Dr Michael Sernik, November 2005 - In 1819, an American dentist, Dr. Levi Spear Parmly, emphasized the importance of preventive dentistry. For the next 96 years a growing number of American dentists provided preventive oral health care to their patients. However there was an increasing realisation that dentists were too busy dealing with high levels of tooth decay and gum disease to meet the preventive needs of their patients.
Finally in 1913 Dr. Alfred C. Fones opened the first school of dental hygiene at Connecticut, USA, almost 100 years after Dr. Parmly had introduced "prevention" to the dental community.
Dr. Fones - recognised that teaching appropriate oral health care was vital to the prevention of dental disease.
Dr. Fones' original concept included an exclusive role for women to work as preventive specialists to promote the importance of oral hygiene. The prevention specialists were called "dental hygienists" to draw attention to the importance of mouth cleanliness as a therapeutic regimen for the prevention and treatment of some oral diseases.
According to WHO figures in 2000 these are the Dentist/Hygienist figures for the year 2000.
| Spain 15698/15000 | 955 Hygienists for every 1000 dentists |
| Japan 85518/56466 | 660 Hygienists for every 1000 dentists |
| USA 150,00/81,000 | 540 Hygienists for every 1000 dentists |
| Sweden 9000/2700 | 300 Hygienists for every 1000 dentists |
| Finland 4980/1230 | 246 Hygienists for every 1000 dentists |
| Switzerland 4400/1000 | 227 Hygienists for every 1000 dentists |
| Netherlands 7030/1500 | 213 Hygienists for every 1000 dentists |
| Denmark 4900/1000 | 204 Hygienists for every 1000 dentists |
| South Africa 4387/893 | 203 Hygienists for every 1000 dentists |
| UK 27957/4000 | 143 Hygienists for every 1000 dentists |
| Poland 20,000/2500 | 125 Hygienists for every 1000 dentists |
| Israel 8967/915 | 102 Hygienists for every 1000 dentists |
| Norway 4000/400 | 100 Hygienists for every 1000 dentists |
| Pakistan 5108/350 | 68 Hygienists for every 1000 dentists |
| Philippines 15350/800 | 52 Hygienists for every 1000 dentists |
| Syria 14640/750 | 51 Hygienists for every 1000 dentists |
| Australia 8500/420 | 49 Hygienists for every 1000 dentists |
When I graduated in 1971, I had never heard of a dental hygienist. In fact, the concept of preventive dentistry was portrayed by the University as a fairly recent discovery. I remember visiting Dr Gillings' practice in Lindfield, Sydney with a number of other students. We were told to visit this practice because they practiced Preventive Dentistry. (Now I realise we were looking at a concept that was about 150 years old in the US.) Fortunately, we are now entering a new era of enlightenment in this regard and there are several new schools around Australia that will graduate more hygienists.
We are probably the only 1st world country where there are any articles in the dental press regarding the question of whether dentists are better off having hygienists or not. Some things are simply self-evident:
It takes about 50 minutes for an experienced hygienist to do routine treatment. I've never heard anyone say a dentist can do a superior job in less time. A typical (suburban) dentist has around 1200 patients. If 85% of patients come twice a year, that’s 1700 hours for oral hygiene alone. If a dentist works 4.5 8 hr days for 48 weeks a year, that leaves 28 hours per year to do non-hygiene procedures. Hmmm.
It’s obvious there is nothing rational about dentists not having a hygienist. The fact that 95% of Australian dentists don’t have them, may not be the result of dentists having chosen what is in the patient’s best interests. We have not had hygienists in our dental culture because legislative powers blocked their registration. As a result many patients in this country usually get a cursory 'scrape & polish' instead of the preventive care they deserve.
Recently a ‘dental accountant’ actually advised his dental clients not to employ hygienists, not to employ dentists and not to bother with management training. (He did however recommend his own services.)
I can understand his point of view. Many dentists who attempt to grow their practices will be challenged by management issues as their team grows. Most dental management companies are not run by dentists and dentistry is not just another business where profits are the main objective; so dentists should thoroughly investigate the reputation of all management advisors.
If our collective objective is to place the well-being of our patients above all other considerations, we should continue to embrace the use of hygienists and continue to put pressure on the dental regulators so that Australia can reverse the embarrassment of appearing to be so dentally unevolved in this regard.
Hopefully we may even look forward to overtaking Syria, Philippines and Pakistan someday.
[Published in Australasian Dental Practice November/December 2005]