2010: Hygienists Odyssey

Dec. 1, 1995
If you`re a recent graduate, you will still be working hard in the year 2010. But will it be a labor of love in your chosen profession? As you make your resolutions for 1996, don`t forget to make some professional resolutions too. After all, dental hygiene is poised for great things in the next 15 years.

If you`re a recent graduate, you will still be working hard in the year 2010. But will it be a labor of love in your chosen profession? As you make your resolutions for 1996, don`t forget to make some professional resolutions too. After all, dental hygiene is poised for great things in the next 15 years.

Help make it a reality.

JoAnn R. Gurenlian, RDH, PhD

As we prepare for a new year, it is customary to take a moment to reflect on the past and to make resolutions for the future. Given that we are close to a new century, perhaps our professional resolution should be focused on establishing the future of dental hygiene.

Picture this scenario. The year is 2010, a mere fifteen years from now. In some ways it is hard to imagine what dental hygiene will be like by 2010. Nevertheless, 1996 graduates will be only thirty-something with at least 30 more years of career time available.

So what might dental hygiene look like in the next century. Imagine the changes in health care, science, and technology that can occur within a 15 year time span. Dental hygienists will be working in health-care centers in interdisciplinary teams. Clients will present for a dental hygiene assessment and prevention appointment on a yearly basis as part of a comprehensive physical examination unless a prevailing oral health condition necessitates a therapy appointment.

Many individuals will conduct oral cancer self-examinations on a regular basis at home. Thanks to advances in genetic engineering, they will also conduct at-home caries and periodontal disease activity tests, contacting the hygienist when their pathogenic organism levels have increased. Further, they will have equipment available to debride their mouths (at least supragingival areas) and remove stain as needed. Children will have their teeth sealed using laser devices, and diet and home-care patterns will have changed to the extent that caries will be nearly eradicated.

Impossible, you say? Perhaps, but my sense is that this scenario is barely scratching the surface of possibilities for the year 2010.

Determining the future

How do we determine the future of dental hygiene? There are two approaches that can be taken relative to the future of dental hygiene. One option is to plan the future; the other option is to let others plan the future for dental hygienists. This latter option might be called the "que sera sera" technique and is ill advised.

In attempting to make decisions about the future of the dental hygiene profession, consider using the scenaric approach pioneered by Peter Schwartz and described in his book, "The Art of the Long View." Schwartz defines scenarios as a tool for making better decisions about the future.

With this approach, one creates three scenarios or stories about the way in which the world of dental hygiene might be tomorrow. These stories enable one to recognize and adapt to changing aspects of the present environment. The advantage of scenarios is that it allows the hygienist to consider different pathways that might occur in the future and to find the appropriate movements down each of the possible paths. Thus, the hygienist can be prepared for whichever scenario happens.

Schwartz advocates that scenarios help people "re-perceive" the world. Given that the future is uncertain, he proposes that we question our assumptions about the way the world works so we can see the world more clearly. Scenarios can help us change our view of reality - to broaden our perspective of reality as it is and as it is going to be.

To create a scenario involves a process of refining a decision, conducting some research, gathering information about key elements, trying on various plots, and rehearsing the implications of the scenario. In order to make decisions about the future of dental hygiene, we must be able to articulate decisions being considered and the mind-sets we use to make judgments about the future. For example:

- What is the future of genetic engineering and how does it relate to advances in oral health?

- How will managed care affect the practice of dental hygiene?

- What skills will hygienists need to meet the challenges of a changing health care environment?

- What is it that interests you about the future of dental hygiene?

- What characteristics of yourself might lead you to make a decision about your future that has poor results?

- What factors could lead you to change your mind about the future of dental hygiene?

Focusing on the above questions can help us identify the mind-sets we tend to use in decision making. A mind-set involves the attitudes we have about every situation and person we experience. Reflecting on our mind-sets offers us a chance to research how our thinking influences our reality.

Mind-sets can be powerful enough to influence people to ignore reality. For example, does your mind-set tell you that you have all the skills needed to practice dental hygiene in the future? If so, are your computer skills current enough that you would feel comfortable using an electronic mail system to contact a physician and discuss contraindications for treatment of a particular client?

Identifying those mind-sets enables us to see how we hold ourselves back from considering possibilities. In addition, it reveals our talents for considering options that would not have occurred to another person.

Once our questions and decisions have been explored, we are ready to conduct research and gather information that will enable us to create scenarios. Begin by examining the driving forces that are influencing oral health care. Consider how society, technology, economics, politics, and the environment are affecting oral health care in general and dental hygiene in your area.

We know that our population parameters are changing. Will the needs of the ever increasing geriatric population be different from the pediatric population? How will dental hygiene respond to those changing needs?

We know that politics support managed-care systems. But, how will the upcoming national elections alter laws relating to health care?

When the driving forces have been examined, it is time to identify the predetermined elements and the critical uncertainties. Predetermined elements are those areas that seem certain to occur regardless of the scenario created. For example, prevention seems to be of paramount importance in health care. One can imagine that prevention will be of primary focus for any health-care system of the future.

Critical uncertainties help us prepare for the `what ifs.` This technique has proved very useful in strategic warfare. An armed force may anticipate that opponents will attack a given area. What they need to plan for is that the attack may occur by land, air, or sea using guns, laser devices, or biologic organisms. Planning for uncertainties will help you be prepared to manage the future.

What are the uncertainties for dental hygiene? Consider the following possibilities. With all the allied health professionals in existence, the focus on prevention, and the advances being made in technology, there will not be a need for dental hygienists. Another alternative might be that with dental hygienists serving as preventive oral-health specialists and physicians performing oral and maxillofacial surgery, there will not be a need for dentists.

The next phase of scenario building is to create several plots or stories about the future considering the mind-sets, driving forces, predetermined elements, and critical uncertainties. In creating these plots, it may be useful to consider three points of view: the optimist, the pessimist, and the status quo. In other words, one scenario can focus on unexpected breakthroughs and triumphs that might occur. Another scenario can explore the traps that will exist on the path to success, while a third scenario will focus on recognizing changes as they occur and understanding their significance. Using this approach, the three scenarios on page 14 are offered as possibilities for the future of dental hygiene.

When the plots have been created, the last step of the process is to rehearse the implications of each scenario. This step helps the hygienist become accustomed to the idea of the changes proposed and can assist in preparing for those changes.

Scenario building is an effective way of preparing for the future of dental hygiene. It involves a process of reflection and insight that is meant to explore options and prepare for the unknown. What will the future of dental hygiene be? Not being a futurist nor a prognosticator, my response would be "that depends." If we do not plan our future, Scenario 2, as outlined on page 14, most likely will occur. On the other hand, my recommendation would be to conduct a workshop with some futurists and experts in strategic planning, the thinkers in dental hygiene as well as the doers, with the intention of increasing the likelihood that opportunities such as Scenarios 1 or 3 might occur. Ultimately, the future of dental hygiene depends on you, individually and collectively. I for one welcome the challenge. How about you?

JoAnn R. Gurenlian, RDH, PhD, is president of Gurenlian & Associates. She provides seminar and consulting services for health-care practitioners.

Three scenarios depict hygiene`s future

Scenario 1: Staying on top

Self-regulation of dental hygiene is achieved in a majority of states, and dental hygiene practice acts are broadened in scope. Consistency among states has been promoted to eliminate the disparity of services rendered between the East Coast and West Coast.

By the year 2010, hygienists will take a national written examination every five years for relicensure. The clinical examination will have been eliminated. In order to maintain licensure, continuing education will be mandated with consistent requirements occurring on a national basis, and the hygienist must be a member of the profession`s national organization.

In addition, the accreditation of dental hygiene programs will be managed by the dental hygiene profession. Educational parameters for dental hygiene will be refined and advanced to reflect changes in technology, populations, health-care systems, etc. The majority of programs will be four years in length and doctoral education in dental hygiene will have emerged.

Research in dental hygiene will be a significant component of clinical practice and education.

Scenario 2: A hard road ahead

Federal research monies dry up by 1999, leaving a paucity of resources available for dental hygienists to explore opportunities in oral-health research.

Organized dentistry institutes a five-tiered auxiliary system that effectively eliminates the need for dental hygienists in private practice settings (although hygienists will still function in other arenas in a limited capacity). All four-year entry-level dental hygiene programs will be eliminated and the need for degree-completion programs will dwindle.

Specialty areas in dental hygiene education - such as research, management, and public health - will no longer be taught due to changes in federal and health-care priorities.

Many clinical practitioners will either function as dental assistants or leave the profession entirely. Some hygienists will further their education and become dentists or physicians.

The "think tank" of dental hygiene (those movers and shakers) will become discouraged and retire. By the year 2010, there will be an estimated 20,000 dental hygienists in the workforce.

Scenario 3: A so-so outlook

Self-regulation will be achieved in 30 percent of the states with a variety of options for regulating practice acts. Research in dental hygiene will take on greater importance with more clinical practitioners collecting outcomes data related to client care.

Although the clinical examination for licensure will still exist, the regional boards will have combined their resources and techniques to create one examination organization. Improvements in the content and conduct of the clinical examination will be noted.

Greater emphasis will be placed on changing the structure of dental hygiene education to ensure that students and licensed hygienists can meet the newly revised and adopted standards of practice.

In addition, hygienists will be retrained to meet the challenges of managed oral health-care systems. These hygienists will assume roles as administrators, researchers and clinicians.