The hygienist is in the best position to be a health coach and to diagnose and help manage oral systemic connections, TMJ , airway disorders and orthodontics. Physician assistants and nurse practitioners are now supervising and directing patient care in medical practice. Hygienists are poised with the proper training to do the same thing for the dental practice. It starts with a wellness scan and review of medical history and problem list . The hygienist sees their patient at least twice a year and is in the best position to prevent disease and create wellness.