Mass Fatality Incidents and the Role of the Dental Hygienist: Are We Prepared?

Dental hygienists can fill critical roles during mass fatality incidents in the area of disaster victim identification, providing much needed support to forensic odontologists. The purpose of this paper is to bring awareness that research is needed to assess current dental hygiene programs, continuing education opportunities and the type of approach being used to develop and implement pedagogy in the forensic specialty area, specifically mass fatality preparedness and response for the dental hygienist. Because of the threat of terrorism in the U.S. and natural disasters like hurricanes, the need to prepare dental professionals in disaster response and fatality management is real. The authors\u27 recommendations are to incorporate training in the areas of risk management and infection control in the mortuary setting, antemortem and postmortem records comparison, safe usage of portable radiographic equipment, and proper radiographic technique for the deceased victim. Disaster victim identification training in these areas is necessary for the accurate, efficient and dignified identification of disaster victims while minimizing errors and increasing responder safety. The dental hygiene professional can assist disaster mortuary response efforts in a way that leverages multidisciplinary teams, if effective training programs are implemented

Interventions for the Reduction of Dental Anxiety and Corresponding Behavioral Deficits in Children with Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) can greatly inhibit a child\u27s communication and social interaction skills, impacting their comfort during dental hygiene treatment and services. Children with ASD may exhibit sensory sensitivities, fear of the unfamiliar and lack of socio-cognitive understanding, leading to anxiety and corresponding behavioral deficits. Since the prevalence rates for ASD have risen significantly in the past decade, increased emphasis has been placed on educational and behavior guidance techniques, which can be helpful for children with ASD because of their increased capabilities in visual-processing. The purpose of this literature review is to summarize the interventions available to reduce dental anxiety in children with ASD, and to determine which strategies are best suited for implementation by the dental hygienist. Advancements in technology and socio-behavioral interventions were assessed for appropriate use, efficacy and engagement in the target population. Interventions were categorized into the following groups: picture cards, video technologies and mobile applications

Assessment of Mass Fatality Preparedness and Response Content in Dental Hygiene Education

When mass fatality incidents (MFIs) occur, they can quickly overwhelm local, state, and government agencies, resources, and personnel. It is important to have a rapid and effective response with skilled, multidisciplinary victim identification teams since specific skill sets are necessary to participate in mass fatality preparedness and response. The aims of this study were to determine the extent of formal education related to mass fatality preparedness and response training in U.S. dental hygiene programs and to assess program directors\u27 perceptions of the need for such training. A 23-item cross-sectional survey was emailed to 319 U.S. dental hygiene programs in 2015. Survey questions addressed if the program offered mass fatality preparedness and response training to its students and how much training was given, as well as collecting respondents\u27 demographics and opinions regarding education and training. An overall response rate of 36% was obtained, with 111 program chairs completing the survey. The results showed that only a small percentage of responding programs incorporated coursework related to mass fatality and preparedness in their curricula. Of the responding programs, 84% had no formal instruction on the role of a dental hygienist in MFIs; however, 53 of 69 program directors agreed or strongly agreed that the role of dental hygienists in MFIs should be covered in dental hygiene curricula. The top three barriers to incorporating such training reported by respondents were time requirements, lack of faculty expertise, and lack of equipment. Future research is needed to establish standardized competencies for mass fatality preparedness and response in dental hygiene education

Radiation Safety Practices of Dental Hygienists in the United States

Purpose: The As Low As Reasonably Achievable (ALARA) principle was developed to promote awareness and minimization of radiation exposure and is supported by radiation control and professional organizations. The purpose of this study was to determine licensed dental hygienists\u27 current radiation safety practices. Methods: Data were collected with a 22 item, online survey administered to a convenience sample of 1,500 dental hygienists in the United States. Questions focused on respondents\u27 use of the American Dental Association (ADA) radiographic examination selection guidelines, their individual dental practice policies, and hand-held portable x-ray device use and training. Cross tabulations were obtained using logistic regression and general linear models for significance at a 0.05 level. Results: A response rate of 38% (n = 566) was obtained. A majority of respondents had an associate\u27s degree (62%), were over the age of 55 (41%), and had over 30 years of experience. Respondents with more years of experience were more likely to follow the ADA selection criteria for radiographic need (p=0.0340; SE=0.1093) and respondents with a bachelor\u27s degree or higher were more likely to use techniques to reduce radiation exposure than those with an associate\u27s degree (p=0.0080; SE=0.0169). Respondents who had recently taken dental radiation safety continuing education courses were significantly more likely to wear a clinician lead apron when using a hand-held x-ray device (p=0.0093; M=1.571; SD=1.222). Conclusion: Dental hygienists with more years of experience, a higher level of education, and recent CE course work were more likely to follow ADA radiographic examination selection guidelines and use appropriate techniques to reduce exposure to ionizing radiation

Vital Tooth Whitening Effects on Oral Health-Related Quality of Life in Older Adults

Purpose: The purpose of this study was to determine if vital tooth whitening affects oral health-related quality of life (OHRQOL) in adults age 50 years and older, and if tooth whitening causes increased participation in social activities. Methods: Using a 2 group, single blind, randomized, pre-test, multiple post-test design, 62 participants were enrolled. The experimental group used a whitening product twice daily for 3 weeks. The control group used no whitening products. The Oral Health Impact Profile (OHIP) served as the pre- and post-test measure. The OHIP measures OHRQOL on 7 subscales: functional factors, psychological disabilities, psychological discomforts, physical disabilities, social disabilities, handicaps and physical pain. Additional questions measured the subjects\u27 social activities at baseline, 3 weeks and 3 months. Data from 53 participants, who completed the study, were analyzed using paired t-tests and ANOVA at p=0.05. Results: Statistical significance was observed for the OHIP physical pain subscale (p=0.0029) and the handicap subscale (p=0.05). Pre- to post-test means of the physical pain subscale increased in the experimental group (4.84 to 7.10), suggesting a lower OHRQOL, most likely related to tooth sensitivity experienced by the experimental group. Means from pre- to post-test of the handicap subscale (1.96 to 1.19) reveal that the experimental group reported an improved OHRQOL and felt they were more willing to work. Repeated measures ANOVA and Tukey\u27s post-hoc tests revealed that the experimental group reported significantly less (p=0.04) social activities at the 3 month post-test (3.92 to 3.45). No statistically significant between-group differences were observed in the overall OHIP score for functional factors, psychological disabilities, psychological discomforts, physical disabilities and social disabilities. Conclusion: Results indicate that vital tooth whitening does not improve overall OHRQOL in older adults

Use of a Simulated-Virtual Training Module to Improve Dental Hygiene Students\u27 Self-Reported Knowledge, Attitudes, and Confidence in Providing Care to Children with Autism Spectrum Disorder: A Pilot Study

Purpose: Autism spectrum disorder (ASD) is a developmental disorder affecting an individual\u27s ability to communicate, interact, behave, and learn. The purpose of this study was to determine knowledge, attitudes, and confidence of dental hygiene students in providing care to children with ASD as a mechanism for evaluating dental hygiene curricula for patients with special needs. Methods: A simulated-virtual training (SVT) intervention was developed as an interactive approach for educating dental hygiene students on providing care to a child patient with ASD. The SVT intervention consisted of a scenario in which the clinician interacted with a child with ASD who was having difficulty in the dental environment. Pre- and post-test surveys measured students\u27 knowledge, attitudes, and perceived confidence related to providing dental hygiene services to children with ASD prior to and following the intervention. The Wilcoxon Signed Rank was used to determine statistical significance at the p=.05 level. Results: Thirty-three second year dental hygiene students completed the pre- and post-test surveys for a response rate of 97%. Statistically significant differences were observed for self-reported confidence to provide care to patients with ASD upon graduation, assessment of the unique needs of children with ASD, and an understanding of the dental needs for children with ASD (p\u3c0.05). Participants\u27 confidence with performing dental hygiene services on children with ASD greatly increased, with statistically significant difference found for almost all services (i.e., oral exam, oral hygiene instruction, oral photos, radiographs, scaling, fluoride treatment; p\u3c0.05) except selective polishing. Most (90%) agreed that there is a need for additional/elective resources to help increase comfort in providing care to children with ASD. Conclusion: Results indicate the SVT intervention increased students\u27 knowledge, attitudes, self-perceived confidence, and comfort. Dental and dental hygiene curricula could include technologies and intervention methods to advance access to dental care by children with ASD

Performance of Dental Hygiene Students in Mass Fatality Training and Radiographic Imaging of Dental Remains

Purpose: Mass fatality incidents can overwhelm local, state and national resources quickly. Dental hygienists are widely distributed and have the potential to increase response teams\u27 capacity. However, appropriate training is required. The literature is void of addressing this type of training for dental hygienists and scant in dentistry. Hence, the purpose of this study was to assess one facet of such training: Whether the use of multimedia is likely to enhance educational outcomes related to mass fatality training. Methods: A randomized, double-blind, pre- and post-test design was used to evaluate the effectiveness of comparable educational modules for 2 groups: a control group (n=19) that received low media training and a treatment group (n=20) that received multimedia training. Participants were second-year, baccalaureate dental hygiene students. Study instruments included a multiple-choice examination, a clinical competency-based radiology lab scored via a standardized rubric, and an assessment of interest in mass fatality education as a specialty. ANOVA was used to analyze results. Results: Participants\u27 pre- and post-test scores and clinical competency-based radiology lab scores increased following both educational approaches. Interest in mass fatality training also increased significantly for all participants (p=0.45). There was no significant difference in pre- and post-test multiple choice scores (p=0.6455), interest (p=0.9133) or overall competency-based radiology lab scores (p=0.997) between groups. Conclusion: Various educational technique may be effective for mass fatality training. However, mass fatality training that incorporates multimedia is an appropriate avenue for training instruction. Continued research about multimedia\u27s role in this specialty area is encouraged

Postmortem Dental Records Identification by Dental Hygiene Students: A Pilot Study

Purpose: Dental hygienists have the potential for filling critical roles in multidisciplinary victim identification teams. The purpose of this pilot study was to evaluate the accuracy of dental hygiene students utilizing dental charting, bitewings, and skull dentitions for the purpose of making identification matches. Methods: Thirty senior dental hygiene students (n=30) independently viewed an asynchronous online multimedia-based presentation on the procedures used for collecting and recording forensic dental evidence. Following the presentation participants attempted to chart and match three bitewing radiograph sets to three human skull dentitions by correlating matches/exclusions. Immediately following the activity, each student completed a questionnaire rating the difficulty of the exercise, as well as their confidence, and willingness to volunteer as a forensics team member. Descriptive statistics were used to analyze the data. Results: Of the total sample 36.7% (n=11) reported having prior experiences with dental radiography; while the majority (63.33%, n=19) reported no prior experience. Participants\u27 accuracy scores for dental charting ranged from 91.23% (SD=9.42) to 99.06% (SD=3.60), with no statistically significant difference based on prior experience (p\u3e0.05). The average interrater reliability was 86% (p\u3c0.0001), indicating a high level of agreement with charting skulls and radiographs. No statistically significant differences were found for charting time, perceived difficulty, or level of confidence when comparing experience among the participants (p\u3e0.05). Conclusions: Regardless of previous experience, dental hygiene students were able to match postmortem dentitions and radiographs with good interrater reliability and did not differ statistically for charting time, perceived difficulty, or confidence. Results suggest dental hygienists can work as effective victim identification team members when educational programs are implemented

Active Shooter Preparedness Among Dental Hygiene Students

Purpose: Active shooter incidents (ASIs) occurring in dental hygiene academic settings present unique challenges and research examining institutional preparation of dental hygiene students for such incidents is lacking. The purpose of this pilot project was to examine the perceived preparedness, confidence, and awareness of dental hygiene students regarding ASIs. Methods: A validated 24-item electronic survey was distributed to dental hygiene students (n=68) at one institution to measure their preparedness, confidence, and awareness regarding ASIs. Descriptive statistics and Pearson correlations were used for data analysis. Results: Fifty-seven dental hygiene students completed the survey for a response rate of 84%. Many participants felt slightly prepared (n=26, 45.6%) or not prepared (n=15, 26.3%) to respond to an ASI in the classroom. Most were slightly confident (n=26, 45.6%) or not confident (n=16, 26.3%) in helping to control the classroom during an ASI. Over half (n=32, 56.1%) were not certain if their institution provided active shooter trainings and were not certain if drills occurred (n=25,43.8%). Perceived preparedness was positively correlated with confidence in helping to control an ASI in the classroom (r(56)=.616, p=.000). Positive correlations were also identified with perceived preparedness to respond in a lab or clinic with the assumption that ASIs are taken seriously at their institution (r(56)=.375, p=.004). Conclusion: A general lack of preparedness and confidence for responding to ASIs may exist among dental hygiene students along with a lack of awareness regarding trainings and drills. Educational institutions should implement best practices for preparing dental hygiene students for ASIs

Testing a Novel 3D Printed Radiographic Imaging Device for Use in Forensic Odontology

There are specific challenges related to forensic dental radiology and difficulties in aligning X-ray equipment to teeth of interest. Researchers used 3D printing to create a new device, the combined holding and aiming device (CHAD), to address the positioning limitations of current dental X-ray devices. Participants (N = 24) used the CHAD, soft dental wax, and a modified external aiming device (MEAD) to determine device preference, radiographer\u27s efficiency, and technique errors. Each participant exposed six X-rays per device for a total of 432 X-rays scored. A significant difference was found at the 0.05 level between the three devices (p = 0.0015), with the MEAD having the least amount of total errors and soft dental wax taking the least amount of time. Total errors were highest when participants used soft dental wax-both the MEAD and the CHAD performed best overall. Further research in forensic dental radiology and use of holding devices is needed