Beyond turf wars: What Colorado’s collaborative model can teach the dental profession

Across the country, organized dentistry and organized dental hygiene are often portrayed as opposing forces. Legislative sessions become battlegrounds, scope-of-practice discussions become territorial disputes, and professional relationships can deteriorate into public conflict.

Colorado has taken a different path.

For decades, the Colorado Dental Association (CDA) and the Colorado Dental Hygienists’ Association (CODHA) have maintained a collaborative relationship rooted in communication, mutual respect, and a shared commitment to improving oral health-care access. While disagreements inevitably arise, Colorado has largely resisted the adversarial “turf war” culture seen in many other states. Instead, the two organizations have worked to build a progressive oral health-care model that benefits providers and patients alike.

A bridge-builder

That spirit of collaboration was recently spotlighted when CDA honored Alyssa Aberle, MBA, RDH, CDIPC, FADHA, with the Advocacy Collaboration Award for her work strengthening relationships between dentistry and dental hygiene in Colorado. The recognition represented more than an individual accomplishment; it symbolized a broader philosophy that oral health care advances most effectively when professions work together rather than against one another.

Aberle has become known as a bridge-builder within organized oral health care. Her advocacy reflects an important principle: collaboration does not require complete agreement. It requires a willingness to engage respectfully, maintain dialogue, and prioritize patient outcomes over professional politics.

Expanding access to care

Colorado’s cooperative culture has also helped shape one of the more progressive oral health-care frameworks in the country. Over the years, lawmakers and professional leaders have supported legislation expanding access to care while recognizing the education and expertise of dental hygienists.

Colorado allows licensed dental hygienists to practice unsupervised dental hygiene within the scope of their education and training. Hygienists may provide preventive services, periodontal procedures, assessments, radiographs, and dental hygiene treatment planning without dentist supervision. The state also permits dental hygienists to own or operate dental hygiene practices and collaborate with dentists when additional care is needed.

Expanded services

In recent years, Colorado further expanded collaborative practice authority by allowing dental hygienists to prescribe and administer certain preventive agents such as fluoride varnish, silver diamine fluoride, nonsystemic antimicrobial agents, nonnarcotic analgesics, and even antibiotics. Hygienists in Colorado may also administer local anesthesia without supervision and place interim therapeutic restorations.

These laws did not emerge from professions working in isolation. They developed within an environment where organized dentistry and organized dental hygiene were willing to communicate and seek practical solutions together.

The result has been a more flexible oral health-care delivery model that increases access for rural and underserved communities while preserving collaborative relationships between providers. Colorado’s framework recognizes that expanding preventive care access does not diminish dentistry; it strengthens the entire oral health-care system. That distinction matters.

Collaborative approach to workforce shortages

That same collaborative mindset has also shaped Colorado’s approach to workforce shortages.

For more than a decade, CDA and CODHA have been engaged in ongoing discussions about workforce sustainability and access to care. In 2009, the University of Colorado School of Dental Medicine closed its Bachelor of Science in dental hygiene program while simultaneously increasing enrollment for dental and internationally trained dentists. Professional leaders immediately recognized the potential for workforce imbalance as Colorado began graduating significantly more dentists than dental hygienists.

Rather than assigning blame or competing for influence, stakeholders worked together to identify long-term solutions. CDA and CODHA formed task forces, researched potential locations for future hygiene programs, and collaborated with educators, legislators, and community leaders to strengthen the state’s oral health-care workforce pipeline.

Measurable results

Those efforts have produced measurable results. Between 2024 and 2025, three new dental hygiene programs opened in Colorado—none of them located in Denver—helping expand educational access into additional regions of the state. At the same time, two of Colorado’s existing dental hygiene programs increased their class sizes to help address workforce demands.

As a result of these collaborative efforts, Colorado has nearly tripled the number of dental hygienists graduating within the state in just the past few years.

Equally important, Colorado’s professional organizations remained committed to maintaining educational quality while expanding workforce capacity. CDA and CODHA worked together to support requirements that all licensed dental professionals graduate from Commission on Dental Accreditation (CODA)-accredited programs, reinforcing a shared commitment to patient safety, professional competency, and high standards of care.

When professional organizations operate from a place of opposition, progress often stalls. Legislative efforts become combative. Clinicians become divided. Students entering the workforce inherit mistrust instead of collaboration. Most importantly, patients lose opportunities for improved access to care.

Colorado demonstrates another possibility.

When dentistry and dental hygiene organizations work together, everyone benefits. Dentists gain stronger preventive partnerships and expanded access pathways for patients. Hygienists gain opportunities to practice more fully within their education and training. Patients benefit from more accessible, team-based care models that prioritize prevention and early intervention.

A powerful message to future professionals

Colorado’s example also sends a powerful message to future professionals. New graduates learn from the culture modeled by organized leadership. If they witness hostility between professions, they may come to view conflict as inevitable. But when they see organizations engaging respectfully—even amid disagreement—they learn that advocacy and collaboration can coexist.

That may be one of Colorado’s greatest achievements: proving that professional collaboration is not weakness. It is leadership.

At a time when many states remain entrenched in scope battles and professional polarization, Colorado offers a compelling alternative. The partnership between CDA and CODHA shows that organized dentistry and organized dental hygiene do not have to choose between advancing their professions and supporting one another. In fact, Colorado’s success suggests the opposite may be true.

The strongest oral health-care systems are often built not through division, but through collaboration.

Also by the author:

• Toxic teams are expensive: The hidden cost of poor culture in dentistry
• “It falls under the dentist’s license”: A risky myth for the entire dental team

Editor’s note: This article first appeared in Clinical Insights newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.