Evaluating ultrasonic instrumentation curricular change: an observational comparison study

Abstract

Background:

Ultrasonic instrumentation (USI) has evolved, but it is unclear if dental hygiene curricula have kept pace. This study compares 2 dental hygiene cohorts with differing USI curricula to investigate if a contemporary USI curriculum enhanced students’ USI preparation, use, and confidence.

Methods:

A 2-group observational study compared a “traditional” USI curriculum (TC) cohort to a later “contemporary” USI curriculum cohort (CC). The new curriculum introduced USI earlier, with more and different inserts, and greater USI philosophical emphasis. Questionnaires were administered to students at the onset (T1) and conclusion (T2) of clinical programming. Ethical approval was received from the Multi-College Ethics Review Process. Statistical calculations included frequencies, proportions, means, and Welch’s 2-sample, 2-tailed t-test statistics describing and comparing the cohorts’ preparation, use of, and confidence in USI (significance threshold 0.05).

Results:

Sample size fluctuated due to student attrition; response rate ranged from 21.5% (17/79) to 52.9% (36/68). Earlier in programming, CC students were significantly more prepared with water control, fulcruming, and curved inserts than TC students. No significant differences emerged between groups in use of ultrasonic versus hand instruments (USI approximately 60% of clinical time; p > 0.05). Initially, TC students had significantly greater confidence than CC students (p < 0.05). While there was no difference between groups at Time 2, CC cohort’s confidence increased statistically significantly from T1 to T2 (p < 0.05).

Discussion & Conclusions:

Both cohorts demonstrated similar use of USI. The CC cohort was better prepared in some aspects of USI and use of curved inserts. Results reveal an ongoing need for program evaluation to best implement USI curriculum.

PRACTICAL IMPLICATIONS OF THIS RESEARCH.

• Further standardization of dental hygiene USI curricula across dental hygiene programs is required.

• Dental hygiene instructors need to recognize their personal philosophies and biases, follow USI research as it evolves, and adopt USI practices and philosophies based on current evidence.

• Additional research on USI and resources to support its instruction are needed.

• Dental hygiene education needs to be sensitive to the demands of clinical practice especially in terms of efficiency in debridement and inflammatory reductions.

INTRODUCTION

The recognition of the oral–systemic link coupled with a more complex insight into the human microbiome has expanded our considerations for periodontal therapy and its ongoing maintenance. No longer is calculus removal the primary goal. Rather, biofilm disruption or removal with ensuing reduction of dysbiosis and subsequent inflammation is considered the appropriate approach for positive endpoints of therapy.¹ Because ultrasonic instrumentation (USI) technology has adapted to these needs,^2,3 the dental hygiene appointment has been transformed. Randomized clinical trials have shown clinical outcomes employing USI are equal to hand scaling alone while often achieving these outcomes more expediently;^4-6 and this with the advantage of preserving more root structure.^7-11 Because USI approaches have progressed, clinical dental hygiene education must also evolve to provide new clinicians with the necessary contemporary skills for entry-to-practice competency (Table 1).¹²

Limited but recent research supports changes to USI curricula within dental hygiene programming.^12-15 Some of these changes include an earlier introduction to ultrasonics, the utilization of more and varied ultrasonic instruments (including curved designs), and a program perspective aligning with research demonstrating, at a minimum, the parity of ultrasonic and hand instrumentation for debridement. These modifications could contribute to greater levels of entry-to-practice competence of graduates.

One previous study examined an enriched ultrasonic curriculum delivery with both in process and outcomes evaluations.¹⁶ Enriched curriculum study participants demonstrated statistically significant improved scores ( p < 0.0001) in preparation and technique for debridement to completion using only ultrasonic instruments compared to the customary curriculum group, which did not receive the enriched curriculum. ¹⁶ Notably, the enriched curriculum participants achieved improved endpoint measures on removing and disrupting 3 types of hard deposits (light, moderate, and heavy) and biofilm reductions with ultrasonic instruments as compared to the customary curriculum participants’ measures. ¹⁶

It is essential that dental hygiene educators continually examine current literature and advocate for evidence-based changes in curriculum. For the present study, the researchers proposed that an enriched USI curriculum founded on a more contemporary approach to debridement, which included an earlier introduction of concepts and a change to inserts, would enhance students’ preparation, use of, and confidence in USI. An additional component to the students’ measures was instructors’ measures of USI ability, which is not reported on in this article. The primary aim of this study was to determine if an enriched, more contemporary USI curriculum is associated with higher levels of student preparation, use of, and confidence in USI.

METHODS

The study was a 2-group observational comparison of an earlier cohort following a more “traditional” USI curriculum (TC) and a more recent class following an enriched, more “contemporary” USI curriculum (CC) (Table 2). These study arms reflected naturally occurring groups, specifically a senior and junior class in a 2-year (6-semester) dental hygiene program in Ontario, Canada, betwee,n 2017 and 2019. The USI curriculum was substantially revised between the 2 cohorts, providing a unique opportunity to measure curricular outcomes. In the CC group, USI curriculum was launched earlier, introduced additional and varied ultrasonic instruments, and placed a stronger emphasis on ultrasonic debridement in the overall program philosophy.

Students’ preparation, use of, and confidence in USI were measured as outcome variables through self-administered online questionnaires delivered at the onset and conclusion of dental hygiene programming. Measurement timing was designed to detect changes in these outcomes from the initial introduction of USI to the end of training and compare these measures between the 2 cohorts (Table 3).

The study received ethical approval from the Multi-College Ethics Review Process (REB Panel) from the host institution ( REB File #6004483 Title: Changes to Ultrasonic Instrumentation Curriculum: An investigation examining the outcomes; Original Approval Date: December 14, 2017; Renewal Approval Date: December 14, 2018 ). SurveyMonkey® was used for the development and distribution of each of the electronic questionnaires.

Face, content, construct, and criterion validity of the survey instruments were based on the aim of the study and the research team’s experience specifically in USI educational research and survey research in general. ^{12, 14} Four versions of the survey instrument were developed by the research team purposely for each of the 2 cohorts and the 2 measurement times (initial and final). The instruments were designed to collect data on the main study constructs: students’ preparedness, use of, and confidence in USI. These elements of validity are somewhat subjective, requiring sound judgement of the researchers who approached the instrument development grounded within their subject expertise, familiarity of the literature, and an ability to operationalize research constructs. ¹⁷ Instrument reliability was enhanced by phrasing multiple research questions about a similar construct in varied ways.

The survey questionnaires consisted primarily of closed-response Likert and forced-response items tailored to this study. One open-ended item included in the questionnaires provided an opportunity for participant feedback, but those data were not analysed. Prior to distribution, survey questionnaires were pilot tested with small convenience samples to assess content, comprehension, and timing; necessary modifications were made.

All enrolled students in both cohorts were invited to participate in the study during an information session and through a follow-up email. Participation did not involve any change to usual program requirements. To minimize perceived duress, students were informed there was no requirement to participate in the study, participation would have no bearing on grades, and that if they chose to participate, responses would be kept anonymous. Further, students were made aware that instructors, including the principal investigator/program coordinator, would have no knowledge of which students participated in the study.

The survey was disseminated in English only by the study coordinator to all students at Time 1 and Time 2 via an email link. Consent was obtained through the survey. The survey remained open for 3 weeks and an electronic reminder was given twice. Students were given a token of appreciation (value $10.00) for each year they participated in the study (i.e., Time 1: initial and Time 2: final). The measurement of student perceptions (SPM) at Time 1: baseline (initial) and Time 2: end of program (final) included questionnaire items capturing demographic information and students’ preparedness, use of, and confidence in USI. Each questionnaire version (i.e., cohort and time) was modified slightly, reflecting the stage of programming of the respective cohort and capturing the different ultrasonic instruments being introduced.

The study coordinator collected completed questionnaires through the SurveyMonkey^® program. All identifying information was removed from completed questionnaires. Data were downloaded into an electronic spreadsheet (Microsoft Excel^® 2010 for Microsoft Windows) accessible only to the research team. At no time were individual responses linked to individual study subjects. Data were securely stored and destroyed according to accepted institutional requirements.

Anonymised data underwent quantitative analysis using SAS/STAT^® by the statistician and research team.,Descriptive and inferential statistical calculations included frequencies, proportions, means, and Welch 2-sample 2-tailed t-tests statistics to describe and compare the 2 cohorts in terms of their preparation, use of, and confidence in USI. The significance threshold was set at 0.05.

Table 1.

Comparison of traditional and contemporary ultrasonic inserts and approaches¹²

Traditional ultrasonic instrumentation	Contemporary ultrasonic instrumentation
Thick diameter inserts	Thin or ultra-thin diameter inserts
Subgingival access limited	Subgingival access is superior
Moderate to heavy calculus removal	Light calculus removal with focus on biofilm removal
Instrument contacts calculus	Instrument contacts calculus and/or cementum/dentin
Medium to high power settings typical	Low power settings typical; medium may be an option
Basic level of knowledge/skill and short “time on task” to achieve competence	Higher level of knowledge/skill and a longer “time on task” to achieve competence
Complete debridement requires use of hand instruments	Complete debridement possible with ultrasonics
Client comfort challenging	Client comfort most usual

Table 2.

Curriculum plan

Academic term	Traditional curriculum (earlier class)			Contemporary curriculum (later class)
Term 1 (preclinic: Sept–Dec)	n/a			Intro to curved slim diameter (Slimline 10R/10L) inserts after explorer and probe
Term 2 (preclinic and partner care: Jan–April)	Intro to straight standard and slim diameter (Satin Swivel 1000, Slimline 10S) inserts			Intro to straight standard diameter, straight slim diameter, and straight ultra-slim diameter (Powerline 1000, Slimline 1000 and Thinsert) inserts
Term 3 (client care: May–June)	Use of straight standard and slim diameter inserts in clinic			Use of all 5 inserts in clinic
Term 4 (client care: Sept–Dec)	Intro and use of curved slim diameter (Slimline 10R/10L) inserts			Continue
Term 5 (client care: Jan–April)	Continue			Continue
Term 6 (client care: May–June)	Continue			Continue

Table 3.

Analysis plan

	Early fall 2017	Late fall 2017	Winter 2018	Late spring 2018	Fall 2018	Winter 2019	Spring 2019
Class of 2018: senior cohort (TC)	N/A	Time 1: Term 4 (SPM)	N/A	Time 2: Term 6 (SPM)	N/A	N/A	N/A
Class of 2019: junior cohort (CC)	N/A	N/A	N/A	Time 1: Term 3 (SPM)	N/A	N/A	Time 2: Term 6 (SPM)

SPM: student perception measures of preparedness, use, and confidence (online questionnaire)

RESULTS

Initial and final questionnaires were distributed to the entire TC and CC classes at Time 1 and Time 2, respectively. The response rate fluctuated over the course of the study; there was some attrition to the sample size reflecting a typical loss in student registration over the course of this demanding academic program at this institution (Table 4). Overall, the response rate was adequate, while there was a smaller response rate with the CC class at Time 1. Both cohorts were asked about their highest level of education and their age, and the groups were found to be similar.

Section 1: Preparation in ultrasonic instrumentation

Both cohorts were asked about their preparedness in USI as compared to hand instrumentation at both Time 1 and Time 2. No statistically significant differences were detected ( p > 0.05). However, while the CC cohort remained virtually unchanged in their level of preparedness from Time 1 to Time 2, the TC cohort demonstrated a decreasing level of preparedness with USI relative to their preparedness with manual instrumentation from the initial to the final measurement time (Table 5).

Table 4.

Response rate

	TC group (respondents/sample size)	CC group (respondents/sample size)
Time 1	32/67 [47.8%]	17/79 [21.5%]
Time 2	24/67 [35.8%]	36/68 [52.9%]

Table 5.

Mean levels of preparedness scores^a

Preparedness with ultrasonics (relative to hand instrumentation)	Time 1	Time 2
TC class	1.47	1.75
CC class	1.5	1.45

^a1: feel more prepared – 3: feel less prepared; p > 0.05

Study subjects were also asked about their preparedness with specific aspects of USI (Figure 1). While few differences between groups and between times were detected, at Time 1, the CC group reported being statistically significantly ( p < 0.05) more prepared with water control and fulcruming than the TC group (Table 6). Overall, when group data were combined, the groups reported being statistically significantly more prepared with client selection at Time 2 than at Time 1 ( p < 0.05).

The questionnaire also specifically explored students’ preparedness with the curved instruments (10R/10L). Closer examination of curved inserts was warranted due to the substantially earlier introduction of these inserts to the CC class as part of the new curriculum. Students were asked about their preparedness in using the curved inserts in anterior and posterior teeth (both times; both cohorts) and in shallow sulci, furcations, and pockets (CC group Time 2; TC group both times).

At Time 1, the CC class reported statistically significant higher levels of preparedness than the TC class with the 10R/10L in both anterior and posterior sextants ( p < 0.05) (Table 7). Overall, when Time 1 and Time 2 data were combined, the CC class was statistically significantly ( p < 0.05) more prepared with 10R/10L ultrasonic instruments in the anterior and posterior regions of the dentition and in shallow sulci than the TC students. Finally, when both cohorts’ data were combined, there was an overall statistically significant ( p < 0.05) increase in preparedness with ultrasonic instruments in shallow sulci at Time 2 compared to Time 1.

Section 2: Use of ultrasonic instruments

Figure 1.

Aspects of ultrasonic instrumentation

Table 6.

Mean levels of preparedness: Specific aspect of ultrasonic instrumentation scores^a

Preparedness with ultrasonics (specific aspects) Time 1	Water control	Fulcrum
TC class	2.2	2.1
CC class	1.6b	1.5b

^a1: feel very prepared – 4: feel not very prepared

^bStatistically significant compared to TC class; p < 0.05

Table 7.

Mean levels of preparedness: Curved instruments scores (10R/10L)^a

Preparedness with ultrasonics (curved inserts)	Time 1 Anterior	Time 2 Anterior	Time 1 Posterior	Time 2 Posterior
TC class	2.72	2.5	2.21	2.04
CC class	2.14b	2.1	1.64c	1.73

^a1: feel very prepared – 4: feel not very prepared

^bStatistically significant compared to TC class T1; p < 0.05

^cStatistically significant compared to TC class T1; p < 0.05

Table 8.

Mean proportion of time using ultrasonic instruments

% time using ultrasonics	Time 1	Time 2
TC class	60.62 %	59.56 %
CC class	n/aa	59.83%

^aItem not included in CC class at Time 1 (no data); p > 0.05

Table 9.

Mean use of ultrasonic versus hand instruments^a

Typical use of ultrasonics vs hand	Time 1	Time 2
TC class	3.28	3.25
CC class	n/ab	3.55

^a1: hand instruments only – 5: ultrasonic instruments only

^bItem not included in CC class at Time 1 (no data); p > 0.05

Table 10.

Mean overall confidence scores^a

Confidence using ultrasonics	Time 1	Time 2
TC class	1.84b	2.25
CC class	2.5	1.64c

^a1: very confident – 5: not very confident

^bStatistically significant compared to CC class

^cStatistically significant compared to Time 1; p < 0.05

Students were asked several questions at both Time 1 and Time 2 about their use of ultrasonic instruments in relation to hand instruments. Use of ultrasonic instruments was measured in several ways to enhance the reliability of the findings. There were no statistically significant differences between the groups at either Time 1 or Time 2 or between the 2 groups in use of USI when measured as,the proportion of a clinical session students allocated to ultrasonics versus hand instruments. Students consistently reported using ultrasonic instruments approximately 60% of their overall debridement time (Table 8).

Both cohorts were also asked about their overall approach to debridement in terms of their use of ultrasonics and hand instrumentation. A higher score reflected greater use of USI, but no statistically significant differences were found between groups ( p > 0.05). However, the CC class showed a greater tendency to use USI at Time 2 than the TC group at both Times 1 and 2, but this was not statistically significant ( p > 0.05) (Table 9).

Comparisons between groups were carried out regarding the use of specific ultrasonic inserts at Times 1 and 2, excluding the CC class at Time 1 due to a small wording difference in their Time 1 questionnaire. Note that there was little overlap between the 2 cohorts in the ultrasonic inserts introduced, allowing for few comparisons between cohorts, apart from the curved left and right inserts (Slimline 10R/10L). When comparing the TC group’s use of all their inserts at Time 1 and 2, no statistically significant ( p > 0.05) differences were observed in specific ultrasonic insert use during a typical debridement appointment. In addition, no statistically significant ( p > 0.05) differences were found in use of the curved inserts when comparing the 2 cohorts at Time 2.

Section 3: Confidence in ultrasonic instrumentation

Both cohorts were asked about their confidence in using ultrasonics at both stages of programming. At Time 1, the results showed the TC class had statistically significant ( p < 0.05) greater confidence in USI than the CC class. While the CC class reported having statistically significant higher levels of confidence at Time 2 than they did at Time 1 ( p < 0.05) (Table 10), there was no significant difference between the 2 groups at Time 2.

DISCUSSION

Dental hygiene programs across North America have been making changes to clinical programming including enhancing USI curricula. While the COVID-19 pandemic may have interrupted the shift in curricular emphasis because of an avoidance of aerosol-generating procedures, the focus on USI will likely return post-pandemic. This study was predicated on a dental hygiene USI curriculum change occurring pre-pandemic, providing an opportunity to measure the associated outcomes of that change as a naturally occurring phenomenon. Although providing an excellent opportunity to measure the outcomes of curricular change, such a research design restricts what can and cannot be effectively controlled, measured, and compared. The findings from this study offer interesting results worthy of reflection and suggest further research questions.

Active discourse among dental hygiene educators continues on manual and powered instrumentation and the optimal preparation of the new graduate. Inherent in that dialogue is how much curricular focus should be on USI. Many dental hygiene educators experienced their foundational education when hand instrumentation was predominant and USI was viewed as adjunctive; it is reasonable that these attitudes remain entrenched for many.^13,14 In a 2015 Canadian study, it was found that more than one-third of new graduates were less prepared in the use of USI than with hand skills.¹² Further, for power instrumentation skills, over 80% of graduates were more prepared with traditional straight inserts than with more contemporary modified and curved designs and were more confident with supra- versus subgingival use of power scaling.¹² Previous work noted ultrasonics were often delivered in the latter semesters of programming, preclinic and clinic practice time was lacking, and almost 60% of graduating students felt USI use was not reinforced in clinics.^12,14

Interestingly, in the present study, both the CC and TC cohorts reported greater (60%) use of USI over the course of the clinical program as compared to hand instrumentation. Although this study reflects the educational context, previous research showed new graduates use ultrasonics in practice just over 50% of the time.¹² The greater reliance on ultrasonics demonstrated in this study may become more pronounced in time given ultrasonic use tends to increase in clinical practice.¹² While the contemporary curricular approach reinforces a greater application of USI than hand instrumentation, this may not be realized in the educational environment for various reasons including clinical requirements and clinical faculty personal philosophies and biases.

Earlier in programming, the TC class reported greater confidence in USI than the CC class, which was surprising given their respective programming. This result may have been due to the TC cohort being further into their clinical education than the contemporary cohort at Time 1, which may have contributed to an overall increased comfort and confidence level. However, these results may also be explained by the “The Four Stages of Competence” phenomenon, ^18,19 where learners with only initial knowledge or skill are unaware of what they have yet to learn and may inappropriately claim confidence: termed “unconscious incompetence”. A similar result was noted in an earlier study by Asadoorian and colleagues where relationships between perceived preparedness, use of, and confidence in USI showed the shortest dental hygiene programs reported the highest levels of student confidence.¹²

While not shown to be statistically significant, in this study the TC cohort also reported decreasing levels of confidence over time. It can be speculated that, with the more difficult instruments to master (slim, curved 10R/10L), these students were shifting to higher levels on the competency continuum and beginning to become increasingly conscious of their lack of competence with USI: “conscious incompetence”. The CC class, in contrast, demonstrated a statistically significant increased level of overall confidence at Time 2 compared to Time 1, indicating a more expected trajectory with improved confidence as programming continued.

Interestingly, no differences were shown between groups in their reported preparation with USI as compared to hand instrumentation at either the initial or later time. This finding raises interesting questions about the shift in educational emphasis to USI as compared to hand instrumentation and may assuage some dental hygiene educators’ concerns that contemporary USI curriculum results in students’ decreased preparation with hand instrumentation.

However, this finding raises broader questions about how much programming should be dedicated to hand instrumentation in a modern, evidence-based clinical curriculum, especially when more contemporary technology use produces similar clinical results in less time with fewer instruments.^4,5 While this study included several questions exploring preparedness with specific aspects of USI, only at Time 1 did statistically significant results emerge, with the CC class reporting greater preparation with water control and fulcruming. Within the contemporary curriculum a much greater emphasis in USI is placed on the use of direct vision with high-volume evacuation. The development of this skillset demands the implementation of alternate clinician–client positioning, grasp, fulcrum position, and activation compared to hand instrumentation, signifying a unique USI-specific approach rather than simply transferring hand instrumentation abilities to the USI context.

These researchers were particularly interested in investigating learning outcomes surrounding the slim, curved 10R/10L ultrasonic instruments given their much earlier introduction in the contemporary curriculum. New graduates have been shown to rely heavily on straight inserts in clinical situations where curved inserts should theoretically be applied.^12,14 In this study, the CC cohort reported greater preparation with the curved instruments at Time, 1 in anterior and posterior regions compared to the TC cohort. Additionally, when both Time 1 and Time 2 data were combined, the CC group again reported higher levels of preparation than the TC class in anterior and posterior regions and with shallow sulci. These results may support contemporarily trained graduates using a more theoretically sound application of appropriate inserts, as well as the introduction of slim, curved instruments earlier in programming concomitant with an overall de-emphasis of straight inserts to elicit the desired outcome in clinical dental hygiene practice upon graduation.

When reviewing the results of the study overall, there are some positive, albeit nuanced, findings associated with the contemporary ultrasonic curriculum. In a previous study by Botbyl and Goulding¹⁶ it was stated that, although an enhanced, more contemporary curriculum resulted in graduates measuring higher on the competence scale, the study was not designed to identify which of the modified elements (discovery learning techniques, guided discussion methods or earlier and concurrent application of ultrasonic and hand instrument skills) were most responsible for the improvement. The present study, due to its observational design, measured the overall outcomes of an enriched curriculum—specifically, an earlier introduction of more, varied ultrasonic inserts within an overall contemporary, evidence-based educational philosophy. The premise being that this more evidence-based approach allows for more guided practice and consultation with faculty and allows appropriate theoretical principles to be corrected and applied.

However, the dental hygiene clinical environment presents uncontrolled conditions preventing an entirely distinct comparison of a traditional versus contemporary USI curriculum. For example, an overall agreed upon programmatic philosophy on USI curriculum has not been established at the host institution, and, as likely in many other schools, students encounter clinical instructors with various approaches to ultrasonic and hand instrumentation. Calibration among clinical dental hygiene faculty is an ongoing challenge involving many aspects including personal philosophies, experience, current skills, level of education, instrument preference, technology choices, and demographics. Some equivocal findings from this study may reflect an educational environment still processing the adoption of new technology and science and not yet fully shifted to a contemporary USI curriculum. Research on USI curriculum is in its infancy with research first emerging in 2015. Additionally, ultrasonic teaching resources, although greatly improved in recent years, have yet to gain parity with those offered for hand instrumentation.

In thinking about future curriculum and appropriately shifting program philosophies, it is critical that instructors acknowledge current research. Contemporary designs of ultrasonic instruments and new technology allow greater depth of access, more conformation to root anatomy, removal of biofilm, greater conservation of tooth substance, and reduced operator fatigue and hand strain.²⁰ These authors assert that such features support a greater reliance on USI for the modern dental hygiene clinician. In addition, other recent research shows calculus detection is comparable with the ODU 11/12 explorer and the Thinsert®, an ultrathin ultrasonic instrument, which could mitigate concerns about tactile sensitivity with ultrasonic inserts for assessment, treatment, and maintenance of periodontal disease.²¹

The time benefits of USI should also be seriously considered. Research shows USI can shorten treatment time up to 1 minute per tooth in a 90-minute periodontal appointment as compared to hand instrumentation with equivalent clinical outcomes including in cases of greater disease severity. ^{4, 5} In increasingly resource-conscious environments, the additional time and cost savings achieved through ultrasonic debridement, including the elimination of sharpening, should also be recognized. Educators should be sensitive to the constraints of clinical practice, particularly where outcomes are not compromised. This is important as the dental hygiene profession attempts to have increasingly positive impacts on oral inflammation and overall health, not only in the general population, but also in vulnerable population groups often with reduced access to care.

This study measured students’ self-perceptions of USI preparedness, use, and confidence, and such perceptions are subject to bias and do not serve as direct proxy measures for students’ ability. In addition, as mentioned earlier, there are several limitations to observational research, including being more prone to human bias and unidentified confounding, and overestimating effects. In this study, some direct comparisons between groups were not possible due to the differences between groups and their programming. While observational research cannot demonstrate causation, empirically measuring curricular outcomes is a constructive progression from basing curriculum on faculty conjecture and anecdotal, traditional views.

The researchers believe that this study adds to the ongoing discourse on USI curricular change and contributes to a building knowledge. In going forward, a clearer understanding of the circumstances that prompt students’ use of ultrasonic instruments versus hand instruments will be required. To achieve a deeper understanding of how instrumentation theory is applied in clinical teaching, clinical protocols including how debridement appointments are managed warrant further study. The authors recommend, within the educational environment, that debridement appointment planning be made more explicit and evidence-based and clearly indicate which ultrasonic instruments best suit the needs of the client. For example, reviewing the varying areas in the dentition and noting pocket depths, deposit type, tissue architecture, inflammation, and other parameters would encourage students to experience both power and manual instrumentation with a more critically reflective and client-centred perspective. To support such change, faculty and students would likely benefit from a more evidence-based and standardized approach to instrumentation in both instruction and evaluation along with more robust USI educational supports. While the COVID-19 pandemic may have reversed some strides forward in advancing USI curricula, these authors assert that it is time to resume the reorientation of dental hygiene debridement curricula.

CONCLUSIONS

This study compared a traditional versus an enriched, contemporary USI curriculum that introduced USI earlier in programming, with more and different inserts, and with a greater philosophical emphasis on USI. Although students from both cohorts demonstrated similar levels of use of USI (60%), students following the “contemporary” USI curriculum were shown to have higher levels of preparedness in some aspects of USI and in using curved inserts and were found to have improving levels of confidence by the end of dental hygiene programming. The study reveals the ongoing need for a more standardized and evidence-based approach to USI dental hygiene curriculum and evaluation.

CONFLICTS OF INTEREST

This study was supported by an unrestricted educational grant from Dentsply Sirona.