The scope of practice for the dental hygienist has significantly expanded in the last decade. At no other time in dental history has our profession experienced more clinical advancements and changes in the intricate role the hygienist plays within the entire dental team.
The most significant opportunity for dental hygienists has come through a revitalization of their entire professional career. Hygienists can now embrace a new scope of practice and elevated standards of care supported by the current advances in research, technology, and evidence-based science. More than ever before, the role of the dental hygienist is key to the success of the dental practice!
A major development comes from the changes in standard of care in evidence-based science. For example, with the introduction of biofilm, dental hygienists and dentists have altered the way in which they plan treatment for their patients. Biofilm is a complex community of bacteria adhering to an inert or living tissue. Bacterial biofilm is the causative factor that plays an integral role in the etiology of periodontal disease and caries. We address the biofilm with specific technique and technologies to assure the best results for our patients. Not only are plaque and calculus removed, but the biofilm infection is addressed with specific instrumentation and techniques. Additionally, to address biofilm as a part of the patient’s treatment plan (with co-diagnosis) during case presentation, the patient advances his or her perception of the current sophistication of his or her dental needs.
Another major advance in our job responsibility is risk assessment. Risk assessment involves the comprehensive dental and health challenges that may affect a patient’s immune system and overall health and well-being. Beyond the standard clinical criteria of plaque, calculus, pocket depths, hemorrhage, and active decay and pain, there are other contributing factors that play key roles in the patient’s host modulated response to treatment.
Assess these risks before finalizing treatment plans:
• Heart murmur
• Artificial joint prosthesis
• Women with osteoporosis, taking birth control pills, pregnant, nursing, or in menopause
• Stress
• Nutritional deficiency and/or obesity
• Diabetes and prediabetic conditions
• Tobacco use of any kind
• High blood pressure (new guidelines)
• Family history of heart disease, high cholesterol, high blood pressure, obesity
• Drugs that cause dental intraoral effects and systemic effects
• Occlusal disease
• Restorative dentistry
• Oral cancer screening
• Psychological history
• Self-care evaluation
• Genetic predisposition
During a JP Institute consultation, we offer a risk assessment survey to determine both the number and significance of causative and contributing factors of the current health challenges of patients. These changes affect the quality of patients’ lives and are instrumental in how important the role of the dental hygienist is to patients’ health and to the entire practice. The changes are continually noted to guide optimum prescription, treatment, and prognosis for the patient.
Another monumental leap for the dental profession is the level of knowledge necessary for the hygienist to provide restorative and esthetic support for the patient. The prediagnosis discovery phase demands a more refined level of skill for proficiency. Just as technology and research have advanced in the periodontal realm, so have advances occurred in the restorative and esthetics arenas of the dental practice. Therefore, to provide comprehensive support for patients, the hygienist is required to learn new “prediagnostic” skills as well as advancements in case presentation skills. The office philosophy has always set the parameters for the skills necessary for hygienists to support their patients in comprehensive care.
It is more critical for hygienists to have a thorough understanding of the neuromuscular or occlusal philosophy, the cosmetic and esthetic philosophy, whether the office provides amalgams, and how the doctor chooses to provide dentistry for patients, which is ascertained through sophisticated discovery questions. It is critical that the hygienist agrees with the philosophies of the practice.
The cliché “You don’t know what you don’t know” comes into play here. As a hygienist, you may not have had exposure to a philosophy in order to formulate a definite opinion. You may not have practiced in the office where the philosophy was implemented correctly, which might affect your opinion about that philosophy. For today’s dental hygienists to truly advance their skills, it is advantageous to explore different philosophies discussed in seminars, testimonials from other hygienists, a national peer meeting with ADHA or RDH Under One Roof, or temporary hygiene work to determine whether the philosophy fits their belief system of integrity and ethics.
Cosmetics in dentistry is one of the most valuable “patient perceived” procedures. Cosmetics can affect patients’ self-esteem so profoundly that it improves their quality of life forever. Comprehensive cosmetic education is truly a gift to patients. Education should come from all team members, but especially from the hygienists because of the amount of one-on-one time they give to their patients. The JP Institute believes the hygienist has an ethical responsibility to engage in a discussion of all procedures and services available to patients. These procedures can truly make a difference in how the hygienist feels about the level of care provided for patients, which empowers the entire dental hygiene profession.
Sophisticated product knowledge advances the scope of patient care. As quickly as research and technology advance in all aspects of patient care, so does product availability to support dental and overall health and well-being. A thorough understanding of what is available, how and why it works, and in which situations it is best recommended to the patient are key ways the hygienist can educate patients about new products.
One of the most exciting new products available to dental hygienists is Oraqix. Dentists love it too. Oraqix is an anesthetic periodontal gel that allows the clinician to provide root debridement in most cases without injecting anesthetic. While the product is still new, first surveys are showing remarkable results. We anticipate this to be another product that can give hygienists opportunities to provide optimal care for patients, especially in states where it is illegal for hygienists to provide injections.
The product Arestin has revolutionized dental hygienists’ opportunities to achieve incredible results with patients. Not since the general practice has accepted nonsurgical periodontal treatment as a standard of care and a daily procedure for our patients have we had such a significant product to treat periodontal disease. The site-specific antibiotic therapy is placed in the pocket at the time of root planing and has had profound results in periodontally involved patients.
Another product the dental hygienist can use to enhance patient care is Vizilite by Zila Pharmaceuticals. This oral cancer screening product may help the dental professional save a patient’s life. One American dies every hour from oral cancer, and the death rate has not decreased significantly in more than 40 years. Vizilite is a simple device to improve the identification, evaluation, and monitoring of oral mucosa abnormalities in populations at increased risk for oral cancer. With Vizilite, an oral mucosa lesion will become illuminated and appear distinctly white compared to surrounding “normal” tissue. Hygienists and doctors report a greater ease in identifying suspicious lesions at a much earlier stage for specialist referral.
Many significant technologies have advanced the scope of today’s dental hygienist. The following are only a few of JP Institute’s favorites for optimal patient care. These include lasers for soft-tissue use and caries detection, voice-activated periodontal charting systems, loupes for the dental hygienist, communication systems (like the CAESY System) that will advance our educational support for the patients, and microultrasonic therapy.
Lasers for soft tissue in hygiene are a treatment modality that initiates the body’s own healing capabilities with amazing results. Lasers are the byproducts of altering energy from the electromagnetic scale in such a way that the energy is converted from light energy to thermal energy. The tissue changes are immediate as stippling, reduced hemorrhaging, color changes, and reduced inflammation occur. The caries-detecting lasers allow us to discover and diagnose the very beginning of caries long before we can use our standard explorer or X-ray protocols.
Voice-activated periodontal charting, such as the new software by PerioPal, is the most comprehensive system to date, allowing the hygienist to stay within the parameters of thorough charting and effective time management.
From our perspective, loupes for dental hygienists may be the best technology for career longevity. As we age, our clarity of vision is impaired. Because of the necessity to see with the utmost clarity, the hygienist leans closer toward the patient. Dental loupes are great for precision in instrumentation and in discovering open margins, fractured fillings, and cracked teeth.
Proper posture for the clinician and any subsequent occupational safety issues are paramount as well. Dr. Hal Meador is a periodontist who teaches ergonomics and the prevention and treatment of occupational pain. Dr. Meador states, “There are two kinds of clinicians, those who have occupational pain, and those who will!” Properly fit, dental loupes, made by Designs for Vision, force the clinician to sit erect, with precise care for the patient remaining an important benefit.
The CAESY Patient Education System by Patterson Dental has remained current with our patient education needs. With CAESY, it is important to review the benefits of procedures you’ve presented with patients at chairside. It is critical to give patients a combination of “high-tech/high-touch” comfort. The old adage “A picture is worth a thousand words” holds true. By adding the picture with a professional CAESY dialogue and your own personal presentation, the patient has a better grasp of the value of the procedures to accept the next level of patient care.
Microultrasonics are power-driven (magnetostrictive and piezo) scaler products featuring thinner tips and varied shapes. The thinner tips create the possibility that definitive root debridement can be accomplished with a power-driven instrument. Technique modifications enable results we never imagined possible. The most current ultrasonic technology has advanced to include computer chips for regulating the sustained power to the tip. The thinner tips are also important for effective removal of biofilm.
The face of dentistry is changing in so many areas; the opportunities for dental hygienists are unlimited. For example, the hygienist can create a great external marketing presence in his or her community as well as in some of the dental “spas” that are currently opening up. A hygienist can create his or her own niche for patient care within these offices, and the concepts can be fun or unique.
We also occasionally see hygienists switching their roles to that of treatment coordinator. Due to the vast degree of knowledge necessary for today’s dental hygienist, the treatment coordinator position is a natural fit. In that role, hygienists can educate and bring an immediate increase to case acceptance for comprehensive care if their skills are current and progressive.
By remaining committed to professional career development, hygienists can stay focused on what dentistry’s developments are. As hygienists, we may then walk gracefully into developing our professional future that continues to evolve with pride and dignity.
Peggy Sprague, RDH, is a co-founder of The JP Institute, which has taught clinical protocols, technology, and evidence-based science since 1979. The JP Institute is proud to announce its Registered Dental Hygienist Mastership Certification Program. Call (800) 946-4944 for a complimentary practice or career profile to analyze opportunities for professional development, advancing clinical protocols, technology and product integration, management systems, and profit potentials.
