To develop students’ understanding of the relationship between oral health, the community and its health care system.
Upon completion of this subject students will have acquired:
- An introductory understanding of the patterns of dental diseases
- An understanding of the role of the dental profession in improving health status
- An understanding of some of the existing mechanisms and issues for delivering oral health services.
The History of Dental Hygiene Practice in Australia
Dental therapists and hygienists joined the dental profession world to handle specific dental care issues in relation to access to dental care in a bid to complement the dentists in their work (3). The extension and advancement of the various responsibilities and latitude of dental hygienists, dental therapists as well as oral health therapists marks the beginning of a path to addressing issues that concerns the clinical practice such as workforce shortages in underserved communities characterized by greater oral health disparities. The three sets of oral health specialists are progressively playing a critical role in the delivery of oral health services in Australia (1-3). The dental hygiene practice started in 1971 in Australia they principally deliver health education, precautionary, periodontal and orthodontic supplementary services to all.
Dental experts examine, diagnose, and develop plans for the oral health management majorly to kids and teenagers and refer patients whose conditions are beyond their scope of practice to dentists (3, 5, 7). While oral health therapists are new entrants to the dental team, their schooling and training traverses coaching aspects of a dental therapist and hygienist (5, 7). Currently, the Australian tertiary education sector offers oral health therapy training and this implies the transition of professionals whose help is critical in enhancing access to dental services the public adult dental patients especially from the disadvantaged groups. Access to oral health care by the socioeconomic disadvantaged groups is an emerging problem in the western countries and expanding the role and scope of dental care is the ultimate solution to this challenge.
Interestingly, dental hygienists traditionally play a much bigger role in the delivery of oral health care than their counterparts, dental therapists. Conversely, in Australia, it took relatively a lot of time for dental hygienist profession to establish long after dental therapists had been in practice. Dental therapists offer restorative dental care to children, adolescents, and adults. OHTs also participate in promotion of health, education, and research as well as in the management and development policy. OHT perform dental examinations and diagnosis and help advance oral healthcare plans (7, 11). These include taking x-rays of teeth and jaws, prepare cavities and fillings to restore the teeth, and extract deciduous teeth with the help of local anaesthetic whenever deemed necessary. OHTs provide nutritional counselling, oral health awareness, and promotion among other dental hygiene services to persons of all ages.
The dental hygiene services under their focus include the use of preventive, educative, and therapeutic approaches of controlling oral conditions. OHTs have the best knowledge and expertise to cover the wide gap of oral care parities associated with socioeconomic differences among different groups in Australia because their training borrows from aspects of both dental hygienists and dental therapists (11-12). OHTs work alongside dentists to offer the much needed oral health care to children and adults. They play a critical role in reducing the pressure that was previously pilling over dentists to handle all cases relating to dental care (5). Currently, they are well-equipped to handle the basics of dental and oral care and only refer their patients to dentists to handle cases that are beyond their knowledge and expertise. This is a great step forward to attaining the goal of effective management of oral and dental care especially for the group that has been left behind over time.
Roles and Responsibilities of Dental Experts
On the interviews of OHTs working in a public hospital OHT A and an OHT working in a private hospital OHT B, there is no difference between the roles and responsibilities of the OHT except for their perceptions and experiences at their respective work stations. Both practitioners cited that OHT gives them an opportunity to enhance the oral health of their patients. They reiterated that they have dual qualifications of dental therapists and dental hygienists. They offer oral health assessment that is the initial step in trying to improve oral health for older patients. However, health assessment does not replace a comprehensive dental evaluation but rather used as the first phase of identifying whether or not an older patient suffers any oral health challenges and the need to make referrals (6, 9). They highlighted the six question oral health assessment tools (OHATs) that does not require a clinical assessment report and is always recommended for older people who can use it for self-reporting.
The six questions revolve around having own natural teeth, pain in the mouth while chewing, need for a dental visit for any reason, experience of shyness while smiling or laughing, experience of having difficulties while eating, and finally having difficulty relaxing because of teeth problems. Similarly, for older patients who cannot self-report, they mentioned another set of OHATs that included visual inspection of eight classes of oral health such as lips, tongue, gums and oral tissues, saliva, natural teeth, dental pain, oral cleanliness as well as dentures (2, 4). OHT A perform diagnosis, treatment, as well as administration and offer precautionary services for children and adolescents and for adults for all ages while OHT B focuses on young children and adolescents. They both conduct restorative and periodontal treatments, tooth removal where necessary, and promote oral health and other healthy oral behaviours among the disadvantaged population segment. They all admitted that working with a dentist is always under a particular structured professional relationship given the complementary nature of their work.
About the perception of public and private hospitals, OHT A admitted that some of his patient's complaint about the stressful environment around public hospitals in Australia. Public hospitals are best in handling emergencies and acute care and are relatively preferred by patients falling under the two categories (3, 8). Moreover, the fact that the biggest beneficiaries of private health insurance are of ages between 60-79 years and who are also the majority of target patients by OHTs, majority prefer public hospitals because of the high-quality medical care. However, the pressure on public facilities is significant hence; there is a lot of work (7, 9). Conversely, OHT B also admitted receiving a lot of patients who cite the calmness and availability of OHTs at their institution for choosing the private facility. All Australians have the choice of going to either a public or a private hospital depending on the information at hand based on referrals through friends or personal past experiences in either public or private hospitals. Lastly, they both had a passion to help their patients to improve their oral health.
The Role of Oral Health Therapists
The provision of dental care still faces issues of shortage of dental care practitioners, and access issues due to affordability because not all patients have private insurance cover. Currently, individuals fund most of dental care as the government and private health insurance fund a relatively smaller portion of the fund (3-6). The labour party has preferred state-funded dental services for socioeconomic disadvantaged groups in the larger community while the coalition prefers involvement of state in public health services and supporting private health insurance through incentives and rebates and of late supporting the limited Medicare benefits for only patients suffering from chronic illnesses (9). Both OHT A and OHT B were motivated by the urge to help patients improve their oral health.
Both oral health therapists (OHT), dental therapists (DT) and dental hygienists (DH) can only cooperate with a dentist under a structured specialized rapport (5). This kind of relationship eliminates the inefficiencies previously associated with the supervisory role of the dentists over their allied health practitioners. However, deep in meaning, the arrangement still operates according to the original intent of the supervisory role of dentists though in a different fashion.
The scope of roles and responsibilities of OHT, DT, and DH include restorative treatment, oral health promotion, removal of tooth, gum treatment among other oral care but it is important to note that one needs at least two-year full-time learning program for DT and DH and three-year full-time degree training course approved by the Australian National Board (1-5). Dental therapists examine and treat teeth for children and adolescents under the direction of a dentist in either a public or a private organization. A dental hygienist is a highly skilled professional offering preventive service to patients across all ages without removing or refilling the teeth. In so doing, they work in collaboration with dentists to determine the right therapeutic treatment measures for patients independently deliver dental services. OHTs offer primary oral health care for both children and grown-ups as they have the qualifications of both DTs and DHs and can, therefore, perform the role of a DT or a DH (7, 9). Oral health patients have different experiences depending on the nature of their illnesses and the manner in which they were handled at the diagnosis and treatment phases.
Some patients prefer certain doctors and hospitals, irrespective of where they work, public or private because of the great experience they have had with them in the past (5-7). While oral health practitioners may have similar qualifications, the passion and commitment to their work contributes significantly to the different levels of professionalism that they exhibit at the workplace. The oral health care sector has limitations that are associated with shortages of oral care professionals to serve the deserving population. Most patients still cannot access oral health care because of the costs involved. (12) However, through government intervention, there is potential of improving access and training more oral health care professionals to eliminate the shortages and access to funding.
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