The roles of other dental personnel in the patient care provided by dental hygienists in traditional and nontraditional settings

The information presented in this paper was obtained as part of an ongoing longitudinal study of 1982 dental hygiene graduates. This portion of the study was contracted by the American Dental Hygienists' Association and investigated the roles of personnel other than the dental hygienist in dental hygiene patient care by collecting data on (1) the numbers of personnel by personnel category, (2) the activities that other personnel provide to assist the hygienist in providing care, (3) the frequency at which the dentist evaluates the hygienist's work and (4) the frequency at which the dentist examines the hygienist's patients. In September 1986, mail questionnaires were sent to a cohort of 1,008 dental hygienists who graduated in 1982. Responses were received from 766 subjects--a 76% response rate overall and 77% response rate from subjects with valid addresses. Data were analyzed for clinical dental hygienists working in traditional and nontraditional settings. The median numbers of personnel were similar in both traditional and nontraditional settings; however, the means and standard deviations were larger for nontraditional settings. The most common forms of assistance provided by other personnel were billing and scheduling patients; a greater percentage of hygienists in traditional settings had this type of help. Hygienists were more likely to report that dentists examined their patients rather than evaluated the hygienists' work, and hygienists in nontraditional settings reported less dentist involvement with dental hygiene patient care than did hygienists in traditional settings.     

Prevalence of Nontraditional Dental Hygiene Practice

There is little knowledge of the number or the work characteristics of dental hygienists outside the private-practice setting. This survey was conducted to determine the percentage of hygienists practicing in nontraditional (nonprivate-practice) settings and the types of settings in which they are employed. Mail questionnaires were returned from a total of 21,847 (56.9%) of the hygienists in the survey sample. The percentage of active hygienists practicing in nontraditional settings was 11.8. Dental or dental hygiene schools, and government and nongovernment-supported clinics were the most frequent nontraditional practice settings. State supervision requirements were found to be associated significantly with the prevalence of nontraditional hygiene practice.     

Methods of charging and the fees charged for dental hygiene services in traditional and nontraditional settings

The information presented in this paper was obtained as part of an ongoing longitudinal study of 1982 dental hygiene graduates. This portion of the study was contracted by the American Dental Hygienists' Association and investigated the methods of charging for dental hygiene services and the fees charged for these services. In September 1986, mail questionnaires were sent to a cohort of 1,008 dental hygienists who graduated in 1982. Responses were received from 766 subjects--a 76% response rate overall and a 77% response rate from subjects with valid addresses and who had received the questionnaires. Data were analyzed for clinical dental hygienists in traditional and nontraditional settings. Results showed that the methods of charging for services and the fees charged were similar in both settings. Although most hygienists provided many services, only one fee for these services was charged in most settings. The mean prophylaxis fee for child patients at traditional settings was $23.52, and $23.38 at nontraditional settings. The mean prophylaxis fee for adult patients at traditional settings was $31.23, and $32.61 at nontraditional settings.     

The economics of dental hygiene work in traditional and nontraditional settings

The information presented in this paper was obtained as part of an ongoing longitudinal study of 1982 dental hygiene graduates. This portion of the study was contracted by the American Dental Hygienists' Association and provides information about method and amount of remuneration, fringe benefits, pay increases, and amount of money generated from dental hygienists' services. Data presented here were collected at two points in time: September 1985 and September 1986. The September 1985 survey was returned by 850 dental hygienists (83%) and the September 1986 survey was completed by 766 subjects (77%). Data were analyzed for clinical dental hygienists working in traditional and nontraditional settings. Results showed that most dental hygienists were salaried (80% traditional, 100% nontraditional) with a 1985 mean annual income of $19,160 for traditional and $17,197 for nontraditional hygienists. The mean daily wage in 1986 was $106.27 for traditional and $85.12 for nontraditional hygienists. Nontraditional hygienists were more likely to have received a pay increase in the previous six months and to receive fringe benefits than were traditional hygienists. Wages earned and money generated from dental hygiene services varied greatly. On the average, hygienists' wages constituted about one-third of the fees their services generated.     

Dental hygiene and direct access to care: Past and present

The American Dental Hygienists' Association (ADHA) defines direct access as the ability of a dental hygienist to initiate treatment based on their assessment of patient's needs without the specific authorization of a dentist, treat the patient without the physical presence of a dentist and maintain a provider–patient relationship. In 2000, there were nine direct access states; currently, there are 42 states that have authorized some form of direct access. The ADHA has been instrumental in these legislative initiatives through strong advocacy efforts. While research and data support the benefits of direct preventive/therapeutic care provided by dental hygienists, many barriers remain. This paper chronicles key partnerships that have influenced and advocated for direct access and the recognition of dental hygienists as primary healthcare providers. The National Governors Association released a report in 2014 suggesting that dental hygienists be ‘deployed’ outside of dental offices as one strategy to increase access to oral health care along with reducing restrictive dental practice acts and increasing the scope of practice for dental hygienists. The December 2021 release of the National Institutes of Health report, Oral Health in America, further supports greater access to dental hygiene preventive/therapeutic care. This paper also reflects on opportunities and barriers as they relate to workforce policy, provides examples of effective state policies and illustrates an educational curriculum specifically created to prepare dental hygienists to provide oral health services in settings outside of the dental office. Dental hygiene education must ensure that graduates are future-ready as essential healthcare providers, prepared to deliver direct access to dental hygiene care.     

Technology is a Critical Game Changer to the Practice of Dental Hygiene

Dental hygienists will need to embrace 21st century technology to adapt to workplace settings.Background and PurposeTo stay relevant in the workforce, dental hygienists need mastery of new skills and technologies. The purpose of this paper is to elucidate the vast array of technological advances impacting dental practice and the consequent implications for oral health care providers.Critical AnalysisNew technologies have provided unparalleled opportunities for degree and career advancement for dental hygienists. Advances in science and technology are providing patients with better quality and more convenient oral health care. Dental hygienists need technological skills that enable them to fully utilize technology as a strategy for consultation with dentists and other health care professionals and for other purposes. Continuing education and life-long learning factor into preparing dental hygienists for 21st century technologies.ConclusionWith technological advances, less adaptive professionals could potentially see a decrease in demand for their services. Possessing a high level of knowledge of dentistry and dental hygiene does not ensure a position in the workforce. Knowledge of technologies and associated skills are required for quality patient care and career and personal growth.     

Teledentistry-assisted, affiliated practice for dental hygienists: an innovative oral health workforce model

The 2010 U.S. Patient Protection and Affordable Care Act (PPACA) calls for training programs to develop mid-level dental health care providers to work in areas with underserved populations. In 2004, legislation was passed in Arizona allowing qualified dental hygienists to enter into an affiliated practice relationship with a dentist to provide oral health care services for underserved populations without general or direct supervision in public health settings. In response, the Northern Arizona University (NAU) Dental Hygiene Department developed a teledentistry-assisted, affiliated practice dental hygiene model that places a dental hygienist in the role of the mid-level practitioner as part of a digitally linked oral health care team. Utilizing current technologies, affiliated practice dental hygienists can digitally acquire and transmit diagnostic data to a distant dentist for triage, diagnosis, and patient referral in addition to providing preventive services permitted within the dental hygiene scope of practice. This article provides information about the PPACA and the Arizona affiliated practice dental hygiene model, defines teledentistry, identifies the digital equipment used in NAU's teledentistry model, give an overview of NAU's teledentistry training, describes NAU's first teledentistry clinical experience, presents statistical analyses and evaluation of NAU students' ability to acquire diagnostically efficacious digital data from remote locations, and summarizes details of remote applications of teledentistry-assisted, affiliated practice dental hygiene workforce model successes.     

Smoking Cessation Practices in Dental Offices

We have surveyed the health promotion efforts of dentists and dental hygienists in general dental practice in Chittenden County, Vermont, in relation to smoking. The response rate was 61 percent. Smoking issues were addressed by 76 percent of dentists and 81 percent of dental hygienists in approximately one quarter of their smoking patients. Although the majority of both dentists and dental hygienists advised their patients to change their smoking behavior, their advice was usually to cut down rather than to quit. Most of the respondents--78 percent of dentists and 93 percent of dental hygienists--considered it appropriate to give advice about smoking during visits for routine dental care and 68 percent and 89 percent, respectively, were willing to learn brief methods of advising their patients about smoking. Experience with giving advice about smoking and agreement that it was appropriate to give such advice were both strongly related to willingness to learn brief methods of giving such advice. In individual dental practices, there were virtually no correlations between the dentist's and the dental hygienist's behaviors as far as the proportion of patients from whom a smoking history was taken, the proportion of smokers advised about smoking, the content of the advice, or the nature of the advice. Only nine percent of dentists and 11 percent of dental hygienists were current smokers.     

Characteristics of Patients Seeking Care from Independent Dental Hygienist Practices

Objectives : This study determined demographic characteristics, satisfaction with care, and likelihood of follow-up dentist visits for patients seen in office-based, independent, dental hygienist practices. Methods : New patients were surveyed after their initial visits to independent hygienist practices to assess their demographic characteristics and satisfaction with care at both the beginning of practice operations and 18 months after the start of these practices. Follow-up surveys were sent to patients 12 and 24 months after their initial visits to the independently practicing dental hygienists to determine if patients had visited a dentist. Results : Most respondents were white, female, had attended some college, and reported high family incomes. Ninety-eight percent of respondents were satisfied with their dental hygiene care. Follow-up questionnaires revealed that over 80 percent of respondents visited the dentist within 12 months of receiving dental hygiene care in independent settings. This level of follow-up care with dentists was found both for respondents who reported having a regular dentist at their initial visits with the hygienists and for those who reported not having a regular dentist. Conclusion : Independent practice by dental hygienists provided access to dental hygiene care and encouraged visits to the dentist.     

Independent dental hygiene practice worldwide: a report of two meetings

Objectives: Following a meeting at the EUROPERIO in Berlin in 2003, a forum on Independent Practice of Dental Hygienists was held at the International Symposium on Dental Hygiene (ISDH) in Madrid July, 2004. The forum was organized and moderated by Beate Gatermann, President of the German Dental Hygiene Association. The participants were asked to address the following issues: population of country/state; population of dentists; population of state recognized dental hygienists (Canada/USA etc.); number of hygienists with ‘Diploma’ (Europe); duration of dental hygiene education; cost of education (2/3 year base approximately); when and how independent practice began in the country and who must be consulted or approve the application for an independent office (e.g. Health Department); what services are allowed? Can dental hygienists administer local anaesthesia in the dental office, and if so, must a dentist be present? Can dental hygienists purchase the necessary medication for the injection? Does the dental hygienist require additional education to provide local anaesthesia? How are the patients charged? Does the country offer a service fee list? Do insurance companies pay claims of the dental hygienist? What is the approximate average fee per hour charged (€/$)? Do dentists refer patients to you? If so, do they need a letter of referral? Are dental hygienists allowed to take radiographs in independent dental hygiene offices?     

How Swedish dental hygienists apply their training program in the field

Abstract – The purpose of this study was to evaluate how clinical practice by Swedish dental hygienists was related to type of dental delivery system, period of training, educational institution attended and patient category. Dental hygienists from 14 different dental hygiene schools were represented. Of these schools. 11 are still in operation. A specially designed questionnaire was posted to all dental hygienists in Sweden ( n = 1857). A total of 1399 questionnaire (75.3%) were completed and returned, providing data on 15546 dental appointments. 37.2% of the Swedish dental hygienists are presently working in private practices, 45.8% in the public dental health service and 6.2% in both. Of the patients treated by hygienists, 88.7% were adults: 99.5% in private practice and 78.4% in the public dental health service. 42.0% of all dental hygienists were trained in 1980–84. The mean treatment time per appointment in private practice was 49.7 min and 45 min in the public dental health service. Scaling, root-planing and removal of overhangs took 27 min per visit in private practice and 22 min in the public dental health service. However, there were no significant differences in methods in the two delivery systems with respect to examinations, self-care training, professional mechanical toothcleaning (PMTC), topical fluoride application, or salivary and oral microbiology tests. The adult patient categories were periodontal risk (45.1%), caries risk (9.1%) and hygiene (34.6%). In periodontal risk patients, scaling, root-planing and removal of overhangs took 28 min per appointment and 14 min in caries risk patients.     

Dental Providers' Attitudes Regarding the Application of Fluoride Varnish by Pediatric Health Care Providers

Objectives: To ascertain what proportion of dental hygienists and dentists in Indiana, United States, support the application of fluoride varnish in medical offices, and to determine if support differed by dental provider characteristics, practice characteristics, a limited assessment of knowledge about fluoride, or use of fluoride. Methods: Practicing dental hygienists and dentists in 2005 were asked to fill out a mail questionnaire. Logistic regression models tested the association of independent variables with support for medical providers applying varnish. Results: Response rates were 36% (dental hygienists) and 37% (dentists); median year of graduation was 1988 and 1981. Sixty‐six percent of respondents were in solo practices, 82% of dentists in general practice, 5% in dental pediatrics, and 13% were other specialists. While 51.2% of dental professionals agreed that medical practices could apply fluoride varnish, 29% responded “none” should be allowed, and 19% were undecided. In the multivariable logistic regression for support of medical practices applying fluoride versus not supporting it, three practice characteristics and two measures of fluoride use were significant. Provider characteristics and a limited assessment about knowledge about fluoride were not significant. Conclusions: Half of dental professionals felt that it was appropriate for medical providers to apply fluoride varnish; pediatric dental professionals were less supportive. A few dental practice characteristics were associated with acceptance of the use of fluoride varnish by medical care providers: targeting messages to dental hygienists and those with practices in mixed rural‐urban areas may be a useful approach to garner greater support for this medical/dental partnership.     

Managerial role development of the dental hygienist in initial patient interactions

In 1985, the American Dental Hygienists' Association (ADHA) identified six roles for the future of dental hygiene: change agent, health promoter/educator, clinician, researcher, consumer advocate, and administrator/manager. As part of the role definition implicit in the identification of these roles, dental hygienists must enlarge their view of themselves as clinicians and realize the importance of these six roles in total patient care. The purpose of this paper is to focus on the dental hygienist's managerial role in initial patient interactions and to identify skills essential to manage this responsibility. This paper also examines different teaching strategies that could be used by dental hygiene educators to enhance managerial role development.     

Accuracy of dental hygienists in diagnosing dental decay

Abstract During recent decades, the duties and care rendered by Swedish dental hygienists have continuously expanded, and since 1991 they are licensed to practice dental hygiene independently. The aim of the present study was to investigate the accuracy of dental hygienists in examining and recording dental caries in comparison with dentists performing identical examinations. The study included two parts: A) Registration of carious lesions from radiographs of 100 extracted teeth, where the correct diagnosis could be verified, and B) clinical examination and registration of carious lesions in 213 patients. No statistically significant differences could be found between the dental hygienists” and their control dentists' accuracy to diagnose and record dental decay, with the exception of the number of initial lesions (white spot lesions) registered clinically, where the dental hygienists recorded more buccal and lingual lesions. Irrespective of the group of examiners (dental hygienists or dentists), however, the inter-examiner variation was wide. The variation decreased with the size of the lesion and increased with the age of the patient. This study suggests that no patient with a restorative treatment need would have been neglected if the dental hygienists had performed the examination, and, possibly, a more accurate non-restorative treatment need would have been addressed.     

Dentist involvement in care provided by the dental hygienist

This study investigated a nationwide sample of dental hygienists to determine the extent of dentist involvement during the patient's appointment with the dental hygienist. The American Dental Hygienists' Association identified the need for additional study of dentist involvement and contracted for data to be obtained as part of the ongoing longitudinal study of 1982 dental hygiene graduates. Mail questionnaires were sent to a nationwide cohort of 1,008 dental hygienists who graduated in 1982. Responses were received from 812 subjects, an 83% response rate from subjects with valid addresses. Data indicated that, on the average, the dentist spends 10 minutes with the dental hygienist's patient at the end of the dental hygiene appointment. This time is divided almost equally among talking with the patient, performing an oral examination, and discussing diagnosis and treatment needs.     

Characteristics of employment and job satisfaction in nontraditional dental hygiene practice settings

Little is known concerning the employment characteristics of hygienists practicing in nontraditional settings. Respondents were identified through screening (n = 38,380) a listing of the entire population of hygienists licensed in the United States. The screening identified 1,301 hygienists practicing in nontraditional settings. These hygienists were mailed comprehensive questionnaires; completed questionnaires were returned by 84.3 percent of the hygienists. Data were collected describing hygienists' reasons for seeking employment in nontraditional settings, their sources of information concerning job opportunities in nontraditional settings, benefits, and job satisfaction. The main source of information concerning employment opportunities in nontraditional settings was "word of mouth." Hygienists were motivated to seek employment in nontraditional settings primarily by a desire for a more challenging position and personal satisfaction. The hygienists were overwhelmingly satisfied with all aspects of nontraditional employment except opportunities for advancement. Respondents were found to receive standard benefits similar to those of employees in other industries.     

A proposed model for a collaborative approach to dental hygiene research

Abstract:  As dental hygiene responds to the increased need for quality oral health services, dental hygienists seek quality research findings on which to base their practice decisions. However, the amount of research published by dental hygienists, and addressing dental hygiene interventions, remains limited. There are few dental hygienists in Canada working in positions that have time dedicated to research activities. To increase the amount of dental hygiene research, innovative approaches such as collaborative research must be considered. This paper considers measures that facilitate the conduct of collaborative research, and discusses challenges to the process that should be considered during the design. An example of a group investigation is presented, involving dental hygiene educators who collaborated on a research project implemented within their respective educational institutions. A model for a collaborative approach to future research initiatives is proposed. Lessons learned are shared and recommendations are put forward. It is suggested that innovative collaborations such as this may help to increase the body of knowledge for dental hygiene in Canada.     

Service mix in general dental practices employing and not employing dental hygienists

Abstract Service mix studies conducted in Australia have indicated a low provision of periodontal services. The service mix in Australian general dental practices employing dental hygienists has not been studied. This study compares the service mix between 18 practices employing hygienists and 29 practices not employing hygienists in Adelaide. Practices employing hygienists tended to be larger group practices, with younger dentists seeing a younger set of patients. Practices employing dental hygienists provided a mean of 97.9 services to 57.2 patients over 2 days, significantly higher than the mean of 68.8 procedures to 39.1 patients in practices not employing dental hygienists. Comparing the % of procedures provided in treatment categories as a ratio of total procedures, practices employing dental hygienists provided significantly more periodontal procedures and less oral surgery, prosthetic and restorative procedures. Periodontally-related services accounted for an average of 37.7% of procedures in practices employing dental hygienists compared with 18.9% in practices not employing dental hygienists (p(0.05). Periodontal and preventive treatment of 50.7%) of patients in practices employing hygienists was delegated to a hygienist, and the level of delegation of periodontally-related procedures was 77.2%. Over 90% of procedures performed by hygienists were periodontally-related, with the removal of subgingival calculus accounting for 57.7% of all procedures provided by dental hygienists. In conclusion, practices employing hygienists had a more periodontally-orientated service mix, with hygienists acting to complement the services of dentists in the provision of periodontal services, rather than as a substitute for the dentist.