Written by: Will Peakin

There is a growing body of opinion within the profession that questions whether we are training too few hygiene therapists. It was articulated recently by Professor Philip Taylor, Dean of Dental Surgery at the Royal College of Surgeons in Edinburgh, who was speaking during a question-and-answer session at the Scottish Dental Association’s Summit in May.

“Should we be training as many dentists? Should we start to train more hygiene therapists? We actually need [them] if we are going to solve the periodontal problem,” he said. “Like the model in some of the states in America,” he suggested, “where you have one dentist, you have 20 hygienists or 20 therapists that are working away. And the dentist [is] the person doing the diagnostics, making the treatment plan, and doing the more complex treatment.”

Professor Taylor’s comments were backed by Kyle Anderson, of the British Association of Dental Therapists. He told Ireland’s Dental magazine: “There is a pivotal role that therapists and hygienists can play, following the pandemic, in practice. Periodontal disease has been linked to health conditions such as diabetes, heart disease and Alzheimer’s, and as highlighted in several recent international and British studies, it could now pose serious risk of COVID-19 complications.

“Therapists and hygienists are best suited to treat periodontal disease and more can be done to prevent the progression of gum disease. The treatment for periodontal disease can be carried out without requiring AGP’s and is largely based on prevention. The hygienist and therapist, if given the opportunity to provide their full scope of practice, could reduce waiting times for appointments with the dentist by triaging and providing treatment under referral or working under direct access.”

It is fitting, then, to highlight a success story in this field. For more than 20 years, Joanne Knox has worked tirelessly helping her patients focus on preventative measures to keep their teeth and gums healthy. As an award-winning dental hygienist, she knows the importance of keeping your mouth healthy – and she wants her patients to have better access to professionals like her who offer this specialist service. Now, Joanne has opened her own practice – Pure Dental Hygiene in Coleraine – one of one of only two practices in Ireland that offer exclusive access to dental hygiene services.

“In 2013 the Government changed the rules allowing the general public to access a dental hygienist directly, without the need for a referral from a dentist,” said Joanne. “When this happened, I saw the opportunity for hygienists to become a more accessible independent entity. I was fortunate to work in practices that embraced dental hygiene and encouraged me to treat patients via direct access under their umbrella. With their support and encouragement, I was honoured with the title of Northern Ireland Health Care Awards Dental Hygienist of the Year 2018.”

Joanne echoes Kyle’s views: “Dental hygienists are trained to the highest of standards, to treat gum disease and educate patients about preventing tooth decay. There’s a lot more to a dental hygienist than just cleaning teeth. A hygienist manages the prevention and treatments to maintain gum health, which in turn makes the job of a dentist easier. People are now more aware than ever of the significance of periodontal health to holistic health benefits.

“In the times we are currently living through we all understand more how important it is to control bacteria and maintain good hygiene and your mouth is no different. Our primary focus is on the prevention of dental disease because it’s true that prevention is cheaper than cure. We do routine cleaning and polishing, the treatment of mild to severe gum issues, bleaching and we make sports’ guards, among other things. This is your opportunity to see a hygienist with no waiting lists while also staying with your own dentist.”

Joanne also treats children: “We offer a treatment called the Pure Tiny. This is a fun introduction to the dental surgery environment. The younger you get them sitting in the chair the better. We are all about preventing the actual need for treatment so preventative treatments and education are key. Teeth can be disclosed, and the kids can physically see the plaque on their teeth – they then get a gentle clean and polish.”

Her journey to this point has been bittersweet. “Having my own practice has always been my dream but genuinely never thought I would have the nerve to pursue it. Over lockdown all dental practices were shut, so for the first time in my 20-year career, I was at home. I had time to re-evaluate what was important and what I wanted and needed from life. People ask me how I have been able to set up a business during a pandemic. My answer is that it was forced upon me by various events and to a large part by my mum who was my biggest supporter.

“On the practical side, it happened because the building came onto the market. But reflecting on everything, I see my mum’s part has been immense. She has been the driver of it all while alive and I believe, beyond.  Mum has always pushed me towards running my own practice. My husband and I were caring for mum and living in her home when I saw a premises, in an area I loved, had become available online.

I showed it to my mother and said: ‘Wouldn’t that be a fantastic practice mum?’. The last text message my mum sent me before she died was about the premises. She had written: ‘Do you think it will be signed and sealed?’” Several months after being diagnosed with an aggressive brain tumour, Joanne’s mother, Hester Kernoghan, died on August 9 last year. She was 65.  “I cared for my mother up to her death. I could tell the tumour was rapidly growing. Her care was difficult, and her death was fairly traumatic for me – mum died in my arms.”

In her will, Hester had left enough money to help get her daughter’s dream business off the ground. And after acquiring the premises, under coronavirus restrictions with no honeymoon, Joanne married Peter last October. The newlyweds then spent 10 weeks kitting out the building. “We were able to turn the premises around quickly because Peter is a builder and we worked 12 hours a day, seven days a week. Peter built it and I helped with wiring and lagging pipes. We were blown away

by the support of the dental company – BF Mulholland – that helped us fit out the premises; they became like family.” Joanne’s sparkling new practice includes two Belmont Voyager chairs.

“I knew my mum was still pushing me to follow my dream,” she said. “I was also seeing a crisis in dental health with the coronavirus closing all but emergency care and I could design my practice with COVID-19 safety in mind.” Now operational, Joanne is living her dream and will be eternally thankful to her devoted mum. “My patients have already ranged from age three to 92 in the few weeks after we opened. I know mum would be delighted with this. If there’s anything the last year has taught me is that life is short, dreams require courage, risk, passion and of course a mother’s love.”