Thinking Big

There is a dynamic health care revolution afoot that could leave the dental hygiene profession foundering in its past or rising to exhilarating and unprecedented heights. The keys to future professional success will be found in totally new approaches to integrated science and patient consumer advocacy.

By altering its present course, the dental hygiene profession can assume leadership in the risk assessment movement by embracing novel, creative approaches to research and preventive dental medicine.

The diagnosis, prevention, and treatment of acute and chronic oral diseases will be revolutionized in the next decade(s) by the astonishing advances being made in the life sciences. In particular, the genomic, proteomic, molecular imaging, and regenerative medicine era is upon us. Current literature is also replete with studies that are finding and exploring linkages between oral diseases and a host of systemic health issues including cardiovascular disease, stroke, pulmonary disease, adverse pregnancy outcomes, and diabetes. Health care professionals will also continue to be challenged by the burden of preventable diseases and disorders rooted in complex social, economic, and political issues. The visible outcome of the latter is an increase in the uninsured, reduced access to care, and a continuing marginalization of oral health issues among federal legislative leaders. As the federal government abdicates its responsibilities to address oral health care access, the states are increasingly taking on this challenge.

Quite frankly, dental and dental hygiene education have not been particularly responsive to the forces driving these profound changes, including the social demographic changes in the nation and the world; the media and its role in promoting (or not) oral health issues and literacy; the economics of health care and health professional education; public policy and regulatory issues including licensure, accreditation, and access to care issues; the dental industry; consumer demand; and, of course, science and technology.

Dental hygiene has not fully embraced the expectations of a changing health care system; the evolving inter- and multidisciplinary nature of science, technology, and patient care; and the integration of emerging technologies with clinical potential. The good news is that where challenges are evident, opportunity lies. The dental hygiene community has an unprecedented opportunity to provide leadership in the revolution in oral disease prevention. To continue to be effective and to differentiate itself from past initiatives in prevention, dental hygiene must understand and embrace the profound shift that is occurring in moving from a surgical, mechanical patient care approach to a nonsurgical, biologic, pharmacologic, medical approach.

To take advantage of scientific advances in the context of today’s complex socioeconomic and political structure, the dental hygiene community must refocus its efforts on risk assessment and preventive health modalities. The hallmark of dental hygiene’s future may be measured in its willingness to nurture and engage research, particularly at the translational and clinical research levels. In this way, dental hygiene, working closely with organized dentistry, can facilitate the rapid integration of research findings, from the laboratory to patient care, and usher in a new area of dental medicine.

The shift in dental hygiene will require that industry provide new materials, tools, and methods of information dissemination to ensure the rapid transfer of science to the public. The contemporary hygienist cannot and should not be content with cleaning teeth and providing health information to patients in the operatory. The hygienist of the future must be an even stronger person of science who uses evidence to move patient care toward a new era of prevention, recognizing that genomics and proteomics will offer innovative solutions. This may require the hygienist to become a strategic advocate for consumer health and to gain a comfort level moving further out of the operatory.

Tools of the Future

The current wisdom is that it takes about 17 to 20 years for a discovery to reach the practitioners and thus benefit the patient. This is much too long! The dental hygiene professional can accelerate this process. Additionally, the tools of the future are not the tools of the past. Novel biologic-based diagnostics, risk assessment tools, and preventives will replace stainless steel instruments and metals to assess, prevent, and treat oral infections. Imagine a future where:

• A simple biological probe diagnoses tooth decay.

• A dentist no longer needs to remove early decay.

• Teeth are restored with mineral rinses, not silver amalgam or other filling materials.

• Cavities are treated without local anesthesia.

• A vaccine is used to prevent tooth decay.

• Saliva replaces blood and urine as a diagnostic fluid and health surveillance tool.

• Hygienists are employed in medical care settings, not just dental offices and clinical research laboratories.

In this future, dental hygiene can be a primary health provider relentlessly pushing for preventive measures to improve health. So even though tooth brushing, flossing, and prophylaxis will continue to some extent, dental hygiene must move past these preventives to a new cluster of biologically-based approaches. Within this framework, dental hygiene can seize the opportunity to lead the profession in emphasizing oral health as an integral component of an overall wellness model.

Clearly, this future will require the dental hygiene profession to rethink its role in the larger health professional community. Indeed, the only real constant in this new environment is change itself including:

• More integration of the science and dental/medical communities,

• New strategic partnerships with dentistry where the emphasis is on the patient and not the provider,

• New integrated curriculum models,

• New practitioner models,

• Different approaches to national and state boards, as well as licensing, and

• Greater engagement with society.

Perhaps most important, dentists must broaden their view of the roles of hygienists and the entire dental community must be flexible and agile in both responding to and leading change.

Dental hygiene, like other health care professionals, must be willing to recognize the inadequacies of the current model of education and practice and seek bold, new solutions. Thinking big, in this case, is necessary!

The integration of hygiene with new risk assessment science, aimed toward preventing oral diseases across the spectrum of the population, is but one dimension of the change that dental hygiene must consider, but it is a critically important one replete with a network of ramifications. The survival of dental hygiene and the dental profession in our new “flat” world will depend on the success of new collaborations and partnerships with constituent communities and the public.

The public health of the nation is dependent on a vibrant dental health profession. The current chasm that exists between what is taught, how it is taught, product development, and clinical care can be bridged in a constructive and exciting manner. If the dental hygiene profession is willing to embrace and seize the new science-based preventive initiative, it has the capacity to provide the evidence basis for educating the public and fellow health care professionals. The net result could be the dental hygiene profession providing novel approaches to patient care as a fundamental component of an overarching primary care health professions team.

There is a critical need for action now. The great advances in oral health that we have experienced in the past decades will erode if something isn’t done to combat the current landscape. This includes more than 40 million people without health insurance, more than three times that amount without dental insurance, and cutbacks occurring on a daily basis in dental services.

Innovation in education and patient care fueled by science and driven by consumer need and demand must be the goals for the future. The movement of prevention to the forefront of the health care system, led by dental hygiene, can yield incredible rewards in terms of the cohorts of people who would have a reduced disease burden with a consequent reduction in health care costs. Dental hygiene must wed science and prevention to its future.

The public good would be best served by innovative dental hygiene partnerships with the constellation of health care providers and a renewed partnership with dentistry and industry. The integration of dental hygiene in the research community and the larger health professions holds the promise of dental hygiene being on the forefront of the eradication of preventable oral diseases and disorders. Dental hygiene has extremely fulfilling and exciting opportunities ahead—it can choose to keep its current path or to make a difference.

From Dimensions of Dental Hygiene. December 2005;3(12):10, 12.