The scientific program is an integral part of the Canadian Dental Hygienists Association’s biennial national conference. The following studies will be presented, either orally or in poster format, between October 3 and 5, 2019, in St. John’s, Newfoundland and Labrador.
. 2019 Oct 1;53(3):183–188.
Can J Dent Hyg. 2019 Oct 1;53(3):183–188.
Background
A predominantly clinical dental hygiene refresher course for dental hygienists seeking re-entry into practice was offered in Alberta for over 15 years. Because of the varied educational and practice histories of course participants, however, a newly developed dental hygiene refresher course incorporated a 3-month online component to be completed prior to the clinical practicum. Kern, Thomas, and Hughes’ 6-step curriculum development approach (2009) guided the online program design, and Olmstead’s framework for preparing professionals (2010) guided the development of learning activities specific to dental hygienists.
Objective
This project aimed to determine how course participants perceive the interactive online learning activities of the refresher course and to assess their perception of preparedness for the clinical practicum.
Approach
This 2-part program evaluation included a post-course group session with participants and clinical instructors and the Distance Education Learning Environments Survey (Walker & Fraser, 2005) which measures student perceptions of instructor support, student interaction and collaboration, personal relevance, authentic learning, active learning, and student autonomy.
Results
Sixteen participants completed the new refresher course from March through June 2019. Three clinical instructors also provided post-course feedback. Participants reported feeling prepared for clinical sessions; valued flexibility and independence of online learning; and appreciated online interactions with fellow course participants prior to meeting face-to-face in clinics but requested more case studies, fewer small assignments, and questioned the relevancy of some assignments. Clinical instructors reported participants came prepared with updated knowledge for the clinic sessions after completing the online activities.
Conclusion
The 3-month online course with self-paced asynchronous activities improved preparation of participants for the onsite clinical practicum. Participants valued the interactive learning activities and convenience of distance education. However, they also made recommendations for future changes. Phase 2 of the evaluation provided increased understanding of participants’ perceptions of the overall course experience and their resulting performance during the onsite clinical practicum. The combined feedback will allow for further enhancements to the refresher course to ensure appropriate review and preparation by participants for the course and for successful re-entry into dental hygiene practice.
Can J Dent Hyg. 2019 Oct 1;53(3):183–188.
Objective
Oral epithelial dysplasia (OED) is recognized as potentially malignant. However, when dysplasia coincides with striking lichenoid changes, the cellular atypia is often discounted as reactive. The objective of this literature review was to assess the malignant potential of OED with striking lichenoid features (lichenoid dysplasia, LD), compared to OED without lichenoid features.
Method
A systematic search of electronic databases was conducted using PubMed and MEDLINE EBSCO. The following key words were used: [“lichenoid dysplasia” OR “lichenoid mucositis”] AND [“progression” OR “cancer”]. The references and bibliographies of included studies and papers were also scrutinized. English-language, full-text, primary, peer-reviewed publications were included in this literature review. Review articles and papers that did not answer the primary research question were excluded.
Results
The search strategy produced 68 articles, 7 of which met the inclusion and exclusion criteria: 3 molecular studies investigating the expression of biomarkers implicated in cancer progression, 2 case reports of LD that progressed to oral squamous cell carcinoma, and 2 retrospective studies, one of which compared clinical and histological characteristics of LD and OED, while the other investigated the proportion and rate of malignant transformation of both LD and OED.
Conclusion
Variability in diagnostic criteria and inadequate documentation contribute to the ongoing debate regarding the malignant potential of LD. However, most studies support the finding that OED has malignant risk, regardless of lichenoid changes. Well-designed prospective studies are required to further investigate the malignant potential of LD.
Can J Dent Hyg. 2019 Oct 1;53(3):183–188.
Objective
To determine the extent of the difference in health complications among a population of individuals with diabetes who report “poor to fair” versus “good to excellent” oral health.
Method
A prospective cohort study was undertaken of individuals with diabetes from the Canadian Community Health Survey 2003 and 2007–2008 (N = 5,183). Self-reported oral health was linked to electronic health records. Participants under the age of 40, missing self-reported oral health, and those who could not be identified in linked databases were excluded. Diabetes complications were extracted from health records based on ICD codes. A series of Cox Proportional hazards and multinomial logistic regression models were constructed to determine the risk of diabetes complications and the odds of acute or chronic complications, respectively. Participants who did not experience any diabetes complication were censored at time of death or at the study termination date (March 31, 2016). Models were adjusted for age and sex, followed by social characteristics (income, education, ethnicity, and rural vs urban living) and behavioural factors (smoking status, alcohol consumption, physical activity, and dental visits).
Results
Diabetes complications among participants differed by self-reported oral health. For those reporting “poor to fair” oral health, the hazard of a diabetes complication was approximately 30% greater (HR 1.29 95%CI 1.03, 1.61) than for those reporting “good to excellent” oral health, in a fully adjusted model. For those reporting “poor to fair” oral health, the odds of an acute and chronic complication were approximately 10% (OR 1.10 95%CI 0.81, 1.51) and 34% greater (OR 1.34 95%CI 1.11, 1.61), respectively, in a fully adjusted model.
Conclusion
Oral health status is associated with diabetes complications and it appears that this link is influenced by the chronic nature of the periodontitis–diabetes link. This study is the first to explore the oral health–diabetes health link among individuals with diabetes in Ontario, Canada.
Can J Dent Hyg. 2019 Oct 1;53(3):183–188.
Background
Head and neck cancer (HNC) accounts for approximately 4% of all new cancer cases in Canada and 3% of all cancer deaths. While a moderate decrease in HNC has been documented, the incidence of oropharyngeal cancers related to human papillomavirus (HPV) is increasing and is predicted to surpass the prevalence rate of cervical cancer by 2020. Radiation therapy is often used in the treatment of HNC, resulting in acute and chronic side effects. Educating clients to seek pre- and post-radiation treatment dental care is essential to mitigate oral complications. Routine HNC screenings facilitate earlier detection and can improve survival rates.
Objective
This interprofessional student collaboration session was created for dental hygiene (DH), radiation therapy (RT), and medical laboratory science (MLS) students to better understand the client’s cancer care experience, beyond the DH/RT/MLS points of practice.
Approach
The first time the session was offered, RT and DH students completed pre-session and post-session surveys. In 4 separate stations, students role-played client education scenarios and identified and described their unique roles and respective responsibilities in a client’s oncological journey, before, during, and after treatment. Following the session, students participated in a question-and-answer discussion. The second year, we offered 2 sessions instead of one, included MLS students as well as client partners who had been diagnosed with HNC, and made use of the university’s Linear Accelerator Training Suite in hopes of accommodating deeper learning about person-centred care.
Evaluation
All students indicated that they learned a significant amount about the client experience during cancer care and about HNC multidisciplinary care specifically. They articulated feeling more confident in providing clients and their families with mindful, empathetic, high-quality care.
Can J Dent Hyg. 2019 Oct 1;53(3):183–188.
Objectives
Calculus is a calcified mineralized plaque that plays an important etiological role in periodontal diseases. Most anticalculus agents in toothpaste prevent calculus but barely remove existing calculus and may damage tooth structures. The purpose of this randomized controlled clinical study was to test the efficacy of a newly developed anticalculus toothpaste (D-Tart toothpaste) in removing calculus and dental stains compared to Crest antitartar toothpaste.
Method
The study design was reviewed and approved by the Research Ethics Board at McGill University (application A08-M35-16B), and all study participants signed informed written consents before their participation. Eighty-three clients who fulfilled the inclusion criteria were blindly and randomly assigned to 2 study groups. Forty-two participants received the intervention (D-Tart toothpaste), and forty-one received the control toothpaste (Crest toothpaste). Calculus, stain, QHI plaque, and gingival indices scores were recorded and compared at baseline, 3, 6, and 9 months, using a generalized linear model analysis with the Wald Chi-Squared Test. Scaling and polishing were offered to all participants at the 3-month visit and the end of the study.
Results
At 3 months, the intervention group showed 32% less total calculus compared to the baseline mean score (p = 0.0007) and 59% less total calculus compared to the control group (p = 0.0001). Over the 9 months, the mean calculus score for Crest users was 79% higher than for D-Tart users (p = 0.0008). There was a significant improvement in the gingival health of D-Tart users compared to the Crest group at all intervals. However, both toothpastes were comparable in terms of stain removal, which was significantly lower than at baseline (p < 0.0001).
Evaluation
D-Tart toothpaste shows superior efficiency in removing and preventing calculus accumulation than the control toothpaste, and it could be helpful in preventing stain formation after 9 months of use.
Can J Dent Hyg. 2019 Oct 1;53(3):183–188.
Objective
This project aimed to examine the variation in admission criteria used by Canadian dental hygiene (DH) programs and determine whether these criteria are predictive of student success on the National Dental Hygiene Certification Examination (NDHCE).
Method
Because this study was deemed outside the mandate of the Research Ethics Board, ethics approval was waived. Admission criteria were compiled from websites of 30 English-language DH programs. Data collected included secondary and post-secondary prerequisite courses, total required post-secondary credits, entrance average/GPA, interview and/or essay, and any other non-cognitive requirements. DH programs were contacted by email or phone to obtain information not available on the websites. The 2015–2017 NDHCE school results were collected from the National Dental Hygiene Certification Board’s website. The association between admission criteria and NDHCE school success rate was determined by calculating Pearson’s product-moment correlation coefficient.
Results
A strong correlation was found between the number of post-secondary prerequisite credits required and NDHCE success rates (r = 0.674). There was a weak correlation between program length and NDHCE success rates (r = 0.177). Admission criteria included academic performance, non-cognitive requirements, and standardized testing. Academic performance as an admission criterion, which included GPA or high school averages, was the most common criterion used.
Conclusion
Graduates of programs that required more post-secondary prerequisites may fare better on the NDHCE because the rigour of the prerequisites may have removed lower performing students from the applicant pool. Various interview processes were used by DH programs, with each type capturing different attributes. Standardized testing may equalize the discrepancies in grades from prerequisites obtained from different institutions. Due to variation in selection processes for DH programs, it is difficult to isolate variables that are predictive of success on the NDHCE. However, academic criteria such as the number of prerequisite credits required may predict DH student success.
Can J Dent Hyg. 2019 Oct 1;53(3):183–188.
Objective
The purpose of the study was to explore the family-life roles and experiences of mature female dental hygiene students, as well as the different mechanisms used for coping with role conflict in order to better enable and support individual student success.
Methods
This study employed a mixed-methods explanatory approach whereby quantitative data were obtained from mature female dental hygiene students (N = 12) via a 10-item questionnaire comprising both closed and open-ended questions. Closed-ended questions were summarized using descriptive statistics. Open-ended questions were examined for common themes. Additional qualitative data were obtained through personal in-depth interviews examining for supplementary common themes.
Results
These females identified “mothering” as their primary role prior to entering school and while attending school. All participants indicated the greatest challenge was “time”—time to be a parent, time to complete household responsibilities or time to complete academic work. Yet the prime benefit reported was increased self-confidence. Role conflict was self-imposed. The coping strategy of role redefinition was found to be most beneficial to support change, growth, and development. The educational system offered the least amount of support according to these respondents.
Conclusion
The mature female student requires support when returning to higher education. Institutions of higher education need to be cognisant of specific characteristics, barriers, and challenges any student encounters to facilitate their success.
Can J Dent Hyg. 2019 Oct 1;53(3):183–188.
Background & Objectives
Many nursing home residents do not receive adequate oral care from staff. When teeth and dentures are not cleaned regularly, risks increase for caries, gingivitis, oral infections, respiratory pneumonia, diabetes, heart disease, lowered nutrition, and reduced social interactions. The objective of this study was to determine which of 2 methods of in-service training could be effective in motivating staff to carry out oral care with resistant residents.
Methods
Following ethics approval from the researchers’ university and from participating nursing homes, 6 nursing homes in New Brunswick were randomly assigned to 1 of 2 methods of in-service training—a traditional lecture session about the importance of oral health or a new discussion-based session that addressed staff questions, concerns, and past experiences with residents who resisted oral care. In total, 40 staff members received the traditional method of training and 64 participated in the discussion session. Trained dental hygienists measured the oral status of residents at time of training and 4 weeks post-training to index the quality of oral care carried out following training. Three indices were utilized: Gingival Index (GI), Simplified Oral Hygiene Index (OHI-S), and Denture Oral Hygiene Index (OHI-D) [developed by the first author]. Immediately following training, staff filled out a 9-item Likert survey developed for this study that included questions about satisfaction with the training, usefulness of the strategies discussed, and confidence in providing oral care.
Results
Two 2 (Training method) x 2 (Time of measurement) ANOVAs yielded significant interactions for biofilm and calculus, indicating that the discussion training resulted in superior oral care. Staff members were equally satisfied with both types of training.
Conclusion
Training focusing on practical techniques for providing care that is safe for both the resident with dementia and the staff member may be more effective than traditional approaches, which often focus on the health consequences of not providing adequate oral care.
Can J Dent Hyg. 2019 Oct 1;53(3):183–188.
Objective
Dental magnification loupes may be a source of cross contamination. The primary objective of this pilot project was to evaluate the efficacy of infection control protocol used by third-year dental students. A secondary objective was to determine if a type of procedure could be predictive of contamination.
Methods
Loupes (N = 25) were swabbed at baseline, wiped with disinfectant, and swabbed again. Students used the loupes for 5 days, after which the loupes were swabbed again. Students followed standard disinfection protocol and were not informed of the purpose of the study. Samples were cultured on blood agar plates and incubated (370C) for 1 to 2 days in aerobic and anaerobic environments. The numbers of microbes from each sample were enumerated by viable cell count. McNemar’s test was used to compare the proportion of contaminated loupes at baseline and day 5. Backward stepwise (Wald) logistic regression was conducted to determine if type of procedure performed was a predictor of contamination at day 5.
Results
Viable cell counts ranged between 0 and >200. Loupes were classified as not contaminated (0 to 20 colonies), moderately contaminated (20 to 100 colonies) or highly contaminated (>100 colonies). At each time point, 40% of loupes were either moderately or highly contaminated with aerobic and/or anaerobic bacteria. There was no change in the proportion of loupes contaminated between baseline and day 5 (p = 1.000) for either bacteria. Overall, 36% (n = 9) of student loupes were uncontaminated at both time points, 16% (n = 4) were contaminated at both times points, and 48% (n = 12) were contaminated either at baseline or day 5. The only procedure that was a significant predictor of contamination was if a restoration was performed on day 5 (immediately before loupe collection) (p < 0.01).
Conclusion
The data suggest that only 36% of students consistently followed disinfection protocols. Future study is needed to determine which types of procedures cause the greatest amount of contamination.
Can J Dent Hyg. 2019 Oct 1;53(3):183–188.
Objective
The objective of this study was to evaluate the impact of preclinical peer assessment on the creation of Class II composite restorations on tooth #15(MO) and # 46(MOD), including rubber dam, tofflemire, and matrix band placements.
Methods
A quasi-experimental design was chosen for this study, which utilized a convenience sample of 20 dental hygiene students enrolled in the winter 2018 Restorative Dentistry course at John Abbott College. Participants were randomly divided into a control group (n = 10; no peer assessment) and an experimental group (n = 10; peer assessment). Quantitative and qualitative data were collected from both research groups. Quantitative data analysed the effectiveness of peer assessment on students’ performance score in creating acceptable Class II composite restorations on tooth #15(MO) and #46(MOD) and the qualitative data consisted of responses to 8 questions adapted from the Clinical Teaching Preference Questionnaire (Iwasiw & Goldberg, 1993) using a 5-point Likert scale ranging from strongly agree to strongly disagree and 3 open-ended questions using an anonymous online survey to assess students’ perception of peer-assessment practice trials. A t-test (Two-Sample Assuming Equal Variances) was performed comparing the control and experimental group performance scores on precognitive, psychomotor, and procedural tests. All responses remained confidential. The study received ethics approval from John Abbott College’s ethical committee, certificate number JACREB201711.
Results
The results showed that peer assessment did not significantly improve students’ ability to create acceptable Class II composite restorations. A possible explanation might be the short time (2 weeks) that the experimental group had to gain experience as evaluators. However, students did benefit from the peer-assessment strategy as was supported by their responses to the open-ended questions. With its small sample size, short training time, and low number of peer-assessment encounters, this study’s findings cannot be generalized. Although these results were not very encouraging, it was the first peer-assessment implementation in dental hygiene education.
Conclusion
While this study did not find a positive impact of peer assessment on the achievement of performance scores, it did partially substantiate the benefits of peer-assessment use when creating Class II composite restorations, based on students’ perceptions. Further research in the dental hygiene field would be of a great help to investigate the impact of peer assessment in students’ active learning.
Can J Dent Hyg. 2019 Oct 1;53(3):183–188.
Objectives
1) To establish the patterns and frequencies of self-reported occupation-related musculoskeletal disorders (MSD) among dental hygienists in Canada; 2) To identify strengths and weaknesses of MSD prevention training in accredited dental hygiene program curricula.
Methods
An online survey was distributed via Canadian Dental Hygienists Association social media webpages to registered dental hygienists in Canada. The survey asked questions on demographics, practice history, MSD history, preventive measures, and injury prevention curriculum. Phone and email interviews were conducted with representatives from 8 accredited, English-speaking dental hygiene schools in Canada. Interviews covered questions on injury prevention curriculum. The study was approved by the university’s Research Ethics Board (#DENTUNIT2018-04).
Results
There were 647 respondents to the survey. Years in practice ranged from less than 1 year to more than 21 years, with 61% having practised for less than 10 years. Most (60%) worked full time. Eighty-three percent of respondents had suffered from an MSD related to their dental hygiene career. The most common region of injury was the neck, followed by the wrist/hand. The most common diagnoses were tendonitis and carpal tunnel syndrome. There was a positive correlation between number of years in practice and the presence of injury (r = 0.238, p < 0.001). Half of respondents felt that they had been adequately trained on injury prevention. Five of eight dental hygiene schools felt their injury prevention curriculum was sufficient. Identified program strengths include a focus on fitness and self-care, extensive preclinical and clinical training with a focus on positioning and technique, and calibration of instructors to assess ergonomics. Suggestions for improvements were as follows: dedicated ergonomics courses, injury prevention tools, and education on specific MSD and ways to prevent them.
Conclusion
This survey found an alarmingly high prevalence of MSD among Canadian dental hygienists. This is particularly concerning given the relatively low number of years in practice of the respondents. Despite generally positive views on the current state of injury prevention training, these data suggest that improvements are needed.
Can J Dent Hyg. 2019 Oct 1;53(3):183–188.
Objective
This study aimed to identify the barriers to dental care utilization faced by individuals with autism spectrum disorder (ASD) in comparison with individuals without ASD.
Method
A case-control study of 105 ASD and 100 healthy individuals was conducted to compare their oral health knowledge and dental care challenges. Data collection was made by a self-designed questionnaire. The questionnaire’s content validity was established by a panel of experts. The questionnaire was pilot tested using 5 ASD caregivers who were asked to answer the questionnaire and provide feedback. Test-retest reliability was achieved by administering the questionnaire twice to the same individuals (n = 5). Lists of special-care centres associated with ASD were obtained from the Ministry of Social Development. Similar questionnaire forms (without a few questions specific to children with ASD) were sent to parents of children without ASD studying at schools in the same region of the special-care centres.
Results
Fewer ASD individuals brushed their teeth once or twice daily (31.5%), compared to the control group (41.9 %). Intake of sweets and soda more than once a day was higher among ASD individuals (43.5%, 32.2%) than among the control group (37.2%, 30.9%) respectively. The least common reason for a dental visit among individuals with ASD was for a routine check-up. Barriers such as embarrassment (43.5%), lack of specialist dental staff (28.6%), lack of knowledge of how to treat clients with disabilities (26.6%), and inadequate facilities (34%) are significantly (p < 0.05) higher among individuals with ASD than the control group.
Conclusion
Knowing the factors that are associated with dental care for ASD individuals may assist in reducing barriers to dental care utilization. This study may guide the development of resources to enhance access to dental services and reduce the incidence of oral diseases and increase tooth retention among this population.
Can J Dent Hyg. 2019 Oct 1;53(3):183–188.
Background
In 2017, Canada accepted 320,000 new immigrants. This vulnerable population faces many barriers to receiving oral care.
Objective
The purpose of this study was to determine the oral health status of recent refugees to Nova Scotia with the intent of providing data to help inform provincial oral health care policy.
Methods
Approval was granted by the Dalhousie University Research Ethics Board (REB #2018-4444). Participants were recruited from a list of clients who were treated in the Refugee Oral Health Clinic at Dalhousie University from September 2017 to April 2019. Each participant completed a questionnaire that included questions about demographics, oral hygiene habits, and professional oral care. A clinical oral examination that included probing depths, clinical attachment loss (CAL), calculus, debris, gingival status, and decayed, missing and filled teeth (DMFT) was completed by second-year dental hygiene students and verified by a single calibrated professor at the Dalhousie University Dental Clinic. A one-sample Chi-squared test was conducted to compare the clinical data, and one-sample t-tests used to compare DMFT to national data derived from the 2007–2009 Canadian Health Measures Survey.
Results
91.9% of new refugees to Nova Scotia are unemployed, and 71.7% visit a dentist for emergency care only. One hundred percent reported not having insurance for oral care. Of the participants, 95.6% have probing depths greater than 4 mm and 89.7% have CAL greater than 4 mm compared to only 20.1% and 15% of the Canadian population. Debris and inflammation scores for the refugee population were moderate to severe compared to mild for the Canadian population. The refugee population had more decayed and missing teeth than the Canadian population, but fewer filled teeth.
Conclusion
When compared to the average Canadian population, new refugees to Nova Scotia have poorer oral health as indicated by periodontal and gingival indices. This population also has more decayed and missing teeth, but fewer filled teeth. More research is required to identify barriers to care and strategies to reduce these barriers.
Can J Dent Hyg. 2019 Oct 1;53(3):183–188.
Introduction
In 2016, a report published by the Associated Press, “Medical Benefits of Dental Floss Unproven,” stated that the US federal government no longer supported flossing due to the lack of longitudinal clinical studies. In response, a pilot study by the Dental Hygiene South Texas Oral Health Network (DH-STOHN) was developed to gather data from practising dental hygienists (DH) and dental hygiene educators (DHE) to assess the effects of the AP report on attitudes towards presenting flossing to their clients.
Methods
An online survey, formatted with Likert-type dichotomous and open-ended questions, was used to recruit DH and DHE members of DH-STOHN and the Texas Dental Hygiene Association, resulting in a convenience sample of 71 participants. All data were anonymized, aggregated, and analysed for frequency, means, binary outcomes, and thematic narrative. The study was approved as exempt #HSC 20170132E.
Results
Respondents were primarily female (97%), non-Hispanic white (73%), age 46 years or older (41%), with more than 20 years’ experience (58%), full-time in practice or educators (each 34%), held associate degrees (48%) of which 74% also held bachelor’s or master’s degree, and were aware of the report (77%), 33% of whom had learned of it from “patients, family, and friends.”. Most (61%) disagreed that there was “no evidence” to support flossing. Many (49%) felt the report’s references were not reliable. Flossing was by far (62%) the least recommended method for interdental cleaning, with dental hygienists stating, “Clinicians ultimately hold the experience and knowledge to exercise the best judgement in the interests of our patients.” Only 41% felt the report changed their discussion about flossing. “I let them know some type of interdental cleaning is still important.”
Conclusion
While initial reactions described low levels of confidence in the AP resources, the report enhanced discussions with clients. Dental hygienists are well suited to use their expertise and critical thinking skills to determine individualized oral care techniques for their clients.