Standards for Dental Therapy and Dental Hygiene Education

As the landscape of oral health care and the delivery of services continue to undergo change, the American Dental Hygienists’ Association (ADHA) is working toward ensuring that the addition of midlevel practitioners to the dental team, including dental therapists, is a positive for patients and the profession of dental hygiene. The ADHA is committed to the development of providers who are appropriately educated and well prepared to deliver safe, quality oral health care to those who need it most. As such, the organization supports oral health care workforce models that culminate in: graduation from an accredited institution, professional licensure, and direct access to patient care.¹ Simultaneously, the organization is working on revisions to the accreditation standards for dental hygiene, as a well-educated workforce is a well-prepared workforce best able to effectively and safely treat patients.

DENTAL THERAPIST ACCREDITATION STANDARDS

The effort to advance the dental therapist model of care received a boost in August 2015 when the Commission on Dental Accreditation (CODA) authorized the implementation of an accreditation process for dental therapy education programs with the release of Accreditation Standards for Dental Therapy Education Programs. These accreditation standards contain some key provisions that will guide state policymakers and educational institutions as they consider authorizing dental therapists and dental therapy education programs. All authorized functions of a dental therapist—as required by state statute—must be included in the curriculum at the level, depth, and scope required by the state.

The CODA Accreditation Standards for Dental Therapy Education Programs specify the minimum acceptable requirements for educational programs and provide guidance regarding alternative and preferred methods of meeting the standards. Table 1 (page 27) lists the competencies identified within the clinical sciences section of the dental therapy education program accreditation standards. The CODA standards require at least 3 academic years of full-time instruction or their equivalent at the post-secondary level. In order to afford educational institutions maximum flexibility, the specific academic degree to be awarded is not identified in the accreditation standards. There is no mention of supervision within the dental therapy education standards, as supervision is determined by state regulation, not national accreditation standards.

The ADHA lead the effort in advocating for “advanced standing,” which affords dental assistants and dental hygienists who are entering a dental therapy program to be granted credit for prior coursework toward completion of the dental therapy degree. The educational institution determines what credits are to be recognized in determining the advanced standing.

DENTAL HYGIENE EDUCATION

In 1986, the ADHA Board of Trustees envisioned the evolution of the dental hygiene profession and, thus, adopted a policy supporting the baccalaureate degree as the entry into the profession. Since that time, dental hygiene scope of practice,¹ practice settings, and the roles of dental hygienists have grown significantly. In addition, the dental hygiene curriculum has expanded to accommodate scientific advancements in oral health. However, the number of associate-degree dental hygiene programs has grown, while the number of baccalaureate degree programs has decreased. Today, dental hygiene program directors and faculty are frequently faced with an overcrowded curriculum within a 3-year time frame.

Recently, the ADHA put out a call to its members interested in reviewing the existing Accreditation Standards for Dental Hygiene Education Programs. An ad-hoc work group was convened to review and develop proposed revisions. Nearly 200 dental hygienists from across the country participated. Approximately 80% self-identified as dental hygiene educators. With ADHA policies as their guide, along with recommendations from ADHA’s white paper, “Transforming Dental Hygiene Education and the Profession for the 21st Century,”² the group met virtually and shared their experience and expertise.

In June 2017, ADHA presented CODA with recommended revisions to the Accreditation Standards for Dental Hygiene Education Programs. The CODA Dental Hygiene Review Committee (DH RC), under the leadership of ADHA appointed CODA Commissioner, Susan Callahan Barnard, DHSc, RDH, was charged with reviewing and submitting recommended changes to the full commission for consideration at its summer 2017 meeting. ADHA was pleased the DH RC recommended nearly all of ADHA’s suggested revisions. On August 4, 2017, CODA adopted revisions to Standards 2-14 and 3-7. The new Standard 2-14 now states: “Graduates must be competent in providing dental hygiene care for all types of classifications of periodontal diseases including patients who exhibit moderate to severe periodontal disease with added competencies in providing dental hygiene care for patients with peri-implant disease.”³ The word “disease” was changed to “diseases.” As peri-implant disease is a type of periodontal disease, by making “periodontal disease” plural, peri-implant disease is included in the classifications of periodontal disease. The revised Standard 3-7 reads: “The full time faculty of a dental hygiene program must possess a baccalaureate or higher degree.”³ Both of these standards were immediately implemented.

CODA has asked ADHA for additional information surrounding revisions to two of the standards. Standard 2-1 focuses on the entry-level degree awarded to graduates of dental hygiene education programs. This revision would move the entry-level degree to the baccalaureate level. The suggested change to Standard 3-7 would require all full-time faculty and part-time faculty providing didactic instruction in dental hygiene education programs to hold a master’s degree or higher.

PROPOSED REVISIONS

Following the meeting in the summer of 2017, CODA has directed that proposed revisions to Accreditation Standards for Dental Hygiene Education Programs be circulated to the communities of interest for comment until June 1, 2018, for consideration at the August 2018 CODA meeting. In addition, CODA will conduct a hearing on the proposed revisions at the ADHA Annual Meeting in June 2018 in Columbus, Ohio. CODA Hearings will also be conducted at the American Dental Association Annual Meeting in Atlanta in October 2017 and the American Dental Education Association Annual Meeting in Orlando, Florida, in March 2018.

Several revisions and additions to the “Definition of Terms Used in Dental Hygiene Accreditation Standards” have been suggested:

Dental hygiene diagnosis: The identification of an individual’s health behaviors, attitudes, and oral health care needs for which a dental hygienist is educationally qualified and licensed to provide. The dental hygiene diagnosis requires evidence-based critical analysis and interpretation of assessments in order to reach conclusions about the patient’s dental hygiene treatment needs.

Dental hygiene process of care: Provides a framework where the individualized needs of the patient can be met, and to identify the causative or influencing factors of a condition that can be reduced, eliminated, or prevented by the dental hygienist. There are six components to the dental hygiene process of care: assessment, dental hygiene diagnosis, planning, implementation, evaluation, and documentation.

Interprofessional education: When students and/or professionals from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.

Additional revisions regarding dental hygiene faculty calibration have been suggested to Standard 2: Educational Program.⁴ The ADHA led the effort in proposing these suggested revisions to advance dental hygiene education programs to best prepare professionals for their evolving scope of practice. Written comments may be submitted to Michelle Smith, CODA’s manager of allied dental education at smithmi@ada.org. The ADHA is also ready to assist dental hygienists across the country who are interested in submitting written or oral testimony.

THE ONLY CONSTANT IS CHANGE

The dental hygiene profession is part of the nation’s overall health care delivery system, which is experiencing significant change. As the profession continues to evolve, the accreditation standards for dental hygiene education programs need to keep pace with the greater changes occurring throughout the country to ensure that graduates are prepared to enter the dental hygiene profession. ADHA serves as a national advocacy organization through our policy, which strongly recommends that all accredited dental hygiene programs prepare students for licensure in any US or Canadian jurisdiction.¹ 

ADHA actively advocates to empower and support dental hygienists throughout their careers. Dental therapy presents a new opportunity to improve the public’s oral and overall health, and potentially affords a possible career path for dental hygienists.

As the landscape of oral health care delivery continues to evolve and the pressure to effectively address the nation’s access-to-professional-oral-health-care problem intensifies, dental hygienists need to remain up to date on the changes in the dental hygiene accreditation standards, as well as the final implementation of dental therapy accreditation standards.

From Perspectives on the Midlevel Practitioner, a supplement to Dimensions of Dental Hygiene. October 2017;4(10):24-27.