Access to care: What can dental hygienists do to improve access?

Access to care has been a population-wide problem since the beginning of dental hygiene. Even as late as the mid-20th century, during World War II, the failure of having fewer than six opposing teeth was the most common cause of military deferral.(1) In the early 20th century, prevention began to be recognized as an important concept, first promoted by Thaddeus Hyatt and then Alfred C. Fones.(2)

As we all know, Dr. Fones trained Irene Newman as the first modern era dental hygienist with the goal of going out into the community to prevent oral disease.(3) Why are more than one-third of Americans still unable to receive even basic preventive care, let alone dentistry?

I decided to write this commentary because the issue of access and the nation’s oral health is now hitting the mainstream media. While it has been covered periodically by National Public Radio,(4) there is now a book about the topic: Teeth by Mary Otto and is reviewed in the New Republic, June 2017 issue.(5) The author had originally reported in the Washington Post the story about the Maryland youth who died of an abscessed tooth in 2007.(5)

The reviewer, Adam Gaffney, finds the book to be a thorough depiction of the past and present lack of care for a vast number of US citizens, and notes that the book offers some solutions, including utilizing dental hygienists for preventive care, at least.(5) He goes on to declare that universal dental coverage is the only thing that will erase the gap, much like the United Kingdom, which reported in 2015 in the British Medical Journal that English citizens had as good oral health as US citizens.(5)

Hard to believe, I know, but not when measured against the long lines at Mission of Mercy dental days, in which I have participated.(6) People want good teeth and a healthy mouth, but barriers that have existed for far too long prevent them from accessing care.

So, what is to be done? Are we to be an occupation or a profession? Do we follow the supervising dentist’s lead, or do we make patient care decisions based on evidence and patient preferences? In other words, are we advocates for our patients and the public, or for our bosses?

We should each act to change practice acts, which I know many have been doing. Support the ADHA and urge the organization to push for change; a united voice is more powerful than one person alone. When pediatricians are being asked to apply fluoride varnishes to children’s teeth,(7) something is wrong. Join, advocate and change the oral health landscape for everyone.

Jeanne M. Chambers, RDH, MPH, has been a practicing registered dental hygienist for 45 years, graduating summa cum laude from Forsyth School for Dental Hygienists in 1972. She has worked in a variety of settings, including public health, a periodontal practice, and general practice. In 2007, she graduated cum laude from Harvard University with a bachelor’s degree and in 2015 from University of Massachusetts, cum laude with an master’s in public health. Currently, she is private practice part-time and is an adjunct at Mount Ida College in the dental hygiene program. She can be contacted at jeannechambers5@gmail.com.

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