Reimagining the role and scope of the work done by dental hygienists.
Do you ever Feel like we're trapped in a box? Does that box look like 50-minute prophies back-to-back to back-to-back?
Have you ever pondered what it could be like outside of that box? Have you ever wondered who even made the box?
While I can’t blame anyone in particular for the box or even say that it is a bad box, I can say there is so much more if we are willing to imagine life and dental hygiene outside of the prophy box.
Positioned to Do More
Let's look at the traditional role of a dental hygienist in a private practice dental office. What would it be like if we took all our education, continuing education, and experience to transform the typical dental recare appointment into a wellness visit unparalleled by any other provider?
Americans see their dentist more than any other medical provider. That puts us in the prime position to make a revolutionary change to the health care system in America. Because we are trained to be health screeners for the entire body, why not give it a whirl? Recently, I have seen dental hygienists integrate total body health into their assessment and treatment plan with outstanding results. The referrals for cardiovascular and endocrine (thyroid & diabetes) evaluations are prolific. These diseases are top killers in our country. How great is it that some of our colleagues are catching them early? When I speak to “whole body” RDHs, they report feeling valuable and fulfilled in their work. Who doesn’t want that?
Working Toward Structural Change
What about the work that we perform in that dental office? After an amazing assessment and appropriate referral (if necessary) is completed, what else can we provide for them in our office that we currently are not?
Certainly, incredible periodontal therapy is at the top of my list. In addition, there is also an insatiable market for cosmetic procedures that we are already trained and licensed to do. This will have a wide range of appeal within specific geographic markets and consumer demographics. Rural farm towns may not be a hot spot for these services but a bustling city like Phoenix might.
The caveat to the “licensed” part of that claim will vary state to state. Which is another area of potential for dental hygienists that is often overlooked. There is endless work to be done for dentistry at the legislative level in our government. With everything from hygiene scope of practice to the abysmal state of dental insurance in need of attention, our entire profession needs great men and women with our background to lobby for appropriate laws. There are states in the union that still don’t allow local anesthesia and nitrous oxide to be administered by RDHs. That is especially alarming when other professions can do all kinds of procedures without a license. For example, in Idaho, medical assistants can administer local anesthesia and there are no requirements for training and licensure for phlebotomy. I do not know what the correct answers are in all these situations are but surely there is a large measure of logic and reason we could add to the current set of laws.
Other Settings for Hygiene Expertise
Might we also challenge working in the dental office only? What if it were commonplace to consult with a dental hygienist at the pediatrician’s office? Parents all over the country seek special care for their children to offer them the best chance of living a healthy life. We know that oral health is critical from the beginning of life. Sadly, many parents have no idea how to care for those cute gummy grins and are devastated when their child is in oral pain or has dark spots across all their front teeth.
The pediatrician’s dental hygienist could have profound nutrition and hygiene discussions with the parents. They could apply fluoride varnish, place sealants such as my product of choice in any setting—GC Fuji TRIAGE®—and make sure the family had a great dentist to visit for their regular dental appointments.
Imagine if children and their parents were equipped with the knowledge and skill to avoid that first round of dental decay? How great would it be to know that the full body infections of caries and gingivitis were vastly reduced because of the support we provided at the earliest stages of life? I know you know parents who believe that apple juice in the bottle is fabulous for a little one’s health. Such a great easy way to get fruit!..... Friends, we are soooo needed in this realm. And to be clear, that was a joke. Apple juice does not count as a serving of fruit.
Expanding upon the children and their parents needing our knowledge and assistance, what about the schools? Many schools have a nurse available regularly, if not daily. I see this position as a territorial position where a dental hygienist would be hired by the school district to rotate through the buildings within the district. It seems like an oral wellness program with classes for children in pre-kindergarten through 12th grades would further help eradicate the oral health calamity of our nation.
The Oral Health in America report from 2022 shows that dental caries is still the most prevalent disease in Americans even though it is largely preventable. We are seeing that the oral disease is directly connected to gut health and the rest of the systems in our bodies which means that if we can improve oral health and dental IQ in children, we can effectively promote overall wellness in our entire future population.
This career sounds particularly fun to me. Imagine creating classes for the little babes and having candid conversations with the teenagers. The collection of experiences from that large age range would be ongoingly entertaining. This also seems like a great program to have the potential for varnish and sealant placement as well as emergency screenings for toothaches. It would be similar to going to the school nurse for a headache, but the student would be able to have a professional evaluate their ailment and refer them to the appropriate place for treatment.
In the last few decades there has been a major push for dental hygiene care in nursing homes. This idea is brilliant and, if given more attention, it has the potential to improve the quality of life for our treasured elderly population on a large scale.
Often oral health is the battle that does not get fought in facilities where people are unable to care independently for themselves. I have a patient who comes in every month for a prophy (in this case it’s my best effort with the ultrasonic as fast as possible until I can see that her tolerance is spent) to help ward off pain associated with dental neglect. The nursing home she lives in takes great care of the rest of her body but because oral health has been overlooked, her daughter seeks treatment outside the facility. She does not want her mom to end up with a mouth full of cavities and gum disease. It is not a perfect scenario but a monthly visit to our office is better than the “nothing” that happens at her residence.
It seems that if this area of care was given more interest and support, the difference we could make would be profound. There is a cost associated with having a hygienist on staff at these facilities that I believe we could build into the cost of attendance, acquire grants for, or utilize the money otherwise needed for dental emergencies that would be avoided if there was regular care present. If you would like to see how big of a difference we can make and how rewarding the work can be, check out the Geriatric Toothfairy, Sonya Dunbar on Instagram. The joy and help she delivers to her patients and the fulfillment her career brings is priceless.
One of the largest needs I see in our nation is for dental hygienists to become myofunctional therapists. Or at least adding myofunctional therapy skills to help with the large number of patients we see every day in need of this service. The disease that our nation is suffering from based on mouth breathing, poor sleep, tongue ties, speech impediments, and skeletal formation is prolific. We have a great education in head and neck anatomy and a huge part of oral wellness is correct breathing, eating, sleeping, and speaking patterns.
A dental hygiene license is the perfect jumping off point to gain further skill to help our patients improve their oral and overall health in this way. There is not a day that goes by when I work as a clinician that I don’t scramble to find a myofunctional therapist to refer to. I live in Idaho and my favorite is Cheryl Shafer, RDH in Maryland. Thank goodness for Zoom, and even at that, there are not enough hours in the day to take referrals from the whole country.
She has saved people from surgery, sleep apnea, ADHD, and a gamut of other diseases that otherwise “have no treatment” or “just needs a pill” or “let’s pull a few teeth” and the list goes on. I have seen her work firsthand with my daughter. A child who has had surgery for airway issues that only helped mildly for a few months. After a few short appointments and a few specific exercises for homework, this girl no longer takes allergy medication every day, sleeps through the night, does not have headaches, does not have puffy eyes all the time, and can chew her food with her mouth closed. It is literally life changing. And as a professional, Cheryl works from home, sets her own fees, sees a positive difference in her patients’ lives immediately, and has career satisfaction to one of the highest levels I have ever seen.
Realizing the Potential
There are countless ways that we hygienists can expand our scope of practice. We have unlimited potential. There has never been a better time to reimagine our careers. To visualize and increase the contribution we make to the health and wellness of our country.
What it will take is getting outside of the clock in and clock out prophy box most of us have felt trapped in at one time or another. I invite every single one of us RDHs to examine and reimagine our career. Whether we feel called to elevate our private practice game, create a new position at a different venue, lobby for more appropriate laws, or expand upon geriatric or myofunctional dreams, this is our time to think bigger.
Dream without limits. Make the most profound impact we possibly can. While the task will require work, the reward is sure to be exhilarating. Cheers to our careers as RDHs, reimagined.