Representing Dental Hygienists

As the largest national organization representing the interests of more than 185,000 dental hygienists across the country, the American Dental Hygienists’ Association (ADHA) exists to unite, empower, and support the profession of dental hygiene and improve the public’s oral and overall health. Supporting dental hygienists throughout their careers is a cornerstone of the ADHA’s strategic plan. Dental hygienists across the country are experiencing professional change as the oral health care delivery system evolves regarding access to care, reimbursement, and new workforce models, to name a few. Many dental hygienists are concerned about the availability of employment in private practice, as well as everyday workplace challenges. Within this time of change is great opportunity for dental hygienists and the profession to grow and play a larger role in the health care delivery system in the United States. One of the ADHA’s roles is to make sense of the change dental hygienists are experiencing and to demonstrate how opportunities are emerging during these turbulent times.

DIRECT ACCESS

One of the ways career options can be unduly restricted is the requirement that dental hygienists be under the direct supervision of a dentist. The ADHA has long advocated for efforts that advance direct access. The ADHA defines direct access as, “the ability of dental hygienists to initiate treatment based on their assessment of a patient’s needs without the specific authorization of a dentist, treat the patient without the presence of a dentist, and maintain a provider-patient relationship.”¹

In ADHA’s efforts to balance priorities that support individual dental hygienists as well as advocating to create new career options, the ADHA policy also states: “ADHA advocates that dental hygiene and/or dental practice acts be amended so that the services of dental hygienists can be fully utilized in all settings.”² The ADHA recently collaborated with the Georgia Dental Hygienists’ Association (GDHA) to promote direct access in the state of Georgia through support of HB 684—legislation that would expand the safety-net settings where dental hygienists can work without the direct supervision of a dentist. The US Federal Trade Commission (FTC) also supports dental hygienists maintaining direct access to patients. An FTC representative sent a letter of comment to Senator Valencia Seay of Georgia commenting on HB 684. The conclusion of the FTC comment letter stated: “By eliminating the direct supervision requirement for dental hygienists’ services delivered in expanded safety-net settings, and for dental screenings delivered in any setting, HB 684 will likely promote greater competition in the provision of preventive dental care services, leading to increased access and more cost-effective care, especially for Georgia’s most vulnerable populations. Retaining the direct supervision requirement in the settings covered by HB 684 would likely preclude these benefits of competition. Finally, authoritative sources have found no countervailing health or safety benefits to health care consumers from such requirements. Accordingly, HB 684 appears to be a procompetitive improvement in the law that would benefit Georgia health care consumers.”³

Although HB 684 died in committee, the ADHA will continue to use the FTC’s letter of comment in other states deliberating similar legislation that unnecessarily and archaically restricts practice settings for dental hygienists.

The states of Illinois and Utah were added to the list of direct access states in 2016, bringing the total to 39. In Illinois, public health dental hygienists (licensed dental hygienists) can now work in public-health settings, such as federally qualified health centers (FQHC); local, state, or federal public health facilities; Head Start programs; special supplemental nutrition programs for Women, Infants, and Children (WIC); or certified school-based health centers or school-based oral health programs. This provider also works collaboratively with a licensed dentist pursuant to a written public health supervision agreement that allows the public health dental hygienist to treat patients without a dentist first examining the patient and being present in the facility during treatment.

In Utah, dental hygienists can now practice in public health settings under a collaborative agreement with a dentist. The law allows them to perform services remotely in homebound patient residences, schools, nursing homes, assisted living facilities, community health centers, FQHCs, and mobile dental health programs that employ a dentist.

Once state law is changed to allow dental hygienists to provide services in direct-access practice settings, dental hygiene education programs must update their curricula to ensure that dental hygiene students are prepared to pursue these new practice opportunities. Simultaneously, practicing dental hygienists need to be aware of the significant changes happening in their home states and acquire the knowledge, skills, and professional network to pursue new career opportunities. The ADHA remains dedicated to informing dental hygienists about the changes taking place across the US and to providing resources to help dental hygienists grow their careers on the local, state, and national levels.

MIDLEVEL ORAL HEALTH PRACTITIONERS

As the US experienced the introduction of dental therapy first in Alaska, then Minnesota, and now other states, the ADHA was faced with a significant decision regarding how dental therapy would impact the profession of dental hygiene. Essentially, the decision came down to whether the dental hygiene profession would openly oppose the introduction of dental therapy or become involved in and directly impact the dental therapy movement. The ADHA House of Delegates and Board of Trustees thoroughly debated the dental therapy issue and developed policy supporting midlevel oral health practitioners as a career option for dental hygienists. Central to this, the ADHA has defined a midlevel oral health practitioner as “a licensed dental hygienist who has graduated from an accredited dental hygiene program and who provides primary oral health care directly to patients to promote and restore oral health through assessment, diagnosis, treatment, evaluation, and referral services. The midlevel oral health practitioner has met the educational requirements to provide services within an expanded scope of care, and practices under regulations set forth by the appropriate licensing agency.”⁴

The ADHA has led the effort to ensure that the dental hygiene workforce is at the forefront of any deliberations involving the creation of a new oral health provider. Without the ADHA taking a proactive approach to the introduction of dental therapy, a new profession may have been born that was not built on dental hygiene. In fact, the initial draft of the dental therapy education standards was fraught with unnecessary constraints on supervision, evaluation, and treatment planning. With recognition that this career path may not suit all dental hygienists, the ADHA is committed to supporting dental hygienists in the exploration of current and future career pathways.

DENTAL THERAPY EDUCATION STANDARDS

One of the ADHA’s most significant advocacy efforts was its multiyear work to ensure that the Commission on Dental Accreditation (CODA) adopted dental therapy education standards that were reflective of this new professional. This gets at the core of the ADHA’s support of oral workforce models that culminate in graduation from an accredited institution, professional licensure, and direct access to patient care.

In 2013, CODA issued the initial draft of the dental therapy education standards. It specifically asked if the nondental hygiene track was appropriate or whether the proposed dental therapy education standards should be modified to support a dental hygiene-based track. The ADHA worked in tandem with state associations to ensure the standards would include a dental hygiene-based track, as well as advanced standing for dental hygienists. In August 2015, CODA voted to implement the accreditation process for dental therapy education programs.

The creation and implementation of national dental therapy education standards provide credibility and greater acceptance as more states continue to consider this new provider. Dental therapy offers yet another career option for dental hygienists and is one way we can expand oral health care access.

ADVANCING DENTAL HYGIENE EDUCATION PROGRAMS

The future of the dental hygiene profession and the growth of career opportunities rest on the dental hygiene education system. As state laws and regulations governing the profession rapidly change, dental hygiene education programs must update their curricula. The ADHA is committed to advancing dental hygiene education programs. The organization worked in partnership with the Academy for Academic Leadership—a collaborative of scholars, educational experts, and academic leaders—to complete phase two of the Transforming Dental Hygiene Education pilot program. Currently, nine dental hygiene education programs are working to integrate new learning domains and competencies. The programs in the second cohort of the pilot program are Fones School of Dental Hygiene-University of Bridgeport in Bridgeport, Connecticut; Foothill College in Los Altos Hills, California; Ivy Tech Community College in South Bend, Indiana; Midlands Technical College in Columbia, South Carolina; Old Dominion University in Norfolk, Virginia; Southern Illinois University in Carbondale; Texas Woman’s University in Denton; and University of Minnesota and Normandale Community College in Bloomington, Minnesota.

Faculty from the pilot groups were asked to make changes to their programs to effectively respond to the needs of today’s patient populations in order to ensure dental hygienists are best prepared for future practice environments. Many of the programs added interprofessional education so that students learn to collaborate and seamlessly work among different disciplines. The ADHA was encouraged by many of the pilot program’s initial outcomes, such as the incorporation of telehealth and mobile dentistry into didactic and clinical activities. Some programs developed and implemented curricula related to the use of lasers by dental hygienists, while others incorporated entrepreneurial concepts into their curricula to promote business/practice management, leadership, policy/advocacy, motivational interviewing, and evidence-based decision making.

Several programs created or expanded articulation agreements to create a pathway to achieving academic progression to a bachelor’s degree, while others took their programs from an associate-level program to a baccalaureate degree program—a position long supported by the ADHA. We are proud of their initiative and accomplishments and look forward to working with programs across the country on these efforts.

CONCLUSION

All ADHA efforts reflect our core ideology—to unite, empower, service, and support the dental hygiene profession. The local, state, and national levels are working together, listening and responding to the concerns of all dental hygienists. The ADHA values dental hygienists across the country. Whether you are interested in career opportunities within dental hygiene or you are a student, a part-time or full-time professional, or a seasoned dental hygienist, the ADHA provides you with the tools and resources to map your career path and support your professional growth.

From Perspectives on the Midlevel Practitioner, a supplement to Dimensions of Dental Hygiene. October 2016;3(10):28-31.