Joan M. Davis

Effect of hormone replacement therapy (HRT) on periodontal status of postmenopausal women

Summary Background The risks/benefits balance of hormone replacement therapy (HRT) is controversial. The aim of this study was to assess the periodontal status of a postmenopausal women group receiving HRT and to determine the effects of HRT on clinical measures of periodontal disease. Material/Methods Ninety-one postmenopausal women, 52 taking HRT (HRT+) and 39 not taking HRT (HRT−), completed the study. Clinical parameters measured included visible supragingival plaque, probing pocket depth (PD) and clinical attachment level (CAL). Gingival status was recorded as gingival bleeding on probing (BOP). Previous oral contraceptive use and current and past smoking status were also assessed. Results Data indicated that PD and CAL were not significantly different between HRT+ patients and HRT− patients (P=0.8067 and P=0.1627, respectively). The HRT+ group exhibited significantly lower visible plaque levels compared to the control group (P<0.0001). The percentage of gingival sites with positive BOP was significantly lower in the HRT+ group compared to the HRT− group (34.85% vs. 65.15%; P=0.0007). Plaque accumulation was also tested in ANCOVA as a possible explanatory variable for the differences observed in gingival bleeding. The ANCOVA showed no significant differences in gingival bleeding between HRT+ and HRT− women (P=0.4677). No significant differences in past smoking status and oral contraceptive use were detected between HRT+ and HRT− women (P=0.9999 and P=0.0845, respectively). Conclusions These findings indicated that long-term HRT was not associated with relevant effects on periodontal status and clinical measures of periodontal disease, thus suggesting that HRT may not confer protection against periodontitis in postmenopausal women.

Factors affecting adoption of tobacco education in dental hygiene programs.

BACKGROUND Tobacco cessation interventions provided by health care professionals, including dental hygienists can significantly increase the rate of tobacco cessation, yet providers feel inadequately prepared to deliver such interventions. METHODS 96 dental hygiene faculty completed a survey measuring attitudes, subjective norms, and perceived behavioral control to determine their influence on teaching and assessing tobacco cessation intervention competencies. RESULTS Prior experience with providing tobacco cessation counseling, perceptions of internal confidence and control of barriers were significantly related to covering tobacco-related topics. CONCLUSION Comprehensive, flexible tobacco education curriculum guides may help faculty overcome barriers to incorporating tobacco education in dental hygiene programs.

Assessing the Current Status of Tobacco Dependence Education Curricula in US Physician Assistant Programs

Purpose: Tobacco use continues to be the single most preventable cause of death and disease in the United States. A paradigm shift is needed in physician assistant (PA) education to address tobacco dependence as a chronic, relapsing disease requiring patient education, counseling, treatment, and follow‐up. Methods: A national study was conducted to assess the existing tobacco dependence education currently offered in US PA programs. An established tobacco dependence curriculum survey was revised and mailed to the 141 accredited PA programs in the United States during the 2008–2009 academic year. The survey asked respondents to report the following with regard to tobacco dependence education content in their PA program: (1) Perceived self‐efficacy and barriers; (2) Medical topics covered and minutes spent; (3) Evaluation of students’ competency level; (4) Tobacco courses, topics, and resources used; and (5) Level of tobacco‐cessation competency expected upon graduation. Results: A total of 79 surveys were returned (56% response rate). Though, on average, over 827 minutes (14 hours) were devoted to tobacco dependence education curriculum, most minutes (223 minutes) were spent on the health effects of tobacco use, with only 42 minutes spent on cessation counseling, 55 minutes on medications, and 13 minutes on integrating tobacco‐cessation into clinical practice. Conclusions: PA educators have the unique opportunity to affect tobacco‐related morbidity and mortality. The present study demonstrates that PA instructors are more than adequately teaching students about tobacco use. However, it is not clear if students are being adequately taught how to assist patients to quit using tobacco.

A qualitative study of tobacco dependence treatment in 19 US dental hygiene programs.

Introduction The US Public Health Service calls for health professionals to provide tobacco dependence counseling for patients. The purpose of this study was to understand how dental hygiene programs make decisions about and provide training for tobacco dependence counseling to help them graduate more fully competent hygienists. Methods We conducted interviews (N = 32) with mainly program and clinic directors from 19 US dental hygiene education programs for this qualitative case study. We explored fluoride therapy training and tooth whitening training for comparison. Two analysts summarized the transcripts into a case study for each program. Results All programs reported a similar process of learning about and choosing a method for teaching the topics explored. The programs used a common process, ADPIE (assess, diagnose, plan, implement, evaluate), to structure students’ clinical encounters. Almost all programs train students to ask about tobacco use and to advise quitting, but few programs train students to effectively help patients to quit and only 2 programs evaluated the competence of all students to provide such training. ADPIE shows promise for integrating tobacco dependence treatment more fully into the clinical training of dental hygiene students. Comparison to tooth whitening and fluoride therapy training indicated that complexity of the treatment and alignment with dental hygiene’s mission were themes related to training decisions. Conclusion Full implementation of tobacco dependence counseling into dental hygiene education requires a commitment by dental hygiene educators to train students and faculty in counseling techniques and their evaluation. We identified an existing clinical structure as showing promise for facilitating improvement.