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CANADIAN JOURNAL OF DENTAL HYGIENE JOURNAL CANADIEN DE L HYGIÈNE DENTAIRE CJDH JCHD SEPTEMBER OCTOBER 2007, VOL. 41, NO. 5 THE OFFICIAL JOURNAL OF THE CANADIAN DENTAL HYGIENISTS ASSOCIATION P RESIDENT S M ESSAGE DE LA PRÉSIDENTE A Year of Opportunities Une année fructueuse By Bonnie Blank, AASc, BSc(DH), MA Teamwork is the ability to work together toward a common vision. The ability to direct individual accomplishments toward organizational objectives. It is the fuel that allows common people to attain uncommon results. Andrew Carnegie THE CANADIAN DENTAL HYGIENISTS ASSOCIATION (CDHA) is the collective voice and vision of dental hygienists in Canada, advancing the profession, supporting its members and contributing to the oral health and general well-being of the public. In pursuing these objectives, CDHA seeks to bring about high-quality, accessible oral-health care. This is the vision CDHA has been dedicated to for 40 years. It shapes how the board, executive director and staff work to fulfill our mandate. Teamwork is a critical component of any kind of progress. This past year as president, I have had an opportunity to experience first-hand exactly what teamwork can accomplish. I have been able to observe, contribute to and be a part of this process. By working collaboratively, I feel a great sense of support and satisfaction. And we accomplished much. CDHA has developed official positions on several critical issues this year. The organization has grown to 12,500 members. We continue to advocate for increased access to dental care by making presentations to Parliament and by developing position papers with specific recommendations to increase dental-hygiene service to segments of the population that are underserved. CDHA has developed official positions on several critical issues this year, allowing dental hygiene to play a leadership role. Position papers and statements were published on the link between periodontal disease and systemic diseases such as heart disease, lung disease and diabetes and preterm, low-birth-weight babies. Addressing this link is recognized internationally as a necessary component of disease prevention that ultimately will help improve the health of people worldwide. A Year of Opportunities continued on page 234 par Bonnie Blank, AASc, BSc(DH), MA Le travail d équipe, est la capacité de travailler ensemble vers une vision commune; la capacité de diriger les réalisations individuelles vers des objectifs organisationnels; le carburant qui permet aux gens ordinaires d atteindre des résultats extraordinaires. [Traduction] Andrew Carnegie L ASSOCIATION CANADIENNE DES HYGIÉNISTES DENtaires (ACHD) est la voix et la vision collectives des hygiénistes dentaires au Canada. Elle a pour objectifs de faire avancer la profession, d appuyer ses membres et de contribuer à la santé buccodentaire et au mieux-être général du public. Par l atteinte de ces objectifs, l ACHD vise l établissement de soins de santé buccodentaire accessibles et de haute qualité. Cette année, l ACHD a élaboré des positions officielles sur plusieurs questions importantes. Depuis 40 ans, cette vision est au cœur de tous les efforts de l ACHD. Elle détermine la façon dont le conseil d administration, la directrice exécutive et le personnel travaillent pour accomplir leur mandat. Le travail d équipe est un élément important de tout progrès, quel qu il soit. Au cours de la dernière année, en tant que présidente, j ai eu l occasion de constater directement tout ce qu il est possible d accomplir grâce au travail d équipe. J ai été en mesure d observer ce processus, d y contribuer et d en faire partie. En travaillant en collaboration avec d autres, j ai éprouvé un fort sentiment d appui et de satisfaction. Ensemble, nous avons beaucoup accompli. L association a grandi et compte maintenant membres. Nous continuons de faire valoir l importance d un accès accru aux soins dentaires au moyen de présentations au Parlement et d énoncés de position, dans lesquels nous formulons des recommandations précises pour accroître les services d hygiène dentaire offerts aux groupes de population mal desservis. Cette année, l ACHD a élaboré des positions officielles sur plusieurs questions importantes qui ont permis de mettre en relief le rôle prépondérant de l hygiène dentaire. Nous avons diffusé des énoncés de position et des déclarations traitant du lien entre la maladie parodontale et Une année fructueuse suite à la page 234 SEPTEMBER OCTOBER 2007, VOL. 41, NO. 5 CANADIAN JOURNAL OF DENTAL HYGIENE (CJDH) 211 CDHA BOARD OF DIRECTORS Bonnie Blank President; DHEC Diane Thériault Past President; New Brunswick Carol-Ann Yakiwchuk President Elect; Manitoba Lynn Smith British Columbia Maureen Bowerman Saskatchewan Evie Jesin Ontario Anna Maria Cuzzolini Quebec Alison MacDougall Prince Edward Island Wanda Fedora Nova Scotia Palmer Nelson Newfoundland and Labrador RESEARCH ADVISORY COMMITTEE Susanne Sunell Dianne Gallagher Joanne Clovis Marilyn Goulding Sandra Cobban Salme Lavigne Bonnie Craig Barbara Long Shafik Dharamsi Gladys Stewart Indu Dhir SCIENTIFIC EDITOR Susanne Sunell MANAGING EDITOR Marja Hughes ACQUISITIONS EDITOR Laura Myers TRANSLATION AND REVISION Jacynthe Morin Louise Saint-André GRAPHIC DESIGN AND PRODUCTION Mike Donnelly Published on behalf of the CDHA six times per year (January/February, March/April, May/June, July/August, September/October and November/December) by Adams Jette, Publishing Division, 100 Argyle Avenue, Suite 202, Ottawa, ON K2P 1B6. Tel.: (613) , ext Canada Post # CANADIAN POSTMASTER Notice of change of address and undeliverables to: Canadian Dental Hygienists Association 96 Centrepointe Drive, Ottawa, ON K2G 6B1 ADVERTISING Keith Health Care Inc Hurontario Street, Suite 104 Mississauga, ON L5G 4S1 (905) SUBSCRIPTIONS Annual subscriptions are $90 plus GST for libraries and educational institutions in Canada; $135 plus GST otherwise in Canada; C$145 elsewhere. One dollar per issue is allocated from membership fees for journal production. CDHA CN ISSN X (Print) ISSN (Online) GST Registration No. R CDHA OFFICE STAFF Executive Director: Susan A. Ziebarth Health Policy Communications Specialist: Judy Lux Director of Education: Laura Myers Information Coordinator: Brenda Leggett Executive Assistant: Frances Patterson Administrative Assistant: Lythecia Blanchard Reception and Membership Services: Shawna Savoie CDHA CORPORATE SPONSORS Crest Oral-B Johnson & Johnson Pfizer Consumer Healthcare Sunstar Butler All CDHA members are invited to call the CDHA Member/Library Line toll-free, with questions/inquiries from Monday to Friday, 8:30 a.m. 5:00 p.m. ET. Toll free: , Fax: (613) Internet: The Canadian Journal of Dental Hygiene (CJDH) is the official publication of the Canadian Dental Hygienists Association. The CDHA invites submissions of original research, discussion papers and statements of opinion of interest to the dental hygiene profession. All manuscripts are refereed anonymously. Editorial contributions to the CJDH do not necessarily represent the views of the CDHA, its staff or its board of directors, nor can the CDHA guarantee the authenticity of the reported research. As well, advertisement in or with the journal does not imply endorsement or guarantee by the CDHA of the product, service, manufacturer or provider All materials subject to this copyright may be photocopied or copied from the website for the non-commercial purposes of scientific or educational advancement. Cover photo: Stockdisc/Getty Images C ONTENTS E VIDENCE FOR PRACTICE Abstracts from IADR Meeting, March 2007, New Orleans O BSERVATIONS Legislative Changes in Ontario: Self-Initiation Has Finally Arrived By Fran Richardson So Now You Can Open Your Own Practice What Do You Do Next? By Ann Wright Oral Health Care: A Necessary Public Good Now and into the Future By the Canadian Dental Hygienists Association The Independent Practice By Brian Gomes D EPARTMENTS President s Message de la présidente A Year of Opportunities / Une année fructueuse Executive Director s Message de la directrice générale Independent Practice: An Idea Whose Time Has Come / L exercice autonome de l hygiène dentaire : Une idée qui a fait son chemin 215 CDHA 2007 Dental Hygiene Recognition Program Programme de reconnaissance en hygiène dentaire de l ACHD pour Book Review: Communicating in Dental Practice: Stress-Free Dentistry and Improved Patient Care The Library Column: Fly Like a Bird Annual General Meeting Notice Avis de convocation de l assemblée annuelle Probing the Net: Dental Hygiene: Another Perspective CDHA National List of Service Codes Classified Advertising Advertisers Index The CDHA acknowledges the financial support of the Government of Canada through the Canada Magazine Fund toward editorial costs. SEPTEMBER OCTOBER 2007, VOL. 41, NO. 5 CANADIAN JOURNAL OF DENTAL HYGIENE (CJDH) 213 E XECUTIVE D IRECTOR S M ESSAGE DE LA DIRECTRICE GÉNÉRALE Independent Practice An Idea Whose Time Has Come By Susan Ziebarth, BSc, MHA, CHE He must be independent and brave, and sure of himself and of the importance of his work, because if he isn t he will never survive the scorching blasts of derision that will probably greet his first efforts Robert E. Sherwood ON SEPTEMBER 15, CDHA WAS PLEASED TO WELcome 100 members to the association s inaugural Independent Practice Workshop. This event marks an exciting new era for the profession and the association as independent practice is becoming a reality in many provinces. The workshop is the first step in the development of a certificate program and online courses to promote business excellence for independent dental hygienists. Due to Independent practice is becoming a reality in many provinces. the overwhelmingly positive response, the workshop will be repeated in Toronto at the end of January This program is one component of CDHA s initiatives to meet the goal established by the board of directors to provide resources for business success to our members. You will find more resources on the members-only website and in this issue of the journal, notably: an article on the history of the new self-initiation legislation in Ontario with a sidebar on what is involved in setting up your independent practice, a library column with many useful links to sources of information you will need, and an article on risk protection. Other areas CDHA is working on with regard to independent practice relate to third-party reimbursement of dental hygienists. Over the past six years, we have seen more and more willingness on the part of insurers to accept dental-hygiene claims from independent dental hygienists, although the progress has been slow. CDHA has been actively involved in the development of the National e-claims Standard and our work will ensure any future standards will be applicable to dental hygienists. We also are working with software companies to expand their products to meet your needs and to establish a dentalhygiene electronic-claims-submission program. Independent Practice An Idea Whose Time Has Come continued on page 227 L exercice autonome de l hygiène dentaire Une idée qui a fait son chemin Par Susan Ziebarth, B. Sc., MHA, CHE Il doit être indépendant, courageux, sûr de lui-même et de l importance de son travail parce que s il ne l est pas, il ne survivra jamais aux propos acerbes de dérision qui salueront ses premiers efforts. [Traduction libre] Robert E. Sherwood LE 15 SEPTEMBRE DERNIER, L ACHD ACCUEILLAIT AVEC plaisir 100 membres venus participer à son atelier inaugural sur l exercice autonome de l hygiène dentaire. Cet événement marque le début d une ère prometteuse pour la profession et pour l association puisque l exercice autonome devient réalité dans plusieurs provinces. L atelier constitue la première étape du développement d un programme de certificat et de formation en ligne visant à favoriser l excellence dans l exercice autonome de l hygiène dentaire. Compte tenu de l extraordinaire accueil dont il a joui, l atelier sera offert de nouveau à L exercice autonome devient réalité dans plusieurs provinces. Toronto à la fin de janvier Ce programme s inscrit dans les projets de l ACHD visant à offrir à ses membres des ressources leur permettant de réussir en affaires, objectif établi par le conseil d administration. Le site Web réservé aux membres et cette édition du journal contiennent diverses sources d information à ce sujet, notamment un article sur l histoire de la nouvelle loi ontarienne en matière d exercice autonome de l hygiène dentaire, avec un encadré sur ce que comporte l établissement d un cabinet, une rubrique documentaire comprenant plusieurs liens utiles vers des sources d information essentielles et un article sur l assurance responsabilité. L action de l ACHD en matière d exercice autonome de la profession touche aussi le remboursement des services d hygiène dentaire par des tiers. Bien que les progrès aient été lents, on remarque depuis six ans une tendance croissante de la part des assureurs à accepter les demandes de remboursement pour les services d hygiénistes dentaires L exercice autonome de l hygiène dentaire Une idée qui a fait son chemin suite à la page 243 SEPTEMBER OCTOBER 2007, VOL. 41, NO. 5 CANADIAN JOURNAL OF DENTAL HYGIENE (CJDH) 215 O BSERVATIONS Legislative Changes in Ontario: Self-Initiation Has Finally Arrived By Fran Richardson ON SEPTEMBER 1, 2007, THE ONTARIO DENTAL Hygiene Act, 1991 was amended to permit dental hygienists to self-initiate their authorized act of scaling teeth and root planing, including curetting surrounding tissue. This amendment to the Act was neither all that was desired by the profession nor all that was promised by the government. However, it will enable the public of Ontario to choose when, where and from whom they wish to receive preventive oral-health-care services, and it will provide dental hygienists the freedom to choose where to practice their profession. The amendment is of benefit to both the public and the profession. HISTORY When dental hygiene achieved self-regulation in Ontario in 1994, forces external to the profession convinced the government of the day to include the provision in the Dental Hygiene Act, 1991 (DHA) that an order from a member of the Royal College of Dental Surgeons of Ontario (RCDSO) had to be given before a registrant of the College of Dental Hygienists of Ontario (CDHO) could perform their authorized acts. When this order provision was included in the DHA, there was no complementary requirement for the order to be given in the Dental Act, 1991, which put many dental hygienists in a situation where they could have been in contravention of their Act because there was no mechanism for giving an order. Consequently, the CDHO and the RCDSO agreed on the The new legislation will enable the public of Ontario to choose when, where and from whom they wish to receive preventive oral health-care services... Some people will choose to have a house call. concept of standing orders for those dental hygienists who work in dental offices and protocols for those in public health. Unfortunately, many dentists were reluctant to provide orders for clients who were unable physically to attend the dental office and, thus, the intent of the DHA to facilitate access to preventive oral-health care was never fully realized. The CDHO Transitional Council immediately saw the flaw in the legislation and requested an amendment. In 1994, the Ministry of Health indicated to the CDHO that orders were to be flexible and not unreasonably withheld by the issuing dentists. Unfortunately, as time progressed, organized dentistry tightened its stance on when, where and to whom orders could be given and the issuing of orders became a mechanism for controlling the practice of dental hygiene. While this scenario unfolded in Ontario, it also played out elsewhere in North America, most notably in jurisdictions that were seeking self-regulation for the dental-hygiene profession. Where self-regulation was achieved, it often came with an apron string to dentistry that ostensibly tied the practice of dental hygiene to the dental office in most cases. Where dental hygienists did take the initiative to institute mobile clinics to visit clients who were unable to visit a traditional dental office, they found significant resistance from local dentists and, in many cases, were unable to secure the orders necessary to complete the preventive service. True, there are many forward-thinking dentists who have been supportive of the dental-hygiene profession s desire to take oral-health services to clients who are unable to come to a dental office, but they work silently in the background for fear of reprisal by their colleagues who are not as progressive. (In recent years, a greater effort has been made by organized dentistry to reach out to residents in long-term care and residential homes.) As the CDHO grew and matured as a regulatory college under the Regulated Health Professions Act, 1991 (RHPA), it became increasingly evident that the order requirement in the DHA not only hampered access to important preventive oral-health services, but also indirectly regulated the dental-hygiene profession by giving control to another regulated health profession. Many thought this to be paternalistic and economically driven. The more organized dentistry tried to control the practice of dental hygiene, the more the dental-hygiene profession, their public supporters and the regulators realized that the Act had to be amended for the good of the people of Ontario. No public good was achieved by maintaining the order. In fact, a 1996 report by an independent advisory body to the Minister of Health recommended that the Act be amended, but politics intervened and it took another 11 years before that recommendation, albeit in an incomplete form, was finally enacted. For almost 14 years, the college requested and challenged successive provincial governments to listen to the profession and heed the needs of the Ontario public. It seemed to many of the supporters of the amendment that the government instead was listening to health-care pro- 216 JOURNAL CANADIEN DE L HYGIÈNE DENTAIRE (JCHD) SEPTEMBRE OCTOBRE 2007, VOL. 41, N O 5 fessionals who were against change and an alternative delivery system they could not control. In the meantime, nursing moved to the nurse-practitioner model and registered practical nurses were permitted to self-initiate. But both are part of provincial health-care funding and the result of a cost-conscious government s incentive to find alternatives. Oral health, by and large, is not included in the provincial health-care funding system and therefore did not appear to be a priority issue for legislative change. And a powerful, well-funded lobby was adamantly opposed to any legislative initiative that reduced the dentistry monopoly on oral-health care. WHAT HAPPENED TO MOVE THE ISSUE ALONG? During the 2003 provincial election campaign, a dental hygienist who felt passionately about making the DHA amendment a reality used her personal connections to secure a promise, in writing, from the future provincial premier that, if elected, he would amend the Act. Dental hygienists constantly reminded the premier of his promise and expected him to keep it! An agreement that the Act should be amended was reached between the provincial dental and dental hygiene associations and the two related regulatory organizations after many delays partially caused by ill-advised closed-dialogue sessions between the two associations. Those sessions resulted in a very strict Contraindications Regulation for Self-Initiation. The catch was that the dental organizations insisted that dental hygienists currently are not qualified to self-initiate, while the dental-hygiene organizations insisted that no fur
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