The profession of dental hygiene in Bahrain: a dental hygiene educator working and living in the Kingdom of Bahrain

Access, March, 2008 by Claudine Paula Drew

Bahrain is a small island, approximately 15 miles wide and 35 miles long, located 13 miles off the east coast of Saudi Arabia in the Persian Gulf. This small kingdom has rich history dating back thousands of years. It housed the Dilmun civilization, which was part of the Bronze Age trading empires. Because of its strategic location along the Mesopotamia/Indus Valley trading route, it provided an oasis for ships to secure fresh water. This communication with outsiders promoted strong diversity and social systems within its inhabitants. Today, the country exhibits a tolerance of other cultures and lives in easy acceptance of its neighbors and global visitors. The Bahraini hospitality is renowned (Figure 1).

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Dental Hygiene Profession

The Ministry of Health's College of Health Sciences graduated its first class of dental hygienists nearly 20 years ago. Dental hygiene has continued to grow from that time forward, despite a few challenges. In 2006, an evening program at the College of Health Sciences was initiated by the Department of Labour to strengthen the number of not only dental hygienists, but also other allied health care providers such as nurses, midwives, pharmacy technicians and radiography technicians. This additional program will increase the associate degree dental hygiene class from approximately 10 to 20 graduates per year. The populace of Bahrain needs these additional dental hygienists, who bring better preventive services to all sectors of the Kingdom through either the Ministry of Health clinics or private clinics. The concept of prevention is relatively new, and educating the dental patient to maintain a healthy dentition proves to be a daily and ongoing challenge.

It is noted that the predominance of dental caries is on the rise here in Bahrain. In 1986, the DMFT score recorded by the Oral Healthcare branch for the Eastern Mediterranean Region (EMRO) of The World Health Organization (WHO) was moderately low, at 1.0 for Bahrain's 12-year-old population. In 1995, that same group showed a rise to 1.4 (Table I). (1) In a recent discussion with Azhar Naseeb, BDS," MDPH, MScHCM, the dental public health consultant at the Bahrain Ministry of Health, this caries trend and DMFT score appear to be on the upswing. Naseeb does not have all of the 2005 data compiled and tabulated, but she is expecting that the dental caries score and the DMFT will be even higher in this newest 2005 survey due in a few months to WHO.

The periodontal profile from the EMRO states that 71 percent of 15- to 19-year olds surveyed had calculus, while only 18 percent of this same age group had no periodontal disease involvement (1986). (2) Although there is no periodontal profile for 1995, the 2005 preliminary findings demonstrate that approximately one third of the 12- and 15-year-old Bahrainis have periodontal disease of 4 to 6 mm pocket depth (Table II). (3) It would appear from these preliminary findings that there is a great need for preventive gingival and periodontal maintenance services.

Who better to bring these needed preventive services to the public than the graduate dental hygienist? The dentist is needed for many curative and aesthetic procedures while the dental hygienist's main role has always been in the area of prevention. As you know, preventive services include but are not limited to individualized home care education through mechanical and chemical interventions, complete oral prophylactic preventive maintenance, periodontal recare therapy maintenance, diet counseling, fluoride application in clinic and home procedures, smoking cessation, protective athletic mouthguards, tooth desensitizing agents and dental sealants.

Another important consideration from the WHO-EMRO's recent report is the distribution of the health care workers (Tables III and IV). For every 100,000 people in Bahrain in 2004, there are only 46 dentists. (4) Compare this with the U.S. statistic in 2003 showing that there were 703 dentists for every 100,000 people. Bahrain is in definite need of more oral health care providers.

In Bahrain, the dental hygienist is becoming an important member of the dental team. The career path for the dental hygienist is expanding into the private sector. At present, the licensed dental hygienist can work

* in public clinics and private dental settings

* as primary and secondary school dental hygienists

* in higher education as a dental hygiene teacher

* in administration, such as WHO or local ministries, setting up preventive dental programs, such as sealant applications.

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Dental hygienists do not participate as employees in either the dental or pharmaceutical industry, and they are nonexistent in oral research.

Dental Hygiene Education

The current educational dental hygiene model consists of five semesters. The first semester contains general education courses such as anatomy and physiology, chemistry, English, etc. The ensuing tour semesters include the preclinical, clinical, nutrition, prevention, pathology, epidemiology, oral radiology and patient management courses, to name a few. This model is fashioned after the American dental hygiene curriculum. At present, there are two full-time American dental hygiene educators: Program head Paula Parise, RDH, MS, and the author. Part-time Bahraini faculty members who teach the evening curriculum include dentists and local dental hygienists (Figure 2).