Melanie Simmer-Beck

Effectiveness of an Alternative Dental Workforce Model on the Oral Health of Low-Income Children in a School-Based Setting

OBJECTIVES We evaluated the effect of an alternative dental workforce program-Kansass Extended Care Permit (ECP) program--as a function of changes in oral health. METHODS We examined data from the 2008 to 2012 electronic medical records of children (n = 295) in a Midwestern US suburb who participated in a school-based oral health program in which preventive oral health care was delivered by ECP dental hygienists. We examined changes in oral health status as a function of sealants, caries, restorations, and treatment urgency with descriptive statistics, multivariate analysis of variance, Kruskal-Wallis test, and Pearson correlations. RESULTS The number of encounters with the ECP dental hygienist had a statistically significant effect on changes in decay (P = .014), restorations (P = .002), and treatment urgency (P = .038). Based on Pearson correlations, as encounters increased, there was a significant decrease in decay (-0.12), increase in restorations (0.21), and decrease in treatment urgency (-0.15). CONCLUSIONS Increasing numbers of encounters with alternative providers (ECP dental hygienists), such as with school-based oral health programs, can improve the oral health status of low-income children who would not otherwise have received oral health services.

Changes in posture: a case study of a dental hygienist's use of magnification loupes.

PURPOSE Evidence suggests that using magnification loupes will improve the posture of dental clinicians, thus decreasing work-related musculoskeletal disorders. The purpose of this case study was to document the experiences of a dental hygienist during a four week acclimatization period. METHODS Documentation was comprised of self-reports from the dental hygienists reflective journaling and postural measurements made by a trained observer using Bransons Posture Assessment Instrument (BPAI), a validated posture assessment instrument. Journal reports and postural measurements were made prior to the use of the magnification loupes and over the subsequent three week trial. CONCLUSION Use of the magnification loupes was a positive experience. The BPAI results indicated a positive change in neck and low back posture. Further trials of the effectiveness of magnification loupes in reducing musculoskeletal disorders with this occupational group are recommended.

An evidence-based review of ergonomic features of dental hygiene instruments

OBJECTIVES The purpose of this paper is to describe the research identifying dental hygiene risk factors, outline the structural characteristics of the various tools that dental hygienists use and discuss the evidence to support ergonomic tool re-designs. METHODS Two databases, Medline and Cinahl, were used to identify epidemiological research studies from 1998--2008 that describe the prevalence of musculoskeletal disorders in dental hygienists. The length, diameter, mass and padding of twenty-one (n=21) dental instruments and instrument grip combinations and twenty-two (n=22) mirrors and mirror grip combinations are described. RESULTS The length, mass and diameter of dental instruments and dental mirrors ranged from 16.3 cm to 17.5 cm and 15.9 cm to 18.5 cm, from 10.0 g to 25.0 g and 5.0 g to 30.0 g, and from 6.5 mm to 11 mm and 6 mm to 14 mm, respectively. Padding instruments and mirrors increased the mass by approximately 5.0 g. The literature does not suggest an optimal length for dental instruments or dental mirrors. The literature suggests that the optimal diameter for dental instruments and mirrors is at least 10 mm, the optimal weight is 15.0 g or less, and padding decreases muscle activity. CONCLUSIONS Dental hygienists should be educated to select a variety of instrument handles based upon the parameters described above.

Examining the effect of the Flextend Orthotic Device on grip strength: a pilot study.

Strengthening exercises like those used to treat carpal tunnel syndrome have been recommended for prevention however their effectiveness when used in this manner are not known. The purpose of this study was to determine the effects of the Flextend Orthotic Device on grip strength of dental hygiene students. This study used a convenience sample of 24 (n=24) first year dental hygiene students. Students were randomly assigned to either the Flextend Orthotic Exercise glove group or a control group. A series of grip strength measurements were taken periodically throughout the study using a hydraulic hand dynamometer. In a repeated measures analysis of covariance there were no significant effects for study group (p=0.812) time (p=0.954), nor was there a significant interaction between group and time (p=0.858). Use of the Flextend Orthotic Device did not additionally increase grip strength among dental hygiene students over the eight week time period. In none of the weeks post baseline was there a significant difference between the Flextend Orthotic Device group and control groups.

Gender differences in the association of periodontitis and type 2 diabetes

AIMS THE OBJECTIVE WAS TO INVESTIGATE IF GENDER DIFFERENCES EXIST IN THE ASSOCIATIONS BETWEEN PERIODONTITIS AND TYPE 2 DIABETES. DISPROPORTIONATE DISPARITIES BY GENDER WERE FOUND TO EXIST IN RATES OF BOTH PERIODONTITIS AND DIABETES WITH RESPECT TO DEMOGRAPHICS AND BEHAVIOURAL PREDICTORS THAT CANNOT BE EXPLAINED SOLELY BY THE WELL-ESTABLISHED ASSOCIATION BETWEEN THESE TWO DISEASES. MATERIALS AND METHODS MULTIPLE DATASETS WERE EXTRACTED FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY (NHANES) 2009-2014, WHICH USED A STRATIFIED MULTISTAGE PROBABILITY SAMPLING TO OBTAIN SAMPLES FROM ALL CIVILIAN NON-INSTITUTIONALISED PEOPLE IN THE USA. BIVARIATE RELATIONSHIPS BETWEEN EACH EXPLANATORY VARIABLE AND PERIODONTITIS LEVEL WERE ASSESSED WITH ODDS RATIOS (OR) AND THEIR 95% CONFIDENCE INTERVALS (CI). A SET OF WEIGHTED LOGISTIC REGRESSION MODELS WAS USED TO INVESTIGATE THE ASSOCIATION DIFFERENTIATIONS BETWEEN PERIODONTITIS AND DIABETES BY GENDER. C-STATISTICS MEASURED THE GOODNESS-OF-FIT OF WEIGHTED LOGISTIC REGRESSION MODELS. RESULTS THE PREVALENCE OF MODERATE-SEVERE PERIODONTITIS WAS 36.39% AND 22.71% AMONG PARTICIPANTS WITH TYPE 2 DIABETES AND WITHOUT DIABETES, RESPECTIVELY. TYPE 2 DIABETES WAS SIGNIFICANTLY ASSOCIATED WITH MODERATE-SEVERE PERIODONTITIS OR (OR = 1.47, 95% CI: 1.18-1.82) AMONG MALES EVEN AFTER ADJUSTING FOR DEMOGRAPHICS, SOCIOECONOMIC STATUS AND ORAL HEALTH BEHAVIOURS. THE AFOREMENTIONED RELATIONSHIP WAS NOT FOUND IN FEMALES. FURTHERMORE, DIFFERENT RELATIONSHIPS OF MODERATE-SEVERE PERIODONTITIS WITH BODY MASS INDEX AND THE USE OF MOUTHWASH WERE FOUND BETWEEN THE MALES AND FEMALES. CONCLUSIONS THE CURRENT FINDINGS SUGGEST THAT IMPORTANT IMPROVEMENTS IN THE DEVELOPMENT OF GENDER-SPECIFIC STRATEGIES IN PREVENTION, SUCH AS ORAL HOME-CARE, TO REDUCE THE HIGH PREVALENCE OF PERIODONTAL DISEASE AND MAINTAIN GOOD ORAL HEALTH ARE VITAL, AND ARE ESPECIALLY IMPORTANT FOR MALE DIABETIC PATIENTS AND THOSE WHO ARE AT HIGH RISK OF DEVELOPING DIABETES, SUCH AS THOSE WHO ARE OBESE.

Assessing the Effectiveness of a School-Based Dental Clinic on the Oral Health of Children Who Lack Access to Dental Care: A Program Evaluation.

This program evaluation examines the effectiveness of a school-based dental clinic. A repeated-measures design was used to longitudinally examine secondary data from participants (N = 293). Encounter intensity was developed to normalize data. Multivariate analysis of variance and Kruskal–Wallis test were used to investigate the effect of encounter intensity on the change in decay, restorations, and treatment urgency. A Pearson’s correlation was used to measure the strengths of association. Encounter intensity had a statistically significant effect on change in decay (p = .005), restorations (p = .000), and treatment urgency (p = .001). As encounter intensity increased, there was a significant association with the decrease in decay (−.167), increase in restorations (.221), and reduction in referral urgency (−.188). Incorporating dental care into a school-based health center resulted in improved oral health in underserved children while overcoming barriers that typically restrict access. The collaboration of school nurses with the school-based dental clinic was an important element for maximizing student access to dental care.

Using Registered Dental Hygienists to Promote a School-Based Approach to Dental Public Health

We examine a strategy for improving oral health in the United States by focusing on low-income children in school-based settings. Vulnerable children often experience cultural, social, economic, structural, and geographic barriers when trying to access dental services in traditional dental office settings. These disparities have been discussed for more than a decade in multiple US Department of Health and Human Services publications. One solution is to revise dental practice acts to allow registered dental hygienists increased scope of services, expanded public health delivery opportunities, and decreased dentist supervision. We provide examples of how federally qualified health centers have implemented successful school-based dental models within the parameters of two state policies that allow registered dental hygienists varying levels of dentist supervision. Changes to dental practice acts at the state level allowing registered dental hygienists to practice with limited supervision in community settings, such as schools, may provide vulnerable populations greater access to screening and preventive services. We derive our recommendations from expert opinion.