Why strengthening the dental hygienist profession is key to solving the oral health crisis
One day in April 2024, a 52-year-old woman in Cromwell, Connecticut, sat in the dentist's chair while her registered dental hygienist (RDH) administered a prophylaxis. It is a thorough, personalized preventive care program designed to maintain oral health, prevent the progression of gum disease, and screen for systemic disease.
The hygienist checked her mouth and found a lump. The hygienist took her to a panoramic X-ray machine and discovered a mass in her mouth, which ultimately led to the patient's second diagnosis of type B non-Hodgkin lymphoma. The patient received chemotherapy promptly and thanked the hygienist for saving her life.
Stories like this highlight an important disconnect. Most patients view regular visits to a dental professional as “getting cleaned.” They sit in the dental chair and the hygienist performs a “routine” teeth cleaning and polishing, and maybe they get an X-ray. The dentist then examines the patient, and the dental hygienist instructs them on how to improve their oral hygiene at home. This perception of RDH's role is inconsistent with reality.
As America's oral health crisis worsens, we need greater recognition of the vital, life-saving care RDHs provide. We need to maintain rigorous educational standards for entry into the dental hygiene profession.
RDH: Professionals on the front lines of preventive care
Scaling and polishing to remove biofilm and tartar is critical to preventing or slowing the progression of periodontitis, but RDHs are trained and have the skills to perform more advanced care. They are dental and medical detectives, using the mouth as a portal into other vital organs, including the digestive tract and respiratory tract.
Poor oral health may exacerbate or be associated with other chronic conditions, such as cardiovascular disease, diabetes, cancer, Alzheimer’s disease, and more. Some people with gum disease have difficulty controlling blood sugar levels. A properly educated RDH can recognize this and more.
In addition to screening for oral cancer, oropharyngeal cancer, and other head and neck cancers, dental hygienists screen for symptoms that may indicate systemic disease:
- The patient's breath has a slightly sweet smell, suggesting they may have diabetes
- Enlarged tonsils and crowded teeth may indicate sleep apnea
- Suspicious moles or lesions on a patient's head or face, which may indicate skin cancer
- Dangerous levels of high blood pressure that put patients at risk for heart attack or stroke
Many RDHs also perform advanced care modalities such as desiccation therapy, guided biofilm therapy, silver diamine fluoride, and saliva testing protocols. Although hygienists are considered “cosmetologists,” many aspire to practice within the scope of their license and are passionate about changing overall health outcomes for their patients.
Why the movement to weaken education standards could impact patient care
In the worst-case scenario, some states are considering or have passed legislation that would lower educational standards for entry into the dental profession. Dental hygienists who graduate from a Commission on Dental Accreditation (CODA) accredited school receive nearly 3,000 hours of didactic and clinical training. By comparison, Arizona's new law allows dental prophylactic assistants with only 175 hours of didactic training and at least 150 preventive treatments to perform scaling and polishing at the gum line.
These measures will put more patients at risk for undiagnosed oral, oropharyngeal, and head and neck cancers, advanced oral disease, and may exacerbate other chronic health problems. In fact, more than 40% of adults over the age of 30 have periodontitis. Approximately 34 million school hours are lost to emergency dental care each year. Imagine the greater impact that less trained hygienists and assistants would have on American health without the rigorous preventive screening provided by the CODA certification program.
More than just a credential, CODA certification is an assurance that patients receive qualified, evidence-based care from dental hygienists qualified to prevent oral and systemic disease.
RDH: Providing a higher standard of care to every patient
When patients sit in our chairs, they trust us to use our knowledge, skills and training to provide quality care that improves and maintains their overall health and quality of life. RDH takes this responsibility seriously. The long-held belief that RDH is just about cleaning teeth must change. There needs to be greater recognition of the value of preventive oral health care and greater respect and recognition for the role an accredited RDH plays in identifying potential health problems early and truly saving and improving lives.
By expanding the scope of practice offered by RDHs (not reducing it) and raising the educational standards for dental assistants, we can not only position RDHs as experts in preventive care but also make progress in solving America's oral health crisis and mitigating systemic disease.
Photo: wildpixel, Getty Images
Lisandra Maisonet is a licensed dental hygienist with over 35 years of dental experience, including 23 years as a preventive specialist. During her career, she held many leadership positions in professional associations. As Director of Operations and Chief Hygienist for 26 dental practices, Lisaandra has an in-depth understanding of the needs of hygienists and is committed to driving the growth of the profession. She also serves as executive director of the Oral Health Awareness Project, an organization dedicated to protecting the oral health of the community by raising public awareness of the important role of licensed dental hygienists and advocating for policies that prevent substandard, unaccredited dental care practices.
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