As a profession, dental hygiene is at a tipping point. We are balancing on a scale. On one end, the occupational model of practice, and on the other end, the professional practice model. The past 30 years have been a period of sustained growth for the professional model of practice. Dental hygiene professional practice has been augmented through the capacity to formulate a dental hygiene diagnosis, authorization to prescribe some medications, and the ability to open an independent practice in many jurisdictions. As significant as these high points are, there is still work to be done.
Public perception of dental hygienists is generally positive.1 However, many continue to view the role of the dental hygienist as an auxiliary to the dentist, rather than as a collaborative partner of the oral health care team.1 Such a perception is a problem. Health inequalities place enormous strain on the healthcare system; and in many instances, poor oral health contributes to diminished overall health outcomes.2 There are well established connections of overall health to oral health, with linkages to diabetes, respiratory disease, and emerging research in negative cardiovascular outcomes.3
Due to economic barriers, not all members of the public can access a private dental practice.4 The solution is apparent. Dental hygienists who are qualified, educated professionals in oral health care and disease prevention may provide health promotion, as well as primary and secondary preventive measures at the community level before oral health problems present in hospital emergency rooms; often ending in an antibiotic or narcotic prescription, persisting pain or extraction.2,5
So, why are more dental hygienists not reaching patients at the community level? Where are the opportunities? A scroll through any employment search engine will yield hundreds of opportunities for dental hygienists; many for an occasional Saturday, an evening here, a morning there, all in private dental practice, without a single opportunity in a community healthcare setting. In order for oral health inequalities to be addressed, the healthcare provider qualified to meet the unmet needs of the community must physically be in the community and not in a private practice.
As someone who has worked in dental hygiene education for twelve years and has studied health care policy and administration, I see an untapped opportunity for new graduates, along with unrealized benefits for members of the community. I have often asked why more dental hygienists are not pursuing opportunities beyond private clinical practice? I believe the answer is twofold.
Firstly, many new graduates believe the only valid employment opportunity post-graduation is private dental practice. Secondly, opportunities for dental hygienists in the community health care setting are very limited. Thus, I propose two potential avenues for exploration for a solution. An examination of how dental hygiene educators influence student career aspirations and an encouragement of decision-makers to consider the inclusion of dental hygienists on interdisciplinary healthcare teams.
Research emphasizes the fundamental role of college faculty in shaping the attitudes and aspirations of the student.6 Just as students are often asked to self-reflect, I encourage my colleagues in dental hygiene education to do the same. How often do we refer to post-graduate careers only in a private practice context? Alternatively, how often do we refer to roles of the dental hygienist, researcher, educator, and administrator as a footnote to clinical practice? In clinical education, do we say “check” with a dentist or “collaborate” or “consult” with a dentist? Our lexicon cannot change reality; however, language can indeed modify the lens in which reality is viewed.7 As educators, we must be mindful that our language does not impart a limited worldview on the student.
Exposing students to potential roles in a community capacity is a starting point. However, it is perhaps futile if those roles do not exist. As dental hygienists, we can advocate for increased recognition of the dental hygienist as a valued and crucial member of the health care team. Professional associations offer excellent advocacy resources to assist members motivated to start an advocacy project. Also, dental hygienists may participate in community health initiatives through application to Board of Directors’ postings; thus, bringing the voice of a dental hygienist to the decision-making table. Finally, dental hygienists can have their voices heard through voting. Supporting political candidates who value oral health care and are willing to put pressure on policy makers and stakeholders for an increased presence of dental hygienists in the community will increase public awareness of their role in healthcare.
Change can be tough and often the fallback is to stick with what we know. However, the dire state of oral health care in our communities is too critical to ignore. Dental hygiene educators can be the catalyst for much needed solutions by directing new graduates to opportunities where the people who need them most can access them. Decision-makers can also help by ensuring there is a place for the dental hygienist to serve all constituents, not just those who hold private dental insurance. An increased presence of dental hygienists in the community is a win-win for the profession and society.
This article is dedicated to Paul Sharma, Director of Chronic Disease and Injury Prevention at Region of Peel, for giving me a chance in dental hygiene education many years ago. Thank you.
1. Turner J. Oral Health for Total Health: The Integral Role of the Dental Hygienist. Oral Health [Internet]. 2019 [cited 12 August 2019];. Available from: https://www.oralhealthgroup.com/features/oral-health-for-total-health-the-integral-role-of-the-dental-hygienist/
2. Farmer J, Peressini S, Lawrence H. Exploring the role of the dental hygienist in reducing oral health disparities in Canada: A qualitative study. International Journal of Dental Hygiene. 2017;16(2):e1-e9.
3. 3. Gao L, Xu T, Huang G, Jiang S, Gu Y, Chen F. Oral microbiomes: more and more importance in oral cavity and whole body. Protein & Cell. 2018;9(5):488-500.
4. Bedos C, Loignon C, Landry A, Allison P, Richard L. How health professionals perceive and experience treating people on social assistance: a qualitative study among dentists in Montreal, Canada. BMC Health Services Research. 2013;13(1).
5. Hasan S. Prescription from ER doctor: expand public dental programs. The Star [Internet]. 2017 [cited 12 August 2019];. Available from: https://www.thestar.com/opinion/commentary/2017/02/21/prescription-from-er-doctor-expand-public-dental-programs.html
6. Komarraju M, Musulkin S, Bhattacharya G. Role of Student–Faculty Interactions in Developing College Students’ Academic Self-Concept, Motivation, and Achievement. Journal of College Student Development. 2010;51(3):332-342.
7. Schafer J. Words Have Power [Internet]. Psychology Today. 2010 [cited 12 August 2019]. Available from: https://www.psychologytoday.com/us/blog/let-their-words-do-the-talking/201011/words-have-power
About The Author
Natalie Muccioli Emery is a dental hygiene educator at Oxford College, she is dedicated to addressing oral health inequalities and issues surrounding access to oral health care. She received her bachelor’s degree in Health Administration, Health Services Management from Ryerson University and has worked in private dental practice for 12 years. She serves on the Board of Directors for the Gift from the Heart project. Natalie hopes for a future where dental hygienists will be valued members of interdisciplinary health care teams helping to improve overall health outcomes.