APDH’s Perspective

Working Outside the Private-Practice Box
Affiliated Practice Dental Hygiene

I give all the credit to my amazing instructors at the University of New Mexico for my interest in dental public health and for choosing to work as an Affiliated Practice Dental Hygienist. There was a very strong emphasis in my education on the importance of increasing access to dental care for underserved populations. By the time I graduated with my bachelor’s degree in 2000, I had enjoyed many rotations providing care within these underserved populations. My rotations included dental hygiene care within Indian Health Services, a clinic for children with disabilities, long-term nursing care facilities, and elementary school classrooms in low-income areas. As of 1999, New Mexico had passed legislation called Collaborative Dental Hygiene Practice. This allowed hygienists to provide dental hygiene services without general supervision in a cooperative working relationship with a dentist. I knew I was destined to take advantage of this opportunity to deliver care in populations outside of private practice.
As many of my college friends graduated and moved on, homesickness set in, and I made my way back to the Phoenix area to be near family. Although I settled in at a wonderful family practice, my desire to deliver care to the underserved was never extinguished. Arizona passed the Affiliated Practice legislation in 2004. The following year, my co-worker at the family practice, Lynnette Martin-Richey RDH, left to develop a children’s dental clinic along with Michelle Gross-Panico, RDH, MA, , DHSc. These two trail-blazing hygienists partnered with Chandler Regional Hospital, and in 2007, they established the first children’s dental clinic in Arizona using the Affiliated Practice Dental Hygiene model.
The housing and economic bubble-burst around this time brought with it a cut-back in hours at the family practice. We lost many patients because they had been let go from their jobs and had lost dental insurance. I wasn’t bothered at the time because I was truly busy with my home life and raising little ones. However, as the years passed, that desire to work in public health kept gnawing at me. Finally, in 2012, I felt that it was time to look for an opportunity to increase my work hours. Perhaps it was fate, but while searching an online job site, I found that there was an opening at the very clinic my former co-worker had helped to establish. The job description required that the candidate be an Affiliated Practice Dental Hygienist. I am living proof that the process for becoming an AP hygienist is not overwhelming or difficult. Within one week, I had all the documents completed and had earned all the required CE credits from online courses.
I was blessed to receive the position and began working at the Dignity Health Children’s Dental Clinic in October of 2012. Working within the Affiliated Practice model it’s a dream come true. The dental clinic is an entry point into the dental care system for many of our patients. Almost all the patients we see are uninsured and a vast majority of them are high caries risk. They would likely not receive any dental services if the clinic were not in existence. Myself, or one of my fellow AP hygienists, are often the first dental provider our patients encounter. We are able to provide all preventive dental hygiene services and make necessary referrals for restorative care. Gone are the days of 30 minute child prophys for me. I am scheduled an hour or an hour and 15 minutes per patient, which includes children up to age 18. Oral hygiene education is a key component in affecting behavior change in our patients, so I am allotted that chair time to disclose every patient and work on proper brushing and flossing techniques. Neither my patient nor I have to wait around for a dentist exam. Based on my oral evaluations, I can refer patients for restorative care with partnering dentists. The dentist I am affiliated with comes on a monthly basis to review radiographs and is available for consultation if any issues arise.
I truly feel that I am playing a part in increasing access to dental care for an underserved population. It is an amazing reward to see patients come to value their oral health and change their behaviors for a healthier smile. I encourage all hygienists who share a desire to help the underserved to take advantage of the Affiliated Practice opportunities. A great way to learn more about AP employment models and job openings is by visiting molarcoalition.org and becoming a member today.

Audrey McFarland BSDH