Dental hygiene: reflecting on our past, preparing for our future.Introduction
As we reflect on the past, it is apparent that the Advanced Dental Hygiene dental hygiene
The practice of keeping the mouth, teeth, and gums clean and healthy to prevent disease. Also called oral hygiene. Practitioner (ADHP ADHP Advanced Dental Hygiene Practitioner
ADHP Alabama Department of Public Health
ADHP Association for the Development of Human Potential ) and the American Dental Hygienists' Association's (ADHA ADHA American Dental Hygienists' Association
ADHA Additional Duty Hour Allowance
ADHA Australian Department of Health and Aging ) new branding campaign have the potential to elevate the profession and ultimately improve access to care as Alfred C. Fones, DDS (1) (Digital Data Storage) See DAT.
(2) (Data Dictionary System) See QuickBuild and OpenDDS.
(3) (Dataphone Digital S , imagined a century ago (Figure 1). To understand our achievements, let us review where we have been.
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In the mid 1800s, dental pioneers recognized the benefit of a clean oral cavity oral cavity
The part of the mouth behind the teeth and gums that is bounded above by the hard and soft palates and below by the tongue and the mucous membrane connecting it with the inner part of the mandible. . Prevention was a frequent topic of discussion. By 1900, the value of periodic removal of plaque from teeth was documented by Dr. David Smith, who told dentists that recall appointments had improved his patients' health--not just their oral health, but also their overall health. Dr. L. S. Parmly had been recommending the regular use of waxed silk floss (Free, Libre and Open Source Software) See free software and open source. , and M. L. Rhein, MD, DDS, was vocal in promoting dental home care education for his patients. (1)
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At this time, dental print advertising appeared for toothpaste and animal hair toothbrushes (Figures 2 and 3). Although silk dental floss dental floss
A waxed or unwaxed thread used to remove food particles and plaque from the teeth. was available, it was not readily used by the masses. Most patients had not embraced the concept of preventive oral health and visited the dentist only when they were in pain. (2)
In 1902, Dr. Cyrus Wright published an article reflecting his predecessors' ideas while defining his concept of a new specialist to help patients maintain optimum health (Figure 4). (3)
"With this training and the dental college certificate, these ladies may be employed by dentists for this special work, or may practice at parlors of their own, or at the homes of patients, the dentists using their influence and recommending the new specialists, just as physicians and surgeons Physicians and surgeons are medical practitioners who treat illness and injury by prescribing medication, performing diagnostic tests and evaluations, performing surgery, and providing other medical services and advice. recommend and insist upon the services of the trained nurse...." (3)
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Fones later credited Wright as the visionary who saw the future of dental hygiene. (1) Rhein initially proposed calling this new professional a dental nurse, who would be the graduate of a special new training school, an offshoot of nursing programs. Rhein recommended state board examinations to insure competence and wrote:
"The cleansing of the mouths of properly selected patients in the dispensaries, combined with the proper education for preserving oral hygienic conditions would be of greater value in the uplifting of the masses than any other means at present employed." (4)
Fones taught his dental assistant dental assistant
A person trained to assist a dentist with clinical and administrative procedures. , Irene Newman, to treat his patients in 1906. It is believed that other dentists also used this system of apprenticeship. (5) Fones didn't like the term "dental nurse" since it indicated disease rather than prevention and health. "These women are not to perform any service that resembles the work of the medical nurse," he wrote. (6) It was Fones who originated the name dental hygienist dental hygienist
A person trained and licensed to provide preventive dental services, such as cleaning the teeth, usually in conjunction with a dentist. .
Around the same time (1910) in Ohio, Dr. William G. Ebersole conducted the "Marion School Experiment." The goals of prevention of dental disease for children, overall health and affiliation with the schools were paramount in the creation of the profession.
"Public welfare was not the only goal of the dental hygiene campaign. The program also gave dentists the opportunity to prove "scientifically" that their efforts were vitally important to the overall well being of the children's health Children's Health Definition
Children's health encompasses the physical, mental, emotional, and social well-being of children from infancy through adolescence. ." (7)
Ebersol opened a school to educate dental hygienist-like auxiliaries. It was one year before organized dentistry in Ohio closed the program. This was in fact the first program for dental hygiene-like auxiliaries.
After documenting the success of using a dental hygienist to improve the health of his private patients in Connecticut, Fones wanted the children in Bridgeport to be able to "secure similar prophylactic service ... in contradiction to relief and repair dental clinics." (1) To establish a program for women to work in school clinics, Fortes invited his colleagues to lecture the new students, and all enthusiastically volunteered their services. Rhein was one of the lecturers; another was Cordelia O'Neil, a teacher who had been involved with the now defunct Marion School Project Ohio. The original school was located in his carriage house. Students were recruited in the local newspaper in 1913. For $20, they could attend a lecture series and six weeks of practical training. This program lasted three years, and, as expected, all graduates worked initially in the Bridgeport Connecticut public school system (Figures 5 and 6). (1)
Fones' original plan had been to improve students' general health by improving their dental health through preventive services. The Bridgeport Board of Education initially approved this project for five years. The grant money, the volunteer services of the dental faculty, and the donations from SS White Company all occurred with the belief that the program was not meant to be permanent. The original program was a success. (8)
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Fones felt that dental hygiene programs should be continued as a standardized course, two years in length. (6) When the original program closed, he went "on the road" to continue to advocate the creation of legislation for the new profession and to propose the new curriculum at a variety of sites throughout the country. As a result of the efforts of Fortes and his colleagues, legislation in New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of , Connecticut and Massachusetts allowed the first collegiate schools of dental hygiene to open. Many of the original graduates of the Fortes School were teachers and directors of these and other new programs. The first three schools to open, around 1916, were The New York School New York school
Painters who participated in the development of contemporary art, particularly Abstract Expressionism, in or around New York City in the 1940s and '50s. of Dental Hygiene (affiliated with Columbia University); The Rochester Dental Dispensary dispensary: see clinic. in Rochester, N.Y.; and the Forsyth Dental Infirmary for Children in Boston, Mass. (1)
Data on the success of Fones graduates in the elementary schools of Bridgeport was documented over five years. This laid the groundwork for the future of school dental health programs. Data is available in a 1939 Journal of the American Dental Hygienists' Association article by Mabel McCarthy, RDH RDH
Registered Dental Hygienist
n an abbreviation for registered dental hygienist. , an original Fortes graduate. (2)
The 1920s and 1930s
In a 1926 article, Fones acknowledged the following schools in addition to the original three (Figures 9 and 10): (1)
University of California-San Francisco, California Marquette University-Milwaukee, Wisconsin University of Michigan-Ann Arbor, Michigan University of Minnesota-Minneapolis, Minnesota Northwestern University-Chicago, Illinois University of Pennsylvania-Philadelphia, Pennsylvania Temple University-Philadelphia, Pennsylvania
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With new schools opening throughout the country and legislative changes needed, hygienists organized the American Dental Hygienists' Association (ADHA). The following quote from 1927 is a membership appeal to practicing dental hygienists, expressing feelings similar to those of today.
"What you get out of it [membership] will depend ... on what you put in. If you stay on the outside edge, lost in the dimness of inconspicuousness in·con·spic·u·ous
Not readily noticeable.
incon·spic , your returns on the investment will be slim, but if you come forward where you may be seen, then will you be amply repaid in more efficiency, alertness, and contentment." (10)
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At the same time hygienists were organizing, the public was beginning to practice home care more regularly than before. This was in part due to the use of nylon in the late 1930s, which made toothbrushes and floss more affordable (Figure 11). Charles Bass, MD, medical dean at Tulane University, was a prevention advocate who taught innovative tooth-brushing and flossing flossing,
n the mechanical cleansing of interproximal tooth surfaces with stringlike, waxed or unwaxed dental floss or tape.
n. techniques to his patients. He published numerous articles and lectured on what became the "Bass technique." (11))
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By 1938, there were only 19 dental hygiene schools opened throughout the United States. During this period, many of the existing schools offered certificates after one year of education and others gave associate degrees. Baccalaureate degrees were available in Hawaii in 1938 and at University of Michigan (body, education) University of Michigan - A large cosmopolitan university in the Midwest USA. Over 50000 students are enrolled at the University of Michigan's three campuses. The students come from 50 states and over 100 foreign countries. in 1939. (12)
The 1940s - 1950s
Meetings were set by the American Dental Association American Dental Association (ADA),
n.pr a nonprofit professional association whose membership is dental professionals in the United States. Its purpose is to assist its members in providing the highest professional and ethical care to the citizens of the (ADA Ada, city, United States
Ada (ā`ə), city (1990 pop. 15,820), seat of Pontotoc co., S central Okla.; inc. 1904. It is a large cattle market and the center of a rich oil and ranch area. ) Council on Dental Education to establish curriculum and standards for all dental hygiene programs. There were schools that wanted a four-year minimum requirement. The committee, which was chaired by Frances Stoll, RDH, EdD, decided that, after 1947, all accredited accredited
recognition by an appropriate authority that the performance of a particular institution has satisfied a prestated set of criteria.
cattle herds which have achieved a low level of reactors to, e.g. dental hygiene programs would be a minimum of two years in length. (6) Interestingly, Dr. Wilkins was a member of the committee. (6,8)
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The Fones School of Dental Hygiene re-opened in 1947 (Figures 12 and 13). One of the original faculty members, and co-author of the first Fones textbook, Robert Strang, MD, DDS, became the new director at the Junior College of Connecticut (University of Bridgeport University of Bridgeport is a private, non-sectarian university in Bridgeport, Connecticut, USA. Its campus is located in South Bridgeport on Long Island Sound. The University offers undergraduate, graduate, and health sciences programs. ). The first master's program in dental hygiene was offered at Columbia University in 1953 to prepare future teachers and administrators. Sigma Phi Alpha, the national dental hygiene honor society, was founded in 1959.
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During the mid 1940s, a pilot study of fluoridation fluoridation (flr'ĭdā`shən), process of adding a fluoride to the water supply of a community to preserve the teeth of the inhabitants. in paired cities evaluated the effect of adding sodium fluoride sodium fluoride
A colorless crystalline salt used in fluoridation of water, in treatment of tooth decay, and as an insecticide and a disinfectant. to the public water supply and found it to be beneficial. By the mid 1950s, fluoride treatments were routine in dental offices.
Also of note, in 1951, Texas became the last state to established licensure for dental hygiene (Figure 14).
The 1960s - 1970s
Issues of diversity and the woman's liberation movement were important in the '60s. The National Dental Hygienists' Association National Dental Hygienists' Association (NDHA),
n.pr an association established by African-American dental hygienists in order to focus on the professional needs of African-American dental hygienists; it is affiliated with the National Dental Association (NDHA NDHA National Digital Heritage Archive (New Zealand)
NDHA National Dental Hygienists' Association
NDHA Nevada Dental Hygienists' Association
NDHA Nebraska Dental Hygienists' Association ) re-organized as a result of difficult issues with segregation within some local dental societies. This was the time of the civil rights movement, and NDHA addressed the needs of the minority community. NDHA remains active today and works cooperatively with ADHA. (15) There were a few practicing male hygienists who had been trained in the military, but it was not until 1965 that ADHA by-laws were changed to allow equality for male dental hygienists. (15) The first male dental hygienist graduated from the University of New Mexico The University of New Mexico (UNM) is a public university in Albuquerque, New Mexico. It was founded in 1889. It also offers multiple bachelor's, master's, doctoral, and professional degree programs in all areas of the arts, sciences, and engineering. in that year. (6) A few other firsts during the 1960s:
* the new Dental Hygiene National Board Exam (1962--see box on this page)
* the first electric toothbrush in America (1962)
* the first insurance policies issued for professional liability (1963)
* continuing education continuing education: see adult education.
or adult education
Any form of learning provided for adults. In the U.S. the University of Wisconsin was the first academic institution to offer such programs (1904). recommended by ADHA for the first time (1967).
* Sealants became accepted preventive treatment preventive treatment
See prophylactic treatment. for children.
Another major issue of the 1960s was the promotion of Expanded Function Dental Auxiliaries (EFDA--see box on page 17).
In the 1970s, new auxiliaries were created in all aspects of medicine. The movement for holistic health holistic health,
n a concept in which concern for health requires a perspective of the individual as an integrated system rather than as a collection of parts and functions. care and prevention, along with increased government funding resulted in tremendous growth of allied health programs within community colleges throughout the United States. The number of dental hygiene schools dramatically increased (Figure 18). In 1974, the first dental hygienist was appointed to a state dental board in Maryland. (25) A dental hygienist independently owned and managed a practice in the mid-seventies. This experimentation with ownership led the ADHA House of Delegates House of Delegates
The lower house of the state legislature in Maryland, Virginia, and West Virginia. to issue an official statement in 1980 indicating that dental hygienists may own their own dental hygiene practice. (5)
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The buzzword A term that refers to the latest technology or a term that sounds catchy. If not a flash in the pan, new technologies become mainstream. For example, Java was a hot buzzword in the 1990s, but should remain a major topic for decades. among health care practitioners in the 1970s was "behavior modification behavior modification
1. The use of basic learning techniques, such as conditioning, biofeedback, reinforcement, or aversion therapy, to teach simple skills or alter undesirable behavior.
2. See behavior therapy. ." Dr. Robert Barkley lectured on patient motivation for prevention. (26) Plaque control strategies changed when Dr. Paul H. Keyes adapted a number of old techniques to decrease the amount of bacteria in periodontal periodontal /peri·odon·tal/ (per?e-o-don´t'l)
1. pertaining to the periodontal ligament or periodontium.
2. near or around a tooth.
1. pockets. Dental practices throughout the country purchased microscopes and utilized his technique for "anti-infective non-surgical periodontal treatment." (27) Ultrasonic scaler use spread rapidly, and dental sealants became more popular.
The 1980s Until Today
With sit-down dentistry, pants became necessary for modesty (Figure 19). Caps were phased out. Capping ceremonies were replaced by pinninq ceremonies. Uniforms became available in colors.
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A new magazine, RDH, began and was followed by the introduction of ADHA's Access in 1987. By that time, HIV/AIDS HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome was being covered regularly in the dental literature, having been identified in 1981. OSHA OSHA
Occupational Safety and Health Administration, a branch of the US Department of Labor responsible for establishing and enforcing safety and health standards in the workplace. recommendations arrived in 1985, followed by mandated changes in 1988. Sterilization and personal protection radically changed.
The first home tooth-bleaching system became available in 1989 and the esthetic es·thet·ic
Variant of aesthetic. dentistry movement (28) increased the demand for veneers and implants.
Demographic changes within the United States population led to the creation of the Hispanic Dental Association in 1990, which included dental hygienists. To meet the need for access to care, additional responsibilities for dental hygienists were legalized in many parts of the country.
Use of computers in dentistry increased, and along with it new software became available. The popular Web site AmyRDH began in 1999. Within the dental office, comfort with new technology led to greater acceptance of digital radiography digital radiography Imaging A format for producing x-rays in which film used to produce conventional x-ray images is replaced with more sensitive sensitive electronics; DXRs produce images with1⁄2 . Plaque was renamed biofilm Biofilm
An adhesive substance, the glycocalyx, and the bacterial community which it envelops at the interface of a liquid and a surface. When a liquid is in contact with an inert surface, any bacteria within the liquid are attracted to the surface and adhere , and varnish became an accepted treatment for tooth sensitivity and preventive dentistry preventive dentistry
The branch of dentistry that deals with the preservation of healthy teeth and gums and the prevention of dental caries and oral disease. .
It is interesting to see how some of the unresolved issues from 1975 are being resolved today: (29)
* The difficulty in achieving fluoridation.
Many cities in the United States are still resistant to fluoridation. In some cases, this is due to anti-fluoridationists with misinformation mis·in·form
tr.v. mis·in·formed, mis·in·form·ing, mis·in·forms
To provide with incorrect information.
mis . Elsewhere, the challenge is that treatment of water supplies occurs at the municipal or county level, so changes in the law and development of funding for fluoridation needs to occur in many local areas rather than one state level. Nevertheless, according to the Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. , nearly 70% of the population does have access to a fluoridated water supply. (30) Dental sealants, fluoride therapies, varnish programs and other new preventive treatments are frequently utilized for the prevention of dental caries caries
or tooth decay
Localized disease that causes decay and cavities in teeth. It begins at the tooth's surface and may penetrate the dentin and the pulp cavity. and strengthening enamel.
* Portability of licensure between states. "Dentistry and dental hygiene are among the few remaining professions without one uniform national clinical licensure exam." (22) Almost every state currently provides a system for dental hygienists to obtain a license upon relocation, either by endorsement or credentials. Typically, additional requirements exist that may include a clinical examination. There is movement to put in place a nationally accepted clinical exam, such as the recently developed American Dental Hygiene Licensing Examination (ADHEX). Although state boards state boards Examinations administered by a US state board of medical examiners to license a physician in a particular state; these examinations play an ever-decreasing role in state medical licensure, as these bodies now rely on standardized national examinations will continue to have the ultimate authority on licensure in their states for the foreseeable future, uniformity of the clinical exam should facilitate whatever portability process a state has in place. ADHA has recently announced a page of its Web site devoted exclusively to assisting dental hygienists in acquiring a license in another state.
* "The need to convince the dental profession of the value of the dental hygiene profession, their expanded capabilities, and the loss to the dentists when these auxiliaries are not fully utilized ..." (29)
ADA's Web site acknowledges that dental hygienists are considered valued members of the dental team. (32) In fact, the value of the screening and prevention services provided by dental hygienists has become more evident in recent years, as research reveals the connection between preventable oral diseases and systemic disease.
A current goal for ADHA is to work in partnership with dentists to advance the oral health of our patients. (22) ADHA is working more collaboratively with the dental community today than in past years. "By augmenting productivity of the dental team, we will extend the accessibility of oral health care. That includes the importance of dental hygienists to recognize and treat periodontal disease Periodontal Disease Definition
Periodontal diseases are a group of diseases that affect the tissues that support and anchor the teeth. Left untreated, periodontal disease results in the destruction of the gums, alveolar bone (the part of the jaws where ." (33)
ADHA representatives in Washington now work collaboratively with other health professional groups on coalition-building to reduce unmet dental needs throughout the country. This involves working with legislators who can support increased funding for all issues relating to preventive dentistry. "As prevention specialists, dental hygienists understand that recognizing the connection between oral health and total health can prevent disease, treat problems while they are still manageable, conserve critical health care dollars and save lives." (22)
The ADHA branding initiative will improve public understanding and acceptance of dental hygienists. (22) Ann Battrell, RDH, BS, MS, executive director of ADHA, states, "Steps have been taken to ensure that ADHA is relevant to today's dental hygienist and creates an environment where every dental hygienist feels welcomed." (34)
This brings us to the development of the ADHP. According to ADHA Immediate Past President Margaret Lappan Green, RDH, MS, "The ADHP would deliver diagnostic, preventive, therapeutic and minimally invasive restorative services directly to underserved Americans." (22)
Dr. Fones and his colleagues envisioned dental hygienists as auxiliaries who would improve the overall health of children; today, dental hygienists are true prevention specialists. They equally educate and treat a multitude of patients, providing professional advice and care for optimal oral health, which we know impacts total health.
Current technology offers treatment of adults and children in ways the dental pioneers could not have imagined at the turn of the century. New diagnostic tools are available for detection of oral cancer, dental caries and periodontal disease. Over the last few decades, increased numbers of dental hygienists have received advanced degrees and many practice in non-traditional settings, such as industry, corporations, research facilities and on forensic teams.
Legislative changes allow local anesthesia Anesthesia, Local Definition
Local or regional anesthesia involves the injection or application of an anesthetic drug to a specific area of the body, as opposed to the entire body and brain as occurs during general anesthesia. and general supervision in most parts of the country. Dental hygienists serve on many state boards of dentistry and participate in regulation of their practice. In many states, dental hygienists have direct reimbursement from Medicaid. The use of evidence-based practice will help us to properly use each new technology and opportunity as it unfolds (35) and the ADHP and the new branding campaign will improve access to care and respect for our profession.
Moving forward, it becomes evident that we should reflect on past unresolved issues as they continue to be resolved and take pleasure in the heightened respect for dental hygiene which will result in better health care for everyone. Dr. Fones would be pleased to see the path his vision has taken.
* The Early Textbooks in Dental Hygiene
The first textbook for dental hygiene was "Mouth Hygiene" published in 1916, compiled by Dr. Alfred C. Fones with 19 contributors (Figure 7). Four editions of the text were published between 1916 and 1934. Following the death of Fones in 1935, Dr. Russell Bunting, former dean at University of Michigan, became editor, and the title changed to "Oral Hygiene Oral Hygiene Definition
Oral hygiene is the practice of keeping the mouth clean and healthy by brushing and flossing to prevent tooth decay and gum disease. ." The format of the text remained the same.
[FIGURE 7 OMITTED]
A new version of the textbook was re-issued in the 1960s, with Pauline Steele, RDH, MS as editor. Renamed "Dimensions of Dental Hygiene,' (8) the text continued through four editions until the 1980s.
In 1959, when Esther Wilkins, RDH, DMD (1) (Digital Micromirror Device) See DLP.
(2) (Digital Multi-layer Disk) See high-def DVD formats. , was director of the dental hygiene program at the University of Washington, Lea & Febiger Publishing
Company invited her to reformat (1) To change the record layout of a file or database.
(2) To initialize a disk over again. the student clinical instruction manual from her program as an updated dental hygiene textbook. It became "Clinical Practice of the Dental Hygienist." The objectives as stated in the preface of the first edition would continue to appear through the 10th edition currently in production (Figure 8):
[FIGURE 8 OMITTED]
"It is expected that the book will be useful as a textbook for preclinical and clinical theory and practice courses for students, as a reference and guide for practicing dental hygienists, and as a source of review material for temporarily retired dental hygienists with plans for returning to practice." (9)
The first edition contained many concepts that are still correct today. Other chapters describing the ergonomics of standing correctly, since practicing in a seated position was rare at the time, and how to disinfect To remove the virus code that has attached itself to a legitimate file. Sometimes, the antivirus program cannot untangle the code, and the infected file has to be deleted. See quarantine. instruments with boiling water seem funny to us now.
* About Product Advertising
At the end of the 1940s, television was becoming common in American households, so families saw the first black and white commercials for toothpaste. This was a big departure from advertising that regularly appeared in family magazines since the turn of the century.
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Colgate advertising promised "dating success" with fresh breath and the protection of teeth with a "Gardol shield" (Figure 15). Pepsodent was known for its jingle, "You'll wonder where the yellow went when you brush your teeth with Pepsodent." Advertising for Ipana toothpaste was directed at children, with Bucky Beaver and the slogan, "Brusha, Brusha, Brusha ..." (Figure 16).
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In 1956, Crest began the advertising campaign, "Look Mom, No Cavities," featuring Norman Rockwell illustrations (Figure 17). It was the first toothpaste with stannous fluoride stannous fluoride
A preparation of stannous tin and fluoride used to fluoridate toothpaste and other dental preparations. added, taking toothpaste from being cosmetic to being therapeutic. (13)
Pepsodent lost its place as a top-selling brand since it did not offer a fluoridecontaining product. The leading brands in 1958 were Colgate, Gleem, Pepsodent, Crest and Stripe. (13) Crest got an endorsement from ADA in 1960 for fluoride effectiveness, and Colgate received the endorsement in 1969. That changed their promotion from the use of "Gardol" to sodium monofluorophosphate sodium monofluorophosphate (mon´ōfl (MFP (MultiFunction Printer, MultiFunction Peripheral) See all-in-one and MFD. ). (14)
* About the Dental Hygiene National Boards
The first Dental Hygiene National Board Examination (DHNBE) was offered in 1962 as a four-part subject examination. In 1973, it was changed to "a function oriented" exam. In 1998, a case-based section was added.
Shailer Peterson, PhD, authored the first review book for Mosby following the creation of the new DHNBE in 1962. "Comprehensive Review for Dental Hygienists" was published in four editions until 1980.
Michele Darby, BSDH BSDH British Society for Disability and Oral Health (formerly: British Society of Dentistry for the Handicapped)
BSDH Bachelor of Science in Dental Hygiene , MS, and Dr. Eleanor Bushee were contributors to the Peterson review book and were invited to continue the series after Peterson's death. The first edition, re-named "Mosby's Comprehensive Review of Dental Hygiene" was published in 1986, and there have been six editions to date with Darby as primary editor.
There have been other review book authors and publishers; however, the Mosby series is the longest consecutively running board review text.
* The United States' Experience with the New Zealand New Zealand (zē`lənd), island country (2005 est. pop. 4,035,000), 104,454 sq mi (270,534 sq km), in the S Pacific Ocean, over 1,000 mi (1,600 km) SE of Australia. The capital is Wellington; the largest city and leading port is Auckland. Dental Nurse Model and Expanded Functions
In the 1920s, dental nurses were successfully utilized in New Zealand to treat children's dental neglect. New Zealand dental nurses focused on restorative work rather than the preventive curriculum advocated by Fones for dental hygienists in America.
As early as 1944, Dr. John O. McCall advocated that the New Zealand type dental nurse be utilized to improve access to care for children. Since not all states had passed dental hygiene licensure acts, ADHA did not agree to the concept. (6,16)
The issue of delegation of expanded functions was explored at the Forsyth Dental Center starting in the 1950s with a program that was scheduled to last five years, but was discontinued after one year by organized dentistry. (17)
The United States Public Health Service United States Public Health Service (USPHS),
n.pr a major division of the Department of Health and Human Services. The USPHS provides oversight of the following agencies: the Centers for Disease Control and Prevention (CDC); Food and Drug Administration funded a large study of Expanded Function Dental Auxiliaries (EFDAs) in the 1960s with programs at the University of Alabama The University of Alabama (also known as Alabama, UA or colloquially as 'Bama) is a public coeducational university located in Tuscaloosa, Alabama, USA. Founded in 1831, UA is the flagship campus of the University of Alabama System. , Indian Health Service The Indian Health Service (IHS) is an Operating Division (OPDIV) within the U.S. Department of Health and Human Services responsible for providing federal health services to American Indians and Alaska Natives. , University of the Pacific, University of North Carolina North Carolina, state in the SE United States. It is bordered by the Atlantic Ocean (E), South Carolina and Georgia (S), Tennessee (W), and Virginia (N). Facts and Figures
Area, 52,586 sq mi (136,198 sq km). Pop. and Louisville Kentucky, which was also home to the study of Dental Auxiliary Utilization (DAU DAU - /dow/ [German Fidonet] D"ummster Anzunehmender User. A German acronym for stupidest imaginable user. From the engineering-slang GAU for Gr"osster Anzunehmender Unfall (worst foreseeable accident), especially of a LNG tank farm plant or something with similarly disastrous ). DAU was the use of fourhanded four·hand·ed
1. Games Involving or requiring four players: fourhanded bridge.
2. Designed for four hands, as a piano duet.
Adj. 1. sit-down dentistry with patients in a supine position to increase dental productivity. (18)
Training in Expanded Auxiliary Management (TEAM) was studied in dental schools throughout the country. The program included auxiliaries who administered local anesthesia, cut hard and soft tissues and placed restorative material. These studies, as others previously, showed positive results; however, the programs were discontinued. (19)
In 1972, graduate dental hygienists at Forsyth received advanced training in the areas of local anesthesia and preparation/restoration of dental caries, in a project known as The Forsyth Experiment. The project was not continued, even though it, too, showed positive results as an alternative system for dental care. (17)
In 2004, the first Alaska Dental Health Aide Therapists graduated from a program in New Zealand to address the oral health needs of Alaska natives in rural settings under the supervision of licensed dentists. The state approved the program in 2005; however, ADA started proceedings to have the program terminated. Fortunately, in July 2007, ADA agreed to settle the dispute and work cooperatively with the Alaska program toward improving the oral health of Alaska Natives. (20,21)
Currently, ADHA is developing the ADHP to improve access to care for underserved American populations (see box on this page). (22)
* About the ADHP
TO improve the underserved public's health, the advanced dental hygiene practitioner provides access to early interventions, quality preventive oral healthcare and referrals to dentists and other healthcare providers. (23)
The ADHP (Advanced Dental Hygiene Practitioner) will be a licensed dental hygienist educated at the Master's Degree level who will provide primary oral healthcare services (preventive, therapeutic, and restorative). This will be a midlevel provider mid·lev·el provider
A medical provider who is not a physician but is licensed to diagnose and treat patients under the supervision of a physician. similar to the nurse practitioner nurse practitioner
n. Abbr. NP
A registered nurse with special training for providing primary health care, including many tasks customarily performed by a physician. who will improve access to oral health care similar to the way the nurse practitioner has provided an additional entry point to medical care. Oral healthcare services will be made available to underserved and un-served populations, including patients with special needs, as part of a multi-disciplinary healthcare team. The ADHP will serve as a new practice option for today's dental hygienists. (24)
(1.) Fones AC. The origin and history of the dental hygienist movement. J Am Dent Assoc 1926; 1809-21.
(2.) McCarthy MG. Dr, Alfred C, Fones--the father of dental hygiene. J Am Dent Hyg Assoc 1939; 16: 16-31,
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Rhoda Gladstone, RDH, MS is currently a clinical professor at New York University New York University, mainly in New York City; coeducational; chartered 1831, opened 1832 as the Univ. of the City of New York, renamed 1896. It comprises 13 schools and colleges, maintaining 4 main centers (including the Medical Center) in the city, as well as the Dental School and taught at Union County College Union County College is an accredited, co-educational, two-year, public, community college located in Union County, New Jersey. As the oldest community college in New Jersey, Union County College has been serving both career-minded and transfer-oriented students since 1933. in New Jersey. She is a graduate of the Fortes School of Dental Hygiene, Boston University and Columbia University. As an active member of the New Jersey Dental Hygienists' Association she has been an ADHA delegate and SADHA advisor. In addition, she co-edited the original on-line instructor's guide for Dr. Esther Wilkins' text, "Clinical Practice of the Dental Hygienist," and has been presenting a PowerPoint program on the history of dental hygiene to many dental groups.
Acknowledgments by Gladstone: My experience at the Fones School of Dental Hygiene in the 1960s with two of the original pioneers, Mabel McCarthy and Dr. Robert Strang, influenced my interest in researching the history of dental hygiene. I wish to thank my colleagues Marilyn Cortell and Winnie Fumad who suggested that I move this article forward and Dr. Esther Wilkins, the ultimate mentor, for her advice and fact checking.
Wendy M. Garcia, RDH, MSEd, is assistant professor at the Fones School of Dental Hygiene, University of Bridgeport, Bridgeport, Conn., and coordinator of public health. She teaches head and neck anatomy Head and neck anatomy focuses on the structures of the head and neck of the human body, including the brain, bones, muscles, blood vessels, nerves, glands, nose, mouth, teeth, tongue, and throat. , pharmacology, public health, internship for the BS degree, and dental hygiene leadership in the MS in dental hygiene program that starts fall 2007. She earned her AS and MSEd at the University of Bridgeport, her BS in dental hygiene from the University of New Haven The University of New Haven is a private, comprehensive, coeducational university located in suburban West Haven, Connecticut that was originally founded in 1920 as the New Haven Junior College (a division of Boston's Northeastern University). , Conn., and is currently working toward her EdD at the University of Bridgeport. She is a past president of the Connecticut Dental Hygienists' Association.