Dental Hygiene and Radical Change: Two Unlikely Partners

Dental Hygiene and Radical Change: Two Unlikely Partners

In Canada, thousands of people go without access to oral health care services each day. Many of those who go without access to oral health care services belong to communities or populations who are marginalized or disenfranchised. People who encounter barriers accessing oral health care services include individuals on social assistance programs, older adults (a growing demographic in Canada), Newcomers to Canada, and Indigenous Peoples. Yet, as a Dental Hygiene Educator since 2007, I have had the privilege to see hundreds of oral health care professionals graduate. I often ask myself, where do these graduates go? As a discipline, Dental Hygiene Programs across Canada are contributing hundreds of oral health care professionals each year, yet thousands of Canadians do not have an oral health care provider. Something is not adding up.

To me, the glaring disconnect between the supply of oral health care professionals and the number of people who need them but cannot access them is unacceptable, and it is time to have a real talk about real solutions.

I like to akin this problem to an "elephant in the room" or in dental hygiene terms, a giant piece of subgingival calculus on the mesial of tooth 1.6. I would argue that it is a logical comparison. Collectively, we know there is a problem. We see the signs, the inflammation, we feel it, and if we look under the surface, we can identify the cause. Where the comparison is lost is on the action. Most dental hygienists take no issue picking up an SG 11/12, or my personal favourite an SG 15/16 (note to dental hygiene students, please study dental hygiene scalers beyond what was included in your dental hygiene program kit!) and removing the offending piece of calculus. In fact, many gain a sense of professional fulfillment from the action of scaling a tooth.

Now let's reframe the situation, access to oral health care is the piece of calculus, and it is causing a host of problems on both a micro and macrosocial level for the Canadian population. Lack of access to oral health care leads to pain, disability, low self-esteem, loss of work, and strain on the healthcare system. The latter, strain on the healthcare system that we all feel, effects us when we personally access health care services in the form of, wait times in the hospital, hallway medicine and pinched community services. Therefore, the lack of access to oral health care hurts us all, not just the populations mentioned.

So why do we jump to remove the piece of calculus, yet hesitate to mobilize on the access to oral health care issue? You might be reading this thinking, wait a minute, "I volunteer, I am involved in my community, the private dental practice I work in offers payment plans to assist people paying their oral health care bills." Volunteering, community involvement, and empathy are all incredible actions that are not to be minimized or diminished. However, the access to oral health care problem is far too great to ignore, and every dental hygienist needs to be aware of its magnitude. Collectively as a profession, we possess the knowledge, skills and expertise in oral disease prevention to be instrumental in the solution to this problem.

Access to oral health care is a complicated problem with many contributing factors. Therefore, the solution to the problem is not simple and will be multifaceted and require cooperation and collaboration of many stakeholders.

My next entry is going to explore (no pun intended) a starting point to creating solutions to access to oral health care barriers. I propose a logical starting point, dental hygiene education. Dental hygiene education must undergo a radical transformation. Radical and dental hygiene, two terms I never thought would go together, but its time.

I will close this post with a quote from the ADHA's Journal of Dental Hygiene: Special Commemorative Issue.

"Some dental hygiene professionals will elect to maintain the status quo, some will consider the chance too costly and will blame others for dental hygiene's demise, and some will accept the challenge with bold optimism, for the arena of a "developing profession" is more fulfilling than one quietly slipping into obsolescence."" – Pauline Brine, RDH, MPH

I think I found my new mantra.


References:

Photo by Nam Anh on Unsplash

Access Angst: A CDHA Position Paper on Access to Oral Health Services. Ottawa: Canadian Dental Hygienists Association; 2003.

Canadian Academy of Health Sciences. Improving access to oral health care for vulnerable people living in Canada. 2014.

Canadian Institute for Health Information. Distribution and Internal Migration of Canada’s Dentist Workforce. Ottawa: CIHI; 2007.

Farmer J, Peressini S, Lawrence H. Exploring the role of the dental hygienist in reducing oral health disparities in Canada: A qualitative study. International Journal of Dental Hygiene. 2017;16(2):e1-e9.

Information on Hospital Emergency Room Visits for Dental Problems in Ontario | Alliance for Healthier Communities [Internet]. Allianceon.org. 2014 [cited 8 November 2019]. Available from: https://www.allianceon.org/Information-Hospital-Emergency-Room-Visits-Dental-Problems-Ontario

The State of Oral Health in Canada: A Call to Action for Dental Hygienists

For many years the dental hygienist fit an archetypal profile, female, auxiliary and predominately employed in a private dental practice setting. Over the past 25 years, that archetype is slowly and rightfully fading from conventional thinking. Some, including myself, would prefer to see that archetype shattered. Now more than ever, as the gap widens between rich and poor, we need dental hygienists stepping outside of conventional roles such as private dental practice and applying their skill set to areas where their voice can effect change. These areas include those where the decisions are made, such as government and community health settings. There is too much disparity in Canada concerning access to oral health care.

The Canadian Academy of Health Sciences (2014) outlined the following significant issues about oral health and how it is accessed in Canada:

·      6 million Canadians avoid visiting the dentist every year because of lack of finances

·      The pain, discomfort and disability caused by poor oral health in low-income and even middle-income brackets has resulted in a measurable loss of opportunity

·      The bulk of dental care is provided in the private sector, with only about 6 percent expenditure on dental care in the public sector

·      Although private sector dentistry provides quality oral health care for the majority of people living in Canada, it remains inaccessible to vulnerable populations for a myriad of reasons

The inability to access oral health care is a public health crisis and the majority of the skilled oral health care professionals who would be instrumental in helping to address these issues are behind closed doors in private dental practice settings. The surplus of oral health care professionals, yet lack of access to oral health care creates an interesting dichotomy; you cannot solve a public health crisis from a private dental clinic.

Where does that leave us? As an educator in a dental hygiene program, I ask myself and my students every day how we can mobilize the workforce of oral health care professionals to campaign for change. How can new graduates be motivated to explore roles beyond traditional clinicians in the industry? I believe the answer is two-fold. Firstly, dental hygienists need to be moved to action by the grim statistics surrounding access to oral health care in Canada. Secondly, opportunities must exist for dental hygienists to utilize their skill set and truly act as agents of change. It is time to put down the scaler and pick up the megaphone.

What do you think?

Reference:

Canadian Academy of Health Sciences, 2014. Improving access to oral health care for vulnerable people living in Canada.