Rise of the Public Health Dental Hygienist

In the decade following the release of the Surgeon General’s landmark report, “Oral Health in America,” public health dental hygienists across the United States began to explore new ways to meet the needs of the underserved. They started to collaborate more effectively with state oral health programs, oral health coalitions, other health care professionals, and advocacy groups to propose new policies and draft legislation aimed at changing the dental hygiene scope of practice in order to increase access to care for vulnerable populations. Much of this effort has focused on creating new opportunities for dental hygienists who wish to further their education and training. Today, 55 bachelor degree completion programs and 22 master-level degree programs are operating with administrative, research, policy, public health, and mid-level provider tracks. In these progressive roles, public health dental hygienists are addressing the substantial unmet needs of disadvantaged populations. In addition, legislative efforts have opened the door for public health dental hygienists to have direct access to patients and deliver advanced clinical services, such as placing/removing temporary restorations, amalgams, and composite resin restorations.

EMERGING OPPORTUNITIES

Public health dental hygienists have also moved beyond the clinical setting, with many becoming public health and Medicaid administrators. In this capacity, they serve as leaders not only in the dental hygiene profession, but also in government and civic affairs. At the federal level, public health dental hygienists provide technical assistance on legislative and regulatory language. At the state level, they serve as oral health program directors and state Medicaid and Children’s Health Insurance Program (CHIP) directors. These roles are instrumental in establishing key policies that advance the public’s oral health, as well as improve access to critical oral health services for low-income individuals. At the community level, public health dental hygienists work closely with childcare, preschool, and elementary school staff, school nurses, administrators, and other health care professionals caring for individuals and families. Their goal is to increase access to oral health services among the populations they serve. This new role positions the public health dental hygienist as a leader who will effectively collaborate with other providers to identify access disparities and link individuals to the services they need.

With the onset of managed care by state Medicaid and CHIP programs, public health dental hygienists will be taking on new roles, such as providing guidance, technical assistance, and oversight to state-managed care organizations and dental benefits administrator contracts. Many of these new state contractors have never worked in government before and, as such, may stumble over the bureaucracy of rules and regulation. Dental hygienists are already demonstrating the capacity to offer both states and these vendors the necessary technical assistance and expertise to effectively implement and manage these programs.

On the other hand, public health dental hygienists who have been serving underprivileged populations may begin to experience funding shortfalls as the financing once used for both start-up and operations has shifted to supporting infrastructure development. Public health dental hygienists who wish to continue providing direct oral health care services will have to develop and implement savvy business models to ensure the sustainability of their programs. They will become more accountable to governing health care systems and their funding sources. Quality metrics will be used to assess program performance within these new systems of care. Only programs that demonstrate the delivery of quality-driven, efficient, and effective care with positive health outcomes will survive.

The Patient Protection and Affordable Care Act is forcing these changes. Medicaid and CHIP programs have expanded in all 50 states and the District of Columbia, and enrollment is expected to increase. Oral health disparities continue to persist, demonstrating the need for new policies and programs, as well as increased funding to support start-up activities and ongoing financing to fund service delivery. These and other environmental factors continue to change the public health dental hygiene discipline’s trajectory.

HEALTH CARE REFORM

The intent behind health care reform is to create a fiscally responsible national system of health care that offers equitable, quality-driven health care services to all Americans. Under health care reform, Americans will experience changes in the care they receive—many may have access to health care for the first time. As with all health care professionals, public health dental hygienists will need to be open to innovation as new professional opportunities and health care policies and regulations emerge. They will need to play an active part in determining the best roles and responsibilities for dental hygiene. If the profession doesn’t set its own course, others will. Traditional public health dentistry once meant providing dental services to poor people. Today, dental public health goes far beyond this limited idea. Health care reform has created the opportunity to truly impact the oral health of Americans. With new and innovative health care delivery models, pioneering policy development, and advocacy efforts to support them, public health dental hygienists and their professional colleagues may well break new ground in achieving healthier outcomes for America’s most vulnerable populations.

From Perspectives on Dental Hygiene, a supplement to Dimensions of Dental Hygiene. November 2014;12(11):26–27.