Dental hygiene did not advance concepts related to theoretical models until the early 1990s when a paradigm for the discipline of dental hygiene science was proposed by Darby and Walsh. The concepts defined as central to the discipline of dental hygiene included: client, environment, health/oral health, and dental hygiene actions. ADHA adopted this paradigm and the concepts contributed to a refined definition of the discipline of dental hygiene which evolved from a listing of duties to a framework that recognized that dental hygiene was a study of phenomenon allowing for a continuum of knowledge advancement through research and theory development.
Human Needs Conceptual Model
In addition to a paradigm for the discipline of dental hygiene, Darby and Walsh proposed the Human Needs Conceptual Model for Dental Hygiene as the first theoretical model for the discipline. This model was derived from Maslow’s basic human needs theory and Yura and Walsh’s human theory.
Human Needs Conceptual Model Part I >
Darby ML, Walsh M. A proposed human needs conceptual model for dental hygiene. Part 1. J Dent Hyg. 1993;67(60:326-334.
Human Needs Conceptual Model Part II >
Darby MS, Walsh MM. Application of the human needs conceptual model of dental hygiene to the role of the clinician. Part 2. J Dent Hyg. 1993;67(6):336-346.
In 2016, MacDonald and Bowen conducted a theory analysis of the Dental Hygiene Human Needs Conceptual Model. This theoretical model was analyzed for coherency, usability and logic to professional practice using a seven-step process based on the Walker and Avant Theory Analysis with two independent reviewers. The conceptual model was found to be logical, meaningful, usable and generalizable. The authors concluded that although this model offers a holistic view of the client, there is very little research that has been conducted to support the efficacy of the model.
Oral Health-Related Quality of Life Model
In 1998, Williams, Gadbury-Amyot, Bray, Manner and Collins proposed the Oral Health-Related Quality of Life Model for Dental Hygiene. This model was designed to measure health and disease along a dynamic continuum and examined six primary domains including health/preclinical disease, biological/clinical disease, symptom status, functional status, health perceptions, and general quality of life.
Williams KB, Gadbury-Amyot CC, Bray KK, Manne D, Collins P. Oral health-related quality of life: A model for dental hygiene. J Dent Hyg. 1998;72(2):19-26.
One year later, Gadbury-Amyot, et al reported on a study designed to establish the construct validity and reliability of the model.
Gadbury-Amyot CC, Williams KB, Krust-Bray K, Manne D, Collins P. Validity and reliability of the oral health-related quality of life instrument for dental hygiene. J Dent Hyg. 1999;73(2):126-134.
Eighteen years later, Gadbury-Amyot, et al conducted a study to determine the impact of the OHRQL Model for Dental Hygiene on education, research and practice. The authors conducted a search using PubMed and Google Scholar to identify citations using the two original papers. They noted there were limited applications of this model, although the model appeared to be actively used in Japan.
Client Self-Care Commitment Model
In 2000, Calley, et al proposed an approach to motivate clients to improve their oral health with the Client Self-Care Commitment Model (CSCCM). This model is comprised of five domains: initiation, assessment, negotiation, commitment and evaluation.
Calley KH, Rogo R, Miller DL, Hess G, Eisenhauer L. A proposed client self-care model. J Dent Hyg. 2000; 74(1):24-35.
In 2006, Jönsson, Lindberg, Oscarson and Öhrn used the CSCCM as part of a randomized controlled clinical trial to test an initial therapy intervention on 75 individuals to determine if compliance and oral self-care behaviors would improve as part of a periodontal program in Sweden. Results revealed the individuals in the intervention program had more favorable outcomes than the control group and patients reported that the CSCCM intervention influenced their oral self-care habits in a positive direction.
In 2014, Miles, et al. reported results of an exploratory study of the use of the CSCCM as part of an instructional module in a dental hygiene curriculum to determine the impact on students’ client-centered knowledge, values and actions.
Transtheoretical Model for Oral Self-Care Behavioral Change
In 2002, Astroth, et al proposed the Transtheoretical Model for Oral Self-Care Behavioral Change, which comprised four components: stages of change, decisional balance, processes of change, and self-efficacy or confidence in one’s ability to make change. The paper reviewed the development of the model and provided suggested applications for dental hygiene clinical practice.
Astroth DB, Cross-Poline GN, Stach DJ, Tillis, TSI, Annan SD. The transtheoretical model: An approach to behavioral change. J Dent Hyg. 2002: 76(4):286-295.
In 2003, Tillis, et al studied the validity and reliability of the transtheoretical model and concluded the stages of change and decisional balance instruments were reliable and valid, and reflected anticipated differences across stages of oral self-care adoption. They recommended the model could be used for oral self-care behaviors, and further research could be conducted to support the use of this model as a framework for understanding and developing interventions related to oral self-care behavioral change.
Tillis TS, Stach DJ, Cross-Poline GN, Annan SD, Astroth DB, Wolf P. The transtheoretical model applied to an oral self-care behavioral change: development and testing of instruments for stages of change and decisional balance. J Dent Hyg. 2003:77(1):16-25.
In 2015, Rogo and Portillo proposed an e-model for online learning communities. Within this model there are four stages through which learners experience learning communities: building a foundation for the learning community; building a supportive network within the learning community; investing in the learning community to enhance learning; and transforming the learning community.
Advocacy Empowerment Model
In 2018, Bono et al created an Advocacy Empowerment Model to enhance participation in legislative advocacy. The authors recommended using this model for health policy development.
Synergy in Social Action Theory
Also in 2018, Rogo presented the Synergy in Social Action Theory. This theoretical model for dental hygiene incorporates three elements of the theory: learning and educating processes in social action, critical awareness and empowerment, and individual action and collective action. This synergy creates a power that is greater than the sum of the parts. The dynamic system helps to challenge the status quo and has the potential to improve access to oral health care.
Additions for Theoretical Models
In 2015, Portillo, et al, proposed a theoretical model called the E-Model for Online Learning Communities. This model describes a four-state progression of online learning communities in graduate dental hygiene education. The developmental process includes building a foundation, building a supportive network, investing in the community, and transforming the learning community demonstrating how graduate dental hygiene students evolve from formal course-based communities into informal, self-sustaining learning networks. The model emphasizes key metamorphosis elements including relationships, affective development, and cognitive development, with affective growth exerting the strongest influence on learners’ progression.
Affective Advocacy Model
In 2021, Bono, et al created an Affective Advocacy Model based on the use of Legislative Advocacy Project (LAP) used among undergraduate and graduate students. This model describes how a structured LAP can move learners through the lower levels of the affective domain, including receiving, responding, and valuing, by integrating cognitive knowledge with real-world advocacy activities thereby increasing students’ advocacy knowledge, values, and actions. This model frames advocacy education as a progression where experiential learning helps students internalize the importance of civic engagement and overcome common barriers such as time constraints and discomfort with legislative communication.
Social Intelligence Self-Care Conceptual Model
In 2023, Rogo, et al, presented the Social Intelligence Self-care Conceptual Model. This model integrates person-centered care, Social Intelligence (SI) and the Client Self-Care Commitment Model to explain how dental hygienists’ interpersonal behaviors influence patient’s commitment to oral self-care. The model was built from patient perspectives collected through open-ended questionnaires administered after a minimum 15-minute self-care education session in a dental hygiene clinic. The model incorporates patients’ positive and negative perceptions into adapted SI capability definitions and combined these with person-centered principles. This model is intended for use in education and clinical practice to improve person-centered care and oral health outcomes.
Conceptual Model using CliftonStrengths® to support Professional Development
Also in 2023, Bono, et al, described a conceptual model using CliftonStrengths® to support dental hygiene student’s professional development. This model shows a helix configuration related to the integral interactions between faculty and students representing ongoing professional development and continued growth of professional identity. The model illustrates students’ strengths along a continuum from problem solving challenges to expanding professional development and preparing for the evolving workplace.