By Charla J. Lautar, RDH, PhD, and Faith Y. Miller, CDA, RDH, MSEd
The dental hygiene profession is constantly changing. One of the recent major changes has been the inclusion of public health as a thread that connects the roles of the dental hygienist. The 2005 House of Delegates of the American Dental Hygienists' Association (ADHA) adopted the current version of the Professional Roles of the Dental Hygienist. According to information from the ADHA Web site, this new graphic change (see Figure 1) is to "visually illustrate the changes to the profession." With this integration of public health, the education of the dental hygienist needs to incorporate service-learning in addition to clinical internships and other community activities. Where clinical internships and community activities meet the need of the dental hygiene student in terms of development of skills or other training requirements, service-learning activities bridge theory with the practical, meet the needs of the community, develop a sense of civic responsibility, and include a reflective component.1-2 (See Figure 1)
Government documents have discussed the disparities in oral health among various population groups and the need for partnerships and involvement of students in community activities.3-5 Additionally, professional and educational organizations have supported the development of competencies and mandated dental hygiene students to treat a variety of population groups including children.6-7 Furthermore, less restrictive supervision laws have made it possible for dental hygienists to work in alternative practice settings instead of working under direct supervision in the traditional private dental office.
Aim One in the Public Health section of the ADHA publication, Dental Hygiene: Focus on Advancing the Profession, recommends "expand(ing) community service models to provide students with adequate experience in community-based health settings serving diverse populations, including low-income groups."8 One educational opportunity available to dental hygiene students is a partnership with the state or local public health department to implement school-based oral health programs. This not only provides preventive services to those groups at a higher risk for oral disease, but allows dental hygiene students to use skills learned in the curriculum to help meet the oral health needs of the community, while instilling a sense of civic responsibility. Service-learning provides one avenue in which dental hygiene programs can foster public health activities in the curriculum.
"The National Commission on Service-Learning in its recently issued report titled Learning in Deed: The Power of Service-Learning for American Schools, offers a definition of service-learning that incorporated the most essential features common to service-learning across the country. According to the Commission, service-learning is different from volunteerism in that it is "a teaching and learning approach that integrates community service with academic study to enrich learning, teach civic responsibility, and strengthen communities."9
Not only can service-learning improve technical competency, but in this case — the application of pit and fissure sealants — it can expose students to other roles outside the traditional private practice setting. The following outlines the perceptions of dental hygiene students who participated in a school-based dental sealant program used as a service-learning activity.
The dental sealant grant program
In the past few years, the dental hygiene students at Southern Illinois University, Carbondale (SIUC), have participated in a school-based dental sealant grant program (DSGP) funded through the Illinois Department of Public Health. The DSGP provides funding to purchase portable equipment and supplies necessary for the placement of dental sealants in the school setting. Initially, dental hygiene students volunteered to participate in this activity and it was not associated with any course in the dental hygiene curriculum. However, junior students attained credit toward the sealant requirement in clinic and senior students received credit toward the number of hours in community-related activities. Not all junior and senior dental hygiene students were able to participate due to scheduling conflicts with courses and other commitments. Due to the teaching commitments of the faculty members involved and the need for direct supervision at the initiation of this service-learning experience, the DSGP was restricted to one half-day a week and was a volunteer service activity.
At the beginning of the program, there were problems finding a dentist to provide exams for the children and (at that time) supervision for the dental hygienists and the students. Another issue was finding dentists who were either Medicaid providers or willing to become Medicaid providers. Currently, the DSGP has a supervising dentist who is a member of the dental hygiene faculty. This has been a tremendous asset to the delivery of preventive oral services and education, as the burden of recruiting a dentist is no longer a factor. This lends itself to bringing a level of continuity in care, since the DSGP dentist also provides care for clients in the campus-based Community Dental Clinic sponsored by the SIUC Dental Hygiene Program.
Methods
After the session of placing dental sealants, individual dental hygiene students (n=28) wrote self-reporting responses to three reflective open- and closed-ended questions. Student anonymity was respected and SIUC's Human Subjects Committee approved the study. As with the service-learning activity of placing sealants, responding to the three-item questionnaire was voluntary. Some students responded to the questionnaire after the first time they participated because that may have been the only time they had the opportunity to participate. Other students responded at the last time they participated, and still others responded some time during a series of sessions in which they participated. Here are the three questions:
• What did you learn from the experience (working with the sealant program)?
• Part A. By placing sealants outside a formal clinical setting, do you or did you feel proficient in applying sealants in a formal clinical setting?
Part B. Why or why not?
• Part A. Would this experience encourage you to apply for a position in a nonclinical setting?
Part B. Why or why not?
Responses were collected over a one-calendar-year period and included participation not only in elementary and middle schools but also in a summer Vacation Bible School and summer lunch program. Frequencies were used in the tabulation of responses for the first part (Part A) in questions two and three. Responses to the other questions were coded into themes. For the purpose of this experience, the term "nonclinical setting" is defined as a setting that is neither a dental private practice nor a dental hygiene educational facility.
Results
As previously stated, there were three reflective questions evaluating the service-learning activity. Responses to Question 1 are indicated in Table 1. More than 45 percent (n=13) of the responding dental hygiene students felt working with the sealant program heightened their awareness of the unmet needs of underprivileged children and the benefits of providing sealants in a school-based program. Approximately 40 percent of the dental hygiene students (n=11) benefited not only from working with children, but also felt they learned more in a relaxed environment. Some examples included: adapting to settings other than the traditional clinical environment, learning how to work faster, and learning to be resourceful in "less than desirable conditions."
see related table below
Question 2 was divided into two parts: Part A. asked about proficiency in placing sealants, while Part B asked for an explanation for the response in Part A. When asked if the experience impacted their proficiency in placing dental sealants, the majority of the dental hygiene students (89 percent, n=25) responded positively (See Figure 2).
Reasons why students felt proficient are listed in Table 2. These responses seem to indicate the students' focus on the environment as well as the task of placing sealants. Conversely, the two students who responded negatively to Question 2 indicated problems with the portable equipment and the sealant material as reasons why they did not feel proficient. One student responded "undecided" on this question.
see related table below
Finally, in Question 3 students were asked if this experience would encourage them to apply for a position in a nonclinical setting. The format of this question was similar to Question 2. The students were asked to elaborate on reasons why this experience would influence their decision for future employment. As in Question 1, students' responses paralleled meeting unmet needs of underprivileged children. Specific responses are indicated in Table 3.
see related table below
However, the reasons for not seeking employment in a nonclinical setting would be lack of patience working with children and problems associated with a nonclinical environment (i.e., equipment too restricting). Even though some students may choose not to work in a nonclinical setting, there were indications that they would either volunteer or work part time. In addition, students stated that they preferred more clinical experience before working in another mode of practice. And 64.2 percent reported they would seek employment in a nonclinical setting (See Figure 3).
Discussion
Although it may be suggested that the students who participated in the DSGP would be those students who would be interested in alternative practice settings, volunteerism, and working with children, it can be argued that some students participated because they needed the community hours or to meet a dental sealant requirement for clinic. Likewise, the responses of both the junior and senior dental hygiene students were grouped together, and seniors may be more comfortable with sealants in the schools due to the additional year of experience with placing dental sealants.
As practicing dental hygienists become more involved in nontraditional or alternative practice settings, it will be advantageous for dental hygiene students to be invited to participate in service-learning activities. The range of oral health services that can be provided by dental hygienists should increase as supervision laws become less restrictive and other community constituents continue to value the public health role of the dental hygienist. References available upon request.
References
1. Eyler J, Giles DE. Where's the learning in service-learning? San Francisco, CA Jossey-Bass Publishers 1999.
2. Howard J, editor. Service-learning course design workbook. Michigan Journal of Community Service Learning (Companion Volume) 2000.
3. USDHHS. A national call to action to promote oral health. Washington, D.C: U.S. Government Printing Office 2003.
4. USDHHS. (2000a) Oral Health in America: A Report of the Surgeon General. Washington, D.C: U.S. Government Printing Office.
5. USDHHS. (200b). Healthy People 2010: Health Objectives for the Nation. Washington, D.C.: U.S. Government Printing Office.
6. American Dental Education Association. Competencies for entry into the profession of dental hygiene. Washington, D.C.; July 2005; 69, (7): 803-807.
7. American Dental Association, Commission on Dental Accreditation (1998). Standard 2-18 revision: January 1, 2005. Accreditation Standards for Dental Hygiene Programs, Chicago, Ill.
8. American Dental Hygienists' Association. (June 2005). Dental hygiene: focus on the future: advancing the profession. Chicago, Ill.. Retrieved Dec. 26, 2005.
9. National Service-Learning Clearinghouse. Service-learning is¿ Retrieved Jan. 9, 2005, from http://servicelearning.org/welcome_to_service-learning/service-learning_is/index.php.
Charla J. Lautar, RDH, PHD, is an associate professor and director of the School of Allied Health at Southern Illinois University, Carbondale. She also serves as co-coordinator of the DSGP sponsored by the SIUC Dental Hygiene Program. Dr. Lautar teaches ethics and jurisprudence and is co-author of Ethics, Jurisprudence, and Practice Management in Dental Hygiene. Direct inquiries to Dr. Lautar by e-mailing: [email protected]
Faith Y. Miller, CDA, RDH, MSEd, is an assistant professor in dental hygiene at Southern Illinois University Carbondale. She also serves as co-coordinator of the DSGP sponsored by the SIUC Dental Hygiene Program. Her teaching responsibilities include periodontics, preventive oral care, and clinic. Direct inquiries to Ms. Miller by e-mailing [email protected].
