We just told Congress that we?re ready to serve, so why are we talking about dogs and cats?

I have been an enthusiastic proponent of the ADHA ever since I was a student. I have been a past constituent president and currently serve as a national delegate. I urge membership whenever I get the chance (like right now). They are our national voice. We need them.

Heidi Emmerling, RDH, MA

I have been an enthusiastic proponent of the ADHA ever since I was a student. I have been a past constituent president and currently serve as a national delegate. I urge membership whenever I get the chance (like right now). They are our national voice. We need them.

However, as with membership in any organization, I do not agree with all of its policies. Case and point: their established liaison with the American Veterinary Dental College.

I find it a shame that the ADHA feels hygienists can?t find enough underserved patients to treat in the human population. This surprises me in light of ADHA?s overwhelming support of national healthcare reform and managed care. Shouldn?t we conserve our resources to meet those needs?

According to testimony from the Coalition for Oral Health (of which, I am proud to report, ADHA was a member) presented to the House of Representatives, middle class Americans live in fear that the loss or change of job means the loss of insurance. They provided numerous examples of unmet dental needs.

A Head Start program health coordinator noted a child in the program who was demonstrating what was believed to be anti-social behavior. This also was the only child whose parents had not arranged for the required dental exam and follow-up care. When the program staff got the child to a pediatric dentist, they found advanced decay, multiple abscesses, and broken teeth. The problems were so severe that the child had to be treated under general anesthesia in a local hospital. Within one week after treatment, this little boy responded to the teacher and played with his classmates.

A young man with cerebral palsy and mental retardation had lived at home most of his life. His mother drove him to the closest dental school (110 miles away) for his dental care. When she died, he was placed in a philanthropic nursing home. He was able to continue medical care, but no arrangements were made for dental care. He eventually suffered from advanced dental caries. However, no funds were available to pay for the oral surgeon, the anesthesiologist, and the operating room. Fortunately, a dental staff member at a local health department negotiated fees and was able to acquire necessary funds from a private foundation.

Residents of nursing homes across the country have little or no access to preventive dental care. Although medical care is required for Medicare and Medicaid certification, nursing homes have more limited responsibility for dental care. One 23-year-old female for whom staff was especially concerned had not been eating and was lethargic. She had teeth rotted to the gums and multiple abscesses. Although surely suffering from intense pain, she did not have the ability to express the nature of her problem. It was determined that she would require a substantial amount of dental care in a hospital setting under general anesthesia. The family lacked the funds it would cost for the operating room. It was two weeks before arrangements could be made within the system so that this woman could receive the care that she needed.

In all of these cases, cost-effective preventive dental hygiene would have prevented these sad stories. Many examples exist of where the absence of preventive treatments places patients? welfare and, potentially, their lives in jeopardy. Dental caries, gingivitis, and periodontitis can be prevented through regular preventive care. Hygienists need to be able to intervene. We need to be able to break down the restrictive barriers to our state practice acts that prohibit us from treating these people.

With this important task before us, why are we focusing on animals? Does this not divert resources of energy and money away from more pressing goals of interest to the members of the ADHA?

I called the ADHA and spoke with several divisions: professional development, communications, and the executive office. None of these divisions could confirm a pressing interest of their members to establish this liaison. I was told the decision to establish the liaison was strictly the president?s prerogative.

I conducted my own admittedly informal survey among colleagues and found very little interest in this as a full-fledged career. One hygienist tells me he was approached by a vet. Apparently, the vet quickly changed his mind when the hygienist told him what the salary requirement was for a registered dental hygienist. The vet explained that what he normally pays fully qualified animal health technicians (AHTs who are qualified to administer drugs or do blood work-ups on the animals) was less than half of the going rate for a registered dental hygienist ... and the vet would not even pay that amount since my colleague was not an AHT.

It seems registered dental hygienists are considered to be Ounregistered assistantsO in many state veterinary practice acts. Several of my high-school educated patients clean dogs? teeth at the vet?s. Are registered dental hygienists in the same league? After working so hard to become licensed and registered I fail to see the appeal of pursuing a position which labels us Ounregistered assistants.O

Several veterinarians have explained to me that dental hygiene procedures are great for show animals that need periodontal therapy. However, the relatively short lifespan of most domestic animals makes perio a mute point for the vast majority.

Sure, we are always curious about alternative careers. I can see how hygienists might want to dabble in veterinary hygiene as a boredom release, a hobby, or a sideline. However, I do not see the demand for this as a career path hygienists are clamoring to pursue. I question what the sanctioning of this liaison by our official organization costs us not only monetarily but professionally. Hygienists are licensed educated professionals who have many people demanding our services.

Let?s meet those needs first.

Source: Statement of the Coalition for Oral Heath submitted to the Subcommittee on Ways and Means, U.S. house of Representatives. March 30, 1993.

Heidi Emmerling, RDH, MA, is a consulting editor for RDH, a writer, speaker, and clinician from Sparks, Nevada. Her e-mail address is heidi@unr.edu.

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