Dental Hygiene in Progress

As we celebrate 100 years of dental hygiene, remembering our history is important. Dental hygiene has experienced a metamorphosis over the past century. It is no longer a “female” profession. Dental hygienists have expanded their career opportunities through advanced education and broadened their horizons into other fields—from research to entrepreneurship. They have achieved independent practice in some states. Alfred C. Fones, DDS, and Irene Newman would be proud. As history shapes our future, we need to remember our roots, learn from our missteps, and continue to grow our profession.

AUSPICIOUS BEGINNINGS

The term “dental hygiene” is attributed to the profession’s founder, Alfred C. Fones, DDS. He was a major inventive force in the dental hygiene movement, and his vision was twofold. Not only did he think dental hygienists could play an integral role in private dental offices, he also believed it was just as important for dental hygienists to provide care for those patients with little or no access to oral health care services.¹ Fones and Newman instilled in their students the importance of both clinical and public health dental hygiene.²

The first class of dental hygiene professionals began working in public schools in 1914. The following year, the first dental hygienist was employed outside of a public school setting at New Haven Hospital in Connecticut. In late 1915, the Connecticut Dental Practice Act was passed, defining the practice of dental hygiene, and beginning the regulation of dental hygiene by dentists that continues today in most states.

ORGANIZED DENTAL HYGIENE

The first state dental hygiene association was formed by Connecticut dental hygienists in 1914. The original Connecticut Dental Hygienists’ Association started with 19 charter and nine associate members. A group of California dental hygienists worked tirelessly to create a national organization, and in 1923 their vision was realized with the creation of the American Dental Hygienists’ Association (ADHA), which offered membership to all state and component organizations. ADHA’s first national meeting was held in Cleveland in September of 1923 with 46 dental hygienists from across the country in attendance. Winifred Hart of Bridgeport, Conn, was elected president.³

Since its inception, ADHA’s main goal has been to improve communication and cooperation among dental hygienists. Today, the ADHA represents the professional interests of the more than 180,000 dental hygienists across the United States. Leading the way as a cohesive force, ADHA continues to advance the dental hygiene profession.⁴

Dental hygiene’s first professional journal, published in 1927, was titled the Journal of the American Dental Hygienists’ Association. The journal was a refereed, scholarly journal that provided cutting-edge research and educational viewpoints written and reviewed by the recognized leaders in the dental hygiene profession. The publication continues today as the Journal of Dental Hygiene, which is available exclusively online to ADHA members.

MAJOR MILESTONES

By 1939, there were 8,000 dental hygienists in the US, with most treating patients in private practice. ADHA adopted the term “registered dental hygienist” as the official credential for the profession in 1949. In 1951, New Mexico and Texas became the last states to sanction dental hygiene licensure in the US.

The first National Board Dental Hygiene Examination was introduced in 1962. There were four examinations consisting of 100 test items, each of which covered three subjects. There were 1,569 dental hygiene students who sat for the first examination and 1,490 passed—a 95% success rate. In 1973, a single, comprehensive dental hygiene examination consisting of approximately 400 test items replaced the four-examination series. In 1998, the examination was restructured to include 350 items, of which 150 were associated with patient case study material.⁵

As the dental hygiene profession continued to grow, the word “female” was deleted from the ADHA Constitution and Bylaws in 1964. Subsequently, the first male dental hygienist, Jack Orio, RDH, graduated from the University of New Mexico in 1965.⁶ The following year, admission requirements for dental hygiene schools were introduced, which mandated that students meet certain requirements before entering a dental hygiene program of study.⁶

The first four dental hygienists were commissioned into the Medical Service Corps of the US Army in 1972, and in 1975, the US Army approved the addition of community health dental hygienists to provide services to enlisted soldiers and their families.⁸

Similar to other health care professions, ADHA supported the requirement of earning a certain number of continuing education units to renew dental hygiene licensure. ADHA disseminated the first continuing education guidelines in 1973.⁶

Today, the oversight of continuing education licensure requirements is done by individual state dental boards. For example, dental hygienists are required to complete 24 contact hours of continuing education during each triennial registration period in New York State.

In an effort to improve the scientific foundation of dental hygiene and encourage clinical research, the National Center for Dental Hygiene Research was founded in 1993. Supported by a grant from the US Department of Health and Human Services’ Bureau of Health Professions, the center’s goals include supporting oral health research, creating an infrastructure to further dental hygiene research, and strengthening the evidence base supporting dental hygiene. The center subsequently changed its name to the National Center for Dental Hygiene Research and Practic

e when it began incorporating translational research, designed to improve clinical practice, into its platform. In 2007, there were 152,000 registered dental hygienists in the US. That numbered continued to grow to 181,800 in 2010.⁹ With increasing numbers of dental hygienists to represent, ADHA continues to advocate for dental hygiene practice as a fundamental component of the health care delivery system.

ADVANCING THE PRACTICE OF DENTAL HYGIENE

Washington was the first state to expand its dental hygiene practice act to include the administration of local anesthesia by dental hygienists under direct supervision in 1971. Even though New Mexico was one of the last states to grant dental hygiene licensure, it was the first state to allow administration of local anesthesia by dental hygienists under general supervision in 1972.⁶ By 1990, 14 states had permitted dental hygienists to administer local anesthesia. At the turn of the century, more than half of the states across the country allowed dental hygienists to administer local anesthesia. Today, 45 states have expended their dental hygiene practice acts to include this important technique (Figure 1).¹²

In 1980, Colorado became the first state to allow dental hygienists to practice without direct supervision by a dentist. Now many states have some form of autonomy within their practice acts—ranging from collaborative practice and advanced dental hygiene practitioner (ADHP) to dental therapist and community dental health coordinator.¹³

The California legislature created the registered dental hygienist in alternative practice in 1998. These dental hygienists administer oral care and preventive services to special populations in alternative settings.⁶ In 2004, ADHA became the first national oral health organization to propose a new oral health provider, the ADHP. This mid-level provider can provide much-needed restorative care to underserved populations.¹³ The ADHP model enables more patients to be treated and referred to dentists or other health care professionals for comprehensive care. ADHPs work in collaboration with dentists and other members of the oral health care team. The intention of the ADHP position is to deliver quality oral health care services in a variety of public health settings, such as community health centers, school-based health clinics, Head Start or preschool programs, long-term care facilities, and hospitals. The demand for oral health services is particularly acute in such venues and ADHPs can help meet the needs of underserved communities.¹ Minnesota passed the first law in the country to allow students educated under the ADHP model to become licensed to practice in 2009.⁶ For more information on the expansion of practice acts.

ONWARD AND UPWARD

Since the profession began, prevention, public health, and improving access to care remain at the core of dental hygiene. With continued growth and advancement, dental hygienists will see their scope of practice expand, as well as the opening of additional professional opportunities in a variety of areas. Independent practice, self-governance, and expanded licensure are all in dental hygiene’s future. The dental hygiene profession has continually evolved over the past 100 years. If history is any indication of the profession’s potential growth, get ready for the next 100 years.

REFERENCES

1. University of Bridgeport. History of the Fones School of Dental Hygiene. Available at: www.bridgeport.edu/ academics/ fones school/ history.aspx. Accessed March 13, 2013.
2. Connecticut Dental Hygienists’ Association. History of Dental Hygiene. Available at: www.cdha-rdh.com/home/historyofdentalhygiene.html. Accessed March 13, 2013.
3. Motley WE. Part two— founding the association. American Dental Hygienists’ Association 75th Anniversary Scrapbook. 1988:4–5.
4. American Dental Hygienists’ Association. Mission and History. Available at: www.adha.org/mission-history. Accessed March 13, 2013.
5. Joint Commission on National Dental Examinations. Technical Report: The National Board Dental Hygiene Examination. Available at: www.ada.org/ sections/ education And Careers/ pdfs/ nbdhe_technical_ report.pdf. Accessed March 13, 2013.
6. American Dental Hygienists’ Association. 100 Years of Dental Hygiene. Available at: www.adha.org/100-timeline/timeline.html. Accessed March 13, 2013.
7. Sigma Phi Alpha. History. Available at: www.sigmaphialpha.org/about/history.htm. Accessed March 13, 2013.
8. Office of the Surgeon General. Highlights in the History of US Army Dentistry. Available at: www.history.amedd.army.mil/corps/dental/general/highlights/Highlights.pdf. Accessed March 13, 2013.
9. Bureau of Labor Statistics. Occupational Outlook Handbook: Dental Hygienists. Available at: www.bls.gov/ooh/Healthcare/Dental-hygienists.htm. Accessed March 13, 2013.
10. Mingee TL. Changes in the dental hygiene profession. Available at: www.rdhmag.com/articles/print/volume-23/issue-7/feature/changes-in-the-dental-hygiene-profession.html. AccessedMarch 13, 2013.
11. ADHA. ADA Policies. Available at: www.adha.org/resources-docs/7522_Preceptorship_ADA_Policies.pdf. Accessed March 14, 2013.
12. ADHA. States Where Dental Hygienists May Administer Local Anesthesia. Available at: www.adha.org/resources-docs/7521_Local_Anesthesia_by_State.pdf. Accessed March 15, 2013.
13. American Dental Hygienists’ Association. Workforce Models and Advanced Practice. Available at: www.adha.org/workforce-models-apdh. Accessed March 13, 2013.

From Dimensions of Dental Hygiene. Centennial Celebration of Dental Hygiene 1913-2013; 24-26, 28, 31.