Dental hygiene is a rapidly growing profession in British Columbia, with more than 3300 Registered Dental Hygienists (RDH) practicing in the province–more than double the number when I graduated 22 years ago. In that time, the profession has evolved from almost all dental hygienists working as employees of dentists in private clinics to dental hygienists working in diverse alternative practice settings with a strong focus on reaching the under-served. This trend has been driven by new legislation in 2012 approved by Minister Mike De Jong which enables dental hygienists with degree-level competencies and 3500 hours practice experience to work independently in any setting (CDHBC, 2018).
My focus as a dental hygiene educator is to inspire students through authentic experiences in outreach settings in hope that more dental hygienists will strive to provide services to those who have the highest needs and who are often the hardest to reach. But who might this be?
As with all health professions, there is growing awareness that the social determinants of health such as poverty, housing, food insecurity, and lack of social support have the largest influence over one’s pathway to health and wellness (or disease), and that lifestyle choices such as smoking, nutrition, and daily oral hygiene are less powerful predictors (Raphael 2014). Today, many segments of the population experience barriers to accessing both public and private dental care; this is often the case for refugees, newcomers, low income families and individuals without dental insurance, people with disabilities, seniors in institutions and on fixed incomes, rural and remote populations, and Indigenous Peoples (CAHS, 2014). But what is the impact of limited access to dental care?
Pain and discomfort from untreated oral infections such as periodontal disease, tooth decay, oral candida infection, mouth sores, and oral cancer are rampant in those with limited access to dental care–all of which place an immense burden on the health care system. Oral infection is connected to a growing list of chronic conditions such as diabetes, cardiovascular disease and stroke, respiratory diseases, and pregnancy outcomes.
Many recommendations are proposed, but the suggestion to expand the dental workforce through training of a dually trained dental hygienist – dental therapist (CAHS, 2014; CDHA, 2017) is posed to drive rapid innovation in dental hygiene education in Canada . In many countries, dental hygienists (DH) are dually trained and licenced as dental therapists (DT) with the abilities to prevent and treat a more comprehensive array of dental diseases more cost effectively. Canada is moving in this direction, with a position statement to support dually trained DH-DT’s (CDHA, 2017) with a national blueprint for the training curriculum underway and set to launch in the next few years.
College of Dental Hygienists of British Columbia. (2018). 365-day rule exempt registration class. Retrieved on Aug 20, 2018 from: http://www.cdhbc.com/Registration-Renewal/365-Day-Rule-Exempt-Registration-Class.aspx
Raphael, D. (2014). Social determinants of health: The Canadian facts. Video retrieved on Aug 20, 2018 from: http://thecanadianfacts.org/
Canadian Academy of Health Sciences. (2014). Improving access to oral health care: For vulnerable people living in Canada. Retrieved on Aug 20, 2018 from: http://cahs-acss.ca/wp-content/uploads/2015/07/Access_to_Oral_Care_FINAL_REPORT_EN.pdf
Canadian Dental Hygienists’ Association. (2017). CDHA position statement: Filling the gap in oral health care. Ottawa, Ontario. Retrieved on Aug 20, 2018 from: https://files.cdha.ca/profession/DualProviderPositionPaper-EN.pdf