A Dental Hygienist in All Settings

More than 100 years after Alfred Fones, DDS, established the profession, dental hygienists remain the prevention specialists within the realm of oral health care. The importance of the dental hygienist continues to expand, and the idea that a dental hygienist can play a key role in primary health care as a “dental hygienist in all settings,” is not just a dream—it is a reality that is fast approaching. The profession is rapidly changing, primarily in response to the great need that exists for oral health care access and equity. In addition, our scientific understanding of patient-centered holistic care supports the inclusion of oral health for total body health and well-being.

Dental hygienists have much to learn from the success of other allied health providers. Clinicians, such as nurses and physician assistants, have been continually adapting based on the nation’s complex health care needs. Similarly, dental hygienists now find themselves facing a future of new roles and functions within oral health care. Not unlike other medical professions, dental hygienists should expect new challenges when addressing the diverse delivery and inequity issues in current health care systems. It is not surprising that similarities exist in the evolution of the dental hygienist and the nurse practitioner, as these professions share a history of facilitating disease prevention.

NURSE PRACTITIONERS

Many key areas in the creation of the nurse practitioner are analogous to the current progression of dental hygienists. The political, social, educational, and public health environments that spurred the formation of the nurse practitioner seem to be in play again with the conception of the advanced dental hygiene practitioner.¹ One of the most critical areas to consider at this point is dental hygiene education. Essentially, nurses recognized that with higher levels of education, they could gain the knowledge, skills, and momentum needed to make critical changes to their positions within primary care. The same reality can be true for the advancement of dental hygienists.

In the 1960s, nurses were looking to practice to the fullest extent of their skills in a variety of settings.² Health care organizations at the time were looking to better serve their patients. Health care costs were drastically rising after World War II. Vulnerable populations, including women, children, and older adults, had difficulty accessing primary care providers. Nurses knew they could be used more effectively in the health care system to improve care outcomes if they were able to practice to the fullest extent of their training. Considering the health care environment, Loretta Ford, EdD, RN, PNP, FAAN, FAANP, and Henry Silver, MD, launched the first program at the University of Colorado to conceptualize the nurse practitioner as a “a nurse for all settings.”² These pioneers understood that greater responsibilities and tasks within health care required higher levels of education. Therefore, nurse practitioners transitioned from nurses earning a certificate or baccalaureate degree or completing continuing education to completing graduate degrees and extensive training.² This process did not happen overnight and required time and effort. Today, registered nurse practitioners must earn a master’s or doctoral degree and additional licensure in order to practice.³ This advanced training and licensure prepares nurses to become leaders, change-agents, and decision makers who can continuously improve their skills and their patient care outcomes.

EDUCATION

Across the nation, a similar transformation is happening in the dental hygiene profession. In many dental hygiene programs, a shift from an associate’s level of education to a bachelor’s level of education is occurring at the entry level. In addition, as dental hygienists take on more expanded roles in health care, the number of master’s degree programs is growing to educate midlevel oral health practitioners. As society continues to recognize the need for oral prevention specialists in various aspects of health care delivery, the education and specialized training of dental hygienists must proportionately expand.

Consider dental radiography. Many dental hygienists were trained to use film-based radiographs in clinical dental assessments. Yet today, few offices use film radiographs. Dental offices are now operating with digital radiography, a science that is constantly improving to create better diagnostic images. Additionally, many general dentists have cone-beam computed tomography systems to facilitate optimum dental care for each patient. Today’s dental hygienists must have adequate training in all aspects of dental radiology, as well as periodontal and therapeutic care. This illustrates the demand for more thorough training and education, substantiating the need for the whole profession to require a bachelor’s degree at the entry level.

The 2013 white paper “Transforming Dental Hygiene Education and the Profession for the 21st Century” from the American Dental Hygienists’ Association stated that, like nurses, “dental hygienists must also have the opportunity to achieve the highest level of education with seamless progression and articulation to higher degrees.”⁴

CONCLUSION

The reform of the current health care system has exposed massive gaps in oral health for vulnerable and underserved populations in the United States. These gaps can be addressed only through innovation and collaboration with other health professions, and through opportunities for advanced education and training of midlevel practitioners. Dental hygienists will become crucial team members within primary care systems that support holistic patient-centered care. These potential new roles and applications of the science of dental hygiene require progressive education and training. Just as the nursing field created new graduate-level education to successfully integrate the nurse practitioner into primary care, the field of dental hygiene should also be looking to advance its understanding, create higher levels of education, and effectively expand the profession’s responsibilities in health care. Only with more knowledge and understanding of oral health science can dental hygienists become oral health specialists in all settings.

From Perspectives on the Midlevel Practitioner, a supplement to Dimensions of Dental Hygiene. October 2016;3(10):48-49.