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Canadian Journal of Dental Hygiene (CJDH)

Welcome to the new online home of the Canadian Journal of Dental Hygiene! This dedicated website offers our global audience easy access to all articles published since 2005, as well as to general information about the journal, its policies, and its manuscript submission procedures.

The Canadian Journal of Dental Hygiene (CJDH), established in 1966, is the peer-reviewed research journal of the Canadian Dental Hygienists Association. Published in February (electronic-only issue), June, and October, CJDH welcomes submissions in English and French on topics of relevance to dental hygiene practice, education, policy, and theory.

To discuss a possible contribution to the journal, please contact the scientific editor at

For details on how to submit a manuscript to the journal, please visit our Guidelines for Authors page.

Current Issue

2021 - Volume 55

February (Vol. 55 No. 1)

Original Research
Literature Review
Position Paper


The federal government’s call to dental hygienists for vaccine promotion

Salme E Lavigne*, PhD, RDH | Can J Dent Hyg 2021;55(1): 3-6

Original Research

Basement membrane degeneration is common in lichenoid mucositis with dysplasia

Iris Lin, BDSc, RDH; Denise M Laronde, PhD, DHP(C); Lewei Zhang, BDS, Dip Oral Path, PhD, FRCD(C); Miriam P Rosin, PhD; Ilena Yim, BDSc(DH); Leigha D Rock, PhD, RDH | Can J Dent Hyg 2021;55(1): 9-16

Background Two subtypes of lichenoid mucositis (LM) with oral epithelial dysplasia have been proposed, with differing risks of malignant transformation. However, no research has been done to authenticate this hypothesis. The study objective was to determine whether there are 2 subcategories within this entity, one with primary lichenoid and secondary dysplastic features (L1D2), and the other with primary dysplastic and secondary lichenoid features (D1L2), and to compare the proportion of malignant progression in these groups. Methods Patients with a diagnosis of lichenoid mucositis with low-grade (mild/moderate) oral epithelial dysplasia, no history of head and neck cancer, and who had at least 5 years of follow-up were eligible to participate in this nested case–control study. Cases (n = 10) were defined as lesions that progressed to severe dysplasia, carcinoma in situ or squamous cell carcinoma; controls (n = 32) were defined as those that did not progress. Immunohistochemistry was performed to assess for basement membrane (BM) degeneration using collagen IV—an integral BM protein. Results Lesions that progressed to cancer exhibited a similar proportion of BM degeneration at baseline (70%) compared to non-progressors (78%), with no statistically significant difference between groups (p = 0.69). Conclusion BM degeneration is frequently seen in LM with dysplasia and alone does not appear to be a predictor of malignant progression in lesions with both lichenoid and low-grade dysplastic features. Dysplasia should not be discounted in the presence of LM. Lesions that display any degree of dysplasia warrant clinical follow-up and continued monitoring.

Enhancing learning in an online oral epidemiology and statistics course

Batoul Shariati, DDS, MPH, PhD; Zul Kanji, EdD, DHP(C);Shimae Soheilipour , DDS, PhD; Lyana Patrick ; Afsaneh Sharif, PhD | Can J Dent Hyg 2021;55(1): 17-29

Background: Students in the Faculty of Dentistry at the University of British Columbia have articulated challenges in understanding learning objectives in their oral epidemiology and statistics course. This study aimed to measure the impact of a course renewal intended to enhance student learning. Examples of educational interventions included providing more time for activities, increasing student interactivity, and integrating more hands-on applicable exercises using statistical software. Methods: An online mixed-methods survey using a 5-point Likert scale and open-ended questions was distributed to 43 dental hygiene students before the course renewal and again to a second cohort of 43 students after course revisions. The survey asked students to rank their levels of challenge and self-confidence in learning 23 of the course objectives throughout each academic year. Four semi-structured interviews were also conducted with faculty and staff members involved in teaching or coordinating this course to understand their experiences after the course revisions. Results: Response rates were 32% to 57%. After the course renewal, the extent to which students in the entry-to-practice cohort felt extremely challenged to learn each objective was significantly reduced (25% vs. 3%,p< 0.001), and students’ self-confidence scores significantly increased (12% vs. 30%,p< 0.001). The changes on the challenge and confidence scores in the degree-completion cohort were not statistically significant (23% vs. 24% and 31% vs. 36%, respectively). Student satisfaction levels increased in all 6 categories measured. Conclusion: Providing students with more time to absorb their learning, increasing interactivity, offering timely feedback, and integrating applicable exercises using statistical software resulted in an enhanced learning environment.

Development and pilot testing of an oral hygiene self-care photonovel for Punjabi immigrants: a qualitative study

Navdeep Kaur, PhD; Daniel Kandelman, DrCD, DMD, MPH; Louise Potvin, PhD | Can J Dent Hyg 2021;55(1): 30-38

Introduction: The purpose of this research study was to develop and pilot test a culturally and linguistically appropriate oral hygiene self-care photonovel for Punjabi immigrants. Methods: Purposeful sampling technique was used to recruit 5 members of a Punjabi community organization (the Sikh Women’s Association of Montreal) for participation in 3 focus group sessions in August 2015. A thematic content analysis approach was used to sort the data, enabling identification of the storyline and photonovel contents from the themes that emerged. Comic Life 3 version 3.1.1 software was used to create a “Safeguard Your Smile” (SYS) photonovel, which was printed for pilot testing. Ten additional participants were recruited for this pilot testing, enabling further revision of the photonovel based on their suggestions. Results: Four major themes emerged from the focus group discussions: 1) lack of understanding of oral hygiene self-care and risk factors; 2) lack of oral hygiene self-care-related awareness and routine; 3) lack of emphasis on prevention by oral health care providers; and 4) perceived barriers to accessing dental health care. Thematic content analysis revealed a lack of knowledge of oral hygiene self-care skills and routine. Guided by these overarching themes, a final version of the photonovel script was created including photographs of key characters. The photonovel was subsequently printed for pilot testing. Pilot test results revealed close to 80% of participants agreed that the SYS photonovel was culturally and linguistically appropriate and easy to understand. Conclusions: A culturally and linguistically appropriate photonovel may be a useful tool for enhancing oral hygiene self-care knowledge among ethnic communities. Further studies are required to test the effectiveness of such a tool.

Effect of diagnostic score reporting following a structured clinical assessment of dental hygiene student performance

Alix Clarke, MSc; Hollis Lai, PhD; Alexandra DE Sheppard, RDH, BA, MEd; Minn N Yoon, PhD | Can J Dent Hyg 2021;55(1): 39-47

Background Diagnostic score reporting is one method of providing feedback to all students following a structured clinical assessment but its effect on learning has not been studied. The objective of this study was to assess the impact of this feedback on student reflection and performance following a dental hygiene assessment. Methods In 2016, dental hygiene students at the University of Alberta participated in a mock structured clinical assessment during which they were randomly assigned to receive a diagnostic score report (intervention group) or an overall percentage grade of performance (control group). The students later reflected upon their performance and took their regularly scheduled structured clinical assessment. Reflections underwent content analysis by diagnostic domains (eliciting essential information, effective communication, client-centred care, and interpreting findings). Results were analysed for group differences. Results Students performed best on eliciting essential information (92%) and poorest on interpreting findings (42%). The intervention group was more likely to view interpreting findings as a weakness, p = 0.007, while the control group was more likely to view eliciting essential information as a weakness, p = 0.04. No differences were found on the actual assessment scores, p > 0.05. Discussion Students who received diagnostic score reporting appeared to reflect more accurately upon their weaknesses. However, this knowledge did not translate into improved performance. Modifications and enhancements to the report may be necessary before an effect on performance will be seen. Conclusion Diagnostic score reporting is a promising feedback method that may aid student reflection. More research is needed to determine if these reports can improve performance.

Literature Review

Development of diagnostic score reporting for a dental hygiene structured clinical assessment

Alix Clarke, MSc; Hollis Lai, PhD; Alexandra DE Sheppard, BA, MEd, RDH; Minn N Yoon, PhD | Can J Dent Hyg 2021;55(1): 48-56

Background Structured clinical assessments capture key information about performance that is rarely shared with the student as feedback. The purpose of this review is to describe a general framework for applying diagnostic score reporting within the context of a structured clinical assessment and to demonstrate that framework within dental hygiene. Methods The framework was developed using current research in the areas of structured clinical assessments, test development, feedback in higher education, and diagnostic score reporting. An assessment blueprint establishes valid diagnostic domains by linking clinical competencies and test items to the domains (e.g., knowledge or skills) the assessment intends to measure. Domain scores can be given to students as reports that identify strengths and weaknesses and provide information on how to improve. Results The framework for diagnostic score reporting was applied to a dental hygiene structured clinical assessment at the University of Alberta in 2016. Canadian dental hygiene entry-to-practice competencies guided the assessment blueprinting process, and a modified Delphi technique was used to validate the blueprint. The final report identified 4 competency-based skills relevant to the examination: effective communication, client-centred care, eliciting essential information, and interpreting findings. Students received reports on their performance within each domain. Discussion Diagnostic score reporting has the potential to solve many of the issues faced by administrators, such as item confidentiality and the time-consuming nature of providing individual feedback. Conclusion Diagnostic score reporting offers a promising framework for providing valid and timely feedback to all students following a structured clinical assessment.

Position Paper

An umbrella review of systematic reviews of the relationship between type 2 diabetes and periodontitis: Position paper from the Canadian Dental Hygienists Association

Salme E Lavigne, PhD, RDH; Jane L Forrest, EdD, RDH | Can J Dent Hyg 2021;55(1): 57-67

Aim: The aim of this paper is to review the most current evidence of the nature of this relationship and examine whether non-surgical periodontal therapy (NSPT) significantly lowers glycemic (HbA1c) control. Methods: The PICO question was, “For individuals with type 2 diabetes mellitus (T2DM) and periodontitis, will non-surgical periodontal therapy (NSPT), as compared to no treatment, improve the individual’s glycemic control as measured by HbA1c.” Only systematic reviews (SRs) with or without a meta-analysis (MA) of randomized controlled trials (RCTs) or umbrella reviews of SRs and MAs of RCTs published in the English language between 2007 and 2019 were included. Several databases were searched as per their protocols. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality. Results: Of 54 records retrieved, after elimination of duplicates and studies not meeting inclusion criteria, 5 SRs/MAs and 3 umbrella reviews of SRs/MAs were selected. All 5 SRs/MAs reported reductions in HbA1c levels 3 months following NSPT, but effect sizes were small and 2 were not statistically significant. The 3 umbrella reviews consistently reported small reductions in HbA1c, but high levels of heterogeneity and moderate to high risk of bias. The Bradford Hill criteria failed to support a causal relationship between periodontitis and T2DM. Conclusions: Whether NSPT compared with no treatment in persons with T2DM improves the individual HbA1c remains unclear as does the exact nature of the relationship between periodontitis and T2DM.