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The way oral health information is communicated by dental providers has a major impact on patients' levels of health literacy and health. Dental hygienists are the front-line, primary providers of [...]

INTRODUCTION Untreated dental caries is a leading cause of preventable pain, tooth loss, and loss of time from school and work in the United States (US). (1) Despite the existence [...], Purpose The purpose of this study was to determine dental hygiene students' perspectives regarding their knowledge and understanding about caries prevention strategies and their intention to use these regimens in clinical practice. Dental hygienists' knowledge and understanding of caries prevention is critical because they are the primary providers of these regimens and the relevant education. Methods This 2019 national cross-sectional online survey was designed by the University of Maryland (UMD), structured by the ADA staff for online administration, distributed and collected by the American Dental Hygienists' Association (ADHA) to 9533 email addresses, and de-identified response data were analyzed by UMD. The survey included questions on three caries preventive regimens: fluoride varnish, dental sealants, and silver diamine fluoride (SDF), and items on community water fluoridation (CWF), respondent's demographics and intent to use the regimens. Statistical analyses included descriptive statistics and analysis of variance. Significance was set at p Results Of the 235 surveys returned (response rate 2.5%) the majority were female, White and born in the United States. Over half were in associate degree programs; nearly a third were in baccalaureate programs. Respondents reported greater knowledge/understanding and intention to use fluoride varnish and dental sealants than SDF. Less than half (44.7%) reported knowledge/ understanding of SDF and only 22.6% had a high level of confidence regarding applying it. Additionally, only 31.1% indicated they were extremely likely to use SDF upon graduation. Conclusions To reduce the prevalence of caries, dental hygiene graduates must be well-versed with the latest science-based preventive procedures, including non-invasive caries prevention and control therapies. The results of this survey, albeit non representative of the general population of dental hygiene students, suggest a need for a more extensive review of the caries preventive regimen content, especially for silver diamine fluoride, of dental hygiene curricular programs. Keywords dental hygiene education, caries prevention, non-invasive caries preventive regimens, fluoride varnish, dental sealants, silver diamine fluoride, community water fluoridation

Introduction Identification of the Human Papillomavirus (HPV) as a causal agent for oropharyngeal cancers has prompted public health interests. The oral HPV infection prevalence among U.S. adults was estimated to [...], Purpose: Human Papillomavirus (HPV) has been identified as a causal agent for oropharyngeal cancers, suggesting a new role for dental hygienists in HPV-related cancer prevention strategies. Health literacy assessment is an approach that can be used to understand providers' informational assets and needs for educating and discussing HPV prevention with patients. This study aimed to understand dental hygienists' level of health literacy regarding HPV-related oropharyngeal cancers. Methods: Four focus group sessions with dental hygienists (n=48) were conducted at a national conference. The constant comparison method, with a priori codes for health literacy competencies (i.e., access/understand/appraise/apply), was utilized for this qualitative study. Results: Participants mentioned a variety of modes (e.g., magazines, journals) for accessing HPVinformation; however, descriptions of understanding HPV and its relationship to oropharyngeal cancer varied. Participants considered patients' personal characteristics, the dental practice environment, and professional factors to appraise HPV-related information. Additionally, participants self-described themselves as being "prevention specialists." These factors influenced how dental hygienists applied primary and secondary prevention of HPV-related care issues with their patients (e.g., education and oral-cancer screenings). Conclusions: Dental hygienists recognized the importance of HPV and oropharyngeal cancer prevention efforts, including oral-cancer screenings and promotion of the HPV vaccine. The study findings identified opportunities for intervention focusing on primary prevention. Key words: Health literacy, health education, oral cancer, HPV+ oropharyngeal cancer, cancer prevention This manuscript supports the NDHRA priority area: Professional development: Education (evaluation). Submitted for publication: 12/12/16; accepted 3/30/17

Introduction Dental caries is a persistent public health problem, particularly among low-income children in the United States. (1-2) While national data has demonstrated an overall decrease in caries prevalence among [...], Purpose: The objective of this qualitative pilot study was to gain an in-depth understanding of dental hygienists and dentists perspectives regarding children's oral health and what needs to be done to prevent early childhood caries (ECC), the most frequent chronic disease of childhood. Methods: A skilled facilitator conducted four focus groups and four phone interviews with 20 dental hygienists and 17 dentists practicing in a variety of locations within the state of Maryland. The interview guide was based on results from previous state-wide surveys of dental hygienists and dentists. Sessions were recorded, transcribed, and reviewed by the PI and facilitator. Qualitative content analysis was used to identify and manually code themes. Results: Focus groups and interviews provided rich and insightful information for strategies to help solve the ECC problem in Maryland, which supplemented the earlier quantitative mail survey data. Three key themes emerged: challenges to preventing ECC among low-income families; necessary educational methods and practices; and, the need for inter-professional collaboration. Discussions focused on issues related to educating parents with low oral health literacy about how to prevent ECC and the value of including non-dental health care providers, such as pediatricians and school nurses, in the caries prevention process. Conclusions: Current approaches to educating low-income adults about caries prevention are insufficient to prevent ECC and dental care providers cannot accomplish this goal alone. Ensuring that all dental care providers have a science-based understanding of caries prevention is critical. Integrating science-based oral health preventive care into medical and nursing undergraduate programs could increase providers' knowledge and confidence towards incorporating oral health into patient care plans; improve the oral health literacy of providers and patients; and improve patient oral health outcomes. This manuscript supports the NDHRA priority area: Professional development: education (educational models) Submitted for publication: 5/10/16: accepted:3/8/17

Introduction The oral health of Americans depends in large part on the effective transfer of research results to appropriate user groups--health providers, policy makers, other scientists and, most importantly, the [...], Purpose: The purpose of this study was to determine dental hygienists' use of recommended techniques to communicate science-based information for intervention and prevention of oral disease. Methods: A 30-item survey containing 18 communication techniques representing 5 domains including 7 basic skills were mailed to a random sample of 1,258 Maryland dental hygienists to determine their use of recommended communication techniques. Results: The response rate was 43% (n=540). Nearly all were females (98%) and 58% practiced in solo settings. About half of respondents used 6 of the 18 techniques routinely. Approximately three-quarters of respondents reported they rarely or never used 3 of the 7 basic recommended techniques. Only one basic technique (use of simple language) was used by over 90%. Respondents who had taken a communications course other than in dental hygiene school were significantly more likely to use communication techniques on a routine basis than those who had not (p Conclusion: Dental hygienists and their patients would benefit from using the recommended communication tools and techniques to address individual patient needs. To improve oral health outcomes, dental hygiene education must strengthen health literacy knowledge and communication skills in dental hygiene education programs and through continuing education courses for practicing hygienists. Keywords: dental hygienists, recommended communication techniques, health literacy, health communication and dental health education This study supports the NDHRA priority area, Health Promotion/ Disease Prevention: Assess strategies for effective communication between the dental hygienist and client.

Introduction Reduction in the prevalence of dental caries has been a target of concentrated U.S. public health efforts since the mid 20th century, and dental caries has declined dramatically in [...], Purpose: The purpose of this study was to assess Maryland dental hygienists' knowledge, practices and opinions regarding dental caries prevention and early detection. Methods: A 30 item survey was mailed to 1,258 Maryland dental hygienists. Two follow-up mailings and email reminders were sent. Results: The response rate was 43% (n=540). Nearly all respondents were female (98%), and 58% practiced in solo settings. Knowledge and certainty of knowledge were moderate: sealants are needed regardless of topical fluoride use (55% certain, 40% less certain), newly erupted permanent molars are the best candidates for sealants (54%, 36%) and professionally applied fluorides are desirable in areas without fluoridated water (55%, 36%). Fewer were certain that incipient lesions can be remineralized before cavitation (23%, 69%), and dilute, frequently administered fluorides are more effective in caries prevention than concentrated, less frequently administered fluorides (6%, 24%). Opinions regarding effectiveness of protocols for 2 age groups from 6 months to 6 years, the challenges of early childhood caries (ECC), prevention practices regarding sealant and topical fluoride applications varied widely. Eighty-nine percent reported routinely assessing dental caries risk factors of child patients and 90% were interested in continuing education courses. There were no significant differences between different types of practice settings, year of graduation, race/ethnicity or gender. Conclusion: Knowledge of recommended guidelines for fluoride and sealant application support clinical decision-making and self-care counseling. Misinformation and lack of understanding of current research and recommendations identify a need for educational interventions in undergraduate dental hygiene programs and through continuing education for practicing hygienists. Keywords: Dental caries, dental hygienists, oral health, practice guidelines, clinical practice variations This study supports the NDHRA priority area, Clinical Dental Hygiene Care; Assess the use of evidence-based treatment recommendations in dental hygiene practice.

Introduction It's Our Problem, Not Theirs Health literacy has been consistently defined as the degree to which individuals have the capacity to obtain, process and understand basic health information needed [...]

Introduction Each year, approximately 30,000 U.S. persons are diagnosed with oral and pharyngeal cancers (hereafter referred to as oral cancer) and nearly 8,000 die from them. (1) These statistics have [...], Purpose. The purpose of this qualitative study was to obtain in-depth information on dental hygienists' awareness and opinions of oral cancer, oral cancer examinations, and related factors. These findings were intended to supplement a previous statewide survey of Maryland dental hygienists on the subject. Methods. A professional focus group moderator conducted two focus groups in Maryland. Two types of focus groups were used--one face-to-face focus group session with 10 dental hygienists in the Baltimore are and one telephone focus group among 7 dental hygienists who practiced on the Eastern Shore. Criterion-purposeful sampling and qualitative content analysis were used. Results. Six major themes emerged from the focus groups: dental hygienists' lack of awareness of Maryland's oral cancer statistics, level of training to provide oral cancer examinations, provision of oral cancer examinations and barriers for not providing them, reactions to Maryland surveys of dental hygienists and dentists, assessment of oral cancer risk factors, and interest in additional training. Conclusions. The focus groups provided in-depth information about why oral cancer examinations are or are not provided on a routine basis, as well as ideas for providing updates on oral cancer prevention and early detection for dental hygienists. Moreover, some participants recommended that updates on how to conduct an oral cancer examination be a requirement, as updates on infection control are now. Keywords. Maryland dental hygienists, focus groups, oral cancer prevention, oral cancer examinations, qualitative research.

Introduction Oral cancers (of the lip, tongue, mouth, and pharynx) account for nearly 3% of the approximately one million new cases of invasive cancer occurring each year in the United [...], Purpose. This study examined Maryland dental hygienists' knowledge of tobacco and alcohol use as oral cancer risk behaviors; the practice of obtaining comprehensive medical histories regarding patients' current, past, and type/amount of alcohol and tobacco used; and their opinions about the adequacy of their tobacco and alcohol cessation educational preparation in a state that ranks unusually high for oral cancer mortality rates. Methods. The data source was the Maryland Oral Cancer Survey of Dental Hygienists conducted in November 1997 (MDOCSDH, 1997) with a simple random sample of 700 dental hygienists selected from a registry of 2,677 licensed dental hygienists in Maryland. Data were collected with a 40-item self-administered mailed questionnaire. Unweighted data from 331 returned surveys (response rate = 60%) were analyzed using SAS and SUDAAN Software. Stratified and logistic data analysis techniques were utilized, and the results were evaluated statistically using a .05 level of significance. Results. Nearly all of the responding dental hygienists knew that tobacco is an oral cancer risk factor. Most probed their patients' present use of tobacco in medical histories; however, fewer assessed patients' past use and type/amount of tobacco used. Very few believed that they were adequately prepared to provide tobacco cessation education, although the majority agreed that dental hygienists should be prepared to provide this type of information. The majority of respondents also knew that alcohol use is an oral cancer risk factor; however, less probed their patients' present use of alcohol in medical histories compared to assessing present tobacco use. Even fewer assessed patients' past use and type/amount of alcohol used. A very small minority believed that they were adequately prepared to provide alcohol cessation education. Yet, in contrast to tobacco cessation counseling preparation, few respondents believed that dental hygienists should be prepared to provide alcohol cessation education. There was a significant relationship (p [is less than] .05) between screening for all three aspects of tobacco use and agreement of dental hygienists that they were adequately prepared to provide tobacco cessation education. Of seven background characteristics, practice setting was the only one found to be positively associated (p [is less than] .05) with even one of three complete medical history screening indices--the practice of assessing all three tobacco screening items. Conclusion. There is a need to provide more complete and accurate information in tobacco and alcohol educational programs for Maryland dental hygienists. Additional research is needed to explore sources of noninterest or discomfort in assessing patients' use of these substances, since a substantial number of Maryland dental hygienists do not assess all aspects of patients' tobacco and alcohol usage and do not agree that dental hygienists should be prepared to provide tobacco and alcohol cessation education for their patients. Maryland dental hygienists' opinions regarding the adequacy of their tobacco and alcohol cessation education appear to accurately reflect their practice of obtaining comprehensive medical histories regarding these substances. Keywords. Oral cancer, oral cancer screening, oral cancer risks, tobacco, alcohol

Introduction Dental caries is a chronic, infectious, multifactorial disease that can occur throughout a person's lifetime. Although the prevalence of dental caries has declined and the pattern and progression have [...], Purpose. The aim of this study was to determine the knowledge, opinions, and practices of dental hygienists in the areas of dental caries etiology and prevention. Methods. A pretested, validated 35-question survey instrument was mailed to a one percent national, stratified random sample of dental hygienists in the United States (n=960) in October 1996. Four complete mailings of the instrument resulted in a 67% response rate, of which 77% were useable (n=498). Respondents were asked if they agreed or disagreed with statements on caries etiology and preventive procedures, and also asked to rate the effectiveness of procedures for preventing dental caries in children and adults. Data were analyzed using descriptive statistics, t-tests, and ANOVA. Results. Overall level of knowledge of caries etiology and preventive procedures was low. More than 40% of subjects did not recognize that remineralization is the most important mechanism of action of fluoride, and fewer than 50% recognized that dental caries is a chronic infectious disease. Analysis of four factors thought to be related to knowledge and practice showed that younger graduates, more recent graduates, and ADHA members were more knowledgeable about the effectiveness of caries preventive procedures for children (p [is less than] .01). Although an overwhelming majority correctly agreed that adults benefit from fluoride and that root caries is an emerging problem, this knowledge was inconsistent with practice (p=.02). Fewer than 35% reported that they provide fluoride to adults of any age, or they wait until the disease is present. For children and adults who did receive fluoride treatments, a one-minute application of an APF gel or foam was most often provided. Conclusions. Correct information about the etiology and prevention of dental caries is a predisposing factor to making informed decisions. Overall, respondents overrated the effectiveness of flossing and toothbrushing while underrating the effectiveness of fluorides. In the majority of cases, efficiency rather than efficacy was given priority when providing a topical fluoride treatment. An improved understanding of dental caries etiology and the scientific evidence for appropriate caries preventive procedures will allow dental hygienists to prevent and manage this disease better. Keywords. Knowledge of caries etiology, caries prevention, fluorides, dental hygienists, Healthy People 2000

The workshop title refers to how qualitative methods, carefully and sensitively applied, can help researchers deepen their understanding of health beliefs, behavior and literacy and their origins among health care [...], Overview: This interactive workshop is designed to build dental hygiene researchers' confidence and skills for effectively using qualitative research methodologies, particularly focus groups and interviews, for oral healthcare research. The presenters' approach incorporates brief highlights of an institutional review board-approved qualitative research plan for, and preliminary findings from, a 2010-2011 Maryland qualitative and quantitative oral health study with pregnant women and parents of young children, and also with health care providers (dental hygienists, dentists, pediatricians, family practitioners and nurse practitioners). The study was conducted by the Herschel S. Horowitz Center for Health Literacy at the University of Maryland.

The first assessment of health literacy among American adults was recently released by the U.S. Department of Education. The study found that nearly 80 million adults are not able to [...]