Entering the Field of Orthodontics

After 30 years of teaching as a dental hygiene educator in a baccalaureate dental hygiene program at the University of Colorado Denver School of Dental Medicine, I entered the intriguing world of orthodontics and adolescent patients. Orthodontics—the diagnosis, prevention, and treatment of dental and facial malocclusions—is a field that may be unfamiliar to some dental hygienists.

Dental hygienists may find themselves at the point where the practice of traditional clinical dental hygiene is no longer an option due to musculoskeletal problems. Others can still practice comfortably and love communicating with patients and helping with their oral health care regimens, but are in need of a change. If either of these scenarios describes you, then consider a career shift. A dental hygienist brings a highly desired skill set to orthodontics. The strengths of dental hygienists are an excellent fit for the needs of the orthodontic practice setting (Table 1). Working in orthodontics can offer dental hygienists a fresh start to their careers without the need for retooling or additional education.

TABLE 1. DENTAL HYGIENE STRENGTHS THAT ARE VALUABLE IN AN ORTHODONTIC PRACTICE.

• Expertise in effective oral hygiene care.
• Ability to work autonomously.
• Extensive knowledge of oral health care products.
• Skills in patient education.
• Expertise in behavior modification.
• Team leadershipskills.

A GOOD FIT

Skill sets held by dental hygienists may not be fulfilled by current team members in the orthodontic practice. Prevention, the key strength of dental hygiene, is a necessary part of successful orthodontic practice. Effective preventive education and motivating behavior change can be challenging in orthodontic practices. Orthodontists are often frustrated by their patients’ low levels of compliance with recommended self-care practices. They appreciate ideas about how to motivate their patients.

Dental hygienists know how to effectively develop, organize, and manage oral self-care programs autonomously. The dental hygienist is the expert of the dental team in fluorides, nutritional counseling, sugars, non-nutritive sweeteners and sugar alcohols, soft drink/sports drink consumption, decalcification, and educating about the etiology of caries and periodontal diseases, both of which are prevalent in the orthodontic population.^1,2

Dental hygienists have the most comprehensive knowledge of oral health care products including manual and power toothbrushes, floss, interdental aids, dentifrices, mouthrinses, oral irrigators, and other devices for managing plaque biofilms, all of which are integral to orthodontic patients maintaining their oral health. Dental hygienists can also educate and direct dental assistants as they promote effective oral hygiene habits.

Dental hygienists are well-versed in behavior modification. Behavior change theories, such as the health belief model, theory of reasoned action, and motivational interviewing, are the most well-known approaches. Table 2 provides definitions of these theories^3-5 and Table 3 provides additional resources.

Although many orthodontic patients are adults, a patient population familiar to dental hygienists, working with children and adolescents may be a new experience and provide interesting challenges.

THE ORTHODONTIST’S NEEDS

Patients are more satisfied when treatment length is shorter in all facets of oral health and general health care. Healthy supporting tissues improve the predictability of tooth movement, which results in less orthodontic treatment time. Additionally, motivated patients do not miss adjustment appointments since patient compliance directly impacts treatment time.

Orthodontists value being able to start cases in a timely manner. They do not like banding and bracketing when plaque biofilm control is lacking and tissues are inflamed. The dental hygienist’s skills can speed up case starts.

Orthodontists worry that if their patients return to the general dentist with decalcification and/or gingivitis, future referrals may be affected. Orthodontic practices need dental hygienists to help produce positive patient outcomes.

MAKING THE TRANSITION

Orthodontists may not realize the benefits of partnering with dental hygienists. Consequently, it is helpful for dental hygienists to explain the benefits of their skill sets to potential orthodontist employers. Approaching orthodontists who currently have a referral relationship with your practice is a good place to start.

Orthodontists may want to consider providing clinical dental hygiene services in addition to their current practice offerings. Because patients need to maintain monthly orthodontic adjustment appointments, parents of pediatric patients and busy adult patients appreciate accomplishing the dental hygiene visit at the same time and in the same setting. In the orthodontic office, the archwires can be removed prior to probing and scaling and then immediately replaced, allowing these procedures to be more effectively performed. In the traditional separation of orthodontic and general practice settings, patients had to visit the orthodontic office to have archwires removed prior to a dental hygiene visit and then return to have the archwires replaced. Replacing three stops with one is a plus.

How will referring general dental offices react to learning that dental hygiene services are available during orthodontic appointments? Dental hygienists in general practice who have labored to scale around appliances might actually be grateful. Ideally, dentists will appreciate knowing their patients are able to receive comprehensive dental hygiene care while wearing appliances before they return to the general practice.

Dental hygienists in an orthodontic office can recommend specific patient oral hygiene practices to effectively deplaque around appliances. Dental manufacturing companies are introducing products to help improve dental hygiene treatment during orthodontics— from hand instruments that can reach around appliances to prophy angles that have removable rubber cups revealing rubber points for easier polishing around orthodontic appliances. These innovations are especially helpful for adult orthodontic patients who tend to accumulate stain.

Dental hygienists in the orthodontic setting need to perform thorough intraoral and extraoral examinations and identify new or existing restorative needs to be addressed within the patient’s general practice. Sometimes patients don’t realize they should still continue their regular dental visits. With frequent referrals, a successful collaboration between general dental and orthodontic practices is more likely.

BONUS POINTS

Orthodontic practices are generally uplifting environments. Patients do not arrive in pain and other than slight discomfort with adjustments, very little pain is inflicted. Injections are seldom needed. Patients are generally very positive about the unfolding cosmetic and/or functional changes. Camaraderie and teamwork are prevailing themes in the orthodontic settings both of which are strong suits of dental hygienists.

Orthodontists are some of the brightest members of the dental team. Orthodontic residencies generally admit those in the top 5% to 10% of the dental school class.⁶ These dentists have to love and understand physics and math.

Orthodontics is not just about cosmetics and crowding. Serious disorders are also treated, such as cleft palate and other developmental anomalies. When treatment improves appearance, people’s lives can be changed due to enhanced social acceptance and improved self-esteem.

For dental hygienists working in general practices, facilitating referrals to orthodontic practices is important. Becoming educated about current orthodontic strategies and innovations can help dental hygienists make knowledgeable suggestions and referrals for patients. Part two of this article will feature an interview with Ricky Harrell, DMD, assistant professor in Graduate Orthodontics at the University of Colorado Denver School of Dental Medicine, who will explain several concepts that are integral to understanding the current practice of orthodontics.

REFERENCES

1. Al Mulla AH, Kharsa SA, Kjellberg H, Birkhed D. Caries risk profiles in orthodontic patients at follow-up using Cariogram. Angle Orthod. 2009;79:323-330.
2. Bollen AM. Effects of malocclusions and orthodontics on periodontal health: evidence from a systematic review. J Dent Educ. 2008;72:912-918.
3. Glanz K, Rimer BK, Lewis FM. Health Behavior and Health Education. Theory, Research and Practice. San Fransisco: Wiley & Sons; 2002.
4. Miller K. Communications Theories: Perspectives, Processes, and Contexts. New York: McGraw-Hill; 2005.
5. Rollnnick S, Miller WR. What is motivational interviewing? Behav Cogn Psychother. 2005;23:325-334.
6. Rinchuse DJ, Rinchuse DJ. Graduate orthodontic programs: who is admitted? Am J Orthod Dentofacial Orthop. 2004;125:747-750.

From Dimensions of Dental Hygiene. February 2011; 9(2): 32, 34, 36.