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Meet the Hygienist Who Pushed For Silver Diamine Fluoride Approval — And Got It

Before coronavirus, Halverson spent half her week at a dental office she’s worked at for 30 years; the other half is spent bringing care to those who can’t get there on their own.

Heidi Halverson's Dental Hygiene At Home for elderly and high-needs patients.

Heidi Halverson only goes into the office three days a week. But she doesn’t take a break the other days — she runs her own company, Dental Hygiene at Home. As a dental hygienist with nearly 40 years of experience, Halverson decided seven years ago to help patients who can’t get to a traditional office. She spends three days a week visiting long-term care facilities in Montana, caring for the elderly and people with disabilities.

According to research from the Health Policy Institute, 56 percent of seniors in the United States do not receive dental services on a regular schedule, making it harder to manage chronic conditions, nutrition, quality of life, and other aspects of overall health and wellbeing. Today, one way to reach these people is by bringing care to them — a major component of Preventistry. This hygienist is truly living Preventistry as part of her daily life.

What are some of the common oral care issues patients in long-term care facilities face?

What people don’t realize is older people often feel less pain in their mouths. As dentin gets thicker and closes off the pulp chamber — which houses your nerves and blood supply — there’s little pain. So elderly people break off teeth and don’t even know it. Facilities have told me, “We found this tooth in a recliner.” Or last week I saw a patient and said, “Oh my gosh, you’re missing your front tooth!” and she responded, “Yea, pretty sure I swallowed it.” But no pain also means you don’t think you need to brush, and so I spend a lot of my time getting deep into the gum line and treating decayed teeth. Unfortunately there’s no oral care in any of these long-term care facilities, even if you’re a millionaire — it just wasn’t wrapped up into Medicare when it was formed so it isn’t part of the facility experience. These residents don’t have a relationship with a dentist anymore, so that’s where I can step in. 

open Dental Hygiene At Home, which brings oral health care to elderly and high-needs patients in Montana.You succeeded last year in getting silver diamine fluoride (SDF) approved by the State Board of Dentistry so dental hygienists could use it in alternate care settings. How difficult was that process?

It was a huge deal! Our board is heavy on dentists (who typically don’t want SDF applied without a dentist’s approval) so we went on a huge campaign. Our messaging focused on how effective and inexpensive SDF can be — especially useful for older patients and those with high needs.

We really only had to sway one board member to get it passed. So we got letters from dentists, doctors and attorneys from all over the country to show their support - we are all part of the same team working together to make people healthier, and SDF is a gamechanger in terms of managing oral disease more broadly. A reporter covered our efforts and showed the research in an article that ran in local papers around the state. It was published on Wednesday, and the vote was Friday, so it had a big impact. This older board member who’s always voted with the dentists voted with the hygienists after seeing it — and just how hard it can be for a hygienist to get physician approval — and then the other dentists swung. The last count was 7-2. 

Why is SDF so critical to your work?

Studies (like this one) show the simplicity of SDF is especially effective in elderly and high-needs patients who can’t make it to a dentist and sometimes can’t sit for the length of average oral care treatments. I’m saving teeth! You put thousands of dollars into dental work over the years for beautiful teeth, and then it all goes to pot if you don’t continue regular oral care for the rest of your life. One of my patients who recently passed was so handsome — he was on The Ed Sullivan Show. When I saw him, he’d already had five teeth extracted, but I went to see him every month for three years and we were able to save his other teeth from the same fate. He was able to eat and to nourish himself — and he was so handsome right to the end.

Read more stories about Preventists changing their communities and learn more about the future of oral health at Preventistry.org.