Julie Rodriguez-Bencosme

	The concept of providing dental services in a hospital dates back to the late 1700's in New York City, to treat the poor.  The majority of the dental care rendered in many hospitals is focused on the diagnosis and treatment care necessary to support the recovery of the medically compromised patients admitted for serious head and neck diseases, infection, or trauma. To support the need for training dental personnel, teaching hospitals include training programs for graduate dental students, and rotate them through a dental department and other appropriate departments such as emergency medicine, internal medicine and anesthesiology. Every year more than 1,000 dentists receive training in a hospital. The scope of practice varies greatly, being dependent on such factors as bed capacity, funding and the level of specialty expertise.

	The duties and responsibilities of the dental hygienist in a private practice have been established  over many years by laws as well as tradition. Less defined, however, is the role of a dental hygienist in a  hospital setting. The services that a dental hygienist provides in a hospital go far beyond the traditional duties of teaching oral hygiene instructions, exposing radiographs, scaling and root planning. The dental hygiene patients in a public health setting are typically underserved groups.  Many hospitals provide a great portion of their primary care through their outpatient services including dental care. This is especially true in neighborhoods with high poverty rates and large number of uninsured individuals.

	A dental hygienist in a hospital setting is in a unique position to perform a variety of duties in meeting the oral health needs of the inpatients and outpatients of the hospital. Establishing outreach programs for different patients is an exhilarating experience. One can begin with the prenatal outpatients by informing expectant mothers about the importance of proper dental care starting early in a child's life. Another outreach activity is coordinating preventive oral health programs for pediatric inpatients. It is gratifying to see how much the children enjoy the oral health presentation.  

	In order to be successful in a hospital environment, a dental hygienist must be highly organized and detailed oriented.  The documentation and infection control requirements in a hospital are far more stringent than a private office.  There are many governing agencies both at a state and federal  levels that monitor a patient's safety. Hospitals routinely have accreditation inspections by various agencies including  the Joint Commission Accreditation of Health Care Organizations (JACHO ). Hospitals either public or not-for-profit depend on positive outcomes from these agencies to receive further funding.

	A typical day for a dental hygienist in a hospital outpatient dental clinic can include providing care to 5-10 patients each day.  Most of these patients are special needs patients or medically compromised. Patients with conditions such as the developmentally disabled, physically challenged and cancer survivors, to name a few, are best treated in a hospital based dental clinic. Many of these patient's primary care physicians are located within the same hospital. It is convenient for consultation between the physician and the dental staff. The services provided by a dental hygienist in this setting, includes periodontal debridement, root planning, polishing and home care instructions. A dental hygienist also has to be creative as how to provide patient care since some of these patients are wheelchair bound or need assistance getting into the dental chair. Motivating patients to improve their oral hygiene care can be a life changing experiencefor the patients. Many patients have had emergency dental care and few have received preventive instructions. The patients are very satisfied and appreciative after receiving theseservices. It makes the essence of being a dental hygienist more rewarding. The hospital setting provides the dental hygienist the advantage of working along side a team of oral surgeons, dentist, nurses and medical doctors. The dental hygienist on staff may be asked to provide dental hygiene instructions to the nurse's for their beridden patients.

	Nurse’s are educated on the correlation of biofilm in the oral cavity and systemic diseases. This information is well received by the nurse's during their regularly scheduled inservice. The amount of knowledge an individual gains from the daily interaction of working with these healthcare professionals is insurmountable! A dental hygienist becomes proficien in emergency care, medicine, pharmacology and pathology. The unexpected becomes the norm!

	Someone who is considering a hospital dental hygiene position, must keep in mind that the position requires a great deal of patience, ingenuity and dedication to the patients. Many of these patients may be encountering preventive oral hygiene care for the first time in their lives. Due to the present economy, hospital dental practice is now becoming an alternative for dental care rather than the traditional private office setting. Most hospitals accept Medicaid, private insurance and sliding scale fees for the uninsured as payment for dental services.

	Hospital dental hygiene is a very exciting and rewarding career. The constant changes keep one sharp and abreast. I should know, I practiced dental hygiene in two hospitals for over ten years! My best memories are the smiles from patients when they thanked me for such a pleasant dental experience. They would always say, "I have never had my teeth cleaned that way before!" Check your local hospital's personnel office to see if your dream job is waiting for you!
	 

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		Entry 1: Journal of a changed hygienist

		Part Two: Diary of an unemployed hygienist 

		Part Three: Diary of an unemployed hygienist

Julie Rodriguez-Bencosme

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