Dental Hygiene Case Studies

Dental hygiene students from a local program visit a geriatric day care called Camp Sunshine to implement a service learning project. These older adults are functionally independent, although they are medically compromised. Under faculty supervision, the students screen the older adult clients to identify denture cleanliness and teach them how to clean their dentures daily. The goals are to improve their oral health by cleaning their dentures or partial dentures, increase their awareness of the need for daily oral care, and empower them to clean their dentures. The students compute the mean scores of the denture cleanliness measure for future evaluation of the program outcomes. The educational program consists of three weekly visits to teach and provide practice in various aspects of denture care. During the first weekly lesson, the students use motivational interviewing to identify the clients' current practices and intentions regarding daily denture cleaning. The students use this information to plan individualized instruction for each client. The students return in 6 months to measure denture cleanliness to evaluate the success of the program. Although the outcomes indicate improvement in cleanliness for the majority of the clients, the results are skewed as a result of a large number of them missing one of the weekly sessions because they came down with the flu that week. At the end of the program, the students prepare a final report in which they communicate the outcomes of the program to the facility director and propose funding of supplies by Camp Sunshine for future programs. 1. Which of the following terms BEST describes the situation described related to the flu? A. Cluster B. Endemic C. Epidemic D. Occurrence E. Pandemic 2. Which of the following is an ethical responsibility of the students and faculty who are implementing this program? A. Communicate oral findings to the staff of the facility B. Prepare a formal report of findings to submit to the health department C. Refer clients who have suspicious lesions identified during the program D. Take the dentures back to the dental hygiene clinic to clean them more thoroughly 3. What is the BEST teaching method for the psychomotor learning in this program? A. Demonstration B. Guided practice C. Lecture D. A video presentation 4. Which health education and health promotion theory is BEST reflected by the strategies used in the educational program? A. Health belief model B. Organizational change theory C. Social cognitive theory D. Trans-theoretical model (stages of change theory) 5. Which statistic is BEST to determine the statistical significance of the improved denture cleanliness? A. Analysis of variance (ANOVA) B. Chi-square C. Correlation coefficient D. The t-test 6. What is the BEST way for the students to provide the final report? A. Discuss the results at a meeting with the administrators in which they provide a written proposal of the funding request B. Include in the written proposal a list of the clients with their baseline and post-test cleanliness scores C. Include in the written proposal tables and graphs that summarize the pretest and post-test denture cleanliness data D. Write a few paragraphs in the proposal that describe the statistical analysis of the pretest and post-test denture cleanliness data

1. C 2. C 3. B 4. D 5. D 6. C

A high dental caries rate has been reported by the school nurses in Head Start children in the county on the basis of the rate of toothaches and absences. The families are primarily Spanish-speaking Hispanic and East Indian migrant farm workers. They reside in predominantly rural settings with individual well-water supplies. At an informational meeting, the Head Start dental health coordinator introduces the goal of the program to the Head Start family advocates. A team of dental hygiene students from the local college is asked to design a comprehensive program to address the problem of dental caries in this population. They begin by collecting baseline data using the deft, OHI-S, and GI and identify a high level of S-ECC. 1. Which of the following is indicated by the second component of the caries index used in this program? A. Decayed surface B. Decayed tooth C. Tooth that needs to be extracted because of the severity of decay D. Tooth that has been extracted because of decay E. Tooth that has naturally exfoliated 2. Which of the following would be MOST appropriate to explain during the informational session? A. Benefits of community water fluoridation B. Cause of early childhood caries C. Effectiveness of daily brushing D. Value of healthy food choices 3. All the following would be an appropriate source of funding for this program EXCEPT: A. CHIP B. Head Start grant C. Medicare D. Medicaid E. Private funding from a local foundation 4. Which preventive program is indicated for this target population? A. Distribution of fluoridated dentifrice B. Professional fluoride applications every 6 moths C. School fluoride varnish program D. School sealant program E. Water fluoridation 5. Which of the following describes the level of ECC for the older age of this population? A. No smooth-surface caries is present. B. No cavitated lesions are present on anterior teeth. C. Number of carious lesions is less than four. D. The number of carious lesions is greater than five.

1. 2. 3. 4. 5.

Dental hygiene students conduct a study to compare the effectiveness of two non-alcohol mouthrinses, a 0.02% NaF rinse (Listerine Zero) and a 0.07% CPC rinse (Crest Pro Health), in controlling plaque biofilm and gingivitis. A sample of 136 healthy adult volunteers is taken from the university dental hygiene clinic. Only dentate adults with no to mild periodontitis are accepted to participate in the study. The study participants are qualified for inclusion in the study by their plaque biofilm forming potential and presence of mild gingivitis. Two groups are formed, and an unmarked bottle of mouthrinse is given to each participant. Study participants and examiners are unaware of the formula used by each participant. One group receives the 0.07% CPC mouthrinse, and the other group receives the 0.02% NaF mouthrinse. All other ingredients of both rinses are standardized. Two examiners are calibrated in the use of the PlI and GI to measure plaque biofilm at baseline, 2 months, and 4 months. The baseline PlI scores are used during group assignment to ensure that the two groups have equivalent oral hygiene. 1. What sampling technique is used for this study? A. Convenience sampling B. Judgmental or purposive sampling C. Random sampling D. Stratified random sampling E. Systematic sampling 2. The application of the PlI in this study is an example of which step in the scientific method? A. Collection, organization, and analysis of data B. Formulation of a hypothesis C. Identification and statement of the problem D. Verification, rejection, or modification of the hypothesis 3. Which of the following is a statement of the null hypothesis for this study? A. Neither mouthrinse is effective in controlling plaque and gingivitis. B. Plaque and gingivitis are strongly associated. C. The 0.02% NaF mouthrinse and the 0.07% CPC mouthrinse differ in ability to control plaque and gingivitis. D. There is no difference between the ability of the 0.02% NaF mouthrinse and the 0.07% CPC mouthrinse to control plaque and gingivitis. E. Which controls plaque and gingivitis better, the 0.02% NaF mouthrinse or the 0.07% CPC mouthrinse? 4. What type of study is reflected by the methods of this research study? Select FOUR types of studies from the following list. A. Analytic study B. Clinical trial C. Double-blind study D. Experimental study E. Post-test only study F. Retrospective study G. Time-series study 5. Which of the following is controlled by the procedures used with the examiners as they measure the plaque biofilm? A. Inter-examiner reliability B. Intra-examiner reliability C. Inter-examiner variability D. Intra-examiner variability

1. A 2. A 3. D 4. B, C, D, & G 5. A

The human resources director of an urban county hospital is alarmed by the rising cost of employee health insurance premiums related to tobacco-associated health conditions. The administrator charges the occupational health director, a dental hygienist, with addressing the issue of employee tobacco consumption. Employee demographics for the hospital are as follows: 40% Caucasian, 38% African American, 12% Hispanic, and 10% Asian. The dental hygienist conducts an employee tobacco usage survey as part of the program planning process. Analysis of the survey reveals mean cigarette usage per day of 4.6 for administrators, 19.6 for clerical support staff, 10.6 for nurses, 6.2 for physicians, and 19.8 for allied health technicians. Standard deviation is 2.2 cigarettes for all groups. Cigarette packs are known to contain 20 cigarettes. A computer-based educational program is planned for the initial intervention with the goal of reducing daily cigarette usage. 1. Based on the survey results, which of the following is the highest-priority population to target with an intervention? A. Allied health technicians B. Clerical support staff C. Hospital administrators D. Hospital patients E. Nurses F. Physicians G. All the groups are equally important and should be targeted at the same time. 2. Which of the following is the BEST instructional objective for this initiative? A. After completing the educational program, participants will understand the harmful effects of tobacco and how they contribute to oral and systemic diseases and conditions. B. Participants will be able to list recommended methods to control cravings that can lead to failure. C. Ninety percent of the staff will voluntarily participate in the program during the first month of availability. D. On completion of the computer- based educational program, staff members will be able to correctly identify 80% of the harmful ingredients in tobacco. 3. What is the MOST important cultural factor to consider when planning an intervention for this population? A. Age B. Gender C. Educational level D. Ethnic background E. Health literacy 4. Which step of program planning is BEST represented by the survey described in the scenario? A. Analysis of needs B. Collection of data C. Determination of priorities D. Implementation and strategy development E. Program evaluation 5. The data reported from the survey represent ordinal data. A pie chart is the most appropriate graphic representation of these results. A. Both statements are TRUE. B. Both statements are FALSE. C. The first statement is TRUE; the second statement is FALSE. D. The first statement is FALSE; the second statement is TRUE.

1. A 2. D 3. E 4. C 5. B --- The type of data collected (number of cigarettes smoked per day) is considered to be ratio data, information that represents whole numbers on a scale with an absolute zero point.

The administrator of a group home for mentally challenged adults has received multiple complaints from the attending caregivers regarding the residents' oral health. Limited manual dexterity abilities of the residents require that they receive assistance with oral hygiene routines; yet complaints of severe resident halitosis and bleeding during normal oral hygiene routines have made the caregivers reluctant to provide assistance. Frustrated by a lack of staff compliance, the group home administrator contacts the local county public health dental hygienist, knowing that the county health department has a grant for oral care for this population. After gathering basic demographic information, the dental hygienist makes a visit to the home to determine the actual oral health status of the residents. 1. What is the BEST way for the dental hygienist to assess the actual oral hygiene routines in the group home? A. Assess the values of caregivers by conducting focus groups B. Measure the plaque biofilm and gingivitis scores of residents over time C. Observe the residents' ability to brush correctly D. Observe the caregivers' ability to brush correctly E. Survey the beliefs and attitudes of caregivers with a questionnaire 2. From initial observations, what Healthy People 2020 objective is MOST applicable to this target group? A. Reduce untreated dental decay in children and adults B. Reduce gingivitis and destructive periodontal disease in adults C. Increase detection of oral cancer lesions at stage I D. Increase annual use of dental services by residents of long- term care facilities 3. What known characteristics about this population can be utilized in a community profile? Select THREE characteristics from the following list. A. Age B. Ethnicity C. Source of funding D. Gender E. Geographic location F. Literacy level G. Population setting 4. Which of the following is the BEST use of the dental hygienist in this situation? A. Conduct an educational program on daily oral hygiene care for the residents B. Make available dental hygiene services for the residents using portable equipment C. Present an in-service training program to the group home staff D. Provide daily oral hygiene care for the residents 5. Which of the following is an effective teaching strategy to raise the caregivers' compliance in this situation? A. Demonstrate to them the proper oral hygiene procedures B. Provide a lecture for them on the importance of oral hygiene C. Show them pictures of good oral health versus oral disease D. Provide training on how to maintain personal oral hygiene skills for themselves

1. B 2. B 3. A, C, & G 4. C 5. D

The director of the Vintage Retirement Center contacts the local dental hygiene society to provide a seminar on oral health and conduct oral cancer screenings for the purpose of improving the oral health of the residents. The facility has a population of 100 well residents between ages 60 and 78 who have a middle SES; 80% of the residents are Dentate, with varying numbers of teeth present. The oral health assessment results reveal a mean PlI of 2.1, mean GI of 0.8, mean DMFT of 5.2, mean D of 2.0, RCI of 2.1, and untreated root caries of 1.5. Correlation analysis reveals a correlation coefficient of r = 0.81 for the relationship between the RCI and PlI of this group. About 70% of the residents report having a dental home where they receive routine dental care. Over 50% of them report signs and symptoms of xerostomia. A SMART objective is established to improve the oral hygiene within 6 months by a six-member team of volunteer members of the Dental Hygiene Society delivering an oral hygiene educational program for residents and staff, providing oral hygiene supplies, and following up with reminders and motivational techniques to enhance the residents' daily effective oral hygiene. The Society has a budget for community oral health that can be used to support the program. 1. The correlation between the RCI and PlI demonstrates what relationship between root caries and plaque biofilm in this target population? A. Moderate positive B. Strong negative C. Strong positive D. Weak negative E. Little if any 2. What level of oral hygiene is revealed by the mean PlI? A. No plaque present B. Slight plaque present C. Moderate plaque present D. Severe plaque present E. Cannot be determined from the information provided 3. What change in the DMFT scores would indicate that the needs are being met 5 years after implementation of a program? A. Decrease in the total DMFT score B. Decrease in D, no change in M, and increase in F C. No change in D, decrease in M, and increase in F D. Decrease in D, increase in M, and increase in F E. Both B and D could be acceptable indicators of success 4. Which component of the SMART objective is missing? A. Achievable B. Measurable C. Relevant D. Specific E. Time-bound 5. All the following preventive programs are indicated by the assessment results EXCEPT one. Which one is this exception? A. Educational presentation on basic oral hygiene B. Referral for restorative treatment C. Use of a 0.12% chlorhexidine rinse daily D. Daily use of a higher- concentration fluoride dentifrice 6. Which of the following programs should be planned to address one of the Healthy People 2020 Oral Health objectives for this target population? A. Denture marking and educational presentation on denture care B. Oral cancer screening and referral, as needed C. Referral to a Medicaid provider for dental treatment D. Screening of periodontal condition and referral, as needed E. Treatment with fluoride varnish to control dentinal hypersensitivity 7. What is the BEST measure of the success of this program? A. Administrative support for the program B. Improved oral health indicators of the residents C. Improved oral hygiene of the residents D. Increased availability of oral hygiene supplies for the use by the residents E. Increased oral health knowledge of the staff

1. C 2. C 3. E 4. B 5. C 6. B 7. B

The director of a local nursing home has contracted with a public health dental hygienist to design an oral health protocol for the 300 residents. Currently, a registered nurse performs the intake oral examination. The majority of the residents are partially edentulous, have partial removable dentures, and require assistance with daily hygiene practices. The caregivers state that the residents have severe halitosis, trouble eating, and frequently lose their removable partial dentures. The dental hygienist observes that the caregivers are neglecting daily oral hygiene care and are not conducting oral cancer screenings. On the basis of these observations, the dental hygienist determines to carry out oral hygiene and oral cancer screening of all residents and introduce an educational component for the facility's caregivers and interested family members. Students from the local dental hygiene educational program are recruited to assist with the educational program. The caregivers' knowledge is measured prior to and a week following the educational program; these measures are compared to evaluate changes in knowledge. The caregivers' ability to conduct oral cancer screening is evaluated weekly for several weeks after the educational program. The success of the program will be evaluated by screening the residents again 1 year later to identify any lesions that have not been found during the year. If the data reveal lesions that have not been identified, the dental hygienist plans to work with the director of nursing to establish a new protocol for routine oral cancer screening by the registered nurses on staff. The dental hygienist secures funding from a local foundation for the equipment needed to screen the residents. 1. What type of study is represented by evaluating the change of knowledge as a result of the educational component? A. Case-control B. Correlational C. Crossover D. Pretest/post-test E. Time-series 2. What type of data is being collected by the screening? A. Qualitative and primary B. Qualitative and secondary C. Quantitative and primary D. Quantitative and secondary 3. Which term BEST describes the extent of oral cancer lesions found at the 1-year evaluation screening? A. Count B. Incidence C. Prevalence D. Proportion E. Rate 4. Which core public health function is exemplified by the potential future establishment of a new program protocol? A. Assessment B. Assurance C. Policy development D. Prevention 5. The stakeholders involved in this program represent what level of public health involvement? A. Local B. State C. National D. A combination of two or more levels 6. What is the BEST method to use for the weekly evaluation of the caregivers' ability to conduct oral cancer screening in this program? A. Administer a weekly written test over the cancer screening procedure B. Interview the residents about the caregivers' technique C. Observe the caregivers conducing oral cancer screening D. Survey the family members about the caregivers' technique

1. D 2. A 3. B 4. C 5. A 6. C

You have been employed as a public health dental hygienist in a local health department to provide educational presentations for the participants in the WIC program in a non-fluoridated community. The natural fluoride (F) concentration of the community water supply is 0.3 ppm F. One of your first assignments is to present an educational program on basic oral health practices for culturally diverse pregnant teens in three alternative high schools that have day care facilities. 1. Which of the following roles of the dental hygienist is illustrated by this activity? A. Administrator/manager B. Advocate C. Clinician D. Educator 2. How much additional fluoride is required to bring the F concentration of the water supply to the optimal level? A. 0.4 ppm F B. 0.7 ppm F C. 1 ppm F D. 0.4 to 0.9 ppm F 3. What is the first step that should be accomplished to conduct this program? A. Develop a lesson plan for the educational session for the pregnant teens B. Meet with the people involved to determine program goals and objectives C. Plan an educational presentation for the day care children D. Request funding for oral hygiene supplies from the local health department E. Select teaching strategies for the educational program 4. Which index would be appropriate to determine the rate of pregnancy gingivitis in this population? A. CPI B. CPITN C. GI D. PSR 5. Which of the following agencies would be the BEST resource for program planning for this population? A. National Maternal and Child Oral Health Resource Center B. DHHS Centers for Medicare and Medicaid C. Public Health Service D. DHHS Human Resources and Services Administration

1. D 2. B 3. B 4. C 5. A

A local dental hygienists' association and a faith-based organization collaborate to target a school for a comprehensive oral disease prevention program. The school serves a population that consists of 50% Medicaid-eligible children, and 75% of them receive the school lunch program. The ethnic group representation is 15% Hispanic American, 5% African American, and 80% non-Hispanic white. The fluoride concentration of the community water is below the optimal level. A public health hygienist screens the children in preschool through grade 5 annually. Data for 2014 indicate a 22% urgent decay rate across all ages. Further assessment reveals that many of the children are not seeing a dentist routinely. A sealant program is conducted in grades 2 and 5. A fluoride varnish program is conducted with the preschoolers and grade K, including two applications annually; these children are screened for dental caries with a tongue blade and available light at the time of each application. An educational program is designed to meet the needs of the children in this school. Finally, the team explores the option of a fluoridation campaign to achieve water fluoridation in this community. 1. Which of the following is a required action for this program? A. Phone call to each family to describe the program B. Presence of a dentist while the fluoride varnish is placed by hygienists C. Radiographs before placing sealants D. Written informed consent form signed by parents or legal guardians of all children who participate 2. What assessment classification is used with preschoolers and grade K in this program? A. Type I B. Type II C. Type III D. Type IV 3. What would have been the BEST means of identifying the reported decay rate? A. Basic Screening Survey (BSS) B. deft C. DMFT D. RCI 4. The same education materials can be used with participants in the other schools in the district, because the cultural diversity of this population represents the cultural diversity of the general U.S. population. A. Both the statement and the reason are correct and related. B. Both the statement and the reason are correct but NOT related. C. The statement is CORRECT, but the reason is NOT correct. D. The statement is NOT correct, but the reason is CORRECT. E. NEITHER the statement NOR the reason is correct. 5. What is the basis for deciding to target this school with this program? A. Convenience B. Cultural diversity of the school C. Random selection of the school D. SES of the children in the school 6. Which of the following should be done FIRST in this program? A. Contact key community leaders to obtain a broad base of support for fluoridation B. Determine the fluoride level of the community water supply C. Organize a massive community education program about the benefits and safety of fluoridation D. Schedule a referendum to allow the citizens to express their opinion about fluoridation E. Testify before the city council to convince them to fluoridate the water 7. Which of the following programs has the HIGHEST priority to further meet the needs of this population? A. Conduct a daily classroom fluoride rinse program B. Establish dental homes and refer children for treatment C. Make plans to implement school water fluoridation D. Plan a health fair for the children and the families

1. D 2. D 3. A 4. E 5. D 6. A 7. B

A dental hygiene U.S. Public Health Services (USPHS)- commissioned core officer is assigned to an Indian Health Service (IHS) clinic to improve the oral care of pregnant women in an American Indian rural community with a population of 26,000. Approximately 20% of the pregnant women in this population develop gestational diabetes. When a woman first sees the physician in the clinic for prenatal care, she is referred to the dental clinic for a dental examination. Only 25% of the patients referred over the previous 6 months complied with the dental referral, scheduled an appointment, and received treatment. The community is not classified a "dental manpower shortage area" because of the staffing of this clinic and the existence of this program. A survey of the pregnant women served by this clinic reveals that the women do not realize their risk for diabetes, are unaware of the relationship between oral health status and diabetes, and do not understand the benefits of an oral health assessment in relation to their overall health and the health of their babies. For the purpose of discussing the problem and possible solutions, the dental hygienist arranges a meeting of the medical clinic director, the dental clinic director, the medicine man of the Indian tribe, and a dental clinic staff member who is a member of the tribe. This team sets a goal of doubling the rate of compliance with the dental referral to 30% within 6 months. 1. Which of the following is the BEST intervention to implement first to meet the goal of the program? A. Conduct a mailing program to remind pregnant women to schedule an appointment for a dental examination B. Develop an oral health screening program to be implemented during prenatal care visits C. Develop written educational materials for distribution during prenatal visits D. Document the oral condition of the women who have complied and received a dental examination E. Plan an educational presentation for the pregnant women on the relationship among oral health, systemic health, and the risks and consequences of diabetes 2. On the basis of the results of the survey, which health education theory is indicated as the foundation for an oral health education intervention to meet the goal? A. Health belief model B. Learning ladder C. Social cognitive theory D. Theory of reasoned action E. Trans-theoretical model (stages of change theory) 3. Lack of compliance with the dental referral could be a result of which TWO of the following factors? A. Cost of dental care B. Lack of available appointments C. Lack of transportation to the dental clinic D. Low dentist-to-population ratio E. Low health literacy 4. The dental referral by the medical clinic is an example of which characteristic of public health? A. Application of biostatistics to analyze population health problems B. Community rather than the individual as the client C. Multi-disciplinary team approach to solving public health problems D. Social responsibilities for oral health 5. Which theory of health promotion is exemplified by this program? A. Community organization B. Diffusion of innovation C. Organizational change D. Sense of coherence

1. E 2. A 3. C & E 4. C 5. A