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Researchers Looking to Expand Health Care Roles of Dental Professionals

Neff (foreground) with other members of the research team: Kelley, Paulson and Darby

A team of researchers led by James Alan Neff of Old Dominion University's College of Health Sciences has received a $900,000 grant from the National Institutes of Health (NIH) to study ways that dental practitioners can become more involved in promoting the overall well-being of their patients.

The award, which came from a challenge-grant program backed by federal stimulus funds, was hailed by ODU administrators as evidence of ODU's growing competitiveness in health-related research. NIH received more than 20,000 research proposals for the program, and only 200 received awards. "This is a great achievement for our proposal to be ranked within the top 1 percent of submissions," said Mohammad Karim, ODU's vice president for research.

The National Institute on Dental and Craniofacial Research is the specific provider of the support for the two-year project.

Neff said dental practitioners perform examinations on more than half of the United States population each year-surveys show that somewhere between 60 and 70 percent of the nation's residents make at least one visit to a dentist's office or dental clinic annually. "These examinations," he added, "can detect a lot more than tooth decay and gum disease."

The American Dental Association and American Dental Hygienists' Association already have initiatives that encourage more involvement by dental practitioners in the fights against oral cancer and tobacco use. Researchers at ODU's College of Health Sciences also have looked into interventions by dentists and dental hygienists in suspected cases of eating disorders, such as bulimia nervosa.

Neff pointed out that there are unique aspects of the dental setting that provide opportunities for encouraging oral health promotion. For example, medical forms completed at the beginning of the visit provide an opening to discuss health matters and risk factors. Also, he said, "time spent in the dental chair while the hygienist cleans the person's teeth offers a teachable moment for the hygienist to give advice and to encourage specific types of health promoting behaviors."

An important aspect of the study is that it builds on the dental hygienists'role as a patient educator. The new project will provide formal training for hygienists to learn well-established motivational interviewing interventions that have been effective in promoting healthy behaviors in a number of areas.

"Notably, while the American Dental Hygiene Association has promoted its own tobacco cessation approach to its members, the approach has not been highly formalized and hygienists generally have not had access to structured training needed to learn the approach," Neff said. "The present project will build on existing approaches to improve the ability of hygienists to impact a variety of risk factors for oral cancer, smoking, and other related oral health concerns. The project also incorporates the role of the dentist as an authority figure, who will follow up on the hygienists."

In addition to Neff, who is a professor of community and environmental health, the project team members from ODU are Michele Darby, eminent professor of dental hygiene, and Michelle Kelley, professor of psychology in the College of Sciences. The core team also includes James Paulson, a pediatric psychologist at Eastern Virginia Medical School and an expert in research statistics.

Project consultants are Dr. Tegwyn Brickhouse and Dr. John Gunsolley of the Virginia Commonwealth University School of Dentistry; Scott Walters of the University of Texas School of Public Health, Dallas; and Margaret Walsh of the University of California, San Francisco.

The researchers will invite 30 dental practices in Hampton Roads to participate in the project. Each of these practices has participated before in College of Health Sciences surveys, according to Neff. In the end, he said, the project holds great potential "for low-cost contributions that will have an enormous public-health significance."

A tool to be studied will be a nationally tested public-health process dubbed SBIRT, which stands for screening, brief intervention, referral and treatment.

Neff said the researchers won the grant "in the face of lottery-like odds" largely because their idea was good. "This has great potential to help train dental practitioners in extremely busy dental practices to deal with oral health problems more efficiently and effectively by using effective techniques demonstrated to work with a variety of behaviors," he said. "But beyond the study idea, we put together an incredibly strong, multidisciplinary team with strong records of NIH funding and nationally known consultants," Neff said.

Previous research by Neff has focused on substance abuse by minorities, mental health of minorities, research design and statistics, and program evaluation. Darby, the author of two leading dental hygiene textbooks, is the graduate program director for the Gene W. Hirschfeld School of Dental Hygiene in ODU's College of Health Sciences. Kelley leads a research team that earlier this year received a $1.6 million grant from the National Institute on Drug Abuse to examine trickle-down benefits to children whose parents are treated for drug abuse.

This article was posted on: November 25, 2009

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