According to the Research Trisha E. O’Hehir, RDH, BS
Editorial Director, Hygienetown Magazine

The American Dental Hygienists’ Association is creating the “nurse practitioner of dentistry” in the form of an Advanced Dental Hygiene Practitioner. Perhaps the word “advanced” isn’t necessary, as we don’t as yet have a “Dental Hygiene Practitioner.” An ADHP will work without supervision providing prevention, local anesthesia, basic restorative procedures, and simple surgical extractions. Periodontal care and medicine also need to be included in this model, to provide a balanced and comprehensive professional who can address the needs of unserved and underserved populations – those who don’t currently see a dentist. Creating a new level of dental hygiene care creates the need for a new role for dentists as collaborative team leaders via technology. This is a win-win project for both dentists and hygienists.

The idea of hygienists “drilling and filling” isn’t new. It started more than 55 years ago with the first five-year study beginning in 1947. An American Dental Association resolution opposing the study triggered a battle in the Massachusetts press between supporters who believed the idea was justified, considering the high rate of decay among the state’s children, and dentists who condemned the project as “socialistic and dangerous.” Unfortunately, the project was halted, but not before participants had demonstrated considerable proficiency with restorative skills.

Determined dentists in Boston tried to resurrect the idea of the advanced dental hygiene practitioner with the “Forysth Experiment,” between 1965 and 1977. The experiment successfully demonstrated that hygienists learned to anesthetize, drill and place Class I-V restorations in less time than it took dental students, and the hygienists’ work was the same quality as practicing dentists’. These results met only resistance as the Massachusetts Board of Dental Examiners voted unanimously that cutting tooth structure was against the law for hygienists, eventually halting the research. Dr. Ralph Lobene, the research project director, wrote and published a book in 1979 on both the success and defeat of the project.

There may have been contributing factors to the defeat of the Forsyth Experiment. During the 1970s, the federal government offered dental schools funding to build new buildings if enrollment were doubled; thinking more dentists would mean care for folks in rural areas. However, new dentists, with no incentive to move to rural areas, moved to big cities instead and struggled to earn a living during the recession of the 1970-80s. If dentists aren’t busy, it’s difficult for them to embrace a new level of practitioner who would be doing some of their work – even if the intent were to reach unserved populations.

That’s the history. Currently the balance in numbers between dentists and hygienists will change dramatically in the next decade as dental graduates of the 1970s retire, fewer dentists are graduated, and more women dentists elect to work part-time. As the number of dentists declines, the number of hygienists increases. New dental hygiene schools are opening each year and hygienists are remaining in practice longer. This shift in the DDS/RDH balance will be important to consider as disease levels remain the same and cosmetic dentistry demands increase for dentists. As the number of dentists decreases in the future, the dental hygiene practitioner will be the logical professional to address the simple oral health and restorative needs of those not currently seeing a dentist.

Just as nurse practitioners work independently, yet in collaboration with physicians, technology may allow the dental hygiene practitioner to reach populations now unserved by dentistry while partnering with dentists via technology. As dentistry goes digital, electronic and video conferencing become viable options for a team approach to patient care. Creation of the dental hygiene practitioner will provide new opportunities for dentists. Those ready to retire at the peak of their expertise will be sought after for consultation services. A dentist in the city or suburbs could consult with many ADHPs in different rural areas through the use of video conferencing.

To sum up, with a solid foundation in basic sciences, the biochemistry of caries and periodontal disease, periodontal medicine, and diagnostic and counseling skills, the dental hygiene practitioner/dentist team can reduce the level of dental disease in this country. It’s an exciting challenge and an exhilarating opportunity in oral health care. This can be a win-win prospect for both dentists and hygienists, with the oral health of the public being the biggest winner of all.