The ETSU dental hygiene program is very competitive and rigorous for those admitted. Student dental hygienists may experience higher levels of anxiety and more stressors while completing their course work and clinical hours than they have previously experienced in general education and prerequisite courses. These increased number of stressors and higher levels of anxiety may have negative impacts on students’ academic performance and success in clinical learning environments. A better understanding of the actual need for a stress reduction and anxiety management curriculum will facilitate creating and implementing this type of curriculum. A total of 44 current ETSU dental hygiene students were included in the study, juniors (55%) and (45%) seniors. Nearly all respondents reported their current stress and anxiety levels are affecting their lives (97.5%). Consistently over a third of students who completed surveys from the ETSU dental hygiene program are experiencing physical symptoms of stress and anxiety including headaches, gastrointestinal distress, trouble sleeping, eating too much or too little daily, tense muscles, worry or phobias, anger or hostility, irritability or hostility, and nervousness 2-3 times a week. The average stress level of the 44 ETSU dental hygiene students reported on a 1-10 scale was a 7.65. Nearly half (40%) of all ETSU dental hygiene students currently enrolled reported their stress level as 8 out of 10 with 10 defined as “I can only think of my stress and anxiety”. Further research including an educational intervention to help teach students skills and coping mechanisms to manage and reduce stress and anxiety was recommended.

Many factors influence poor oral health among disadvantaged populations including socioeconomic circumstances, knowledge of disease prevention strategies and ability to implement those strategies, public policies, insurance status, insurance policies, dental providers and other challenges to accessing dental care. Often these issues converge and result in early disadvantages to achieving good oral health (Horton & Barker, 2010). Addressing even some of the factors that contribute to poor oral health may provide ways to change the dental health status of historically underserved populations. The purpose of this research is to explore my role as a practitioner and researcher in the creation of a hygienist-based, community-site located, teledentistry supported system of dental care for underserved populations and the intersection of my experiences with cultural, societal and educational occurrences. This autoethnography examined my own experiences and also explored the experiences of a small sample of others who participated in onsite dental care systems utilizing hygienists as the prevention-focused primary care provider. As Ellis and Bochner (1996) note “Autoethnography stands as a current attempt to, quite literally, come to terms with sustaining questions of self and culture” (p. 193). The findings that emerged from my work included a realization that the dental industry creates and perpetuates the collective neglect of large portions of the US population. Some of this neglect is embedded in traditional power structures in dentistry, gender bias and distrust in professional skills as a result of separate professional education structures. The result for many people is untreated dental disease, a profound lack of health equity, increased shame due to poor oral health as well as missing school. There are ways to address the collective neglect of the dental industry through the reframing of the dental hygienist as the prevention-focused primary care oral health provider in professional education programs then integrating this provider type into community settings like schools.

One of the most important factors in accessing dental care is having dental insurance. For people with low incomes, Medicaid is the main source of health insurance. Medi-Cal is California’s Medicaid program. Adult dental services were mostly eliminated in Medi-Cal in 2009 due to the economic downturn and partially restored in 2014. The objective of this study is to evaluate the effect of change in Medi-Cal dental coverage, specifically the partial restoration of adult dental coverage in 2014, on dental care utilization among Medi-Cal beneficiaries. The partial restoration significantly increased the utilization rates in dental clinics from 2014 to 2017 (22% in 2017 vs. 12% in 2013) for the overall population. However, the magnitude of increase differs in different age groups and ethnic groups. More statistically significant findings show greater utilization rates among beneficiaries of 19-64 than 65-74 and 75+ years old. Also, more significant findings show lower utilization among Black than White, Hispanic or Asian beneficiaries. The partial restoration significantly reduced the dental related ER visits among Medi-Cal beneficiaries from 2015 to 2017. However, the reduction is largely seen in beneficiaries of 19-64 years old in the ethnic groups of White and Black with reductions of 20 and 15 visits per 1,000 enrollees respectively in 2017 comparing to 2013. The dental related ER visits were lower for Hispanics and Asians, and remained very low among those 65 years old and above. In addition, the partial restoration resulted in increases in participation of dental care providers in the Medi-Cal program.

Oral health is strongly correlated to systemic health in the United States. Dental professionals play a significant role in addressing the oral health and prevention of disease for populations in the United States. Because many areas in the United States lack access to dental care, the federal government considers dental hygienists part of the solution. It is now paying attention to restrictive dental hygiene scope of practice rules in each state. State dental boards, comprised mainly of dentists, make these rules based on their perception of dental hygienists' lack of education. This study explored fourth-year dental students' perceptions of the dental hygienist's education and scope of practice. This research found that while dental students felt that the dental hygienist would be a positive addition to their future practices, they did not wholly understand the rigors of dental hygiene education. In addition, dental schools may need to educate on the differences between direct and general supervision.

Quality assurance in healthcare is fundamental in ensuring the achievement of desired outcomes for patients. In 2011 a quality assurance plan was created at the East Tennessee State University (ETSU) dental hygiene program in order to meet accreditation standards. The purpose of this study was to evaluate this plan in order to determine its effectiveness in improving the quality of patient care indicators. One hundred fifty patient charts were selected and audited. Deficiencies were counted in the categories of assessment, treatment, documentation, referral, caries management, perio management, patient education, and follow-up. Research findings were varied; however, external variables with the potential to affect the study’s results were identified. Furthermore, statistical process control procedures indicated that the quality assurance program was effective or had the potential to be effective. Although further research is warranted, this study could be used to improve quality assurance practices at the ETSU dental hygiene program.

Implementation of electronic health records by the Health Information Technology for Economic and Clinical Health has led to the implementation of electronic dental records (EDRs) and digital radiography in dental offices. The purpose of this study was to determine the state of the implementation and usage of EDRs and digital radiographs by the private general and pediatric dental practices in Mississippi as well as reasons why the dental practices are not moving forward with the advanced technology. A survey was emailed to 712 dental practices: 116 responded (16% response rate), and 104 consented to participate (89.66%). Results indicated dental practices in Mississippi using EDRs was 46.07%, EDRs with paper records was 42.70%, and only paper records was 11.24%. Results indicated dental practices using digital radiography was 76.40%, conventional radiography was 13.48%, and both was 10.11%. Common reasons for not advancing were cost, insufficient training, computer/software issues, and “too old.”

Although tobacco cessation is an uphill battle for almost everyone who attempts to quit, it is important that dental hygienists do not assume that patients are not interested. Dental hygienists are in an ideal position to offer cessation help to their tobacco using patients. The purpose of this study was to gain a better understanding of the tobacco cessation practices among central Texas dental hygienists. Specifically, dental hygienists were asked about beliefs, motivation, and confidence with regard to their tobacco cessation practice. A positive significant, moderate, relationship was found between beliefs and confidence (r=0.647), beliefs and practices (r=0.704), knowledge and capability (r=0.579), motivation and capability (r=0.529), motivation and practice (r=0.605), and years of practice and capability (r=0.699). The mean confidence scores for hygienists with more than 20 years of experience differed from those with 1-5 years of experience (p=.003) and 6-10 years of experience (p=.025).

A self-perpetuating cycle of poor health literacy and poor oral health knowledge and behavior affects approximately 90 million people in the United States, most especially those from low-income groups and other at-risk populations such as those with addiction. Poor oral health can result from lack of access to regular preventive dental appointments, lack of access to restorative care when dental diseases are treatable, and low oral health knowledge that leads to poor oral health self-care behaviors. In addition, patients' dental anxiety can impede care, because highly anxious people often avoid dental appointments. To address these issues, this inquiry examined oral health knowledge, attitudes toward oral health, and levels of dental anxiety among women in two residential chemical dependency treatment programs. Participants engaged in oral health intervention sessions to determine possible efficacy of the educational intervention. Results indicate positive outcomes in increases in oral health knowledge and behavior. The frequency of high-to-severe dental anxiety is much higher in this sample than in the general population. Implications are discussed, including use of economically efficient small-group oral health education training.

Nurse Practitioners (NPs) comprise a significant portion of the U.S. primary care workforce and play an essential role in patients' health awareness, prevention strategies, disease management, and in providing appropriate provider referrals. Nurse Practitioners receive education on the oral-systemic connection, yet there have been limited studies on the clinical practice of NPs assessing the oral cavity to evaluate the condition of the teeth and the oral tissues. The purpose of this study was to explore the nurse practitioners’ knowledge and practice habits of assessing the oral cavity for diseases or abnormalities in the mouth that can, in turn, affect overall health. A total of 66 NPs were included in the study, primarily female (91%) with master’s degrees (77%). While knowledge and education were not significantly associated, this research found significant associations between confidence and assessments, less than one-third (30.3%) were confident in their knowledge and ability to evaluate oral abnormalities.