Dental hygienist

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Dental hygienist holding a scaler

A registered dental hygienist (RDH) is a licensed dental professional who specializes in preventive oral health, typically focusing on techniques in oral hygiene. Dental hygienists provide three types of services to their patients. The first of these is preventive services to promote and maintain good oral health. The second is educational services to help patients develop behaviors that promote better oral health and help them understand the importance of practicing these behaviors. The third type of service provided is therapeutic services which are treatments meant to stop disease and maintain healthy tissues in the mouth.[1] Local dental regulations determine the scope of practice of dental hygienists. In most jurisdictions, hygienists work for a dentist or dental specialist, and some are licensed to administer local anesthesia and perform dental radiography.[citation needed] The major role of a dental hygienist is to perform periodontal therapy which inclused things such periodontal charting, periodontal debridement (scaling and root planing), prophylaxis (cleaning) for patients with periodontal disease. In addition dental hygienist are able to perform examinations, make diagnosis, take intraoral radiographs, dental sealants, administration of fluoride, and provide patient specific oral hygiene instruction.

Dental hygienist work together with other dental professionals to contribute to an interdisciplinary approach with the aim of providing optimum oral health care to the patient. Dental hygienists also offer expertise in their field and can provide a dental hygiene diagnosis, which is an integral component of the comprehensive dental diagnosis.[2]

Treatment Phases of Periodontal Therapy[edit]

A dental hygienist at work

Periodontal therapy is a continuous cycle that requires regular evaluation and maintenance to optimise treatment outcomes. Its treatment is normally carried out by a Dental Hygienist or Oral Health Therapist, but involves all members of the dental team and specialists throughout the course of care. There are six phases undertaken by dental professionals when undertaking periodontal therapy, which are as follows;[3]

Systemic Pre-Phase[edit]

This includes, but is not limited to;

  • A full review of the patient's medical history to identify the patients systemic health, as well as establishing a provisional diagnosis. The provisional diagnosis is generated following a comprehensive oral examination, data collection and radiographic interpretation.
  • An ASA classification should be established to indicate future treatment options of the patient, whilst considering the implications of risk factors, such as medical conditions (ie. endocarditis, diabetes, smoking). This also allows the dental clinician to begin planning all non-surgical therapy.
  • All emergency treatment should be addressed, this includes emergency periodontal treatment.
  • The patients compliance should be established during this phase as optimal oral hygiene practices need to be employed in order to assist with treatment planning and, long term goals and results.

Initial Phase: Non-Surgical Periodontal Therapy[edit]

Non-surgical periodontal therapy is concerned primarily with disease prevention, and is accomplished through patient and clinician cooperative interaction. It is normally accomplished with the incorporation of patient education and motivational interviewing, and if appropriate may include discussions regarding nutrition and/ or smoking cessation. The various treatments involved in this phase include;

  • Debridement
  • Antimicrobial Therapy
  • Correction of Local Risk Factors
  • Fluoride Therapy
  • Caries Control and Placement of Temporary Restorations
  • Occlusal Therapy
  • Minor Orthodontic Treatment

If disease is present, secondary prevention may be necessary, the cause of disease should be identified and noted, and the relevant professional movement should be identified and patient instruction for plaque control established in an attempt to reinstate a healthy oral condition. THerefore, mechanical and chemical plaque control are involved in this phase. This may be via;

  • Plaque Disclosing Agents
  • Manual/ Electric Toothbrushes
  • Toothbrushing Techniques
  • Interdental Aids
  • Dentifrices
  • Chemical Plaque Control (Antimicrobial Mouthwashes)

Re-Evaluation of Non-Surgical Periodontal Therapy[edit]

This phase is continuous throughout treatment, allowing the dental professional and the patient to monitor the patients oral health status and assists in recognising the need for change/ amendment to the previously formulated treatment plan, according to the patients specific needs. Treatment is monitored using accurate periodontal charting and clinical observation of hard and soft tissues by the dental professional. The results of this dictates what follows the non-surgical periodontal phase. The three generalised outcomes that may result are essentially;

  • The patient progresses straight to the Maintenance Phase
  • The patient returns to the Non-Surgical Periodontal Therapy Phase, until such a time as their periodontal status is satisfactory
  • The patent advances to the Corrective Phase

Corrective Phase: Surgical Periodontal Therapy[edit]

The corrective phase is not needed for al patients, but is dictated by the outcomes of the re-evaluation phase, encompassing all indicated;

  • Periodontal surgery
  • Endodontic surgery
  • Placement of dental implants

Supportive Periodontal Therapy/ Restorative Therapy[edit]

As with the Corrective Phase, Supportive Periodontal Therapy is not needed for al patients, but is too dictated by the outcomes of the re-evaluation phase. It includes all required;

  • Dental restorations
  • Fixed and removable prosthesis

A re-evaluation of the overall response to treatment should be conducted at the end of this phase before continuing onto the Maintenance Phase.

Maintenance Phase[edit]

The Maintenance Phase involves continuous care, at patient specific levels. It includes all measures used by the dental team and patient to stop the disease reoccurring, with the objective of keeping the dentition functioning for was long as possible in the oral cavity.

History of Dental Hygienist[edit]

  • In the late 1800’s dental disease prevention methods started to become popular amongst dentist and dental nurses were being trained by dentists to perform routine prophylaxis treatment in the fight against dental disease. During this period D. D. Smith of Philadelphia demonstrated the prophylactic methods to his colleagues and patients and the acceptance of his theories become increasingly popular.[4]
  • In 1898 Smith presented a lecture on his system of periodic oral prophylaxis, which required patients to attend regular visits for prophylactic treatment and education sessions around oral home care.[5]
  • In 1906 one of his followers Alferd C. Fones took a great interest into Smith’s theories and began to train his cousin, Irene Newman, to act as an apprentice, scaling and polishing teeth as well as giving instructions on how to keep their mouths clean with daily home care practices. She was then to become the first recognised dental hygienist.
  • In 1910 the Ohio College of Dental Surgery offered a formal course for “dental nurses.” However, dentists in Ohio strongly opposed the formal training school, and those who completed the coursework were never allowed to practice. The course was soon to be discontinued in 1914 due to the backlash from the dental community.
  • In 1913 the term dental hygienist was devised and Alfred Fones began the first school for dental hygienists in Connecticut

1914 the first legal dental hygienists graduated from Dr. Fones’ dental hygiene program and legally allowed to provide patients with prophylaxis treatment.

  • In 1915 Connecticut amended the dental practice act to include the regulation of dental hygienists and other states followed amending dental hygiene regulations outlining the scope of practice of a dental hygienist.
  • 1923 the first meeting of the American Dental Hygienist Association took place
  • 1950 Dental hygienists were recognised in Canada and the University of Toronto established the first dental hygiene program in the country.
  • 1965 over 15,400 dental hygienists were working in America
  • 1974 Dental hygienists were employed by the government of New Zealand to treat members of the New Zealand army
  • 1975 Dental hygiene profession was introduced in Australia
  • 1994 dental hygienists in New Zealand to work publically and privately
  • 2006 Auckland University of Technology Bachelor of Health Science (Oral Health):3years (dual-degree in Dental Hygiene and Dental Therapy)

Training[edit]

Australia[edit]

Dental hygienists in Australia must be graduates from a dental hygiene program, with either an advanced diploma (TAFE), associate degree, or more commonly a bachelor's degree from a dental hygiene school that is accredited by the Australian Dental Council (ADC).

In Australia It is a legal requirement for graduates to be registered with the Dental Board of Australia before practising as a dental hygienist in any state or territory in Australia. For full details, see the Dental Board of Australia's website. Dental Board of Australia

The Dental Hygienists’ Association of Australia (DHAA) Inc., established in 1975, is the peak body representing registered dental hygiene service providers in Australia. A dental hygienist does not need to be employed by a dentist but can independently assess patients and make treatment plans within their scope of practice whilst working in the community. The National Law requires the same level of professional responsibility from dental hygienists, oral health therapists and dental therapists as it does from dentists, dental specialists and dental prosthetists in that all practitioners must have their own professional indemnity insurance and radiation licences. They are also required to complete 60 hours of mandatory continuing education in a three year cycle. [6]

A Bachelor of Oral Health is the most common degree program. Students entering a bachelor's degree program are required to have a high school diploma or equivalent. Most Bachelor of Oral Health programs now qualify students as both Dental Hygienists and Dental Therapists, collectively known as Oral Health Therapist[citation needed]

Canada[edit]

Dental hygienists in Canada must have completed a diploma program, this can be 19 months to 3 years. All dental hygiene students must pass a NDHCB (NDHCB) examination after graduation. This examination is offered three times per year, January, May and September. Three universities in Canada offer Bachelor of Science degrees in Dental Hygiene: Dalhousie University, University of Alberta, University of British Columbia.[3][4][5]

Dental hygiene across Canada is a well-respected career with many opportunities. These possibilities include working in clinical, administration, education, research and public health positions. The wages vary throughout the country; from approximately $32 per hour in some areas to as high as $55 per hour in others. A surplus of new dental hygiene graduates in recent years has resulted in a decrease in wages in some regions.

Some of the downfalls to practicing in different provinces are the different regulations. For instance, in BC, the hygienist cannot provide treatment without the patient receiving a dental exam in the previous 365 days unless the practicing hygienist has an extended duty module (resident-care module). In AB, BC, MB and SK, hygienists also administer local anesthesia if qualified to do so.[6][7][8][9] In Ontario, dental hygienists may take further training to become a restorative dental hygienist. Registered dental hygienists must register every year by December 31st. Ontario dental hygienists must also prove continuing competence by maintaining a professional portfolio yearly. In Ontario, dental hygienists are registered with the College of Dental Hygienists of Ontario (CDHO). [7]

Dental hygienists in BC, ON, NS and AB are able to open their own private clinics and practice without a dentist on staff.

United States[edit]

Dental hygienists in the United States must be graduates from a dental hygiene program, with either an associate degree (most common), a certificate, a bachelor's degree or a master's degree from a dental hygienist school that is accredited by the American Dental Association (ADA).[8]

All dental hygienists in the United States must be licensed by the state in which they practice, after completing a minimum of two years of school and passing a written board as well as a clinical board exam.[9] State requirements vary by state, and are controlled by state dental boards.[10]

Dental hygienists school programs usually require both general education courses and courses specific to the field of dental hygiene. General education courses important to dental hygiene degrees include college level algebra, biology, and chemistry. Courses specific to dental hygiene may include anatomy, oral anatomy, materials science, pharmacology, radiography, periodontology, nutrition, and clinical skills.

A Bachelor's of Science in Dental Hygiene is typically a four-year program. Students entering a bachelor's degree program are required to have a high school diploma or equivalent, but many dental hygienists with an associate's degree or certification enter the bachelor's degree programs to expand their clinical expertise and help advance their careers.

Graduate degrees in the field of dental hygiene are typically two-year programs and are completed after the bachelor's degree. Common graduate courses in dental hygiene include Healthcare Management, Lab Instruction, and Clinical Instruction.

After completing one of the more than 200 accredited dental hygiene programs in the United States, dental hygienists must be licensed in the state in which they work. Licensure requirements for becoming a Registered Dental Hygienist (RDH) vary from state to state, but most require a two-year degree, a written examination, and a clinical examination. The National Board Dental Hygiene Examination is intended to fulfill the written examination requirements. The clinical examination is typically administered by the state licensing board.

In addition, the American Dental Hygienists' Association has defined a more advanced level of dental hygiene, the Advanced Dental Hygiene Practitioner otherwise known as a dental therapist.


Direct Access to Care with a Dental Hygienist[edit]

The dental hygienists in select parts of North America can provide dental hygiene treatment based on the assessment of a patient’s needs without the authorization of a dentist, treat the patient in absence of a dentist, and also maintain a provider-patient relationship.

Canada

British Columbia

1995 - A client must have seen a dentist within the previous 365 days in order for the hygienist to provide dental hygiene treatment.

2012 - New bylaws offers an exemption from the 365-day rule if hygienists are registered in the Full Registration (365 Day Rule Exempt) class. [11]

Alberta

2006 - Dental hygienists are able to offer their services in many practice settings including independent practice.[12]

Manitoba

2008 - If the dental hygienist has practiced for more than 3000 hours, and the client does not have a complex medical condition than the hygienists do not require the supervision of a dentist. [13]

Ontario

2007 - Registered dental hygienists in Ontario who have been approved by the College of Dental Hygienists of Ontario can practice independently. [14]

United States

California

1998 - Registered Dental Hygienist in Alternative Practice (RDHAP): RDHAPs may provide services for homebound persons or at residential facilities, schools, institutions and in dental health professional shortage areas without the supervision of a dentist. RDHAPs can provide patient care for up to 18 months and longer if the patient obtains a prescription for additional oral treatment from a dentist or physician . [15]

Colorado

1987 - Unsupervised Practice: Hygienists may have their own dental hygiene practice; there are no requirement for the authorization or supervision of a dentist for most services. [16]

Connecticut

1999 - Public Health Dental Hygienist: Dental hygienists may practice without supervision in institutions, public health facilities, group homes, and schools as long as they have two years of work experience. [17]

Maine

2008 - Independent Practice Dental Hygienist: A dental hygienist licensed with an independent practice may work without the supervision of a dentist, providing that the dental hygienist has to complete 2,000 work hours of clinical practice during the two years prior to applying for an independent license, as well as a bachelor's degree from a CODA accredited dental hygiene program or complete 6,000 work hours of clinical practice during the six years prior to applying for an independent license, as well as an associate degree from a CODA accredited dental hygiene program. [18]

Michigan

2005 - PA 161 Dental Hygienist: Hygienists with grantee status can work in a public or nonprofit environment, a school or nursing home that administers dental care to a low-income population. Dentists collaborating with dental hygienists do not need to be present to authorize or administer treatment. However, dental hygienists must have the availability to communicate with a dentist in order to review patient records and establish emergency protocols. Hygienists need to apply to the state department of community health for grantee status. [19]

Washington

1984 - Unsupervised Practice: Dental hygienist practice without the supervision of a dentist is allowed in hospitals, group homes, nursing homes, home health agencies, Health and Human Service state institutions, jails, and public health facilities as long as the hygienist refers their patients to a dentist for treatment. Hygienist must have at least two years of work experience within the last 5 years. [20]

See also[edit]

Further reading[edit]

  • Mueller-Joseph, L., & Petersen, M. (1995). Dental Hygiene Process: Diagnosis and Care Planning. Albany, NY: Delmar.

References[edit]

  1. ^ Wilkins, Esther M. "The Professional Dental Hygienist." Clinical Practice of the Dental Hygienist. 11th ed. Philadelphia: Lippincott Williams & Wilkins, 2013. 5-6. Print.
  2. ^ American Dental Hygienists' Association - Standards of Practice
  3. ^ Nield-Gehrig, J. and D. Willmann, Eds. (2008). Foundations of Periodontics for the Dental Hygienist.
  4. ^ Danner, V. "Looking back at 75 years of the Journal; former editors reflect on their time with the Journal". Journal of Dental Hygiene. Retrieved 16 March 2014. 
  5. ^ Danner, V. "Looking back at 75 years of the Journal; former editors reflect on their time with the Journal". Journal of Dental Hygiene. Retrieved 16 March 2014. 
  6. ^ [1], The Dental Hygienists’ Association of Australia Inc. June 2013 ‘’’Response to the Dental Board of Australia’s Preliminary Consultation on the Draft Scope of Practice Registration Standard and Guidelines.’’’ Pages 2-12
  7. ^ [2][dead link]
  8. ^ American Dental Hygienists' Association - Education
  9. ^ Dental Hygienist License Information
  10. ^ American Association of Dental Boards
  11. ^ "Dental Hygiene". Retrieved 1 April 2014. 
  12. ^ "Dental Hygienists Profession Regulation". Alberta Queen's Printer. Retrieved 1 April 2014. 
  13. ^ "The Dental Hygienists Act". Statutory Publications. Retrieved 1 April 2014. 
  14. ^ "Health Professions Regulatory Advisory Council". Retrieved 1 April 2014. 
  15. ^ "RDHAP Application Instructions". Retrieved 1 April 2014. 
  16. ^ "Direct Access States". ADHA. Retrieved 1 April 2014. 
  17. ^ "20 Professional and Occupational Licensing, Certification, Title Protection and Registration". Retrieved 1 April 2014. 
  18. ^ "Public Laws". Retrieved 1 April 2014. 
  19. ^ "Public Health Code Excerpt". Retrieved 1 April 2014. 
  20. ^ "Washington State Legislator". Retrieved 1 April 2014. 

External links[edit]