The role of the dental hygienist in the public health sector; an Australian perspective

A review of the literature on dental hygienists and their utilisation in the dental workforce is presented. Dental hygienists are employed as part of a dental team in the prevention and management of the two most common and costly oral diseases; dental caries and periodontal disease. The potential scope for dental hygienists in the public health sector in Australia is examined in the light of broader issues relating to changing disease patterns, service delivery and the treatment of patients with special needs. Prevention and treatment of oral disease by the dental hygienist in schools, institutions, nursing homes, hospitals and residential facilities is discussed, with emphasis on such issues as legislation, productivity and quality assurance. Implications for the future training of dental hygienists are presented and recommendations made for increasing their utilisation in the public sector.     

辽宁省公立口腔医疗机构及人力资源调查分析

目的对2011年辽宁省公立口腔医疗机构进行普查,分析了解辽宁省公立医疗机构口腔卫生人力资源状况。方法经各级卫生行政管理部门对注册机构逐级下发问卷并有效回收,对辽宁省所有公立口腔医疗机构进行普查。调查内容包括辽宁省公立医院口腔卫生人力资源的数量、结构、层次、分布、设备状况等。结果辽宁省公立口腔医疗机构共有506家,三级医院16家,二级医院96家,一级医院394家;口腔医生2 485人,护士773人,技工416人;椅位2 242台。全省公立口腔人力资源总体以中青年为主(76.58%)。口腔医生的结构以主治医师、大学本科学历、口腔综合专业为主,分别占35.57%、43.50%和59.76%。牙科辅助人员以初级职称为主。其中,护士结构以大专学历、口腔综合专业为主,占49.94%和58.60%;技工结构以中专及以下学历、修复专业为主,占65.14%和40.63%。医生、护士、技工比为6∶2∶1;护、椅比为1∶2.9;修复医生与技工比为1.67∶1。结论辽宁省公立口腔卫生人力资源结构层次不合理,牙科辅助人员相对不足。应加强公立口腔医疗机构中卫生人力资源的合理配置和有效利用。     

Expanding Health Insurance Coverage and the Implications for Dentistry

Numerous proposals have been suggested for expanding health insurance coverage to the over 30 million Americans without health insurance. These proposals range from establishing a program of national health insurance modeled after the Canadian system to establishing statewide risk pools. Many of these proposals could have an impact on financial access to dental care for the approximately 120 million people without dental insurance. Dental insurance coverage has been shown to increase access to dental services and improve oral health status. Oral health professionals could facilitate discussions concerning health insurance expansion by informing policymakers about important preventive benefits to be gained by improving access to dental services. Dental public health professionals can serve as a bridge between organized dentistry and health policymakers by providing information to help formulate the priorities and characteristics of a dental health insurance program. This visibility and influence in the health policy arena would be beneficial to dentistry and could ultimately result in greater access to dental services and improved oral health for the uninsured.     

Collaboration between dental faculties and National Dental Associations (NDAs) within the World Dental Federation-European Regional Organization zone: an NDAs perspective

Although improvements in certain oral health measures have been achieved, many global oral health matters and challenges exist. Collaborations and partnerships among various institutions are crucial in solving such problems. The main aim of the present study was to analyse the nature and extent of the partnership between dental faculties and National Dental Associations (NDAs). A questionnaire was developed, focusing on the relationship between NDAs and dental faculties within the World Dental Federation-European Regional Organization (FDI-ERO) zone with regard to major professional activities, such as dental education (both undergraduate and continuing education), workforce issues, improvement of national oral health, and science and knowledge transfer. The questionnaire was sent to all member NDAs within the ERO zone. The response rate was 21/41 (53.65%). The major activities in which NDAs were found to be involved were improvement of national oral health (100%), followed by continuing education activities (90%), whereas the activity which received least involvement was the development of an undergraduate dental curriculum (52%). The NDAs perceived their relationship with dental faculties to be quite satisfactory in the fields of continuing education, science and knowledge transfer, and the implementation of new technologies into daily dental practice. However, it was suggested that their relationship needed significant improvement with regard to the development of an undergraduate dental education curriculum, dental workforce issues and negotiations with the authorities regarding professional matters/issues. As the two important elements of organised dentistry, NDAs and dental faculties have a significant role to play in the improvement of oral health and in finding solutions to global oral health challenges; therefore, their collaboration and partnership are crucial for this purpose. On the basis of the perceptions of NDAs regarding their relationship with dental faculties, it can be concluded that their partnership can and should be further improved.     

中国口腔医疗保险发展之分析

本文通过查阅大量文献,分析口腔疾病的特点、影响口腔服务利用的因素以及国内外口腔保险的现状,着重讨论了口腔医疗保险对改善口腔医疗服务利用率和促进人群口腔健康的积极作用,利用PEST分析法分析了在中国建立和完善口腔医疗保险的必要性和可行性,提出急需解决的核心问题和发展策略.只有发展口腔保险事业,提高人们对口腔健康的关注度以...     

Analysis of the extent and efficiency of the partnership and collaboration between the dental faculties and National Dental Associations within the FDI–ERO zone: a dental faculties' perspective

Background and aim: As National Dental Associations and dental faculties can be considered as the two major institutions representing national organised dentistry, their further extended collaboration is crucial in responding to the many global oral health matters and issues. The main aim of the present study is to analyse the nature and extent of the partnership between the dental faculties and NDAs. Methods: A questionnaire was developed focusing on the relationship between National Dental Associations and the dental faculties within the World Dental Federation–European Regional Organisation zone regarding their major professional activities such as dental education, workforce issues, improvement of national oral health, science and knowledge transfer. The questionnaire was sent to 173 dental faculties within the countries in the European Regional Organisation zone. Results: Response rate was 62/173 (35.8%). Major activities of dental faculties were listed as implementation of new technologies into practice (72%), followed by improvement of national oral health (65%), while the least involved activity was dental workforce issues (42%). The dental faculties perceived their relationship with the National Dental Associations as quite satisfactory in the field of continuing education and science and knowledge transfer. However, their relationship was suggested to need significant improvement when dealing with undergraduate dental education curriculum, dental workforce issues and negotiations with the authorities regarding professional matters/issues. Discussion and conclusions: Despite the fact that there are differences between the perceived competences and responsibilities of the two bodies, the presence of so many potential areas of collaboration, the increasing expectations from the individual dentists/dental profession and the new challenges of the dental profession give this relationship significant importance. Communication, regular contacts, more joint activities and improved collaboration is needed between dental faculties and National Dental Associations to overcome such professional matters and issues.     

The virtual dental home: a critique

The Virtual Dental Home is a concept of the Pacific Center for Special Care of the Arthur A. Dugoni School of Dentistry in San Francisco. It is designed to improve access to dental care for underserved populations, specifically children and institutionalized adults. This article describes the development and implementation of the Virtual Dental Home, subsequently critiquing the concept. The criteria for a dental home are not met by the program. It is the equivalent of a traditional public oral health prevention and screening program, with the additional dimension of allowing dental hygienists and assistants to place interim glass ionomer restorations in dental cavities. The critique questions the need to insert a “cloud” dentist into the process. The routine utilization of radiographs is also challenged. The VDH not only lacks the attributes of a dental home, it has not been shown to be as efficient and effective as traditional programs staffed by dental hygienists and dental therapists. The article concludes by describing how programs utilizing dental therapists could address the deficiencies of the Virtual Dental Home, effectively improving access to oral health care for underserved populations.     

Academic Dental Public Health Diplomates: Their Distribution and Recommendations Concerning the Predoctoral Dental Public Health Faculty

Objectives : The purpose of this study was to assess the representation of academically based diplomates of the American Board of Dental Public Health (ABDPH) and to identify their perceptions on the training of dental public health predoctoral faculty. Methods : Data were collected by a mailed, self-administered, 13-item questionnaire. The population was the 48 diplomates of the ABDPH as of March 1997 associated with academic institutions. Results : Twenty of the 55 US dental schools had a diplomate of the ABDPH with a mean of 1.8 diplomates per school with a diplomate. An average of 4.5 full-time faculty members per school were associated with teaching dental public health. A master's degree in public health (MPH) was the most frequently suggested educational requirement for dental public health faculty. Continuing education courses were training needs perceived for dental public health faculty. The lack of time, money, and incentives, along with perceived rigidity of requirements for board certification, were reported as major barriers for faculty becoming dental public health board certified. Conclusion : Numerous challenges confront the development of a strong dental public health presence in US dental schools. These challenges include, among others, insufficient numbers of academic dental public health specialists and insufficient motivations to encourage promising candidates to pursue specialty status.     

A Symposium on Building a Coalition To Improve the Public''s Oral Health: Reaction Paper

The dental research community has a social and civic responsibility to participate actively in promoting the public's oral health, but participation should be carefully orchestrated with other groups. The ADHA "Hearing on Needs" has stimulated a coalescing of groups and individuals to contribute to the welfare of society's oral health. Dental organizations—especially dental public health organizations—need to work more cooper- atively together to work, in turn, with other organizations. "In union, there is strength."     

A Symposium on the Future of Dentistry Report: Implications for the Public Sector: Impact on Dental Hygiene

This paper reviews the six recommendations as approved by the House of Delegates of the American Dental Association in 1983. Each recommendation is reviewed in relation to public health and preventive dentistry as well as the established goal of dental hygiene: "To improve the public's total health by increasing the awareness of and access to quality oral health care and to position the dental hygienist as the preventive oral health professional." To reach this goal it is recommended that dental hygienists seek out opportunities in the public sector where there is more job satisfaction, their professional roles have higher acceptance with both coworkers and patients, and there is a high level of interaction with other health-care professionals.     

An assessment of the dental public health infrastructure in the United States

OBJECTIVES: The National Institute of Dental and Craniofacial Research commissioned an assessment of the dental public health infrastructure in the United States as a first step toward ensuring its adequacy. This study examined several elements of the U.S. dental public health infrastructure in government, education, workforce, and regulatory issues, focused primarily at the state level. METHODS: Data were drawn from a wide range of sources, including original surveys, analysis of existing databases, and compilation of publicly available information. RESULTS: In 2002, 72.5% of states had a full-time dental director and 65% of state dental programs had total budgets of 1 million dollars or less. Among U.S. dental schools, 68% had a dental public health academic unit. Twelve and a half percent of dental schools and 64.3% of dental hygiene programs had no faculty member with a public health degree. Among schools of public health, 15% offered a graduate degree in a dental public health concentration area, and 60% had no faculty member with a dental or dental hygiene degree. There were 141 active diplomates of the American Board of Dental Public Health as of February 2001; 15% worked for state, county, or local governments. In May 2003, there were 640 U.S. members of the American Association of Public Health Dentistry with few members in most states. In 2002, 544 American Dental Association members reported their specialty as Dental Public Health, which ranged from 0 in five states to 41 in California. Just two states had a public health dentist on their dental licensing boards. CONCLUSIONS: Findings suggest the U.S. dental public health workforce is small, most state programs have scant funding, the field has minimal presence in academia, and dental public health has little role in the regulation of dentistry and dental hygiene. Successful efforts to enhance the many aspects of the U.S. dental public health infrastructure will require substantial collaboration among many diverse partners.     

Supply of dental health information by 182 Dutch organizations working in the field of dentistry

Abstract Little is known about the exchange of Dental Health Information (DHI), as part of the dental health education process, between the Dutch public, organizations active in or related to dentistry and Dutch dental professionals. Based on the ideas of Havelock a communication model was developed. The main question was: how and through which organizations is information supplied, on what subjects related to dental health? A group was formed, consisting of 182 organizations and institutions and 85% decided to collaborate with the study. Telephone interviews were used for the sampling of the data. Of the 154 organizations and institutions only 56% reported to be active in the field of DHI. Preventive information appears to be the main subject. Not the public, but dental professionals and other provider groups are seen as the main target groups. DHI activities appear to consist mainly of providing written information material with a preventive content. These activities are hardly evaluated. Further on: there seems to be no central coordination for DHI activities in the Netherlands. It is concluded that in the field of DHI activities the resource system (organizations and institutions who generate information) and the users system (the public and dental patients) are not in accordance with each other.     

Empowerment Through Mentorship and Leadership

Leadership is vital to future growth and change in the dental hygiene profession.Background and PurposeAs health care reform emerges, state practice acts expand and new models of dental hygiene practice are created and implemented, dental hygienists will assume leadership positions that may be quite different from the more traditional leadership roles they assume today. These dental hygienist leaders will envision, creatively design and implement oral health care programs to improve the oral health of the public. Mentoring, a vital component of leadership development, is critical for dental hygienists to acquire knowledge, guidance, and growth.MethodsThis paper provides a literature-supported overview of leadership and mentoring principles applicable to dental hygienists in their personal and professional lives. Opportunities for dental hygienists to assume leadership roles are also described.ConclusionsDental hygienists are poised to become leaders and vital members of the professional team promoting and integrating oral health care as a part of general health. Consequently, the dental hygienist's leadership roles are likely to expand and can be strengthened through mentoring relationships and mentoring teams. Ultimately, this can increase professional growth and career satisfaction for the dental hygienist as well as improve oral health care for the public.     

The dental therapist movement in the United States: A critique of current trends

Dental therapists are members of the oral health workforce in over 50 countries in the world typically caring for children in publically funded school‐based programs. A movement has developed in the United States to introduce dental therapists to the oral health workforce in an attempt to improve access to care and to reduce disparities in oral health. This article critiques trends in the United States movement in the context of the history and success of dental therapists practicing internationally. While supporting the dental therapist movement, we challenge: a) the use of dental therapists treating adults, versus focusing on children; b) the use of dental therapists in the private versus the public/not‐for‐profit sector; and c) requirements that a dental therapist must also be credentialed as a dental hygienist.     

An argument for dental hygiene to develop as a discipline

Abstract:  The practice of dental hygiene was developed to provide oral health education and preventive oral health care, originally for children. It has grown to provide oral health services valued by a broad spectrum of society, but has not attained the desired respect and status accorded to other professional groups. Objective:  Professional disciplines link actions of practitioners with the science that is the foundation of practice. The purpose of this paper is to examine whether dental hygiene practice could benefit from pursuit of development as a discipline. Methods:  Literature on professionalization and disciplines, related to dental hygiene in general and the North American context specifically, was retrieved from databases and grey sources, such as organizational reports. Dental hygiene's current characteristics relative to a discipline were examined. Results:  Dental hygiene has developed some characteristics of a discipline, such as identifying a metaparadigm that includes concepts of the client, the environment, health/oral health and dental hygiene actions, with a perspective that includes a focus on disease prevention and oral health promotion. However, research production by dental hygienists has been limited, and often not situated within theoretical or conceptual frameworks. Conclusion:  Dental hygiene draws its knowledge for practice from a variety of sources. Dental hygiene could strengthen its value to society by prioritizing development of highly skilled researchers to study interventions leading to improved oral outcomes, and transferring that knowledge to practitioners, strengthening links between practice and science. Intentional pursuit of knowledge for practice would lead to dental hygiene's eventual emergence as a professional discipline.     

A Researcher''s View

The Food and Drug Administration (FDA), by ensuring that the health care products used by Americans are both safe and effective, provides an essential regulatory function. With respect to the regulation of dental drug products, this researcher perceives that the FDA has not changed or modified its position on a number of issues to reflect new scientific information. Reasons for this inflexibility include the size and ponderousness of the agency, inadequate staff with dental expertise, and a failure to keep current with new dental research findings. The FDA must solve these problems if it wishes to regulate intelligently. The acceptance and certification programs of the American Dental Association ensure that products offered to the profession and the public that bear its seal of acceptance are safe and effective. The ADA's Council on Dental Therapeutics has a long history of staying current on issues in dental research and public health and regularly seeks consultation from eminently qualified experts. Overall, it has done an excellent job over the years in conducting an important voluntary regulatory program. Both the FDA and the ADA benefit and help protect the oral health of the public.     

Advancing Education in Dental Hygiene

The changing health care environment and societal imperatives indicate the need for transformative change within the dental hygiene profession to serve the emerging needs of the public. The American Dental Hygienists' Association is leading the way toward meaningful change.Background and PurposeThe American Dental Hygienists' Association (ADHA) has as its vision the integration of dental hygienists into the health care delivery system as essential primary care providers to expand access to oral health care. This article provides data on current dental hygiene education programs and those in development. Also included is a discussion regarding how the dental hygiene profession can better serve the health and wellness needs of society by transforming the way graduates are prepared for the future.MethodADHA's dental hygiene survey center data, policies and a futuristic analysis plus a review of the professional literature describe the current state of dental hygiene education and the profession. A discussion of societal, health care and educational trends that creates the imperative for transformation of the dental hygiene profession is provided.ConclusionsUltimately, the purpose of advancing education in dental hygiene is to achieve better oral and overall health for more people. The profession's responsibility to the public includes evaluating its own ability to provide care and taking the steps necessary to ensure its maximum effectiveness. ADHA is leading this process for dental hygienists in diverse ways. It is imperative that the dental hygiene profession understands and embraces the changing health care environment. Through open dialog and the sharing of evidence the professional path will be determined along with forward movement for the benefit of society and the dental hygiene profession.     

A Symposium on the Future of Dentistry Report: Implications for the Public Sector: Dentistry''s Blueprint for the Future

This report deals with a three-year study by the American Dental Association pertaining to the Future of Dentistry. The report covers environment of dentistry, dental research, dental manpower, public and professional concerns, dental education, and dental practice. It concludes with the following recommendations: Convert public unmet need into demand for dental services. Prepare practitioners (existing and future) to be more patient/market oriented. Broaden practitioner's clinical skills and mix of services offered to the public. Influence the quality and quantity of the manpower supply. Stimulate research and development. Improve the profession's ability to favorably influence public policy.     

Evaluation of a Dental Public Health Program for Old-age Pensioners in Denmark

A high priority is given to improvements in the oral health of the elderly in Scandinavia. In 1987 a Danish municipality established a dental public health care program for old-age pensioners. All 67-year-old citizens were offered school-based preventive and curative care using guidelines and principles established by the Danish Municipal Dental Service for children. Care was provided free of charge. Citizens not wishing to obtain care through the public system could do so from private dental practitioners. Reimbursement for care obtained from the private system was provided by the National Health Insurance and the municipality. The purpose of this study was to evaluate the outcome of the program after three years of operation. A follow-up design was used and data were collected by interviews and clinical registrations. At baseline and follow-up 216 (71%) and 235 (77%) pensioners, respectively, were interviewed about their self-assessments of dental health, dental knowledge, attitudes, and behavior. Clinical data were collected only for the elderly who participated in the public program, and included 194 persons at baseline and 187 at follow-up. These data included information on tooth loss, dental caries, periodontal health, and presence and function of removable dentures. At the follow-up, 86 percent of all respondents had regular dental visits of at least once a year compared to 46 percent at baseline; 75 percent participated in the public program and 11 percent obtained care from private practitioners. At the end of the intervention period, fewer elderly reported symptoms of poor oral health or impaired function of dentures. Moreover, improvements in self-care, knowledge, and attitudes in oral health were found. The clinical data showed a reduction in unmet need for dental treatment. More preventive care services were given to attenders of the public program than the private one. The present evaluation of systematic public dental care demonstrates positive results in improvment of the oral health and life-quality among the elderly.     

Holes a plenty: oral health status a major issue for newly arrived refugees in Australia

BACKGROUND: Dental health needs of newly arrived refugees are much greater than for the wider Australian community. This paper identifies the disparities and highlights major dental health issues for Australia's growing and constantly changing refugee population. METHODS: Using available data and the decayed, missing and filled teeth (DMFT) index as a measure of oral health, the reported oral health status of refugee groups in Australia was compared with that of the general population, Indigenous Australians, recipients of public dental services, special needs groups in Australia and other refugee groups outside Australia. RESULTS: The reported oral health status of Australian refugees compared poorly with the comparison groups. Of particular concern was the number of reported untreated decayed teeth (D). This ranged from a mean of 2.0 to 5.2 compared with 0.6 to 1.4 for the general Australian population. Refugee groups also reported fewer filled teeth (1.0 to 5.8) compared with the general population (4.1 to 9.3). Similar results were found when reported D, M and F teeth for refugees were compared to Indigenous Australians, public dental service recipients, immigrants and special needs groups in Australia. CONCLUSIONS: Dental health of refugees, particularly untreated decay, compared poorly to that of Indigenous Australians, and special needs populations in Australia who all have known worse dental health than the general population. There is an urgent need for the inclusion of this at risk population among targeted dental services. In addition, sources of health related data must clearly identify refugees to enable appropriate comparisons with other population groups. Recommendations for refugees are made regarding on-arrival dental assessment and treatment, and community based oral health programmes.