The modern role of the dental hygienist

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Published: Wednesday, 18 September 2013 10:51 Written by 

Tracey Lennemann,RD H, BA FULL CV

Backed by policy, advocacy, and legislation, opportunities in the second decade of this millennium are throwing open doors to wider scope of practice for dental hygienists in Canada. Dental hygienists today are riding the successes of decades of work that our pioneers in the field of dental hygiene paved for us. We owe ourselves the responsibilities to carry forward the principles of our profession, and re-evaluate our roles as dental hygienists in the wider world of overall health.

 

  1. Consultation, education, chartings, health history, medical changes, and updates You should be updating and reviewing each client, every visit. It only takes a few minutes and is essential in determining overall possible links to periodontal disease and other dental conditions. Are you involved in the initial treatment planning? Are you regularly educating clients about oral disease and links to general health? Do you have a protocol for updating health histories and taking X-rays?
  2. Periodontal risk assessments These assessments are of extreme importance to determining therapeutic options for clients. Complete annual periodontal charting including measuring of bone loss, pocket depths, recession, furcation involvement, mobility, abrasion and/or any other defects found. Plaque indexes, bleeding/inflammation indexes, oral hygiene indexes, taking, updating and interpreting X-rays, and DNA testing of subgingival bacterial colonies help evaluate the status of health or disease of a patient. These findings should be evaluated during the first several visits and then monitored at each consecutive visit. How comfortable do you feel in implementing periodontal treatment? Do your skills need to be optimized, improved, or renewed?
  3. Other risk assessments Caries risk assessment including caries detection and control, DNA saliva and sulcular fluid testing, nutritional analysis, smoking cessation, oral cancer screening, intra and extra oral examinations are also important to the general health of patients. They are carried out when the patient shows signs of high risk factors contributing to each specific condition. Have you implemented any of these advanced screenings into your oral health programs?
  4. Therapeutic treatments After assessing the client, a dental hygienist must develop an individual treatment plan. General light plaque debridement with ultrasonic power scalers and some hand instruments, polish, including air and manual, and some oral care instructions can be split as two appointments depending upon the condition of the disease and time allotment. Non surgical periodontal treatment (curettage) and presurgical periodontal treatment (soft and hard tissue curettage) which uses hand instruments for removing rough root surfaces and dead tissue in deep pockets can be completed in multiple separate visits. Are you advancing your skills for periodontal therapy? Are you using the latest instruments and techniques for optimal treatment results? Take some time this month to re-evaluate your role as a key part of a dental team. Answering these questions will help you determine some professional goals for this new decade.

Think about the following questions:

  1. Do you like what you do? Is it fulfilling or a bit boring?
  2. Is your job just a job or a career/profession?
  3. Are you working to your full potential?
  4. How is your relationship with the dental team? Can it be improved?
  5. Do you work as part of a team or as an individual in it?
  6. Do you have or are you interested in opening your own independent practice?
  7. Who do you network with? Do you have good dental contact lists and referral practices?
  8. How many continuing educations courses have you attended each year?
  9. Do you implement this information regularly to your practice or just attend courses for the credits?
  10. Are you working with modern technologies and equipment?
  11. How effective are your communication skills?
  12. Do you think you are a good motivator for your clients?
  13. What can you do to create a more successful dental team and practice?

We should then assess our clinical duties and how we align ourselves with the workflow. Think about how you can involve the dental team and what you can improve and update this year. Your current familiarity with the various methodologies, therapies and techniques, and how you implement them within your treatment plans are part of this self assessment.

Dentistry as we knew it twenty years ago has changed. A profession that was primarily mechanical and repair oriented is developing into a medical profession. It is not about trying to treat many people in a short time period. Research is bringing forward increasing links between the oral cavity and systemic diseases. Studies and statistics are providing us with more information as to the bidirectional relationship of periodontal disease and systemic conditions.¹ Therapies will take more time and be more involved than previously. Therefore, the role of the dental hygienist has changed.

We now know that periodontal disease is an inflammatory disease.² Health or disease of the oral cavity can contribute to the overall status of such systemic conditions as diabetes, heart disease, and circulatory problems, and in some cases can even effect medical treatments. The improved life expectancy and the increase in older population grow with the increase in health issues and systemic diseases.³ The need for oral health and care is more important than before.

Case report

A diabetes Type 1 patient came in with heavy bleeding, gingival inflammation, 5-6-7 mm pockets and poor oral care. The doctors were having problems regulating his medication and kept changing the dosage. Periodontal therapy was completed in a series of 4 appointments and his oral hygiene optimized. At the 3 month periodontal recall appointment his plaque scores and oral hygiene had not only improved but he now needed only half of the medication to regulate his blood sugar before periodontal treatment. Dental therapy and treatments helped him improve his oral health and helped stabilize his medication, blood sugar levels and improve his general health as well—a bidirectional effect of one disease to another.

Knowing how oral disease is linked to systemic conditions is vital for individual treatment planning. The more systemic complications a client has, the more diligent a dental hygienist must be when recommending therapeutic options specific to that client’s needs. More time and treatment sessions will be needed to complete the therapy therefore increasing the time and money a patient will have to invest in his/her dental treatment. This must be explained, educated and “sold” to the client, so your communications skills must be at their best. As well, working with latest technologies, systems and updating hands on skills determine success of therapy.

A dental hygienist is no longer a “tooth cleaning person” as was believed in the past. Our duties are complex and multifaceted. We must wear many different hats: consultant, confidant, guidance counsellor, teacher, educator, oral therapist, trusted person, visionary, technician, motivator, conservative periodontal specialist, brand manager, sales representative, team leader and psychiatrist are some of the roles dental hygienists occasionally slide into.

A dental hygienist is a health professional, and respects the clients and the entire dental team. Advance communication, people skills and compassion are valuable leadership skills. Cotreatment planning with the dentist, support of dental team, motivation and education of clients, along with application of new therapies, treatments, and products are valuable characteristics of a good dental hygienist. Flexibility and good listening skills will help develop a step by step plan for treating and guiding patients to a stable oral condition and possibly reducing risk factors that lead to other systemic conditions. I encourage you to review your duties as a dental hygienist, make some goals and plans to improve your skills, update your knowledge and apply modern therapies to become that dental hygienist you started out to be. It is not just about cleaning teeth anymore. It is now about saving lives.

References
  1. Kim J, Amar S. Periodontal disease and systemic 1. conditions: a bidirectional relationship. Odontology. 2006;94(1):10–21.
  2. Kantarci A, Van Dyke TE . Resolution of inflammation in periodontitis. J Periodontal  . 2005;76/11(Suppl):2186–2174.     
  3. Macunovich DJ. Birth Quake: The Baby Boom and Its Aftershocks. 2002.

Tracey Lennemann is an international professional speaker and trainer. She has been a practising clinical dental hygienist since 1986 in the USA and in Europe. Her motivational and educational programs have provided a unique integration of sales, communication and customer service tools designed to help the dental professional promote prophylaxis and periodontal concepts to their patients and clients.

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