The Evolving Landscape of the Dental Hygiene Profession

The dental hygiene profession is facing an interesting and challenging time. Workforce issues continue to be a concern post-pandemic while the national and state dental associations are pushing new legislation that undermines the dental hygiene profession. Navigating these challenges while striving for greater professional autonomy can seem daunting — but it’s more crucial than ever.

During the pandemic many dental hygienists were leaving the workforce; some to retire and others to avoid risking new and devastating viral infection. Not all practices took precautions, and some decided placing colleagues at risk was too disturbing to continue working in those settings¹ Fortunately, as the pandemic pushes further behind us, the profession is making meaningful progress.

In terms of dental hygiene education, according to the most recent Commission on Dental Accreditation (CODA) survey on dental hygiene,² first year enrollment in dental hygiene education programs has increased steadily since 2020-2021, surpassing rates recorded between 2013-2014 through 2021-2022. Additionally, first year capacity numbers have increased steadily over the past 4 years. Total enrollment of dental hygiene students has reached an all-time high increasing by 3.9% for both 2022-2023 and 2023-2024 with the majority of graduates (72.6%) employed in dental offices.²

In addition, the American Dental Hygienists’ Association (ADHA) has been taking steps to address workforce issues by hosting webinars on leadership and managing workplace issues. More recently, ADHA, in partnership with the Delta Dental Foundation, has launched the Hygienist Inspired Chairside Recruitment program. This initiative aims to train dental hygienists and inform the public about the benefits of pursuing a career in oral health. It is focused on enhancing and diversifying the oral hygiene workforce, with a particular focus on public health sectors and underserved communities.

Although these steps are positive, it is important to keep perspective. According to the latest results of the economic outlook and emerging issues in dentistry provided by the American Dental Association (ADA) Health Policy Institute (HPI),³ 31.7% of dentist respondents indicated they have been recruiting for dental hygienists over the past 3 months, with 77.8% indicating that recruitment has been challenging.³ A previous study performed by the ADA HPI in partnership with the ADHA and dental assisting organizations, revealed key workplace issues that needed to be addressed to improve the shortage situation.⁴ Dental hygiene respondents indicated that health insurance, paid sick time, paid leave, and continuing education or professional development funds were important benefits for recruitment and retention. Additionally, factors associated with the attrition of dental hygienists included negative workplace culture, insufficient pay, lack of growth opportunities, inadequate benefits, and feeling overworked.⁴ These issues have not been sufficiently addressed by the ADA or dental employers and may be associated reasons for continued workforce shortage issues. Failure to recognize the importance of these issues and their impact on the recruitment and retention of dental hygienists remains a conundrum.

Another challenge relates to the recent resolutions passed by the ADA House of Delegates which supports dental students, dental residents, and foreign-trained dentists to be licensed to practice dental hygiene. While each state promulgates its own rules on this issue, the fact that organized dentistry considers the education of these groups to be comparable to the education of dental hygienists is astounding. The age-old notion that dental hygienists merely “clean teeth” is passe and it is time the dental field acknowledges the extensive preventive and therapeutic services performed by dental hygienists. Equally important, both dentists and dental hygienists (yes, we, too) must stop diminishing the value of dental hygienists as licensed healthcare providers by viewing them as teeth scrapers. In their paper on teamwork in dentistry, Preshaw et al⁵ state

“…it is imperative that dental hygienists (DHs) and dental therapists (DTs) are not viewed as ‘scaling machines’ who just provide a ‘scale and polish’ (terminology that has now been removed from the lexicon of periodontology in the United Kingdom because it both devalues and incorrectly describes the important clinical procedures that form a fundamental component of effective periodontal care). DHs and DTs are autonomous clinicians with specific skill sets.

In response to the recent ADA resolutions, the ADHA published a position statement that addresses their perspective as follows:⁶

“The ADHA firmly believes that any individual seeking to practice dental hygiene in the US must complete a CODA-accredited dental hygiene education program, and meet the clinical training, examination and practice requirements necessary to earn a dental hygiene license, without exception.”

Equally concerning is the ADA’s proposed Dental Access Model Act (DAMA), supported by the American Legislative Exchange Council (ALEC) a measure advocating for dental assistants to perform scaling procedures. This model is based on a recently initiated pilot program in Missouri and legislation in Wisconsin, neither of which is based on sound data that demonstrates safety, appropriateness, or efficacy. Promoting oral preventive assistants nationwide endangers patient safety, compromises quality of care, and undermines the established standards of dental hygiene practice. The ADHA opposes this initiative and has published a position statement urging “stakeholders to pursue evidence-based solutions that prioritize patient safety and improved access to oral healthcare.”⁷

Some progress has been made that is both beneficial to the profession and the public.  The Dentist and Dental Hygienist (DDH) Compact has made significant progress toward improving licensure portability in the US. Ten states have already enacted legislation and 10 more states have filed legislation for 2025. This initiative has been a long-standing collaboration with the Department of Defense, Council of State Governments, ADA, American Dental Support Organizations, Coalition for Modernizing Dental Licensure, and state dental and dental hygiene associations, to improve portability of oral health professionals and increase access to care. To learn more about this compact process visit ddhcompact.org.

In addition, ADHA is working to increase professional autonomy for dental hygienists through the following policies. ADHA:⁸

• Supports the pursuit of professional autonomy and affirms the profession has the responsibility to have full authority for its own professional standards of education, practice, legislation, licensure, and discipline
• Advocates for dental hygienists owning and operating dental hygiene practices, entering into provider agreements, and receiving direct and third-party payments for services rendered
• Emphasizes that dental hygienists should receive direct reimbursement for services provided
• Affirms that dental hygienists are competent to provide dental hygiene services without supervision

While the profession is encountering challenges and looking ahead to new opportunities, dental hygienists can support the association by staying informed, educating patients about the importance of care from a licensed dental hygienist, engaging with their employers to share perspectives, and educating legislators about these issues before decisions are made that could detrimentally impact public health.

References

1. Morrissey, RW, Gurenlian, JR, Estrich, CG, et al. Employment patterns of dental hygienists in the United States during the COVID-19 pandemic: An Update. J Dent Hyg. 2022 Feb; 96(1):27-33.
2. American Dental Association Commission on Dental Accreditation. 2023-24 dental hygiene report.
3. American Dental Association. Health Policy Institute. Economic outlook and emerging issues in dentistry, 4^th Quarter, 2024.
4. ADA Health Policy Institute in collaboration with the American Dental Assistants Association, American Dental Hygienists’ Association, Dental Assisting National Board, and IgniteDA. Dental workforce shortages: Data to navigate today’s labor market. October 2022.
5. Preshaw, PM, Minnery, H, Dunn, I, et al. Teamworking in dentistry: The importance for dentists, dental hygienists and dental therapists to work effectively together—A narrative review. Int J Dent Hyg.2024;0:1-7.
6. American Dental Hygienists’ Association. Position statement on dental hygiene education. December 2, 2024.  2025.
7. American Dental Hygienists’ Association. Position statement dental access model act. December 20, 2024.
8. American Dental Hygienists’ Association. ADHA Policy & Bylaws Manual. 2024.