Introduction
With advancing knowledge and evolving research, it is becoming clear amongst healthcare disciplines what a critical role hygienists play in prevention, detection, education, and creating an access point for patients to enter the healthcare system. (1) Dental hygienists should no longer be defined by the private dental practice but instead, be viewed as an integral link between oral and systemic health. There are several vulnerable, underserved populations that could truly benefit from the breadth of care provided by dental hygienists, and this is being addressed through advanced level practitioners. (1) If hygienists are to be seen in various healthcare settings such as geriatric care facilities, pediatric medical offices, schools, public health centers, and research clinics, then the entry level degree program must introduce these opportunities so that a terminal degree can allow for specialized knowledge within these certain levels of dental hygiene. (2) By permitting hygienists to provide direct access to care across state lines to collaborate with other healthcare providers and creating specialized levels of dental hygiene within graduate degree hygiene programs, the field will be taking a significant step forward in addressing the oral healthcare disparities facing the nation. (3)
Direct Access
Direct access dental hygienists have been providing care for years in several settings outside of the traditional clinic. Although the benefit for these patients speaks for itself, there are still state restrictions and educational barriers that prevent dental hygienists from providing optimal care. (3) With the number of graduating dentists declining and the number of graduating hygienists increasing, it will be imperative that more dental hygienists are given the opportunity to assess and treat patients without the presence of a dentist. (1) School programs that have incorporated direct access authorization into their curriculum and states that have adopted this additional certification have seen the impact that oral healthcare specialists can provide. (4) Dental hygienists are not only equipped to meet patients in their unique settings outside of the traditional clinic, but also are able to advocate for the oral health needs of these populations and collaborate with various healthcare professionals involved in community outreach programs and public health projects. (4) It is well known that underserved populations are at higher risk for oral health concerns and are plagued by chronic systemic disease. Dental hygienists providing direct access to care ideally can focus on risk reduction and disease management for these patients. (5) This could contribute to a critical shift in the existing healthcare delivery model by bringing awareness to other healthcare disciplines that oral health is intimately connected with systemic health and that hygienists serve as key members in chronic disease management and risk reduction. (5)
Dental Hygiene Specialization
For dental hygienists to be incorporated into healthcare settings aside from the traditional dental clinic, the current entry level curriculum needs to move beyond setting hygienists up to begin practicing in this environment. (4) Accreditation standards within the curriculum are necessary, however student dental hygienists need to be made aware that there are levels in which they can practice and that there are several patient populations that could immensely benefit from the care they can provide. (6) Educators are in a unique position to inform students about settings and opportunities that exist for hygienists that want to utilize their knowledge and skillset in an environment outside of private practice. (6) By providing students in entry level programs with experiences working in various healthcare settings, hygienists will be able to better connect their future patients with the necessary providers based on the patient’s individual needs. These specific settings could include assisted living homes treating geriatrics, family medicine offices assessing HbA1C levels in diabetics and educating patients on their risks for periodontal disease, school-based programs administering sealants and fluoride, and OB/GYN offices screening and educating new mothers about oral health risks associated with pregnancy. (5) This will allow hygienists to connect with the necessary providers based on what the patient needs. If student hygienists are provided with this information and given the experience, then they can further their education or training in post-graduate level study to specialize in the certain patient population they seek to treat. (2) Just as other healthcare providers choose a specialty to practice, dental hygienists should have this opportunity as well and if this trend continues, the specific needs of underserved populations will be met more readily.
Conclusion
Dental hygienists practicing in alternative settings is gradually increasing and keeping the curriculum of entry level programs dynamic, will be a positive force in adapting to the evolving needs of society. These oral healthcare specialists provide vast expertise in oral systemic health and breaking down the dependency on dental supervision will allow for increased access to care for numerous populations. (3) If the incidence of periodontal disease and childhood caries are to reduce in the coming years, then creating more opportunity for varying levels of dental hygienists to reach these communities so they can play an active role in early detection, prevention, and treatment, will be imperative.
References
Guyton, B., LeBeau, J., Sorci, R., & Doneen, A. (2016). Commentary on an innovative interprofessional dental practice for 2026. Journal of Evidence Based Dental Practice, 16, 11–19. https://doi.org/10.1016/j.jebdp.2016.01.014
Harbison, L. A., Gurenlian, J. A. R., Freudenthal, J., & Moffit, D. (2020). Direct Access Dental Hygienists' Perceptions Concerning Geriatric Curriculum in Entry-Level Dental Hygiene Programs. The Journal of Dental Hygiene, 94(5), 22–29.
Myers-Wright, N., & Lamster, I. B. (2016). A new practice approach for Oral Health Professionals. Journal of Evidence Based Dental Practice, 16, 43–51. https://doi.org/10.1016/j.jebdp.2016.01.027
Naughton, D. K. (2014). Expanding oral care opportunities: Direct access care provided by dental hygienists in the United States. Journal of Evidence Based Dental Practice, 14, 171–182. https://doi.org/10.1016/j.jebdp.2014.04.003
Rowley, L. J., & Stein, S. M. (2016). A baccalaureate education curriculum to prepare dental hygienists for expanded public health practice. Journal of Evidence Based Dental Practice, 16, 122–128. https://doi.org/10.1016/j.jebdp.2016.01.024
Tilliss, T. (2016). Beyond the Operatory and Into Opportunity. Journal of Evidenced Based Dental Practice, 16, 2–3. https://doi.org/10.1016/S1532-3382(16)30041-0
