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...completed a prospective cohort study to determine whether care proposed by dental directors exposed to evidence-based practices was significantly different from the care provided by dental hygienists who screened children enrolled in the provincially mandated Children in Need of Treatment (CINOT) program.
Results. The dental directors and dental hygienists each prepared a treatment plan for the 71 children enrolled in this study. These plans were analyzed using a paired t-test model after being translated into relative value units (RVU). It was determined that there was no statistically significant difference between the overall dental treatment proposed by the dental hygienists and the treatment proposed by the dental directors (p=.749). A similar analysis stratified by subject site and by service type also showed no significant differences.
Conclusions. The results suggest that dental hygienists are equally as effective as dental directors in screening high-needs children and may be capable of assuming the role of first point of contact for children within high-need dental programs.
Keywords: Screening, high-need patients, emergency care, children, CINOT, dental hygienists, public health, dentistry
Introduction
Public health dental hygienists (henceforth referred to as PHDH) are an integral part of the dental screening programs in Ontario schools. As part of the Province's Health Promotion and Protection Act, Public Health Units (PHUs) are mandated to screen all junior and senior kindergarten entrants (five- and six-year-olds), as well as provide screening in high-need elementary schools and at the PHU itself.
While the general screening is performed by a licensed PHDH and a certified dental assistant, screening to determine the eligibility of a high-need child for treatment under the Children in Need of Treatment (CINOT) program is the responsibility of the PHU dental director. This is a resource-intensive responsibility often held by one person within each PHU.
Review of the Literature
There is limited but encouraging evidence in the literature that dental hygienists can be as effective as dentists in screening patients. In Sweden, where dental hygienists are licensed to practice independently, a study comparing dental hygienists' capabilities at diagnosing dental decay relative to dentists' showed that there was no significant difference in the identification and recording of dental decay, with the exception of initial lesions, which were identified more frequently by the dental hygienists. (1) A US study also demonstrated that dentists and dental hygienists had good inter-examiner reliability when screening for dental caries among children in the first and fifth grades. (2)
A 2000 Swedish study in a nursing home setting also showed that there was "acceptable" inter-examiner agreement between dentists and dental hygienists. (3) The authors noted that the difference was often due to a dental hygienist's propensity to err on the side of caution, thereby over-reporting oral conditions as compared to dentists.
Conversely, a British study measuring the validity of having dental hygienists perform school screenings following a standard training program showed that the dental hygienists did not achieve the required levels of sensitivity and specificity. The authors concluded that this training was insufficient for the dental hygienists. (4)
The limited evidence provided by the literature seems promising, and there is also literature to support community-based interventions by dental hygienists, (5) but the current body of evidence is insufficient...
NOTE: All illustrations and photos
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