Prevention Centered

Author: Andrea Kowalczyk, RDH, BS– – Dental Hygiene Performance Coach – Enhanced Hygiene

It is a well known fact that in the United States, our healthcare system is generally focused on the treatment of disease, rather than the prevention of it. According to a September 2012 New England Journal of Medicine perspective of healthcare in the US, researchers Farshad Fani Marvasti, M.D., M.P.H., and Randall S. Stafford, M.D., Ph.D. concluded the following: “Although the United States pays more for medical care than any other country, problems abound in our health care system. Unsustainable costs, poor outcomes, poor patient satisfaction, and worsening health disparities all point to a need for transformative change. Unfortunately, many modifiable risk factors for chronic diseases are not being addressed adequately. A prevention model, focused on forestalling the development of disease before symptoms or life-threatening events occur, is the best solution.”*

In this system of treatment focused healthcare delivery, Dental Hygienists, as disease prevention experts, stand out from the crowd.  The formal definition of a Dental Hygienist according to the American Dental Hygiene Association is: “A licensed dental professional who specializes in preventive oral health, typically focusing on techniques in oral hygiene. Dental hygienists provide three types of services to their patients. The first of these is preventive services to promote and maintain good oral health. The second is educational services to help patients develop behaviors that promote better oral health and help them understand the importance of practicing these behaviors. The third type of service provided is therapeutic services which are treatments meant to stop disease and maintain healthy tissues in the mouth.” **

So there we have it. Dental Hygienists by their very definition are preventative specialists. Unfortunately, as prevention education experts, some hygienists are working in an environment that is not conducive to what hygienists are trained to do; prevent oral disease.

To illustrate this, most dental practices hire hygienists to provide preventative prophylaxis for patients. Commonly, this is where the preventative care in many practices begins and ends.

Whether you practice in a cosmetic, pediatric, or general office, it is a good idea to notice how much emphasis is put on the prevention of oral disease. Here are some questions to ask:

Does your office?

     – Offer in office fluoride varnish to adult patients at risk of caries?

     – Offer sealants for children and high decay risk adults?

     – Dispense or write prescriptions for at home fluoride?

     – Perform a caries risk assessment?

     – Do you periodontally probe each new patient?

     – Are you performing oral cancer screenings?

     – Do you offer smoking cessation and nutritional counseling?

If the answer is no to more than a few of these questions, the practice is not centered on prevention. Take heart, however, in knowing that becoming a more prevention centered practice is within easy reach!

The great thing about prevention in the dental office is that it is usually non-invasive and very inexpensive. Caries Risk Assessment is nothing more than a questionnaire, a conversation with the patient to determine risk factors, or possibly a saliva sample. Other than fluoride, preventative measures consist of healthy dietary changes and frequent cleanings, not medications. Radiation from digital x-rays is minimal. Oral cancer screening can be done either visually or with a harmless UV light.

In addition to being the right thing to do for our patients, prevention can be quite profitable for the practice when fluoride products are dispensed, sealants applied, and periodontal disease properly treated.

Prevention may begin in the hygiene department, but it should not stay there. Every team member should be focused on oral disease prevention. I want to advise my hygienist peers to not wait for the dentist or office manager to lead the way in prevention protocols; afterall, you were hired to be the prevention expert! 

*Farshad Fani Marvasti, M.D., M.P.H., and Randall S. Stafford, M.D., Ph.D.

N Engl J Med 2012; 367:889-891September 6, 2012DOI: 10.1056/NEJMp1206230