My experience working as a public health dental hygienist

Katie Melko, MSDH, RDH, has worked as a public health dental hygienist for 10 years, and she wouldn't want to do anything else.

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Have you worked in a public health setting before? Volunteered for an event? Or simply remember going to senior centers or schools to give an oral health presentation in school?

All of these things are part of working as a public health hygienist and are so important to helping people who have limited resources in their life. I’ve been working in public health settings for the last ten years of my career and I honestly wouldn’t change a thing. Have there been times where I question everything and want to hide myself in a hole? Absolutely. Most of the time I find this work very rewarding and very challenging, and it helps keep my day-to-day routine from being dull and redundant. Public health also has an array of emotions; in the same day I can go from being very happy, to sad, to overwhelmed, and plain grateful. This all comes from the interactions with my patients and getting a little insight into their lives.

When I was in hygiene school, my class did a public health rotation at a special needs facility, and I fell in love with public health. I knew that I didn’t want to work in private practice after I got exposure to it. When I graduated, I temped for six months and one of my assignments was for a mobile dental program with a dentist and three other hygienists, and I loved it.

This is what sparked me to start my own nonprofit called Miles For Smiles. I started this nonprofit and ran it for five years before closing it, but in that five years, we would donate books and toothbrush goody bags, and host education presentations, charity events, and free dental days. The problem at that time was I didn’t know how to market the program and I didn't have much help outside of my family and friends, so I made the decision to close it and go back to school for my master’s degree. I learned so much during that degree that if I had waited and started it up then, I think it would have been more of a success.

During these years, I would volunteer at events and kept applying to public health jobs until I finally landed one. I still work at this job part time, but I also worked as a full-time mobile dental hygienist going to schools, day cares, homeless shelters, soup kitchens, and community events, providing dental care and oral hygiene instructions for five years. I then made the decision to going into teaching, and I teach dental hygiene students at a clinical rotation site that has a dental clinic in a long-term living facility. I also teach community rotation too. I have also worked in a community health center clinic full-time and got the opportunity to treat people in the community who are recovering from drug addiction or alcoholism, starting over after getting out of prison, people who have come here from other countries, and the homeless.

As I’ve said, most days are so rewarding, but some are very trying and test your limits. I personally will always be a public health hygienist and the variety has taught me so much about myself and in dentistry. I think that this experience has helped me as a teacher as well.

Understanding access-to-care issues

Socioeconomic status (SES) is something that has been controlling health care and public health efforts for a very long time. Someone who has a low SES usually doesn’t receive regular care, eat well, or get quality sleep. Parents who work multiple jobs and night shifts usually don’t get near the eight hours of needed sleep. Children raised by a single parent usually have more issues with health and sleep.

Most of this is due to limited resources and education. Education is my number one issue—if a person isn’t educated on a subject, then more than likely that person will avoid it or continue to do things the same way. People who have limited income tend to eat fast food that is cheap and convenient. People with food stamps will tend to spend money on junk food and frozen foods because it’s more affordable and the dollar stretches. If people aren’t educated on the health effects of these eating patterns, then why would they stop?

Most food bags I see at schools for children to take home are filled with not so healthy foods, limited fruit and vegetables, and many canned goods as well. If parents or people in the community knew about available resources and had a chance to be educated on how to shop smarter, take advantage of cooking classes, and how to manage finances better so that they eat better and feed their children better, I feel they would. If you could explain dental care and the importance of preventative measures instead of emergency care, and how to get affordable care, I feel more people would take advantage.

Some of this is due to the need to educate people who live below the poverty level on the resources available for them, empowering them to live a better life. Some of this is due to a language barrier—they don’t understand what we say, but are too embarrassed to tell us this. At one of my jobs, we have a language line so that we can better connect with our patients. This resource has been amazing for me to be able to educate and build a rapport with my patients. I have also gained more compliance with treatment because they understand what is going on, versus being confused and not returning for a long time, or not at all.

In the communities that I serve, we have so many readily available resources ranging from nutrition; exercise; and mental, medical, and dental care. We operate as a multidisciplinary center to help give the best integrated care to our patients. For example, a child who is here for a medical appointment can also have an RDH come in and do caries risk assessment and fluoride treatment. During these visits, we have a chance to educate patients and parents and give them a heads up on what we see. These small additions to the visit can help reduce ER visits for dental pain and get this child on regular preventive care. A patient who has diabetes can be in our dental clinic and have a nurse come and offer retinopathy or foot screening and education about services available to better help the patient manage his or her disease.

Transportation, financial issues, and limited resources, all present obstacles to accessing care. Even though we work hard to help bridge these gaps, it is still a huge issue to date. Volunteering and helping create programs to mend these gaps are so important for our future generations to come. Public health is widely affected by SES because it makes are target populations, those that can most use our help, hard to reach and access. Most patients are either uninsured or have state insurance; patients who do have insurance usually don’t utilize the services in dental because they simply don’t know where to go or don’t know what is covered and just think they can’t afford the care. There are dental offices that offer a sliding fee scale for uninsured patients and also will accept state insurance, there are resources available online for state insurance on what offices in the area take their insurance.

When it comes to public health and SES, the main issues are education and getting the available resources in places that are visited by uninsured and low-SES patients. Having services available in soup kitchens, senior centers, homeless shelters, schools, head start programs, group homes, and rehabilitation centers is important to provide more access to care. It still surprises me when patients say they didn’t know their insurance covered something, or that they have been brushing wrong their whole lives, or how they thought dry mouth was just something they had to live with. Taking that extra time to provide a little TLC is what makes me love working as a public health hygienist. It isn’t always the ideal situation, but we get the job done and provide great care to people who would otherwise go without the services.

I encourage you to reach out to your community and volunteer to do an in-service presentation to nurses and nursing assistants, and to the residents or patients there. It is such a great eye-opening experience and it is also really appreciated. And remember providing education is the cornerstone to any success story—without the proper knowledge, how can we all achieve our goals?

Also by Katie Melko, MSDH, RDH

Childhood weight: What the data about childhood obesity and childhood dental caries tell us

Tailoring appointments: Special needs patients

Katie Melko, MSDH, RDH, is a public health hygienist at Community Health Center Inc. She graduated from Fones School of Dental Hygiene at the University of Bridgeport in 2016 with a master of science in dental hygiene. She has practiced dental hygiene since 2009.

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