TORONTO, Canada--Dental hygienists could be running their own cleaning clinics by next year and helping the underserviced in long-term care homes, small towns and aboriginal reserves if a bill before the Ontario legislature becomes law.
More than 8,000 dental hygienists in Ontario want the authority to self-initiate--the power to clean teeth without a dentist present--although they would be restricted from doing any other dental work.
Health Minister George Smitherman has decided hygienists should be able to work independently and made it a part of his omnibus Health System Improvements Bill, which was introduced last week.
"Dental hygienists have the capability (to) help patients on their own,'' Smitherman said.
"What we have an obligation to do as often as we can is use everybody's full potential. In health care we call that scope of practice and what we've done with dental hygienists is expanded their scope of practice, and that will be very, very good for them and very good for patients as well.''
Empowering hygienists would lead to cheaper cleanings for those without dental insurance and increased access for those who struggle to get care, said Cathy Mazal-Kuula, council president of the College of Dental Hygienists of Ontario.
"We need better access in outlining areas that are not serviced and we have 900 dental hygienists who are very portable,'' Mazal-Kuula said.
"And we want better access for the people who cannot afford to pay a dentist (so they can visit) hygienists when they really want their teeth cleaned.''
Hygienists, who could either establish their own clinics or regularly travel through areas that don't have a resident dentist, can clean a patient's teeth for about half the price of a typical dentist visit, she added.
"We don't have the overhead that (dentists) do and we're not expecting to make the large salaries they do,'' Mazal-Kuula said.
A hygienist might make as much as $80,000 after taxes, while there "probably isn't a dentist in this province making less than $300,000 and that would probably be at the lower scale,'' she added.
Donna Rubin, chief executive of the Ontario Association of Non-Profit Homes and Services for Seniors, said she still needs to be assured that hygienists will be fully trained to do the job on their own but would love to see them working in long-term care facilities.
"We don't often get dentists and doctors to visit, it's not easy to get professionals in a long-term care home,'' she said.
"So that's why it's of prime importance for us. Dental hygiene of the elderly is a concern and to facilitate their cleaning and their oral health is important to us.''
Studies have linked gum disease to heart disease and stroke, pneumonia and other respiratory diseases, and Rubin said there have been many cases of seniors who had dental problems go untreated because they were too weak to leave their long-term care home for help.
"A lot of our population is at the very frail end of the spectrum, they're 85-plus, they have multiple chronic conditions and the average resident is on at least seven medications a day.''
Even in less serious cases, untreated dental problems could lead to problems eating, undue pain or infection, she added.
The Ontario Dental Association, which consulted with the hygienists as the bill was being drafted, supports self-initiated hygienists, as long as there are very clear regulations and they get additional education before they're allowed to work on their own.
"This is one of the more invasive acts in dentistry, where the dentist or hygienist is going below the surface of the gum, is causing bleeding, and is in a bacteria-laden environment,'' said association president Dr. Ian McConnachie.
"There are risks associated with it, it's a whole lot more than just cleaning teeth. Therefore, there is a need for very good controlled safeguards.''
Even with the dentists' support, Mazal-Kuula is worried that hygienists might not get their wish.
They've been advocating for more than 10 years _ through three provincial governments and five different ministers of health _ and similar legislation has made it through the legislature only to die on the vine.
"We certainly are concerned,'' Mazal-Kuula said. "We don't want to see that happen again. It would be a very big loss for the province of Ontario.''
