Concorde Blog - Jun 11, 2020
A dental hygienist provides a variety of oral treatments to patients including cleanings, inspections for signs of gum disease and cavities, and gives ongoing and preventive care (1). The work is always performed in a dental office and under the supervision of a dentist. Dental hygienists also work with the dentist when further care is needed that is outside the scope of the duties the dental hygienist is allowed to perform. Following is an in-depth look at the role the dental hygienist fulfills in the field of oral care.
Duties of a Dental Hygienist
Dental hygienists clean teeth and uncover structural issues in the teeth along with diseases of the gums, tongue, and mouth. When the dental hygienist finds an issue, they bring it to the attention of the attending dentist for further investigation and repair. Finding these issues involves performing visual exams, taking X-rays, and looking at the patient's history of treatment to track progression. A dental hygienist is limited to performing teeth cleaning and related services. They don't work with veneers or braces, nor do they perform surgery on the mouth. Here is a look at the general duties of the dental hygienist:
Examining and Preparing a Patient for Teeth Cleaning
The first thing a dental hygienist does is perform an exam of the patient's oral cavity. An exam, or screening, involves looking at the patient's teeth and making observations regarding the state of the teeth, looking for signs of gum disease, and looking for other issues such as cancer, trauma to the mouth, and cracked or broken teeth. The goal is to determine the overall oral health of the patient.
If the patient has been seen at the practice before, the dental hygienist takes notes, compares them against the notes from previous visits, and proceeds with the treatment accordingly. If the patient is new to the practice, a new file is started and the dental hygienist has the patient fill out intake forms along with an exam.
For existing patients, the dental hygienist looks for changes in existing conditions, checks fillings, compares observations from the visual exam to what's been seen in prior visits, and checks for signs of new issues needing preventative treatment. All observations have to be written down for future visits, along with notations for issues that a dentist needs to focus on when performing their examination after the cleaning and/or treatment has been completed by the dental hygienist.
After the exam has been completed, the dental hygienist takes X-rays depending on the status of the patient. If X-rays have already been taken of the patient's mouth in the calendar year, there's usually no need for further X-rays unless there's an ongoing condition that's being monitored. A patient who is new to the practice will get a full set of X-rays so the dental hygienist and dentist can make observations of problems that aren't visible to the eye.
Inspect the Mouth for Gum Disease
Next, the dental hygienist checks for signs of gum disease, also known as gingivitis. Signs of gum disease include:
- Red and swollen gums.
- Gums bleed easily when brushed or flossed.
- Receding gums.
- Separating or loose teeth.
- Pus between the teeth.
The dental hygienist uses tools to probe the gums and confirm or refute the existence of gum disease. Take Impressions of Existing Teeth
If the patient requires future repair or replacement work, the dental hygienist will create a negative impression of the teeth for the dentist and/or dental lab. A dental tray is filled with a material that creates accurate impressions of the teeth. The tray is placed into the patient's mouth. Once the impression material has cured, the tray is removed from the mouth and put aside for processing at a later time.
In the event the patient requires anesthetics for a procedure, the dental hygienist or qualified individual in the practice administers a numbing agent to the patient's mouth. Most states allow a dental hygienist to gain accreditation and give injections with anesthetics, but some states also require board certification to give shots of an anesthetic.
Treating a Patient's Teeth
Once the initial exam has been completed, the dental hygienist then begins the process of cleaning the teeth and gums. The first step is to remove the buildup of plaque and tartar from the teeth and below the gum line. A dental hygienist will use manual, ultrasonic, and mechanical tools known as a flex shaft or rotary motors. Manual tools are used to scrape and pick away at pockets of build-up on the teeth while mechanical tools are employed to remove deposits that resist removal by hand.
Plaque and tartar combine into a form of buildup known as calculus. The calculus layer can cause tooth staining, bad breath, gum inflammation, and gingivitis. It frequently goes below the gum line and the dental hygienist has to pull the gums away from the teeth in order to remove the build-up. A probe is used to pull the gum back and clean away the build-up of calculus.
Sometimes calculus builds up into a large deposit between and behind the teeth. This has to be removed prior to further cleaning and can cause the patient's teeth to feel loose. Removing the buildup requires a sensitive touch and applying the right amount of pressure at the right time. After removal, the dental hygienist has clear access to the teeth and can further assess their condition.
Hand and mechanical tools are employed at the discretion of the dental hygienist. As previously mentioned, hand tools are used first to remove the buildup of calculus and other materials in the mouth. They're also used as much as possible due to the fact they're less likely to damage teeth.
Rotary tools feature a hand piece and foot pedal for operation and work at high RPMs. There's more risk of tooth damage with the rotary tool, but they are an important part of teeth cleaning as hand tools aren't always strong enough to remove deposits. The dental hygienist uses their skills and training to inform them regarding which tool they should use at any given moment.
Dental hygienists can also opt to use ultrasonic cleaning tools which are gentler on the teeth and gums. People with sensitive teeth find they can tolerate the experience with ultrasonic cleaning tools, as other tools can be too harsh. The drawback to ultrasonic tools is that they have a tendency to create spray that's full of organic material removed from the mouth. This increases the risk of transmission of saliva-borne diseases from the patient and some dental hygienists may prefer to forego the use of the tool in favor of minimizing risks of transmission.
Scaling and Root Planing
Scaling and root planing is employed for treatment of gingivitis and is also done when the patient hasn't undergone a cleaning for some time. The dental hygienist pulls the gum back from the teeth and exposes the roots for scaling and planing. The act of scaling involves removing plaque and tartar deposits from the root surfaces. Planing smooths out the roots and makes it harder for calculus and bacteria to take hold. The gums reattach to the teeth and create a stronger bond, which makes it harder for gingivitis to return.
A patient may not have issues with gingivitis but hasn't had a deep cleaning or any kind of tooth-cleaning apart from brushing for a long time. Scaling and root planing have the same benefits because removing calculus helps to keep a mouth healthy and reduces the potential for gingivitis to become an issue over time.
Apply Sealants and Fluoride Treatments
Sealants are applied to the molars for the purpose of preventing tooth decay in children and adults. Children benefit from the use of sealants during the prime decay years between 6 to 14. The sealant can last up to 9 years before the treatment needs to be refreshed. Adults also benefit from the use of sealants as long as their molars are in good condition.
When a patient decides they'd like to have their teeth sealed, the dental hygienist applies the sealant at the end of the cleaning. This prevents unwanted materials from getting trapped against the tooth and instigating decay. The sealant is applied to the tooth and a UV light cures the material to make the seal permanent.
A dental hygienist can also perform fluoride treatments for patients. The dental treatment uses a much higher percentage of fluoride than what is available in commercial toothpaste and treatments. Fluoride treatments come in different forms and are applied directly to the teeth or in a tray that goes over the patient's teeth. The treatment gives teeth an intense dose of fluoride and helps strengthen teeth over time. It can be repeated every three, six, or 12 months.
Perform Teeth Whitening Treatments
The dental hygienist is qualified to administer teeth whitening processes to a patient's teeth. The treatment for whitening teeth uses products that have higher percentages of cleaning agents than what is available over the counter and can only be applied by a qualified or licensed professional. A dental hygienist applies the treatment to the teeth via a tray or painting the agent directly onto the teeth, then cleaning the agent off once the treatment has completed. It's worth noting that dental whitening treatments do not work on veneers.
Post-Cleaning Care and Counseling
Once the cleaning has been completed, the dental hygienist counsels the patient about what was seen in the mouth, actions taken to resolve the issue, and how the patient can care for their teeth to reduce or eliminate the return of the problem.
Some patients engage in habits that are bad for their teeth but may be unaware of their impact. The dental hygienist can take the opportunity to discuss the habits and why cessation of said habits is a good idea. During the counseling, the dental hygienist can point out the physical effects of the habit on the mouth and its structures along with any existing evidence they discovered during the cleaning.
The dental hygienist can give advice on tooth care products that can help alleviate an existing condition and prevent new ones from forming. They can promote a brand they feel strongly about, discuss the different types of cleaning tools on the market and their efficacy, and provide the patient with samples of products that are only available through the dental office. The goal of counseling is to give the patient information and tools that help them keep their teeth clean so that further cleanings don't have to be as in-depth.
Pros and Cons of Being a Dental Hygienist
The job of a dental hygienist is one of caring for people, helping them maintain a healthy mouth, and reducing the potential for tooth loss over time. Following is a look at the pros and cons of becoming a dental hygienist and why it's a good career for those who need flexibility in their working life along with a stable job outlook (2).
The dental hygienist field is growing as Baby Boomers and Millennials start to require more dental maintenance as they age. There will be no lack of patients needing preventative dental care and the demand for dental hygienists won't slow down for decades.
On average, it takes two to three years to attain an associate's degree for dental hygiene as opposed to four years for an undergraduate degree. It should be noted that the length of time needed to get an associate's in dental hygiene depends on the program specifics and personal attendance or time allowance.
Working hours tend to be flexible and a dental hygienist can opt to work part- or full-time. It's also possible to schedule the day so patients are seen at a preferred time of day due to the fact that the work doesn't deal with emergencies and relies on patients to come in every six months for cleaning and maintenance.
There tends to be very little variation in the work and it isn't overly challenging. Any serious work is handled by the dentist as the dental hygienist isn't qualified to manage issues like cavities and fractured teeth. Patients can also be difficult to work with as they can find it uncomfortable to have someone working in their mouth for various reasons. However, the cons are relatively minor and are easily worked around. Working as a dental hygienist can be very rewarding and has a lot to offer as a long-term career.
The dental hygienist program may not be for everyone because the work requires investigating people's mouths and working on teeth. However, it's a good option for those who want to work in a health care field, but want a job that's reliable and steady and free from the ups and downs that come in many medical settings. Contact Concorde Career Colleges today to learn about how you can get an education as a dental hygienist and get yourself ready for a rewarding career with our comprehensive learning programs.
1. "Occupational Outlook Handbook: Dental Hygienists, Summary," U.S. Bureau of Labor Statistics, https://www.bls.gov/ooh/healthcare/dental-hygienists.htm 2. "Start Your New Career: 11 Benefits of Being a Dental Hygienist," USA Today Classifieds, https://classifieds.usatoday.com/blog/careers/start-your-new-career-11-benefits-of-being-a-dental-hygienist/