Promote, Prevent, Protect

Promote. Prevent. Protect. These are the words that define public health. According to the American Association of Public Health Dentistry, dental public health is the science and art of preventing and controlling dental diseases and promoting oral health through organized community efforts. Over the years, the purview of dental public health has been within federal, state, and local health agencies. Additionally, dental public health core functions, such as assessment and policy development and assurance, provided a structure to promote oral health through public health services. Increasingly, dental hygienists are playing a vital role in many state health agencies in promoting oral health and performing these core functions.

In 2013, the Association of State and Territorial Dental Directors sent out a short, informal survey to state oral health programs to assess the number of dental hygienists employed or contracted with oral health programs. The responses were mixed, with a variety of dental hygienists managing programs (promotion and education) that addressed communities, while other dental hygienists performed clinical duties (prevention and protection), such as coordinating dental sealant programs within school settings.

There are a number of career opportunities for dental hygienists in public health. The resource document “Careers in Public Health” published by the American Dental Hygienists’ Association provides a general description of the roles dental hygienists play in a variety of public health settings.¹ These roles are based on the current education, licensure, training, and experience required for public health dental hygienists. Direct access workforce models also offer opportunities for dental hygienists to provide preventive services in public health settings. Dental hygienists within these models are reaching underserved populations in public health settings that do not have access to private dental practices.

REACHING THE UNDERSERVED

Public health dental hygienists look out for the well-being of entire populations and take steps to prevent disease, promote healthy lifestyles, and protect individuals living in communities. Today, public health dental hygienists are going beyond the traditional oral health boundaries and integrating oral health into programs promoting health and preventing chronic disease, such as diabetes management programs, tobacco cessation programs, and cancer prevention programs. Funding opportunities are requiring greater care coordination in order to be more cost-effective and attain a broader reach. Public health dental hygienists are involved in maternal and child health programs, such as the Special Supplemental Nutrition Program for Women, Infants, and Children and Head Start programs, in addition to chronic disease management programs. Within these public health programs, education and promotion of oral health accompany systemic disease prevention. Public health hygienists may serve as consultants to oral health care coordination within other programs.

Public health dental hygienists also provide preventive services to the public. In states that allow direct access, dental hygienists can provide preventive care in schools, adult day care sites, assisted living, long-term care facilities, and other nontraditional settings. Midlevel practitioners offer an additional avenue to providing care in the public health realm. Changes also need to be made to dental hygiene practice acts to remove supervision restrictions so public health dental hygienists can provide preventive services in aging populations that are served in physician groups and hospital systems.

The Affordable Care Act (ACA) of 2010 provided a number of opportunities for public health dental hygienists. The mandate that pediatric dental services be covered as an essential benefit expanded the ability to treat children. The ACA is also focused on the provision of quality care with the goal of improving outcomes while reducing costs. The key to achieving these goals in a pediatric population lies in promoting access to oral health services by providing infant oral health care and fluoride varnish programs and expanding school-based dental sealant programs. Public health dental hygienists are well positioned to promote and provide these services.

The opportunity for care coordination is also greatly improved under the ACA. Not only are public health dental hygienists serving in a variety of settings, but the type of services they provide is expanding. For instance, public health dental hygienists may provide counseling in a tobacco dependency program, offer nutrition counseling, and perform blood pressure checks and diabetes monitoring. Increased care coordination with the medical community will help improve health outcomes and reduce costs.

AGING ADULTS

The biggest hurdle that remains is how to provide comprehensive health care to the growing number of older adults in the United States. Unfortunately, adult dental coverage is not a mandatory benefit under the ACA and Medicare offers little to no preventive dental coverage. The challenge for public health dental hygienists is to provide preventive services in the continuum of care for the aging population and to meet the triple aim of quality with improved outcomes at reduced cost. Addressing the needs of the aging population will require a more systematic approach. Advocacy on the role of public health dental hygienists in this arena needs to be an ongoing effort. Prevention will always be imperative to improving both oral and overall health, and public health dental hygienists are poised to be key players.

From Perspectives on the Midlevel Practitioner, a supplement to Dimensions of Dental Hygiene. October 2015;12(10):38–39.