Search

Background: Mission of Mercy (MOM) emergency dental clinics are a resource for populations lacking access to dental care. We designed a MOM event incorporating health equity components with established community partners who shared a common vision of addressing the oral health, physical health, and social service needs of Maryland and Washington, DC area residents. Although studies have explored associations between oral and chronic health conditions, few studies to our knowledge have examined the relationship between these conditions and receipt of dental services. Therefore, this study explored these associations and the opportunity for better care coordination.Methods: Oral health data from the 2014 Mid-Maryland Mission of Mercy and Health Equity Festival event was analyzed. A descriptive analysis assessed frequencies and percentages of participant sociodemographics characteristics, oral health and chronic disease risk(s), and dental services delivered. Chi-square tests and multivariate logistic regression were conducted to determine the associations between 1) oral health and chronic disease risk(s) and dental services; and 2) oral health and chronic disease risk(s) and participant characteristics.Results: Approximately 66.2% (n = 666) of the 1007 participants had one or more chronic conditions and/or risk factors (diabetes, high blood pressure, and tobacco use). These individuals had a significantly higher likelihood of receiving an oral surgery procedure (specifically, tooth extraction) (only one condition/risk: OR = 2.40, 95%, CI = 1.48-3.90, p < .001; two conditions/risks: OR = 3.12, 95% CI = 1.78-5.46, p < .001).Conclusion: The 2014 Mid-Maryland Mission of Mercy emergency dental clinic attracted people with risk factors for oral and chronic diseases. Those with one or more risk factors were more likely to receive oral surgery (specifically, tooth extraction). These findings strongly suggest that organizers of MOM emergency dental clinics include wrap-around primary care, health promotion and disease prevention services along with provision of dental services. While such events will not solve the general and oral health challenges of participants, we believe they provide an opportunity to provide basic preventive services. These findings also present an opportunity to inform planning for future MOMs and emphasize the importance of using these public health events to create linkages with other services to support follow-up and care coordination. [ABSTRACT FROM AUTHOR]

The article discusses issues related to mutuality of health literacy and need to foster effective health literacy among caregivers and professional health communicators. Topics discussed include initiatives taken by the government of the U.S. to promote a health literate society, health literacy policy of the nation and establishment of Dental Action Committee (DAC) in Maryland to provide a blueprint for accessibility of dental care for low-income children.

Objectives. We sought to determine Maryland adults' knowledge, understanding, opinions, and practices with respect to prevention and early detection of dental caries. Methods. We conducted a statewide random-digit-dialing, computer-assisted telephone survey in 2010 among 770 adults who had a child aged 6 years or younger living in their home. A traditional random-digit sample and a targeted low-income sample were included. Analyses included frequencies, percentages, the χ2 test, and multivariate logistic regression. Results. Respondents' overall level of knowledge about preventing dental caries was low. Those with higher levels of education were more likely to have correct information regarding prevention and early detection of dental caries. Nearly all respondents (97.9%) reported that they were aware of fluoride, but only 57.8% knew its purpose. More than one third (35.1%) of the respondents were not aware of dental sealants. Those with lower levels of education were significantly less likely to drink tap water, as were their children, and significantly less likely to have had a dental appointment in the preceding past 12 months. Conclusions. Our results demonstrate the need to increase oral health literacy regarding caries prevention and early detection. [ABSTRACT FROM AUTHOR]

Article Title and Bibliographic Information: Efficacy of dental prophylaxis (rubber cup) for the prevention of caries and gingivitis: a systematic review of literature. Azarpazhooh A, Main PA. Br Dent J 2009;207:E14. Reviewer: Alice M. Horowitz, PhD Purpose/Question: To determine the efficacy of rubber cup prophylaxis before the application of fluoride for the prevention of dental caries or at a regular recall appointment for the prevention of gingivitis Source of Funding: Information not available Type of Study/Design: Systematic review Level of Evidence: Level 1: Good-quality, patient-oriented evidence Strength of Recommendation Grade: Grade A: Consistent, good-quality patient-oriented evidence [Copyright &y& Elsevier]

A conference paper about a workshop on building confidence and skills in dental hygiene researchers for effective use of qualitative research methodologies is presented. It discusses various purposes for which the presenters will use slides, demonstrations and audience participation activities including discussing the components of a research plan for focus groups and interviews and developing a focus group or interview guide.

The article discusses the author's reasons for nominating Jay W. Friedman for the 2009 "American Journal of Public Health" (AJPH) Author of the Year award.

Profiles Charles W. Gish, a dentist and the recipient of the John W. Knutson Distinguished Service Award in Dental Public Health in 2004 in the U.S. Family background; Educational attainment; Contributions of Gish in the field of dentistry.

Comments on the maintenance of oral health status through prevention-oriented practices. Importance of the practice of good oral health habits; Reduction of the risk of tooth loss; Differences of health education models in suggestion of ideologies and methods.

Presents a letter to the editor in response to the article "Improving the Oral Health of Alaska Natives," by E. Sekiguchi, A. H. Guay, L. J. Brown, et al which appeared in a 2005 issue of the "American Journal of Public Health."

: BackgroundFindings from previous surveys suggest low utilization of oral cancer examinations, even though this examination is noninvasive. The purpose of this analysis is to compare the use of an oral cancer examination (OCE) and a skin cancer examination (SCE) in the past 12 months within the United States. Both exams are noninvasive and include a visual component.: MethodsWeighted data from the Adult Prevention Supplement of the 1998 National Health Interview Survey (NHIS) for adults 40 years of age or older were analyzed using SAS and SUDAAN. A ratio compared the percentage reporting an OCE (%OCE) with the percentage reporting a SCE (%SCE).: ResultsThe percentage having an OCE in the past year (13.8%) was very similar to the percentage having a SCE (13.5%) during that same period. With increasing age group, the %OCE/%SCE ratio varied inversely from 1.60 (C.I. 1.42–1.78) among persons 40–49 years to 0.62 (C.I. 0.55–0.69) among persons 70+ years. The ratio was similar in whites and blacks, males and females, and Hispanics and non-Hispanics. There was a positive gradient in the ratio by education and family income.: ConclusionsOverall, less than 15% of the population is receiving either of these examinations, although the American Cancer Society recommends both of them on an annual basis for individuals 40 years of age and older. To increase detection of these cancers at early stages, extensive educational and media campaigns for the public and providers identifying risk factors and the availability of and the need for these examinations are required. [Copyright &y& Elsevier]

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

Community water fluoridation (CWF) and its effect in reducing the burden of dental caries (tooth decay) is considered one of the 10 public health achievements in the 20th century. In the U.S., three-quarters (74.4%) of people on community water supplies have optimally fluoridated water, and each year approximately 90 communities actively consider starting or discontinuing CWF. CWF exists within the policy environment and includes actions taken by local community councils, health and water boards, and groups; state legislatures and health departments; national regulatory and science agencies; independent science entities; and professional and nonprofit organizations. Epidemiologists have been in the forefront of CWF. Experience with the past 70 years reveals that the coming decades will bring additional questions, recommendations, and challenges for CWF. The continued involvement of epidemiologists as part of multidisciplinary teams is needed in research, surveillance, peer review of studies, assessment of systematic review findings, and in the translation and communication of science findings to audiences with limited science/health literacy. This chapter's purpose is to 1) examine how epidemiologic evidence regarding CWF has been translated into practice and policy, 2) examine how recommendations for and challenges to CWF have affected epidemiologic research and community decision-making, and 3) identify lessons learned for epidemiologists. [ABSTRACT FROM AUTHOR]

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 HPV- information; 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. [ABSTRACT FROM AUTHOR]

Overview: This report presents the results of systematic reviews of effectiveness, applicability, other positive and negative effects, economic evaluations, and barriers to use of selected population-based interventions intended to prevent or control dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis of recommendations by the Task Force on Community Preventive Services (the Task Force) about the use of these selected interventions. The Task Force recommendations are presented in this supplement. [Copyright &y& Elsevier]

Purpose The purpose of this study was to determine dental hygiene students' perspectives regarding their knowledge and understanding about caries prevention strategies and their intention to use these regimens in clinical practice. Dental hygienists' knowledge and understanding of caries prevention is critical because they are the primary providers of these regimens and the relevant education. Methods This 2019 national cross-sectional online survey was designed by the University of Maryland (UMD), structured by the ADA staff for online administration, distributed and collected by the American Dental Hygienists' Association (ADHA) to 9533 email addresses, and de-identified response data were analyzed by UMD. The survey included questions on three caries preventive regimens: fluoride varnish, dental sealants, and silver diamine fluoride (SDF), and items on community water fluoridation (CWF), respondent's demographics and intent to use the regimens. Statistical analyses included descriptive statistics and analysis of variance. Significance was set at p <0.05. Results Of the 235 surveys returned (response rate 2.5%) the majority were female, White and born in the United States. Over half were in associate degree programs; nearly a third were in baccalaureate programs. Respondents reported greater knowledge/understanding and intention to use fluoride varnish and dental sealants than SDF. Less than half (44.7%) reported knowledge/understanding of SDF and only 22.6% had a high level of confidence regarding applying it. Additionally, only 31.1% indicated they were extremely likely to use SDF upon graduation. Conclusions To reduce the prevalence of caries, dental hygiene graduates must be well-versed with the latest science-based preventive procedures, including non-invasive caries prevention and control therapies. The results of this survey, albeit non representative of the general population of dental hygiene students, suggest a need for a more extensive review of the caries preventive regimen content, especially for silver diamine fluoride, of dental hygiene curricular programs., (Copyright © 2024 The American Dental Hygienists’ Association.)

Background: Approximately 8% of elementary school-aged children in the United States have food allergies, a complicated health management situation that requires parents to use many types of health literacy, empowerment, and advocacy skills to work with school staff to protect their children., Objective: This cross-sectional study examined (a) whether the highest versus lowest levels of functional, communicative, and critical health literacy are associated with higher perceived effectiveness of parental advocacy behaviors for safe food allergy management in schools [parental advocacy]; and (b) whether communicative and critical health literacy are more strongly associated with parental advocacy than functional health literacy., Methods: A sample of parents of elementary school-aged children was recruited through 26 food allergy organizations and a research patient registry. Participants completed an anonymous online survey. Self-reported measurements of parental health literacy, empowerment, and advocacy were adapted and refined through pre-testing and pilot-testing. General linear model analyses were conducted to predict parental advocacy., Key Results: Participants ( N = 313) were predominantly White, college-educated mothers with moderately high levels of food allergy knowledge, health literacy, empowerment, and parental advocacy skills. Parents who scored at the highest levels in the three dimensions of health literacy reported they engaged in more effective advocacy behaviors than parents who scored at the lowest levels. Parental advocacy was predicted largely by parental empowerment and the quality of the relationship with the school ( B = .41 and B = .40, respectively). Functional health literacy and the child's diagnosis of asthma were smaller predictors. While accounting for covariates, functional health literacy was significantly associated with parental advocacy whereas communicative and critical health literacy were not., Conclusions: Interventions to impact parental empowerment and parent-school relationships, including a health-literate universal precautions approach of communicating food allergy school policies, may influence parental advocacy for food allergy safety in schools. Further research could use a performance-based multidimensional measure of health literacy. [ HLRP: Health Literacy Research and Practice . 2023;7(3):e165-e175. ].

The aim of this study was to assess university students' knowledge and understanding about HPV and its association with their vaccination status and health literacy. A sample of 383 undergraduate university students between the ages of 18 and 26 were recruited between February 14 and March 22, 2018. An electronic survey was administered to assess knowledge and HPV awareness, vaccination status, and health literacy. Participants had moderate mean knowledge scores of 6.02 of a possible 11 (SD = 3.06). There was a positive association between health literacy and HPV knowledge and a statistically significant difference in knowledge scores between those who are vaccinated and unvaccinated p < 0.001. This study expanded available research on HPV vaccine and its uptake among university students and can be used to develop educational interventions. Continuous examination of HPV knowledge gaps and identifying factors that affect vaccine uptake is pivotal to increasing vaccination rates., (© 2021. American Association for Cancer Education.)

Studies demonstrate that dental providers value effective provider-patient communication but use few recommended communication techniques. This study explored perspectives of California dental providers and oral health literacy experts in the United States on use of communication techniques. We conducted a qualitative key informant interview study with 50 participants between November 2019 and March 2020, including 44 dental providers (dentists, hygienists, and assistants) in public or private practice in California and 6 oral health literacy (OHL) experts. We undertook thematic analysis of interview transcripts and descriptive statistics about interviewees from pre-surveys. Dental providers reported frequently speaking slowly, and using simple language and models/radiographs to communicate with patients, while infrequently using interpretation/translation, illustrations, teach-back, or motivational interviewing. Providers reported using only 6 of the 18 American Medical Association's (AMA) recommended communication techniques and only 3 of the 7 AMA's basic communication techniques. A majority of providers indicated using one of five oral health assessment and educational strategies. Key barriers to effective communication included limited time, financial incentives promoting treatment over prevention, lack of OHL training, limited plain-language patient education materials, and patients with low OHL knowledge. Dental organizations should prioritize supporting dental providers in effective patient communication practices. Standardizing OHL continuing education, creating an evidence-based OHL toolkit for dental teams, ensuring accessible interpretation/translation services, and incentivizing dental providers to deliver education could improve oral health literacy and outcomes.

Introduction: There is a paucity of research on awareness, education, and interventions that address increased risk of developing periodontal disease, the sixth complication of diabetes. Examining the knowledge of patients with diabetes and understanding of the bidirectional relationship between periodontal disease and diabetes could inform future diabetes self-management care. We assessed the knowledge and understanding of the bidirectional relationship between diabetes and periodontal disease; examined gender, education, and income differences in this knowledge and understanding, as well as other differences in dental hygiene practices., Methods: A Web-based survey was conducted using a convenience sample of patients with diabetes., Results: A total of 927 patients with diabetes participated in the study. Gender and education were significantly associated with knowledge and understanding of the bidirectional relationship between diabetes and periodontal disease in patients with diabetes. After controlling for diabetes duration, dental insurance status, and other covariates, males had less knowledge and understanding of the bidirectional relationship between diabetes and periodontal disease compared with females ( P  < .0001). Those with higher education ( P < . 002) and those who received health care provider recommendations to obtain regular dental visits ( P  < .00001) had greater understanding of the association between diabetes and periodontal disease., Conclusions: This study highlights the need for 1) educating male and low-education patients with diabetes in particular about their increased risk of periodontal disease and the need for regular dental visits, and 2) health care providers and dental health providers to work together to address the needs of their diabetic patients., Competing Interests: Conflict of interest: None., (© Copyright 2020 by the American Board of Family Medicine.)

This chapter provides a review of the evolution of oral health literacy including its impact on oral health outcomes, the current status of oral health literacy initiatives and future research needs. Using the Healthy People 2010 definition, the chapter describes opportunities needed to improve oral health literacy among health providers as well as individuals/patients, communities and policy-makers. Studies of the two most prevalent dental diseasesâĂŤdental caries and periodontal diseases - reveal that increasing the oral health literacy of the public and health care providers can play a major role in reducing these diseases. Increasing oral health literacy by creating access to accurate knowledge and supporting use of science-based preventive measures is essential. A major part of the chapter describes oral health literacy's influence in the integration of dental and medical care. The chapter provides an extensive list of research needed to further our understanding of the impact of oral health literacy on health disparities and the health of the population.

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

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

With dental caries being a common chronic disease in children and adults, oral health literacy is needed to improve oral health and prevent caries. If oral health providers themselves are confused about preventive strategies, they cannot effectively educate the public or other health care providers. The aim of this study was to assess University of Maryland dental hygiene students' understanding of and ability to communicate caries preventive strategies to low-income populations during a community service-learning program in 2013 and 2014. Fifty baccalaureate degree dental hygiene students were asked to complete surveys before and after receiving a presentation on caries preventive strategies and after an outreach event, and 77 low-income caregivers were asked to complete surveys before and after receiving oral health education from the students. The key knowledge question on all surveys asked respondents to select the "single best way to prevent tooth decay" (i.e., provide caries prevention) from a list that included the following items: limit sweets, going to the dentist, brushing teeth, using fluoride toothpaste, flossing, drinking fluoridated water, fluoride varnish, and sealants. Of the 50 students, 41 completed all three surveys, for a response rate of 82%; all 77 caregivers (100%) completed the survey before the counseling session, and 37 (48%) completed the survey afterwards. While the results showed a significant knowledge increase for the students that drinking fluoridated water is the best caries prevention strategy, only 44% of them correctly ranked that option first even on the final survey, and only 8% of the caregivers ranked that option first even after counseling. These results suggested that neither the students nor the caregivers understood the benefits of community water fluoridation (CWF), even after the interventions. In spite of their low knowledge scores, it was encouraging that 86-92% of the caregivers reported that the students demonstrated respect for them and spent an appropriate amount of time with them and that they understood the information the students communicated. In discussions after the surveys, the students reported that they had received inconsistent messages from faculty members regarding the benefits of CWF, which resulted in their confusion. These results led the authors to revise their program's instruction to increase the students' knowledge of caries prevention strategies.

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., (Copyright © 2017 The American Dental Hygienists’ Association.)

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

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

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 < 0.01)., 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.

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.

Background: The authors conducted a national survey to determine the communication techniques that dentists use routinely and variations in their use., Methods: American Dental Association Survey Center staff members mailed an 86-item questionnaire to a random sample of 6,300 U.S. dentists in private practice. Participants reported routine use ("most of the time" or "always") during a typical week of 18 communication techniques, of which seven are basic techniques. The authors used analysis of variance and ordinary least squares regression models to test the association of communication, provider and practice characteristics with the number of techniques., Results: Dentists routinely use an average of 7.1 of the 18 techniques and 3.1 of the seven basic techniques. Two-thirds or more of dentists used four of the techniques (hand out printed materials, speak slowly, use models or radiographs to explain, use simple language). Less than one-fourth of dentists used any of the techniques in the teach-back method or patient-friendly practice domains. A dentist's age, race/ethnicity, education outside the United States and area of dentistry affected use. Health literacy variables (awareness, education in communication, practice-level change, outcome expectancy) and lack of time were associated with the number of techniques used., Conclusions: Routine use of all of the communication techniques is low among dentists, including some techniques thought to be most effective with patients with low literacy skills., Practice Implications: Professional education is needed to improve knowledge about communication techniques and to ensure that they are used effectively. A firm foundation for these efforts requires the development, evaluation and dissemination of communication guidelines for dental care professionals.

Effective communication with patients is the cornerstone of quality dental care and oral health outcomes. Oral health literacy skills are critical to empowering individuals' ability to improve their oral health. A large part of the American public has low health literacy skills. Low health literacy contributes to disease and is costly. Being able to understand health information and how to obtain services is critical to oral health management. The communication skills of the dental team are pivotal to increasing oral health literacy skills of Americans.

Background: Teaching cancer prevention and detection is important in health professional education. It is desirable to select a comprehensive framework for teaching oral cancer (OC) prevention and detection skills., Methods: The PRECEDE-PROCEED model was used to design a randomized pretest and posttest study of the OC prevention and detection skills of dental students (n = 104). OC knowledge, opinions, and competencies were evaluated., Results: Second year students in the intervention group were more competent than those in the control group., Conclusions: The novel use of PRECEDE-PROCEED sets a precedent for designing a standardized OC curriculum for a wide range of health professional disciplines.

Background: Because South Carolina has the fourth highest mortality rate for oral cancer among the 50 states, dental students in the state must be knowledgeable about prevention and early detection of the disease., Methods: In 2002, the authors surveyed 163 students using a written questionnaire (response rate, 79.1 percent). The questionnaire included questions about oral cancer risk and nonrisk factors as well as oral cancer diagnostic signs, symptoms and examination procedures. The authors performed univariate and bivariate analyses (alpha < or = .025)., Results: At least 93 percent of the students replied that tobacco, alcohol and previous oral cancer lesions were risk factors. One hundred six students (65 percent) knew that the most likely site for oral cancer is the ventrolateral border of the tongue. Students differed in their overall knowledge of risk factors (P = .002), nonrisk factors (P < .001) and diagnostic procedures (P < .001)., Conclusion: Although students' level of knowledge increased with academic year, educators and policy-makers need to place greater emphasis on oral cancer education and training in dental schools., Practice Implications: Morbidity and mortality are likely to be reduced if dentists know how to prevent and detect oral cancer.

Purpose: The purpose of this study was to obtain pilot information concerning the attitudes of pediatric dentists regarding their role in tobacco intervention for children and adolescent patients., Methods: A 1-page survey, which was adapted and pretested from a previous, comprehensive survey, was distributed to all registrants at the 2001 American Academy of Pediatric Dentistry Annual Meeting in Atlanta, Ga. Descriptive and exploratory multivariable techniques were used to analyze the data., Results: Of the 173 respondents, only 18% had ever received training in tobacco cessation counseling. Although most dentists agreed that they should play a role in tobacco intervention with their young patients, the majority was not comfortable with this task. Pediatric dentists with tobacco counseling training were more likely to accept their role in tobacco prevention and cessation efforts and were more confident in their ability to do so than were their counterparts. Pediatric dentists consider tobacco cessation an important role in their practices, but do not consider themselves well prepared to act on this responsibility., Conclusions: The results of this pilot survey strongly suggest that a similar, national, comprehensive study should be conducted among pediatric dentists.

Overview: In any given 12-month period, Maryland ranks 27th among all states and the District of Columbia in estimated new cases of oral cancer. The state also has the seventh highest overall mortality rate for oral cancer. Because of earlier research indicating that Maryland adults had little knowledge and many misconceptions about oral cancer, the authors undertook a study to obtain in-depth information from Maryland adults 40 years of age or older on oral cancer, oral cancer examinations and factors associated with having an oral cancer examination., Methods: The authors conducted a qualitative descriptive study using information gathered from three focus groups consisting of nine, 10 and seven adults respectively, and which met at two locations. The authors hired a private focus group research firm, which randomly selected participants from a telephone list of local residents. A professionally trained moderator conducted all focus groups using a semistructured interview guide., Results: Participants were struck by the fact that they rarely hear about this type of cancer. Many said that they never had had an oral cancer examination and did not know there was such a thing. Many participants also reported that they likely would be more comfortable discussing oral cancer with their physicians than with their dentists., Conclusions: These findings provide additional in-depth insights to earlier work about Maryland adults' oral cancer knowledge, opinions and practices. The state plans to use this information to develop educational materials and interventions for the public to promote oral cancer prevention and early detection in Maryland., Clinical Implications: Extensive public education about oral and pharyngeal cancers should be provided in dental offices and clinics, as well as in mass media of all types. More clinicians should include comprehensive oral cancer screenings in their oral examinations, and they should explain to patients what they are doing when they provide these screenings.

Oral and pharyngeal cancers are associated with high mortality rates, a situation usually attributed to late-stage diagnosis. Dentists in British Columbia and Nova Scotia were surveyed regarding their practices and opinions related to oral and pharyngeal cancer. In February 1998 a pretested, 41-item survey was mailed to a random sample of dentists in British Columbia (n = 817) and the population of dentists in Nova Scotia (N = 423). A reminder postcard and one additional mailing were sent to nonrespondents. Of the 670 dentists supplying usable responses (response rate 55.2%), only 56.7% agreed that their knowledge of the subject was current. Of 8 health history items, dentists assessed 5 on average, with most (88.0%) asking about the patients' current use of tobacco. A total of 72.7% of the responding dentists performed an oral cancer examination for all edentulous patients at every appointment, but 10.9% never did so. Similarly, 70.7% of the dentists always provided an oral cancer examination at the initial appointment for patients 40 years of age and older, but 9.8% never did so. Undergraduate training related to oral cancer examination was reported as good by only 52.2% of the dentists. About three-quarters of all dentists (77.0%) were interested in taking continuing education courses on this subject. Differences between the 2 provinces were not statistically significant (p > 0.01). Dentists in British Columbia and Nova Scotia could benefit from undergraduate and continuing education courses to increase their knowledge of health history assessment, examination for oral and pharyngeal cancers, and risk reduction strategies, such as counselling about tobacco cessation.

Oral and pharyngeal cancers are largely preventable and can be successfully treated when diagnosed at an early stage. Dentists in British Columbia and Nova Scotia were surveyed regarding their knowledge and opinions about oral and pharyngeal cancer. In February 1998 a pretested 41-item survey was mailed to a random sample of dentists in British Columbia and the population of dentists in Nova Scotia. A reminder postcard and one additional mailing were sent to nonrespondents. Of the 670 dentists supplying usable responses (response rate 55.2%) only 56.7% agreed that their knowledge of the subject was current. Most dentists correctly identified tobacco use (99.4%) and alcohol use (90.4%) as risk factors, but fewer correctly identified factors such as the use of spicy foods (57.0%) and poor oral hygiene (46.3%) as not being risk factors. Only 42.5% identified both erythroplakia and leukoplakia, in that order, as the conditions most likely associated with oral cancer. Indices of risk and diagnostic knowledge were constructed by summing the number of correct responses to items in each domain. On 16 risk factors the mean correct score was 9.2, and on 14 diagnostic procedures the mean correct score was 10.0. Only 38.5% of dentists had consistent levels of knowledge on both indices. Differences between the provinces were statistically significant (p < 0.01) for only 2 knowledge items. About three-quarters of all dentists (77.0%) were interested in taking continuing education courses. Dentists in British Columbia and Nova Scotia could benefit from undergraduate and continuing education courses to increase their knowledge of risk and diagnostic factors for oral cancer.

The objective of this study was to assess family physicians' knowledge, opinions and practices regarding oral cancers in the state of Maryland, USA. A 40-item, self-administered questionnaire was mailed to all members of the Maryland Academy of Family Physicians. Unweighted data (n=240) were analyzed using SAS and SUDAAN software; results were evaluated using an alpha < or =0.05. Family physicians (FPs) were aware of the major risk factors for oral cancers, but misinformation existed about the non-risk factors. Approximately 77% asked their patients the eight questions related to risk factors for oral cancer when taking a medical history but less than 24% provided an oral cancer examination to patients 40 years of age and over. Nearly 64% were interested in a continuing education course about oral cancer. This survey identified gaps in knowledge and practices among FPs but it is encouraging that they expressed interest in continuing education courses on this topic.

The purpose of this study was to obtain in-depth information on Maryland physicians' knowledge, opinions and practices about oral cancer examinations. The qualitative descriptive study used one focus group conducted in a conference facility and nine one-on-one interviews at private medical offices. A criterion-purposeful sampling was used for selection of participants. Generally, we found low awareness of, and surprise about, Maryland's high oral cancer mortality rates. Physicians were not surprised that they detect more lesions than dentists, although most physicians did not provide oral cancer examinations on a routine basis. Physicians were interested in attending continuing medical education (CME) courses on oral cancer prevention and early detection but only if worked into other CME programs on cancer. They were very interested in having hands-on training on performing an oral cancer examination. These findings will be used to implement educational interventions for Maryland physicians to help increase early detection of oral cancers.

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 area 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.