In the United States, the delivery of dental care involves different private and government entities. Many hygienists are familiar with private dental practices and insurance companies, but many are not as familiar with the government agencies that influence dental care. Various federal, state, and local government entities deal with dental care issues. Departments on the federal and state levels influence dental care, and local agencies often provide dental care to the population.
* Federal influence - Although state practice acts and dental boards govern dental hygiene practice, the federal government does influence dental care provided to many citizens. Dental hygienists can work as practitioners, health educators and promoters, and administrators in a variety of federal positions. Currently, hygienists may work in dental clinics with the Department of Veterans Affairs; in federal prisons and camps with the Department of Justice; within the Department of Agriculture's Women, Infant, Children Program (WIC); and at military bases (Department of Defense) around the world.
Hygienists can work in many of these positions as independent contractors, for a dental employment agency, or positioned as civil servants through the Department of State.
Fittingly, the Department of Health and Human Services provides the most career avenues for the dental hygienist. The HHS is the government's principal agency for protecting the health of all Americans and providing essential human services, especially for those least able to help themselves. The HHS is divided into two operating divisions, the Public Health Services Division and the Human Services Division.
The Public Health Services Division includes:
- The National Institutes of Health (specifically, the National Institute of Dental and Craniofacial Research, which is responsible for dental research)
- The Food and Drug Administration
- The Centers for Disease Control and Prevention
- The Indian Health Services
- The Health Resources Services Administration
- The Agency for Toxic and Substances and Disease Registry
- The Substance Abuse and Mental Health Services Administration
- The Agency for Health Care Policy and Research
Additionally, dental hygienists with a bachelor's degree may be commissioned as public health service officers with the Public Health Service. Commissioned public health service officers work in a variety of positions - including clinical, educational, and administrative areas - depending on educational level and experience. These positions offer a variety of employment settings in a multitude of locations around the United States.
The Human Services Division includes the Health Care Finance Administration, which encompasses Medicaid and Medicare. Medicaid generally funds dental care for the indigent population. Hygienists may work for clinics, practices, schools, and nursing homes that primarily care for patients utilizing Medicaid insurance, or they may work in an administrative capacity for Medicaid. The Administration for Aging is responsible for enhancing and supporting the older population's independence, and the Administration for Children and Families is responsible for Early Head Start and Head Start programs. These agencies are also included in the Human Services Division. Early Head Start and Head Start consult with dental hygienists on dental issues and, in some states, hire dental hygienists to provide dental hygiene services.
- State influence - Individual states regulate the practice of dental hygiene and dentistry by the state practice acts or statutes (law), as well as by the rules and regulations developed by the dental boards or dental consultants. Dental directors, who generally work within the state health departments, provide consultation and develop state programs. In many states, dental hygienists are able to work as the state dental director. State prisons, Medicaid programs, Children's Health Insurance Programs, and state institutions may also employ hygienists.
- Local influence - Locally run day-care facilities, Early Head Start and Head Start programs, school, tribal dental clinics, and migrant clinics may also employ hygienists as clinicians, educators, and/or administrators. Many hygienists who work in these settings have initiated their own dental hygiene positions. Great opportunities are available in these and other settings for hygienists who are willing to develop a dental hygiene position and work on securing funding via government or private grants or through Medicaid or CHIPS reimbursement. Developing such positions requires community involvement skills that the professional dental hygienist possesses.
Although dental-care delivery in the United States is most often practiced in the private dental sector, many positions are available in federal, state, and local government agencies. An exciting career move for the hygienist would entail the development of the first dental hygiene position in one of these settings. Hygienists can prove very effective in delivering dental care to a variety of populations in these settings.
Christine Nathe, RDH, MS, is the author of Dental Public Health: Contemporary Practice for the Dental Hygienist. For more detailed information on a variety of career avenues for the dental hygienist, the book can be referenced at Prentice Hall's Web site at http://www/prenhall.com/DENTAL or at http://www.amazon.com. Nathe is an associate professor in the division of dental hygiene at the University of New Mexico. She can be reached by e-mail at cnathe@salud. unm.edu.
