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Utilization of Evidence-Based Teaching in U.S. Dental Hygiene Curricula.


Evidence-Based Medicine (EBM) has philosophical origins extending back to the mid-19th century.[1] EBM is an approach to the care and treatment of patients wherein the health professional includes the "conscientious, explicit, and judicious use of the most current, best evidence in making clinical decisions regarding the care of individual patients."[2] EB practice integrates individual clinical expertise with the best available external clinical evidence obtained from systematic research.[2] It is also a process of life-long, problem-based learning. In this process, patient care requires the incorporation of the best scientific evidence available regarding diagnosis, prognosis, therapy, and treatment.[3] With this method the health professional: 1) converts clinical problems into answerable questions; 2) efficiently finds the best evidence with which to answer the question (whether from the clinical examination, the diagnostic laboratory, the published literature, or other sources); 3) critically appraises the evidence for its validity (closeness to the truth) and usefulness (clinical applicability); 4) applies the results of this appraisal in clinical practice; and, 5) constantly evaluates the performance of the EB treatment.[3]

The concept of evidence-based practice has received significant attention in health care. Not only has EBM been acknowledged by practicing physicians and nurses, but increasing research is emerging as to its application in medical and nursing education as well. The rationale behind incorporating an EB approach in medical and nursing education is basic, using the most effective strategies known for keeping current with professional practice. Health care providers using an EB approach have learned the skills that enable them to become self-directed, problem-based, adult learners who can recognize gaps in their knowledge; pose well formulated, answerable, clinical questions; locate the best available evidence; critically appraise it; and integrate the results with their clinical expertise.[4] When students educated with an EB teaching approach were compared with students educated by traditional teaching methods, researchers found that EB educated students were clearly more adept at using critical thinking strategies and higher level reasoning skills.[5] Moreover, it has been shown that EB educated students are self-directed, life-long learners.[5]

Evidence-Based practice is a process that restructures the way health professionals think about clinical problems. Traditionally, health professionals have placed high value on their accumulated personal knowledge and adherence to long-held standard practices when making clinical decisions.[6] Conversely, an EB approach encourages the professional's integration of the resulting knowledge with clinical expertise and patient preferences to determine the best treatment for individual patients. EB practice therefore requires the blending of research knowledge with provider experience.[7]

As the dental hygiene profession moves toward EB, patient-centered care, dental hygiene educators are encouraged to modify their teaching and student learning strategies. One key modification is the introduction and incorporation of the critical appraisal process by dental hygiene students when reviewing research.[8] It is imperative that dental hygiene programs encourage students to reject the traditional notion that all learning must be completed under the formal guidance of an instructor. As an alternative, students must be encouraged to independently access current scientific literature, critically evaluate the validity of its clinical findings, and challenge the effectiveness of traditional dental hygiene interventions.[8]

In order for students to obtain the skills necessary for EB practice, dental hygiene educators must carefully assess the current status of their curriculum. Based on their assessment, modifications to teaching/learning strategies and curricular revisions can be made. By incorporating the requisite EB skills, educators will better prepare their graduates as critical thinkers, problem solvers, and life-long learners.[8]

Little is known about the EB practices that dental hygiene students are taught, and even less has been published in the literature regarding EB education as it relates to dental hygiene. The purpose of this study was to assess current utilization of EB teaching philosophies in dental hygiene education.

Review of the Literature

For several years, medical schools have been appraising the outcomes of their EB educated students. For example, Shin and Haynes[9] investigated graduates of medical schools that emphasized problem-based learning and critical appraisal, and compared them to with graduates of a traditional (non-EB, non-critical appraisal) school. The graduates were evaluated on their knowledge of clinically important advances pertaining to hypertension. The traditional school graduates' knowledge exhibited the usual, progressive deterioration regarding the current and accepted protocol for detection, evaluation, and management of hypertension. Conversely, the knowledge of the problem-based, critically educated graduates remained at a high level and up to date, even 15 years after graduation. The authors concluded that EB educated students possessed greater critical-thinking and life-long learning skills than those students educated by a traditional philosophy.

Without knowledge of the current research, professionals put themselves in situations where they rely on "what's always worked" rather than what has been researched and critically appraised. The best treatment may not be the "old stand-by, cookbook" approach of what has always been used in the diagnosis, treatment, and management of patient care. The best treatment comes from the use of the best evidence possible to make clinical decisions.[5]

Students who learn information-seeking skills and understand how they apply to clinical practice graduate with the necessary skills to treat patients based on current evidence. The EB educated students know how to access the current research and have the skills to determine if the research is to be accepted as sound evidence or disregarded as research without merit. Once these skills are learned, ideally the students will continue these life-long learning behaviors as practicing professionals. This lifelong learning mentality exemplifies an EB educated individual who stays abreast of the literature and applies the critically appraised evidence in clinical decisions.

How do students access the current, best, critically appraised research? Ideally, educators will include teaching strategies as an integral part of their curriculum to encourage critical appraisal of literature, information seeking via the Internet or other databases, discussion groups/study clubs, and simulated patient case scenarios with treatment planning rationale using current evidence. Through these activities and guided patient experience, students would have the opportunity to practice making treatment decisions based on the evidence while under the guidance of the educator. At the crux of having these activities work successfully are educators that are themselves knowledgeable in EB decision-making and know how to use EB decisions in the treatment of patients.

In the mid-1990s, articles focused on how computers could and should be utilized for clinical practice,-practice management, dental hygiene education, and research began to surface.[10,11] At that time, attention was called to the need for dental hygiene programs to bring computer applications to the forefront of the curriculum.[10] The early EB articles were written before the recent explosion of the World Wide Web and the Internet. Therefore, utilization of electronic databases was yet to be studied.

A few studies followed which focused on the computer application behavior and information seeking patterns of dental hygienists.[10,11] Much of this research concluded that dental hygienists utilize computers on a regular basis for word processing but do not use them for information seeking via the Web. A 1992 survey of dental hygiene students found the overall use of computers and the Internet in dental hygiene curricula was low.[10] In addition, online databases were rarely accessed for information.[11] The Gravois et al.[10] survey revealed computer skills should be introduced to students while they are obtaining their dental hygiene degree. They also concluded that once professional information was gathered, the dental hygienists did not possess the skills necessary to critically appraise the research themselves. Dental hygienists relied on personal experience, credibility of the journal, and discussions with colleagues to confirm the credibility of the research.[11] In addition, the researchers found that dental hygienists need to improve computer literacy skills while in school and through continuing education to keep them current with the newer methods of electronic information retrieval and communications. In summary, dental hygienists need to access a variety of information sources to provide quality health care.[11]

With the evolution of dentistry and dental hygiene, new discoveries lead to new treatments and, eventually, to new recommendations to maintain health and treat disease. Dental and dental hygiene education must not merely respond to this evolutionary process, but must facilitate the transition of useful knowledge from laboratory science to clinical practice.[12] In 1997, Brutvan[8] stated: "As our profession moves toward evidence-based, patient-centered care, we will be faced with the challenge of defining what is appropriate dental hygiene care for each patient. For the dental hygiene practitioner, it will mean the application of high-level cognitive skills in assessing the quality of clinical studies and the efficacy of dental hygiene services for each patient. For dental hygiene educators, it will mean modifying teaching strategies to include the critical appraisal of evidence."

In 1997, the American Dental Hygienists' Association (ADHA) House of Delegates adopted a resolution which states: "ADHA advocates evidence-based, patient-centered dental hygiene practice. Action plans include developing research proposals and seeking funding sources to support research relative to EB education, patient-centered dental hygiene practice. Other action plans include the publishing of bibliography, articles, and other resource materials relative to this issue in appropriate ADHA information forums, such as the Journal of Dental Hygiene, Access, and the ADHA Web site."[13]

How have these recommendations for dental hygiene education been answered? The purpose of this research was to survey U.S. dental hygiene program directors to determine: 1) demographic information, 2) specific EB student instruction methods used, 3) if and how programs use an EB philosophy, 4) perceptions of faculty skills in incorporating EB instruction, and 5) opinions and attitudes regarding future need to incorporate EB philosophies in dental hygiene education.

Methods and Materials

In May 1999, a convenience sample of seven U.S. dental hygiene program directors pilot tested the survey instrument. Pilot survey revisions were incorporated into the final survey prior to mailing it to all 235 U.S. dental hygiene program directors in June 1999. Program director information was obtained from the ADHA Web page ( The stamped, pre-addressed survey packets were mailed and included a cover letter explaining the importance and purpose of the study. Identification numbers were used to ensure subject confidentiality while permitting follow-up of non-respondents. Participants were asked to return the completed surveys two weeks after the survey was mailed. A one-month wash-out period separated the initial mailing from the second mailing to non-respondents.

The survey contained three primary domains: 1) demographics of the respondent, consisting of 7 closed-ended questions; 2) curricular information, consisting of 12 closed-ended questions; and, 3) opinions and future needs assessments consisting of 1 closed-ended and one open-ended question. To organize the survey, it was arranged into five sections as follows: Section I: Program Director Demographics, Section II: Student Instruction, Section III: Curriculum, Section IV: Faculty Skills, and Section V: Program Directors' Opinions and Future Needs.

Following the demographic section, respondents were provided the following foundational working definition of evidence-based education.
      An evidence-based (EB) philosophy includes skills in acquiring,
   assessing, interpreting, critically analyzing, and incorporating the
   scientific literature into clinical practice.

      Evidence-Based (EB) education includes the following principles:

   1. Using the most current and valid research findings for instruction of
   dental hygiene students.

   2. Teaching critical evaluation and appraisal of the literature. Critical
   appraisal of the literature refers to the idea that the students have an
   understanding of basic research and statistical concepts needed for the
   determination of sound evidence.

   3. Using electronic databases to retrieve the most current and clinically
   relevant research articles.

The research reflects that students educated using EB principles develop the skills necessary for demonstrating critical thinking and life-long learning.

Data from the completed surveys were initially entered into an Excel spreadsheet then transferred to SAS for Windows. Frequency listings of the responses were compiled as descriptive statistics. All data collected from the survey instrument were analyzed and reported.


Completed surveys were received from 164 of 235 program directors after two mailings for a response rate of 70%. The majority (68%) of respondents were from associate/certificate degree dental hygiene programs. Forty-two percent of the programs graduate approximately 21-30 students each year, 26% graduate 16-20 students, 15% graduate 31-40 students, 9% graduate 11-15 students, and 7% graduate more than 41 students per year. No respondents indicated graduating less than 10 students per year. Demographic information regarding full-time faculty also was assessed. Forty-eight percent of respondents reported 4-5 full-time faculty members, 33% reported 1-3, 17% reported 6-9, and 2% reported more than 10.

When asked about the teaching of research methods, 20% indicated the fundamentals of research methods were taught as a separate course. Seventy percent of respondents indicated research methods were taught, but only as a portion of a dental hygiene course. Eight percent of respondents did not teach the fundamentals of research methods in the curriculum, while 2% indicated using methods other than those listed in the survey.

Table I displays information about the retrieval and transfer of EB information by students. The majority of programs reported giving students formal orientation in the use of library (88%), literature indices and databases (86%), and use of the Internet for conducting literature searches (69%). Students were also formally taught to evaluate information retrieved from the Internet, evaluate the validity and reliability of research for clinical importance (89%), and evaluate research findings for clinical importance (90%). To a lesser extent, students were introduced to and encouraged to make EB recommendations to patients. The most commonly used information retrieval methods used by dental hygiene students were also assessed. Textbooks were the most widely used resource by students (62%) followed by library databases (37%). Students sought the opinion of faculty to retrieve information most often (28%) and often (46%). Dental hygiene chat rooms were rarely used (44%) or never used (24%) by students.
Table I. Formal instruction in information-seeking,
research, and clinical application in U.S. dental
hygiene programs

                                          n     Yes

Evaluation of research findings for
clinical importance                       212   90%

Evaluation of the validity and
reliability for clinical importance       209   89%

Orientation to the library                207   88%

Use of library literature indices &
databases (Medline, CINAHL, PubMed)       202   86%

Use of Internet for conducting searches   186   79%

Evaluation of information retrieved
from the Internet                         162   69%

How to apply EB findings to patients in
clinic                                    160   68%

How to make recommendations to patients
based on evidence                         157   67%

Directors were asked when students learned critical appraisal of the literature. Thirty-seven percent of respondents reported beginning teaching critical appraisal skills in the first year of the dental hygiene curriculum, while four percent of respondents taught critical appraisal skills in the summer between the first and second year. Thirty-five percent introduced critical appraisal of the literature in the first half of the second year, and 15% waited until the last semester. Two percent of respondents did not teach critical appraisal at all. Almost all dental hygiene programs used dental hygiene faculty to teach critical appraisal (95%). Emphasis of critical appraisal of the literature received in dental hygiene programs also was assessed (Table II). The majority of respondents (46%) indicated some emphasis was placed on critical appraisal by 50% or less of their faculty.
Table II. Emphasis on critical appraisal of the literature

                                                   n    Percent

Great emphasis (a minimum of 76% of faculty
incorporate critical appraisal in their courses)   23     14%

Moderate emphasis (51-75% of faculty
incorporate critical appraisal in their courses)   56     35%

Some emphasis (26-50% of faculty incorporate
critical appraisal in their courses)               73     46%

No emphasis (less than 25% of faculty
incorporate critical appraisal in their courses)    7     4%

Ten common student activities and assignments were listed to assess curricular strategies used to incorporate an EB approach (Table III). Respondents were asked to rate the student activities and assignments used in their curriculum from four possibilities based on frequency of use. The most frequently used activities and assignments were oral presentations and literature searches (48% and 44%, respectively). The least used were table clinics, continuing education attendance, and student research projects/papers.
Table III. Curricular utilization encouraging
evidence-based teaching and learning

1 = Never used
2 = Used rarely (1 time)
3 = Used occasionally (2-4 times)
4 = Used frequently throughout the curriculum (>5 times)

Student activities and assignment     1       2       3       4

Oral presentations                   1%     8%      44%     48%
                                     n=2    n=19    n=103   n=113

Literature searches                  1%     6%      49%     44%
                                     n=2    n=14    n=115   n=103

Case presentations                   3%     14%     53%     29%
                                     n=7    n=33    n=125   n=68

Article Critiques                    2%     24%     52%     23%
                                     n=5    n=56    n=122   n=54

Research project/Paper/Proposal      9%     28%     46%     17%
                                     n=21   n=66    n=108   n=40

Writing abstracts                    9%     32%     44%     15%
                                     n=21   n=75    n=103   n=35

Community-based assessment and       4%     39%     43%     13%
evaluation project                   n=9    n=92    n=101   n=31

CE attendance                        18%    29%     36%     16%
                                     n=42   n=68    n=85    n=38

Writing/Presenting product reviews   10%    42%     42%     6%
                                     n=24   n=99    n=99    n=14

Table clinics                        23%    57%     13%     6%
                                     n=51   n=134   n=31    n=14

Participants were asked to identify methods used in teaching nine core dental hygiene courses (Table IV). Teaching methods to be selected from were case-based, problem-based, debates, electronic discussions, and other. Case-based teaching methods were used primarily in "clinical dental hygiene/ theory" (94%) and "periodontology" (88%). A problem-based format was used predominately in "clinical dental hygiene/theory" (63%) and "community oral health" (61%). Very few respondents indicated use of debates or electronic discussion as a teaching method in any course. Poor utilization of all or most of the teaching methods was demonstrated in "dental materials and the biological sciences."
Table IV. Methods utilized to encourage
evidence-based teaching/learning

                        Case-based   Problem-base   Debates

Clinical DH / Theory      94%           63%          15%
                          n=220         n=148        n=35

Periodontology            88%           56%          7%
                          n=207         n=132        n=16

Biological science        19%           31%          2%
                          n=45          n=73         n=5

Radiology                 56%           50%          2%
                          n=132         n=118        n=5

Pathology                 69%           49%          3%
                          n=162         n=115        n=7

Community oral health     67%           61%          28%
                          n=157         n=143        n=66

Nutrition                 48%           42%          7%
                          n=113         n=99         n=16

Dental materials          25%           39%          4%
                          n=59          n=92         n=9

Research                  2%            4%           13%
                          n=5           n=9          n=31

                        Discussions   Other

Clinical DH / Theory       17%        6%
                           n=40       n=14

Periodontology             15%        6%
                           n=35       n=14

Biological science         4%         8%
                           n=9        n=19

Radiology                  4%         7%
                           n=9        n=16

Pathology                  10%        4%
                           n=24       n=9

Community oral health      10%        7%
                           n=24       n=16

Nutrition                  7%         4%
                           n=16       n=9

Dental materials           4%         11%
                           n=9        n=26

Research                   16%        6%
                           n=38       n=14

The extent to which dental hygiene students had access to electronic databases and Internet searches was also assessed. Sixty-four percent of respondents had complete and ready access to electronic databases and Internet searches, which means students have access to electronic databases and the Internet in a library on campus, in a student area in the dental hygiene building, or as close as the dental hygiene area. Thirty-five percent reported having limited access because the library was in another building on campus, while one percent of respondents had no on-campus access to computers with the Internet.

Dental hygiene program directors were asked to answer questions regarding their faculties' skills in incorporating EB philosophies. Degrees of emphasis, incorporation, and utilization of these philosophies in dental hygiene programs by faculty were also assessed. About half of the faculty updated lecture content frequently to incorporate new evidence from the literature (55%), and used current literature references in lectures (44%). Subsequent to utilization questions, directors were asked to identify barriers to implementing an EB philosophy in their program (Table V). The greatest barriers to implementing an EB philosophy in respondents' dental hygiene programs were the lack of faculty skills (37%), no available time (34%), and lack of financial resources/backing (33%).
Table V. Barriers to implementing an
evidenced-based philosophy


Lack of faculty skills   37%

No available time        34%

Lack of financial        33%
resources/backing        n=78

Lack of technical        28%
support                  n=66

No available             21%
support staff            n=49

Lack of interest         15%
from faculty             n=35

Lack of library          9%
resources                n=21

No available             2%
databases                n=5

Program directors were asked what their programs needed to better incorporate EB teaching. The majority of respondents cited the need for faculty development on using an EB philosophy in their program (84%). Thirty-three percent indicated a need for computers within the department for students' Internet access. Thirty-one percent indicated that requiting laptop computers with modems for Internet connection for all dental hygiene students would improve the implementation of EB teaching. Twenty-four percent of respondents indicated a desire for computers within the department to ensure each student access to perform electronic database searches.

Finally, program directors were asked an open-ended question regarding how their program and faculty were incorporating EB principles, teaching, and evaluation methods. Respondents indicated an attempt to incorporate some EB philosophies in the curricula. "Each faculty supports writing across the curriculum so some journal research is required in almost every course." "We try to incorporate and emphasize as much EB principles as possible from the very first day of the curriculum." Many program directors expressed concern regarding the "need for professional development." Others stated: "We have the information--time is the factor."


This survey obtained data regarding the information-seeking practices of student dental hygienists, their use of EB decision-making skills in clinic, the current status of EB utilization in U.S. dental hygiene programs, and opinions about future needs for incorporating an EB philosophy in dental hygiene education in the next millennium. From this survey, it is evident that programs were teaching students the skills necessary for finding current evidence. Most programs provided students with formal instruction in library orientation, use of library literature indices/databases, and use of the Internet for searches.

Dental hygiene programs also reported teaching the transfer of information retrieved to the next step of evaluation by providing students with formal instruction on evaluating the information retrieved. The survey findings indicated many programs were incorporating evaluation of scientific publications for validity and reliability and evaluating research findings for clinical importance. Unfortunately, many programs did not take the information to the final step. Fewer respondents indicated teaching students how to make EB recommendations to patients, or how to apply EB findings to patient care during clinical decision-making.

The acquisition, analysis, and application of evidence complete the process of EB patient care. Dental hygiene programs are making great strides in the acquisition and analysis of EB data. However, there is a need for dental hygiene programs to incorporate the final step--evidence-based diagnosis, treatment planning, and application of EB findings in clinical situations. The incorporation of EB findings in practice is the ultimate goal of an EB philosophy dental hygiene curriculum, so dental hygienists can graduate with the ability to appraise the scientific literature for use in practice.

Although educators are well aware that information in textbooks is out of date, this survey revealed the textbook is still the most widely used method of information retrieval for dental hygiene students. For many educators, the time constraints of teaching several courses, having several clinic sessions to supervise per week, and the requirements of other scholarly activity limit the amount of time one can spend finding alternative methods of information retrieval. However, dental hygiene educators must work to move away from having students use textbooks as the primary source of information. Sole reliance on textbooks and expert faculty knowledge does not promote the critical thinking skills that students must have to provide optimal patient care.[14] Students must learn to develop independent, EB methods of clinical decision-making. Without the use of other sources (current journal articles, Internet literature searches, industry-based Web sites), access to current information may be missed altogether. The textbook is an ideal tool for introducing fundamental information, but from that fundamental information, students should be encouraged to find additional current information regarding the topic.

This study found the utilization of EB teaching and learning methodologies to be skewed. Utilization does not occur throughout the entire dental hygiene curriculum, throughout each course, rather it occurs only in select core dental hygiene courses. Most faculty in clinical "dental hygiene/theory" courses utilized case-based and problem-based methodologies. "Periodontology," "radiology," "pathology," and "community oral health" used these methodologies to a slightly lesser extent. Courses in "biological sciences" and "dental materials" had minimal or no utilization of case-based and problem-based methodologies. Only a small number of programs indicated using any of the other methodologies (debates, electronic discussions, and other) in any core dental hygiene course. Therefore, the results demonstrate that dental hygiene educators are still utilizing lecture as the method of choice for educating students. A 1996-1997 survey of U.S. medical schools found similar results. Seventy-four percent of responding schools indicated lecture as the primary means of teaching medical students.[15]

A 1998 study of continuing medical education compared students taught via a problem-based approach vs. a lecture-based approach. Results revealed students taught through a problem-based learning modality demonstrated greater knowledge acquisition and greater improvements in clinical reasoning skills than those taught in a lecture-based group, which has long been criticized for its lack of stimulation of critical thought.[16] To stimulate critical thinking and explore students' problem-solving skills, alternative methods to lecturing such as debates, electronic discussions, problem-based learning, and case-based learning are excellent educational tools. As an initial step, dental hygiene educators could begin implementing these methods in any courses. These methods encourage students to use their critical-thinking and problem-solving skills, which are not stimulated in any way by the passive learning of lecture.

The foundation of health care hinges on the production and utilization of current, sound research. From research, health professionals are given current information in diagnostic innovations, treatment interventions, and outcome assessments. One of the themes of this study was to evaluate dental hygiene education's emphasis on teaching research to students, more specifically, how research is generated, how research methodologies influence a study's results, the critical analysis of research in the scientific literature, and the application of critically appraised research findings in clinical decision-making. Results from this survey indicate the utilization of research is not receiving adequate attention in dental hygiene curricula. Seventy percent of respondents indicated research was only taught as a portion of a dental hygiene course. This raises a question as to the extent and thoroughness in instructing students regarding research and its impact on practicing dental hygienists' treatment options and clinical decision-making processes. This question is exacerbated by the fact that in 8% of dental hygiene programs, research was not taught at all. If research is not a priority in the curriculum it likely will not be a priority of the practicing dental hygienist.

The use of EB decision-making in clinical situations was also assessed. In 67% of programs, directors indicated students are taught how to make recommendations to patients based on evidence and apply the findings to patients in clinic. An interesting follow-up study to this research would be to survey the respondents who are teaching EB decision-making and application in clinic to assess their teaching and evaluation systems.

An overall view of U.S. dental hygiene programs revealed most programs have the capabilities for information retrieval via computers, most have the appropriate library resources for data acquisition, and most teach how to critically appraise the accessed information. However, 84% of respondents stated faculty development on EB teaching philosophies as a significant need in their program.

Possible methods to increase faculty development could be through seminars and in-service courses, and online tutorials in the development of certain EB philosophies in dental hygiene education. Foundationally, the core of using an EB philosophy in a dental hygiene program is the understanding of critical appraisal and how to apply it to clinical situations. To critically appraise evidence, one must possess the necessary skills of statistical analysis and research design. Faculty development in the incorporation of scientific evidence in their program could easily be developed in a workshop setting. Once the faculties possess skills in determining best evidence, alternative methods of information retrieval would then benefit the faculty.

Areas introduced in this type of online course or workshop might be: using library databases for literature searching; using the Internet for literature searching; using commercial Web sites for gathering information; accessing corporate Web sites for image acquisition and simulated cases; developing online course syllabi; utilizing Internet hyperlinks in lecture outlines; using dental hygiene chat rooms; using email for professional networking; and using tutorials on CD-ROM. The incorporation of faculty development seminars in these areas will help educators feel comfortable with these educational technologies. Once educators are exposed to the various information technologies and the concept of using critically appraised evidence, dental hygiene programs will be well on their way to becoming grounded in EB philosophies.

With a foundational overview of instructional strategies, student learning activities and faculty resources, dental hygiene educators will be able to draw conclusions regarding the strengths and needs of their programs in preparing students for EB practice. In 1995 Jeffcoat stated that the education environment should encourage the critical review of research findings and foster communication among students, researchers, and clinicians.[17] This teaches students to be inquisitive, critical thinkers, and lifelong learners, and these individuals will accept new therapy based on data, not hearsay. Dental hygiene educators have the responsibility to not only introduce the acquisition and critical analysis of evidence for clinical decision-making from day one, but also to reinforce its use throughout the curriculum so that an EB approach becomes the new tradition of clinical decision-making for dental hygiene practice.


Overall, U.S. dental hygiene program directors' responses indicate attempts to utilize some key principles of an EB curriculum. Most programs are teaching data acquisition through using library indices, library databases, Internet searches, and Web-based electronic methods. Programs are also including student activities that encourage critical appraisal such as oral presentations, literature review, case presentations, and article critiquing.

Not all faculty in core courses in the curricula are incorporating EB activities equally. Much improvement is needed in devising ways for EB utilization in "dental materials" and the "biological sciences." Success in using an EB approach has been demonstrated in "clinical dental hygiene/theory," "periodontology," "pathology," "radiology," and "community oral health." In order for a dental hygiene program to become one of EB philosophy and practice, it must incorporate EB philosophies in all core dental hygiene courses. Curricular-wide utilization, from the didactic setting to the clinical setting, stresses the importance of its use to the dental hygiene student. Once dental hygiene didactic courses utilize the EB approach, clinical courses must follow. Therefore, the acquisition of information, the appraisal of the information, and the application of the evidence are achieved.

Future research is needed in faculty assessment of their needs for implementing an EB philosophy in their curriculum. Once faculty needs have been determined, implementation tactics can be established. Future research that assesses outcomes in the programs utilizing an EB philosophy for patient care also should be assessed.

With information about EB practice gradually being introduced in the literature, conferences and workshops being held on EB practice and education, as well as Web sites being devoted to EB practice and teaching, health professionals are beginning to have access to a vast array of EB practice and education information resources. Ideally, dental hygiene educators will adopt a curricular-wide EB philosophy to graduate competent, critical thinkers who effectively treat patients based on their appraisal of the most current, critically appraised evidence.


The author would like to express thanks to the individuals who pilot tested the survey instrument: Susan Daniel, Michelle Darby, Jane Forrest, Mary George, Susan Kass, Deanne Shuman, and Karen Williams. This paper is based on the first author's master's degree thesis, and the study was funded with a grant from the American Dental Hygienists' Association Institute for Oral Health. Finally, the author would like to extend thanks and appreciation to her thesis committee members who are listed as co-authors on this paper.


[1.] Sackett D, Rosenberg W, Gray J, Haynes R, Richardson W: Evidence-based medicine: What it is and what it isn't. Br Med J 1996;312:71-72.

[2.] Centre for Evidence-Based Dentistry Institute of Health Sciences, Oxford. (1994). Aims of the Centre for Evidence-based Dentistry, Centre for Evidence-Based Dentistry Institute of Health Sciences, Oxford web page, 1-3,

[3.] Sackett D, Haynes R: EBM Notebook on the need for evidence-based medicine. J Evidence Based Med 1995;1(1):5-8.

[4.] Geddes J, Reynolds S, Streiner D, Szatmari P, Haynes R: Evidence-based practice in mental health. J Mental Health 1998;1:4-5.

[5.] Sackett D, Richardson S, Rosenberg W, Haynes R: Evidence-Based Medicine. How to Practise and Teach EBM, London, England, Churchill-Livingstone, 1997.

[6.] Niederman R, Badomac R: Tradition-based dental care and evidence-based dental care. J Dent Res 1999;78(7)1288-1291.

[7.] Bader J, Ismail A, Clarkston J: Evidence-based dentistry and the dental research community. J Dent Res 1999;78(9):1480-1483.

[8.] Brutvan E: Current trends in dental hygiene education and practice. J Dent Hyg 1998;72(4):44-50.

[9.] Shin J, Haynes R: The effect of problem-based, self-directed undergraduate education on life-long learning. Can Med Assoc J 1993;148:969-76.

[10.] Gravois S, Bowen D, Fisher W, Patrick S: Dental hygienists' information-seeking practices. J Dent Educ 1995;59(11):1027-1033.

[11.] Covington P, Craig B: Survey of the information-seeking patterns of dental hygienists. J Dent Educ 1998;(8):573-77.

[12.] Jeffcoat M, Clark W: Research, technology transfer, and dentistry. J Dent Educ 1995;59(1):169-184.

[13.] Perno-McKenzie M: American Dental Hygienists' Association Education Update: President's Message. ADHA Newsletter 1998;17(2):1-3.

[14.] Kessenich C, Guyatt G, DiCenso A: Teaching nursing students evidence-based nursing. Nurse Educ 1997;22(6):25-29.

[15.] Kumar K, Daniel J, Doig D, Agamanolis D: Teaching of pathology in united states medical schools. Human Path 1998;29(7):750-755.

[16.] Doucet M, Purdy R, Kaufman D, Langille D: Comparison of problem-based learning and lecture format in continuing medical education on headache diagnosis and management. Med Educ 1998;32(6):590-596.

[17.] Jeffcoat M, McGuire M, Newman M: Evidence-based periodontal treatment, highlights from the 1996 World Workshop in Periodontics. JADA 1997;128(6):713-724.

Stacy R. Chichester, RDH, MS, is a clinical assistant professor; Rebecca S. Wilder, RDH, MS, is an associate professor and the director of graduate dental hygiene education; and Ginger B. Mann, RDH, MS, is a clinical associate professor, all in the Department of Dental Ecology at the University of North Carolina at Chapel Hill School of Dentistry. Ed Neal, EdD, is the director of faculty development at the Center for Teaching and Learning, University of North Carolina at Chapel Hill.
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Author:Chichester, Stacy R.; Wilder, Rebecca S.; Mann, Ginger B.; Neal, Ed
Publication:Journal of Dental Hygiene
Geographic Code:1USA
Date:Mar 22, 2001
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