With a shortage of oral health-care providers on the horizon, restorative hygienists in the state of Washington are poised to help ease the burden.
In a 2005 report titled, Dental Hygiene: Focus on Advancing the Profession, the American Dental Hygienists’ Association said, “Access to preventive and therapeutic oral health care can be increased by maximizing the services hygienists are educated to provide, and expanding dental hygiene practice settings ...”1 The 2005 ADHA report defined a dental hygienist as “a licensed health care professional, who supports the health and well being of the American public through oral health promotion, education, prevention, and therapeutic services.”
As of September 2004, seven states allowed the placement of restorations by dental hygienists. They are Maine, Michigan, Minnesota, Missouri, New Hampshire, Tennessee, and Washington. However, most of these states allow only the placement of amalgam material prior to packing, carving, and finishing by the dentist. Only Washington state allows dental hygienists to not only place amalgam material, but also pack, carve, and finish amalgam and composite restorations.2
Restorative hygiene was instituted in Washington in 1971. Since then, no disciplinary issues have been brought before the Washington State Department of Health related to the placement of restorations by hygienists, according to Colleen Gaylord, chairman of the Regulation and Practice Committee of the Washington Dental Hygienists’ Association. A high level of confidence persists in the skill and training of the state’s hygienists.
The Dental Workforce Study/2001, commissioned by the Washington State Dental Association, found that approximately 28 percent of the state’s hygienists in private practice performed restorative care functions, typically for five to nine hours per month.3 Because hygienists are universally prohibited from cutting hard tissue, restorative hygienists work in partnership with a supervising dentist, completing the restoration after the tooth is initially prepared. By utilizing the restorative endorsement, restorative hygienists provide therapeutic services that enhance their value to the dental team.
Why I love restorative hygiene
I was attracted to restorative hygiene as a dental hygiene student. Thanks to a wonderful instructor and mentor, I envisioned using these additional skills during my career. After graduation, I interviewed with a large dental practice in Tacoma, Wash., that was looking for a hygienist who could administer local anesthesia, and place, condense, and carve restorations. It was then that I took on the challenge to refine skills, gain confidence, and increase speed. Over time, I have combined the science and artistic aspects of restorative hygiene with traditional dental hygiene preventive therapies.
I moved on to new employment with a dental company affiliated with three states on the West Coast, where I am currently practicing. We serve a large and diverse patient base in an area with limited access for our clients. With the aid of my management team and support of the dentist and staff, I proposed and developed a pilot program to practice restorative hygiene. The pilot has been successful for more than a year now, accepted by both the staff and patients. The company is ready to expand the pilot program to other Washington dental offices, and I am currently collaborating with administrative resources to facilitate training and implementation. Soon I will have peer hygienists, working alongside dentists, practicing restorative hygiene!
What are the benefits of restorative hygiene?
The benefits can be summed up in one word: Access! With a shortage of oral health-care providers on the horizon, restorative hygienists in the state of Washington are poised to help ease this burden. This is especially critical in specific patient populations such as the elderly, the uninsured, the underinsured, and children. Furthermore, the current regulation allows us to practice to the full scope of our licensure. After all, what is the point of extensive training in dental materials and techniques or preparing for and taking a restorative board exam if we are restricted?
Implementing a restorative schedule allows the dentist more time for other procedures. Dentists can save teeth with root canals and prosthetics, eliminate infection and pain by extracting hopeless teeth, and improve client self-esteem by performing advanced cosmetic procedures. At the same time, my restorative patients report that they appreciate the beautiful esthetics of cosmetic resins and the functionality of the restorations that I have mastered. Not to mention the satisfaction that I, as a clinician, have when I help to complete a treatment plan and the client is restored to optimal oral health.
I also use this opportunity as a springboard to educate patients about the prevention of oral disease. Traditionally, clients have recognized hygienists as simply “tooth cleaners.” By utilizing restorative and expanded duties, I have gained credibility with clients and peers by moving closer to providing total care.
I have immensely enjoyed the variety that restorative hygiene allows me as an adjunct to the traditional dental hygiene therapies I practice one day a week. I consider myself fortunate to have had the opportunity to implement new processes within my office. I am excited about the prospects of mentoring fellow hygienists to challenge themselves to a different level of care for their clients.
Given the documented impending shortage of dental professionals, it is clear that the past methods of delivering oral health care are no longer going to be adequate. The patient population is increasing and the population of dental professionals is shrinking.
Trained hygienists in Washington state have practiced restorative hygiene for decades without adverse incidents. This can be used as a model of how dental hygienists can rise to meet the challenge, using the skills and knowledge acquired through training in dental hygiene schools, study clubs, and continuing education courses. By allowing dental hygienists to practice to the extent of their educational training and competencies, they benefit the population at large and the individual dental offices where they work.
Stan Hutton, RDH, has been a practicing dental hygienist for 16 years. He works at Willamette Dental Group. Mr. Hutton is a graduate of Clark College in Vancouver, Wash., and is a member of the ADHA.
Viki A. Points, MPH, RDH, graduated from Mt. Hood Community College in Gresham Ore., in 1990, and Portland State University in 2005. She is licensed to practice in both Washington and Oregon. She has been employed as a clinical hygienist for Willamette Dental for the past 14 years, 10 of those as a lead hygienist. She is completing the requirements for LAP credentials and hopes to work outside of the clinical setting with underserved populations in the near future. She serves as a member of the Government Relations Council and Public Affairs Committee of the Oregon Dental Hygienists’ Association and is an Advisory Board member to the Pacific University School of Health Sciences.
Cara Kao-Young, RDH, BSDH, LAP, has been hygienist for 15 years. She graduated from Portland Community College with associate’s degree and a bachelor’s degree from Eastern Washington University in 2001. She worked as dental hygiene administrator before teaching dental hygiene and Community Oral Health at PCC.
1 American Dental Hygienists’ Association. (2005, June) Dental hygiene - Focus on advancing the profession. Retrieved July 5, 2005, from www.adha.org.
2 State Practice Acts. (2004, July) Dental hygienists restorative duties by state. Retrieved September 15, 2004, from www.adha.org.
3 Washington State Dental Association. (2001) Dental workforce study. Retrieved June 24, 2005, from www.wsda.org.
Gaylord, C. (2005, March) E-mail from Melissa Johnson to Kristen Simmons. Retrieved March 3, 2005.
Hutton, S. (2005, June) Restorative hygienist, Willamette Dental, Silverdale, WA. Personal interview, June 30, 2005.Tips for restorative hygiene
Basic restorative techniques are taught in dental hygiene school, but how do you get beyond the basics? Working alongside a variety of dentists, reading journals, attending workshops, and reading instruction sheets accompanying the dental materials have been invaluable to me.
More important, however, is the physical manipulation, placement, and carving of the materials that help achieve the confidence and speed that make restorative hygiene a viable part of a dental practice. There is no substitute for experience; typodont practice is an excellent start. I advise starting with small restorations - one or two surfaces in composite, amalgam, and glass ionomer. With each restoration comes confidence and the ability to move on to more challenging fillings.
Restorative materials are constantly changing. New materials come with an MSDS and instructions for technique considerations. Read and apply these, even if it requires practice with a typodont. Know the material you are working with and its physical properties; for example, does it release fluoride? Does it contain glass particles? Can you layer this material over another?
I assure you, patients will ask the above questions. When you give an educated answer, your credibility rises. You may even be able to share these techniques with your dentist! Use the high-speed handpiece to shape, carve, and smooth restorations with a variety of burs, and become accustomed to how a high-speed handpiece reacts with different materials. Many hygienists I have talked with seem intimidated by the high-speed handpiece, but with a little practice, you could be restoring a tooth to its original anatomy in no time.
Restoration of the original anatomy is always challenging. Again, dental hygiene students are educated and well trained with knowledge in dental anatomy, according to ADA accreditation standards. As with most things in life, the more you practice, the better you get.