It's no secret that I'm an advocate for improving oral care in dependent adult populations. I'm in it so deep that I refrain from using the term "geriatric" because younger people are in dependent living situations too, and have a much bigger problem because they often have many more teeth. Dependent people need better oral care.
Dr. Gurenlian's article in the April 2011 issue of RDH posed an idea for increasing oral care by offering increased "training in geriatric oral health care as part of the curricula in dental and dental hygiene programs." Not a bad idea, if the questions on the national board exams reflect that training. Here's the thing: the schools have to prepare students for the national board exam – that's it.
What we need – to follow the nurses' model – are specialty dental hygienists and dentists (post-graduate specialty training in the oral care of dependent adults, and a special designation). Established dental hygienists could take on a separate designation and leave room for the new graduates to hone their skills in a general dental office; they graduate as safe beginners.
But, no. There are few states that offer this advanced training, designation, autonomy, or the oversight by anyone other than a dentist. There are currently no traditional dental hygienist jobs in almost 100% of the markets in the United States today. Schools are graduating new dental hygienists at an alarming rate. The ADHA has even initiated a letter writing campaign to alert CODA of the glut.
This comment may sound like rabble rousing – it may be time to reflect on the benefits of having a dental hygiene license at all. Even with advanced training or more primary training in school, unless the resident comes to the office, there is currently no way to put that education into practice. In most states, a dental hygienist risks his/her license by simply brushing and flossing a resident's teeth without an examination by a dentist during the preceding 12 months.
In order to meet the goals identified by Dr. Gurenlian, we must attempt to address the following aspects of this problem:
- Education of medicine
- Financial benefit to the facilities
- Legislation so dental hygienists can access residents
- Increase dental hygiene research and publication to prove outcomes
- Remove the focus from treatment to prevention
- Public awareness, so guardians will release funds for oral care
Oh, and to put Dr. Gurenlian's mind at ease, fewer than 10% of people end up in skilled nursing facilities.
Shirley Gutkowski, RDH, BSDH, FACE
Sun Prairie, Wisconsin
The letter from E.J. Neiburger, DDS, (March 2011 issue) reeks of animosity and lack of respect for dental hygienists. His name calling is abhorrent, and he seems to blame hygienists for the current economic problems in the dental field. If only we could work faster and faster doing 30 minute "cleanings," then his problems would be solved. Let's see: Five minutes to seat the patient and go over the health history, 10 minutes for X-rays, including developing and mounting, 10 minutes for perio charting, five minutes for the dentist to do the exam, and five minutes to clean the room. Where does that leave time for scaling and polishing?
Does he not realize that most lawsuits brought against dentists are because of failure to diagnose periodontal disease? I am sorry, but an expanded duties assistant is not qualified, does not have the education, and is not licensed to do what we do. Most of us take pride in our work and try to do our best for the patient and the dental practice. Yes, it is sad but true that most of us do not want to work for tyrants. I suspect that if Neiburger looked in the mirror, he would see the cause of many of his problems. And, I did not read anywhere that he values quality of care. Production seems to be his utmost priority.
Now if we would all just be nice "little girls and boys" and not think and do exactly as we are told, everything would be just fine.
Ann Howell, RDH, BS
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