The Future for Dental Hygienists: Expanding the Profession’s Scope

During your previous dental exams and cleaning, you may have seen your dentist for a few minutes. But the main interaction was probably with the hygienist, right? Even though dental hygienists take care of numerous patients each day, this profession…

During your previous dental exams and cleaning, you may have seen your dentist for a few minutes. But the main interaction was probably with the hygienist, right? Even though dental hygienists take care of numerous patients each day, this profession can sometimes be overlooked.

In fact, had an interesting commentary about this matter:

How to embrace the phrase, ‘Oh, you’re just a hygienist!’

I am certain that every hygienist has heard the phrase, “Oh, you’re just a hygienist.” I recently attended a function, and someone I was introduced to uttered the dreaded phrase. The “just” hit me in the chest as if I was wearing a shirt with a bull’s-eye on it. Everyone around us continued to engage in their conversations, and I noticed I was the only person in the room that actually reacted to the “just.” Yes, I am just a hygienist:

  • Yes, I just review the patient’s medical history with them verbally because sometimes when patients are nervous they forget to write valuable medical information down on forms.
  • Yes, I just talk to my patient for 45 minutes while I am “cleaning teeth” in order to help them feel comfortable and more importantly assess their stress level while gaining insight into their overall health.
  • Yes, I just perform oral cancer screenings, periodontal charting, decay assessments, oral hygiene assessments, sealant placements, fluoride treatments, detailed explanations regarding dental treatments, and deal with any other overall health concerns they may have, often referring them back to their physician.
  • Yes, I just sterilize the operatory, equipment, and dental instruments according to state regulations to ensure the health and safety of my patients and myself.
  • Yes, I just obtained my bachelor’s degree in allied dental health, completed continuing education requirements, maintained my local anesthesia license, maintained my dental hygiene license, maintained my nitrous oxide administration credits, and continue to research dental technology to ensure that my patients are receiving the best dental hygiene care possible.

. . . I know the varied abilities and diverse opportunities being a hygienist represents. Still, I’ve chosen to fully embrace the phrase, “you’re just a hygienist.” Why? I do so to follow the brilliant and humble example of the Dalai Lama who once said, “I describe myself as a simple Buddhist monk. No more, no less.” My fellow hygienists, I hope you are proud to be just hygienists!

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The Future for Dental Hygienists: Expanding the Profession’s Scope

Even though this is just one hygienist’s experience, perhaps there needs to be a greater appreciation all around–and not just from patients, but from peers in the medical community. But even if the profession is currently undervalued, that doesn’t mean that it will be in the future.

Thankfully, the Dental Tribune says that because of their education and skills, hygienists should be allowed to contribute more to the field as oral health care becomes more accessible:

ADHA white paper looks at hygienist’s role in diagnosis

“Through dental hygiene diagnoses, dental hygienists educate patients on behaviors that minimize risks of oral infections, help detect risk factors for infectious diseases and cancers of the head and neck,” said ADHA president Betty Kabel, RDH, BS. “This elevates the role of the dental hygienist within the overall health care system, as we seek to expand the access to oral care. It’s important to utilize the dental hygiene diagnoses regularly and consistently to ensure optimal care for our patients.”

While dental hygienists’ rigorous education prepares them to provide preventive and therapeutic oral health services, the profession’s scope of practice varies from state to state. ADHA emphasizes that it is important for dental hygienists to fully utilize their education to provide oral health care services that fall within their scope. . .

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As you can see, while being an undervalued professional is certainly a concern, perhaps the issue here is deeper. If each state has different practicing standards and needs, maybe hygienists themselves may be hesitant to establish a foothold on their role. In fact, one New York hygienist talks about this struggle that hygienists may undervalue themselves since they are often concerned with being “gatekeepers” or “people-pleasers” between patients and dentists.

But this hygienist encourages her fellow hygienists to speak up about diagnosis issues–especially since they have the license to do so. Again, even though a hygienist’s role may be undervalued and uncertain now, it does look like the profession will continue to expand its scope.

One study even showed that healthcare for patients improved when hygienists were allowed to expand their roles:

Can expanding hygienists’ practice improve adult care?

Does expanding a hygienist’s scope of practice translate to improved oral healthcare at the state level? Researchers from New York believe it does, according to the results of a survey published this month in Health Affairs.

With the debates about dental therapists and dental telemedicine ongoing, researchers from the University at Albany in New York updated a previous study to investigate if hygienists with expanded practice options could reduce the oral disease burden.

“Scope of practice for dental hygienists … had a positive and significant association with having no teeth removed because of decay or disease,” wrote lead study author Margaret Langelier and colleagues (Health Affairs, December 2016, Vol. 35:12, pp. 2207-2215).

You can read more about the changing roles of hygienists at the American Dental Hygienists’ Association (ADHA) website. The association is concerned with this profession’s value, since “confusion still exists on how to implement it into daily practice.”

As the focus of public health oral healthcare has shifted from treatment to prevention, reaching underserved populations has received increased attention. Fifteen years ago, study authors created a new index to quantify hygienists’ scope of practice. With the current study, they wanted to see if any change in index scores also correlated with an expansion of hygienists’ scope of practice.

In 2001, the authors created the Dental Hygiene Professional Practice Index (DHPPI), which is comprised of four categories:

  • Regulation
  • Supervision by practice setting
  • Tasks permitted under varying levels of supervision
  • Reimbursement

The authors also compiled state-by-state scores and found that states that had new or expanded dental hygiene practice models had higher scores in general than states that have not enacted an expanded practice model.

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Even though hygienists have been undervalued, it’s certainly reassuring to see recent studies back up their claims. Their roles should be expanded and duties should be standardized so the ADHA doesn’t have to report continued discrepancies.

Stephen Nozaki, DDS, MPH, DIDIA

Dr. Stephen Nozaki is the owner and lead dentist at Image Dental in Stockton. He is a dedicated professional born and raised in California's Central Valley. With a commitment to his community, he brings advanced dental techniques learned from extensive education and continuous training from around the world. A third-generation Japanese American, Dr. Nozaki has a rich background that includes international living and a deep passion for both dentistry and outdoor activities. His focus in dentistry aligns with his passion for cosmetics and dental implants.