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Bringing patient education into Full Bloom

Feb. 1, 2007
patient education is an important part of a dental hygienist’s job. We learn many methods, but a large body of information that could help us is not included.
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by Ann-Marie DePalma, RDH, BS, FAADH, and Toni Adams, RDH, BA

patient education is an important part of a dental hygienist’s job. We learn many methods, but a large body of information that could help us is not included. We, the authors, feel that dental hygienists can enhance their patient education efforts by applying educational learning theories. Both of us came to appreciate the value of this information when we were exposed to it in separate master’s programs. Our goal in sharing what we have learned is to help dental hygienists add to their knowledge and so become better educators, which can improve the quality of oral health for all. We will address several theories in different articles, and we will begin with Bloom’s taxonomy.

In dental hygiene programs and curricula, instructors stress the importance of critical thinking. But as hygienists, do we understand what critical thinking means and where it comes from? Noted educator Benjamin Bloom developed a philosophy of learning that is meant to stimulate critical thinking. Critical thinking as defined in Wikipedia ( is “the mental process of analyzing or evaluating information, particularly statements or propositions that people have offered as true.” In other words, critical thinkers are able to clarify and evaluate the accuracy and appropriateness of information in order to solve problems and make high-level decisions.

Bloom developed his taxonomy theory of learning based on learning styles. He theorized that there are three basic areas of learning: cognitive, affective, and psychomotor. Each will have an effect on the second level of his theory, which is the hierarchy of questioning designed to develop increasingly complex levels of awareness. As hygienists we are all aware of Bloom’s taxonomy, although we don’t realize it. Every time you attend a continuing-education program and the course objectives are printed in a handout or discussed, you are exposed to Bloom’s taxonomy.

The cognitive area of learning involves knowledge or intellectual development (student will learn XYZ procedure). Affective learning involves an emotional response such as a feeling, value, or attitude (student will express opinions on dental hygiene ethical situations). A psychomotor skill is acquiring a physical skill (student will demonstrate appropriate use of a power scaler). Within each level of knowledge is the level of awareness. Listed from simple to complex, these are:

  • Knowledge - eliciting facts
  • Comprehension - understanding and interpreting facts
  • Application - relating facts to novel situations
  • Analysis - dissecting facts into their component parts
  • Synthesis - combining disparate facts to create new knowledge
  • Evaluation - applying certain criteria to judge the value of something
  • We can use Bloom’s taxonomy to stimulate critical thinking in our patients and ourselves. When we want to move to higher levels of thinking, we can challenge our thought processes with questions that move up Bloom’s hierarchy of questions. We are faced with a myriad of daily decisions, such as when is polishing an appropriate maintenance procedure and what type of prophy paste should be used.The current emphasis on evidence-based dentistry (EBD) is another example where the use of Bloom’s taxonomy can enhance critical thinking skills. EBD, a hot topic in dental and dental hygiene literature, is a philosophy of practice, a system of investigation that helps us find the best scientific evidence to support our clinical choices. The application of Bloom’s taxonomy helps us think critically in order to apply EBD. The majority of our patient education efforts employ the knowledge and comprehension levels, the lowest levels of the taxonomy. We are eliciting facts regarding a patient’s dental hygiene knowledge or dental IQ, and we focus on helping the patient understand the importance of dental care. Knowledge and comprehension are important foundations, but we also want to employ the taxonomy to help the patient apply, analyze, compare, and evaluate the basic knowledge. For example, we care for a diabetic patient who does not visit regularly for recare appointments. With knowledge of current research and rapport with the patient, we can inform him of the relationships between dental biofilm and diabetes. Further, if we employ Blooms taxonomy, we can also help him become involved in his own care and begin to ask his own questions.How do we use Bloom’s taxonomy and critical thinking in dental hygiene? First, develop a question that can be answered. Name the problem, define your terms, and formulate a reasonable question that has been addressed in the research.Second, search for answers to your question. This applies Bloom’s application step. Find applicable research and demonstrate its relationship to your question. Use personal journal collections, search the Internet (Medline, professional association Web sites), go to a nearby university library, ask colleagues, or post a question to a professional online discussion group, such as the research you find. This uses Bloom’s analysis level that calls us to dissect, differentiate, and order the information we find. The knowledge we gain through analysis is then applied to our question. Choose the relevant research, organize the data into a logical and understandable format, and offer it to your patients as the best information available.Finally, you need to assess or evaluate the results. Did the information that you found help solve the problem? Was it the best information available? Did it get optimum results? What other questions were raised during researching?Bloom’s taxonomy and EBD are not necessarily linear works. One can move back and forth through the process before finally making a decision. One must evaluate as the choices are applied to the patient. One may formulate new questions as one progresses, because research in one area may lead to an unexpected path.As a health-care practitioner, you need to involve the patient in all steps. Discuss the question/problem at hand and use the research that you have found. Maybe some information contradicts other information. Maybe there are several viable choices, and the patient may prefer one over another. Then together as a health-care team, you and the patient can apply the decisions and evaluate the results. If the first effort doesn’t bring about the desired effects, continue the process until you find an approach, treatment, or philosophy that works. Your efforts can be applied to other patients with similar issues.In 2004, Ismail and Bader reported in JADA about a dentist who used EBD/Bloom’s taxonomy to answer a pediatric oncologist’s question about the best way to prevent oral mucostitis in pediatric head/neck cancer patients undergoing chemotherapy. Chlorhexidine rinses were the gold standard and common choice, but they had side effects, and the dentist couldn’t find the scientific evidence to support their use. In his research, he learned that ice chips might be an effective and less expensive alternative, which they proved to be. So, by applying critical thinking and EBD, the dentist was able to assist a medical colleague and offer some relief to his patients.Critical thinking, EBD, and Bloom’s taxonomy play an important role in the dental hygienist’s practice. We need to use the best information available to formulate questions, search for answers, evaluate the information, apply the knowledge, and evaluate the progress so that we can provide the ultimate care for our patients. References• Ismail AI, Bader D. Evidence-based dentistry in clinical practice. Journal of the American Dental Association 2004; 135:78-83.
    • Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-based medicine: How to practice and teach EBM (2nd ed.). Edinburgh: Churchill Livingstone 2000.
    Ann-Marie C. DePalma, RDH, BS, FAADH, is currently a faculty member at Mt. Ida College’s dental hygiene program after spending more than 25 years in private practice. She is a Fellow in the American Academy of Dental Hygiene and is also pursuing a master’s degree in education in instructional design. Ann-Marie has written numerous articles and provides continuing education programs for dental hygienists and dental team members. She can be reached at [email protected].Toni S. Adams, RDH, BA, practiced as a dental hygienist for 26 years and loved working in a variety of offices before retiring due to hand problems. She subsequently earned a bachelor’s in communication studies and has completed all but her thesis toward a master’s in the same field, focusing on health, instructional, and intercultural communication. She enjoys writing for and speaking to dental professionals about communication issues, has won awards for speaking, writing, leadership, and scholarship, has taught university level public speaking classes, and is currently writing a communication handbook for dental hygienists. She welcomes comments and inquiries to [email protected].