BS as the entry level degree
I do believe that the academic entry level to practice dental hygiene should be a baccalaureate degree. With the predominate entry level dental hygiene degree being an associate’s degree, most dental hygienists do not have the option to continue their education to earn a master’s degree or a doctoral degree without first earning their bachelor’s degree.1 There is an increasing shortage in dental hygiene educators and by having the entry level degree be a baccalaureate degree, this will help close the gap and promote dental hygienists to become dental hygiene educators. Additionally, baccalaureate programs require a research component in their curriculum.1 Having this additional educational experience makes the dental hygienist a more well-rounded clinician because they learn how to use evidence based decision making in practice. They learn the science to why they are making the treatment decisions and recommendations instead of deciding based off solely what they learned in school was the norm. The field of dentistry is underrepresented amongst the public and I believe that if the entry level to dental hygiene were a baccalaureate degree, it would hold more prestige because the public would know that their dental provider is held to high academic standards.1
Access to care
Access to care in dentistry and dental hygiene is a growing problem in Ohio and across the country. To address this issue, mid-level providers have been on the rise. The titles include Advanced Dental Hygiene Practitioner (ADHP), Alaskan Dental Health Aide Therapist (DHAT), Minnesota Dental Therapist/ Advanced Dental Therapist (DT/ADT), and Community Dental Health Coordinator (CDHC).2 Each licensure has its own scope of practice that varies state by state but all require additional education and training from a traditional registered dental hygienist license. Collectively, these four licenses and titles allow a dental hygienist to do more than what we traditionally already do. They would be allowed to expand their abilities to be able to address restorative needs such as restore primary and permanent teeth, preform non-surgical extractions, and place and remove sutures, amongst others.2 They allow dental hygienists to serve underserved populations and geographic locations where access to a dentist is very limited. Teledentristry has become a more widely used vessel to attack the access to care issue; it allows a dental hygienist to see patients without the dentist present and are still able to get an exam and diagnosis through the computer. Intra and extra oral photos, radiographs, and charted findings are reviewed by a dentist and a treatment plan can be approved for the dental hygienist to carry out.2
Clinical testing
Clinical testing for licensure currently has many ethical issues because we are required to sit for a live-patient exam. Some of the ethical issues this exam has include delaying treatment until testing date, paying patients to sit for board exams, traveling to testing sites with patients and instruments (safety and infection control), competition for patients among students, and not completing treatment (comprehensive care).3,4 Dentistry is the only health care profession to require a clinical licensure exam. The ADA has proposed for this exam to be changed and alternative paths for licensure have been discussed. Other states have already implemented alternative testing methods such as in New York from 2003-2006, students must either complete an approved residency program for one year or pass a clinical examination. Since 2007, students must complete an approved clinically-based dental residency program for at least one year.3,4 Another alternative method is the Non-Patient Based OSCE which requires the student to pass a station-type exam where students answer extended matching questions based on models, radiographs, casts and case histories.3,4 California has implemented the Hybrid Portfolio method of testing where students will have the option to take a school-based licensure exam that allows them to build a portfolio of completed clinical experiences and competency exams in seven subject areas over their last year in the dental program.3,4 The last proposed alternative is for licensure to be integrated in the program, meaning if the student graduated from an accredited program, they are automatically licensed.3,4 The above alternative methods all eliminate a live-patient exam and are more ethical to the patient and provider.3,4
Academic educator positions
A clinical track position requires the individual to be responsible primarily teaching, some scholarship, and providing service activities. Their contracts are typically for a certain length of time, usually between three to five years, and they must apply for reappointment.5 The advantages include being more focused on teaching and not being required to conduct research and the disadvantages include shorter employment contracts and having the possibility of being terminated at any point.5 A tenure track position requires the individual to be responsible for teaching, research, and service. They are evaluated at a defined time-period, have strict criteria regarding quality and quantity of publications in refereed journals, teaching, excellence, and service activities. If they meet criteria during their evaluation, they are promoted and obtain tenure.5 If they do not meet criteria during their evaluation, they are terminated from the institution.5 If the individual earned tenure, they are granted the right not to be dismissed without cause after an initial probationary period. The advantages include having job security after the probation period and room for promotion and the disadvantages include possibly being terminated if criteria are not met by evaluation day and having to conduct research on top of their teaching duties.5
General supervision
General supervision, as described in House Bill 463, allows dental professionals to practice without a dentist directly supervising. There are rules put in place for dental hygienists, EFDAs, and dental assistants to be able to legally practice within their scope.6 Dental personnel may provide services and treatment for up to fifteen days without a dentist present.7 For dental hygienists, you must have one year and one thousand five hundred hours of clinical experience, have completed a medical emergencies course after graduation from a dental hygiene program, and must comply with the written protocols that the dentist whom they are working for has laid out.7 There are other qualifications of the dentist that must be completed such as having completed the patients’ medical and dental history less than one year ago.7 Dental hygienists may not administer local anesthesia, administer or monitor nitrous oxide, preform procedures while the patient is anesthetized, preform definitive subgingival curettage or SRP, place sulcluar chemotherapeutic agents, or preform bleaching procedures. A certified dental assistant and an EDFA must have two years and three thousand hours of clinical experience, have had their skills examined by the employing dentist, and the dentist must have examined the patient within one year. They can apply fluoride varnish, apply disclosing solution, and recement temporary crowns with temporary cement, amongst others. I do agree with these proposed rules because it allows patient care to continue even if the dentist is not present in the office.6,7