The role of the DH, DT and OHT in Special Needs...
Transcript of The role of the DH, DT and OHT in Special Needs...
![Page 1: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/1.jpg)
The role of the DH, DT and OHT in Special Needs Dentistry
Clare McNally Dental Hygienist, PhD Candidate
University of Adelaide, South Australian Dental Service and Westmead Centre for Oral Health
![Page 2: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/2.jpg)
In practice
• My experience consists of: – General, Periodontal and Orthodontic practice – Domiciliary aged care
• Research project – Westmead Centre for Oral Health
• Focus on intellectually and physically disabled patients – South Australian Dental Service
• Focus on medically complex and head and neck cancer
• Completing a PhD looking into the oral health of hospitalised older patients
![Page 3: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/3.jpg)
Why?
![Page 4: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/4.jpg)
Definitions
• Dental hygienist and dental therapist – Classical definitions similar to those used
internationally
• Oral health therapist – Merging of the DH and DT
![Page 5: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/5.jpg)
In practice
Dental hygienists, dental therapists and oral health therapists exercise autonomous decision making in those areas in which they have been formally educated and trained. They may only practice within a structured professional relationship with a dentist. They must not practise as independent practitioners. They may practise in a range of environments that are not limited to direct supervision.
h"p://www.dentalboard.gov.au/Registra7on-‐Standards.aspx
![Page 6: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/6.jpg)
Australian Program Development Ins$tu$on Program Year commenced
Gillies Plains TAFE Dental Hygiene 1974
Melbourne Uni Dip DH & DT, BOH 1996, merged 2005
UQ/QUT BOH 1999
Adelaide Uni BOH 2002
Griffith Uni BOH 2004 – closed
Sydney and Newcastle Uni BOH 2005
LaTrobe Uni BOH 2006
CSU BOH 2008
Cur7n Uni ADDH, DT, BOH 1974, 2011
CQU BOH 2012
RMIT, Holmesglen New programs 2013
![Page 7: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/7.jpg)
Special Needs Dentistry What is special needs dentistry: ‘Is that part of dentistry concerned with the oral health of people adversely affected by intellectual disability, medical, physical, or psychiatric issues.’
E"nger et al. Journal of Dental Educa3on August 1, 2004 vol. 68 no. 8 803-‐806
![Page 8: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/8.jpg)
Special Needs Dentistry
• We know that: – Ageing population – People are retaining their teeth throughout life
• Increased risk of periodontal disease and caries
– People are living longer with chronic illnesses – Polypharmacy is common, particularly in the
elderly, and has a huge impact on the oral cavity – Increased success in cancer management
![Page 9: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/9.jpg)
Special Needs Dentistry Many groups of people within Australian society are at a high risk of being defined as special needs, but who may not be presently covered by traditional definitions:
– Indigenous communities – Homebound Elderly – Head and neck cancer survivors – Low socio-economic families seen at maternal and child
health centres – Hospitalised patients of all ages, particularly ICU – Generally underserviced populations
![Page 10: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/10.jpg)
Special Needs Dentistry
• These groups have in common: – A lack of dental tradition – Poor dental attendance – Long time on public dental waiting lists – Urgent need for oral health education
• Through appropriately developed and targeted oral health promotion programs
– Need for preventive and simple restorative dental services
![Page 11: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/11.jpg)
Special Needs Dentistry
• The points made thus far are common knowledge
• Why rehash? • Is an area of dentistry that is most suited to the
integration of the DH, DT and OHT – Reported underutilisation of hygienists
• Dentists involvement, motivation
![Page 12: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/12.jpg)
Let’s look at the education
![Page 13: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/13.jpg)
Undergraduate education
• Regularly reported that OHTs, DHs and DTs can fill the gap by moving into aged care and special needs
• Current BOH models tend to be a merging of the two qualifications
• Difficulty getting access to clinic space and patient care in all Aust programs
![Page 14: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/14.jpg)
Undergraduate education
• Dentists have reported feeling inadequately educated throughout their program in medically complex and geriatric patients
• Registration and scope of practice have led education – Current DBA scope of practice enables direct
access to DHs, DTs and OHTs – Under review
![Page 15: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/15.jpg)
Undergraduate education
• DHs, DTs, OHTs graduate, similarly to dentists with enough skill and knowledge to get through successfully in general practice
• DHs, DTs and OHTs should also have
enough skill to work in perio, paedo and ortho specialty areas
![Page 16: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/16.jpg)
Undergraduate education
• All undergrad students within dental programs should be given clinical rotations in special needs: – Rural and regional – Indigenous – Aged care – Acute care hospital setting – Children and schools – Maternal and child health centres
• Learning medically complex and special needs on the job is difficult and potentially life-threatening
![Page 17: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/17.jpg)
Undergraduate education
• At Sydney Uni – Students get a rotation through SCU in 2nd and 3rd
year
• At Adelaide Uni – 3rd year students get a rotation through SNU and
outplacement clinics
• At Melbourne Uni – Students were rotated through the Dom Unit
![Page 18: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/18.jpg)
Undergraduate education
![Page 19: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/19.jpg)
Postgraduate training
• This is a necessity
• We are a profession expanding too quickly • DHs, DTs and OHTs engaged in important
research throughout Australia • Concern over branding as specialist, rather
than specialised
![Page 20: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/20.jpg)
Postgraduate Training • Further education required in:
– Medical and scientific knowledge • Related to our work • Major diseases that can have an impact on the mouth • Syndromes, Cancers, other chronic diseases • Pharmacology
– Reading of blood test results – understanding what they indicate in relation to treatment
– Sequencing of treatment • Medical, Dietetics, Speech Pathology, Dental
– Anatomy and physiology – Counselling
• Management of patients with terminal disease – Education
• Provision of adult education to other members of the medical profession – RNs, GPs and medical specialists.
– Nutrition
![Page 21: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/21.jpg)
Postgraduate Training
• Not possible to learn everything at the undergraduate level
• Need comprehensive clinical dental and patient management skills to work in the field
• Opportunity for expansion of the employment opportunities to wards in major hospitals to support oral med and special needs specialists
![Page 22: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/22.jpg)
Post-graduate education
![Page 23: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/23.jpg)
Post-graduate education
![Page 24: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/24.jpg)
Post-graduate education
![Page 25: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/25.jpg)
Postgraduate education
![Page 26: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/26.jpg)
Continuing education
• Appropriateness – Given the discussion around u-grad and p-grad
• People doing it for ‘hours/points’ • Requires structure and potentially recognition
from the Board • Lots of international opportunities for
increasing knowledge, limited in Australia
![Page 27: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/27.jpg)
Continuing education
![Page 28: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/28.jpg)
Continuing education
![Page 29: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/29.jpg)
Continuing education
![Page 30: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/30.jpg)
Continuing education
![Page 31: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/31.jpg)
Reminder
Dental hygienists, dental therapists and oral health therapists exercise autonomous decision making in those areas in which they have been formally educated and trained. They may only practice within a structured professional relationship with a dentist. They must not practise as independent practitioners. They may practise in a range of environments that are not limited to direct supervision.
h"p://www.dentalboard.gov.au/Registra7on-‐Standards.aspx
![Page 32: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/32.jpg)
In practice
![Page 33: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/33.jpg)
In practice
• Skills that vary from the dentist • Support team approach to dentistry • More appropriate utilisation of all members of
the team • Affordable • Transportable
![Page 34: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/34.jpg)
In practice
• Employment opportunities – Whilst it is nice and at times appropriate - people
wanting to make a career in SND, shouldn’t have to volunteer their time
– Expansion of DHs, DTs and OHTs in the public sector
– Treating patients with chronic illness and polypharmacy in the private sector
– A change in the delivery of dentistry, make the DH, DT and OHT the first point of call • Allows for screening, triage, prevention, education
![Page 35: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/35.jpg)
Summary
• There is a need for DHs, DTs and OHTs in Special Needs Dentistry
• The education needs to be appropriate and post-graduate opportunities need to more readily available
• Considerations for unique models of dentistry that best suit the patient and the community
![Page 37: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/37.jpg)
References Berkey, D.B., et al., Barriers influencing dental care in long-term care facilities. Gerodontics, 1988. 4(6): p. 315-9.
Chalmers, J.M., et al., Opinions of dentists and directors of nursing concerning dental care provision for Adelaide nursing homes. Australian Dental Journal, 2001. 46(4): p. 277-83.
Hopcraft, M.S., et al., Dental service provision in Victorian residential aged care facilities. Australian Dental Journal, 2008. 53(3): p. 239-45.
Nunez, B.S. et al., Opinions on the provision of dental care in Iowa nursing homes. Special Care in Dentistry, 2011, 31(1), p 33-40.
MacEntee, M.I., et al., Opinions of dentists on the treatment of elderly patients in long-term care facilities. Journal of Public Health Dentistry, 1992. 52(4): p. 239-44.
Nicol, R., et al., Effectiveness of health care worker training on the oral health of elderly residents of nursing homes. Community Dentistry & Oral Epidemiology, 2005. 33(2): p. 115-24.
![Page 38: The role of the DH, DT and OHT in Special Needs Dentistryiadh.org/wp-content/uploads/2013/10/McNally_C_Role-of-Hygienist-i… · OHT in Special Needs Dentistry Clare McNally Dental](https://reader033.fdocuments.in/reader033/viewer/2022052718/5f04d9c97e708231d4100617/html5/thumbnails/38.jpg)
References Paulsson, G., et al., Evaluation of an oral health education program for nursing personnel in special housing facilities for the elderly. Special Care in Dentistry, 1998. 18(6): p. 234-42. Paulsson, G., et al., Recall of an oral health education programme by nursing personnel in special housing facilities for the elderly. Gerodontology, 2001. 18(1): p. 7-14. Paulsson, G., et al., The effect of an oral health education program after three years. Special Care in Dentistry, 2003. 23(2): p. 63-9. Simons, D., et al., An evaluation of an oral health training programme for carers of the elderly in residential homes. British Dental Journal, 2000. 188(4): p. 206-10. Wardh, I., et al., Assessments of oral health care in dependent older persons in nursing facilities. Acta Odontologica Scandinavica, 2002. 60(6): p. 330-336. Wardh, I., et al., Dental auscultation for nursing personnel as a model of oral health care education: development, baseline, and 6-month follow-up assessments. Acta Odontologica Scandinavica, 2002. 60(1): p. 13-9.