"Paging dental hygiene": Why this should be heard in hospitals everywhere

Editor's note: This article is a capstone project from three students at Pacific University in Oregon. Watch for more capstone projects in future issues of RDH eVillage.

Submitted by Calli Pellatz, BSDH (c), Taiba Qaaderi, BSDH (c), Angela Kluting, BSDH (c)
Mónica Sarmiento, EPDH, RDH, Kathryn Moore, MS, EPDH, RDH

We all know the drill when it comes to good oral health habits: brush twice a day and floss once a day. However, have you considered what oral care looks like for hospitalized patients? Dental hygiene student Taiba Qaaderi asked herself this question at a young age after an unfortunate personal experience that highlighted the importance of oral care protocols in a hospital setting. As a student, she now understands more of the oral and systemic link and strongly believes a dental hygienist should be an integral member of a hospital care team.

This shares Taiba’s personal story as well as offers insight to the roles and responsibilities a registered dental hygienist can have in a hospital setting from the perspective of two dental hygienists with experience working in this setting.

Taiba’s story

"I was helping my grandmother in the shower when she told me she was experiencing unusual chest pain. At the time, I was 13 years old and had limited knowledge regarding the medical field but I knew immediately something was seriously wrong and called my parents. My parents were on their way back home and asked me to call 911. My grandmother always feared hospitals and asked that I remain by her side. Her breathing was labored and her chest pain worsened as the time passed. I was devastated and felt hopeless. I held her hand as I waited with her for the paramedics to arrive.

My grandmother was taken to the hospital due to a severe heart attack; while recovering from heart surgery, she sadly lost her battle. A lack of oral care protocols led to an increased risk of bacterial infection in her bloodstream, which ultimately prevented her recovery. Having poor oral health puts a person at risk for heart disease. If the gums are inflamed due to the bacteria that causes periodontal disease, that same bacteria can get into the bloodstream causing the arteries to build plaque and harden.¹ Oral bacteria can lead to blood flow problems and heart blockages that can increase the risks of a heart attack.

My grandmother survived her first heart attack, but the bacterial infection from her oral cavity spread into her bloodstream and put her into a coma. My heart still hurts when I remember this moment. Having to translate for my parents while grieving the loss of my grandmother was one of the most difficult experiences I have had to endure. I was too young to comprehend everything I was translating to my parents at the time. Reflecting back is heartbreaking because I cannot help but wonder if things would be different had there been consistent oral care protocols in place. Would she be here today watching me graduate?"

Growing your career through dental-medical integration

A call for collaborative change

Taiba’s story is one of many for a call to action to have more dental hygienists working collaboratively with health-care professionals in hospital settings.² The World Health Organization (WHO) defines interprofessional collaboration as "multiple health workers from different professional backgrounds working together with patients, families, carers, and communities to deliver the highest quality of care across settings.”³ According to the American Dental Hygienists' Association (ADHA), there are currently 26 states in the United States that allow dental hygienists to practice within the hospital setting under the direct or general supervision of a physician or dentist; however, most organizations are not utilizing this collaborative approach.⁴ There is an opportunity to increase research efforts and collect data to see how a dental hygienist could help increase patient care outcomes and the overall satisfaction of patients, families, and caretakers.

The role and responsibilities of a dental hygienist in a hospital setting vary across institutions. We interviewed Sherry Lemon, MS, RDH, who up until recently worked as a dental hygienist and faculty member for Oregon Health and Science University department of Pediatric Dentistry at the School of Dentistry in conjunction with Doernbecher Children’s Hospital for 19 years. She explained that her role was predominantly clinical, providing dental hygiene services to children of all ages at the hospital’s dental clinic. Another important aspect of her role involved training medical and dental residents on behavior management strategies and evaluating the medical histories of medically compromised patients.

In Arizona, Katharine Martinez, MPH, BS, RDH, has been working at Phoenix Children's Hospital as an oral health educator for nearly three years. Her primary roles and responsibilities within the hospital include overseeing all critical and acute care with an intensive focus on hematology/oncology in the Bone Marrow Transplant units. Katharine’s role also focuses on educating hospitalized patients and caregivers, following patients throughout their treatment, overseeing and designing hospital oral health protocols, training medical professionals on oral care, and providing valuable input in committees for infection control protocols.

Although Katharine primarily works within the hematology/oncology unit, she reports her role is quickly evolving and she has been able to support the hospital in more ways than anticipated. Through both interviews we are able to gain valuable insight on the different ways a dental hygienist can be integrated into the hospital setting and the support this can provide the hospital team and patients. There appears to be a need and opportunities for dental hygienists in inpatient and outpatient hospital care settings.

Paging dental hygiene

In reviewing the literature, we discovered there is no tool readily available to assess oral care protocols for hospitalized patients. With the help of community mentors, we developed a survey that can be utilized to assess oral care protocols and the perceptions of administrators, support staff, and medical professionals on adding a registered dental hygienist to the hospital’s multidisciplinary team. It is our hope the survey can be used and modified as needed by anyone nationwide to help develop oral care recommendations in hospital settings and potentially pave the way for more positions where dental hygienists can continue to make an impact as oral disease prevention and health promotion specialists. Perhaps one day, “paging dental hygiene” will be the new norm as collaborative and interprofessional approaches to health care continue to grow.

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