An innovative approach to dental hygiene

Aug. 1, 2000
Not one of the 75 people attending my presentation had ever experienced a visit to the dental hygienist — as we know it!

Not one of the 75 people attending my presentation had ever experienced a visit to the dental hygienist — as we know it!

Trisha E. O`Hehir, RDH, BS

Recently, I visited a dentist friend in Hungary. My friend lives in the town of Szeged, in the southern part of Hungary, close to the Croatian border. When her colleagues at the University of Szeged learned about my visit, they wanted to hear more about dental hygiene and options for the profession in Hungary. A presentation was arranged for dental school faculty, other university professors, and those in private practice, who were interested in learning more about our profession.

Due to the complications of language translation, a 30-minute presentation was requested. A half-hour before my presentation, I met with the president of the Hungarian Dental Association. This prestigious position is not an elected office, but rather an appointed position. It usually goes to an older, experienced dentist. He spoke English, and we chatted about the future of dental hygiene in Hungary. After our discussion and the presentation, he said repeatedly, "We have to change our thinking!"

Dental hygiene — as we know it — does not exist in Hungary. The country has a two-year, dental-assisting program and a two-week dental hygiene program. Yes, you read that right — two years for dental assisting and two weeks for dental hygiene!

Not one of the 75 people attending my presentation had ever experienced a visit to the dental hygienist, not as we know it! I never did find out what is included in the two-week course, taught by dentists who have never experienced dental hygiene. This program is offered in Budapest and not in Szeged. My next visit to Hungary definitely will include a visit to the school in Budapest.

It was indeed a challenge to explain the profession of dental hygiene and lay out a plan for Hungary, all in 30 minutes, with pauses after each sentence or thought for translation! I decided to cover just three points: 1) how dental hygiene began in the United States, 2) philosophical differences between dentists and hygienists, and 3) the potential for Hungary to be a world leader in oral health by developing a new dental- hygiene model.

Dental hygiene in North America actually began with independent prevention specialists who would make house calls with dental silk and orange-wood sticks. These prevention visits were designed to teach oral hygiene and remove bacterial plaque. Soon after this independent start, dental-hygiene education was brought into the dental-school setting, where it incorporated therapy as well as prevention. Current education and licensure focus primarily on calculus removal and secondarily on prevention. At this point in my presentation, I gave a snapshot of the education of dental hygienists and a listing of the services provided during a typical dental hygiene visit.

The second point I wanted to make was the philosophical conflict between dentists and hygienists. We have seen the ramifications here in the United States, as well as in other countries around the world. No matter where the North American Model of Dental Hygiene is introduced, conflict arises between dentists and dental hygienists. This conflict usually focuses on control and supervision.

There is a philosophical difference between treating disease and preventing it. Dental hygienists basically are dedicated to preventing dentistry, not exactly the goal of dentists. Dentists need dental disease to stay in business and pay the bills. If hygienists were left on their own to achieve the profession`s fundamental goal of preventing disease, I believe we would see an entirely different approach.

There are several reasons why the North American Dental Hygiene Model is not appropriate for Hungary. The first reason is very practical - dental offices are not built with dental hygienists in mind. Offices don`t have an operatory for the hygienist. This has been a problem, for example, in New Zealand, where new graduates have a hard time finding dentists to employ them.

Next, treating adults with periodontal disease is a shortsighted goal. Preventing dental disease is a better investment than treating it. Long-term goals for oral health in Hungary should focus on the children. The next generation should be the focus. Placing value on oral health can be taught to the children now, making oral health something fun and desirable. Oral health needs to be "Disney-fied," if you will. It needs to be part of sports and fashion.

Hungary has a wonderful opportunity to learn from others` experiences and to create a new, effective oral-health professional ... one that can then become the model for other countries. With this introduction, I suggested that dental hygiene be divided into two professions in Hungary: the oral-health therapist and the periodontal therapist. With no previous experience, Hungary is free to develop new models for dental hygiene. My vision for Hungary is the establishment of a strong, primary prevention program to ensure oral health for the coming generation.

The new oral-health therapist should have the skills to keep children free from dental disease and, at the same time, provide a new profession with employment opportunities. The periodontal therapist would be developed after successfully launching the profession of oral health therapist. Education for the periodontal therapist would build on the oral-health therapist program. It would be incorporated into the dental-school curriculum, perhaps 10 years later. I envision a 10-to-1 ratio between the number of oral-health therapists and periodontal therapists.

This will require a dramatic change in thinking. Hungary lived under Communist rule for 50 years, moving to a democracy only 10 years ago. Adults in Hungary feel dental care should be provided by the state and should be free-of-charge. Unfortunately, the dental profession also feels this way! They would like the government to provide the funding for both dentistry and dental hygiene; however, the government has very little money.

Now is the time to take prevention out of the dental model and provide exciting, fun, and desirable approaches that people will want to pay for. You`re probably laughing at this right now! Are you thinking, prevention isn`t fun and people will never pay for it? That`s traditional thinking.

People don`t want to pay for prevention as we know it, but what if it were fun and exciting? Can you imagine highly successful oral-health centers in every shopping center in the world? If you can, you`re on the right track. Prevention, as we know it, may not be fun and exciting, but with a little imagination, it could be. Hungary may be just the beginning!

People involved with higher education in Hungary are eager to pursue the new profession of oral health therapist. The next step is to develop a proposal detailing the profession, complete with educational requirements and employment opportunities. This proposal then will go to the university and the government for approval and educational funding. These are exciting times for oral health around the world.

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 She can be reached by phone at (800) 374-4290 and by e-mail at [email protected].