By JoAnn Gurenlian, RDH, PhD
I realize our profession is working diligently to position dental hygienists in areas that will improve access to care so we can better meet the needs of the underserved. But I would like to champion the need to position dental hygienists in hospital settings. If you have not heard Cindy Kleiman and Virginia Prendergast speak about evidence-based oral care in hospital settings, treat yourself to one of their continuing education courses. You will quickly recognize how essential it is for nurses and dental hygienists to partner in order to guide oral care for intensive care patients, which can reduce the incidence of ventilator-associated pneumonia.1-3
In addition to working with patients in intensive care units, I believe dental hygienists are needed on all floors of the hospital. Of course, you know there's a story behind this. My brother has been in the hospital for eight weeks with multiple comorbidities, including heart failure, kidney failure, a foot infection, internal bleeding, and diabetes. He became septic three times, developed blood clots, and during therapy the therapist pulled on his arm and he developed a massive rotator cuff tear. Suffice it to say he is medically challenged.
My brother underwent several surgical procedures, and after the first three weeks he was discharged to a rehabilitation facility with the goal of restoring his strength. He was so weak and swollen that he could not use his arms, hands, or legs. He was often found seated in a wheelchair for five hours at a time soaked in urine because, although he and our family asked for assistance, no one came to help him with toileting care. As a result, he developed more infections and was back in the hospital for another two weeks, became septic again, and required additional surgery.
After several weeks, he was transferred to a different rehabilitation facility, where he spiked a fever, experienced heart failure, and was returned to the hospital for another 10 days of care. He is now back in a rehab facility, where we hope and pray he will eventually recover.
During his time of hospital and rehab care I inquired about oral care. I brought my stash of manual toothbrushes, toothpaste, and antiseptic mouth rinses to the hospital or rehab center. I brushed my brother's teeth or guided him through his oral care when his swelling resolved enough that he could help himself. When I was traveling, I asked the staff to be sure to help my brother with his oral care to reduce the chances of mouth infection. Everyone smiled sweetly and assured me my brother was getting the best care possible.
But when I asked him if his teeth were being brushed, he told me no. I returned from one trip and learned that his teeth had not been brushed for a whole week. In fact, all of the supplies that I had brought were thrown away. Mind you, I was not too happy with my family that they had not jumped in where I left off, but where was the nursing staff?
So I very nicely asked the staff if anyone had brushed their teeth that day, and if they brushed their teeth every day. They assured me they did. When I asked why my brother did not have his teeth brushed every day, they informed me it was not part of their job. They wash a patient's body but not his or her hair, and they don't enter the mouth.
Huh? Did you know that the mouth is not part of the body? Also, when I brought in new oral health supplies, three times I might add, they very nicely threw them away!
So you might think this is just one incident and most patients don't have this experience. You're probably right. But I started talking to other families, and I asked if their loved ones were receiving oral care. Of course, some said that oral care was not their immediate concern. But others did say, "Come to think of it, my relative has not had his teeth brushed in three days." And, when I asked the staff where my brother's oral health supplies went, they proceeded to bring in a low budget toothbrush and no-name toothpaste for him to use.
The point of this column is not to disparage nursing care. These professionals are busy saving lives. Let's help them by bringing another team member to the table. Dental hygienists could be part of the hospital setting. They could oversee the oral health care of patients, ensuring that oral health infections are reduced during hospital stays and that proper oral care products are used. They could staff the ER for patients who present with oral pain and emergencies, provide preventive services to complex patients who must be treated in a hospital setting, and provide daily care for inpatients during their hospitalization.
I'd love to hear from those of you who already work in this capacity. We need to start advancing these positions in more hospital settings. RDH
- Prendergast V, Kleiman C. Interprofessional practice: translating evidence-based oral care to hospital care. J Dent Hyg. 2015:89 (Suppl 1) 33-35.
- Prendergast V, Kleiman C, King M. The bedside oral exam and the Barrow oral care protocol: Translating evidence-based oral care into practice. Intensive Crit Care Nurs. 2013:29(5):282-90.
- Prendergast V, Hallberg IR, Jahnke H, Kleiman C, Hagell P. Oral health, ventilator-associated pneumonia, and intracranial pressure in intubated patients in a neuroscience intensive care unit. Am J Crit Care. 2009;18(4):368-376.
JOANN R. GURENLIAN, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing education programs to health-care providers. She is a professor and dental hygiene graduate program director at Idaho State University, and past president of the International Federation of Dental Hygienists.