Dental hygienists overlooked as health-care providers’ roles expand

The Chronicle Herald’s June 3 editorial, “Druggists get booster,” discussed the expanded role of pharmacists in the health care system. The article brings to light the case for having more services delivered by health professionals at a lower cost to the health-care system. The question was raised about what services can be offered by other providers, dental hygienists, for instance.

The Dental Hygiene Scope of Practice includes clinical therapy such as the dental cleaning or scaling that many people have experienced. Perhaps lesser known are the health promotion and disease prevention services provided; blood pressure and oral cancer screening, risk assessment for dental tooth decay and gum diseases, smoking cessation and dietary education. Dental hygienists are also educated to administer local anaesthetic. During the H1N1 flu outbreak in 2009, dental hygienists were considered as potential (with training) immunizers.

Until recently, dental hygienists in Nova Scotia were restricted to practice only under the direct supervision of the dentist in a dental practice.

For many people, accessing a dental office is not a reality. Think about frail, elderly or homebound seniors, the institutionalized, and those living in temporary shelters, or worse, without a home. In spite of a Children’s Oral Health Care program, there are families, which, for a multiplicity of reasons, including fear, shame, or lack of awareness, do not or cannot visit the dental office.

In 2009, the new Nova Scotia Dental Hygienists Act was approved and paved the way for dental hygienists to practise outside the walls of the private dental office. The legislation created the potential for dental hygienists to deliver oral health care, to the full extent of their scope of practice, directly to the public in a variety of community locales.

Long-term care facilities, Community Wellness centres and the recently announced (April 11) Early Years centres are ideal settings where dental hygienists have long been missing from existing collaborative health teams.

Unfortunately, the Insured Health Services Act and Regulations, which currently lists dentists and denturists, does not recognize dental hygienists as health-care providers.

They are unable to bill MSI, or other government-funded oral health programs, despite the fact that the same care provided in a dental office by a dental hygienist would be insured.

Due to this barrier, dental hygienists in this province who do see clients directly in alternate settings are in some cases offering free services to those in need.

A dental hygienist provides service in a long-term care facility where a physically and mentally challenged eight-year-old child is a resident.

Given the challenges, it would be difficult and costly to move the child to a dental office. The dental hygienist is asked to see the child, but she cannot make a claim to MSI and the parents cannot afford the care. The dental hygienist is faced with offering her service for free or refusing to see the child.

This is discriminatory to both the client and the professional and does not allow the public open access to the health-care provider of their choice.

Dental hygienists could best support the health care system if ways were found to utilize their full scope of practice in a system which stands up to the health-care mantra often used in Nova Scotia: “The right service, at the right time and in the right place by the right provider.”

We agree with the conclusion in the above-mentioned editorial on pharmacists providing flu shots and other services. The health-care system needs to have more services, which, with appropriate training, are delivered by health-care professionals other than the highest-cost care providers, and we would add in settings appropriate to the individual.

This piece was submitted by the College of Dental Hygienists of Nova Scotia. The CDHNS is the regulatory body for the 670 registered and licensed dental hygienists in the province.



Source: The Chronicle Herald


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