Oral Health Care: An Autoethnography Reflecting on Dentistry\u27s Collective Neglect and Changes in Professional Education Resulting in the Dental Hygienist Being the Prevention-focused Primary Oral Health Care Provider

Many factors influence poor oral health among disadvantaged populations including socioeconomic circumstances, knowledge of disease prevention strategies and ability to implement those strategies, public policies, insurance status, insurance policies, dental providers and other challenges to accessing dental care. Often these issues converge and result in early disadvantages to achieving good oral health (Horton & Barker, 2010). Addressing even some of the factors that contribute to poor oral health may provide ways to change the dental health status of historically underserved populations. The purpose of this research is to explore my role as a practitioner and researcher in the creation of a hygienist-based, community-site located, teledentistry supported system of dental care for underserved populations and the intersection of my experiences with cultural, societal and educational occurrences. This autoethnography examined my own experiences and also explored the experiences of a small sample of others who participated in onsite dental care systems utilizing hygienists as the prevention-focused primary care provider. As Ellis and Bochner (1996) note “Autoethnography stands as a current attempt to, quite literally, come to terms with sustaining questions of self and culture” (p. 193). The findings that emerged from my work included a realization that the dental industry creates and perpetuates the collective neglect of large portions of the US population. Some of this neglect is embedded in traditional power structures in dentistry, gender bias and distrust in professional skills as a result of separate professional education structures. The result for many people is untreated dental disease, a profound lack of health equity, increased shame due to poor oral health as well as missing school. There are ways to address the collective neglect of the dental industry through the reframing of the dental hygienist as the prevention-focused primary care oral health provider in professional education programs then integrating this provider type into community settings like schools