Hygienists, be your own boss

Most people think of a hygienist in the traditional sense: a clinical practitioner focused on prevention who works in a dental office. But now, as a hygienist, you can be your own boss, thanks to new laws put in place in a few states like California and Oregon. Take control of your career — take it to the field.

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The advancement and scope of dental hygiene is continually changing and allowing hygienists to be seen as a valuable asset to the dental team. In the past, hygiene was mainly viewed as a clinical position in a dental practice that provided preventive prophylactic services. Today, dental hygiene is evolving into a more advanced scope of practice. In Oregon, a licensed dental hygienist has the ability to use an expanded practice permit or restorative function endorsement that will allow practice in alternative settings.

RELATED: Cascade Hygiene: How mobile hygiene is taking off in the West

According to theOregon Board of Dentistry, there are currently 4,203 active dental hygiene licenses in Oregon. At the moment, 387 of these licenses have an expanded practice permit (EPP), which allows the hygienist to practice in a more rural setting. The EPP allows hygienists to perform hygiene services without the supervision of a dentist in settings such as nursing homes, public and non-profit community health clinics, homes of adults who are non-mobile, hospitals, and other locations. The EPP allows hygienists to perform necessary prophylactic services to patients except for those services that require supervision of a dentist, such as administering local anesthetic and nitrous oxide, prescribing antibiotics, and assessing overall dental risk of a patient.

In order to apply for the EPP, hygienists must meet specific criteria:
-Active liability insurance
-Current CPR/AED certification
-2,500 hours of supervised dental hygiene services
-40 hours of continuing education

If the applicant is applying for the permit prior to receiving their hygiene license (a student, for instance), they must provide documentation of the following:
-500 hours of supervised clinical dental hygiene services completed on patients in expanded practice use settings
-Active liability insurance
-Current CPR/AED certification
-36 hours of continuing education credits

Furthermore, Oregon allows hygienists to hold restorative function endorsements on hygiene licenses. There are 386 active licenses in Oregon that have this endorsement. Oregon states that a restorative hygienist may complete the placement and finishing of direct alloy and composite restorations under the indirect supervision of a licensed dentist after the supervising dentist has prepared the area for restoration. The restorative care can be performed once the patient has given informed consent for the placement of the restoration by a restorative functions endorsement dental hygienist. Before the patient is released, the final restoration must be checked by a dentist and documented in the chart. In order for the hygienist to apply for this endorsement, they must complete a board approved restorative education program and pass the Western Regional restorative board exam.

There have been a select number of hygienists who have started their own businesses with their expanded practice permits, reaching out to a demographic that is unable to access dental care. DentistryIQ.com covered one of these practices earlier this year (read that story here). Another up-and-coming expanded practice business in Oregon was started by Kyle Johnstone, RDH, EPP, BSDH, MHA. Kyle is 31 years old and had been working full-time as a registered hygienist for nearly three years. He recently started Bright and Clean Mobile Dental Hygiene, LLC in the spring of 2014 and is excited to be using his license in an alternative way that will help the community. After receiving his bachelor’s in dental hygiene and his master’s in healthcare administration from Pacific University, Kyle knew he wanted to do something different and innovative. He has always wanted to be his own boss and have flexible work hours that would still provide a competitive salary. Owning his own dental hygiene business was a dream, and he decided to make it a reality. He started by registering his business name and from there, started purchasing equipment needed for the business that would allow him to provide hygiene services. His next step was to start advertising his business in the community. With the community becoming aware of his dental hygiene business, he has his first prophy appointment scheduled this month!

Like any new business venture, there are benefits and downfalls. Kyle states that the benefits are flexible working hours and building a stronger relationship with the patient. He explains that he is able to spend more time with his patients and create a catered hygiene care plan. On the other hand, there are downfalls to consider. When owning your own business, there is a financial liability to consider. Kyle explains that it can be difficult to start a business due to finances and it may be important to start part-time to work the business into a success. It can also be difficult to find a dentist who is willing to collaborate with the business. Oregon law requires expanded practices to have a dentist that is willing to see referred patients at least once a year.

Kyle also emphasizes the importance of building resources in the community and staying in contact with other expanded practice permit hygienists. These relationships provide support to your business and will allow you to be successful in the future.

Oregon is helping to advance oral healthcare through dental hygienists. It is evident that the schooling and licensure of a dental hygienist in Oregon has many advantages, such as starting a business or placing restorations in addition to hygiene services. Finding a full-time hygiene job has been difficult for most, but having the additional endorsements and permits on a dental hygiene license may provide alternative opportunities.


Ashley Cutler CropAshley Cutler, RDH, EPP, BSDH, is a registered dental hygienist in Portland, Oregon. In 2011, Ashley graduated with honors from Pacific University with a Bachelor of Science in dental hygiene. She was also the recipient of the Colgate Student Achievement Recognition Award. For the past three years, she has been practicing full-time as a dental hygienist in a busy general practice. Ashley finds dental hygiene a rewarding and challenging career and continues to feel fortunate to belong to an amazing profession. She may be contacted at cutl8368@pacificu.edu.

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