Research

Public Health Dental Hygiene: An Option for

Improved Quality of Care and Quality of Life
Jodi L. Olmsted, RDH, BS, MS, EdS, PhD; Nancy Rublee, RDH, CDHC; Emily Zurkawski, PTA, BS;
Laura Kleber, BS
Introduction
Abstract
Lack of access to oral health care
education, preventive and treatment Purpose: The purpose of this research was to document quality of
services continues to plague un-served life (QoL) and quality of care (QoC) measures for families receiving
and underserved children, families and care from dental hygienists within public health departments, and to
elderly in Wisconsin.1 The Northern consider if oral health for families with economic disparities and cul-
Area Health Education Center (NAHEC) tural differences was improved.
provides services covering multiple Methods: A descriptive research study using a retrospective record
counties in the upper one third of the review was conducted considering QoC. A review of state epid “Do
state in an attempt to improve access preventive oral health programs based in local health departments
to health care to underserved commu- provide quality care services, thus impacting QoL for underserved
nities. One way NAHEC meets these populations?”
goals is through educating current Results: A dental hygienist working in public health made significant
and future health care professionals. contributions to improving access to care and QoL in a rural, socio-
Another is supporting preventive pub- economically disadvantaged community. A total of 2,364 children re-
lic health outreach programs. NAHEC ceived education, 1,745 received oral screenings and 1,511 received
serves a 33 county, 30,443 square- dental sealants. Of these, 804 children with caries were referred, with
mile area, larger than Massachusetts, 463 receiving restorations and follow-up care. QoL metrics basis as-
New Hampshire, Vermont and Dela- sessed Health Outcomes & Health Determinants. Initial QoL data was
ware combined.1 Forty-six percent of ranked in the bottom half of the state, while 70% of original deter-
the state’s land mass and 22% of its minant data was also ranked in the bottom half of reported metrics.
population, equating to approximately
1.1 million persons, are encompassed Conclusion: Dental hygienists in public health settings can positively
here.1 affect patients offering preventive care outreach services. Education
and sealant placement were considered effective as measured by
Health Professional Shortage Areas access, delivery and, when required, referral for restorative care. Im-
provement in QoL for individuals was noted through improved health
The Health Resources and Services outcomes and determinant metrics.
Administration maintain lists of des- Keywords: quality of life, quality of care, outcomes, health dispari-
ignated Primary Medical Care, Mental ties, prevention, education, allied health, dental hygiene, access to
Health and Dental Health Professional care, workforce development
Shortage Areas, called HPSAs.2 Geo-
This study supports the NDHRA priority area, Health Services Re-
graphic areas are designated as Health
search: Investigate how alternative models of dental hygiene care
Professional Shortage Areas (HPSA)
delivery can reduce health care inequities.
based on the following criteria:2

• The area has a population to full-time equivalent Many Northern Wisconsin communities are rural
primary care physician ratio of at least 3,500:1 and underserved as defined by national health care
• The area has a population to full-time equivalent standards.2 Thirty of the 64 federally designated Pri-
primary care physician ratio of less than 3,500:1 mary Medical Care HPSAs occupy the Northern region
but greater than 3,000:1 and unusually high needs (47%), and 26 of the state’s 43 federally designated
for primary care services or insufficient capacity of Dental HPSAs are also in the same region (60%).1 Five
existing primary care providers of the 11 counties described in the service area are
• Primary medical care professionals in contiguous Dental HPSAs.1-2 The combined populations of these
areas are over utilized, excessively distant or inac- counties exceed the state average of persons aged
cessible to the population of the area under con- 65+ by more than 5%. The percentage of persons liv-
sideration ing below poverty levels also exceeds state averages.1

Vol. 87 • No. 5 • October 2013 The Journal of Dental Hygiene 299

This geographic area is also home to 5 Native Ameri- removed so all people can access preventive and re-
can Sovereign Nations. Accessing dental care services storative care. Regardless of the needs and differ-
for Native Americans depends on varying tribal stan- ences of populations being studied, be they children,
dards, restrictions and clinic location. Only 1 tribal migrant workers, indigenous populations, or those
clinic exists in the geographic service area described. with socioeconomic or demographic differences, no
Individuals from other minority groups, or those so- one solution to accessing services is perfect for any
cioeconomically disadvantaged, cannot typically ac- specific group.18-29 Even for those with adequate finan-
cess dental care services through the tribal clinic. cial resources, access to care still provides barriers.10
Current literature does not describe care or resultant
Problem impacts on QoC and QoL for patients accessing care
through public health departments.
Little research exists describing both Quality of Life
(QoL) and Quality of Care (QoC) for individuals ac- Care Models for Education and
cessing dental services.3-4 No research exists describ- Provision in Other Locations
ing QoL and QoC for individuals accessing preven-
tive dental care services offered by dental hygienists Different models for bridging the access to care
through public health departments. Dental hygienists gap and addressing workforce development are nec-
in local communities are working through the public essary. The Advanced Dental Hygiene Practitioner,
health department providing oral health education, Dental Health Therapist and Public Health Dental
preliminary screenings and preventive care services. Hygiene Practitioner models can assist in developing
Once individuals are screened, and preventive health and expanding the workforce for meeting oral care
care services provided, public health dental hygienists needs.9-13,15-18,30-32 Expanding the scope of dental prac-
follow a consultation and referral model for address- tice and numbers of advanced educational programs
ing restorative care needs. Following systems proto- available providing education and training for mid-lev-
cols, referrals are made to Federally Qualified Health el providers can aid in overcoming workforce develop-
Clinics and Community Health Centers and/or private ment and access to care barriers. The dental therapist
dentists for restorative dental services and case man- model is recognized internationally as an approach for
agement.2 improving access, while reducing care disparities cost
efficiently.30-33 Educational curriculum programs com-
National Oral Health Care Disparities and Issues bining preventive, restorative, surgical and periodon-
tal content can provide for care needs of both children
A number of reports confirm the existence of health and adults.10
care disparities nationally.5-29 Of special significance
are the reports relating to oral care, including Oral State Health Care Disparities, Access
Health in America: A Report of the Surgeon Gen- and Demographic Issues
eral, and the National Call to Action promoting Oral
Health.5,6 Low income and minority populations often National disparities are mirrored within the
lack access to oral health care, causing significant state.9-10,30-39 Inadequate workforce numbers for meet-
health care disparities. If the ultimate goal of oral ing oral health care restorative needs exist.37-39 Prob-
health care is disease prevention, focusing on provid- lems associated with access to care are compounded
ing care to children seems the most focused approach by not only provider numbers, but demographic distri-
to achieving success. Once oral health education and bution, ethnicity, practice background/orientation and
preventive care services are provided, it is further nec- education.9-10,30-39 Demographic issues alone provide
essary to assure individuals experiencing disease are significant challenges to accessing care.9-10,30-38 Data
treated efficiently and effectively. An inadequate num- is collected annually by the States’ Population Health
ber of providers is one barrier to offering restorative Institute documents Programs and Policies, Health
care, while demographic location and socioeconomic Factors and Health Outcomes by county.40 Health Fac-
disparities are additional barriers. With inadequate tors data documents clinical care provision, including
numbers of dentists in the workforce, restorative and access and QoC, while Health Outcomes document
surgical needs remain unmet.7 Dentist/population ra- morbidity as one measure of QoL.40
tios stand at 58/100,000, however, this proportion is
projected to decline to 45/100,000 by 2020.7-8 One Quality of Life
solution to declining numbers of restorative care pro-
viders includes expanding the dental hygiene scope of QoL is defined as the general well being of indi-
practice, addressing workforce inadequacies.10-18 viduals and societies, based on wealth, employment,
environment, physical and mental health, education,
Populations and groups present with unique and recreation and leisure time, and a sense of social
varying care and access needs. Barriers need to be belonging.39,41 Dental disease, along with these fac-

300 The Journal of Dental Hygiene Vol. 87 • No. 5 • October 2013

tors, affects QoL.39,41-48 The Population Health Institute Methods and Materials
ranks QoL annually for each of the states’ 72 coun- A descriptive research study was conducted fol-
ties. Rankings are based on weighted summaries for lowing Institutional Review Board approval and ex-
individual communities that consider quality of health emption. Using a retrospective records review, public
care, environment, individual behaviors, education health data from 2004 through 2009 was examined.
and jobs.49 Ranking is dynamic, based on changes The research question the study sought to address
as counties improve health outcomes by address- was: “Do preventive oral health programs based in
ing all health factors with effective, evidence based local health departments provide QoC Services, thus
programming and policies.49 Adequately measuring impacting QoL for underserved populations in Dental
and documenting QoL outcomes has been considered HPSAs?” Records evaluated describe documenting ac-
elusive by researchers and experts, as epidemiologic cess to select oral health care services and the resul-
data being collected and evaluated is renormed an- tant outcomes for individuals living in rural, socioeco-
nually. Norm, rather than criterion referencing for this nomically disadvantaged communities.
measure, is a significant issue while considering the
validity of findings. County and state rankings are Population and Sample
triangulated with data from the Centers for Disease
Control (CDC).49 Results are considered both a call to The study sample was drawn from a rural popula-
action and used as necessary data tools for evidence tion within 1 of the state’s 72 counties in a geographi-
based decision making for change initiated by com- cally isolated region in the northern third of the state.
munity leaders. One county’s records were examined. The study’s
convenience sample included 2,364 CDC Sealant Effi-
Quality of Care ciency Assessment for Locals and States (CDC SEALS)
records spanning a 6 year period. These records held
The 21st Century Institute of Medicine definition of data for all children accessing various oral health care
QoC includes care that is safe, effective, patient cen- services through a county’s public health school based
tered, timely, efficient and equitable.46 Thus, safety is outreach program. A limitation of this approach is
the foundation upon which all other aspects of quality generalizability of findings to larger populations. The
care are built.The Population Health Institute consid- demographic breakdown of the study population is in
ers clinical care as a measure of health factors com- Table I.
bining both access and quality of care.49 Health be-
haviors, local environment and social and economic Data Collection & Analysis
factors are also evidence-based measures considered
annually. Clinical care accounts for 20% of this mea- Data analysis was descriptive in nature, document-
sure, health behaviors account for 30%, social and ing and evaluating existing data from the CDC SEALS
economic factors 40% and environmental factors records for clients served in the county studied. This
10%. Even though clinical care accounts for only 20% information begins documenting access to oral health
of this measure, both access to and QoC impact coun- care services offered by dental hygienists working
ty performance rankings. This data is used for pub- through public health departments in rural, socio-
lic health policy formation and implementation within economically disadvantaged communities. Data from
public health departments.49 the CDC SEALS database for preventive care servic-
es documents various QoC measures. Data from the
Protocols for Care in Service County University of Wisconsin School of Medicine and Public
Health Reports was examined for documenting QoL
Service and care protocols for meeting the challeng- measures.49 For the purposes of this study, data anal-
es of improving both QoL and QoC measures in the ysis for quality of care measures specifically focused
demographic region are documented and followed.50 on care provided to children through the school-based
Evidence based practice drives clinical care provision, sealant program.
providing care for populations with low socioeconomic
status and/or diverse ethnic backgrounds. Results
Quality of Care
Purpose
A review of CDC data indicated 2,364 children re-
The purpose of this research was documenting QoL ceived oral health education (100%), of which 1,745
and QoC measures for families receiving care from (74%) of the children educated received oral screen-
dental hygienists within public health departments, ings. Cumulative and annual results are document-
and considering if oral health for families with eco- ed in Table II. Of the 1,745 children screened, 1,511
nomic disparities and cultural differences improved. (87%) had dental sealants placed, and 804 (46%)
with dental caries were referred to federally qualified

Vol. 87 • No. 5 • October 2013 The Journal of Dental Hygiene 301

Table I: Demographic Summary
Year 2004 2005 2006 2007 2008 2009 Total
White 306 267 255 210 223 191 1452
Black 0 4 0 0 4 2 10
Asian 0 0 0 0 0 0 0
Hispanic 0 5 1 0 2 2 10
Native American 6 6 2 3 6 2 25
Pacific Islander 1 3 1 1 1 1 8
Other 1 1 0 2 0 0 4
Non–Reporting 0 0 0 0 0 2 2
Female 4 10 2 4 7 5 32
Male 4 9 2 2 6 4 27
Cumulative
Minority Groups 8 19 4 6 13 9 59

Table II: Cumulative and Annual Analysis of School Based Sealant Program Results
Number of Children Given
Children Untreated Need for Need for Referrals
Year Children Sealants in
Screened Decay Urgent Care Early Care Made
Educated Program
2004 484 380 113 6 104 314 153
2005 595 348 173 4 77 286 83
2006 379 281 159 15 54 259 68
2007 315 240 114 8 56 216 65
2008 328 263 138 14 42 236 57
2009 263 233 107 2 36 200 37
Total 2364 1745 804 49 369 1511 463

health centers or private practices for restorative ser- land counties metrics consistently ranked in the bot-
vices. Of the 804 children referred, 463 (58%) had tom half of the state (Table III). While considering an-
dental restorations placed and received follow-up other key measure, Health Determinants (reflecting
care. Referrals follow a consultative referral protocol.50 health care, health behaviors, socioeconomic factors
Fifty-nine minority children (3.9%) received services and physical environment), 70% of Northern Highland
and the populations and care provided are described counties also ranked in the bottom half of the state.49
in Tables I and II. Additional analyses revealed 30 to Examination of the QoL metrics indicate significant
35% of the total counties’ school-aged child popula- needs for the persons living in these rural areas. It is
tion were Medicaid recipients. Twenty percent of those notable that QoL rankings from 2004 to 2011 show
accessing services had private dental insurance and only gradual improvements.
self-selected out of the program, while the remaining
children (45%) receiving care were uninsured. Discussion
Quality of Life Study findings provided illustrate similar national
findings. The PEW Report provided Wisconsin with
The UW School of Medicine and Public Health yearly a grade of “C,” identifying the states meeting 4 of
reports, the Wisconsin County Health Rankings, not- 8 benchmarks.14 Similar problems plaguing national
ed Northern Highland counties were almost all rated populations- lack of access to oral care and being
below state averages.49 Health rankings are 1 to 72, socioeconomically disadvantaged also plague the
1 being best and 72 worst, based on the number of population described in this study.5-6,11-29 A childhood
counties in the state. Of special note, under the cat- of dental issues can lead to a lifetime of oral health
egory Health Outcomes (based on excess deaths and problems, if early interventions are not implement-
self-reported health status), 80% of Northern High- ed. Relatively low cost solutions including oral health

302 The Journal of Dental Hygiene Vol. 87 • No. 5 • October 2013

education, fluoride and sealant programs can result Table III: Cumulative Description of County
in less time lost at school, work, less disease burden Health Rank
and less pain. Long-term impacts from dental disease
Year Descriptor n
burden on the entire health care system population
could be reduced with education, early intervention 2004 QoL ranking 55/72
and changes in workforce paradigms. 2005 QoL ranking 51/72
2006 QoL ranking 66/72
Table I describes the demographics of the popula-
tion served in Wisconsin. Of the 1,511 children re- 2007 QoL ranking 66/72
ceiving services, it should be noted only 59 (3.9%) 2008 QoL ranking 58/72
were from reported minority groups. A total of 1,452 2009 QoL ranking Data unavailable
(96.1%) children receiving service were Caucasian.
The largest of the minority groups receiving sealants 2010* QoL ranking 61/72
as a preventive care measure were Native American 2011* QoL ranking 53/72
(25, 1.6%). Where the overarching program goal was
improving oral health for families with economic dis- through the preventive program for required interven-
parities and cultural differences, the data documents tion and treatment. Declining disease burden in the
the cultural groups reported here were an extremely communities’ children resulted in declining need for
small percentage of those actually served. restorative care. Numbers of children participating in
and receiving oral health education and dental seal-
Additional analysis of socioeconomic status de- ants in the program remained constant from year to
termined 30 to 35% of the study populations were year, possibly as a result of families recognizing us-
Medicaid recipients, and approximately 45% were un- ing preventive measures resulted in lowering care ex-
insured. These findings illustrate the socioeconomic penses and oral disease burden. Numbers of referrals
need and status of children and families accessing required for restorative care also declined over time.
care through the school based sealant program. Den- The consultative/referral model works successfully for
tal hygienists offering low cost, education and preven- meeting the preventive and restorative care needs of
tion programs through public health departments can children in this community in a cost efficient manner.
positively impact the health of individuals within com- Implementing various school based outreach pro-
munities when services are offered through local area grams through public health departments can expand
schools. access to care for minority and socioeconomically
disadvantaged, underserved populations across the
While considering data in Table II regarding QoC, country. Implementation of educational and preven-
it should be noted the initial numbers of children tive programs like these also allows dental hygienists
screened and treated were higher, declining over to pursue alternative career options beyond traditional
time. The reasons for this were two-fold: first, funding clinical practice. Dental hygienists employed through
supporting the programs became restricted, and sec- public health departments can make significant con-
ondly, there were changes in the numbers of schools tributions improving both access to and quality of care
participating in the program. Direct connections be- for school-aged children.
tween program participation and school funding re-
ductions were identified. As school budgets declined Consideration of the data reflecting QoL measures
preventive programs, similar to the Arts, were some and findings is slightly more problematic as reported
of the first cancelled. Numbers of children screened in Table III. The University of Wisconsin Population
also declined. This decline was directly proportional Health Institute has produced the Wisconsin County
to reduced funding, and school district boards deter- Health Rankings as part of epidemiologic data tracked
mining they could no longer participate in preventive by the University of Wisconsin School of Medicine and
health programs, even though these programs were Public Health.41 Data appears to document improve-
clearly cost efficient in relation to preventing com- ments, however slight, in the epidemiologic reporting
munity disease burden. Individuals on educational on the QoL measures for the population studied. QoL
boards often do not understand how disease affects metrics basis were 2 categories: Health Outcomes
student performance, resulting in lost productivity or (deaths/self-reporting health status) and Health De-
classroom hours when making budgetary cuts. From terminants. Determinant data included health behav-
a public health perspective, funding these programs iors, socioeconomic factors and physical environment.
for community vitality is wise. Data in Table II also Initial QoL outcomes data for 80% of recipients ranked
documented declines over time in numbers of chil- in the bottom half of state, while 70% of person’s orig-
dren requiring urgent care as they entered the referral inal determinant data was also ranked in the bottom
pipeline for restorative care. Children requiring early half of reported metrics. Counties were ranked from
care also declined over time as referrals were made 1 to 72, 1 being considered the best county to live in

Vol. 87 • No. 5 • October 2013 The Journal of Dental Hygiene 303

and 72 the worst. Each year, for both categories, the Access to Care
public health department studied has made improve-
ments as reflected in the QoL data. Where cumula- Considerable effort has been undertaken highlight-
tively the county still ranks in the lower third for this ing access to care issues. Recent reports developed
overall measure, it appears yearly rankings are slowly by Beazoglou et al51 and Bailit52 for the state’s dental
improving.49 Significant concerns exist with using this association and department of health services work-
data for determining if QoL was truly improved for the force development taskforce took the perspective that
population studied. First, data is renormed annually. Wisconsin’s dental workforce needs are no more than
Thus, data is dynamic in nature. Secondly, data gath- a marketing supply and demand issue, rather than ac-
ered and analyzed for this measure continues evolving cess to care issue. The predominant issues are deeper
as public health concerns evolve. With data being re- than marketing, and several issues regarding access
normed annually, and resultant changes from said re- to care require consideration.51-55 Several potential so-
norming, data validity becomes questionable. Another lutions are offered here for discussion.
consideration includes inter-examiner consistency and
reliability for those gathering and reporting data with Number of Work Hours per Calendar Year
epidemiologic research team changes. When measur-
ing QoL, these are significant limitations affecting con- The average person working full time spends ap-
sistency of the state’s epidemiological data. If differing proximately 1,750 to 2,000 hours each year at
researchers are considering and reporting on the ana- work.56,57 Beazoglous’ Wisconsin dental workforce
lytic data found, yearly differences in interpretation or study reported practices averaging 1,385 hours per
results are likely being reported. Politicians and pub- year.51 Analysis of this data identified dental care pro-
lic policy makers use these health data outcomes for viders worked 415 to 615 hours less than full time
determining funding of public health programs. This employees in various businesses and industry.53-57
raises troubling questions about social justice when According to Beazoglous’ convenience survey, it was
state funding supporting public health preventive care reported restorative services were offered 30 to 32
programs is limited when data for determining state hours per week.51 This equates to 43 weeks of part
health outcomes lacks consistency from year to year. time work, with 5 weeks unscheduled yearly.51,53,54,56,57

Identifying QoL metrics might be better measured Access to restorative care services illustrated by
using a survey. Surveying populations receiving care this data alone highlights one access to care issue.
might be a better technique for gathering data deter- If oral care practitioners worked the same amount of
mining if quality of life has been improved. An appro- time as other health care providers or full time em-
priate survey focused on QoL questions would need to ployees in business and industry, access issues might
be developed . A survey might provide better insight decline. Dental hygienists performing expanded func-
into people’s perception of improved QoL rather than tions could have foreseeable impact on QoL for resi-
reliance on broader, epidemiologic data for making dents located in rural, socioeconomically disadvan-
that determination. One recommendation for a future taged communities. Broadening access to care, while
study includes conducting a focused survey asking increasing workforce capacity and improving QoL
questions determining if QoL was impacted rather than could be achieved using the Advanced Dental Hygiene
using state and national data from an epidemiologic Practitioner, Dental Health Therapist or Public Health
perspective.49 Additional study determining QoC and Dental Hygiene Practitioner models for meeting oral
QoL for other public health departments programs in care needs.11-13,15,16,30,31
the Dental HPSA shortage areas should be conducted.
A final recommendation includes further developing Scheduling Practices
and offering a conceptual framework considering the
intersections between QoC, QoL, workforce develop- Scheduling practices typically follow traditional busi-
ment and access to care issues. This conceptual model ness models. Scheduling presents another access to
could be used as a benchmark tool using QoC and QoL care issue. Access to oral health care services, similar
for measuring impact of public health dental hygiene to medical care, should follow Medical Models.32,58-61
practice and program effectiveness. Dental hygienists working through public health de-
partments can expand access by offering care in alter-
Two apparent issues emerged from this investiga- native settings, at alternative times, for meeting care
tion: significant access and demographic bottlenecks needs of community populations.
exist in the pipeline to oral health care services and
workforce development issues as noted by a docu- Care Models
mentable lack of providers. Both these issues have
multifactoral considerations, and each is considered Another actionable consideration for improving ac-
separately. cess to care includes developing and putting in place

304 The Journal of Dental Hygiene Vol. 87 • No. 5 • October 2013

Clinical Emergency Models. In the Medical Model, peo- ment and state demographic issues are important
ple access the Emergency Room for acute care and considerations associated with accessing care, even if
services.32,33,58-61 Similar to the Medical Model, “safe- unpublished state data minimizes these problems.51,52
ty net” dental clinical locations could provide dental Career laddering and educational opportunities for
emergency care. Once emergency care is provided, dental hygienists offering expanded functions can as-
patients are referred back to community practices. In sist in developing and expanding the workforce for
this way, there are clearly defined “safety nets” for meeting oral care needs of the populace.11,15,58-61,64 Us-
care reducing barriers to access.13,58-61 Dental hygien- ing alternative care models and hygienists trained in
ists trained in providing expanded functions, can simi- expanded function care services can impact QoC and
larly affect access to care. QoL for patients in underserved, socioeconomically
disadvantaged rural communities.
Removal of Practice Restrictions
Conclusion
Another bottleneck exists at the system level - leg-
islative restrictions regarding access to care currently Dental hygienists delivering services through
exists.62,63 Dental hygienists occupational preparation public health departments can influence QoL
includes providing educational and preventive care through QoC services. As a result of this descriptive
services for individuals, groups and communities.15,16 research, oral health education and sealant delivery
Hygienists are being limited by legislative practice acts were deemed safe through Wisconsin Dental Exam-
to providing care within specific practice settings or ining Board records and clinically effective (SEALS
locations. Changing legislative codes would allow den- database). It was determined the consultation and
tal hygienists to provide their full scope of practice if referral model works effectively for linking individu-
legislative practice act restrictions are removed.62,63 als with restorative services, including routine follow
up. Additionally, alternative programs can improve
Measureable actions like these can begin shifting access to care for individuals with economic dispari-
oral health care disparities. For changes to occur legis- ties and cultural differences.
lators and restorative oral health care providers mental
paradigms have to shift first. Access to care ultimately Jodi L. Olmsted, RDH, BS, MS, EdS, PhD, is an
improves QoC and QoL for all citizens. Increasing the Assistant Professor at the University of Wisconsin
number of provider service hours worked, modifying Stevens Point in the College of Professional Stud-
scheduling practices, and developing emergency care ies, School of Health Care Professions. She is also a
locations are practical and viable solutions to address- distance education consultant for Kaleidoscope Con-
ing access concerns. Removal of legislative restrictions sulting, LLC. Nancy Rublee, RDH, CDHC, is a Public
is another solution for addressing problems associated Health Dental Hygienist at the Price County Public
with accessing care. Health Department. Emily Zurkawski, PTA, BS, is
a physical therapist assistant at Aegis Therapies.
Workforce Development Laura Kleber, BS, graduated from the University of
Wisconsin Stevens Point, majoring in Health Care
Workforce development is another opportunity. Administration, and works as a Research Adminis-
Declining numbers of restorative practitioners due to trative Assistant for Aurora.
impending retirements, stagnant workforce develop-

Vol. 87 • No. 5 • October 2013 The Journal of Dental Hygiene 305

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