Staying near the schoolyard

Through a variety of public health efforts, hygienists help prevent disease.

Although caries and periodontal diseases are preventable, dental health in the United States remains an issue. In fact, the consequences of this widespread problem are alarming.

For example, caries is one of the most common childhood diseases. Among 5 to 17 year olds, caries is more than five times as common as asthma and seven times as common as hay fever. Approximately 85 percent of 18 year olds have experienced dental decay. Even more unsettling is a report that more than 80 percent of dental decay was found in 25 percent of this population. In addition, these children are from lower-income households, ethnic minorities, and, many times, have special needs. Children too often face challenges when trying to access dental care.

The proportion of adults with at least one site of periodontal attachment of 2 mm or more ranges from 37 to 96 percent, depending upon age. In addition, gingivitis is seen in most Americans, and a particular focus is on the increase of juvenile periodontitis. Emergency rooms also are treating larger numbers of children due to dental disease. Untreated dental disease results in children who have constant pain, difficulty eating, difficulty speaking, chronic infections, increased use of pain medicine, and embarrassment over the esthetic condition of their teeth.

Unfortunately, the children who most need dental care are not receiving it. Dental hygiene treatment can help alleviate this problem, particularly in states where hygienists can provide care as outreach workers.

Hygienists as outreach workers

The elementary school setting was one of the first in which dental hygiene was practiced in the United States. Dr. Alfred Fones, the founder of dental hygiene, thought that hygienists in schools could prevent dental disease from occurring. In addition, he felt that hygienists would refer patients in need of treatment to the private dental office. By placing hygienists in the "field," more patients could be educated on the importance of preventive home care. In addition, more patients could receive information on the dental problems they experienced, and improve the likelihood that they would seek treatment from a dentist.

Hygienists who work in the capacity of an outreach worker treat children in WIC programs, community primary care clinics, Early Head Start and Head Start Programs, private day care/preschool centers, and in elementary schools.

WIC stands for the Special Supplemental Nutrition Program for Women, Infants, and Children and is part of the U.S. Department of Agriculture. Most state WIC programs provide nutritional counseling and vouchers that participants use at grocery stores. Hygienists in many areas of the country collaborate with WIC nutritionists in providing preventive dental education and screenings.

Hygienists also work in an interdisciplinary fashion with local community primary-care clinics. This is a setting where hygienists can easily access pregnant women, infants, and children to provide dental education and hygiene services.

Early Head Start and Head Start programs are funded by the U.S. Department of Health and Human Services, Administration for Children and Families. They provide educational, social, medical, dental, nutritional, and mental health services to pregnant mothers and children up to five years old from low-income families. In many of these settings, hygienists provide education, examinations with dental referrals, cleanings, fluoride applications (varnishes or topical fluoride applications), and sealants.

The pediatric dental office

Many pediatric dental offices employ hygienists to provide education and preventive treatment to patients. But in many states, unfortunately, pediatric dentists do not routinely employ hygienists. The reason may be that pediatric dentists choose to have dental assistants provide polishing, while dentists themselves take on the responsibility of debridement. Interestingly, pediatric dentists routinely employ hygienists in states where assistants are not allowed to provide polishing services.

Many states allow dental assistants to provide "coronal polishing." In some of these states, it is mandatory to complete a continuing education course on coronal polishing. However, many states do not have this requirement.

On the other hand, hygienists have specific training in providing comprehensive dental hygiene care to pediatric patients. In fact, according to the Commission on Dental Accreditation, it is a mandatory standard that hygienists be educated in pediatric dental hygiene.

By educating and treating pediatric patients, the hygienist instills the value of preventive dental care and focuses on individualizing the treatment these patients receive. In many pediatric dental offices, this young segment of the population is not able to access the services of the educated expert in preventive dental services.

Working collaboratively with social institutions, health-care workers, and dentists, hygienists can prevent many dental diseases. Hygienists should be available in community primary care clinics, WIC programs, Early Head Start and Head Start programs, and elementary schools. Adding dental hygienists to these organizations would reach an unprecedented number of American children in need, as well as placing value on prevention. By increasing the number of hygienists employed in pediatric offices, we would have the educated expert treating many of our children by practicing state-of-the-art dental hygiene. Collaboration seems the most logical way of providing care to our youngest citizens.

Christine Nathe, RDH, MS, is an associate professor at the University of New Mexico Division of Dental Hygiene in Albuquerque. Nathe also wrote about pediatric dental hygiene in the book, Dental Public Health: Contemporary Practice for the Dental Hygienist (Prentice-Hall, www.prenticehall.com). She can be contacted at cnathe@salud.unm. edu.

References available upon request.

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