This is not an easy question to answer. There is no clearly defined answer to either question and the answer will vary from state to state. Some direction can be provided by state medical, dietetic and dental boards; the American Dental Hygienists’ Association (ADHA); and the Academy of Nutrition and Dietetics (formerly known as the American Dietetic Association); however, I’ve noted in some cases the information obtained from these sources is inconsistent.
Let me provide some information. It is the position of the ADHA that “The dental hygienist employs critical decision-making skills to reach conclusions about the patient’s needs related to oral health and disease that fall within the dental hygiene scope of practice.” In order to achieve this outcome, ADHA specifies that dental hygienists are to collaborate with the dentist and other healthcare professionals to provide optimum oral health for patients. Observing a need for a single supplement (e.g., calcium) or multivitamin may require a referral to the patient’s health care provider or registered dietitian (RD)/registered dietitian nutritionist (RDN).
According to a position of the Academy of Nutrition and Dietetics, “…the best nutrition-based strategy for promoting optimal health and reducing the risk of chronic disease is to wisely choose a wide variety of foods. Additional nutrients from supplements can help some people meet their nutrition needs as specified by science-based nutrition standards such as the Dietary Reference Intakes.”
As a dietitian, when I suspect a patient may require a single supplement, I evaluate the entire situation. One or two “red flags” is not sensitive enough to make a recommendation for a supplement. I read documentation from all of the health care providers, review the medical and social history, interpret the laboratory tests (e.g., hematocrit, hemoglobin), assess the nutritional status (e.g., analysis obtained from a 3-7 day food record), observe clinical issues (e.g., gingival inflammation) and review the anthropometric information (e.g., height, weight, change in weight). Armed with this information, the RD can provide an acceptable and effective recommendation. It is so easy to exceed the Tolerable Upper Level (UL) of some nutrients, especially when a patient consumes fortified foods or beverages, including a multivitamin. High levels of nutrients can have a drug-nutrient or nutrient-nutrient interaction. For example, iron levels above the UL can decrease zinc absorption or high doses of vitamin E can cause bleeding in individuals taking anticoagulant medications. This type of nutritional assessment is out of the scope of practice for a dental hygienist.
Finally, for nutrition counseling, I tell my students that a general rule of thumb is that it is acceptable when the information pertains to the oral health of the patient and involves information from the 2010 Dietary Guidelines for Americans (http://www.health.gov/dietaryguidelines/) and USDA Choose MyPlate (http://www.choosemyplate.gov/). When counseling involves a complicated health issue (e.g., diabetes) or goes beyond these nutritional education tools, it would be practical to refer the patient to a health care provider or RD/RDN and collaborate with them for appropriate overall care.
Please let me know if you need additional information.
Position of the Association: Dental Hygiene Diagnosis and the Dental Hygiene Process of Care. March 2010
Position of the American Dietetic Association: Nutrient Supplementation. 2009
Cyndee Stegeman, EdD, RDH, RD, LD, CDE
Associate professor, Dental Hygiene Program
University of Cincinnati
Dietitian, Diabetes Education
TriHealth Hospital Systems, Cincinnati