 responses were received for a response rate of 26.1%. Most programs (98.80%, n=82) provide didactic instruction on dental implant maintenance, while less than half (45.8%, n=38) include laboratory instruction in maintenance therapy. On average, students worked with 3.41 implant patients during their clinical education (range = 0-20). Most respondents indicated that clinical competencies are not required for implant maintenance. There were no statistically significant differences found in the curriculum content for teaching dental implant maintenance between associate degree/certificate and baccalaureate entry-level programs. Conclusions: Varied approaches in the assessment and maintenance of peri-implant health were identified among the dental hygiene programs surveyed. These findings may provide an opportunity for program directors to assess their curriculum and create protocols and competencies related to dental implant maintenance. Future research is needed to investigate the curriculum content and evaluate whether programs are implementing maintenance approaches that promote implant health. Keywords: dental implants, implant maintenance therapy, curriculum, dental hygiene process of care, dental hygiene education

Introduction Over the last 30 to 40 years the number of diagnosed autism cases has been rising globally, as well as in the US. (1) This increase in occurrence is [...], Purpose: Individuals with autism need oral health care providers who understand their sensitivities and are responsive to their oral health care needs. The purpose of this study was to understand the oral health care experiences and needs of young adults with autism spectrum disorder (ASD). Methods: A qualitative descriptive research design was used and young adults with ASD were recruited through purposive and snowball sampling. Semi-structured interviews with open-ended questions were conducted and audio-recorded. Pseudonyms were used to protect confidentiality. Interviews were transcribed and data were analyzed simultaneously at the time of data collection. Open coding and axial coding were used to create common categories. Validity was established using investigator triangulation and member checks. Results: Fifteen individuals (ten males and five females) met the inclusion criteria and participated in the study. Participants revealed a range of feelings related to their oral care experiences from positive to neutral to negative. Participants identified likes and dislikes in regard to dental hygiene and dental treatment as well as daily self-care practices. Individuals reported that improvements in communication were needed; some indicated not wanting to disclose their ASD diagnosis with their oral care providers. Multiple auditory, visual, and tactile sensory challenges were experienced while waiting in the reception area and during the provision of oral health care treatment. Participants made recommendations to improve oral health care experiences. Conclusions: Results from this study offered insight into the oral care experiences of young adults with ASD and the challenges they encounter. Additional research is needed to further explore this phenomenon from the perspective of nonverbal individuals with ASD and from the standpoint of oral health care professionals who are working with young adults with developmental disabilities. Keywords: autism spectrum disorder, young adults, oral care, dental hygiene care, access to care, perceptions, qualitative research This manuscript supports the NDHRA priority area, Population level: Access to care (vulnerable populations). Submitted for publication: 6/24/20; accepted: 12/14/20

Introduction There are two major categories of scleroderma, an autoimmune disorder, limited and diffuse. Diffuse scleroderma has widespread skin involvement, rapid progression, and early visceral involvement. (1) Limited cutaneous systemic [...], Purpose: Limited scleroderma is associated with significant risks to the orofacial complex. The purpose of this mixed methods study was to investigate the experiences of participants with limited scleroderma related to oral health quality of life and oral health. Methods: A sequential mixed methods study was used in a population of individuals diagnosed with limited scleroderma. Participants were recruited through rheumatology specialists, referral, and social media; purposive sampling was used to recruit participants to be interviewed. The validated Oral Health Impact profile (OHIP) and Mouth Handicap in Systemic Sclerosis (MHISS) instruments and semi-structured interviews were used for data collection. Quantitative data were analyzed using descriptive statistics and the qualitative data were reported through thematic analysis. Results: Forty-eight (n=48) qualifying participants participated in the quantitative phase, and 12 (n=12) participated in the qualitative phase. Based on a Likert Scale from 0-4, mean OHIP-14 scores ranged from 2.76 to 2.85, with anxiety over oral condition, embarrassed by oral problems, and oral self-consciousness having the greatest negative impact on quality of life. Mean MHISS scores ranged from 2.13 to 3.11. The highest OHRQoL scores were related to dry mouth symptoms. Factors influencing oral health-related quality of life were varied; dry mouth and microstomia were the prevalent complaints. Thematic analysis revealed challenges to oral health included self-care and professional dental care factors, both of which depended upon individual disease expression. Financial and emotional burdens also influenced participants' oral health. Conclusion: The oral health-related quality of life of those with limited scleroderma is impacted by multiple factors and oral health care professionals must seek out improved treatment modalities to address the needs of these vulnerable individuals. Future studies related to interprofessional collaborative care with scleroderma specialists are recommended. Keywords: systemic scleroderma, limited scleroderma, CREST syndrome, oral health-related quality of life, autoimmune disease, patient experience This manuscript supports the NDHRA priority area, Population level: Access to care (vulnerable populations). Submitted for publication: 6/30/20; accepted: 12/15/20

Introduction Stress is a physical, psychological, or emotional response to an internal or external demand. (1) Stress can be beneficial by enhancing productivity and motivation, or stress can be crippling, [...], Purpose: Health science students have an increased source of stress due to the rigorous curriculum, high clinical expectations, and academic demands. The purpose of this study was to determine the effectiveness of a 15-minute yoga intervention to reduce stress in entry-level dental hygiene students. Methods: First year dental hygiene students were invited to participate in the experimental study (n=32) and were randomly assigned to either the experimental or control group. The stress reduction intervention (gentle yoga movements, breathing, and meditation) was performed prior to each final exam for a total of six times. The control group proceeded with their usual pre-exam routines. Baseline and post-trial blood pressure, pulse and 10-item Perceived Stress Scale (PSS) data were recorded for both groups. Repeated measures of blood pressure and pulse were recorded before and after yoga for the experimental group and the control group prior to each exam. Data analyses included Paired-samples t-test, Independent-samples t-test and ANOVA, (p=0.05). Results: The main effect for yoga from pre- to post-session was statistically significant for blood pressure (p=0.02 systolic; p=0.02 diastolic) but not for pulse (p=0.23). Significant effects on blood pressure measures showed yoga movement sessions reduced stress however the effects sizes were small. The paired t-tests indicated the 10-item PSS values were significantly lower (p Conclusions: Fifteen-minutes of yoga movements had feasibility, compliance, and appeared to have positive effects related to stress reduction. No evidence of statistical significance was demonstrated compared to the control. Research on a larger sample of entry-level dental hygiene students using yoga movements over the course of a semester is recommended. Keywords: stress reduction, stress management, dental hygiene students, yoga, physiological measures This manuscript supports the NDHRA priority area, Professional Development: Occupational health (methods to reduce occupational stressors). Submitted for publication: 2/21/20; accepted: 8/31/20

Introduction The COVID-19 pandemic is having a major effect on the dental care delivery system in the United States (US). Patient volume in dental offices fell to about 7% of [...], Purpose: The COVID-19 pandemic has led to drops in patient volume and staffing in dental practices in the United States (US). This study aimed to provide insights on dental hygienists' employment patterns as well as their attitudes toward working as dental hygienists during a pandemic. Methods: Licensed dental hygienists were invited to participate in a web-based 30-question survey between September 29 and October 8, 2020. Employment questions included current and pre-pandemic work status, reasons for not currently working as a dental hygienist, and estimated levels of personal protective equipment (PPE) in the primary work location. All statistical analysis was conducted in Qualtrics Core XM; cross tabulation was used to examine dental hygienist working patterns and attitudes by age, practice PPE supply, and other factors. Results: The COVID-19 pandemic has led to an estimated 8% reduction in dental hygienist employment. The majority (59.1%, n=205) of this reduction is voluntary, with the main reason being general concerns over COVID-19 (48.3%, n=100). Other reasons include issues surrounding childcare and concerns over safety measures in the workplace. Dental hygienists aged 65 and older were most likely to have left the workforce voluntarily. More than half of respondents reported that their work locations had more than a two-week supply of most PPE items, although about 10% did not know supply levels. Dental hygienists working in settings with lower supplies of PPE were more concerned with COVID-19 transmission risk to themselves or to patients. Conclusion: COVID-19 has led to a reduction in the dental hygienist workforce that is likely to persist until the pandemic passes.The dental hygienist labor market has tightened and employers may continue to experience difficulties in filling vacant dental hygienist positions until the pandemic subsides. There is also likely to be a longer term, yet smaller, impact on dental hygiene employment levels. Keywords: COVID-19, employment patterns, dental hygienists, pandemic, dental hygiene workforce This manuscript supports the NDHRA priority area Professional development: Occupational health (Determination and assessment of risks) Submitted for publication: 12/17/20; accepted 1/8/21.

Introduction On February 11, 2020, the Coronaviridae Study Group of the International Committee on Taxonomy of Viruses named the novel beta coronavirus as SARS-CoV-2.1 This etiologic agent, or COVID-19 disease, [...], Purpose: Throughout the COVID-19 pandemic, health care professionals have been challenged to provide appropriate preventive and therapeutic measures while using precautions to minimize disease transmission. The purpose of this study was to estimate the prevalence of COVID-19 among United States (US) dental hygienists, describe infection prevention and control procedures and any associated trends in mental health. Methods: Registered dental hygienists (RDHs) licensed in the US were invited to participate in a 30-question web-based survey. COVID-19 infection items included probable and confirmed results, COVID-19 related symptoms experienced in the last month, and level of concern about COVID-19 transmission to patients and themselves. The validated Patient Health Questionnaire 4 screened respondents for depression or anxiety. Personal protective equipment (PPE) use when treating patients was assessed. The research protocol and survey were approved by the American Dental Association IRB and registered at clinicaltrials.gov (NCT04542915). Kruskal-Wallis and [chi square] tests were used to test for associations between PPE use, PPE supply, mental health symptoms, and concern about COVID-19 transmission. Results: As of October 8, 2020, a total of 4,776 dental hygienists from all 50 states and Puerto Rico participated in the study. Respondents reported elevated symptoms of anxiety and depression. Of the respondents, 3.1% (n=149) had ever tested positive or been diagnosed with COVID-19. The majority of respondents (99.1%; n=3,328) who practiced dental hygiene reported their primary dental practice had enhanced infection prevention or control efforts in response to the pandemic. PPE use was significantly associated with years of experience as a dental hygienist, level of concern about COVID-19, and level of PPE supplies available (p-values Conclusion: As of October 2020, the estimated prevalence rate of dental hygienists in the US having had COVID-19 was low. There is a need for further support for dental hygienists' use of PPE and mental health. Keywords: SARS-CoV-2, COVID-19, occupational health, infection control, personal protective equipment, dental hygienists This manuscript supports the NDHRA priority area Professional development: Occupational health (Determination and assessment of risks). Submitted for publication: 12/17/20; accepted 1/8/21.

Introduction Oral health is an essential component of systemic health; (1,2) however, many people have limited access to oral healthcare services. (3) There are many explanations why accessibility may be [...], Purpose: The purpose of this qualitative ethnographic case study was to explore the perceptions of a team of inter-professional healthcare providers regarding how oral health care was integrated into health care provided within a Federally Qualified Health Center (FQHC) in Brighton, Colorado. Methods: Data were gathered through one-on-one, semi-structured personal interviews, which were recorded and professionally transcribed for evaluation. Purposive sampling included physicians, physician assistants, dentists, and dental hygienists. Descriptive analysis was used to describe the sample demographics. An inductive and deductive approach was utilized to assess the qualitative data and subsequently develop themes. Validity was established using triangulation, member checks, and peer review of data and themes by co-investigators. Results: Eight participants (n=8) were interviewed. Subjects were between the ages of 31 and 58 and had been practicing between 5 and 30 years with an average of 13.6 years and had been employed by the FQHC an average of 6.8 years. Thematic analysis revealed seven themes: interprofessional collaboration supports patient care, immediate consultations lead to improved outcomes for all, shared expertise to optimize care delivery, oral health is health, increased communication through collocation, role clarity does not impede team functioning, and mission driven to provide excellent care. These themes support the domains of patient centered care, communication, and the role clarity of the Interprofessional Care Competency Framework and Team Assessment Toolkit (ICCFTAT). Conclusion: Findings from this study can aid FQHC's in the implementation of integrated oral health care delivery systems. Further research is needed to understand how interprofessional health care collaboration (IPHC) affects the team dynamic in FQHC settings. Keywords: oral health, oral health care integration, interprofessional health care, patient-centered care, medical home, Federally Qualified Health Center This manuscript supports the NDHRA priority area, Professional development: Regulation (interprofessional collaboration). Submitted for publication: 1/18/20; accepted: 5/20/20

Introduction The scope of practice for dental hygienists (DH) has gradually expanded throughout the United States (US) over the past forty years in an effort to increase access to care. [...], Purpose: The growing geriatric population has unique and often complex oral health care needs. The purpose of this study was to explore the perceptions regarding direct access dental hygienists (DH) regarding the geriatric curriculum needed in dental hygiene education programs to prepare DHs to provide direct access care for geriatric populations. Methods: Purposive and network sampling strategies were used to recruit eligible direct access DHs from across the United States for this qualitative study. Semi-structured telephone interviews were conducted until was met. Demographic data were analyzed using descriptive statistics. Open coding techniques were used to identify themes. Results: Ten direct access DHs agreed to participate. Nine themes emerged from the data analysis: combining didactic and hands-on experience, how direct access differs from traditional practice, importance of a standardized course in entry-level programs, need for a specialty course in geriatrics, understanding the geriatric patient, understanding direct access settings, modifications to treatment modalities, process of care, and interprofessional knowledge. Participants indicated that entry-level dental hygiene students should be exposed to hands-on clinical rotations, have a standardized aging and geriatrics course, and potentially incorporate geriatrics as a specialty tract within dental hygiene programs. Conclusion: Geriatrics may not be covered in sufficient depth to prepare entry-level dental hygiene students for work with these populations in direct access settings. Findings from this study may be used to support improvements in geriatric curriculum for entry-level dental hygiene programs. Future research is needed to determine necessary focus and most effective way to disseminate this curricular content. Key Words: geriatric oral health, geriatrics, dental hygiene education, dental hygiene students, direct access dental hygienists, direct access oral care, dental hygiene workforce models

Introduction Cancer is a worldwide health problem and the second leading cause of death in the United States (U.S.), surpassed only by heart disease. (1) Surveillance data projected that in [...], Purpose: The purpose of this study was to investigate the effect a continuing education (CE) course had on dental hygienists' knowledge, attitudes, and practices regarding human papillomavirus (HPV) related oropharyngeal cancer (OPC). Methods: A two-group, experimental post-test only design was used for this study. Randomly selected, licensed dental hygienists in the state of Florida, were recruited by email and assigned to either an experimental or control group. An investigator designed, questionnaire was developed and tested for validity and reliability. The experimental group received a one-hour web-based CE course on HPV related OPC. Six weeks later, a post-test questionnaire was administered to the experimental and control groups via an online platform, Qualtrics[R]. Data were analyzed using descriptive statistics and analysis of variance (ANOVA). Results: Out of 302 dental hygienists who agreed to participate, 133 completed the study for a participation rate of 44.0%. The knowledge score for the experimental group was 72.6% while the control group scored 58.4%. Results demonstrated statistically significant differences between the groups in terms of knowledge (F=33.81, df=1, p=0.00) and attitudes (F=13.91, df=1, p=0.00). No differences were found in oral examination procedures; however, statistically significant differences (F=7.47, df=1, p=0.007) were noted for items related to HPV specific examination practices between the two groups. Conclusion: Additional research is needed to identify what specific types of educational interventions are effective in increasing the HPV-related OPC knowledge and practice behaviors of dental hygienists. Keywords: dental hygienists, human papillomavirus, oropharyngeal cancer, knowledge, attitudes, clinical dental hygiene practice This manuscript supports the NDHRA priority area, Professional development: Education (educational models). Submitted for publication: 7/16/19; accepted: 12/31/19

Introduction Licensure and regulation have been important aspects for public health in the dental hygiene profession since its inception. The purpose of licensing is to protect the health and safety [...], Purpose: The purpose of this study was to identify current requirements for initial licensure and entry into the dental hygiene profession across state dental and dental hygiene licensing boards in the United States. Methods: A non-experimental study design was used to study dental and dental hygiene board licensing requirements in the United States, Puerto Rico and the Virgin Islands. Each regulatory board website was searched for requirements for entrylevel dental hygiene licensure. Requirements were recorded on an Excel spreadsheet. State dental practice acts were reviewed to gather further information and 20 regulatory bodies were contacted to verify accuracy. Descriptive statistics were used to analyze data. Results: Information from a total of 52 dental boards (n=52) was examined for this study. Nearly all boards (n=51, 98.1%), with the exception of Alabama, required completion of entry-level education from a CODA accredited dental hygiene program and successful completion of the National Board Dental Hygiene Examination. Most states (n=51, 98.1%), except Delaware, also required a live-patient, a clinical board examination. Application fees ranged from $47.70 to $600. States varied considerably in terms of requirements for background checks, age, military status, and infection control training. Conclusion: Although the majority of regulatory bodies require completion of entry-level dental hygiene education from a CODA accredited program and successful completion of national board and a live-patient, clinical examination, there is considerable variation in other additional requirements for initial dental hygiene licensure. Keywords: dental hygiene workforce models, dental hygiene education, licensure, accreditation standards, scope of practice This manuscript supports the NDHRA priority area, Professional development: Regulation (scope of practice). Submitted for publication: 6/10/19; accepted: 10/17/19.

Introduction There is a global crisis in regards to the number of people displaced from their homeland as a result of war and persecution. An estimated one in every 113 [...], Purpose: The purpose of this study was to analyze associations between the oral health literacy of refugees and two oral health outcomes: dental care utilization and oral health self-efficacy. Methods: A convenience sample of refugees in the greater Los Angeles area attending English as a second language (ESL) classes sponsored by two refugee assistance organizations was used for this cross-sectional, correlational study. Participants responded to a questionnaire using items from the Health Literacy in Dentistry (HeLD) scale, in addition to items concerning dental care utilization and oral health self-efficacy. Descriptive statistics, chi-square and Fisher's Exact tests were used to analyze results. Results: Sixty-two refugees volunteered to participate (n=62). A majority of the respondents were female from Iraq or Syria, and selected the item "with little difficulty" for all oral health literacy tasks. In regards to dental care utilization, more than half of the respondents were considered high utilizers (63%, n=34) meaning they had visited a dental office within the last year; while a little more than one-third (37%, n=20), were low utilizers, indicating they had either never been to a dental office or it had been more than one year since they had dental treatment. Statistical analysis showed associations between oral health literacy and dental care utilization. However, few associations between oral health literacy and oral health self- efficacy were identified (p=0.0045). Conclusions: Results support the provision of easily obtainable and understandable oral health information to increase oral health literacy and dental care utilization among refugee populations. Future research is needed to examine the oral health literacy among refugees resettling in the United States. Keywords: oral health literacy, health literacy, dental care utilization, oral health self-efficacy, dental public health, refugees This manuscript supports the NDHRA priority area, Population level: Access to care (vulnerable populations). Submitted for publication: 12/14/18; accepted:10/20/19

Introduction The first dental hygiene school was founded by Dr. Alfred C. Fones in 1913. Dental hygiene students were educated in 'mouth hygiene' and instrumentation techniques to remove 'plaque, stain [...], Purpose: Dental hygienists have increased opportunities as work-force models expand opportunities for the profession. The purpose of this study was to identify entry-level dental hygiene program directors' perceptions regarding advancing accreditation standards in dental hygiene education. Methods: An electronic questionnaire was distributed via three mailings during the spring semester of 2019 to the 332 entry-level dental hygiene program directors across the United States for this exploratory, descriptive study. The survey instrument addressed the various dimensions related to changing the accreditation standard for the entry-level dental hygienists to the baccalaureate degree. Descriptive statistics and chi-square tests of association were used to analyze results. Results: A total of 178 responses were received (n=178) for a response rate of 53.6%. Most program directors agreed students complete three years of college education (n=152, 85.4%), and should be educated to understand current and emerging workforce delivery models (n=166, 93.2%). More than half disagreed (n=94, 52.9%) with the statement that there is ample time in the curriculum to prepare students for employment in a variety of oral healthcare settings. Respondents were equally divided concerning changing the accreditation standard for the entry-level to the baccalaureate degree but were in support of modifying the standard to require didactic educators to have a master's degree. Conclusion: Dental hygiene program directors were divided regarding advancing accreditation standards to the baccalaureate degree for entry-level dental hygienists. Further research is needed to include dental hygiene educators' and leaders' perspectives to provide comparative information and a greater understanding regarding increasing accreditation standards. Keywords: dental hygiene education, dental hygiene workforce models, dental hygiene faculty, professional development; baccalaureate degree, accreditation standards

Introduction Teaching methods in higher education have traditionally been delivered through a mass lecture format, limiting the opportunities for interpersonal communication between faculty and students. (1) The quality and quantity [...], Purpose: Higher education teaching has been traditionally delivered through a lecture format, limiting the opportunities for interpersonal communication between faculty and students. The purpose of this study was to determine whether entry- level dental hygiene (DH) students and faculty perceive social media (SM) applications as an effective out-of-class communication (OCC) tool for enhancing learning in a dental hygiene program. Methods: A cross-sectional, comparative research design was used for this pilot study. An investigator-designed, paper survey was administered to a convenience sample of entry-level DH students and faculty from nine dental hygiene programs in Utah, Idaho, Oregon, Washington, and California. Data were analyzed using descriptive and inferential statistics (p=0.05). Results: A total of 418 students and 149 faculty members met the eligibility criteria; 325 DH students (n=325) and 77 faculty completed the surveys (n=77) for a combined response rate of 70.9%. While most faculty and DH students agreed SM could enhance learning for OCC, their level of comfort using these applications varied. Both faculty and DH students use SM applications for questions about assignments, clarification on lecture topics, and feedback on assignments. Statistical significance was found for the frequency of using SM applications for OCC (x2 =16.92; df=4; p =.002). Learning management systems were used and preferred most by both groups followed by Facebook. Statistical significance was found between both groups when ranking electronic devices for OCC. Conclusion: Dental hygiene students and faculty differ in their frequency and levels of comfort in using SM for out-of- class communication. Additional research related to the phenomenon of social media and communication to enhance learning in dental hygiene should be explored. Keywords: social media, education methods, dental hygiene education, curriculum, dental hygiene students This manuscript supports the NDHRA priority area, Professional development: Education (educational models). Submitted for publication: 5/4/19; accepted: 8/8/19

Introduction Local anesthetics have been used in dentistry to aid patients in pain control during non-surgical periodontal therapy (NSPT), restorative care, surgical care, and cosmetic therapy. Washington became the first [...], Purpose: Local anesthetics have been used in dentistry to aid patients in pain control during a wide range of surgical and non-surgical procedures. The purpose of this study was to explore the perspectives of patients regarding the administration of local anesthesia (LA) by dental hygienists. Methods: This qualitative study used an exploratory, online, focus group design. Four online focus groups were held with 18 participants recruited through purposive sampling. Pseudonyms were used to protect participants' confidentiality. A questioning route was established for the groups and validated by focus group experts and pilot testing procedures. Each focus group session was recorded and transcribed. Themes were analyzed using classic analysis strategy. Validity was established using investigator triangulation, saturation and member checks. Results: Three major themes were identified regarding the administration of local anesthesia by dental hygienists. The first theme identified was the patients' experience and the value participants placed on patient-centered care. The second theme was the participants' unclear perceptions regarding the dental hygienists' educational qualifications to administer LA and complete a dental hygiene diagnosis. The third theme revealed future suggestions for dentists and legislators from the participants. Conclusion: This qualitative study offers insight into the patient's perspective of dental hygienists administering LA. Participants supported dental hygienists administering LA and appreciated the aspects of patient-centered care that this practice provided. Patient participants were unclear on educational requirements and training, but supported legislation allowing dental hygienists to administer LA. Keywords: local anesthesia, pain control, delegation skills, dental hygienists, patient centered care This manuscript supports the NDHRA priority area, Professional development: Regulation (scope of practice). Submitted for publication: 3/14/19; accepted: 6/24/19

Introduction The National Cancer Institute (NCI) indicates over 300,000 men and women are living with a prior diagnosis of cancer of the oral cavity and pharynx in the United States [...], Purpose: The purpose of this pilot study was to compare public perceptions of Idaho adults regarding oral cancer (OC) screening with other common cancer screenings including breast cancer (BC), prostate cancer (PC), and colon cancer (CC) screenings. Methods: This study utilized a convenience sample (N = 100) of Idaho residents. A self-designed, validated interview-administered questionnaire was administered by a data collection service using computer-assisted telephone interview software to assess consumer perceptions about cancer screenings. Data were analyzed using descriptive statistics, frequencies, and Pearson's Chi-Square tests. Results: Participants were predominantly white (90%) with a mean age of 52.7 years with some post-high school education (80%) and the majority had received OC screenings (54%).The majority of participants perceived benefits of each specific cancer screening as very helpful: (a) OC screening (60%), (b) BC screening (79.2% females), (c) PC screening (63.8% males), and (d) CC screening (84%), and also reported no perceived risks regarding OC (80%), BC (60.4%), PC (66%) screening. Only 11% reported fear of finding cancer with an OC screening. The study findings supported significant associations (p Conclusion: This study identified associations between consumer perceptions of OC screening when compared with BC, PC, and CC. Concerns about cost and time for cancer screenings may reflect low consumer awareness regarding differences between OC and other cancer screenings. Future studies including larger samples representing more diverse populations are recommended to further explore the basis of participants' perceptions of cancer screenings and to identify ways to minimize barriers to cancer screenings. Keywords: oral cancer, cancer screening, oral neoplasms, cancer prevention, cancer control, health attitudes This manuscript supports the NDHRA priority area Client level: Oral healthcare, (Health promotion: treatments, behaviors, products).

INTRODUCTION Checklists are used successfully in a number of professions to assist with safety protocol and job performance accuracy. Although checklists have been used as a procedural standardization tool in [...], Purpose: A checklist intervention was applied to the dental radiographic acquisition process to determine its effectiveness in improving the diagnostic value of bitewing images and reducing patient exposure to unnecessary radiation. Methods: A mixed-method, nonrandomized research design using two dental hygiene program cohorts (n=33) as control and intervention groups was used to assess the effect of a radiographic checklist on the number and type of radiographic imaging errors. The relationship between perceived value of the checklist and willingness to continue its use was examined and analyzed using descriptive statistics. The effect of previous radiography experience, type and number of acquisition errors, and number of retake exposures were analyzed using Fisher's Exact test, chi-square analysis, Spearman's rho, ANOVA, Cronbach's alpha, Breslow-Day, and Pearson correlation coefficient test. Results: Checklist use did not contribute to an improvement in the diagnostic value of radiographs, nor did the intervention reduce patient exposure to unnecessary radiation. Additionally, analysis did not reveal a statistically significant difference between types of radiographic errors and previous radiography experience. A positive correlation was found between perceived value and willingness to continue checklist use. Conclusion: Similarities between the professions of medicine and dentistry suggest that dental procedures may also benefit from application of checklists. Although a positive association between checklist use and error and retake rate was not realized in this study, checklist use may help to improve the quality of radiographic exposures, thereby impacting patient safety by limiting unnecessary exposure to radiation. Additional research is needed to continue to evaluate the effects of checklist use on dental radiographs. As the body of knowledge related to checklist development and use continues to grow, dental hygienists can look for additional ways to incorporate checklists into practice. Keywords: clinical research; dental radiography; risk assessment; self-assessment This study supports the NDHRA priority area, Occupational Health and Safety: Investigate methods to decrease errors, risks and or hazards in health care and their harmful impact on patients.

INTRODUCTION The failure of the nation's infrastructures to satisfy the oral health needs of isolated, underprivileged or impaired populations is well documented. (1-7) In response to these needs, many state [...], Purpose: Thirteen states in the nation authorize dental hygienists to satisfy re-licensure requirements in part, by performing pro bono oral health services in lieu of participating in continuing education courses This study compared registered dental hygienists' donations of time and professional expertise, perceptions of volunteerism and motivational orientations as they practice in both the presence and absence of a practice act statute intended to incentivize volunteerism. Methods: Volunteer behaviors, perceptions and motivational orientations of a non probability sample of 316 dental hygienists actively licensed by the states of Idaho or Utah, were assessed using an online survey which included the Self Determination Theory General Causality Orientations Scale (GCOS). Survey Monkey results were analyzed using Mann Whitney U tests, Chi-Square analysis and an Independent Samples t-test at the 0.05 level of significance. Results: No statistically significant differences were found between dental hygienists' volunteer behaviors, perceptions of volunteerism or scores on the GCOS Autonomy and Impersonal subscales in the 2 states studied. Statistical analysis of dental hygienists' mean scores on the GCOS measure of Controlled motivational orientation yielded a significant difference (p=0.001) among Utah and Idaho dental hygienists. Conclusion: Dental hygienists require evidence based practice statutes and regulations that keep pace with the need to provide universal access to comprehensive oral care. Additional research is required to determine the effectiveness of legislation intended to encourage registered dental hygienists' altruistic expressions. Dental hygienists are frequently unaware of opportunities to volunteer their services and how state practice act regulations impact those opportunities. Keywords: volunteerism, dental hygienists, practice acts, motivations, incentives, self determination theory, general causality orientations scale This study supports the NDHRA priority area, Health Services Research: Identify how public policies impact the delivery, utilization, and access to oral health care services.

June is the time for celebrating graduations, looking ahead with our annual conference, and moving forward. As we look to the future, we sometimes need to assess our past. As [...]

It has been fifteen years since the Journal of Dental Hygiene published a supplemental issue focusing on incorporating antimicrobial mouthrinse strategies into oral hygiene regimens. At that time, the safety [...]

By now, as you read this editorial, we are at least ten months into a pandemic and no closer to understanding the virology of COVID-19. This virus does not play [...]

Introduction By the year 2040, approximately 25% of the U.S. population will be over age 65. (1) 2 3 4 5 6 People are living longer and retaining more of [...], Purpose: The objective of this study was to investigate knowledge and perceptions of executive directors of long-term care facilities in a large western state regarding oral health of residents, barriers to the provision of optimal oral health care and the collaborative practice role for dental hygienists. Methods: A descriptive, exploratory online survey research design was utilized. A purposive sample of executive directors of long-term care facilities in a large western state certified for Medicare/Medicaid reimbursement was used. An online survey was developed to investigate perceptions and knowledge regarding oral health of long-term care residents, protocol for provision of, and barriers to optimal oral health care, and support for employment of dental hygienists in long-term care facilities. Statistics used for data analysis included frequency distributions, Spearman's rho correlation coefficient and the Mann-Whitney test. Results: Executive directors in long-term care facilities included in the study perceived oral health as an important aspect of general health; however, a knowledge deficit was identified related to oral disease as an exacerbating factor to systemic disease. Financial concerns and low interest among residents/families were identified as major barriers to accessing care. Executive directors supported interprofessional practice of nurses working with dental hygienists to optimize oral health care of residents. No significant associations were found between demographics and facility characteristics. Conclusion: Awareness of the knowledge and perceptions of executive directors providing leadership in these facilities can provide avenues to creating needed change, which can foster improvement in the oral and overall health status of long-term care residents. Support for interprofessional work of nurses and dental hygienists can open a door for innovative practice that optimizes oral health care of long-term care facility residents through the application of shared expertise. Keywords: long-term care, oral health, oral hygiene, executive directors, aging, barriers, geriatric dentistry This study supports the NDHRA priority area, Health Services Research: Identify how public policies impact the delivery, utilization, and access to oral health care services.

Introduction It is estimated that approximately 44.85% of the U.S. population will develop cancer at some point in their lives. (1) According to the National Cancer Institute and the American [...], This manuscript was part of the proceedings from the conference Advances in Practice, hosted by the National Center for Dental Hygiene Research & Practice, held in Phoenix, Arizona, on June 12, 2012. Keywords: women's cancers, HPV testing, cancer prevention This study supports the NDHRA priority area, Clinical Dental Hygiene Care: Assess how dental hygienists are using emerging science throughout the dental hygiene process of care.