Shaping Oral Health

Fred W. Michmershuizen

The American Dental Association (ADA) maintains that dental hygienists should work under the supervision of a dentist and emphasizes the importance of collaborative practice to ensure quality patient care. This position is elucidated in ADA's policy statements and guidelines.^1,2 In short, ADA underscores that hygienists should practice within a defined scope that includes education, assessment, and preventive care.

The American Dental Hygienists' Association (ADHA), on the other hand, advocates for a broad scope of practice for dental hygienists, promoting the role of hygienists as essential providers of preventive oral health care, independent of direct supervision in certain settings. Through its position on the role of dental hygienists and its published Standards for Clinical Dental Hygiene Practice,³ the ADHA emphasizes the importance of allowing hygienists to practice to the fullest extent of their education and training to improve access to care and promote public health. These responsibilities may vary, however, depending on state regulations, educational requirements, and the policies and procedures of individual practice settings. Staying informed about regulatory changes and educational advancements is essential for hygienists to maximize their impact in promoting overall health and wellness, which is why organizations like the ADHA can have such a great impact.

"Some areas of the country are modernizing dentistry and embracing the role of the dental hygienist as a healthcare provider, but the scope of practice for dental hygienists, unfortunately, still varies considerably from state to state," says Erin Haley-Hitz, RDH, BSDH, MS, FADHA, MAADH, president of the American Dental Hygienists' Association (ADHA^®). In addition to her role at ADHA, Haley-Hitz is a hygienist in clinical practice with 30 years of experience. "Some states have been progressive in advancing legislation to increase professional development and direct access to care by allowing dental hygienists to practice to the full extent of their education and training, while others lag behind. Recent advancements in scope of practice for dental hygienists include vaccine administration, teledentistry, prescriptive authority, alternative practice settings, supervising dental assistants in public health settings, and myofunctional therapy."

Haley-Hitz emphasizes the importance of recognizing the evolving role of dental hygienists in the healthcare landscape, highlighting key changes that could enhance their professional status. "There are several things that could change to better recognize the education level, skillsets, and true role of dental hygienists," Haley-Hitz says. "To start, obtaining full professional autonomy over dental hygiene education, practice, and licensure is needed. These changes would help create a more empowering practice environment for dental hygienists, enabling them to serve as primary providers of oral healthcare. Key changes are needed in legislative reform, educational standards, scope of practice and practice settings."

Dental hygiene educator Alicia Murria, RDH, MS, a member of the hygiene faculty at Align Technology, associate hygiene productivity coach at Inspired Hygiene, and alumni member at Forsyth School of Dental Hygiene, agrees. "Limited autonomy and restrictions on independent practice hinders our ability to function at our highest potential," Murria says. "As healthcare providers, we need the ability to diagnose, treat, and bill independently to better serve our patients and expand access to care."

Murria highlights the pressing need for dental hygienists to gain greater control over their practice, advocating for expanded autonomy in treatment decisions. "The most critical area for expansion in our scope of practice is autonomy over treatment decisions," Murria says. "Dental hygienists should be empowered to determine the necessary treatment plans, perform those treatments, and bill as providers. Additionally, working with dental assistants to triage and assess patients' periodontal needs would allow hygienists to operate more efficiently and effectively, elevating patient care. Expanding our scope in this way would ultimately enhance the level of service we provide and improve access to care for more patients. We should be championing the idea of a ‘dental hygiene diagnosis' rather than making hygienists feel that they are unable to ‘diagnose.'"

Tina Clarke, RDH, BSDH, MEd, FADHA, an author, podcaster, and founder of Teacher Tina RDH, says roadblocks in many states often present challenges to dental hygienists who want to reach their full potential. "Hygienists receive high quality education to prepare them to care for a wide variety of patients, but, unfortunately, there are certain states which don't allow hygienists to utilize this education to its fullest potential," Clarke says.

Clarke points to the challenges dental hygienists face within team dynamics, emphasizing the impact of restrictive practices on their professional contributions. "Other members of the dental team may not allow the hygienist to fulfill certain duties," Clarke says. "For example, in the Northwest dental hygienists who have completed the appropriate training and examinations can perform minor restorative functions yet they may work at a dental practice in which the dentist will not allow them to perform this procedure. It can make one feel like all the hard work and education was for nothing."

Yet another hurdle for a dental hygienist, Clarke says, is portability of license. "With the license compact becoming a reality, this should make a big difference," she says.

Haley-Hitz argues that empowerment of hygienists is crucial for both public health and professional satisfaction. "Dental hygienists should be able to practice their full education and training without restriction," Haley-Hitz says. "Reducing barriers and empowering dental hygienists to fully embrace their role will not only lead to better health outcomes for the public but will also improve workforce issues. When dental hygienists have greater control over their environment and practice, they will have greater career contentment, sense of purpose and professional longevity."

As integral members of interdisciplinary healthcare teams, dental hygienists play a vital role in promoting prevention and education, impacting both oral and systemic health. Their unique position allows them to bridge the gap between dentistry and other healthcare disciplines, fostering collaboration that benefits patients holistically.

"In interdisciplinary healthcare teams, dental hygienists serve as prevention specialists," Murria says. "We are one of the few healthcare modalities that focus on prevention and patient education as a primary treatment option. By working alongside other healthcare disciplines, dental hygienists can leverage their vast knowledge of preventive approaches to not only improve oral health but also contribute to the overall health and well-being of patients. This collaboration can lead to healthier bodies and more confident smiles, bridging the gap between oral and systemic health as well as dentistry and other healthcare disciplines."

Murria highlights the multifaceted role of dental hygienists, emphasizing their essential contributions as educators and prevention specialists in the healthcare landscape. "Dental hygienists are mid-level providers and prevention specialists," Murria says. "Our role goes beyond delivering cleanings-we educate patients, help them understand their oral and systemic health, and guide them toward accepting necessary treatments. This educational approach not only improves patient outcomes but also significantly impacts the profitability and production of any dental practice. By spending 40 to 50 minutes with patients, we build trusted relationships, gather crucial health information, and create a foundation for more personalized and effective care. This time with patients is invaluable, allowing us to truly serve their needs and help them feel comfortable and confident in their treatment decisions. Dental hygienists are the systemic link and connection to all things prevention."

Clarke says that dental professionals have long understood the health of the oral cavity impacts total body health and that the rest of the medical community is catching on. "The knowledge and skills of a hygienist can easily be applied in any healthcare setting," Clarke says. "Oral health doesn't just happen in the dental operatory. When hygienists can share their knowledge, the patient always wins."

A recent development the profession is challenged with, Haley-Hitz says, is the growing trend of organized dentistry promoting new workforce models that are less progressive. "This diminishes the value of dental hygienists' education, expertise, and role in interprofessional practice," Haley-Hitz says. "Dental hygienists are facing many workplace challenges, such as reduced time for patient care, overburdened schedules, and the introduction of workforce models that lower educational and licensure standards. These changes fail to address oral-systemic health and the underlying issues that are driving many dental hygienists to leave the profession, threatening both professional integrity and patient outcomes."

Another challenge, Murria says, is the public perception of the role hygienists play. "One of the most significant challenges dental hygienists face is the public's lack of understanding about our role and the full range of services we provide," Murria says. "Many patients still view dental hygiene solely as a cleaning service, which hinders our ability to engage them in the broader preventive and diagnostic care that we are trained to deliver."

As the conversation around healthcare integration evolves, Haley-Hitz emphasizes the crucial role dental hygienists play in preventive care. "The ADHA would like to extend an invitation to any healthcare providers and stakeholders who share the vision of improving healthcare by recognizing and utilizing dental hygienists as the primary preventive specialists in oral healthcare," Haley-Hitz says. "Continued restrictions hinder us from achieving our goal of improving the health outcomes of the individuals we serve. Limiting our scope and autonomy reduces our capacity to fully utilize our skills and knowledge and prevents us from providing the public with needed comprehensive care. To truly impact public health, dental hygienists must be empowered to practice at the top of their license, contributing more effectively to preventive care and addressing health disparities in our communities."

This call to action highlights the need for collaborative efforts to enhance the role of dental hygienists in healthcare.

The evolving role of dental hygienists is vital to the future of oral and systemic healthcare. As advocates for patient education and preventive care, dental hygienists possess the knowledge and skills to bridge the gap between dental and broader health practices. However, to fully realize their potential, it is essential that legislative reforms, educational advancements, and shifts in public perception occur. Empowering dental hygienists to practice independently and to the fullest extent of their training will not only enhance patient care but also improve health outcomes across communities. Fostering an environment that recognizes the importance of hygienists, the experts say, will help create a healthcare system that values collaboration, innovation, and comprehensive care. As the ADHA emphasizes, the time is now for stakeholders to join forces in supporting dental hygienists as primary preventive specialists, ensuring that they can thrive in their roles and contribute meaningfully to public health.