Door-to-Door Dental Hygiene Improves Access - Toronto Star

October 20, 2007
Paul Dalby

House calls are back on the agenda for Ontario's dental hygienists.

After 13 years of being legislated to work under the auspices of dentists, hygienists are once again free agents no longer obligated to work in a dentist's office or under a standing order with a dentist.

For many people in Ontario without dental-care insurance, the change also signals the opportunity to receive preventive oral care at an affordable cost.

According to the Ontario Ministry of Health and Long-Term Care, 6 million people in Ontario do not see a dentist and, therefore, a hygienist for a several reasons, including cost, illness, age, low income or living in remote areas not served by a dentist.

Some, including residents of long-term care homes and people physically unable to travel to a dental office, fall through the cracks.

"The bottom line is that dental hygiene is quite portable and, now, it's not tied to a dental office," says Margaret Carter, executive director of the Ontario Dental Hygienists Association.

"This is all about access and affordability, because dental hygienists have lower overheads and can provide service at lower costs."

The association represents about 6,200 dental hygienists in Ontario, 65 per cent of those practising in the province.

Now, veteran hygienists such as Margit Juhasz of Port Credit and Linda Quest of Hamilton can expand their service to a huge segment of the population formerly deprived of preventive oral care.

"One of my patients is an 82-year-old woman who has cancer of the pancreas," Juhasz says. "She is no longer able to leave her house and had not had her teeth cleaned for five years until I went to her.

"After she sees me, she feels great. They are not rushed, because I only schedule one patient every two hours," she explains. "When I was at the dentist's office, it was more like a dental factory."

Juhasz, 52, has been an independent dental hygienist for six years, working under a standing order with a dentist who allowed her to serve medically compromised clients and to operate an independent clinic in Port Credit.

House calls make up 5 per cent of her business but she feels this number could grow substantially.

Juhasz often has to be resourceful in order to cope with her patients' surroundings.

"If they cannot move, I will clean their teeth while they lie in bed. Hospitals are good because their beds are adjustable," she says. Otherwise an armchair will suffice (recliners are best).

For extra light, she wears a headband flashlight.

Juhasz says house calls are rewarding because the patients look forward to her visits.

"I bring in the news from the outside world and I make them feel good," she says. "I don't use needles, I'm not threatening."

Linda Quest is a 30-year veteran of the profession and decided in 1992 to specialize in long-term care.

"I bought myself a portable hygiene unit with its own compressor and found a dentist who would give me a standing order," says Quest, 58. "We had an arrangement that he could use the unit on my days off."

She was soon serving seven long-term care facilities, which also had a dentist attending. But as the number of dentists dwindled because of retirement, she cut back to three facilities, which she still visits on a regular basis.

"With the new law, I can service many more facilities now," she says. "I have had many requests from directors of long-term care facilities asking me to offer my service, but my hands were tied."

Quest says the elderly have special needs for oral care.

"They may be 80 to 90 years old and on medication, which makes their mouths drier, and they get more plaque on their teeth," she says. "They need more regular cleaning but they don't have the strength or motivation to clean their teeth themselves, so everything is working against them. I see a rapid decline in oral health among the elderly."

Quest says she also has many patients with dementia or Alzheimer's disease who are difficult to treat. "It's heart wrenching really. There is a huge need."