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Table 1 Characteristics of identified studies

From: Incorporating oral health care education in undergraduate nursing curricula - a systematic review

Reference Setting and country Objective Participants Research Design Main findings Limitations
Clemmens, Rodriguez & Leef, 2012 [43] A large private urban university, USA To identify the knowledge, attitudes, and practices of baccalaureate nursing students regarding oral health assessment. A convenience sample of 163 baccalaureates nursing students Descriptive cross-sectional survey Although nursing students felt that oral health is an essential component in nursing practice, they lacked a complete understanding of the critical components of an oral health examination and promotion. Almost all the participants (97%) believed that they had a good understanding of oral health assessment, but only 25% were able to recognise the components of oral health assessment. Less than 2% reported performing an oral health assessment for every patient. The validity and reliability of the survey instrument were not established on the cohort of nurses. Moreover, data collected from a single university so results cannot be generalised.
Doğan, 2013 [44] Marama University, Turkey To assess the differences in oral health behaviour and attitudes between nursing and dental students. 157 nursing students and 71 dental students A comparative descriptive cross-sectional survey The attitudes of dental students to oral health were significantly more positive than that of nursing students (p < 0.001). The proportion of students avoiding visiting a dentist until they had a painful oral condition was significantly higher among nursing students than dental students. A third (33%) of nursing students in comparison to 6% of dental students thought that they could not avoid having false teeth in old age. The dentist found that dental students (58%) were better at brushing in comparison to nursing students (25%). The variation in attitudes and behaviour of nursing and dental students reflected the significance of practical training and curriculum. Data collected from students of one university only so results cannot be generalised.
Haresaku et al., 2018 [45] Nursing, dental, and dental hygiene school belonged to school cooperation in Fukuoka Prefecture, Japan To identify the weak points in knowledge, attitudes, and factors building positive willingness to practice oral health care among nursing and oral healthcare students. First-year nursing (119), dental (88), and dental hygiene students (64) Analytical cross-sectional survey Nursing students had the poorest knowledge and attitudes towards oral health care compared to other student groups. About 40% of nursing students felt they did not know much about oral healthcare, and 39.2% were not interested in oral healthcare. Only half of all students knew that oral health care is necessary to prevent general health problems like cardiovascular disease and aspiration pneumonia. Acknowledging and building interest among nursing students about oral healthcare is associated with a positive willingness for oral health practices. Therefore, it is essential to develop a collaborative nursing oral health curriculum to motivate nursing students. Results collected from a single nursing school, so the attitudes and behaviours cannot be generalised.
Pai, Ribot, Tane, & Murray, 2016 [31] Four Charles Sturt University campuses in regional NSW, Australia To assess final year nursing students’ awareness of the periodontal disease. 30 final year nursing students Cross-sectional quantitative study Nursing students were unable to determine the causes of periodontal disease, but their general knowledge was adequate regarding issues related to periodontal disease. Most participants indicated a lack of confidence in oral health care practice and recommended including more oral health content in the nursing curriculum. A small sample size and data were collected from campuses belonging to the same university, so results cannot be generalised.
Grant et al., 2011 [46] George Brown College (GBC) dental clinic, Ontario, Canada To report the lessons learned from the Interprofessional education (IPE) initiative between dental hygiene and BScN students and identify future directions. Eight 2nd year Dental Hygiene (DH) students participated in teaching oral health to 200 1st year Bachelor of Science (BScN) nursing students and, 15 2nd year BScN students participated in teaching blood pressure measurement to each of 4 pairs of DH students. Quasi-experimental post-survey pilot study Both student groups enjoyed working with each other and sharing skill sets. Students experienced each other’s professional language, which is an essential step for good communication between health professionals. DH students found that BScN students did not have an adequate understanding of the theory of oral health assessment or daily oral care. A pilot study from a single site so results cannot be generalised.
Czarnecki, Kloostra, Boynton, & Inglehart, 2014 [47] Pediatric dentistry clinic, USA To evaluate interprofessional education among nursing and dental students, and pediatric dentistry residents. Experimental group: Data collected from 33 1st year nursing students, 40 3rd year dental students, and six pediatric dentistry residents.
Control group: Data collected from 1st and 2nd-year dental students at the beginning and end of the term.
Quasi-experimental pre- and post-test survey Nursing students showed significant improvement (p < 0.05–0.001) in their oral health behaviour, knowledge, and attitudes regarding the importance of oral care and translating theory into nursing practice. Dental students also improved their attitudes toward the importance of nurses’ engagement in oral health assessment and promotion. All students agreed that interprofessional clinical placements are a better way of learning than only lectures. Results based on a sample from one university only. No control group among nursing students.
Farokhi, Muck, Lozano-Pineda, Boone, & Worabo, 2018 [48] Church-based clinic run in partnership with San Antonio Refugee Health Clinic and University of Texas Health San Antonio, USA To assess the oral health literacy and knowledge gained by patients, community members, medical and nursing students after participating in an IPE activity. Convenience sampling of nursing students (34), medical students (38), community members/parish (17), refugee patients (151) Quasi-experimental pre- and post-survey Ten dental, two dental hygiene, ten medical, and ten nursing students operated the clinic every week. Pre- and post-survey scores (p < 0.0001) showed that IPE benefitted all participants as measured by increased oral health literacy scores among all groups. The program provided patient management in a supportive team culture by expanding their learning of oral-systemic disease connections. Convenience sampling from a single area.
Lewis, Edwards, Whiting, & Donnelly, 2018 [49] University and vocational education sectors, Australia To test if oral health resources designed for workforce training were relevant to entry-level nursing or age care qualifications. Bachelor of Nursing (n = 41), Diploma of Nursing (n = 66) and Certificate in Aged Care course students (n = 17) and educators (6); two educators from each course Mixed-method study This study validated Building Better Oral Health Communities resources as an effective learning and teaching package for entry-level nursing and age care qualifications. Students and educators were highly satisfied with the study materials in promoting interest and providing insight into a comprehensive approach to oral health care. Students’ learning outcomes showed consistently positive attitudes and enhancements in oral health knowledge and skills. Small sample size and non- random sampling. Results are based on self-reporting rather than a clinical assessment of oral health competency.
Nierenberg et al., 2018 [50] School gymnasium, Appalachia, USA To assess dental and nursing students’ reflections on an inter-professional service-learning experience in Appalachia. 36 dental and nursing students from University at Buffalo, NY, USA. Of 31 participants who completed the demographic questions, 21 dental students were in the third year, and ten baccalaureate nursing students were seniors (4th year). Cross-sectional qualitative study Dental and nursing students’ exposure to rural patients who often lack dental care and have severe oral health problems impacted ‘their’ appreciation of interprofessional practice and their willingness to provide care in underserved settings. IPE facilitated care through teamwork, with students gaining mutual respect, confidence, and an increased understanding of the relationship between oral and overall health. Underserved communities benefit tremendously from interprofessional clinical practice as they can consult with multiple providers at one place on the same day. No control group and results collected from one single site.
Coan et al., 2019[51] Two local hospitals with the dedicated educational unit, Indiana, USA To implement and evaluate a collaborative event with patients to help develop dental hygiene and nursing students inter-professional competence 24 dental hygiene and 25 nursing students at the University of Southern Indiana Retrospective pre-post survey design 15 out of 24 dental hygiene and all 25 nursing students completed the Interprofessional Collaborative Competency Attainment Survey (ICCAS). Results showed significant improvement from pretest to post-test for nursing students (85% of items on ICCAS with p ≤ 0.004–0.0001) and dental hygiene students (75% of items on ICCAS). Therefore, structured interprofessional collaborative practice in hospital settings showed a positive effect in developing interprofessional competencies among nursing and dental hygiene students. The collaborative practice helped students from both professions to consider patients’ oral health needs and implications of improved oral health for patients’ overall systemic health. Small sample size and retrospective survey, which causes the risk of recall bias.
Dsouza et al., 2019 [52] University of North Carolina at Chapel Hill, USA To evaluate the influence of an educational intervention on knowledge, confidence, practice behaviours, and perceived barriers of nursing students regarding preventive oral health services. 64 first-year Accelerated Bachelor of Nursing students Quasi-experimental pre-post survey design Pre-survey results indicated that 77% (n = 33) of first-semester accelerated Bachelor of Nursing students had a poor or very poor level of oral health education. Only 7% of students reported that they were providing oral counselling and referrals before the intervention. The post-survey questions showed improvement in oral health knowledge scores and confidence in oral screening and counselling. A significant increase was noticed in the willingness to implement oral health services during clinical visits (p < 0.0001). Post survey qualitative data also documented the benefits of hands-on learning experiences with oral screening, counselling, fluoride varnish application, and referrals. Students found learning from dental hygiene educators useful. Small sample size from a single nursing school and the absence of a control group
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