First Considerations

Applying Dental Sealant

To enter into a collaborative dental hygiene practice arrangement, there are three very major considerations that must be addressed first, before moving ahead...

  1. Have you reached the required hours of clinical practice as identified in MN Statute 150A. 10, subd. 1a?
  2. Have you entered into discussion with a Minnesota licensed dentist who has agreed to enter into a collaborative agreement with you?
  3. Have you narrowed down the population that you intend to reach with your collaborative agreement program? Your planning should be based on a public health-based "needs assessment" of the population, not merely on whether you yourself "think" that the intended population would benefit from or needs your services.

    Ask yourself the following questions:
    1. Does the population that I would like to target already have access to an oral health care provider, e.g. mobile dentistry, portable dentistry?
    2. Is there "need" for this program, i.e. is the population underserved and/or uninsured? (remember that the intent for collaborative practice is to serve those who have difficulty accessing oral health care services--not for persons who are currently well-served in private practice settings).

A Day in the Life of two Apple Tree Dental Collaborative Practice Dental Hygienists:

Karen Engstrom, RDH

My collaborative agreement involves working for Apple Tree Dental, a non-profit organization. The majority of my time is spent in our out-patient clinic in Coon Rapids. On a less regular basis I use my collaborative agreement to provide tele-hygiene services and assessments to Head Start Children.

However, the collaborative agreement work I am most proud of is the 2-3 days a month that I spend at a medical clinic facility providing dental hygiene services to their family of patients. I am set up with a fully equipped mobile dental unit including a cavitron and the ability to take digital radiographs. The majority of the patients are referred to us from their primary physicians, or they learn of us through signs posted explaining our presence in the facility.

A typical day involves seeing 6-8 patients per day, mostly adults who have had little to no dental care or dental education. Some of the patients have complicated medical histories and extensive acute or chronic dental problems. All the patients are covered either under a state assistance plan or pay based on a sliding fee schedule.

I often hear from my patients how difficult and frustrating it has been for them to find someone to care for their dental needs. They are very appreciative and receptive to getting dental care in a facility that is familiar to them and within their transportation area.

Sometimes these patients show tears of happiness just by hearing they will have their teeth cleaned and that they will be examined and treated by a dentist.

During the first visit with me I gather as much preliminary information as I can from them including:

  • Medical History
  • Dental History
  • Chief Complaints
  • Full Mouth Intraoral Radiographs
  • Periodontal Charting
  • Existing Restorations and Soft Tissue Charting
  • Suspicious Caries and/or Urgent Findings

From this information and as time allows, I then proceed with a prophylaxis, oral debridement, or scaling and root planning. Being able to administer local anesthetic during collaborative agreement work has been a huge benefit. I provide oral hygiene instructions and patient education focusing on specific risk factors made known during the appointment. In addition, I discuss the importance of their involvement and commitment to future appointments especially when there is pain and infections involved.

Following their appointment with me, the chart notes and radiographs are reviewed by one of our dentists and we are able to schedule the patient with the dentist and back with me based on their urgency and need. When they are seen by the dentist, a comprehensive exam/diagnosis is completed, the treatment plan is confirmed and restorative work is started.

After spending twenty-five years as a dental hygienist in the private sector of the industry, I am very thankful for what the collaborative agreement has done for the patients I am able to care for, and also for the enthusiasm it has given me towards my career goals.

Deb Olson, RDH

The collaborative agreement that I have with Apple Tree Dental is to provide hygiene services at two facilities that are homes to persons with developmental disabilities.

I provide routine preventive dental services in their homes. Because of the functioning level of these residents, it is difficult for them to understand and cooperative in a traditional office setting. These residents often refuse to cooperate or have an escalation of behavior leading to aggression and/or property damage in the traditional office setting.

Therefore, treatment in their homes is the best alternative. The services I provide are: visual exam, scaling, polishing, flossing and staff training. Any problems are referred to [my collaborative practice dentist] at Apple Tree Dental. Exams are provided on a yearly basis by [our dentist] at each facility.