Strive-The Student View
May-June, 2009 edition  

Evolving Profession of Dental Hygiene and Career Development

By Hannah C. Lee, Megan Alexander and Brooke Richard

Throughout the career of the dental hygiene professional, many important issues come into play that affect the practice of dental hygiene. With new research on dental materials, better and faster technology enhancing dental equipment and different ways to manage a successful dental practice, the dental profession is evolving every day. The main issues of the evolving profession of dental hygiene and career development are the relationship between oral health and total health, preceptorship, third-party payors, access to care, self-regulation and manpower. By understanding these issues, society as well as practitioners can come to understand the challenges that affect the practicing dental hygienist.

Oral Health and Systemic Health

A relevant issue in dental hygiene is how oral health reflects the overall health of the body. A problem arises because many people are not educated about the importance of a healthy mouth. Most people were raised to think that seeing a dental hygienist regularly, even when you do not have any problems, is a luxury—not a necessity.

Now research is showing many correlations between the health of your mouth and the health of your body.[1] According to the American Dental Hygienists’ Association’s (ADHA) Web site, “Research has identified periodontal (gum) disease as a risk factor for heart and lung disease; diabetes; premature, low birth weight babies; and a number of other conditions. The 2000 Surgeon General’s report, ‘Oral Health in America,’ has called attention to this connection and states that, if left untreated, poor oral health is a ‘silent X-factor promoting the onset of life-threatening diseases which are responsible for the deaths of millions of Americans each year.’”[1]

In addition to the research supporting a link between oral and systemic health, data show other areas of concern about the oral health of children and older adults. Statistics from the New York State Department of Health indicate, “Dental decay (cavities) is one of the most common chronic illnesses among children. An estimated 51 million school hours per year are lost in the United States because of dental-related illness.” The article goes on to say, “about 30 percent of adults 65 years old and older have lost all of their natural teeth,” and, “as the nation ages, oral health issues related to gum disease and the impact of medical treatments and medicines will increase.”[2]

Preceptorship

As defined by the ADHA Web site, “The word preceptorship comes from the word preceptor, which means teacher or instructor. But as it is used in relation to dental hygiene, it means to have a practicing dentist train a worker on the job to perform dental hygiene duties, instead of going through a two- to four-year formal, accredited education program and national and regional examinations to obtain a license.”[3]

When talking about preceptorship, many people do not understand how this concept affects the practicing dental hygienist. In order to fully comprehend this matter, people need to realize what a practicing dental hygienist must accomplish before becoming registered. According to ADHA, a “dental hygienist typically spends 1,000 hours of classroom instruction in a college setting, including more than 600 hours of pre-clinical and clinical instruction, under the supervision of dental hygiene educators. Then, they take a national written exam and state or regional clinical exam in order to earn a license to practice dental hygiene….”[3] This affects the patient because in an accredited dental hygiene school, students are given extensive training in recognizing medical, systemic and oral diseases and are taught how to efficiently treat the patient. Being able to recognize and comprehend the extent of the patient’s medical history will allow the dental hygienist to prevent any medical emergencies that may arise during treatment.

Issues in Access to Care

Barriers preventing access to care affect the dental practice, dental hygienist and the patient. They include the patient’s inability to pay for needed treatment, lack transportation to a treatment facility or lack of available dental appointments, an inadequate number of practitioners, state laws that prevent practitioners from providing care in settings that are accessible to the patient, and special needs of the patient that prevent them from accessing care.

Many Americans do not have dental insurance and cannot afford dental treatment with or without the coverage. Some finance companies may allow the patient to make monthly payments for their dental treatment, or their dental office may offer an arrangement that will allow the patient to make payments as well. This option may lift the financial barrier to dental care for the patient, allowing him or her to get total oral health care.

Third-party payors are obligated to pay for services provided to the patient, which raises an issue with the dental office and the patient because each dental plan covers only services specified under the plan.[4] It is important for the patient to understand the coverage on their policy. Insurance is filed as a courtesy of the dental practice; the practice is not liable for charges not covered by the insurance. This may hinder the patient from getting complete care because they may not be able to afford the dental services.

Another access to care issue is the inability to travel to the dental practitioner. The patient may not be able to drive due to a special need or the lack of a vehicle. In the larger cities, though, public transportation and taxis can allow patients to have more freedom to travel to the practitioner. In addition to that, appointment scheduling with a dental hygienist may cause another conflict. The dental practice’s availability may not be compatible with the patient’s agenda due to work, school or family schedules.

Special needs present barriers for some patients; for example, an elderly patient or a patient with Down’s syndrome. Both types require extra attention in their dental care. Some patients may be medically compromised or may not mentally function as well as others. Treatment considerations include being aware of placement and positioning to prevent the patient gagging when taking radiographs; using the “tell-show-do” approach to oral hygiene instruction; speaking in simple language when interacting with the patient; and involving the caregiver.[5]

Self-Regulation and Manpower

By definition, self-regulation provides a profession with the autonomy to govern licensed professionals within the boundaries of patient safety, while maintaining the profession by encouraging expertise in professional practice. According to ADHA, self-regulation means that the state government turns to members of the regulated profession for advice and assistance in carrying out the practice act. For example, dental boards composed overwhelmingly of dentists regulate both their own profession and dental hygiene, even though dental hygienists are the experts on dental hygiene services and should, therefore, have more input on dental hygiene issues.[6] Self-regulation through dental hygiene would allow dental hygienists to have autonomy while still promising the quality of services for clients.

According to the 2008-2009 Occupational Outlook Handbook, the dental hygiene occupation is expected to grow much faster than average through 2016.[7] Employment of dental hygienists is expected to grow 30 percent through 2016. This growth ranks dental hygienists among the 30-fastest growing occupations, in response to increasing demand for dental care. The demand for dental services will grow because of population growth, age of the population, and more focus on preventive dental care.[7]

Opportunities for dental hygienists are expected to grow through 2012 with increased emphasis on disease prevention. The Bureau of Labor Statistics, Office of Occupational Statistics and Employment Projections expect dental hygiene to be one of the top five health professions from 2002 through 2012, and anticipate a 43 percent increase.[8]

Improved awareness of suitable dental care is creating thrilling new career opportunities for dental practitioners. Demand for dental hygienists is at a record high.[8] With the community retaining its natural teeth longer and dentists branching out and performing new surgical and cosmetic procedures, dental hygienists are taking on a more prominent responsibility in the profession and performing procedures that were once set aside solely for dentists.[6]

According to the Health Care Colleges Web site, “Practice patterns also influence employment opportunities for hygienists…with the current trend toward group practice and practice styles that stress effective and productive use of office personnel, job opportunities will continue to increase [for dental hygienists].”[9] Because of this, the new Advanced Dental Hygiene Practitioner (ADHP) position becomes an increasingly relevant topic. The lack of dental professionals in certain areas of the country raises the issue of state laws and the practicing dental hygienist being able to treat patients without supervision.[10]

Each state has laws regarding the dental hygiene-patient relationship for dental treatment. A way to relieve inadequate numbers of available dentists is by having an ADHP.[10] The ADHP will provide preventive and basic restorative oral health care in a more cost-effective manner to a greater number of individuals who previously had limited to no access to oral health care services.[10]

Through the evolving profession of dental hygiene, future licensed dental hygienists will apply their comprehensive education to implement a plan that will provide the best patient care. Enhanced awareness of proper dental care is generating new job opportunities for dental careers, and the escalating demand for dental care places dental hygiene among the 30 fastest-growing careers. “Dental hygienists must play a vital role in the solution to eliminate these disparities and assure quality oral health care for all.”[10] The awareness of each of these obstacles can help the public and practicing dental hygienists to take a stand for themselves and their communities. By participating and rallying to overcome these barriers, not only will the dental hygienist benefit, but the future of the members of society will as well.

Acknowledgment

The student authors would like to thank Geri Waguespack, RDH, MS, course director, Professional Development II, for supervising the completion of this article.

References

1.  Anton P. Oral health-total health: know the connection. American Dental Hygienists’ Association. Available at www.adha.org/media/facts/total_health.htm. Accessed May 5, 2008.
   
2. The impact of oral disease. December 2006. New York State: Department of Health. Available at www.health.state.ny.us/prevention/dental/impact_oral_health.htm. Accessed May 5, 2008.
   
3. On-the-job training: a dangerous proposition. 2005. American Dental Hygienists’ Association. Available at www.adha.org/profissures/preceptorship/paper.htm. Accessed May 5, 2008.
   
4. Gordon J. Digesting the alphabet soup of dental insurance. Available at www.howstuffworks.com/dental20.htm. Accessed Feb. 5, 2008.
   
5. Darby ML. Dental hygiene theory and practice, 2nd ed. Dental management considerations for special needs clients. Elsevier, Inc. 2004.
   
6. The future of oral health: trends and issues. American Dental Hygienists’ Association, 2003. Available at www.adha.org/downloads/future_of_oral_health.pdf. Accessed Nov. 5, 2008.  
7. Occupational outlook handbook. U.S. Department of Labor, 2008-09. Available at ftp://ftp.bls.gov/pub/special.requests/ep/ind-occ.matrix/occ_pdf/occ_29-2021.pdf. Accessed Jan. 8, 2009.
8. Mincer M. Health workforce projections 2002-2012. The U.S. Department of Labor’s Bureau of Labor Statistics, 2004. Available at www.ihcs.msu.edu/LTC/Workgroups/D/Workgroup%20D%20BLS%20projections.pdf. Accessed May 5, 2008.
9. Dental hygienist careers. Health Care Colleges, 2008. Available at www.healthcarecolleges.com/dentalhygienist.html. Accessed May 5, 2008.
10. Access to care position paper. 2001. American Dental Hygienists’ Association, 2001. Available at www.adha.org/profissues/access_to_care.htm. Accessed Feb. 11, 2008.

Hannah C. Lee is a resident of Baton Rouge, La. She attended Louisiana State University (LSU) for four years as an undergraduate. She currently attends LSU Health Sciences Center School of Dentistry while seeking her Bachelor’s degree in Dental Hygiene. She and her husband, Buck A. Lee, plan to remain in Louisiana for the next couple of years.

Megan Alexander is a resident of Central, La. She is currently attending Louisiana State University Health Sciences Center School of Dentistry, where she will receive a Bachelor of Science in Dental Hygiene in May 2009. She previously attended Southeastern Louisiana University for undergraduate studies. Megan enjoys staying active outdoors, playing beach volleyball, running and mountain biking. She plans on working abroad to further her education, then moving back home to practice dental hygiene.

Brooke Richard was born and raised in Lake Charles, La., but is a current resident of Baton Rouge, La. She attended McNeese State University and The University of Louisiana at Lafayette for undergraduate studies. She was accepted into the dental hygiene program at the Louisiana State University Health Sciences Center in 2007 in Baton Rouge. She will receive a Bachelor of Science in Dental Hygiene in May 2009.  She plans to stay in Baton Rouge and practice dental hygiene.