Research points to a number of changes in healthcare delivery, education, and policy that are likely to shape the future of dental hygiene. Health system reform is changing the way “business” is being done in health care. Today's health reform programs are largely focused on improving patient care, reducing health care costs, and improving patient health.1 This movement has initiated a cultural shift in health care delivery encouraging the adoption of comprehensive care that supports “total patient” health as opposed to the traditional model of treating diseases and organ systems.1
How might this impact dental hygiene? Oral health has historically been seen as the “role” of dental professionals and the dental care system, however over the last several decades it is increasingly being recognized part of “total patient” health and prioritized by non-dental health professionals leading to research into new practice models. 2-5
New practice models integrating oral health as part of “total patient” care will have significant implications for the future of dental hygiene. Non-dental health care professionals are delivering oral health care services including oral health risk assessments and screenings, as well as providing preventive treatments such as fluoride varnish, as part of their scope of practice.6-9 These practice models depend upon dental referral networks in order for patients to receive comprehensive oral health care services. As dental professionals with community health training, future dental hygienists will be well positioned to serve as liaisons between medical and dental offices; although, recent research points to an even broader future where dental hygiene professionals practice as part of integrated health care teams in diverse settings across the health system.
Interprofessional/multidisciplinary collaborative practice models are integrating dental hygienists into primary care and pediatric practices to extend more comprehensive oral health care for patients.9-11 These practices are just the tipping point; the door is open for research into multidisciplinary practice models in diverse settings, including oncology and geriatrics. Health care delivery research points to a future where dental hygienists will have increasing opportunity to practice as co-therapists alongside a diverse array of medical colleagues.
Education is responding to health system transformation as well. The adoption of interprofessional health education is encouraging a “new” culture among health professional students, in which each profession plays an important role in supporting and promoting “total patient” health.12-16 Today's dental hygiene students are being exposed to interprofessional education to prepare them for future opportunities. Recently an entire issue of the Journal of Dental Education, was dedicated to exploring the changing health care environment and outlining implications for the future of dental education through the “Advancing Dental Education in the 21st Century” project. A series of papers in the issue were specifically focused on dental hygiene.17,18 In addition to the expansion of interprofessional education, a number of circular enhancements were recommended to prepare dental hygiene for the future including a recommendation to incorporate health policy into dental hygiene education programs.17 The dental hygiene profession will need to identify champions, organize, and advocate for policies that advance oral health for their patients and communities in order to successfully navigate the changing landscape and realize new, expanded practice opportunities.
Coalition groups of dental hygiene professionals and oral health supporters must advocate for policies enabling dental hygienists to practice to the highest level of their education and skills to advance patient and population health in settings across the health system and the community. State practice acts are the policies defining and setting the parameters for the clinical practice of dental hygiene within the state and research demonstrates that policy influences health outcomes.19-21 States with policies enabling dental hygienists to practice to the full extent of their scope of practice and those with the fewest restrictions, report greater oral health service utilization and better population oral health. Barriers in the form of restrictive state policies will need to be overcome for health care reform efforts and interprofessional/multidisciplinary practice to become the reality. States including Colorado, Wisconsin, Minnesota, and others have been successful in promoting interprofessional/multidisciplinary practice and can serve as case studies or examples to follow. Dental hygiene must identify champions from within their ranks, nationally and within states, to carry the torch for policy changes that advance dental hygiene and oral health.
So, what does research tell us about the future of dental hygiene? Change is in the air! Dental hygiene is well positioned to be a relevant part of health system transformation. Our dental hygiene education programs are adapting to prepare our future colleagues for new roles and health care environments. We, as a profession, need to step out of our comfort zones (our favorite dental operatory!) and advocate for the policies that will enable the collective “us” to achieve this future.
Footnotes
Hannah L. Maxey, PhD, MPH, RDH is an assistant professor and the Director of Bowen Center for Health Workforce Research and Policy at Indiana University School of Medicine, Indianapolis, IN.
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