Oral health takes a team approach
ORAL HEALTH
It was a lonely world for dentists when the father of modern dentistry – France’s Pierre Fauchard – began to write about oral care as a discipline separate from medicine, and most dental practitioners worked alone or with just one helper. That was in the 1700s. How times have changed.
Over the past five decades, and particularly in recent years, the face of dentistry has evolved dramatically, with oral care teams now extending even beyond dentists’ offices to involve an array of specialists, including, perhaps to Dr. Fauchard’s chagrin, MDs. According to Canada’s top dentists, the profession’s team approach is at the heart of optimum oral care and the general health of all Canadians.
“Until about the mid-1950s, dentists tended to do everything themselves,” says Dr. Darryl Smith, president of the Canadian Dental Association (CDA). “With changes in thinking and technology, it became obvious that the most effective and efficient way to deliver the best oral care was to add other people to the team.”
Today, most dentists head up teams that include dental assistants, hygienists, administrative staff and specialists who each contribute expertise to patient care – an efficient model increasingly seen in the broader health care community in the emergence of primary health care, in which physicians lead teams of trained health care practitioners such as nurse practitioners, nurses and nutritionists.
The evolution of oral health teams developed in lockstep with modern approaches to preventative oral care, which aim to stem problems such as cavities and gum disease. As a result, the role of dental assistants expanded beyond assisting dentists with treatment procedures to also handle a variety of tasks in accordance with their training — from helping with equipment and instruments to mixing compounds.
Dr. Don Friedlander, CDA vice president, and a dentist in Ottawa for almost 30 years, says his practice includes two dentists, four dental hygienists, two dental assistants and two receptionists. He says the combined efforts promote a creative, supportive and enjoyable working environment.
“Patients benefit from the working collaboration of our team. They get the specific care they need and it works well for us because we all have similar approaches.”
Dr. Larry Levin, president elect of the Ontario Dental Association, has worked as a dentist in Hamilton for 39 years. “The team can help the practice achieve excellence by providing better access for patients, while achieving the highest level of care because everyone is doing what they are superbly trained to do,” he says, “When team members are operating in their areas of expertise, it frees up dentists to do tasks that only they can provide.”
Behind the scenes, up to nine different dental specialists including orthodontists and maxillofacial and oral surgeons to periodontists and public health dentists may collaborate with general practitioners to provide comprehensive care, he says.
Further, Dr. Smith, who leads a practice in northern Alberta, sees the “team” extending even further to include the support of laboratory technicians, equipment makers and suppliers who support “what are essentially small hospitals.”
Perhaps the most significant development in recent years, however, stems from the growing and important recognition that dental health is part of overall health, says Dr. Smith. “Consequently, there is a strong relationship between physicians and the dentists, because we are treating similar diseases, such as bacterial infections, which can cause gum disease for example. This important development has led to dentists now interacting with other health professionals, such as physiotherapists in treatment of joint problems of the jaw.
Finally, adds Dr. Smith, parents and caregivers are getting involved, completing the extended team now helping ensure Canadians benefit from comprehensive oral care.
Dr. Friedlander adds, “The time for working in vertical silos is over. Nowadays we are communicating across professional lines and we’re getting better outcomes for patients.”
He says Canada’s standard of care is world class. “Our dentists, hygienists and assistants have a terrific safety record. This type of one-stop shop has a solid track record with Canadians who enjoy convenient access to very high standards of oral health care.”
Dr. Levin says at his office, the 8:15 morning huddle allows the team to discuss the issues of patients who are coming in, and how to do the best for them. He likens the general practitioner to the quarterback who pulls the office and external teams together to deliver outstanding patient-centred care.
Dr. Friedlander agrees. “The dentists’ education, knowledge of the patient’s medical and dental history and current needs help dentists align everyone’s contribution and ensures that patients receive comprehensive and high-level care.”
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