by JoAnn R. Gurenlian, RDH, PhD
Recently, I had the privilege of attending a KOL meeting sponsored by Philips. The group consisted of distinguished colleagues in dentistry and dental hygiene as well as corporate members. At the meeting, I participated in a panel presentation that focused on issues related to association membership, trends, and professional development. While the entire meeting was inspirational, the panel discussion solidified a concept that is worth mentioning.
One of the topics addressed related to oral disease prevention. A comment was made that we need to carefully examine the oral health needs of the country and create models of prevention that are successful as demonstrated through measurable health outcomes. The reaction from some of the dentists in the room was that calculus removal by dental hygienists is the way to prevent oral disease. Sadly, this prevailing viewpoint is one reason why we are not making strides in health promotion and disease prevention. Scaling, debridement, and removal of deposits are treatment, not prevention.
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Further, several dentists commented that they cannot make money with preventive practices. They noted that insurance companies do not reimburse for prevention, and they do not charge for preventive services. Interesting.
One of the leaders of Philips then commented that it is imperative to "live your mandate," and I thought of all of us in dental hygiene who profess to be the preventive oral health specialists. I wonder if we are living our mandate.
This topic is concerning because we have fallen into the private practice system that is focused predominantly on treatment vs. prevention. This model is realistically based on the value of sustaining a business — not necessarily the value of preventing and managing oral disease. Let's be clear: We absolutely must be able to sustain and grow the businesses of dentistry and dental hygiene. However, we need to ask if this current practice model is one that can make a significant difference in the prevention of oral disease.
Take a moment and reflect on your most recent week in clinical practice. Think about the services you provided. What was the ratio of preventive care to treatment? If services are difficult to quantify, try examining minutes allocated to prevention and treatment. How much time in your 30-minute, 45-minute, or one-hour dental hygiene appointment was spent on preventive procedures, and how much time was devoted to treatment? Do you find yourself spending the majority of your time removing deposits? If so, where does prevention enter into the picture? Is it a thought or an actualization? Do you wish you had more time for prevention? Do you charge for your dental hygiene assessments, screening programs, biofilm management, sealants, fluoride programs, health education, and oral health preventive education? Are you reimbursed for these services, or are these considered "giveaways"? Finally, with all the scaling and debridement, are our patients showing improvement in their oral health? Do we track success and oral health changes in our practice settings?
As we consider the future of health care in general, and oral health care in particular, let's agree to place greater emphasis on the prevention of oral disease. We must recognize that our current system of practice needs improvement if we are to truly change the oral health of this country. To do that requires us to reexamine and reframe clinical practice. It means that dental hygienists must collaborate with other health-care providers and create a practice model that allows us to live our mandate that we are the preventive oral health specialists. It means that we must collaborate with insurance companies that promote prevention so that we are reimbursed for preventive procedures as well as treatment services. Most importantly, living our mandate means that we recognize and value our role in improving health outcomes through prevention, and we demonstrate that value daily.
As we close this year and think about 2014, perhaps we can start generating discussions in our component and state meetings, study clubs, and national forums to revisit our prevention mandate. We need to develop a collective spirit, a unified approach, and a willingness to test new models of oral health care that demonstrate that we can and do make a difference in oral health outcomes.
JOANN R. GURENLIAN, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing-education
programs to health-care providers. She is a professor and dental hygiene graduate program director at Idaho State University, and
president of the International Federation of Dental Hygienists.
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