Since the recognition of the Canadian dental hygiene profession as an independent profession in 1963, the profession has expanded due to increases in aging population and populations with complicated systemic conditions as well as development of technology and research. However the progress of the profession has not been always positive as interprofessional conflict with dentistry has been growing over the role of the primary oral health care provider for the public.¹ To gain a better understanding about the conflict, a concise definition of primary-care provider was needed need²:

• The primary-care provider is the patient’s first point of access to the health-care system;
• The primary-care provider assumes ongoing responsibility for the patient in both health maintenance and illness therapy;
• The primary-care provider takes responsibility or the overall coordination of the care of the patient’s health problems using referrals and community resources.

Providing holistic care is important for the quality of life

The conflict has been spurred on by the changing market for dental services, changes in the regulation of health professions, and by dental hygienists’ attempts to expand scope of practice.¹ Dental hygiene has long been viewed as para-dental occupation, subordinate to dentistry, due to its insufficient training and inability to accurately diagnose or identify dental problems.¹ However this is no longer true with expansion of dental hygiene education with the beginning of 4-year baccalaureate degree programs in Dental Science and education for advanced dental hygiene practitioners (ADHPs) that encompasses thorough learning of following competencies in health promotion, oral disease prevention, clinical therapy and professionalism^3,4: oral health education, advocacy, policy use, communication, critical thinking, research use, scientific investigation, and leadership.

The growth of dental hygiene education has allowed dental hygienists to be competent enough to serve the public as a primary point of contact to receive therapeutic and preventative oral care.¹

Dental hygienists provide therapeutic interventions for optimal oral health

Aside from the traditional dental hygiene care in oral disease prevention and clinical therapies, dental hygiene expanded its scope into health promotion. Such expansion seems to be logical as the primary point of contact with clients and advocate for them for further oral health needs via referrals. Advocacy is one of the core abilities within the standard for Canadian dental hygienists as it is identified as “speaking, writing or acting in favour of a particular cause, policy or group of people – often aims to reduce inequities in health status or access to health services.”^6, Dental hygienists advocate for public health policies that would benefit the public such as support for community water fluoridation to decrease public caries risk⁷ and for amendments in legislations to increase the access to care such as exemption of 365-Day rule in British Columbia.⁸

The dental hygiene practice settings have expanded in accordance to the broaden scope of practice and changes in legislation that allows better access to care. Studies identified the need of dental hygienists in long-term care facilities which often lack regular dental maintenance that could reduce prevalence of dental and periodontal problems.⁹ With increasing evidence of an association between periodontitis and cardiovascular/cerebrovascular disease and inhalation pneumonia as well as increase in life-expectancies of the public, future escalation of oral health problems in such facilities seems to be eminent.⁹

Research is another crucial element of dental hygiene profession. Research is required for all the integral parts of dental hygiene that have been discussed. No appropriate health promotion, education, and policy can be supported without thorough evidence. With the advance of biomedical technology, various attempts have been made in various dental hygiene settings to assess periodontal problems such as looking into medication-induced xerostomia on an elderly population.¹⁰

Over the past 50 years, the Canadian dental hygiene profession has made extensive effort in various scopes of practice to secure its position as a primary oral care profession. Dental hygienists strive for providing holistic care, following their ethical and legal duties to ensure better quality of care for all.

References

1. Adams TL. Inter-professional conflict and professionalization: dentistry and dental hygiene in Ontario. Soc Sci Med. 2004 Jun; 58(11):2243-52.
2. Odrich J. Can dental hygienists affect the periodontal health of the nation? The dental hygienist: A primary care provider. J Public Health Dent. 1985 Sprin;45(2):64-9.
3. Kanji Z, Sunell S, Boschma G, Imai P, Craig BJ. Outcomes of dental hygiene baccalaureate degree education in Canada. J Dent Educ. 2011 Mar;75(3):310-20.
4. Stolberg RL, Brickle CM, Darby MM. Development and status of the advanced dental hygiene practitioner. J Dent Hyg. 2011 spring;85(2):83-91.
5. Lawlor S. Dental hygienists as advocates: put on your purple cape/Les hygiénistes dentaires, comme des avocates: Revêtez votre cape pourpre. Canadian J Dental Hygiene. 2012 Nov;46(4):203-4.
6. Public Health Agency of Canada (PHAC). Core competencies for public health In Canada: Release 1.0. Chapter: 4.0 Partnerships, Collaboration and Advocacy. Ottawa: PHAC. 2007 [cited 2013 Nov 26]. Available from: www.phac-aspc.gc.ca/core_competencies
7. The Canadian Dental Hygienists Association. CHDA position statement: community water fluoridation. 2011 Sep 29 [cited 2013 Nov 26]. Available from: http://www.cdha.ca/AM/Template.cfm?Section=News_and_Events&Template=/CM/ContentDisplay.cfm&CONTENTID=10844
8. British Columbia Dental Hygienists’ Association (BCDHA). Full registration (365 day rule exempt) FAQ’s. 2012 [cited 2013 Nov 26]. Available from: http://www.cdhbc.com/PDF-Files/365-FAQ-s-for-Website-Final-Jul-25-12.aspx
9. Pickard RB, Ablah C. Dental hygienists as providers in long-term care facilities. Spec Care Dentist. 2005;25(1):19-28.
10. Coleman P. Improving oral health care for the frail elderly: a review of widespread problems and best practices. Geriatric Nursing. 2002 Aug; 23(4): 189-198.