The workforce evolution

May 1, 2009
In the 2003 document “A National Call to Action to Promote Oral Health,” the U.S. Surgeon General called for an increase in oral health

by Christine Nathe, RDH, MS
[email protected]

In the 2003 document “A National Call to Action to Promote Oral Health,” the U.S. Surgeon General called for an increase in oral health workforce diversity, capacity, and flexibility. Specifically, it was stated that public and private partnerships should collaborate on how to extend or expand workforce capacity and productivity to address oral health in areas with a health care shortage.

Since 2003, several models have been developed to address this call for action. In Alaska, a dental health therapist was developed by the U.S. Public Health Service to provide restorative and urgent dental care to those in rural or underserved areas. The American Dental Association developed a concept that includes additional dental team members that work under dentist supervision to provide educational and limited restorative intervention.

Of most interest to dental hygiene is the Advanced Dental Hygiene Practitioner (ADHP), developed by the American Dental Hygienists' Association, which is a midlevel dental provider comparable to a nurse practitioner. The ADHP is a dental hygienist with advanced education who also has the skills to reduce dental infections by delivering secondary preventive care. This provider has a master's degree.

Like medicine, dentistry is evolving. Historically, physicians were known as “black bag” doctors who traveled in a very rural America. In past times, people thought of hospitals as being staffed by doctors and nurses. Since the 1800s we have witnessed an evolution in medicine. We no longer think of the “black bag” doctor. We think of an OB-GYN, dermatologist, anesthesiologist, radiologist, and numerous other specialties. We don't consider hospitals as staffed with only doctors and nurses, but a variety of providers including nurses of varying levels, physical therapists, respiratory therapists, radiology techs, dieticians, and more. We know doctors are the experts in their area, but we also recognize that additional health practitioners are integral in providing accessible and comprehensive care.

Dentistry evolved, as medicine did, with our ever changing society. Although dentistry began with local dentists delivering primarily urgent dental care, U.S. dentists now deliver unmatched comprehensive restorative and cosmetic care. Dentistry has prospered. Americans now place unprecedented value on a beautiful smile.

Another positive development in dental care has been the introduction of dental hygiene less than 100 years ago. Dental hygiene introduced the public to prevention, a unique concept to the healing sciences.

In fact, Alfred Fones, the founder of dental hygiene, stated that the results secured by dental hygienists in private and public services, particularly public schools, afford incontrovertible proof of the value of dental hygienists. As dental hygiene continues to grow, Americans value the care delivered by dental hygienists.

We continue to improve restorative and cosmetic dental care, and have added prevention, yet we still have unmet dental issues in the U.S. Many populations do not receive any dental care, and some populations have difficulty accessing dental care. To complicate matters, the U.S. has a growing population and a shrinking number of dentists.

To address these issues, we must envision positive growth in the dental field. We could develop a new level of dental hygiene care that includes primary and secondary prevention. We could have a provider that focuses on prevention, but also stops infection and pain. This provider could help manage patients' dental care so that people do not fall through the cracks, and all patients would be provided primary and secondary preventive care. This provider could be educated at a level that is congruent with other midlevel medical providers.

With the growth of dentistry comes more nondentists providing care, and the growth of other professions. Instead of trying to stop this positive growth, let us work together to proliferate and expand in ways that will help all of us provide care to all of society.