That’s me graduating from Bristol Community College in 2007 where I earned an A.S. degree in Dental Hygiene
There’s no doubt that we hygienists are highly trained, college educated dental professionals. We bring a lot to the table. Our primary focus in dentistry is prevention, education, and non-surgical periodontics (often times, we know more than the dentist in these areas since he or she has so many other areas to keep up with). One of the mantras I often hear from my fellow hygienists is, “Cleaning teeth is only a small part of what we do. We are educated to do much more than that!”. And I completely agree, but here’s my hypothetical question for you. If expanded duty dental assistants could legally scale teeth, would the market still be interested in hiring us college educated hygienists at our current wages? The answer to that question is probably no. But how can we know that? Well, one possible way is to look at what has been happening in the state of Alabama since 1959. Alabama’s unique situation offers a nice natural experiment that can provide some insight into this question. In Alabama, unlike any other state in the U.S., dental assistants only need to complete a one year program to become licensed dental hygienists.
These are the basic requirements of the Alabama Dental Hygiene Program (ADHP).
1. Must have at least two full time years of experience as a dental assistant.
2. Must work at least 30 hours per week with a certified/sponsoring dentist while in the program.
3. Must complete 180 classroom hours (offered on the weekends).
4. Must complete the assigned performance checks, evaluations and 150 prophylactic procedures with a minimum of 100 patients with permanent and/or mixed dentition.
5. Must pass a written and clinical board exam.
What have been the results of the Alabama “experiment”?
1. According to the latest figures, 84% of dental hygienists in Alabama were trained through the ADHP program and only 16% were trained through a traditional two or four year college or university program.
2. The Alabama Dental Association officially supports the ADHP program.
3. I have no hard data, but based on some anecdotal evidence, ADHP hygienists earn about the same as hygienists who have earned a college degree in dental hygiene. Note: Alabama hygienists earn the lowest wages in the U.S.
What do these results tell us about what the market really wants? If similar ADHP type programs were available in every state, would similar results occur? If the market (dentists in most cases) prefers ADHP trained hygienists (or something similar), then should these type programs be legal in every state? Are ADHP hygienists adequately trained? Do ADHP hygienists pose a danger to patients? Are the current wages of hygienists artifically high because the market has no other legal alternatives? What are your thoughts?
Links
http://www.dentalboard.org/pdf/2014%20Instructor%20Manual%20%20revised.pdf
What do these results tell us about what the market really wants? If the market (dentists in most cases) prefers ADHP trained hygienists (or something similar), then should these type programs be legal in every state?
The general public does not know what they want. They only know what they’ve always had and that’s good enough as far as most are concerned. They do not have enough interest in their oral health to give it a moment’s notice. I will not group all dentists together, but I would think dentists are the same for the most part. Everyone fears change. It works fine for them now. Why would they think about changing it.
If similar ADHP type programs were available in every state, would similar results occur?
Yes, most dentists, as the overseers of the hygiene profession in the vast majority of states, would probably find a preceptor type program acceptable. They would have even more one on one personal control over the education of the hygienist. As I am sure there would be a minority who value the current education & training of RDHs and would not support such an idea.
Are ADHP hygienists adequately trained? Do ADHP hygienists pose a danger to patients?
I believe they are adequately trained to clean teeth. I am not sure how educated they are on the actual disease processes or other essential knowledge college educated RDH maintain. In this way, I would say the ADHP hygienist is not a danger to patients, but possibly neglectful in that the more educated you are the more tools you have to be proactively helpful.
Are the current wages of hygienists artifically high because the market has no other legal alternatives? What are your thoughts?
I do not believe so. The alternative is that the dentists could do our job. They choose not to in most cases & thankfully, in many cases they see the merit of our specialized training over their own. I would like to see hygiene go toward a tiered model similar to nursing. LPN is a one year program, RN is a AAS degree, BSN a 4 yr degree, etc and each has expanded functions as the level of education increases.
Hygiene is going on a tired model ..it’s called . The mid level provider. There are two levels . Check out the Minneaota model.
Most states have some level of an independent RDH practitioner, look them
Up in your states that you reside in. My viewpoint is to build upon a wider scope and a mid level
Provider from this platform . Why reinvent the wheel? As RDHs with traditional education we are more than capable to assist in a wider workforce model that’s necessary to reach out to the greater populations such as the elderly, developmentally disabled and rural communities and children that aren’t getting their dental needs met … And on and on … The foundation is there . The importance of moving this forward is how to allow it to be moved forward in the legislative and buerocratic word. We must as a profession and a licensed RDH understand and remain knowledgable and engaged in how change is to occur in our best interest. I all for mid level .. I am one .. And would welcome the opportunity to do more with the populations that I serve ..because most DDS are not reimbursed enough to be able to serve these underserved communities and populations. It’s a wonderful opportunity for growth and expertise , but it must be done properly …..
Great post! It’s a similar argument that dentists are running into with mud level providers. I hadn’t thought about it in this way before!
If you follow the trends and future projections of the dental hygiene profession, this is right on track. No surprises here . Although I do not practice in Alabama, the struggles are similar but with different tones. For instance we have independent RDHAPs here in the state of California, I am one of approximately 600. The turf wars and complications with legislation and the dental community and insurance companies is never ending. In Illinois there is a Senate bill to allow RDAs to scale supra gingival..!!!really I wasn’t aware there were dental police making sure that one didn’t go under the gum line … Also a colleague of mine recently informed me that her DDS was sending his assistant to a cavitron two day course. No bigggie … It’s allowed to remove orthodontic cement around brackets and approved by the ADA. Of course this spawned a conversation between the RDH, she’s also an RDHAP and the DDS. The DDSi formed her that this is where the future is going. He’s all for it. There will be mid level providers.. What their qualifications are will be determined by the State. They will be able to have a larger scope of practice example small fillings and simple extractions but must be under the direct supervision of a DDS. And then the ADHA developed an Advanced dental hygiene practitioner, this is a 3 year program on top of a dental hygiene degree. Why not go to dental school ? Anyhoo! The whole point is , this is where the workforce model is moving . Check out the FTC ( Federal trade commission) reports on this topic. Check out the ADA workforce model projections . Many of these movements are being propelled by the DSO ( Dental service organizations) the dental cottage industry is shrinking and changing. As RNs have moved forward in their ranking and perception in their profession so must we. We must also remember that RNs are unionized , we are not , this gives them leverage that we do not have. Please be an involved member of your association and help change and keep the profession in tact for the safety of the patient community and the ethics of our profession.
Inform the public they are the greatest form of outreach. Honestly the public has no clue most of the time what the difference is between a dental assistant and a hygienist.
Keep up the good work.
So fun to see people thinking about the future of the dental hygiene profession. After 48 years in this profession, I see a much different future, one based on preventing disease not treating it. Our goal should be to prevent dentistry, not become a junior dentist. Dental hygienists are preventive specialists, yet we are not taking responsibility for prevention. We wait, like dentists, for disease to occur that needs fixing – thus the midlevel provider model. Why not the “Oral Health Coach Model” – taking prevention out of the dental office and actually preventing the disease the midlevel providers are so anxious to treat? Removing calculus is not prevention. Worrying about who can legally remove calculus is not helping patients or hygienists. The profession of dental hygiene would make a much bigger impact by preventing disease rather than treating it. Trouble is, the view is very narrow. Those who want midlevel providers can’t see the potential for prevention – they think dental disease is inevitable. It is inevitable if we continue to follow the dental office model of seeing people every six months for calculus removal. Where is the prevention in that? The ADHA doesn’t believe in prevention either – they still spout the brush, floss and use fluoride toothpaste message, a message that isn’t supported by scientific evidence. Sad to see such a narrow view among leaders and members of our profession. If we don’t take responsibility for prevention, someone else will and they won’t be in the dental profession.
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Of course they do, the more knowledge you contain the more topics you can conversate on and build natural rapport with your clients.
I still think that college-trained dental hygienists are a must have in the office, and as you said, the Alabama situation has caused a major effect in wages for all hygienists; almost as if taking away the value of the profession.