Dental hygienists Should Practice at the Top of their License

Too often dental hygienists cannot practice using their full training and competencies, according to Mary Northridge, an associate professor with the Department of Epidemiology and Health Promotion at the New York University College of Dentistry.

By practicing at the top of their license, hygienists can not only be more productive, but manage issues such as talking to patients with pre-diabetes and pre-hypertension by helping to coordinate their primary care needs, she said. Answering questions about diabetes, tobacco use and nutrition are well within their scope of practice.

Northridge herself, diagnosed with a brain tumor at age 50, found “the healthcare system unmanageable for me, and I work in the system.” Her physician daughter helped her navigate yet she believes all patients “need to find navigators, and I don’t think this is one-size-fits all.”

Northridge told of focus group research on why people don’t go to the dentist. Fear of pain, needles and mistrust dominated the conversations.

Her sister, who works with people with severe disabilities, had one client with so much anxiety her sister spent a year working with that client, initially going to the dentist’s office just to read magazines.

Senator Elizabeth Steiner-Hayward, herself a family physician and lawmaker who was introduced at the conference as being involved with some 50 bills in the past Oregon legislative session connected to oral health said “nurses are more trusted than doctors. I think our hygienists are trusted more than dentists.” The senator said she recently spent 30 minutes with her hygienist and five minutes with her dentist.

Aging Adults

Older adults, Northridge said, especially need respect and care. Elders who cannot eat or take their medications without pain from teeth and gum problems face daunting odds.

In Oregon, the percent of adults over 65 without any teeth has held steady at between 16-19 percent for the ten years between 2002-2012, said Bruce Gutelius, the Oregon Health Authority’s chief science officer and deputy state epidemiologist.

Just 10 percent of retirees have dental insurance, and Medicare doesn’t cover oral health, said Donalda Dodson, board chair of the Oregon Oral Health Coalition.

Without regular dental care, people seek help in emergency rooms when their dental pain becomes unbearable, “get a pocketful of pills, and end up back in ER because the actual condition has not been treated,” said Dr. Bruce Austin, Oregon’s dental director.

Between the years 2000-2050 the number of people in nursing homes is expected to double, Austin said, where they more often than not receive poor oral hygiene. Only 16 percent of patients in nursing homes receive dental care and even those who do get only a few seconds of teeth brushing daily.

Pat Berry, professor at Oregon Health Science University Hartford Center of Gerontological Nursing Excellence, said part of the problem is that nurses are taught “absolutely nothing” about oral health.

“We need to rapidly shift this notion (of oral care) from grooming to health care,” Berry said. “Oral care is not considered a high-level skill.”

While fluoridation of water has been presented as a children’s issue, 38 percent of adults who have no teeth live in communities without fluoridation.

“It baffles me,” said Steiner-Hayward that well-educated, internet-savvy people oppose fluoride and immunizations yet accept dental sealants and antibiotics.

Congressman Earl Blumenauer, is often asked whether he’s frustrated by climate change deniers in Washington, D.C., but told conference attendees he’s equally frustrated by fluoridation and vaccination deniers.

Jan can be reached at [email protected].