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Center for the Future of Health Professions Oct. 2023 digest

We are delighted to present the Center for the Future of the Health Professions Digest’s op-ed column for October 2023. We’re committed to supplying trustworthy and precise data and research on the healthcare labor force, with the aim of assisting policymakers and stakeholders within the health system to efficiently plan for a robust future.

In this edition, we’re excited to spotlight Ellen Gohlke’s article, “The Evolution of the Dental Hygiene Profession.” Ellen holds a bachelor’s degree in dental hygiene from Marquette University in Milwaukee, Wisconsin, and is pursuing her master of health science degree from A.T. Still University’s College of Graduate Health Studies (ATSU-CGHS).

Ellen holds many roles and is a full-time clinical hygiene instructor at the Arizona School of Dentistry and Oral Health’s Center for Advanced Oral Health. Here, she mentors students as well as AEGD residents tasked with treating individuals needing special care or managing medical complexities. Additionally, she dedicates part of her time as an adjunct hygiene instructor at Rio Salado College of Dental Hygiene in Tempe, Arizona.

Ellen’s practical experience in dental hygiene extends beyond her academic surroundings, having practiced in Wisconsin and Lausanne, Switzerland, upon graduating from Marquette. She has gained exposure in various dental specialties, including periodontics, pediatric, and general dentistry. In 2019, Ellen was presented with a fellowship in special care dental hygiene (FSCDH).

Passionate about social care, Ellen commits her time to serve underserved communities, focusing primarily on individuals with intellectual, developmental, and chronic medical conditions.

We welcome your reflections and insights on this month’s digest. Share your thoughts with us!

Randy Danielsen, PhD, DHL(h), PA-C Emeritus, DFAAPA

Professor and Director

The Center for the Future of the Health Professions

A.T. Still University

Ellen Gohlke

The evolution of the dental hygiene profession

The dental hygiene profession was first established in 1913 by Alfred Fones, a dentist who realized the importance of having clean, healthy teeth.1 He believed it was essential to train female dental assistants to teach patients oral hygiene. He also believed women were less expensive to train and better at cleaning than men. His focus in dentistry was not on treatment, but more on prevention. Dr. Fones’ dedication to improving patients’ oral hygiene through prevention and education led him to establish the first dental hygiene school in Bridgeport, Connecticut, in 1913. Subsequently, he trained the first dental hygienist, Irene Newman, to work in his practice. Most dental hygienists are familiar with Fones since the “Fones toothbrushing technique” is still taught to dental hygiene students. In 1914, Fones initiated a five-year demonstration project in public schools that documented the success of a dental hygienist in providing education for dental disease prevention.2

In the early 1900s, a dental hygiene program began in the United States, requiring a year of training.3 Today, the country has more than 300 dental hygiene programs, most of which are housed in community colleges.4 People entering the dental hygiene profession can pursue a two-year associate degree, a four-year bachelor of science degree, or a master’s degree in dental hygiene. Dental hygienists must take national and regional license exams to enter practice. Degree completion programs allow dental hygienists with a two-year degree to complete their baccalaureate degree and there are no doctoral programs in dental hygiene in the United States. Dental hygienists pursuing leadership positions in universities, hospitals, federal agencies, and healthcare organizations will seek doctoral degrees in other disciplines.5

Dental hygiene is one of the fastest-growing healthcare occupations today. According to the American Dental Education Association, the dental hygiene workforce is estimated to increase by 20% in 2026.6 There are several reasons why the dental hygiene profession continues to grow in this country. The work schedule flexibility, the ability to improve a patient’s oral health, the potential to earn a good income, and the opportunity to get an advanced degree in dental hygiene are common reasons why people choose this healthcare profession. Many dental hygiene programs have a waiting list for acceptance and enrollment.

Since the pandemic, I have noticed a greater demand for dental hygienists. I still receive phone calls, text messages, or emails from dental colleagues asking if I know a dental hygienist interested in a job. However, the profession has faced some challenges, with more hygienists leaving the profession since the COVID-19 outbreak. Many licensed professionals retired during the pandemic for safety reasons, while others stopped working due to high childcare costs and other practice-related concerns.7 Nevertheless, dissatisfaction with salary and feeling unappreciated in the workplace are the main reasons why dental hygienists stop practicing. As a result, in March of 2022 the American Dental Association’s Health Policy Institute reported over 90% of dentists faced difficulties finding hygienists to hire. Despite dental hygienists leaving or retiring, the number of students entering programs continues to increase.

Dental therapy is a new occupation with a different scope of practice than dental hygiene and requires additional education and training. This occupation is distinct from dental hygiene. Dental therapists primarily work in underserved regions and provide essential restorative dentistry services and preventive care. The number of dental therapy programs continues to grow in the United States. Dental therapy first began in New Zealand in the 1920s.However, it was not until 2005 that the first dental therapist in the United States treated people in a rural Alaskan community.9 The need to provide dental care to people in underserved areas prompted native tribes to seek help for these impoverished areas. Even though most dental therapists in the United States have a dental hygiene degree, programs exist that train dental health aide therapists to provide dental care to rural tribal communities. Dental therapists practice under the supervision of dentists but may treat patients in settings other than dental offices in 13 states across the country. Licensed dental hygienists interested in dental therapy must complete an additional three-year program followed by a credentialing exam in Arizona.

Dental hygienists play an active role in teledentistry, which is especially helpful in providing patient care to those in rural and other underserved areas.10 Training and regulations for dental hygienists related to teledentistry continue to be developed and differ by state. Patients in remote areas of the country will benefit if teledentistry is allowed under the dental hygiene scope of practice by state dental practice acts. A.T. Still University’s Arizona School of Dentistry & Oral Health includes teledentistry coursework in its curriculum and employs dental hygienists who provide teledentistry services in collaboration with dental faculty to reach several communities of vulnerable patient populations. This model can help people across the country with little or no access to oral healthcare resources.

Dental hygienists may be employed in various settings, including skilled nursing facilities, community health clinics, and hospitals. There are also dental hygienist models who are employed within medical practices, most notably in pediatric medical offices.2 There is a growing recognition among medical professionals about the importance of good oral health as it relates to overall health. The link between poor oral health, particularly poor oral hygiene and periodontal disease, and systemic diseases such as diabetes, heart disease, and respiratory disease is well known. Good oral health is medically necessary for many patients who are critically ill, such as those undergoing cancer treatment or organ transplantation, to ensure successful health outcomes.

Graduating from a dental hygiene program years ago usually meant working in a private dental practice setting. Historically, very few dental hygienists taught in educational institutions and public health facilities. Whole-body healthcare was not the focus when I graduated in the 1980s. As a dental hygiene educator, I recognize that the dental hygiene profession advances by training and preparing future oral healthcare providers to treat the entire body, not just the mouth. The dental students and dental hygiene students I mentor who rotate through our Special Care Clinic at ASDOH realize the importance of treating the whole person. Most patients we treat have physical disabilities, intellectual disabilities, and medical comorbidities. Students and dental residents are taught new skill sets and tools to treat these complex populations.

ATSU focuses on pursuing knowledge, the whole body, and patient-centered care. My journey in dental hygiene has changed me into a healthcare provider who treats the entire individual as I educate lifelong learners on the importance of comprehensive healthcare while serving people from disadvantaged, diverse backgrounds. In the Advanced Care Clinic at ASDOH, I am fortunate to work with students, residents, and faculty as we meet the educational, healthcare, and societal needs of these communities in our state. As our population ages and grows, integrating dental and medical healthcare services for patients is essential. According to an article in the Journal of Dental Education, dental hygienists practicing in solo offices will decline by 2040 as the number of hygienists transition to organizations where medical and dental care are combined.11 In the future, dental hygienists will work with other healthcare disciplines while treating patients’ dental care needs.

References

  1. The History of Dental Hygiene and a Look Toward the Future. Access. 2014;28(2):27-29. Accessed August 26, 2023.
  2. Bowen DM. History of dental hygiene research. J Dent Hyg. 2013 Jan; Supple 1:5-22.
  3. Watson, R. (2023), President’s Message. International Journal of Dental Hygiene. Accepted Author Manuscript. https://doi.org/10.1111/idh.12396
  4. Dental Hygiene by the Numbers. American Dental Education Association. 2023
  5. Gurenlian JR, Rogo EJ, Spolarich AE. The Doctoral Degree in Dental Hygiene: Creating New Oral Healthcare Paradigms. J Evid Based Dent Pract. 2016;16 Suppl:144-149. doi:10.1016/j.jebdp.2016.01.011
  6. American Dental Education Association. Why Be a Dental Hygienist? 2015-2023.
  7. Harrison B. HPI Dental Office Employment Declined in March. ADA News. Accessed April 10, 2022. https://adanews.ada.org/ada-news/2022/april/hpi-dental-office-employment-declined-in-march/
  8. Dental Therapy in Arizona. Arizona Oral Health Coalition. Published 2023. https://azohc.org/dental-therapy/
  9. Holland M, Kottek A, Werts M, Mertz E. Expanding Dental Therapy Education Programs. Dimensions of Dental Hygiene. Accessed November 25, 2020. https://dimensionsofdentalhygiene.com/expanding-dental-therapy-education-programs/
  10. Atchison KA, Fellows JL, Inge RE, Valachovic RW. The Changing Face of Dentistry: Perspectives on Trends in Practice Structure and Organization. JDR Clinical & Translational Research. 2022;7(1_suppl):25S-30S. doi:10.1177/23800844221116836
  11. Fried, J.L., Maxey, H.L., Battani, K., Gurenlian, J.R., Byrd, T.O. and Brunick, A. (2017), Preparing the Future Dental Hygiene Workforce: Knowledge, Skills, and Reform. Journal of Dental Education, 81: eS45-eS52. https://doi.org/10.21815/JDE.017.032

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