Extending Patient Care Through Dental Hygienists: A Conversation with Ann Battrell of The American Dental Hygienists’ Association

INSIDE DENTISTRY (ID): What role does the dental hygienist play in oral healthcare?

ANN BATTRELL (AB): Dental hygienists have been a vital part of the dental team since the dental hygiene profession was founded in 1913. A strong working relationship between dental hygienists and dentists is very important in providing quality oral healthcare for patients. The public perception may be that dental hygienists clean teeth. However, dental hygienists serve many more essential roles. ADHA is doing all we can to educate the public that, among dental hygienists’ most important roles, is the prevention of oral diseases such as dental caries and periodontal disease. We want the public to know that most oral disease is entirely preventable with proper preventive care and healthy lifestyle behaviors.

With the emphasis on the importance of oral health as it relates to total health, the dental team is beginning to expand to include our colleagues in medicine and other health professions to provide oral health services in more settings. Dental hygienists can work collaboratively with physicians, nurse practitioners, physician assistants, and others to expand the reach of prevention outreach efforts.

ID: How are dental hygienists’ roles changing and expanding throughout the nation?

AB: We are seeing a lot of activity across the U.S. with regard to expanding the services that dental hygienists provide as well as the settings in which they practice. The need to extend oral healthcare to underserved populations drives this activity. The profession is evolving as is the collaborative relationship with dentists. There are new titles for dental hygienists with advanced education, new titles describing different types of dental hygiene practice, and new ways that dental hygienists are working with dentists and other healthcare providers.

In addition, different types of dental hygiene practices such as collaborative practice and public health supervision are growing in number. In these situations, dental hygienists can develop collaborative practice agreements with dentists to expand their reach of preventive services and refer patients to their collaborating dentists for restorative services.

Also, an increasing number of opportunities are available for dental hygienists in public health settings, due, in part, to statutory changes as well as the growing presence of federally qualified health centers (FQHCs) and community health centers (CHCs).

Dental hygienists can extend care even further in “direct access” states. Currently, 35 states have this designation. These states’ policies allow a dental hygienist to initiate treatment based on his or her assessment of the patient’s needs without the specific authorization of a dentist in at least some settings. They can also provide dental hygiene care without the presence of a dentist and maintain a provider-patient relationship. Five years ago, this number was 28. In 1995, there were only five.

All these changes benefit the public. More people are getting the oral healthcare they need. Ultimately, this is the goal of any collaboration between dental hygienists and dentists. Still, dental hygienists have the skills and knowledge to do even more, and ADHA supports new workforce models such as the one it proposed in 2004, the Advanced Dental Hygiene Practitioner (ADHP). By proposing the ADHP, ADHA became the first national oral health organization to propose a new dental midlevel provider and the first to create a set of competencies for such a position. The ADHP model was created after reviewing the advanced nursing models in the United States and midlevel oral health models in place internationally. More than 50 countries, including Canada, Australia, and the United Kingdom, allow midlevel practitioners to practice in oral health.

Since then, other oral health stakeholders have proposed workforce models with various titles, such as dental therapists and advanced dental therapists, and added to the existing research, pointing to the growing need for a midlevel oral health provider. As an example, the advanced dental therapist (ADT) facilitates collaboration with the dentist, but does not require on-site supervision. The ADT model in Minnesota is based on the familiar nurse practitioner model in various health care settings. The first class of advanced dental therapy students graduated in June 2011 and is currently working toward the 2000 hours of supervised dental therapy practice needed in order to obtain their advanced dental therapy license. In fact, one ADT is already certified and practicing in Minnesota. Once certified, the advanced dental therapists will then practice with dual advanced dental therapy and dental hygiene licensure.

ADHA believes the existing dental hygiene workforce can make a powerful difference in extending oral healthcare to Americans who most need it. More than 150,000 licensed dental hygienists are in the United States—a ready and available workforce—and the educational infrastructure is already established, with 335 entry-level program, 57 degree-completion programs, and 22 master’s degree programs in place across the country.

Many public health advocates agree and have promoted the dental therapist model as a way to address gaps in oral health care, particularly in rural communities. At least seven states—Kansas, Vermont, New Mexico, Washington, New Hampshire, Maine, and Massachusetts—will have introduced proposals this year to establish dental therapist positions. We believe that the growing demand for oral healthcare will create a favorable environment for legislative changes that continue to expand the scope of dental hygiene practice. Doing so will contribute to improving oral health across the nation. And when all is said and done, that is our priority—ensuring that more people receive proper oral healthcare services.

ID: What is the economic state of dental hygiene profession at this time?

AB: The forecast looks promising for dental hygienists. The US Bureau of Labor Statistics predicts a healthy 38% growth in the number of dental hygiene jobs from 2010 to 2020.

ADHA conducted an environmental scan of the dental hygiene profession in 2011 to assist the ADHA Board of Trustees in drafting the 2015 Strategic Plan.

One of the environmental scan findings was the growing elder population with complex oral healthcare needs. This demographic shift can provide more opportunities for dental hygienists to provide their services in assisted living facilities, senior homes, and geriatric centers. According to the environmental scan, this country will have only one dentist per 1,800 people by 2020. This points to both the need and opportunity for dental hygienists.

The profession isn’t without its challenges, though. In some regions of the country, our members are having difficulty finding work or finding enough hours to work. One reason for this is the rapid growth of dental hygiene education programs in markets that already have a significant number of dental hygienists who are unemployed or underemployed. The result is fierce job competition in some regions. However, new opportunities for dental hygienists will also emerge in community centers, healthcare organizations, and retail settings.

ID: How is the ADHA celebrating 100 years of dental hygiene?

AB: We are proud to be celebrating our 100th anniversary as a profession June 19 to 25 in Boston, MA. At the Center for Lifelong Learning (CLL), we offer continuing education, networking, and special events for the entire dental team that will celebrate how far the profession has progressed and the excitement of what’s in store for the future of dental hygiene. We invite our dental colleagues from around the globe to join us as we collaborate on advancing oral health care at this historic milestone.