According to the CDC, the healthcare system could save up to one hundred million dollars each year if dental offices performed screenings for diabetes, high blood pressure, and high cholesterol. (1) It is well understood that dental hygienists are experts in the oral systemic connection, so the question remains as to why these oral health specialists are not being utilized in healthcare institutions outside of the traditional dental practice. Although there is a need for dental hygiene care in these settings, there are numerous other locations where underserved populations that lack access to care are suffering from untreated periodontitis. Another question to ask would be why dental hygienists are unable to collaborate with other healthcare disciplines to screen for diabetes and high cholesterol when providing dental hygiene services. The purpose of this article is to provide ways in which the dental hygiene profession could evolve to answer these critical aforementioned questions and to address the oral systemic health disparities plaguing the nation.
Dental hygiene is at a critical point where changes must be made in the coming years if advancements are to be seen within the profession. States are gradually beginning to adopt mid-level practitioners and are looking to permit direct access dental hygienists to increase availability of oral health care in health profession shortage areas. (2) The impact that dental hygienists could have on the healthcare system through integration with other disciplines has monumental potential in prevention, treatment, and chronic disease management. However, it will be imperative that dental hygiene be self-regulating to enact change and be defined as a true profession. (3) If this is established, the entry-level requirement to practice dental hygiene could be definitively raised and clinicians will be better prepared to administer care to numerous vulnerable populations. Providing dental hygienists with the necessary training to practice in various healthcare settings and creating opportunities for interprofessional socialization will create a unified patient care team. (4) With these transformations, dental hygiene can strive for reciprocity within state licensure requirements and will be viewed as its own individual profession no longer dependent on dental supervision. (5) Instead, dental hygienists can be regarded as an allied healthcare partner that brings forth valuable knowledge in oral-systemic health.
Self-Regulation
Regulation of any healthcare profession is necessary for patients’ wellbeing to make sure they are kept safe and healthy, as well as to protect the public from any harm. (3) Currently, dental hygiene is regulated by the dental profession, with California being the only state thus far to have established their own dental hygiene regulating agency. (6) Dental hygiene is one of the few professions that is controlled by another profession, which poses as a significant barrier to growth. (6) With states permitting the mid-level practitioner and looking for ways to increase professional autonomy so that more individuals can receive the care they need, it is clear that dental hygiene is capable of moving toward self-regulation. (3) Dental hygienists are in the ideal position to advocate for advancements within the profession because these individuals possess an understanding of what regulations dental hygiene needs in order to adapt to the growing oral healthcare demands of the nation. Dental hygienists are not aiming to alter the scope of practice, but rather are looking to raise standards of education, increase opportunity to provide care in various communities, and to be established as an integral healthcare provider that does not require supervision. (3,6) By looking to other disciplines that possess their own regulating body, it is apparent that this will be the first crucial step that dental hygiene must take in the coming years in order for the profession to prosper and establish itself separate from dentistry. (3)
Education
Disparities in oral healthcare are continuing to rise and the current entry-level degree requirement to practice dental hygiene is not sufficient to meet the needs of the dentally underserved. Program length and cost of attendance are a few characteristics that appeal to Associate’s degree seeking students. However, these programs lack in preparing students for roles in leadership, research, and public health. (7) Establishing the Bachelor’s degree as the minimum requirement for entry into the profession will help create clinicians that are better equipped to provide care in alternative practice settings. Growing evidence is showing that students want to pursue roles outside of the traditional practice setting, but dental hygiene programs historically have not prepared students for this type of work. (4) This is encouraging because there are several patient populations in settings like long-term care facilities, schools, and medical offices that are desperately seeking oral health care. For dental hygienists to transition into these settings, the current curriculum model must evolve to incorporate training in the oral-systemic connection, disease prevention in public health, telehealth, and primary care delivery for underserved populations. (4) Students that receive this introduction in their undergraduate curricula can seek out a graduate level degree to further their knowledge in specific areas such as education, administration, and research. (7) Encouraging students to pursue graduate level education is another means to transformation of the dental hygiene profession.
Licensure
Discussions within professional organizations have taken place on whether the current pathway to licensure-didactic plus clinical exam-is a valid measurement of student readiness to practice dental hygiene. The National Board Dental Hygiene Exam (NBDHE) will continue to be a mainstay for assessing conceptual knowledge of dental hygiene and must be passed to receive licensure. (3)The validity of the clinical board being an effective means to measuring skill and readiness of a clinician is of question. (8) External factors that vary between clinicians include providing a live patient that qualifies for treatment, fees students incur to bring their patient to the board exam, and lack of follow up care for their patient. (3,8) Dental hygienists provide care in various areas of oral systemic health including education, prevention, and treatment of chronic conditions. The current model of clinical board assessment does not accurately reflect a student’s ability to provide unique and individualized patient care. (8,9) Alternately, the competencies that the student has successfully met while in their entry-level program could be utilized for clinical assessment for licensure. (9) In addition, each state’s clinical exam is administered under different regional organizations, which can be a barrier for dental hygienists that want to practice across state lines. (5) Eliminating the regional testing board and instead, looking to accreditation competencies met in undergraduate curricula along with the successful completion of the NBDHE will allow for increased portability within licensure of dental hygienists. (3) This will ultimately create a licensing system synonymous amongst dental hygienists and prevent hygienists that want to provide care in numerous states from being confined by regional testing requirements. (3)
Interprofessional education and socialization
In order for dental hygiene to be incorporated into healthcare systems, interprofessional socialization is fundamental and this can essentially begin as part of undergraduate curricula. Most undergraduate dental hygiene programs exist amongst other healthcare programs like nursing, physical therapy, speech-language pathology, and physician’s assistant. (4) Creating opportunity for these programs to collaborate in a team environment fosters growth and allows each healthcare sector to understand what a crucial role each provider brings to a patient’s overall healthcare team. (4,10) Healthcare has traditionally been viewed individually, with patients going to specific settings to receive their specific care needs. For dental hygiene, incorporating these oral healthcare specialists into school-based programs, pediatric medical offices, hospitals, and long-term care facilities could be a catalyst for change because consumers will now be able to receive multiple healthcare needs in one setting. (11,12) Dental hygiene services will no longer just be provided in a dental office but can now be received in a medical office or school, which sends a message of collaboration. (12) People will begin to view dental hygiene and whole-body healthcare as a single entity and partnering with other disciplines will help support this. Interprofessional education and socialization will be a critical component to the transformation of dental hygiene as a self-regulating profession that can provide care in alternative practices.
Conclusion
The call for dental hygienists to engage as educators, advocates, researchers, prevention specialists, and team members is clear. Regulatory bodies and licensure requirements are a few barriers that must be eliminated to create room for forward movement of the profession. (3,5) The development of mid-level practitioners and direct access to care being permitted in certain areas with limitations are beginning steps that demonstrate the value dental hygienists bring to an overall healthcare team. (7) Dental hygienists possess a wide array of skills that historically have not been used to their highest protentional. Through interprofessional education and socialization, dental hygiene will be revered as an integral aspect of prevention, treatment, and chronic disease management. (3) Not only will the lack of access to care be addressed, but more opportunities for dental hygienists to thrive in a comprehensive healthcare environment will exist. (3,11)
References
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