The next 100 years

by JOANN R. GURENLIAN, RDH, PhD

It is wonderful that we are celebrating 100 years of the discipline of dental hygiene. It is exciting to think that we are alive at this point in history and have an opportunity to participate in yearlong events to mark this occasion. We have come so far, but we still have a ways to go. Therefore, I thought I would dedicate this column to the next 100 years. Let me go out on a limb and describe several scenarios demonstrating the progress we could make over the next century in our profession as we work together.

Given changes in health care and emphasis on increasing access to care for the underserved, our education will change dramatically. Our students will learn at least one more language to communicate with their clients, and will have specialized courses in cultural practices to provide care in a meaningful manner to those with other belief systems and values. The dental hygienist of the next professional century will hold a doctoral degree and work as a health-care provider incorporating multiple roles.

This new practitioner will have cross-discipline training to conduct medical and dental assessments, and will work collaboratively on triage teams to perform emergency, preventive, and therapeutic services. This dental hygienist will most likely work in a community care setting rather than the clinical practice settings we are familiar with today.

Advances in technology will ensure that fluoride is provided in all water systems, and caries and periodontal pathogens will be managed through genetic engineering. Brushing and flossing will be replaced with a new antiseptic rinse that controls biofilm and calculus formation. The concept of a "dental cleaning" will no longer exist because clients will be able to perform that care at home. The focus of oral health care will be to reduce the effects of chronic inflammation and infection on the body. Thus, within health care, the mouth will be reconnected to the rest of the body.

Because of advances in education and technology, professional accrediting bodies will no longer exist. Curriculum will be monitored by university-based agencies and centralized across the country. Review and curricular changes will occur every three years, assuring that all programs are consistent and appropriate to societal and health-care needs.

Licensure will be standardized across the country, granted upon completion of the doctoral degree and renewed every five years. Licensees will have to show proof of continued professional development. In order to maintain a license, the dental hygienist will have to participate in research programs that contribute to the body of knowledge. Outcomes will be measured that focus on the improvement of the health of the public. Those health-care disciplines that do not demonstrate this improvement will become obsolete.

Hygienists will receive full compensation for services rendered and the government will award bonuses for each community that shows consistent positive health changes over a three-year time period. These bonuses will support the continued refinement of community facilities and fund further research to maintain and/or improve health.

So, if all of this were to occur, what could you give up? Allow me to suggest the following: professional accreditation organizations, state licensing bodies, clinical practice silos, two- and four-year dental hygiene education programs, cleanings, and supervision mandates. When you recover from your syncope episode, can you imagine this? Would you be excited by this future or frightened? Would you feel challenged that your license renewal was going to be based on improving the profession and the health of the public?

Which health-care profession bases its continued existence on improvements in the public's health? None. Perhaps that could be our starting point. Rather than worrying about clinical skills, our focus for creating a new licensing process would be to create the system that supports improvements in health outcomes. Imagine presenting to a national licensing body the changes that occurred in your setting and receiving recognition for that achievement. Imagine the freedom to provide care at a high standard coupled with the expectation that our value is based on successful health outcomes.

I will venture to say that many of these ideas will not require another one hundred years to accomplish. It may take far less time if we create a focus for our profession that addresses health outcomes. We have had the first one hundred years to make improvements in our techniques. Let's make the next hundred about improving health outcomes! RDH

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 presidentelect of the International Federation of Dental Hygienists.