Transforming Dental Hygiene Education: guiding the redefinition of dental hygienists' education and practice

At the meeting Transforming Dental Hygiene Education, Ann Battrell, MSDH, Executive Director of the American Dental Hygienists’ Association (ADHA), participated in a panel about the title of this article. Questions issued to the participants were: What are the contextual drivers that guide examination and realignment of dental hygienists’ role in a transformed health care system? Do dental hygienists possess core competencies they are unable to apply? What are the potential facilitators and barriers to enable maximal service by dental hygienists for great public impact? Ann spoke from the ADHA perspective, and discussed ADHA’s “Contextual Drivers” as guiding the analysis and repositioning of the dental hygienists’ role in a transformed health care system.

The ADHA Mission Statement is: ADHA strives to advance the art and science of dental hygiene; ensure access to quality oral health care; increase awareness of the cost‐effective benefits of prevention; promote the highest standards of dental hygiene education, licensure, practice and research; and represent and promote the interests of dental hygienists.(1) The ADHA Vision can be found in the ADHA Strategic Plan 2012-2015. The Vision Statement is: ADHA excels as a valued, collaborative and influential, community that is transforming the dental hygiene profession. The Core Ideology overriding all decisions is: Empowering dental hygienists to achieve their full potential as they seek to improve the public’s oral health.(2) Ann discussed dental hygiene education in the context of the ADHA Core Ideology, Strategic Plan, Vision, Mission, Goals, and Objectives. Competencies for the Advanced Dental Hygiene Practitioner (ADHP) were adopted March 10, 2008, by the ADHA Board of Trustees.(3) Also, Standards for Clinical Dental Hygiene Practice guide the individual dental hygienist’s practice.(4) “One hallmark of a true profession is its willingness to assume responsibility for the quality of care that its members provide.”(4) Market forces that will help to shape the profession are: economic factors; the rapid increase in dental hygiene education programs, access to care awareness; the introduction of dental therapy in the USA; direct access states; the Affordable Care Act (ACA); and the dental hygienist being recognized as a primary care provider. Direct Access is defined as “The dental hygienist can initiate treatment based on his or her assessment of the patient’s needs without the specific authorization of a dentist, treat the patient without the presence of a dentist, and can maintain a provider‐patient relationship.” A map of direct access states can be found on the ADHA website.(7)

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It is thought that setting for practice will change, to include more dental hygienists in: hospitals; nursing homes; residential facilities for the elderly, disabled, children, mentally ill; correctional facilities; community health centers, school based health centers; rural health centers; nursery centers, centers, school and head start, job training camps, and physician or nurse practioner facilities. Dental hygienists will continue to serve populations with problems accessing care, and those with poverty level incomes, as well as people residing in dental health and professional shortage areas.(8)

Examples of these expanded roles are the Registered Dental Hygienists in Alternative Practice (RDHAP) in California, and the Expanded Practice Dental Hygienists (EPDH) in Michigan and Oregon. Dental hygienists in New Mexico can own and manage a collaborative dental hygiene practice. The new Minnesota Dental Therapist was discussed; the two models that now exist in the state are the Dental Therapist (DT) and the Advanced Dental Therapist (ADT).(9) Different levels of education and different scopes of practice exist for the two models.

There are many barriers to be able to achieve the mission and goals of the ADHA and the profession. Only twenty three of over 300 dental hygiene education programs are located within dental schools. There is little integration and intra‐professional education. There is sometimes a lack of vision, fear of change, and risk‐aversion within and outside the profession. Dental hygiene educational programs “teach to the boards,” with a narrow technical focus on clinical training primarily for private practice within a dental office setting. We also face a shortage of qualified dental hygiene educators. And last, but not least, is the perception of dental hygienists and dental hygiene by other health professions. The accreditation system for dental hygiene education programs is a barrier, as it currently stands, as it is controlled by the American Dental Association, Commission on Dental Accreditation (ADA CODA). Regulatory control through State Boards of Dentistry are also limiting, such as scope of practice control, practice setting control, licensure portability, and lack of standardized licensee data collection across the U.S. Others addressed these issues and questions from different perspectives. We will discuss those in future newsletters. A White Paper on this meeting is scheduled to be written.References 1. http://www.adha.org/mission-history. 2. http://www.adha.org/resources-docs/7613_Strategic_Plan.pdf. 3. http://www.adha.org/resources-docs/72612_ADHP_Competencies.pdf. 4. http://www.adha.org/resources-docs/7261_Standards_Clinical_Practice.pdf. 5. http://www.adha.org/resources-docs/7261_Standards_Clinical_Practice.pdf. Page 14, Appendix B. 6. http://www.adha.org/direct-access. 7. http://www.adha.org/resources-docs/7524_Direct_Access_Map.pdf. 8. http://bhpr.hrsa.gov/shortage/hpsas/updates/09012011dentalhpsas.html. 9. http://www.adha.org/resources-docs/75113_Minnesota_Story.pdf.