There has to be more to dental hygiene than this: A systemic approach

Due to the COVID-19 pandemic, there will be added pressure on dental hygienists as patients return to our practices. During the lockdown, patients did not have access to our services. Now that the doors have reopened, patient treatments have begun with a renewed focus on protection from the virus.

Even though practices will be extra busy, now is a great time to make some changes to our services. What if we stop simply reacting to the apparent problems and instead make the shift from purely corrective to a preventive dental service, and from oral health to holistic health?

A holistic approach

Dentistry has the potential to assimilate and integrate into the holistic health approach. Until now, patients and other health professionals have considered a visit to a dental office as totally separate from other health care. Patients often view their twice-a-year visits as mandatory checkups and “cleanings” but fail to grasp the entire value we provide. Dental health is connected to our entire well-being and is even thought to be related to heart health.¹

Poor dental hygiene may lead to a higher susceptibility to the human papillomavirus that can contribute to mouth and throat cancers.² In 2013, a study from the University of Central Lancashire School of Medicine and Dentistry pinpointed a specific oral bacteria, Porphyromonas gingivalis, as present in the brains of four out of 10 participants with dementia.³ Research has found that erectile dysfunction,⁴ type 2 diabetes,⁵ irritable bowel syndrome,⁶ and sleep apnea⁷ may also be connected to poor oral hygiene.

This intertwined relationship between dental care and overall health care must carry through to the relationship between patients and dental professionals, both dentists and hygienists. Imagine the impact we could have if hygienists take up our deserved role as holistic health specialists!

The mouth is one of the mirrors of patient health, just like the skin, and we must use this information to guide our patients in their search for optimal well-being. We should take time to inform our patients about these connections with health and become client educators. If we take the holistic approach and help them become healthier, they will understand there is more to the role of the dental hygienist than just scaling their teeth.

Start the conversation

In a 2017 study, 64% of respondents between the ages of 18 and 64 visited the dentist in the last year,⁸ meaning that 36% did not. Moreover, of those who did, the majority walked in for their annual health insurance-covered prophies. In reality, dental hygienists offer and do so much more, including providing treatment of early-onset periodontal disease. We want the best for patients, but sometimes we don’t provide them with information and treatments that can help them become truly healthy. We might think they are not interested or they are only interested in a “free cleaning” from their insurance coverage. However, by not offering a more comprehensive package, a patient’s health journey may be compromised.

Instead, start a conversation with clients outlining the importance of dental health for their overall health and consider offering a set of standard tests. Implementation of tests similar to those provided by physicians, including blood pressure screening, heart rate, oxygen[KB2] , and checking other vital signs are all within the purview of hygienists. Include charting bleeding sites (using currently available software),⁹ oral cancer screenings,¹⁰ airway assessment, nutritional counseling, and salivary testing to help prevent patients from being susceptible to illnesses such as cardiovascular disease, dementia, and oral cancers through early diagnosis.¹¹ Doing all this before picking up a scaler offers an unprecedented level of care.

Not only is this time in history an opportunity for us to expand our roles as health practitioners, but it is also our duty. Our patients have a right to an accurate, complete diagnosis and treatment plan. The American Dental Hygienists’ Association Standards for Clinical Dental Hygiene Practice outlines the importance of considering all aspects of a patient’s health.¹² Hygienists are already highly trained and have the skills and access to procedures to offer the highest quality of care, but unfortunately, many fail to embrace this opportunity to provide comprehensive care adequately.

By offering such a high level of care, patients will see that dental hygienists are professionals who are a crucial part of their health journey, and they will feel more cared for, too.

References

1. Gum Disease and Heart Disease -- What You ... - WebMD. 25 Sep. 2009, https://www.webmd.com/oral-health/features/healthy-teeth-healthy-heart. Accessed Jun. 23, 2020.
2. Norton A. Poor oral hygiene tied to cancer-linked virus. WebMD. Aug. 21, 2013. https://www.webmd.com/oral-health/news/20130821/poor-oral-hygiene-tied-to-cancer-linked-virus-study-finds. Accessed Jun. 23, 2020.
3. Locke T. Can poor dental health cause dementia? WebMD. Jul. 31, 2013. https://www.webmd.com/oral-health/news/20130731/dental-health-dementia. Accessed Jun. 23, 2020.
4. Men’s sexual health may be linked to periodontal health. American Academy of Periodontology. Dec. 4, 2012. https://www.perio.org/consumer/erectile_dysfunction. Accessed Jun. 23, 2020.
5. Leite RS, Marlow MN, Fernandes JK. Oral health and type 2 diabetes. Am J Med Sci. 2013;345(4):271-273. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623289/. Accessed Jun. 23, 2020.
6. Fourie NH, Wang D, Abey SK, et al. The microbiome of the oral mucosa in irritable bowel syndrome. Gut Microbes. 2016;7(4):286-301. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4988452/. Accessed Jun. 23, 2020.
7. Huang Y-S, Guilleminault C. Pediatric obstructive sleep apnea and the critical role of oral-facial growth: evidences. Front Neurol. 2013 Jan 22;3:184. ttps://pubmed.ncbi.nlm.nih.gov/23346072. Accessed Jun. 23, 2020.
8. Table 37. Dental visits in the past year, by selected characteristics: United States, selected years 1997-2017. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/data/hus/2018/037.pdf. Accessed Jun. 23, 2020.
9. Dental practice software. Capterra. https://www.capterra.com/dental-software/. Accessed Jun. 23, 2020.
10. Froum S. 10 steps to perform an oral cancer screening. Dentistry iQ. May 28, 2015. https://www.dentistryiq.com/dentistry/oral-cancer/article/16350620/10-steps-to-perform-an-oral-cancer-screening. Accessed Jun. 23, 2020.
11. LeBeau J. Dentistry’s proactive role in preventing disease. Compend. 2013;34(1). https://www.aegisdentalnetwork.com/cced/2013/01/dentistrys-proactive-role-in-preventing-disease. Accessed Jul. 13, 2020.
12. Standards for clinical dental hygiene practice – revised 2016. American Dental Hygienists’ Association. https://www.adha.org/resources-docs/2016-Revised-Standards-for-Clinical-Dental-Hygiene-Practice.pdf. Accessed Jul. 13, 2020.

Michelle Strange, MSDH, RDH, brings 20 years of experience to her roles in dentistry. She is the cofounder and cohost of A Tale of Two Hygienists podcast, TriviaDent, Level Up Infection Prevention, and owner of MichelleStrangeRDH. A graduate of the Medical University of South Carolina with a Bachelor's of Health Science and the University of Bridgeport with a Master's in Dental Hygiene Education, Strange focuses on expanding the knowledge of her colleagues in health care. Her passion for dentistry and its connection to overall health extends to her community and global efforts, most notably in her work as a weekly dental hygienist volunteer and annual dental mission trip leader.