Who In the World Are Dental Hygienists?

A study of six countriesBy Kathleen Young

• Dental hygienists are known worldwide as preventive care specialists. • How did the profession start?• How has the profession progressed?• How is it different in various countries?

This power point presentation will provide some insight into the dental hygiene profession throughout the world.

In the beginning…

• Dr. Alfred C. fones was an American dentist who has been called the founder of the dental hygiene profession, which began in 1906 when he trained and hired his cousin to clean teeth and perform preventive treatments for children.

• Irene Newman became the world’s first dental hygienist.

• 27 students graduated from the first class of dental hygiene in 1915. (Wikipedia, Alfred Fones)

• Let’s look at the expansion of dental hygiene worldwide since its humble beginnings. I have limited myself to six countries which show the wide variety in dental hygiene throughout the world.

United States• In the United States, the basic educational

requirements involve a high school diploma, college entrance exams and prerequisite courses before the dental hygiene program.

• Once in a dental hygiene program students will typically have 1000 hours or more of classroom instruction and over 600 hours of pre-clinical and clinical instruction.

• Three states have now authorized preceptor or « on the job » training. These states are Kansas, Alabama and Texas. These preceptor trained hygienists are only able to perform prophlaxix above the gumline. (Mingee, 2003) Hmmm…..

United States• The United States has both diploma (AS) and

degree (BS, MS) programs. As of 2007 there were 253 diploma programs and 33 degree programs.(Johnson, 2009)

• Currently there are more dentists that hygienists, but this will change soon since there are now fewer dental schools and more dental hygiene schools.

• Is the glass half full or half empty?– Depends on how you look at things- Trish O’Hehir sees it as an opportunity for

hygienists to provide care for the 50% of the population that doesn’t receive regular dental care. This will be accomplished by changing the way we are able to perform our services.

How are we doing?

• Less than ½ of the dental hygienists in the United States are members of their national professional organization! (Johnson, 2009)

• Efforts have been underway since 2003 to increase the scope of practice and provide an Advanced Dental Hygiene Practitioner (ADHP) This has been difficult since individual states have different requirements for licensure and not all states offer reciprocity. Therefore… changes have to be made legislatively on a state by state basis. (Gadbury-Amyot and Brickle, 2010)

• Minnesota serves as an example to other states about what can be accomplished through the legislative process.

Minnesota• For a period of four years the Minnesota

Dental Hygiene Association worked with the university system, the Minnesota Health Care Safety Net Coalition (SNC), the health department, dental board and others.

• Eventually on May 13, 2009 a bill was signed into law establishing a Dental Therapist and Advanced Dental Therapist. The name change from ADHP to Dental Therapist helped to satisfy the dental community. (Gadbury-Amyot and Brickle, 2010)

• Hooray for democracy!!

Japan

• The first formal training for dental hygienists began in Tokyo in 1949. It was a one year course and originally fell under the category of “vocational training”.

• There are now 136 dental hygiene schools and over 7000 students enrolled. Since 2001 the program has increased from two years to three and in 2004 the first four year course was started. ( Yoshida, Endo & Komaki, 2004)

• The dental hygiene workforce has steadily increased and currently there are more hygienists than dentists. 40% of graduated hygienists are working and less than half are members of their national organization. (Johnson, 2009)

JapanMost dental hygienists in Japan work in private

dental offices (89.7%) A small number work in nursing homes (0.07%). 5.3% work in hospitals and 3.01% work in public government facilities. 550 hygienists work at schools of dental hygiene. ( Yoshida, Endo, & Komaki, 2004)

The legal duties of dental hygienists in Japan are divided into three main parts:1. Dental Prophylaxis2. Dental Assisting, which involves assisting in the dental practice, subgingival scaling, root debridement and placement of temporary restorations.3. Dental health education

Dental hygineists in Japan are not allowed to take x-rays.

Australia

• Dental hygiene was started by a group of dentist that had worked in the United States and Britain. They appreciated working with dental hygienists ( oh, yeah!) so when they returned to Australia, they began the process of introducing legislation to allow dental hygiene practice. This was first enacted in 1972, but it was not until 1996 that it took effect in all states on the mainland. Tasmania was included in 2001.

• Curriculum for the first course was patterned after the US and British dental hygiene curricula. The first course was 12 months and its graduates earned a certificate in dental hygiene.

Australia

• Currently there are 2 two year programs (associate degree) and three 3 year programs which offer a BOH- Bachelor of Oral Health.

• Students can also choose to study dental hygiene through the Australian Defense Force. They offer a certificte in dental hygiene which involves five months of training with an additional year of preceptorship training. These hygienists are only allowed to work in the defense force.

• Australia has a two tier system which involves “Dental Therapists” who can provide dental treatment to children, but only in public institutions. Many dental therapists go on to become dental hygienists which enables them to provide dental care to children and adults in private settings. (Luciak-Donsberger & Aldenhoven, 2004)

AustraliaHygienists in Australia must practice only

under direct supervision, except for South Australia, which in 1992 changed the law to allow dental hygienists to provide care in nursing homes and long term care facilities. ( Luciak-Donsberger & Aldenhoven, 2004)

There are currently 325 female and 5 male hygienists. This in a country of 19 million people!

182 of those work full time and 100 work part time. Most of them (274) work in private offices while 8 of them work in the public sector.

Current salary is between $50,731 and $97,964

Germany

• Structured dental hygiene did not begin in Germany until 1999. This was surprising to me, as Germany is typically a very advanced country. A US hygienist submitted a petition to the German Parliament in 1997. Beate Gaterman, the president of the German Dental Hygienist Association, states that the purpose of the petition was to legalize the profession of dental hygiene in Germany and achieve state recognition. The establishment of this law is being deterred by the German Dental board and the National Health Department. (Gaterman, 2004)

• The German Dental Board has established “advanced training courses” where dental assistants continue their education to become dental hygienists. (at least that is what they are told…)

GermanyIn September 2004 Germany attempted to

begin its first « authentic dental hygiene education » course in association with a Swiss school. It was to be a three year program with international standards. As of 2009 it is still a Continuing Education model for dental assistants, with no diploma or bachelors awarded. (Luciak-Donsberger & Eaton, 2009)

Currently there are 150 dental hygienists with international qualifications working in Germany (all foreign trained). Hygienists working full time get an initial salary of up to 3000 Euros, full social and insurance benefits and after working 1 year they get 4 weeks paid vacation. (DDHV, 2011)

Germany

• An example of an advanced training course is one started in 2000 called the Munster hygiene education program. It is a 6 month program. 400 hours are devoted to clinical training and 550 to academics. At the end of the course there is a six hour written exam, a 30 minute oral exam and a practical exam.

• Persons who complete these “continuous education programs” are NOT board certified. The certificate is recognized only by the German Dental Board. They are not licensed OR registered dental hygienists.

Netherlands

• Dental hygienists in the Netherlands are paramedicals with independent status. ( EU Manual of Dental Practice:version 4, 2008)

• Of the 2000 hygienists in the Netherlands, about 800 of them are in private practice and 200 in public intstitutions. 680 dental hygienists own their own practices. There are 40 dental hygiene educators and less than 25 hygienists work as administrators or consultants. (IFDH, 2008)

• Hygienists who choose to practice independently must have their patients referred by a qualified dentist. They may also practice pediatric dentistry such as fillings and extractions after referral from a dentist. ( EU Manual of Dental Practice:version 4, 2008)

Netherlands

• The Netherlands has four dental hygiene schools, all leading to a degree. They also have a Masters program for dental hygiene.

• 87% of the hygienists in the Netherlands are members of their professional organization! (Johnson, 2009)

• Now, what does that tell you?

NepalNepal is a small country, bordered by China

and India. The average yearly income is $250/year. Only $3 per capita is spent publicly on health.

To receive basic dental hygiene services would cost a patient about 800 Nepal rupees ($11 US) which is food money for a month! Often these services are ineffective because of lack of compliance regimes.

In Nepal, there are Primary Health Care Workers who offer a « Basic Package of Oral Care » This includes:

Nepal Oral health promotion Arrest of caries technique (using silver

fluoride or silver diamine fluoride and stannous fluoride to stop the progress of caries.)

Atraumatic restorative technique (using glass-ionomer cement and hand instruments for single surface restorations and sealants.)

Oral urgent treatment

Many people are too poor to even pay the 50 Nepal rupees (0.70 US) for these services. The Nepalese people visit dental clinics primarily for pain relief. (Knevel, 2005)

Nepal

• Dental hygiene education first began in Nepal in 1997 with the formation of the Kantipur Dental Hospital. A Japanese NGO supported the establishment of this dental hospital, which currently only runs a dental hygiene program.

• There is a two year program and a three year diploma program.

• For both of the courses the students must complete a 5 or 6 month on the job training toward the end of the course.

• The school provides free care for the poor. Students from rural areas can receive scholarships to attend school with the hope they will return to their villages to provide much needed service.

Nepal

• In 2005 there were about 250 dental hygienists in Nepal. The school graduates 40 students each year and they work in dental clinics, hospitals and other community settings, or are self employed. (Knevel, 2005)

ConclusionThis brief overview of a few countries gives us a glimpse of the variety of situations dental hygienists around the world find themselves in. Although dental hygiene has been around for 105 years in the US, we are still fighting for independent practice. Other countries, like the Netherlands have independent practice and can provide basic pediatric dental services. Countries like Germany have not even recognized dental hygiene as a legitimate profession, while Nepal has a degree program. It is difficult to understand what makes the difference, but if I were to make a guess, one thing would be personal support of the national organization which works to enhance the opportunities for dental hygienists. We ARE the world's oral health care specialists!

References

• ADHA-Number of Dental Hygiene Education Programs Offered by State. (n.d.). Retrieved February 2011, from ADHA web site: www.adha.org/downloads/edu/Ed_Program_Map.pdf

• DDHV. (2011). Retrieved April 12, 2011, from German Dental Hygienist Association: http://www.ddhv.de/en/

• (2008). EU Manual of Dental Practice: version 4 .

• Gadbury-Amyot, C., & Brickle, C. (2010). Legislative Initiatives of the Developing Advanced Dental Hygiene Practitioner. Journal of Dental Hygiene , 110-113.

• Gaterman, B. (2004, August). Letter to the Editor. International Journal of Dental Hygiene .

• IFDH. (2008). Retrieved April 12, 2011, from International Federation of Dental Hygienists: www.ifdh.org/workabroad/netherlands.shtml

• International Federation of Dental Hygienists. (2008). Retrieved April 7, 2011, from Australia: http://www.ifdh.org/workabroad/australia.shtml

• Johnson, P. M. (2009). International profiles of dental hygiene 1987 to 2006: a 21 nation comparative study. International Dental Journal , 63-77.

• Knevel, R. (2005). Dental hygienists on top of the world: supporting oral health education in Nepal. International Journal of Dental Hygiene , 205-212.

References, cont’d.

• Luciak-Donsberger, C., & Eaton, K. (2009). Dental hygienists in Europe: trends toward harmonization of education and practices since 2003. International Journal of Dental Hygiene , 273-284.

• Luciak-Donsberger, L., & Aldenhoven, S. (2004). Dental hygiene in Australia: a global perspective. International Journal of Dental Hygiene , 165-171.

• Mingee, T. (2003). Changes in the Dental Hygiene Profession. RDH , 20-25.

• O'Hehir, T. (2003). More hygienists than dentists. RDH , 18-19.

• Pay Scale. (2011). Retrieved April 7, 2011, from www.payscale.com/research/AU/Job=Dental_Hygienist/Hourly_Rate

• Petersilka, G., Neuhoff, D., & Flemmig, T. (2004). Establishing dental hygiene education in Germany: current facts and future perspective. International Journal of Dental Hygiene , 86-92.

• Salary.com. (n.d.). Retrieved April 12, 2011, from http://www1.salary.com/Dental-Hygienist-salary.html

• Wikipedia, Alfred Fones. (n.d.). Retrieved February 2011, from en.wikipedia.org/wiki/Alfred_Fones

• Yoshida, N., Endo, K., & Komaki, M. (2004). Dental Hygiene education in Japan: present status and future directions. International Journal of Dental Hygiene , 179-184.