FACTORS INFLUENCING

CALIFORNIA DENTAL
HYGIENISTS INVOLVEMENT IN
SCHOOL-BASED ORAL HEALTH
PROGRAMS
Katherine Conklin, BS, RDH
Gwen Essex, MS, EdD, RDH
Dorothy Rowe, MS, PhD, RDH
University of California, San Francisco
1

Introduction
2

Childrens oral health problems affects

their academic performance in school1-3

874,000 school days are missed annually 2

School based health centers (SBHC)

provide access to care for the most
vulnerable children in schools where >
70% of students receive free or reduced
price lunches.4

Introduction
3

42% of of the 231 SBHC in

California provide school-based oral
health programs,4 which have been
shown to reduce decay by >50%.5
Greater number of children may
benefit if more dental hygienists
would participate in these
programs.

Purpose of Study
4

To assess the influence of community

oral health experiences during entrylevel dental hygiene (DH) education
on participation in community oral
events after graduation.

Purpose of Study
5

To assess the facilitators and barriers

experienced by licensed dental
hygienists in participating and/or
volunteering in community oral
health programs.

Methods
6

27-item survey instrument on:

Community oral health experiences as a

student
Community oral health experiences as a
licensed DH
Attitudes towards community oral health
Demographic information

Multiple choice, Likert-scale, Openended items

Methods
7

California Dental Hygienists

Association (CDHA) distributed the
survey to those whose email
addresses were in their database

Survey piloted tested on 7 DH

educators in an associate DH program,
and 11 UCSF classmates for clarity
and feasibility

Methods
8

Frequencies were generated for each

survey item using the survey
research program, Qualtrics TM

Cross tabulations were performed on

nominal data to identify significant
relationships between items on the
survey as indicated by p<0.05

Table 1. Demographic
Information
Year of Graduation from Entry-Level DH

(n)

17
35
23
25

(66)
(138)
(92)
(97)

62
33
5

(264)
(140)
(21)

15
31
51
3

(64)
(129)
(214)
(11)

Program:
1960-1979
1980-1999
2000-2010
2011-2014

(36-55 years since graduation)

(16-35 years since graduation)
(5-15 years since graduation)
(1-4 years since graduation)

Number of Children Living at Home:

0
1-2
>3
Number of Days Employed a Week as a DH:
0-1
2-3
4-5
>6

Figure 1. Number Of Respondents Who Participated

In Community Oral Health Programs As a DH Student
10

500
450
400
350
300
250
200
150
100
50
0

School-Based Oral Health

Public Event
Participated Yes

Fluoride
Participated No

Sealant

Figure 1. Discussion
11

A national survey found 95% of

SBHC provided oral health education,
showing DH students had more
opportunities for involvement in
these programs than in fluoride and
sealant programs.6

Table 2. Participation In Programs As A DH Student And The

Level Of Agreement To The Value Of These Experiences To
Professional Development: % and #
12

Strongl
y
Agreed

Agreed

Neutral

Disagr
eed

Strongly
Disagree
d

School-Based
Oral Health
Education
(n=440)

51 (223)

35 (153)

6 (27)

2 (7)

6 (30)

Public Events
(n=307)

53 (163)

37 (113)

6 (19)

1 (4)

3 (8)

Fluoride
(n=230)

53 (121)

37 (84)

7 (16)

1 (3)

3 (6)

Sealant
(n=224)

56 (125)

32 (72)

6 (14)

2 (4)

4 (9)

Table. 2 Discussion- Value to Professional

Development
13

Our findings are consistent with SimmerBeck (2013) and Blue (2012) who state
that community oral health experiences
as a DH student increase the students
awareness of the needs of vulnerable
populations and the role of healthcare
providers in giving back to the
population. 7,8

Table 3. Participation In Programs As A DH Student And Their

Level Of Agreement Of Encouragement Of These Experiences
To Participate After Graduation: % and #
14

Strongl
y
Agreed

Agreed

Neutra
l

Disagr
eed

Strongl
y
Disagre
ed

School-Based Oral 32 (140)

Health Education
(n=439)

27 (117)

26
(114)

8 (37)

7 (31)

Public Events
(n=305)

41 (124)

33 (102)

18 (54)

6 (17)

3 (8)

Fluoride (n=282)

39 (89)

30 (68)

21 (49)

7 (15)

3 (7)

Sealant (n=220)

38 (85)

25 (55)

25 (54)

7 (15)

5 (10

Table 3. Discussion- Encouragement To

Participate After Graduation
15

Studies show that the more time DH

students spent participating in the
community, the more likely they were to
continue after graduation.7

16

Table 4. Attitudes Toward Community Oral

Health Statements As A Licensed Dental
Hygienist: % and #
Strongly Agreed Neutr Disagre Strongl
agreed
al
ed
y
Disagre
ed
All children should have a
dental exam before entering
kindergarten. (n=436)
All children should have
access to affordable dental
care. (n=436)
All elementary schools
should commit to providing
oral health educational
programs. (n=435)

81(355)

15(65)

1(6)

1(2)

2(8)

78(342)

16(70)

3(13)

1(3)

2(8)

60(263)

28(122)

8(33)

2(9)

2(8)

17

Table 4. Discussion- Access to

Care

Marsh (2012), found that DH who

volunteer have a positive attitude
toward community service.9

18

Table 4. Attitudes Toward Community Oral

Health Statements As A Licensed Dental
Hygienist: % and #

All communities should have

fluoride in their drinking
water. (n=436)
All elementary schools
should have the
responsibility to provide oral
health educational
programs. (n=436)
All elementary schools
should incorporate teledentistry. (n=432)

Strongly Agreed Neutr Disagre Strongl

agreed
al
ed
y
Disagre
ed
57(250) 23(101)
3(12)
4(18)
13(55)

56(243)

44(191)

27(117) 10(47)

22(96)

27(11
6)

4(18)

3(11)

4(16)

3(13)

Table 4. Discussion- Tele-Dentistry

19

Respondents neutral level of agreement

with tele-dentistry may be due to the
high percentage of respondents who
have been practicing 16-35 years and
lack awareness of it.10

20

Figure 2. Community Oral Health Programs

In Which Licensed Dental Hygienists Have
Volunteered
Chart Title
80%
70%
60%
50%
40%
30%
20%
10%
0%

Figure 3. Factors Which Encouraged Licensed

Dental Hygienists Participation In Community Oral
Health Programs (n=424)
21

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%

Table 3. Discussion- Encouragement

22

Sandino and Rowe (2014) found a similar

finding when surveying DH students as
to the reasons for choosing DH as a
profession, 89% selected an interest in
helping people as a primary reason.11

23

Table 3. DiscussionEncouragement Comments From

Open-Ended Question

Good feeling you get when helping

others

opportunity to introduce our value to

the public

A patient of mine asked me to speak

to her students. It became a regular
event

24

Figure 4. Factors Which Discouraged

Participation Or More Frequent Participation
In Community Programs

Participated

Did not Participate

Figure 4. Discussion- Time Commitment

25

A 3-year longitudinal study found that

DH students priorities for personal time
commitments and money diminished
after volunteering in their community for
a semester.

26

Table 4. Discussion- Discouraging

Comments From Open-Ended
Question

I have rarely been asked to help. I don't

have time to organize but am willing to
help when asked.

to my knowledge I would need to be

RDHAP to initiate one

schools in my area wanted DDS only

27

Table 5. Relationship Of Participation In

Community Experiences As A Licensed DH To The
Following Survey Items:
My participation in the school-based oral health
educational
program encouraged me to participate in school programs
after graduation.

.00*

All elementary schools should commit to providing oral

health educational programs.

.01*

My participation in the school-based oral health

educational
program was valuable to my professional development.

.01*

ADHA Membership

.02*

As a dental hygiene student, did you participate in

community experiences that promoted oral health.

.06

*Significant relationships indicated by p < 0.05

Limitations
28

Response Bias: response rate 8%

Selection Bias: DH who responded may
have had more interest in the topic
Self-reporting Bias
Recall Bias

Conclusion
29

Dental hygienists involvement in

school-based oral health programs is
influenced by their community
experiences as a DH student and
interest in helping people, but time
commitments and lack of knowledge
of programs limit their involvement.

References
30

1. Kwan SY, Petersen PE, Pine CM, Borutta A. Health-promoting schools:

an opportunity for oral health promotion. Bull World Health Organ. 2005
Sep;83(9):677-85.
2. Tsai C, Wides C, Mertz E. Dental workforce capacity and California's
expanding pediatric Medicaid population. J Calif Dent Assoc. 2014
Nov;42(11):757,64, 766.
3. Albert DA, McManus JM, Mitchell DA. Models for delivering schoolbased dental care. J Sch Health. 2005 May;75(5):157-61.
4. School-Based Oral Health Alliance, accessed May, 28 th 2015 https
://www.schoolhealthcenters.org/school-health-centers-in-ca/need-impact/
5. Niederman R, Gould E, Soncini J, Tavares M, Osborn V, Goodson JM. A
model for extending the reach of the traditional dental practice: the
ForsythKids program. J Am Dent Assoc. 2008 Aug;139(8):1040-50.
6. National School-Based Health Alliance Survey of SBHC, http
://www.sbh4all.org/site/c.ckLQKbOVLkK6E/b.7742441/k.E71F/ SBHC_Data
.htm

References
31

7. Simmer-Beck M, Gadbury-Amyot C, Williams KB, Keselyak NT,

Branson B, Mitchell TV. Measuring the short-term effects of
incorporating academic service learning throughout a dental
hygiene curriculum. Int J Dent Hyg. 2013 Nov;11(4):260-6.
8. Blue CM. Cultivating professional responsibility in a dental
hygiene curriculum. J Dent Educ. 2013 Aug;77(8):1042-51.
9. Marsh LA. Dental hygienist attitudes toward providing care for
the underserved population. J Dent Hyg. 2012 Fall;86(4):315-22.
10. Glassman P, Harrington M, Mertz E, Namakian M. The virtual
dental home: implications for policy and strategy. J Calif Dent
Assoc. 2012 Jul;40(7):605-11.
11. Sandino AH, Rowe DJ. Students from underrepresented racial
and ethnic groups entering the dental hygiene profession. J Dent
Educ. 2014 Mar;78(3):465-72.