Letter from the 2004–2005 ADHA Presidentwsdha.com/clientuploads/pdfs/ADHA pdf/ADHA_Focus_on...Letter from the 2004–2005 ADHA President What would the future of dental hygiene be

Letter from the 2004–2005 ADHA President

What would the future of dental hygiene be if it were written by dental hygienists with thefreedom to envision, to aspire, and to accomplish?

In 2002, the American Dental Hygienists’ Association (ADHA) set out to answer thisquestion when it implemented the “Future of Dental Hygiene” project. Three years later,Dental Hygiene: Focus on Advancing the Profession is realized.

This report encompasses far more than just the future of the dental hygiene profession,which was the original intention. In fact, this report expertly and logically documents ourhistory and current events. It also outlines an innovative direction for dental hygiene’sfuture. There have been significant milestones reached throughout the history of dentalhygiene. However, we clearly have numerous opportunities ahead that will not only benefitthe public’s oral health, but will open doors for dental hygiene professionals in every state.

On behalf of the ADHA Board of Trustees, which approved this report at its winter 2005meeting, I am proud to share the thoughtful, engaging, surprising and possiblycontroversial ideas with our state and local association leaders, members, healthprofessionals, governmental officials, and other interested groups.

The board clearly recognizes and appreciates the time and effort that has gone into thisreport by the advisory board, subcommittees, and ADHA staff. This report exemplifies theendless commitment to ADHA and to the profession of dental hygiene by theseindividuals.

Best regards,

Helena Gallant Tripp, RDHADHA President

AMERICAN DENTAL HYGIENISTS’ ASSOCIATION 11

2 AMERICAN DENTAL HYGIENISTS’ ASSOCIATION

2004–2005 ADHA Board of Trustees

Helena Gallant Tripp, RDHPresident

Katie L. Dawson, RDH, BSPresident-Elect

Marge Green, RDH, MSVice President

Carol A. Jahn, RDH, MSTreasurer

Tammi O. Byrd, RDHImmediate Past President

Jean Connor, RDHDistrict I Trustee

Sherri L. Meyers, RDH, MSDistrict II Trustee

Pamela Quinones, RDH, BSDistrict III Trustee

Anita F. LaTourette, RDHDistrict IV Trustee

Lynn Ramer, LDHDistrict V Trustee

Patricia A. Davis, RDHDistrict VI Trustee

S. Kaye Adams, GDHDistrict VII Trustee

Mary Kelly, RDH, BSDistrict VIII Trustee

Hope Garza, RDH, BSDistrict IX Trustee

Lori J. Brogna, RDHDistrict X Trustee

Sharon Zastrow, RDHDistrict XI Trustee

Caryn Solie, RDHDistrict XII Trustee

Table of Contents

Overview . . . . . . . . . . . . . . . . . . . . . . . page 4

Introduction . . . . . . . . . . . . . . . . . . . . page 6

Research . . . . . . . . . . . . . . . . . . . . . . . page 11

Education . . . . . . . . . . . . . . . . . . . . . . page 16

Practice and Technology . . . . . . . page 20

Licensure and Regulation . . . . . . page 26

Public Health . . . . . . . . . . . . . . . . . . . page 30

Government . . . . . . . . . . . . . . . . . . . . page 34

Conclusion . . . . . . . . . . . . . . . . . . . . . page 36

References . . . . . . . . . . . . . . . . . . . . . page 37

Acknowledgment . . . . . . . . . . . . . . . page 39


Overview

A dental hygienist is a licensed healthcare professional, who supports thehealth and well being of the Americanpublic through oral health promotion,education, prevention, and therapeuticservices. Dental hygienists are graduatesof accredited dental hygiene programs incolleges and universities, and arerequired to pass a national writtenexamination and a state or regionalclinical examination in order to obtain alicense for practice. There are more than120,000 registered dental hygienists inthe United States.1

As health care professionals, dentalhygienists provide oral health expertisein an array of workplace settings. Asclinicians, dental hygienists may chooseto work in private dental offices, school-based dental clinics, hospitals, managedcare organizations, community healthcenters, correctional institutions, andnursing homes. In addition to directpatient care, dental hygienists may workin government, sales or marketingpositions, or as educators, researchers,administrators, health policy makers,managers, consumer advocates, orconsultants.

Dental hygiene practice varies by state,with state regulatory boards determining

the range of services and grantinglicenses for practice. The type and rangeof services differ according to eachstate’s regulations.

The varied settings in which dentalhygienists practice and thecomprehensive dental hygiene servicesthey provide are critical becauseAmericans face an epidemic ofperiodontal (gum) disease and dentalcaries (cavities, also known as toothdecay). Dental caries is the major causeof tooth loss in children, whileperiodontal disease is the major cause oftooth loss in adults. Fifty percent of allAmerican youth ages 17 and under havehad caries in their permanent teeth, while75 percent of the U.S. population hassome form of periodontal (gum) disease.2

In addition, more than 27,000 cases oforal and pharyngeal cancer are diagnosedeach year.3 Despite these seriousconsequences of poor oral health, almosthalf of Americans do not receive regularoral health care.

Additionally, many research studies havesuggested that periodontal (gum) diseaseis a potential risk factor for a number ofdiseases. Research has identified it as apossible risk factor for heart and lungdisease; diabetes; pre-mature and low


Disparities in access

to oral health care

services can be

found today among

population groups

according to

socioeconomic

levels, race and

ethnicity, age, and

gender.

birth-weight babies; and a number ofother conditions. As one example, twoout of three dental hygienists report thatthey see signs of hypertension and heartdisease in their patients.2 If left untreated,poor oral health can increase the risk ofdeveloping potentially life-threateningdiseases that are responsible for the deathsof millions of Americans each year.

Despite the connection between poororal health and a host of systemicdiseases and conditions, disparities inaccess to oral health care services can befound today among population groupsaccording to socioeconomic levels, raceand ethnicity, age, and gender. Researchhas demonstrated that oral disease ratesand oral health needs are highest in low-income and special needs populations,such as the elderly or the disabled.

Access to preventive and therapeutic oralhealth care can be increased bymaximizing the services hygienists areeducated to provide, expanding dentalhygiene practice settings, reimbursingdirectly for services delivered, andremoving restrictive supervisionrequirements.4

It is clear that in order to promote totalhealth, the public needs comprehensive

preventive oral health care and dentalhygienists are the health careprofessionals with the knowledge andskills best suited to meet these needs. Assuch, dental hygienists should beintegrated more fully into the health careworkforce to provide a broader array ofservices to meet the needs of theAmerican public. Legislators and policymakers, as well as other health careentities must recognize and support thisexpanded role for dental hygienists. Theprofession itself must embrace change,focus on growth and development, andplan for its future as well as the futureoral health needs of the public.


Introduction

During the 1980s, members of the dentalhygiene profession, working with theleadership of the American DentalHygienists’ Association (ADHA), held aseries of workshops to address dentalhygiene education and practice. Throughthese workshops, practicing dentalhygienists and educators from around thecountry reached consensus on majorissues of importance to the future ofdental hygiene. A prospectus wasdeveloped that offered a philosophicaland conceptual foundation to meet thechanging societal needs and healthsystems challenges of the 21st century.5

Since those first education and practiceworkshops more than twenty years ago,numerous changes have taken place inhigher education, health care, and publicpolicy.

Colleges and universities have had, andcontinue to face, challenges, particularlyin terms of a deteriorating fiscalenvironment. Cuts in federal tax ratesand state spending patterns haveprompted higher educationadministrators to maximize efficiencyand re-evaluate programs that are costlyto operate. As a result, a number ofdental and dental hygiene programs havebeen closed.

In addition to fiscal concerns, dentalhygiene education faces many otherchallenges: the proliferation of newassociate degree programs; the lack ofincentive for completion of abaccalaureate degree versus an associatedegree; and the various educationallevels for entry into the profession. Inaddition, there is a shortage ofappropriately educated dental hygienefaculty members, no universal plan forthe various levels of dental hygieneeducation, lack of control overaccreditation standards for dentalhygiene education by the dental hygieneprofession, and the threat ofpreceptorship (on-the-job training) orcareer tracks that do not require a formalaccredited education.

While dental hygiene education has beenaddressing these issues, the professionalso has been focused on establishing atheoretical framework to validate dentalhygiene education and practice. ANational Dental Hygiene ResearchAgenda (NDHRA) was formulated andvalidated in 1995.6 In 2001, priorities forNDHRA were recommended thatincluded research related to healthservices, access to care for underservedpopulations, health promotion, anddisease prevention.7


Dental hygiene

education faces

many challenges:

the proliferation of

new associate

degree programs;

the lack of incentive

for completion of a

baccalaureate

degree versus an

associate degree;

and the various

educational levels

for entry into the

profession.

Some in dental hygiene raisedfundamental issues with respect to theuse of this national agenda to guideresearch efforts. However, the dentalhygiene community must commit tousing the agenda to guide research andother professional efforts. A consistentand reliable system is needed to monitorthe progress and outcomes of effortsmade in conducting research, inpreparing hygienists as researchers, andin publishing findings. This tracking andevaluation system will provide directionand focus for the research conducted bydental hygienists.

In 1997, the ADHA House of Delegatesadopted a model of evidence-basedpractice for dental hygiene. This modelcalls for conducting new research andpromoting the application of researchfindings among all members of theprofession—clinicians, educators,administrators, and researchersthemselves. To support research effortsand build a rigorous body of knowledge,a research infrastructure is essential.

Another area of intense change is scienceand technology. Over the years, thehealth care community has achieveddramatic scientific and technologicaladvances, resulting in a greater

understanding of the relationshipbetween oral health and systemicdisease. As the associations betweenperiodontal and cardiovascular diseases,diabetes, low birth-weight and othermedical conditions become betterdefined, it will be incumbent upon dentalhygienists to embrace these changes.

In addition, this past decade witnessedthe release of the first-ever U.S. SurgeonGeneral’s Report on oral health (releasedJune 2000): Oral Health in America: ASurgeon General’s Report (SurgeonGeneral’s Report). The report’s focus onoral health sensitized the nation to theconnection between oral health andsystemic disease and the reality thatthere is a silent epidemic of oral diseasesaffecting poor children, the elderly, andmany members of racial and ethnicminority groups. The report alsomaintained that America’s continuedgrowth has resulted in broad socio-economic differences that hinder theability of some segments of thepopulation to access oral health care.8

Currently, almost 43 million Americanslive in dental health professional shortageareas, as defined by the U.S. Departmentof Health and Human Services HealthResources and Services Administration,9


and 108 million people lack private dentalinsurance, which is more than 2.5 timesthe number of those who lack medicalinsurance.10 As a follow-up to the SurgeonGeneral’s Report, a National Call toAction to Promote Oral Health wasreleased in May 2003 from the U.S.Department of Health and HumanServices to support changes in theresearch and delivery of oral health care.10

Access to care continues to remain aconcern to the public seeking oral healthcare and to dental hygienists attempting toprovide care in all settings in order toimprove oral health for all Americans. Thedisparity in access to oral health care isexacerbated by a current and projectedworsening shortage of dentists. Dentalworkforce data projects a decrease in thenumber of graduating and practicingdentists. According to the Bureau of LaborStatistics, the projected growth for dentistsis 4 percent—slower than average growth.However, for dental hygienists there is aprojected growth of 43 percent—muchfaster than average—through 2012.11

Currently, there are 130,000 dentists inthe U.S., compared to 120,000 practicingdental hygienists.12 However, as thenumber of dentists decreases and thenumber of dental hygienists increases,this balance will shift dramatically. Asthis happens, fewer dentists will beavailable to address the needs of

underserved segments of the population.With accredited education, licensure,growing numbers, and a regulatorysystem already in place, dental hygienistsare the logical oral health care providersto play a key role in filling this void.

The extent of unmet need will worsendramatically unless the oral healthworkforce is provided economic andother incentives to locate/practice inunderserved areas. Further, theseproviders must exhibit culturalcompetence and communication skills tofully meet the needs of increasinglydiverse populations. In addition, thisworkforce must have regulatory authorityto practice to the extent of theireducational qualifications and standardsof competence rather than limited scopesof practice. It is important for dentalhygienists to initiate planning of newmodels of oral health care delivery tomeet the needs of underservedpopulation groups. Once these modelsare initiated, it is important for policymakers and other health care providers tosupport their implementation.

In the face of this increasingly seriousoral health manpower crisis and a lack ofaccess to oral health care for certainsegments of the population reachingcrisis proportions, ADHA determinedthat it was time to prepare for the futureof dental hygiene.


The disparity in

access to oral health

care is exacerbated

by a current and

projected worsening

shortage of dentists.

Dental workforce

data projects a

decrease in the

number of

graduating and

practicing dentists.

In 2002, ADHA appointed a workinggroup of dental hygiene leaders fromaround the country and identified thefollowing focus areas for the creation of areport on the future of dental hygiene:research, education, practice andtechnology, licensure and regulation,public health, and government.Throughout the year, member input wassolicited at the ADHA annual session,board-of-trustees’ strategic planningsession, constituent officers’ workshop,and council meetings. Dental hygienistsand other interested individuals wereencouraged to share their vision and ideasthrough dental hygiene publications andthrough the association’s Web site andemail list forum. Throughout this process,it became clear that dental hygienistsshare a number of fundamental beliefsthat shape the focus and direction ofdental hygiene. These beliefs are:

• Access to oral health care is a right ofall people.

• The oral and general health needs ofthe U.S. population are growing, anddental hygiene practice and educationmust evolve to meet them.

• Dental hygienists should be able toprovide the care they have beeneducated to deliver.

• Dental hygiene is part of an overallhealth care delivery system, not simplyan arm of dentistry. Dental hygiene

must create an integrated model of oralhealth care delivery with other healthcare providers.

• Dental hygiene needs to identify andremove the barriers that restrict thepublic’s access to oral health care.

• Dental hygiene must move from amechanical-based treatment of diseasemodel to a wellness model of care.

• Dental hygienists advocate highstandards of professional practice.

• It is the responsibility of dentalhygienists to determine theprofession’s future regardingeducation, licensure, and practice, andthey should continue to build theprofession’s knowledge through theexpansion of its research base.

The Future Vision for DentalHygiene

To establish the framework for dentalhygiene’s future, hygienists were askedto consider what dental hygiene wouldbe like five years from now and 20 yearsfrom now.

A future vision for dental hygiene,developed by this process, is

Dental hygiene is the preventive oralhealth care profession, highly valued


for its knowledge, skill and commitmentto improving the quality of the nation’soverall health by providing effectiveand accessible oral health care.

The profession contributes to qualityhealth care by utilizing evidence-basedapproaches for clinical decisions,fostering professional growth throughadvanced education and life longlearning, providing leadership inhealth policy to create change andimprove delivery systems that willresult in increased access to care forthe public.

The majority of individuals who choosedental hygiene as a career remainactive in the profession because of theopportunities for personal andprofessional development, the chance tohelp others through public service,stimulating work environments, andfinancial remuneration commensuratewith various professional roles andresponsibilities.

Focus Areas—A Call forAction

To realize the future envisioned by thedental hygiene advisory board, six focusareas were identified as essential to bringabout positive change for the dental

hygiene profession as well as the healthcare delivery system.

• Research• Education• Practice and Technology• Licensure and Regulation• Public Health• Government

Dental hygiene leaders from around thecountry were asked to serve onsubcommittees related to each area of thereport. These groups began to articulate adesired future for each focus area. Theydeveloped goals and recommendations todefine what must occur over the courseof the next decade and beyond to realizethe future for dental hygiene. Thefollowing pages summarize multiplegoals and recommendations developedfor the six focus areas.

As each subcommittee developed itsdraft report, several themes emerged:dental hygienists must developprofessional socialization skills, theremust be greater networking among dentalhygienists and increased collaborationwithin and across career specialties, andthere must be increased collaborationwith policy makers and the public toensure that dental hygienists’ concernsare heard and that the oral health needsof the public are met.


There must be

greater networking

among dental

hygienists and

increased

collaboration within

and across career

specialties to ensure

that dental

hygienists’ concerns

are heard and that

the oral health

needs of the public

are met.

Research

It is widely recognized that dentalhygiene practice must be based on soundresearch and scientific information. Topromote research and advance thescientific base of dental hygiene practice,a research infrastructure is required.Such an infrastructure will supportresearch efforts and enable thesystematic and purposeful building of arigorous body of knowledge. The fiveessential elements of a researchinfrastructure are derived from a modelpublished in the dental hygieneliterature.13

A research infrastructure suggests a levelof coordination and integration ofactivities that extends beyond any oneorganization, institution or center, andrequires considerable commitment,communication and effort on the part ofthe dental hygiene community at large.

A cadre of professionals trained andactively participating in research willsupport the dental hygiene researchinfrastructure. Ideally, researchers in theprofession should be prepared throughdoctoral education. Faculty and studentsneed to be socialized to the importanceand benefits of research and graduateeducation. Further, educational programs

must actively promote research as acareer path. Mechanisms for supportingadvanced education and mentoringsystems are required to enable newresearchers to engage in the researchprocess effectively.

Integrating research throughout allfacets of the profession requiressignificant dedication on the part of alldental hygienists. The professionalcommunity must commit to using theNDHRA to guide research, enhancepatient-centered care and foster otherprofessional efforts. All dentalhygienists, regardless of their practicesettings and professional interests, musttake ownership of the NDHRA.Achieving national health objectivesshould be an inherent part of theirprofessional activities, both inside andoutside of the research arena. This isespecially important for practitioners,who provide the greatest representationof the profession to the public. Thedecisions that they make every day mustbe firmly grounded in knowledge that isobtained from research and clinicalexperience, to improve theirprofessional judgment and ultimately, toimprove the quality of servicesprovided.


Aim One

Create a research infrastructure and supportthe dental hygiene body of knowledgethrough coordinated research initiatives.

Recommendations

1. Critical Mass of Researchers/Scientists:

• Increase the number of dentalhygienists with doctoral degrees inorder to enhance fundingopportunities.

• Increase the number of dentalhygienists with doctoral degrees,with degrees in dental hygiene orother disciplines, including the basicand applied sciences, epidemiology,public health, health policy, education,and other professional degrees.

• Increase the number of dentalhygienists serving as primaryinvestigators in research, as well asthe number of dental hygienists whoare qualified to participate inresearch.

2. Identify Research Priorities:

• Commit to using the ADHANDHRA to guide research and otherprofessional efforts.

• Target research priorities related tohealth services, access tocare/underserved populations, and

health promotion/disease preventionto meet national health objectives.

• Encourage dental hygiene researchersto utilize interdisciplinary models ofcollaboration in research endeavors.

• Identify the status of current researchendeavors.

• Identify the need for studies thatreplicate and validate existing bodiesof work.

• Identify the need for conductingadditional studies to expand uponwhat has already been learned.

• Utilize graduate dental hygieneprograms as “centers” forinvestigation, with concentratedresearch efforts focused on particularfields of study. Using the NDHRA asa guide, these schools could serve asregional sites for multi-centerresearch studies to conduct large-scale investigations that add to thebody of knowledge.

3. Communication Systems to PromoteLinkages:

• Create a uniform taxonomy that isused to define the language of thedental hygiene profession so that theliterature can be indexed accuratelyin national databases such as, but notlimited to, MEDLINE, PubMed,CINAHL, and HealthSTAR.


Integrating research

throughout all facets

of the profession

requires significant

dedication on the

part of all dental

hygienists.

• Develop a consistent and reliablesystem to monitor the progress andoutcomes of dental hygiene research.

• Develop a comprehensive databasefor information management that isutilized uniformly across theprofession, and that reflects thescope of dental hygiene’s body ofknowledge.

• Complete the application process forthe Journal of Dental Hygiene to beincluded in the Science CitationIndex so that the authors anduniversity employers can documentthe impact of their publications.

4. Funding for Research:

• Raise and provide funding for researchprojects that address specific prioritiesidentified by the NDHRA.

• Sponsor training programs for dentalhygiene investigators.

5. Valuing Research:

• Encourage all dental hygieneprograms to adopt an educationalphilosophy that reinforces theimportance of research indocumenting the efficacy of practice,so that an appreciation and basicunderstanding for the processbecomes an inherent part of the valuesystem of each dental hygienist.

• Encourage all dental hygienists to applythe basic research skills of problemsolving, critical thinking, and decisionmaking to all professional activities.

• Create forums for dental hygieneresearchers to present their work,share information, and exchangeideas for future projects with theirresearch colleagues and other dentalhygienists.

Aim Two

Increase the number and quality ofdental hygiene researchers.

Recommendations

• Utilize articulation agreements thatallow dental hygiene students tocomplete baccalaureate degrees andto facilitate their entrance intograduate schools.

• Educate dental hygienists to evaluatethe scope, quality, merit, and utilityof research used to guide evidence-based practice.

• Prepare dental hygienists to developthe skills necessary to apply anevidence-based methodology,including:❍ converting information needs into

clinical questions so that they canbe answered


❍ conducting a computerized literaturesearch with maximum efficiency forfinding the best external evidencewith which to answer the question

❍ critically appraising the evidencefor its validity and usefulness

❍ applying the results of the appraisalor evidence in practice

❍ evaluating their performance inapplying an evidence-basedmethodology.

• Encourage dental hygienists,researchers, journal editors, journalreviewers, and educators to utilizeand comply with the ConsolidatedStandards of Reporting Trials(CONSORT), international standardsnow being adopted by medical anddental journals, to improve thequality of the conduct and reportingof research studies.

• Create opportunities for dentalhygiene educators to share effectivestrategies for teaching and mentoringresearch.

• Develop and implement ADHA-sponsored research developmenttraining workshops on topics such asthe use of technology, informationresources, library skills, andevidence-based teachingmethodologies, offering theseworkshops online and/or as acomponent of professional meetings.

• Establish research as a career path inexisting dental hygiene educationprograms at the master’s degree anddoctoral levels.

Aim Three

Integrate research in all facets of theprofession.

Recommendations

• Utilize the NDHRA as the drivingforce behind the work efforts of theADHA councils and the strategicplan of the association.

• Charge each ADHA council withidentifying research needs, goals,and objectives related to theirspecific areas of interest from theNDHRA.

• Charge the Council on Research andthe ADHA Institute for Oral HealthResearch Grant Review Committeewith systematically managing thefunded research conducted undertheir auspices in order to improveaccountability in the tracking ofresearch progress.

• Work collaboratively with the NationalCenter for Dental Hygiene Researchto maximize resources and work effort.

• Educate all dental hygienists in thescientific method so that they are


Limited availability

of research

resources

necessitates careful

examination of and

consensus as to the

next steps for

advancing

professionalization.

competent in searching andevaluating the literature and adopt anevidence-based philosophy.

• Advocate for increased dentalhygiene research initiatives throughfederal agencies and other public andprivate funding sources.

Summary

Dental hygiene has an emerging researchinfrastructure that must be purposefullyadvanced and supported. To expedite thedevelopment of this infrastructure, theinitial focus and funding of researchefforts should be on the prioritiesidentified from the NDHRA. Building aninfrastructure is particularly critical fordental hygiene in today’s health careenvironment. Limited availability ofresearch resources necessitates carefulexamination of and consensus as to thenext steps for advancingprofessionalization. However, achievingexcellence in practice, the cornerstone ofprofessionalization, is intricately tied toand dependent upon putting into place aviable structure for conducting research.


Education

Historically, the dental hygiene educationcurriculum was predicated on thedelivery of oral health care through theprivate practice dental delivery system.Currently, significant segments of theU.S. population do not receive any oralhealth care through this traditionalsystem. With the many national calls forchanging the oral health care deliverysystem and education of oral healthprofessionals, it is important to revise thedental hygiene educational curriculum toprepare future dental hygienists todeliver quality oral health care to allsegments of the U.S. population and tobe responsive to an evolving health caredelivery system.

As the population ages and becomes moreculturally diverse, overall health and oralhealth needs will become more complex,requiring health care practitioners to havea broad-based education. Healthpromotion and prevention of oral diseases,rather than the current focus on treatmentof existing disease, also must receiveconsiderable attention within the dentalhygiene educational system.

Entry-level dental hygiene programs arecurrently offered in a variety ofeducation settings such as schools ofallied health, dental schools, community

or junior colleges, and technical collegesand universities. Since 1990, there havebeen 95 new programs established, ofwhich only two offer a baccalaureatedegree.14 Programs in educationalsettings that limit their length struggle toincorporate new content and techniquesto enhance oral health care. As a result,curricula are overcrowded.

Workshops held throughout the 1990sand early 2000s addressed the need for adental hygienist who is broadly preparedand has the necessary skills to cope withan accelerating pace of change.Conferences have identified the need tomove toward the baccalaureate degree asthe entry point for the profession with auniversal core curriculum that integratesoral health with interdisciplinarystudies.15,16 The failure to standardizeentry level at the baccalaureate level hashad an adverse impact on the pace ofdevelopment of advanced dental hygieneprograms and the continued developmentof the dental hygiene body ofknowledge. Given that some otherprofessions and allied health professionshave already moved beyond thebaccalaureate degree as the entry topractice, dental hygiene must plan for theadvanced degree as the entry to practicein the future.


With the many

national calls for

changing the oral

health care delivery

system and

education of oral

health professionals,

it is important to

revise the dental

hygiene educational

curriculum to

prepare future

dental hygienists to

deliver quality oral

health care to all

segments of the U.S.

population and to be

responsive to an

evolving health care

delivery system.

A challenge facing dental hygiene is thataccreditation standards for dental hygieneeducation are not established by theprofession. Currently, dental hygieneeducation programs fall under theaccrediting authority of the AmericanDental Association’s Commission onDental Accreditation (ADA CDA). ADACDA consists of 30 individuals, with onlyone appointee made by organized dentalhygiene. Other health professions andallied health professions control their ownaccreditation processes and standardsthrough independent agencies recognizedby the U.S. Department of Education.

Dental hygiene scholars are needed to leadthe development of theory and knowledgeunique to the discipline of dental hygiene.Currently, there is a shortage of dental hygienefaculty that is expected to increase as a resultof program closures in university and dentalschool settings.17 Doctoral preparation ofdental hygienists is essential for building thedental hygiene knowledge base foradvancing the professionalization process.

Aim One

Redesign dental hygiene curricula based onthe increasingly complex oral health needsof the public.

Recommendations

• Evaluate the dental hygienecurriculum and create new models forentry level programs that address❍ oral health needs❍ training programs in community-

based, underserved areas❍ community health and disease

management❍ cultural competence❍ needs of special groups❍ health services research❍ public policy development❍ evidence-based research

methodology and practice❍ collaborative practice models.

• Collaborate with appropriateprofessional organizations to advanceawareness of faculty and dentalhygiene education program leaders toembrace the need for curricularchanges that reflect the oral healthneeds of the public.

• Conduct education workshops thatfocus on curricular advancements.

• Collaborate with appropriateorganizations to design dentalhygiene curricula that better reflectpublic health needs and thecorresponding role of the dentalhygienist.


Aim Two

Advance the educational preparationnecessary for entering the dental hygieneprofession.

Recommendations

• Implement the baccalaureate degreeas the entry point for dental hygienepractice within five years.

• Create articulation agreements,degree completion programs, anddistance learning technology asmechanisms for achieving the goal ofimplementing dental hygiene entry atthe baccalaureate level so that theresources of associate programscontinue to be fully maximized.

• Once the baccalaureate entry-levelsystem has been established, create a10-year plan for initiating themaster’s degree as the entry topractice.

• Conduct educators’ workshopsdesigned to address implementationissues for baccalaureate and master’sdegree programs.

Aim Three

Create an independent dental hygieneaccrediting agency.

Recommendations

• Establish an independent third partyto accredit dental hygiene education,recognized by the U.S. Departmentof Education, beginning withbaccalaureate degree-completionprograms and moving to accreditingmaster’s degree programs. Over time,the agency would accredit all dentalhygiene education programs.

Aim Four

Create a doctoral degree program indental hygiene.

Recommendations

• Develop curricular models for bothprofessional (doctor of science indental hygiene) and academic(doctor of philosophy) doctoralprograms in dental hygiene.

• Conduct educators’ workshops atprofessional meetings to promote thedevelopment of doctoral programs indental hygiene.

• Publish curricular models fordoctoral programs in dental hygieneprofessional journals.


Dental hygiene

scholars are needed

to lead the

development of

theory and

knowledge unique to

the discipline of

dental hygiene.

Summary

At this point in time, our educationprograms have not begun to address theresearch, public health, public policy,cultural, leadership, and fundingchallenges presented in the SurgeonGeneral’s Report. The current entry-leveldental hygiene education model islimited by a curriculum that is narrowlydefined with respect to content andlength. As dental hygiene advances andthe educational preparation for entry intothe profession evolves, the dentalhygiene curriculum must be redesignedto reflect those changes.

Dental hygiene must keep pace withprofessions such as teaching,occupational therapy, and physicaltherapy that have recognized theimportance of advanced education as theentry to practice. As health care deliverysystems change and the relationshipbetween systemic disease and oral healthbecomes more defined, the demands foradvanced-level practitioners willincrease. The knowledge and skills ofdental hygienists will need to expand.Curriculum modifications will need to bemade to reflect these changes. Expandingthe curriculum accordingly will allowdental hygienists to further develop thescientific basis for dental hygienepractice.

Ensuring high standards and qualityeducation at all levels of dental hygieneeducation by the profession will afforddental hygiene the autonomy to adaptcurricular changes as needed to meet thefuture health care needs of the public andthe profession.

Developing curricular models fordoctoral programs in dental hygiene willassist dental hygiene educators increating quality programs that meet theneeds of students, the profession, and themissions of colleges and universities.Providing advanced education specific tothe discipline of dental hygiene willallow greater opportunities for advancingthe art and science of the profession.


Unmet oral health care needs havehistorically been a problem in the U.S.and will likely continue to be in thefuture. The primary factor in controllingoral diseases, including dental caries andperiodontal disease, is the prevention ofthe disease. Often the lack of funding bystate and federal governments to provideoral health services is cited as acontinuing reason for the growing unmetoral health needs of the public. This trendwill likely continue as our nation strugglesto find a means to provide oral healthservices in an economically viable way.

In addition to the economic problemsrelated to oral health care delivery, the lackof availability of oral health care providersis troubling. As previously noted in thisreport, the number of dentists is predictedto grow at a much slower rate (4 percent)compared to the projected growth ofdental hygienists (43 percent).11 This isexpected to create a shortage in thenumber of practicing dentists. Dentalhygienists’ roles must continue to expandas the number of graduating dentalhygienists increases and the number ofgraduating dentists decreases.

The dental hygiene profession hasrecognized the need to expand thetraditional roles of dental hygienists

through the creation of an advanceddental hygiene practitioner as a means toincrease the public’s access to preventiveand therapeutic oral health services.Many areas of the country that lack theavailability of dentists to providerestorative dental services could be betterserved by an advanced dental hygienepractitioner (ADHP) with the authority toprovide not only preventive services, butalso minor restorative services and referpatients with more advanced restorativeneeds on to a dentist. The creation of anadvanced dental hygiene practitioner willrequire dental hygienists and dentists towork together in new ways in order toreach out to underserved populations. Inaddition, changes in state practice actsand educational programs will berequired to assure that the public’sdiverse oral health care needs are met.Should these changes not occur, otherprofessionals such as physicians andnurses will assume this role.

Meeting the demand for dental hygieneservices is currently restricted due tolimitations on the settings in whichdental hygienists are legally allowed topractice and lack of direct reimbursementfor dental hygiene services. To date, notall states allow for direct reimbursementto dental hygienists for services they


The creation of an

advanced dental

hygiene practitioner

(ADHP) will require

dental hygienists

and dentists to work

together in new

ways in order to

reach out to

underserved

populations.

Practice and Technology

perform under the Medicaid program.Fiscal solvency is an important considerationfor all oral health professionals as theyattempt to reach out into the community toprovide oral health care services. In order fordental hygienists to work as primary careproviders, they must be able to receive directreimbursement for services rendered.

The aging of the population, as well as thediverse cultural background of our society,will change the manner in which all healthcare professionals deliver services. TheU.S. Bureau of the Census projects thenumber of Americans over the age of 65will grow 17 percent by 2010 and 76percent between 2010 and 2030.18 Also,according to the Census Bureau, the Asianpopulation is expected to more than tripleto 33 million by 2050 and the African-American population will rise 71 percent tomore than 61 million, but Hispanics willsee the most dramatic increases, projectedto grow by 188 percent, or to 102 million,or more than one-quarter of the Americanpopulation.19 In addition, consumers todayare more technologically savvy, bettereducated, and demand a high return ontheir health care investments. Dentalhygienists need to be better prepared toaddress the multi-faceted needs of ourdiverse population, especially the ever-growing segment of the elderly. Evidence-

based, patient-centered care requires beingmore aware of the desires and needs ofconsumers, and possessing the ability tocommunicate effectively with all groups.

Information technology has transformedsociety and dental hygiene practice over thelast 20 years. The Internet, mobiletechnology, and advances in medicaldiagnostic and therapeutic agents anddevices have changed the way we live andthe manner in which health care providersdeliver services. In dental hygiene, lasers,digital radiography, caries diagnosticequipment, cordless handpieces, a varietyof probes, and other innovations havechanged the landscape of clinical practice.

As more technological advances occur,dental hygienists must use an evidence-basedapproach in evaluation. Dental professionalsalso have seen the direct application ofknowledge gained from what is perhaps thegreatest technological advance of our time:the Human Genome Project (HGP). Begun in1990, the HGP aims to identify all the genesin human DNA, determine the sequences ofthe three billion chemical base pairs thatmake up human DNA, store the informationin databases, improve tools for data analysis,transfer related technologies to the privatesector, and address the ethical, legal, andsocial issues that may arise from the project.


As much as technological advances haveaffected the profession, genomes arepositioned to revolutionize it.

Aim One

Create multiple levels of clinical dentalhygiene practitioners with representativetitles and appropriate levels of educationand degrees.

Recommendations

• Change the title “dental hygienist” toreflect the expanding roles andresponsibilities of the profession.

• Create a licensed advanced dentalhygiene practitioner (ADHP) withadvanced education and training toprovide a wider range of servicesincluding, but not limited to,diagnostic, preventive, restorativeand therapeutic services directly tothe public.

• Create collaborative practice modelsfor dental hygiene that include, butare not limited to, the following:❍ dental hygiene professionals workingwith medical teams, such as:■ contracting with hospitals andprivate practices for in- andoutpatient programs

■ primary care, ob/gyn, pediatric,and geriatric medical programs

■ transplant patient pre- and post-care■ kidney dialysis support■ pre- and post-cardiac care support■ pre- and post-care oncologysupport

■ preventive and therapeutic care forphysically and mentally disabledpatients.

• Create alternative delivery modelsfor providing dental hygiene servicesthat include, but are not limited to,the following:❍ providing preventive and triageservices in-house or on-site forbusinesses/corporations

❍ working as administrators of oralhealth clinics with hygienistsperforming clinical procedures andsupervising licensed and certifieddental assistants

❍ working in school-based/school-linked and college settingsperforming preventive services,routine examinations, and simplerestorative procedures

❍ working with portable equipment orin mobile dental vans performingpreventive services, such as routineexaminations, and simple restorativeprocedures

❍ working in hospitals, chronic carefacilities, and residential facilitiesperforming preventive services,routine examinations, and simplerestorative procedures


Dental professionals

also have seen the

direct application of

knowledge gained

from what is

perhaps the greatest

technological

advance of our time:

the Human Genome

Project.

❍ serving as visiting dental hygieneprofessionals, and owning and operatinghome oral health agencies that providedental hygiene services similar to“visiting nurses.”

• Create curriculum models and competencycertification systems for specialty areas,which include but are not limited to, thefollowing:❍ pediatrics❍ geriatrics❍ periodontics❍ oncology❍ anesthesiology❍ public health❍ forensics❍ developmentally disabled❍ hospital dental hygiene.

Aim Two

Promote direct reimbursement to dentalhygienists for services they provide.

Recommendations

• Advocate with third party payers—medicaland dental—for direct reimbursement fordental hygienists.

• Work with state Medicaid directors torecognize dental hygienists as Medicaidproviders.

• Develop insurance codes that appropriatelyreflect the dental hygiene process of care.

Aim Three

Develop a dental hygiene workforce thatis able to meet the changingdemographic and cultural challenges thatwill occur as a result of America’sevolving population.

Recommendations

• Educate dental hygienists to meet themultiple care needs of the geriatricpopulation.

• Develop education, techniques, andmessages that are more consumer-focused in keeping with a client-centered approach to care.

• Increase the cultural diversity ofdental hygiene professionals.

• Ensure that all dental hygieneprofessionals are culturallycompetent and able to communicateand deliver health care that isculturally sensitive.

Aim Four

Develop a dental hygiene labor force thatkeeps pace with the genetic revolutionand other technological advances.

Recommendations

• Incorporate new technology in thecurriculum of dental hygiene


education programs and professionalcontinuing education.

• Educate dental hygienists abouttechnological advances and theirapplication to dental hygienepractice.

• Provide continuing educationopportunities for learning andapplying new technology forpracticing dental hygienists.

• Activate the ADHA Task Force onGenetics to evaluate the innovationsin genetics and their applications tothe dental hygiene profession.

• Develop ethical and policystatements that address genetics.

• Develop tools to assist dentalhygienists in understanding andaddressing genetic issues.

• Develop innovative technologies toenhance health and wellness.

• Use an evidence-based approach toevaluate the efficacy of newtechnology for dental hygienepractice and its impact on healthoutcomes.

Summary

As our nation addresses the unmet oralhealth needs of our citizens, it has become

imperative for health professions to re-examine their roles and responsibilities inproviding services to the public. Thetraditional method of providing dentalhygiene services through private dentalpractices is inadequate to meet the oralhealth needs of the country, and must beexpanded. The clinical practice of dentalhygiene also must evolve as there areadvancements in technology and science.Dental hygiene must move from amechanically based occupation to anevidence-based health profession. Newroles and responsibilities will develop fordental hygienists as technologicaladvances, practice settings, and dentalhygiene education and regulatoryrequirements evolve. The creation andimplementation of an advanced dentalhygiene practitioner (ADHP) is onemethod of increasing the public’s access topreventive and therapeutic servicesprovided by dental hygienists.

As new models of dental hygienepractice are developed, in addition to thetraditional private practice model, dentalhygienists will be able to meet thepreventive and therapeutic needs ofclients in a variety of settings. Asprimary care providers, they shouldreceive direct reimbursement for theservices they deliver.

The challenge of educating health careprofessionals to deliver evidence-based


Dental hygiene must

move from a

mechanically based

occupation to an

evidence-based

health profession.

care that is culturally sensitive willbecome increasingly more important asAmerica’s population becomes morediverse. In addition, as America’spopulation ages, dental hygienists willhave to adapt their practices to addressthis trend. Moreover, dental hygienistsmust be aware of consumerism’s impacton their profession, including direct-to-consumer marketing, informationtechnology, cost-competition in thehealth care marketplace, and clientexpectation of affordable, quality care.

The clinical practice of dental hygienemust evolve as advancements occur intechnology and science. Dental hygienemust move from a mechanically basedoccupation to an evidence-based healthprofession. New roles andresponsibilities will be created for dentalhygienists as technological advances,practice settings, and dental hygieneeducation requirements evolve. Futuredecades will see technologicaladvancements that will change and shapeour society more quickly than everbefore, as new information about humanhealth and disease is discovered via theHGP. Dental hygienists must learn howto translate this new knowledge intoclinical applications. The development oftools, ethical guidelines, and policies willassist dental hygienists in incorporatingtechnological advances in all settings.


Professional regulation refers to thesupervision of licensure and practicestandards of professions by stategovernment to ensure the health and safetyof the public. Recognizing the purpose ofregulatory boards, it is appropriate for thepublic to play a greater role in professionalregulation. The wave of the future appearsto be increasing the number of consumersparticipating in this process.

Today, dental boards are overwhelminglycomposed of dentists who regulate boththeir own profession and dental hygiene.In most states, consumers and dentalhygienists hold only a minority of seatson the board. Dental boards often makedecisions based on the practice issues andeconomics of private dental offices andfrequently tend to ignore dental hygieneconcerns. Given the conflict of interestthat occurs when employer dentistsregulate their own employees, dentalboards make frequent decisions that limitaccess to dental hygiene services.

Currently, a number of states have dentalhygiene committees or varying degrees ofself-regulation, but they exist in a largelyadvisory capacity. Given the situation, it isimperative that new regulatory models bedeveloped whose primary focus is dental

hygiene. A dental hygiene board wouldeliminate the conflicts of interest that existtoday and foster greater emphasis onproviding a delivery system that affordsexpanded access to dental hygieneservices and oral health care.

In order to assure the public’s health andsafety and access to quality dentalhygiene services now and in the future, itis critical that dental hygieneprofessionals have the authority toregulate themselves by determiningeducational requirements, practicestandards, and competency assurance.

The urgency of expanding access to care ishighlighted by the Surgeon General’sReport, which indicates that a “silentepidemic of oral diseases is affecting ourmost vulnerable citizens—poor children,the elderly, and many members of racialand ethnic minority groups.”8 This disparityis exacerbated by dental workforce datathat projects an oncoming shortage ofdental practitioners. Concomitant to thenumerical decline of dental practitioners,there is a progressive increase in thenumber of dental hygiene schools andtheir graduates. With accredited education,licensure, and a regulatory system alreadyin place, dental hygienists are the logical


It is imperative that

new regulatory

models be

developed whose

primary focus is

dental hygiene.

Licensure and Regulation

manpower resource to play a key role inaddressing access to care. However, access tooral health care continues to be hindered inmany states by restrictive supervisoryrequirements and the scope of practice limits.

Dental hygienists have created new modelsof regulation and care delivery that are safe,effective and allow for the continuedreferral of patients to dentists for furthertreatment. It is time to create furtherpathways for these competent practitionersto meet the oral health needs of Americansociety. As these new regulatory models arecreated, one of the future issues that theywill have to address is the assurance ofcompetence for dental hygiene practitionersthroughout their practice lifetimes.

Although existing state boards have focusedsubstantial resources on assessment of entry-level competence, continued competence hasbeen addressed only indirectly, primarily bymandatory continuing educationrequirements, which were in effect in all butthree states in 2002. There is growing publicinterest in continued competence asevidenced in a 1998 report from the PEWFoundation that recommended:

“States should require that their regulated healthcare practitioners demonstrate their competence in

the knowledge, judgment, technical skills andinterpersonal skills relevant to their jobs throughouttheir careers.”20

The greatest barrier to broad-scaleimplementation of such requirements is anefficient, readily available mechanism toassess all practitioners periodically andscreen out those who need closer scrutiny.It is generally recognized that state boardsof dentistry have neither the resources northe manpower to periodically reassess thecompetence of all practitioners using thetraditional clinical assessment mechanisms.

Dental hygienists should be activelyinvolved in both the development andadministration of a continued competencemechanism for dental hygiene. Being wellprepared for the implementation ofcontinued competence will be an importantfactor in the realization of self-regulationfor dental hygiene.

Aim One

Implement a dental hygiene regulatoryenvironment governed by a majority of dentalhygienists with consumer representationthat ensures the health and safety of thepublic, and enhances access to care.


Recommendations

• Achieve self-regulation in all states.

• Publish examples of models of dentalhygiene self-regulation, with analysisof what has been learned and howthese models have benefited the oralhealth of the public.

• Enhance the ability of dental hygieniststo interpret and enforce the statutes andrules, setting requirements for licensure,re-licensure, and specialty certification.

• Advocate for dental hygienists tointerpret and maintain standards ofpractice and determine the assessmentof professional competence.

• Require graduation from a formal,accredited, post-secondary dentalhygiene program as a prerequisite forlicensure in all states.

• Establish the dental hygiene licenseas the prerequisite for providingthose services requiring theprofessional skills, judgment, andeducation of a dental hygienist.

Aim Two

Implement a practice environment fordental hygienists that expands scope ofpractice, practice settings, and licensuremobility, and eliminates supervisionrequirements.

Recommendations

• Achieve greater mobility to movefrom state to state withoutinterruption in the ability to practice.

• Remove restrictive supervision lawsthat prevent dental hygienists fromproviding oral health care services.

• Create uniformity in the scope ofpractice from state to state.

• Educate dental hygiene students tofunction in all practice settings.

• Collaborate with organized dentalgroups, dental public health, and/orpublic health agencies to create newmodels for the delivery of care thatdemonstrate dental hygienists cansafely and effectively providecompetent care in unsupervisedsettings.

Aim Three

Develop assessment methodologies todetermine initial and continuedcompetence of dental hygienists in theknowledge, judgment, technical skills, andinterpersonal skills relevant to their jobs.

Recommendations

• Develop and promote innovativeassessment methodologies to assurethat applicants for dental hygiene


Dental hygienists

should be actively

involved in both the

development and

administration of a

continued

competence

mechanism for

dental hygiene.

licensure have fulfilled standards ofcompetency for entry into theprofession of dental hygiene.

• Develop and administer a system tocertify dental hygienists withadvanced and/or specialized skills,and document that they have fulfilledstandards of competency to providethose services.

• Develop policy recommendationsand methodologies for a system ofcontinued competence that isrelevant and appropriate for dentalhygienists. As the public and/orlegislative demand for continuedcompetence grows, dental hygienistsshould be prepared to provideguidance to dental hygieneregulatory agencies.

Summary

In most states, the board of dentistry isan arm of state government, isaccountable to the legislature, and has asits sole purpose the protection of thepublic. However, the distinction betweenprotecting the public and protecting theprofession is often poorly understood bythe practicing profession. The scope ofpractice for dentists is fairly uniformacross the country, but the scope ofpractice for dental hygienists variesgreatly from state to state.

Self-regulation would eliminate theconflict of interest that exists today whenemployer dentists regulate their ownemployees and allow for greateremphasis on providing a delivery systemthat affords expanded access to dentalhygiene services and oral health care.

Dental hygiene as a profession shouldtake the lead in bringing together oralhealth stakeholders includingpractitioners, educators, researchers,regulators, third-party payers, healthpolicymakers, and consumers whopossess the expertise to create newpathways for competent practitioners tomeet the oral health needs of society.

There is growing public interest incontinued competence for health profes-sionals and some professions arebeginning to address methodologies forassuring continued competence. Dentalhygienists should be actively involved inboth the development and administrationof a continued competence mechanismfor dental hygiene.


Public Health

Much has been written about the currentstate of the dental public health workforcein the U.S. and what actions are needed toenhance its capacity and capability toaddress the significant oral health problemsfacing the entire nation. With growingattention to and concern for the future ofthe dental public health workforce,policy makers will be faced with difficultchallenges related to gaps in oral healthcare and the expanding role of publichealth dental hygienists in the future.

Dental disease continues to exist inAmerica with profound disparitiesamong our nation’s most vulnerablegroups. Dental disease experience isdisproportionate. Minority, low-income,certain special care (e.g., elderly,disabled) and medically underservedpopulations, as well as many who live inrural communities, suffer from oral painand disease due to an inability to accessoral health care services in a timelymanner. Poor children experience twiceas much dental disease than their moreaffluent peers and are more likely tosuffer severe consequences due to lack oftreatment services. Between the ages 6-8,26 percent of white children haveuntreated dental disease compared to 36percent of African Americans and 43percent of Hispanics. Low-income

children suffer nearly 12 times morerestricted-activity or lost days fromschool than children from higher-incomefamilies. For adults over age 65, nearlyone-third has untreated cavities and 13-39 percent is edentulous.

The Surgeon General’s Report speaks to anumber of public health interventions thathave served to improve the oral health ofAmericans over the last half century.Among them are community waterfluoridation and school-based and schoollinked dental sealant programs. Bothprograms are generally administeredthrough state Offices of Oral Health andare aimed at preventing dental disease atthe state and local levels. Dental hygienistsparticipate in these programs bycoordinating efforts, managing programsand by providing education and technicalassistance. These preventive efforts havehistorically received federal support. Inrecent years, however, public funds havebecome less available and states have beenforced to downsize oral health programs,reducing capacity and limiting full-timeprofessional leadership and adequate staffto implement programs.

The National Call to Action to PromoteOral Health (Call) provided the impetusfor the re-birth of state programs to develop


Poor children

experience twice as

much dental disease

than their more

affluent peers and

are more likely to

suffer severe

consequences due

to lack of treatment

services.

state oral health plans that will move thenational agenda forward. The Call hasidentified five action steps: RemoveBarriers; Change Perceptions; BuildInfrastructure; Expand the Science Base;and Build Partnerships. It is estimatedthat implementation of these steps on thenational, state, and community levelswill serve to promote and enhance theoral health of all Americans.

The dental hygiene profession as anorganization of health care providers needsto recognize and interface with thenational agenda. As state oral health plansunfold, it will be critical for both theprofession as a whole and dentalhygienists as individuals to positionthemselves at the forefront to providedirection and leadership. The opportunityfor progress is here and potential forgrowth and development is bountiful. Withoral health change at hand, hygienists maynow maximize their opportunities toprovide technical expertise and skills tomeet the demands of the nation’s poor.

Aim One

Increase the number of dental hygienistswith training in public health and thosewith graduate degrees in public health.

Recommendations

• Promote and improve public healthcompetency in education, research,and practice.

• Train dental hygienists to useappropriate, standardizedmethodologies to document andevaluate the efficacy of public healthinterventions in addressing oral careneeds (e.g. cost:benefit analysis ofdental hygiene services rendered).

• Establish cultural competency as aneducational priority for dentalhygienists as they seek to promoteand improve oral health for minoritypopulations.

• Recruit and support more studentsfrom diverse backgrounds, includingthe underserved. Establish financialincentives for minority dentalhygiene students.

• Expand state-supported scholarshipand loan forgiveness incentiveprograms to include dental hygienistsat all levels of dental hygienepractice.

• Expand community service modelsto provide students with adequateexperience in community-basedhealth settings serving diverse


populations, including low-incomegroups.

• Establish a standardized core publichealth curriculum for dental hygieneprograms that includes use ofcompetencies and outcome measures.

• Establish the master’s in publichealth as the credential foremployment in public healthleadership/government positions.

Aim Two

Increase the number of dental hygienistsworking in leadership positions andpolicy settings.

Recommendations

• Partner with the larger health carecommunity to establish an ongoingmultidisciplinary leadershipcollaborative that addressespopulation-based public health issuesand reinforces the public dentalhealth workforce.

• Encourage hygienists to assumeleadership roles in developing anddirecting community–based oralhealth education and oral healthinitiatives.

Aim Three

Increase access to oral health careservices by expanding the dental hygienepublic health workforce.

Recommendations

• Advocate for the inclusion of anadvanced dental hygiene practitioneras an integral member of the dentalhygiene public health workforce.

• Promote reciprocity of dentalhygiene credentials by all licensingboards so that dental hygienists mayrelocate more readily to underservedareas.

• Acquire Medicaid dental providerstatus for dental hygienists.

• Guide the expansion of modelstationary and mobile public dentalclinics operating in underservedcommunities.

• Develop and utilize the case-management approach to assureaccess. Contracted dental hygienistsshould collaborate with schoolnurses; Head Start representatives;health services managers; Women,Infants, and Children nutritionists;School-Based Health Center nursepractitioners; and others to identifychildren at risk, those in need of


With oral health

change at hand,

hygienists may now

maximize their

opportunities to

provide technical

expertise and skills

to meet the

demands of the

nation’s poor.

care, and to provide the appropriatereferral.

Summary

The persistent lack of access to basic oralhealth care by many sectors of thepopulation demonstrates the failure ofthe dental profession to assure oralhealth for all Americans. The shortage ofpublic health dentists and hygienists isgrowing and the cultural makeup of thedental workforce is generally notreflective of diversity in the population.

A marked decline in the supply ofdentists in recent years, and a projecteddecline in dental school graduates, raisesmajor concerns about the adequacy ofthe dentist workforce to address unmetoral health care needs. The increasingsupply of dental hygienists and theircontribution to increased productivity indental practices suggest that their role inboth private and public dental care issignificant and warrants greater attention,as well as increased professional andpublic support. We must work toencourage more of these hygienists towork in public health settings.

As the oral health needs of the nationincrease, dental hygienists will need tobecome more knowledgeable and skilledto help to meet the demand for services.

Dental public health curriculum andcommunity service components in dentalhygiene school programs will need to bemore fully developed to adequatelyprepare students to work in public healthsettings.

As the future unfolds, hygienists will beleading the way in oral health careproviding guidance to non-dental healthproviders and other non-traditionalpartners.

In addition, funds at the state and federallevel, which are currently inadequate foreducation, public oral health careservices and for the provision of servicesto low-income populations, will need tobe increased and more readily availableto hygienists for the provision of oralhealth care services.

Finally, state and federal policy changesaddressing oral health care services forMedicaid, low-income and other specialpopulation groups will need to beimplemented, so that the Americanpublic may fully access those oral healthcare services to which they are entitled.


Government

Dental hygienists should take advantage ofopportunities to serve at all levels ofgovernment to administer programs thatprovide access to care for the public,impact and interpret the laws that regulatethe profession, and improve the oral healthof the nation. The contributions of dentalhygienists within government agenciesmay be made as clinicians, administrators,researchers, and community-basededucators or change agents. In many ofthese positions, dental hygienists use thepublic health principle of ensuring the“greatest good for the greatest number”and often use population-based approachesrather than relying on the private practicemodel of individualized patient care.

Aim One

Increase the number of dental hygienistsemployed at all levels of government—federal, state, and local—who are able toinfluence policies and programs, andprovide leadership to improve the oralhealth and general health of the public.

Recommendations

• Increase the number of dentalhygienists serving at all levels ofgovernment in all branches as follows:

❍ Increase the number of dentalhygienists with graduate degreesworking in government settings.

❍ Increase the number of dentalhygienists participating as providersin state or local publicly- orgovernment-funded programs suchas Medicaid and the State Children’sHealth Insurance Program.

❍ Increase the number of dentalhygienists serving in the armedforces as clinicians andadministrators.

❍ Increase the number of dentalhygienists serving as elected andappointed officials.

• Encourage dental hygienists topursue master’s and doctoral degreesin disciplines, such as public health,public administration, business,health policy, and research, so theyare well trained to attain roles ingovernment. Promote distance- andWeb-based courses as a way ofpursuing higher education.

• Develop a public policy focus inundergraduate dental hygieneprograms, including standardizedcurriculum with competencies.

• Increase opportunities for dentalhygiene students and dentalhygienists to participate in


The contributions of

dental hygienists

within government

agencies may be

made as clinicians,

administrators,

researchers, and

community-based

educators or change

agents.

internships and practicums that can beconducted at all levels of government.

• Develop a recruitment plan integratingstrategies that are comprehensive andresponsive to diversity to encourage moredental hygienists to pursue employment infederal, state, and local government.

• Expand loan repayment and tax incentiveprograms for hygienists serving in state andfederal programs.

• Seek changes in state practice acts toincrease access to preventive dental hygieneservices for underserved populations byremoving restrictive supervision barriersand expanding scopes of practice.

• Influence legislation that allows dentalhygienists to be Medicaid providers, in orderto increase access for underserved populations.

• Encourage and support dental hygienists torun for United States Senate, Congress,state legislatures, and other elected offices.

• Encourage government funding agencies tosupport research studies that assess the costs,benefits, and outcomes (health servicesresearch) of dental hygiene services inaddressing public oral health care needs.

• Train dental hygienists to apply for fundingto conduct research studies that utilizeappropriate, standardized methodologies todocument and evaluate the costs, benefits,

and outcomes of dental hygieneservices rendered to the public.

Summary

Dental hygienists have a significantopportunity to have an impact at all levelsof government in order to improve the oralhealth of the public. Two commoncharacteristics that the varied government-related positions share is a focus onprograms that are population-based, andthe need to use research data, both forprogram planning and for evaluation. Asgovernment systems require accountabilityfor the use of public funds, any decision-making must be supported by currentrelevant data. Government programs mustpresent evaluation data that demonstratethe appropriateness and efficacy of chosenstrategies, and document that allocatedresources have been used most judiciously.As most governmental programs do nothave enough resources to treat all diseasesthat occur, they must focus on reducingdisease through primary prevention and onchanging norms through health promotion,disease prevention, and policy initiatives,which are the most cost-effectiveapproaches.


ConclusionAmericans face an epidemic of oraldiseases. Dental caries and periodontaldisease, respectively, continue to be themajor cause of tooth loss in children andadults, while more than 27,000 cases oforal and pharyngeal cancer are diagnosedeach year.

In addition, many research studies havedemonstrated that periodontal disease isa potential risk factor for a number ofdiseases and conditions—heart and lungdisease, diabetes, and pre-mature andlow birth-weight babies—making poororal health an element in life-threateninghealth problems responsible for thedeaths of millions of Americans eachyear.

Despite this critical situation, almost halfof Americans do not receive regular oralhealth care.

Add to this an increasingly serious oralhealth care manpower crisis and a lack ofaccess to oral health care for certainsegments of the population reachingcrisis proportions, and it is obvious thatsomething has to be done. Given thecurrent disparities in access to oral healthcare and the expected worseningshortage of dentists, it is easy to see thatmaximizing the services dental

hygienists are educated to perform—promoting expanded practice settings andremoving restrictive supervisionrequirements—is essential to the currentand future health of the nation.

With accredited education, licensure,growing numbers of dental hygienists,and a regulatory system already in place,dental hygienists are the logical oralhealth care providers to play a key rolein responding to the oral health carechallenges facing the nation.

It is clear that in order to promote totalhealth, the public needs comprehensivepreventive oral health care. Dentalhygienists are the health careprofessionals with the knowledge andskills best suited to meet these needs.Legislators, state regulators, and otherhealth entities must capitalize on theopportunities dental hygienists offer andutilize them more effectively.

In addition, the profession itself mustembrace change, focus on growth anddevelopment, and plan for its future aswell as the future oral health needs of thepublic.


Dental hygienists

are the logical oral

health care

providers to play a

key role in

responding to the

oral health care

challenges facing

the nation.

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The future of oral health: trends and

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Oral health fast facts & stats [Internet].

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The profession itself

must embrace

change, focus on

growth and

development, and

plan for its future as

well as the future

oral health needs of

the public.

Acknowledgment

Literally hundreds of dental hygienists contributed to

the creation of this report. Sincere appreciation is

extended to those who served as committee chairs or

subcommittee members; to the hygienists who

performed external reviews for this report; and, to

the ADHA Board of Trustees and members who

shared their visions and ideas that helped to bring to

focus the future for dental hygiene.


Copyright June 2005American Dental Hygienists’ Association

444 North Michigan AvenueSuite 3400

Chicago, IL 60611312/440-8900

www.adha.org

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