by Anne Nugent Guignon, RDH, MPH
The train is out of the station. There is no turning back. While the stakeholders vie to have their voices heard and new ideas become reality, changes in the delivery of dental services provided by midlevel providers will evolve over the next few years. Access to care is the big engine driving the train.
Demographic changes in the population as well as dramatic shifts in the workforce are fueling changes. The Age Wave, a term coined by gerontologists, identifies seniors as the largest segment in the population. People are living longer and becoming more medically complex. A 50- to 60-year-old is no longer considered an elder, which creates a new group social scientists have classified as new-old rather than old-old. People are keeping their teeth longer, and the impact of oral health on total health is gaining increasing acceptance.
Dental school enrollment and the number of dental schools has dropped dramatically over the last four decades, and retiring dentists outnumber the new graduates ready to fill their spots. The exact opposite is happening in dental hygiene. New programs are popping up all over the country, graduating dental hygiene students in record numbers through accelerated curriculums that take 18 months or less in some schools.
Hygienists who live in states that require them to be employed by a licensed dentist to supervise them face dwindling employment opportunities as the pool of dentist employers shrinks. Another demographic quirk shrinks employment opportunities even further — many female dentists work shorter hours than their male peers due to balancing professional obligations with family obligations. Dental hygienists who are employed are working more years, longer hours, and often work for multiple employers, a clear reflection of today’s limited benefits and economic uncertainty.
While the traditional dental model of a team headed by a dentist will not disappear, innovative concepts continue to surface all over the country. From the RDHAP in California, to independent practice in Maine, to collaborative practice in New Mexico, to the new community dental health care coordinator in Minnesota, opportunities for dental auxiliaries to provide care are developing all across the country.
Groups such as the Kellogg Foundation, legislators, and social and community leaders play a part in the changes. The underserved in nursing homes, remote locations, school-based programs, homebound, and traditional public health clinics have been in the spotlight for years, but access to care issues will lead to more unique opportunities for us to serve.
At this point it’s impossible to predict how many types of midlevel providers there will be, but it is never too soon to develop a plan if you’re interested in becoming involved in one of the new models of care. Taking advantage of these changes means acquiring new skills, additional education, special licensure or registrations, and a comprehensive understanding of what it will take to deliver services outside of the confines of a traditional dental office.
Hygienists all over the country are becoming entrepreneurs and designing unique ways to deliver care. Two patient common denominators remain constant — needs and services. The variables are how and where the care is delivered. The key to the future is portability. Dental hygienists of the future will be allowed to deliver services far outside of the traditional treatment room.
Hygienists who have loupes, portable headlights, and cordless headpieces are already on the path to providing care in alternative settings. Both Discus Dental and Brasseler have cordless rechargeable polishing handpieces. Power scaling and suction are hurdles that are easy to overcome with the right equipment. A number of piezo electric and magnetostrictive units now come with self-contained fluid irrigation units. In a pinch, one can make a portable pressurized water delivery system using a pressurized garden sprayer and a quick-connect valve.
Suction, high-speed handpieces, patient chairs, and operator seating are the next challenges. Each one of these pieces of equipment must be portable, easy to transport, quick to set up, and easy to manage. Dental professionals who go on overseas mission trips know the drill and can operate with whatever is on hand, but providing services on a regular basis outside of a traditional office in this country requires equipment built for the long haul.
There are portable units that range from very basic units that only deliver air/water/suction, while more advanced delivery systems offer both low- or high-speed handpieces and extend the range of services that can be offered. A wide variety of options are available for portable equipment. It is important to have a game plan and to know your needs and goals for providing dental hygiene services in the field. American-based DNTL Works has a history of creating customized, portable dental equipment that is built to meet a user’s specific needs.
The concept of midlevel dental practitioners is here to stay. Many in our profession work diligently to create formats that use our talents and skills, taking us to a new level of professional challenge and creating a whole new horizon for our comfort zone. We can either embrace the change and set our sites on delivering care in new and exciting ways, or we can bury our heads in the sand and mourn the loss of dental hygiene as we knew it.
Anne Nugent Guignon, RDH, MPH, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971.
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