What Do Dental Hygienists Do During a Global Pandemic?

Let’s change the narrative here a bit.  I think we all need this reminder.  Registered Dental Hygienists are the infection control experts of the dental team.  So many private practices have us named as the official OSHA coordinator.  We are highly trained specialists of prevention.  We offer a detail oriented and thorough analysis to the hands-on work we do and the intellectual input we give to our teams.  We educate our patients and our coworkers on the importance of compliance for our safety, the safety of our patients, and by default, our communities.

 

It was March 16^th when my office began taking temperatures on patients and the team.  We stopped using hand-pieces and moved to emergency treatment only.  We were paying close attention to the evolving situation and acted quickly.  As a safety net clinic, we knew we would be keeping our doors open for emergency patients.  So many health centers and universities across the nation did just that.  With very little data on transmission in the dental setting, providers used their best judgment to offer relief to folks with pain and infection.  We learned a new telehealth delivery option in a week.  We stayed connected to our local, state, and national colleagues to remain informed and act in the best interest of everyone involved.  When I think about all the lives safety net dentists saved by keeping patients out of the ER the last 2 months, I am deeply moved.  You all are the real MVPs.  Dentists and their teams are on the front lines here.  While many private offices closed due to unknown factors, the safety net reported for duty.  We have been here all along because offering access to care is what we do.  It is our mission.  When the financial burden became clear because of the decline in volume, our two dentists offered to work one day a week with no pay.  They literally volunteered their time and risked their lives.  Heroic.

 

The hygienists I know are contributing to solutions.  They are writing protocols and planning staff training.  They are contributing to guidelines and continuing education at the state and national level.  They are advising OSHA and the CDC.  I spoke to an entrepreneurial hygienist yesterday who is creating an innovative product for aerosol management for other hygienists that will be released in 4 weeks.  We are rising to the challenge, contributing our expertise, and creating innovation.  During the pandemic, safety net hygienists have been re-assigned to assist on emergency procedures, support their medical team with testing, do contract tracing for health departments, and procure much needed PPE.  Hygiene educators stepped up to change their vastly clinical training to didactic and virtual course work.  Hygienists who work for universities contributed to protocols and oversight and research projects.  We are writing grant proposals to respond to any risk in the clinical setting.  We are cautious and our concerns are valid, but let me be clear, we never stopped being hygienists.  We never will.  We are vital members of the healthcare team, and we do vastly more than clean teeth.

Leveraging Partnerships to Impact Change. Open Your Mouth: Oral Health is Health!

Oral Health America kicked off their national #FallForSmiles campaign with Advocacy Week in Washington, DC October 1st through 5th.  Oral Health advocates from all over the nation showed up virtually and in person to align their efforts and meet with their members of congress.  The event had sponsorship from great partners like 3M and Glaxo Smith-Kline.  It is a week to highlight the importance of oral health equity and policies that impact oral health for all.

This year’s theme was Open Your Mouth: Oral Health is Health!  It highlights the need for advocacy around the importance of oral health and its connection to whole health and social justice.  Monday kicked off with a twitter chat among national advocacy organizations like Children’s Dental Health Project and Families USA.  Social Media is an effective loud speaker to get the message across.  Folks discussed topics like medicare dental coverage, the need for school based health dental prevention programs, fluoridated water, and other vital population based interventions.  The conversation included addressing social determinants of health and health policy and how that has the potential to make oral health more equitable in communities.

Oral Health Advocates showed up from states across the country to meet with their members of congress in DC.  On Tuesday we discussed some talking points to guide and anchor the advocates on pressing issues.  The OHA team prepared packets with their State of Decay report that compares oral health data from state to state.  The folders were meant to leave behind with the staff members to give them some follow up information to digest.  The OHA staff scheduled our visits with leaders.  They matched us with the representatives and senators from our home states so that the power of constituency could work to our advantage.  We spent Tuesday and Wednesday having those important conversations.  There were hygienists, dentists, child advocates, industry leaders, and others who showed up and partnered to elevate the current issues.  We were grouped up regionally and we told our communities’ stories and shared the data.

In Senator Rand Paul‘s office we were able to thank him for his recent advocacy for medicare dental coverage for medically necessary care.  In Representative John Yarmuth‘s office we were able to thank him for his work to protect medicaid dental coverage for the expansion population in Kentucky.  Advocacy is about building relationships.  Health policy should be a bi-partisan issue.  All Americans should have access to quality affordable care.  Reaching across party lines to strategize and create long term goals with partners that will get the results we need.

As the advocates headed back home, the conversation returned to social media yesterday with an Instagram takeover by OHA fellows and interns.  They answered the question “How do you advocate for oral health?”.  It brings us full circle to involve current students and new graduates in the profession.  It will take all of us to make the change we need for oral health equity.  Crossing the span of experience, education, sector, and party, we can partner for oral health for all.  We all have a stake in oral health.  As oral health professionals we have a special responsibility to take our expertise and knowledge to raise awareness with the community at large.  Even more, we have to take the next step to call on key leaders and policy makers to move the needle forward.  Oral Health America has committed resources and effort to leading the way in advocacy for oral health equity.  If you have not joined us yet, do it next year.  I hope to see you there.

July Spotlight

RDH on a mission spotlight Mary Ann Burch

Missions Abroad: How to Find Outreach Opportunities

In January of 2017, I went to Tegucigalpa, Honduras, on a mission trip. Our team of 35 was a diverse group of professionals who brought medical, dental, vision and pharmacy skills to a community of impoverished and neglected people.

Going to a third-world country is difficult to describe; the magnitude a trip like this can have on your life is immense. While you go to help others, you come home with so much more than you expect to receive. I come home every time with a complex mixture of gratitude and guilt. Each person you encounter stays in your heart and calls you to return. I am hoping to join my team for a third time in January of 2018 to visit the community we serve. When I have discussed my trip with other hygienists, so many have been interested in learning more about dental missions. They want to know how I got involved and how they might gain the opportunity to go in the future. My advice to them: volunteer.

In 2013, there were three Remote Area Medical free clinics in Harlan, Somerset and Pikeville, Kentucky. The RAM and MOM (Mission of Mercy) clinics are similar outreach programs that give care to those in need in states across the U.S. RAM’s mission is: “To prevent pain and alleviate suffering by providing free, quality health care to those in need.” In these rural counties, patients lined up the night before we opened the doors to see doctors and dentists for the first time in years. They mentioned income, transportation and no insurance as reasons they had not sought care. Counties in southeastern Kentucky have a rich history of coal mining. As energy trends have shifted away from coal, the Appalachian counties have suffered socio-economically. The folks we saw in this region had case presentations comparable to those in Honduras.

According to the National Organization of State Offices of Rural Health (NOSORH):

• Adults ages 18 to 64 are nearly twice as likely to be edentulous if they are rural residents

• Of the 2,235 Dental Health Professional Shortage Areas, 74 percent are in rural areas

• Rural adults are more likely than non-rural adults to have untreated dental decay (32.6 percent versus 25.7 percent).

Our nation has third-world patients in our rural communities and inner cities. There is a free outreach clinic in my city for the underserved. Louisville is a large metropolitan area. Many suggest the city is over- saturated with dentists, but few accept Medicaid at all, and even less accept Medicaid for adults. The patients seen at this clinic include the homeless, recovering substance users and immigrants. Volunteer clinicians serve two Saturdays per month to bring pain relief and prevention to this gracious group of individuals. Most of the volunteers I encounter in these settings have been on missions overseas. Passion for people knows no borders.

If you are interested in using your clinical skills to serve populations in need, you do not need to look far; there are opportunities all around us. Volunteering in your local community is a way to meet like-minded professionals, help patients who may not get care otherwise and possibly network with existing mission teams. Gaining experience with mobile and portable dentistry will help prepare you for the clinical challenges you may face internationally. Connecting with other clinicians who are determined to make an impact in all settings is the best way to get started. Reach out to your local professional organization’s component, the state board of dentistry, or state oral health coalition to find outreach opportunities near you.

This article first appeared on Modern Hygienist 6/12/17

The importance of data-driven dental outreach programs

Equity: justice according to natural law or right; specifically: freedom from bias or favoritism.—Merriam-Webster Dictionary

As oral health-care providers in public health, it is our duty to ensure efforts for equity are carried through to the population. Freedom from bias or favoritism may seem easy enough, but these can manifest in many different ways. Are we treating patients out of convenience, profitability, or proximity? Sometimes.

Equality is different from equity. The picture below addresses it well. Equality ensures everyone gets the same resources; in the picture that would be one box to stand on. Equity takes deficits and disparities into account. Equity gives the community the resources they need to succeed; in this picture, equity considers height of the individuals. The goal is each person reaching the apple, and giving each person the same resources does not allow apples for all.

The communities we serve will have disadvantages different from their “height.” Patients may lack oral health due to age, race, or location. The Center for Health Care Strategies describes health disparities as “the metrics we use to measure progress toward achieving health equity.” In other words, we will know oral health is equitable when the disparity gaps are closed. The CDC lists the following oral health disparities for our nation:

• Overall. Non-Hispanic blacks, Hispanics, and American Indians, and Alaska Natives generally have the poorest oral health of any racial and ethnic groups in the United States.
• Children and Tooth Decay. The greatest racial and ethnic disparity among children aged 2–4 years and aged 6–8 years is seen in Mexican American and black, non-Hispanic children.
• Adults and Untreated Tooth Decay. Blacks, non-Hispanics, and Mexican Americans aged 35–44 years experience untreated tooth decay nearly twice as much as white, non-Hispanics.
• Tooth Decay and Education. Adults aged 35–44 years with less than a high school education experience untreated tooth decay nearly three times that of adults with at least some college education.
  • In addition, adults aged 35–44 years with less than a high school education experience destructive periodontal (gum) disease nearly three times that of adults with a least some college education.
• Adults and Oral Cancer. The 5–year survival rate is lower for oral pharyngeal (throat) cancers among black men than whites (36% versus 61%).
• Adults and Periodontitis. 47.2% of U.S. adults have some form of periodontal disease. In adults aged 65 and older, 70.1% have periodontal disease.
  • Periodontal Disease is higher in men than women, and greatest among Mexican Americans and Non-Hispanic blacks, and those with less than a high school education. 1

If our goal is to get oral health to all, we have to address the disparity gaps. If we begin focusing our resources where the deficits exist, we will make progress.

Creating a data-driven outreach program may mean stepping out of our comfort zones. We have to leave our neighborhood, away from people that look like us or speak our native language. This is what justice looks like. This is how we achieve oral health equity for all. Everyone deserves oral health. No child should have to attempt to learn in pain. No adult deserves to lose teeth because of his or her education level. These issues are completely preventable. As dental public health providers, we have a responsibility to consider the data in our community. Our local outreach programs can reflect state data, while national systems and policies should address larger scale issues. All programs should be focusing on disparate groups and narrowing the gaps. As program developers and participants, we need to stack our efforts underneath the folks that cannot quite reach the apple. To learn more about oral health equity and the importance of data-driven programs, go to the campaign for oral health equity at OralHealthAmerica.org.

Read more

Oral Health Equity for All
A Framework for Advancing Oral Health Equity
Disparities in Oral Health

Reference
1. Disparities in Oral Health. CDC website. https://www.cdc.gov/oralhealth/oral_health_disparities/. Updated February 14, 2017. Accessed May 23, 2017.

This article first appeared in RDH e-village 5/25/17:

http://www.dentistryiq.com/articles/2017/05/the-importance-of-data-driven-dental-outreach-programs.html

 

 

RDH, The Advocate

As dental hygiene students we learn to care about our patients as individuals.  We tailor fit our recommendations to make a noticeable and lasting impact on their oral and systemic health.  If we are good at that, we see change.  Perhaps they come to a recall visit with no bleeding sights, praise us for the advice, the awesome job we did, how gentle we were, or the distinct change they have noticed after using a product or technique.  We call those wins, we celebrate those moments, and we should.

What about the members of the community we never touch or see?  How do we reach them?  How do we make a larger impact?  How do we care about our patients as members of a community?  How do we translate our passion for progress, health, and prevention to a larger group?  Short answer: Advocacy.

I began working in a federally qualified health center in May of 2014 and could immediately see a difference in case presentation compared to private practice.  I was no longer talking about whitening.  My new patients needed basic care.  Pain relief and therapeutic intervention became the focus.  Mary Otto, author of Teeth: The story of Beauty, Inequality, and the Struggle for Oral Health in America explains it like this:

 

Nobody wants to do the low-end stuff anymore. Of course there is a lot more

money to be made with some of these really high-end procedures. But on

the other hand there’s this vast need for just basic basic care. A third of the

country faces barriers in getting just the most routine preventive and restorative

procedures that can keep people healthy.

 

My patient population falls into that third.  They are suffering and I can help them when they are in my chair.  Their problem is getting to us.  The barriers facing our nation’s poor are sometimes insurmountable.  According to the ADA, approximately 45% of the adult population ages 19-64 does not have dental coverage.  The patients that do have dental insurance may not have a provider near them that accepts their plan, and if they have Medicaid the likelihood of finding a participating dentist decreases more.

Any hygienist working in a public health setting knows the need is vast.  There are not enough clinicians, not enough chairs, not enough hours in the day.  Having been on mission trips abroad, I was shocked to see that people in our country could be suffering at the same level or worse.  I started looking for ways to improve the oral health of the community, not just appointed patients.

My state Oral Health Coalition became a soft place to fall.  The mission statement seemed simple and appropriate: improve the oral health of all the people of Kentucky.  This was a collaborative, inter-professional group of stakeholders working towards a common goal.  I was impressed to see Dentists, Hygienists, Public Health Administrators, Nurse Practitioners, and Educators all at the same table working on solutions together.

The coalition gave me an opportunity be a part of a larger network.  I learned more about oral health as a social justice issue.  Access to care is a systemic problem and will need policy change.  This year was my first time attending an advocacy day at the state capitol.  We met with our legislators and we had conversations about upcoming goals.  It was a day of educating non-dental professionals about the conditions of their constituents.  I was able to tell my patient’s stories and the concerns I have for their health.  It was a different kind of win, another one with a celebration, because it has the opportunity to make an impact for many in the future.

We know our patients.  We know their clinical presentations, but more than that, we know their stories.  We have a responsibility to be their voice and demand change, big change, the kind of change that stops the bleeding, the kind of change that brings health to a community.  Advocate for change RDH.  It comes naturally.

 

 

Building Community

I have worked at a federally qualified health center for over 3 years.  The Health Resources and Services Administration (HRSA) funds the center and we have a Health Professional Shortage Area (HPSA) score of 16.  In simpler words, no one is treating my patients but my office.  There is a 6-week wait for new patients with no signs of pain or infection.  We are located in urban metro Louisville and see a profoundly immigrant population.  My patients need dentistry.  We see active disease daily and the majority of my patients need therapeutic cleanings.  We are a predominantly Medicaid office.  Currently in Kentucky, Medicaid offers a somewhat comprehensive dental benefit for adults, including 2 cleanings per year, SRP 1 time per year, and basic restorative and surgical procedures.  Reimbursement is awful, but seeing as though most states have no adult Medicaid benefit at all, I consider my patients fortunate.  I realize this is not the typical RDH’s workplace setting, but let me just say that I love public health.

I am the component trustee of the Louisville District Dental Hygienist’s Association.  Our component is the largest in our state with over 70 ADHA members.  Our Facebook page has almost 600 members.  Up until the past two years those hygienists were my complete network, my sounding board, my go-to for support and ideas.  I would say less than ten are working in a public health setting.   Two of those ten work with me at our community health center.  More hygienists are moving towards public health opportunities, but the current reality is that most are working in private practice or corporate dental offices.  Many in my circle could not relate to my unique experience.  I had read about trailblazers in Minnesota and South Carolina and looked often to my journals for inspiration and innovation.

Then there was networking.  I consider myself blessed to have had passionate faculty in my hygiene program at University of Louisville School of Dentistry.  Two of my professors are past presidents of the KyDHA and all are members of the national organization.  They recruited me to our local board to be a part of the leadership team.  Every opportunity I have pursued was possible because of hygienists that were members of our professional organization.  I have attended the national conference 3 times and met countless passionate colleagues every year.  The hygienists I have met at ADHA conferences tend to be ambitious, knowledgeable, and connected.  I follow the public health CE track when I attend to meet my state’s PHRDH 5 hour requirement and I always learn a ton.

2 years ago I was elected to the executive committee of Kentucky’s oral health coalition.  The coalition work connected me to a larger network called OH2020.  This is the oral health arm of the national Healthy People 2020 movement.  I attended my first national convening of the network in September of 2016.  Life.  Changing.

This network was diverse in field and background.  Oral Health was our major connection but everyone also shared dedication to progress.  The topics were poignant, the speakers were brilliant, and the hygienists there were my favorite kind: public health.  Some of them were members of our professional organization and some were not.  All of them were champions for their patients.  I found myself wanting to stay connected to this group.  I saw opportunity for collaboration and sharing of best practices.  I wish I had known hygienist A before starting my volunteer community outreach clinic.  I wish I had hygienist B in my contacts before applying to my MPH program.  You get the idea; this group was invaluable to me.

Insert RDH on a mission.  My vision for our community is to connect us.  I am here for you.  You are there for me.  We can discuss all things pertinent to our patient population.  I invite all comments or submissions for discussion.  Join the Facebook group.  Email me ideas.  Follow me on social media.  We will not be pushing products or reviewing practice management (barf!).  We will be changing the world, one oral cavity at a time, together.