Q&A: Dental Hygienist Opens Up for National Dental Hygiene Month

As October comes to an end, so does the national observance recognizing the need and importance of dental hygiene. For this Q&A, one of our own registered dental hygienists (RDHs) opens up about how she came to this career path and why it is invaluable to the oral health care system.

Let's dig in with Laura Skaret, RDH, BSDH | Project Manager, Safety Net Solutions | DentaQuest Institute

Q: Why did you decide to become an RDH?

A: My mom is a dental hygienist, and I got my first job at her office as a dental receptionist and then later was trained on the job to work as a dental assistant. I loved my experience as an assistant and found the work we did fascinating – including the devastating results of dental disease. I saw the cycle of dental disease first hand:  teeth would need small restorations, then larger restorations, then root canals, then crowns, and even sometimes implants. I knew I wanted to focus my career on helping patients prevent and properly manage dental disease rather than repairing the damage after it occurs.

We had a pamphlet in the office that said that enamel was far more valuable than gold (referring to a gold crown).  I found that to be such a thought-provoking and accurate concept.  It’s also similar to the old familiar adage, “an ounce of prevention is worth a pound of cure.”  That couldn’t be more true in the dental field.

Q: Why are hygienists important in the care team? 

A: Dental hygienists are patient advocates. When explaining the dental disease process to patients, I always tell them that my job is essentially to keep them out of the dentist’s chair, but I can only do so much without their buy-in.  Due to the nature of plaque biofilm, the daily care that patients do for their own mouths is far more important than the work that we do in one hour with them at the dental office. Patients go to the dental office maybe two to four times per year, however 365 days a year they are responsible for managing their own oral health.  This means our most important role is to educate and motivate our patients to improve their daily oral health habits. 

Q: What has been your greatest accomplishment or most proud moment in relation to working as an RDH?

A: I’ve realized that it’s not only what you do, but the way that you do it that can make an impact.  I always try to be very kind and compassionate to the questions and concerns of my patients. I’ve had several patients who were terrified of coming to the dental office when I first met them. Years of neglecting their mouths and avoiding the dentist would bring them to our office in a lot of pain and in need of quite a bit of dental work. In addition to using a gentle technique and local and topical anesthetics, I try to help them feel more comfortable by talking them through everything I’m doing or telling them stories to get their mind off of the situation. Sometimes it’s helpful to listen to their story to find out why they have a fear, affirm their past concern, and then assure them that won’t happen today. 

When those patients then continue to come in regularly, you know you’ve not only made a difference for their oral cavity, but for their life as well.  I had one patient who needed lengthy measures to address advanced decay and periodontal (gum) disease.  After we completed her first three visits of needed periodontal therapy, she actually sent a card to my office to thank me for helping her overcome her fear of the dentist.  With a more manageable level of fear, she was able to get the care she needed to restore her smile, which gave her back her confidence.

Q: How does your professional background impact/influence/help you in your DentaQuest Institute (DQI) role?

A: My primary role at DQI is as a project manager for Safety Net Solutions (SNS), a DentaQuest Institute program. Safety Net Solutions helps safety net dental clinics adopt targeted business management best practices.  Our focus is to ensure that these dental offices can maintain financial viability to stay open and provide access to care for the underserved. We also help ensure that they understand their capacity and can maximize access to care by optimizing their productivity.  

My previous experience of working in all areas of the dental office (receptionist, chairside with the dentist, and then also as a hygienist) means I have very comprehensive knowledge of how dental offices work, from scheduling appointments, to managing supplies and inventory, to managing the patient’s care experience, to dealing with dental equipment and instrument shortages. Basically, I can understand and relate to almost any concerns our SNS clients have.

Q: Why do you continue private practice once a week? 

A: Although you can technically keep your annual dental hygiene license “active” by simply paying the license fee each year, I want to keep it active with actual patient care, as well. Also I continue to practice because I love the work!  I love working with patients and helping them improve their oral health. I also believe this helps me stay relevant and engaged with my SNS clients and their common concerns. 

Q: What is one message you hope to impart to anyone interested in becoming an RDH?

A: Hygienists are super important members of the care team! As policy changes and we move forward with accountable care organizations and pay for performance insurance reimbursement models, I think the role dental hygienists play in preventing and managing disease will be brought even more into the forefront. When finances are attached to healthy patient outcomes, dental care teams will attach an even higher value to dental hygienists. 

Also, there is a massive shortage of dental professionals – and dentists in particular – nationwide. Maximizing the use of preventive modalities such as sealants, fluoride varnish, and silver diamine fluoride will help address access gaps where dentists are hard to come by, like rural areas.  Of course, we will never stop needing the education and skills of a dentist, but if we can reduce the demand for the skills of a dentist by reducing the dental disease burden, we can help minimize the gap in access to oral health care.  

Interested in learning more about prevention-focused dental care? Check out the DentaQuest Institute's Online Learning Center and let us know what you think! 

Why are dentistry and oral health care practices seemingly easy to question?

The topic of evidence in dentistry and oral health care has been in the news a lot recently, with articles like this column in the New York Times by a professor of pediatrics.

In his column, Aaron Carroll discusses the differences he sees between his own and his wife’s dental journeys, as well as what little rigorous research has been done to support certain generally recommended dental practices.

What is interesting is that articles like this one and the popular flossing article from the Associated Press, among others, imply that recommendations made by dentists are based solely on limited or weak evidence – or worse, based simply on what the dentist will get paid for by an insurance company.

They also leave readers feeling that plaque removal and cavity prevention/treatment are the only elements necessary to address for good oral health.

Ultimately, Carroll suggests in his column that while lack of evidence doesn’t mean oral health prevention efforts don’t work, we should invest in research to ensure that those things we do are evidence-based.

For those of us in the business of improving oral health, we couldn’t agree more with that conclusion. But let’s take a closer look at some of the points that may have gone overlooked by recent press coverage.

We know that evidence something works for populations doesn’t directly translate into solutions for a specific individual – that is in fact why Carroll and his wife have such dramatically different dental journeys.

Carroll notes he has had just one filling in his life and doesn’t religiously care for his mouth, while his wife has “more fillings than [he] can count” but is fastidious in her oral care routines.

This underscores two important points:

1. Every person is different. Individualizing care is critical to improved oral health.

While evidence-based research informs standards of care, it is the dental team that must develop the best care plan for any given person’s situation. That is why DentaQuest invests in the development and adoption of evidence-based care protocols that focus on prevention, early intervention and disease management.

Our investments in disease management and risk assessment help provide dental teams with the knowledge and tools they need to best serve their patients.

For instance, across a five-year period, the DentaQuest Oral HealthCenter demonstrated that risk assessment and intense preventive efforts (including sealants and fluoride varnish) directly resulted in a reduction in the need for invasive surgical procedures.

Sealants are one of the most cost-effective strategies for protecting teeth, as noted in another recent New York Times column. This is because they provide a physical barrier against cavities. They can even be applied to teeth that are just starting to show signs of new cavities, and stop them from getting bigger.

The best time to seal a tooth is immediately after it erupts in the mouth, and so the DentaQuest Oral Health Center strives to set aside extra time at visits for children ages 6 and 11 since the permanent molars are usually erupting at that time. It is also why the DentaQuest Foundation collaborates so closely with school-based health alliances working to improve access to oral health care – and sealants – among children in grade school.

Additionally, with a patient population of over 10,000, the DentaQuest Oral Health Center works in collaboration with the DentaQuest Institute to refine strategies that make patients healthier. And when these best practices are implemented, they actively improve peoples’ health.

2. Prevention and oral health improvement do not take place solely in the dental chair.

Preventive dental visits provide an important opportunity for people to check in on their oral health habits and get evaluations for early signs of not just dental disease, but also chronic diseases like diabetes and hypertension.

Most of us spend two hours a year in a dental office. And, if we are to reconsider the benefit of two annual preventive visits as Carroll suggests, some of us might end up spending even less time with a clinician. So what about the other 8,758 hours?

The differences in the oral health of Carroll and his wife are not because he brushes with an electric toothbrush every day or because she is doing something “wrong” in her routine. Oral health care is more than just brushing and flossing. In fact, it is about more than your teeth and gums.

To make an impact, we have to take a look at how we pay for oral health care, how our public policies enable it, and how our communities prioritize it, in addition to how we provide it.

Addressing just one of those will not improve oral health care on the larger scale or reduce health care costs, as Carroll aims to do with his recommendations. We know oral health care is indeed critical for overall health. This is why we at DentaQuest look far beyond the dental chair.

For example, as part of Oral Health 2020, the DentaQuest Foundation is investing in efforts to incorporate oral health into the primary education system. Oral health education, screenings, assisted referral, and delivery of preventive care through our schools provide equitable, reliable entry into long-term oral health care.

DentaQuest also champions efforts to include innovative financing models for dental in person-centered approaches to care enabled by the Affordable Care Act (ACA).

Over the last decade, we’ve seen significant movement to transform our health care system into one that improves quality, lowers costs, and makes people healthier. In fact, on the medical side the Triple Aim is starting to be supported by alternative payment and care delivery models that are person-centered and focus on prevention.

Why did that happen? Because experts and advocates knew there had to be a better way forward for a healthier America.

The same is true for oral health. We are beginning to see that it is possible to live in a world where optimal oral health is the expectation, not the exception. We must continue to invest the same transformative energy into improving the oral health of all because you cannot have optimal overall health without optimal oral health.

 

Dental Health Care Needs Quality Improvement Now

The message couldn’t be clearer: The time for the dental profession to jump on the health care quality improvement (QI) bandwagon is now.

In the past quarter-century, the United States has seen medical care improve and per capita health care costs go down thanks to QI standards adapted from other industries like manufacturing. But why has the dental profession been so slow to join the game? Our recent DentaQuest Institute editorial in the July/August 2016 issue of Pediatric Dentistry provides some clues.

In our editorial, we argue that, because of QI’s effectiveness—in medicine and other fields—it is 

“...imperative that dental professionals create the culture and systems necessary to apply QI principles and activities for the benefit for our patients, the public at large, and our profession.” 

That may be easier said than done, but our own Dr. Natalia Chalmers, who heads DentaQuest Institute’s Analytics and Publication team, and her colleagues lay out a number of programs that place a heavy emphasis on QI - from DentaQuest Institute’s EarlyChildhood Caries (ECC) program and the UCLA-First 5 LA Oral Health Program to new initiatives from the American Dental Association’s Dental Quality Alliance. 

The common thread with these programs: they all work.

• Through ECC Collaborative, an effort to reduce dental caries in young children, 32 federally-qualified health centers (FQHCs) significantly improved patient outcomes after implementing a disease-management approach to QI.
• The UCLA program helped 22 local FQHCs redesign workflows based on QI models, improving diagnostic, preventive and treatment services in participating dental clinics. With the “triple aim” of improving patient experiences, improving health status, and lowering costs, the ADA’s Dental Quality Alliance seeks to help dental practices establish processes “to reliably deliver evidence-based care to every patient.”

The authors note small steps may be all that’s needed to push the profession toward QI. For example, the Plan-Do-Study-Act cycle results in a trial-and-error approach until performance improvements are realized. This practice has helped improve quality performance in industries from high-tech to higher education. There’s no reason dentistry can’t do the same.

They also understand that integrating QI into a dental practice requires considerable planning, coordination and commitment. And it takes a team for QI to take root. Dental practitioners, office staff and even patients must be invested in the process for it to work.

That said, dentists need to begin thinking now about QI at the practice level. These efforts will have an enormous impact on the way dental care is delivered. And, as the DentaQuest editorial illustrates, that’s a win-win for everyone.