ed itor’s note
DENTISTS SWIM THE ENGLISH
CHANNEL. DENTAL HYGIENISTS JUST
WADE IN THE SHALLOW END.
Whoa! I’m just talking business here—no judgment passed about the value of
restorative dentistry vs. dental hygiene services. In recent Editor’s Notes, I have
been yelling loud and clear about the need to restore preventive dentistry to its rightful throne in our health-care communities. Kyle Isaacs’ article on page 12 rallies for a “name change” in dental hygiene— not unreasonable. You can almost hear an orientation tour in a dental office: “Down this hallway, we have people who
clean; down this hallway, we have people who heal.” What I am noting is that dentists, by and large, jump
out of the rowboat and start swimming for the British or French coast, whichever is the furthest away. They
fearlessly established businesses in dentistry. The shallow end involves little financial risk.
Penn Well conducted a national survey of 2,100 dental hygienists about “independent practice” (or direct
access, which has become the politically correct term). There is far less interest among the prevention experts in also conquering the business world. The survey results, however, are not a red flag to discourage
investors from sinking money into a dental hygiene business. Among dental hygienists who indicated they
were “very” or “somewhat familiar” with the scope of practice in their states, 56% said they would consider
owning their own business if regulatory obstacles were removed. Of more interest, more than three-quarters
of dental hygienists would practice in “off-site locations” away from the traditional dental office settings.
Ironically, though, the top obstacle that would keep dental hygienists from exploring untraditional op-
portunities is the very traditional dental office; 50% say they “enjoy” the traditional relationships between
dentists and dental hygienists.
The survey also reached some of the pioneers who have started businesses in alternative practice set-
tings. Their feedback illuminates why it’s probably easier for the dentist to swim the English Channel. Yes,
the debts (both dental school and starting a business) and other challenges of managing a business are scary.
But there’s more to the issue for dental hygienists. The dentist’s business thrives on a perception that dental
insurance is a way of life—you’re foolish for not taking advantage of the work benefit.
There is no such perception for dental hygiene services, and this is one area that Isaacs tackles in her
article. We need a name change, Isaacs says, that would help build community awareness about the value of
dental hygiene. Reimbursement issues continue to resolve themselves at a snail’s pace. Businesses are funny
in that way; you provide a service and it would be sweet to get paid for it. Also, some dentists are reluctant to
restructure their practices to accommodate the legally required referrals from hygienists. The patients may
be on Medicaid, for example, or simply too far away from the office. So this legal requirement is complicated
by the question of who completes the care needed for the underserved. Despite these obstacles, the paths
for dental hygiene businesses are being established. Dental hygiene practitioners are swimming the English
Channel, and businesses based on direct access to care will become easier to launch in the future.