September 1, 2005
by Dental Practice Management
I am writing in response to your editorial comments regarding increasing access to care for our long-term care facilities (LTCF) and in general, those members of the public who have limited access to care such as seniors, individuals with low socio-economic status, immigrants, people with disabilities and Aboriginal people.
Personally, I wish to applaud your comments and your recognition that an unfairness and disservice exists due to the restrictions and limitations that have been placed upon our profession as far as limiting the availability of services. I write to you as a practising dental hygienist and on a personal level, the daughter of a long-term care resident in a nursing home. I have been witness to the unintentional omission of essential health services namely oral care, which will in turn have some very disparaging medical implications.
We are in a very exciting time within our profession of dental hygiene, the scope of which has expanded into total health care rather than restrictive oral health care or what I often term, wellness based dentistry. Even though the oral health link with systemic disease has proven an association and in some cases, a bi-directional impact rather than a causative factor, we do know that periodontal disease and the release of inflammatory mediators certainly pose an added burden to our immune system and its ability to function.
In our ongoing efforts to ‘redefine’ the face of dental hygiene, we have to always endeavour to place the best interests of the public first and foremost, beyond our own individual quest for control and this is indeed one of those initiatives borne out of compassion. I am extremely proud of our profession and its contribution to health care and again thank you for not only your support but also increasing the awareness of a request that has been highly overlooked. It’s time to move forward.
Jo-Anne Jones, RDH
Lecturer & Consultant, Anita Jupp & Company
The report by the Dental Hygienist’s Association confirms what we already know: there is inadequate care in several segments of our society. For a variety of reasons, some of which you have touched on.
You refer to “initiatives” that the dental hygienists are “spearheading” to help in resolving these issues but you do not indicate just which “initiatives” you are referring to.
One of the initiatives that hygiene has put forward is that self-initiation and private practice by hygienists will assist in alleviating the concerns relating to costs of providing adequate care and accessibility issues for these under-serviced and vulnerable segments.
A recently completed two-year study of hygiene services in Colorado (JADA Vol. 136, p. 289) sheds some interesting light on these claims. Hygienists have, for nearly two decades, been allowed to open private practices in that state. Today, more than 2,700 hygienists practice in Colorado yet only 20 practice without a dentist’s supervision. Of those 20, almost all practice in affluent or middle-income settings. And the expectation of reduced fees does not seem to have materialized either.
Are our Canadian hygienists that much different that their American colleagues? Will they be?
We heard these same arguments from the denture therapists some 25 years ago. Have they gone where others have failed to tread? Have they maintained a less expensive service?
We all know the answers to these questions. We all know that regardless of initiatives that might seem admirable, the reality will be that those most vulnerable will remain vulnerable, and those in need will remain in need. What is required is collaboration of all oral healthcare providers and government cooperation to ensure that adequate remuneration exists for the provision of care to the segments mentioned. Only when it is cost effective and remuneration adequate will the service be available. Altruism does not pay the bills.
Dr. Victor Kutcher, Stoney Creek, Ontario