Oral health teams, led by hygienists, can pave way to a fresh viewpoint on prevention

Trisha E. O`Hehir, RDH, BS

In the United States, dental hygienists are a part of the dental team. In many countries around the world, though, the dental hygiene profession is just beginning, and hygienists are struggling to become part of the dental team. There is often resistance to their participation on the dental team. My question is, why do we have only one team - the dental team? There are actually sub-teams within the dental team: the perio team, the ortho team, the endo team. All of these teams focus on treating dental disease.

It is time for dental hygienists to form their own team - the oral health team.

The dental treatment team focuses on treating dental disease. The oral health team will focus on maintaining health and preventing disease. Our role in providing conservative periodontal therapy definitely fits within the dental treatment team. However, dental hygienists are the perfect team members to head up the oral health team, just as the dentist is the perfect team member to head up the dental treatment team.

We all are well aware of the roles and responsibilities of the various members of the dental treatment team. Let`s look instead at the oral health team. As the dental professional most focused and educated in preventive approaches, the dental hygienist is the natural team leader. Dental assistants will also be on the team. In some states or countries, dental assistants are trained to provide some dental hygiene services under the supervision of a licensed dental hygienist. There are also public health dentists and preventive oriented general dentists who would find the oral health team more in line with their philosophy.

The primary difference between the two teams would be their approach to dental health. The dental treatment team achieves dental health by treating dental disease and stopping disease progression after it has created enough damage to require therapy. This approach requires individualized treatment within a dental office.

The oral health team promotes basic dental health and prevents the onset of any dental disease. Health promotion and disease prevention may include oral hygiene instructions and coaching, nutritional counseling, plaque removal, placement of sealants, fluoride therapy, counseling for oral habits, and mouthguard use, to name a few. These activities can be provided for individuals, families, or groups in settings other than the traditional dental office. Can you imagine a setting with no dental chair, drill, or suction where people would come for oral health information and training? Just as people visit psychologists or counselors, they would also visit dental hygienists. It may be similar to weekly or monthly visits to a chiropractor for an adjustment to maintain health.

This wouldn`t be the traditional dental hygiene treatment of removing calculus, but, rather, preventing calculus formation. This team would be for hygienists who enjoy working with people to develop good oral health habits. It is for dental hygienists who enjoy being personal trainers. Together with the patients, they could achieve and maintain oral health. When necessary, patients would be referred to the dental treatment team for dental or dental hygiene treatment. These teams may work in the same building or office, or they may be in separate locations. Oral health teams would find locations conducive to frequent visits important.

The advantage of an oral health team from the patient`s perspective would be a nonthreatening environment. Since so many people are fearful of the dentist and dental work, this environment would allow them to seek out oral health information in a comforting setting. With the use of mirrors and intra-oral cameras, people could be taught oral self-examination for screening purposes. They would also learn the importance of seeking a thorough dental examination by a dentist in a dental treatment setting.

By separating oral health promotion and dental treatment, people would receive a clear message. Their own role and responsibility in maintaining oral health on a daily basis would be separated from the concept of treating dental disease. It would be clear that seeking dental treatment for disease does not fulfill the responsibility of daily oral health maintenance.

Many dentists don`t want patients to become wedded to the dental office in order to achieve oral health. Separating the two concepts would allow people to become more involved with their oral health team, while seeing the importance of the dental treatment team for disease intervention.

This separation of treating disease and preventing disease will become more apparent as dentistry moves further into high-tech rehabilitation. We are seeing new materials to replace the traditional silver amalgam. Soon we will see genetically engineered enamel. There are new procedures to enhance implant success and induce bone growth. Cosmetic procedures will continue to evolve at a dramatic pace, offering many more options.

Dentists will be busier than ever, not just treating disease, but also providing a multitude of cosmetic options to enhance both function and appearance.

Creating a new team within a new environment would open the way for development of new oral health care models. Dental hygiene approaches other than the six-month recall may prove to be more effective and desirable to the public. The Swedish model for dental hygiene instruction and fluoride every two weeks could be tested by the oral health team.This approach, or a better one, could be offered by the oral health team within school settings, just as after school sports or band participation are now offered.

A new team with a new environment should stimulate the creativity of team members involved. The challenge is there for educators and public health professionals to combine their expertise and experience in this area to develop new models of oral health care.

We have the science to prevent dental disease; now we need an innovative oral health team to achieve that goal. The dental hygienist is the perfect professional to take on that challenge.

Trisha E. O`Hehir, RDH, BS, is a senior consulting editor of RDH. She also is editor of Perio Reports, a newsletter for dental professionals that addresses periodontics. The Web site for Perio Reports is www.perioreports.com. Her e-mail address is trisha @perioreports.com.