 Dental hygienists are
licensed, preventive oral
health care professionals
who provide educational,
clinical, research,
administrative, and
therapeutic services that
support total health by
promoting optimal oral
 Dental hygienists are required to graduate from an
accredited dental hygiene program that is at least two
years in length. (plus prerequisite core classes)
 Graduation is followed by successful completion of the
National Board Dental Hygiene Examination. This
qualifies graduates to take a state or regional licensing
examination that includes both a written and clinical
 Dental hygienists must be licensed in the state in which
they work and must practice in accordance with
regulatory laws and dental hygiene practice acts.
 Currently there are 313 entry-level dental hygiene
educational programs and 75 baccalaureate degreecompletion and master’s programs.
 There are 16 programs located around the state of
 A dental hygiene education requires an average of 86
credit hours for an Associate degree, or 122 credit hours
for a Baccalaureate degree.
 General education courses: English, speech, psychology and
 Basic science courses: chemistry, anatomy, physiology,
biochemistry, microbiology, pathology, nutrition, and
 Dental science courses: dental anatomy, head and neck anatomy,
oral embryology and histology, oral pathology, radiography,
periodontology, pain control and dental materials
 Dental hygiene science courses: oral health education/preventive
counseling, patient management, clinical dental hygiene,
community dental health, medical and dental emergencies, and
supervised instruction in pre-clinical and clinical practice.
 Accredited dental hygiene programs require an
average of 2,794 clock hours of curriculum.
 This includes 654 clock hours of supervised
clinical dental hygiene instruction
 During the clinical component of the curriculum, dental
hygiene students provide care and debridement for
patients of increasing difficulty.
 They provide treatment for patients with varying
degrees of oral disease from the “healthy” patient’s
preventive visit, to the periodontally involved.
 Consequently, the dental hygienist is the most highly
qualified person in the dental office to provide this type
of care.
Before and after dental hygiene treatment
The need for professional dental
hygiene care
Stages of periodontal disease
Adjunctive services provided by hygienists:
Nutritional counseling
Amalgam polishing
Fluoride therapies
Subgingival Oral irrigation/antimicrobial
Medicament placement
 According to the accreditation standards for dental
hygiene education programs, these subjects prepare
dental hygiene students to communicate effectively,
assume responsibility for individual oral health
counseling, and participate in community health
 The accreditation standards require that dental hygiene
students be prepared to assume responsibility for the
assessment, planning and implementation of preventive
and therapeutic services. They must also be taught how
to assimilate knowledge requiring judgment, decisionmaking skills, and critical analysis
 The Federal 2009 census reports that there are 173,900
licensed dental hygienists and 86,270 dentists in the
United States. Since 1990, the number of dentists per
100,000 U.S. population has continued to decline. This
decline is predicted to continue so that by the year 2020
the number of dentists per 100,000 U.S. population will
fall to 52.7.
 However, since 1990, the number of dental hygiene
programs has increased by 27%. In addition, from
1985–86 to 1995–96, the number of dental hygiene
graduates has increased by 20%, while the number of
dentist graduates has declined by 23%.
Source: ADA Survey of Allied Dental Education, 1986-2008;Commission of
Dental Accreditation Accredited (CODA) Allied Programs List, 2008,2009, 2010
 The United States Health Resources and Services
Administration’s Bureau of Health Professions National
Center for Health Workforce Information and Analysis
has studied dental and dental hygiene workforce issues.
 Two of the regional centers for health workforce studies
have cited and made policy recommendations to
consider expanding the role of dental hygienists to
include the delivery of oral health care services in
shortage areas and to children on Medicaid.
 The Association of State & Territorial Dental Directors
(ASTDD) has developed an Oral Health Improvement
Plan to serve the needs of their state.
 Their vision is that there would be a strong and
effective governmental oral health presence in states
and territories to assure optimal oral health.
 Since the 1980s ASTDD has used the Guidelines for
State and Territorial Oral Health Programs to assist
health agency officials and public health
administrators to develop and operate strong oral
health programs. (revised June 2010)
 Access Georgia’s plan at:
 Dental hygienists are trained and ready to assist with
the goals established by this plan in Georgia.
 It is clear that the numbers of dental hygiene
programs and graduates are increasing and that
licensed dental hygienists are well educated to
provide preventive and therapeutic services to
the public.
 The American Dental Hygienists’ Association
believes that dental hygienists who are graduates
of accredited dental hygiene programs are
competent to provide services without
 Current research has linked periodontal disease to heart
and lung disease, diabetes; and a number of other
systemic diseases.
 Numerous recent studies have also demonstrated the
association between periodontal disease and a variety of
respiratory diseases, including COPD and pneumonia.
 It is well documented that diabetic patients with
periodontal disease have difficulty with glycemic
 Because of the overwhelming science supporting the
“oral-systemic connection”, patients with these systemic
conditions should have access to dental hygiene services
on a very routine basis.
 The first-ever Surgeon General’s Report on Oral
Health has called attention to this important
connection and states, that if left untreated, poor
oral health is a “silent X-factor promoting the
onset of life-threatening diseases which are
responsible for the deaths of millions of
Americans each year.”
Early detection of disease
 The early detection and treatment of oral disease is
critical to saving lives. During oral health examinations,
dental hygienists can detect signs of many diseases and
conditions like HIV, oral cancer, eating disorders,
substance abuse, osteoporosis, and diabetes.
 In addition, dental hygienists can work with patients to
develop oral health care treatment plans that manage
oral infection so it does not exacerbate serious diseases.
 The Surgeon General’s Report on Oral Health
reports serious disparities exist in access to oral
health care, especially among low-income
 One in four American children is born into
poverty (annual income of $17,000 or less for a
family of four). Children and adolescents living
in poverty suffer twice as much tooth decay as
their more affluent peers while their disease is
more likely to go untreated.
Dental Decay (caries)
 Dental caries (decay) is the most common chronic disease
nationally affecting 53% of 6-8 years olds and 84% of 17
year olds.
 A devastating effect of dental decay can be death from the
bacteria that enters the bloodstream as in the 2007 case of
Demonte Driver. He had no access to dental care.
The cost of providing restorative treatment is
more expensive than providing preventive
 It is not only socially responsible, but fiscally prudent, to
increase access to preventive services. Each year millions of
productive hours are lost due to dental diseases.
 An estimated 51 million school hours per year are lost
because of dental-related illness.
 Students ages 5 to 17 years missed 1,611,000 school days in
1996 due to acute dental problems—an average 3.1 days per
100 students.
Community Voices: HealthCare for the Underserved.2001. Poor Oral Health Is No Laughing Matter.
Washington, DC: Community Voices: Health Care for the Underserved.
National Center for Health Statistics. 1996. Current estimates from the National Health Interview Survey,1996
tooth loss caused by dental decay can result
in failure to thrive, impaired speech
development, absence from and inability to
concentrate in school, and reduced self-esteem.”
Office of Disease Prevention and Health Promotion.
2000. Healthy People 2010. In Office of Disease
Prevention and Health Promotion
Other Oral Health Problems
 Serious oral health problems also occur among adults. Each
year about 30,000 Americans are diagnosed with oral and
pharyngeal (throat) cancers, and more than 8,000 people die
of these diseases.
 In addition, almost 30% of elderly adults no longer have
their natural teeth due to tooth decay and gum disease.
 Unlike most medical conditions, the three most
common oral diseases -- dental caries (tooth decay),
gingivitis (gum disease) and periodontitis (advanced gum
and bone disease) -- are proven to be preventable with
the provision of regular oral health care.
 Despite this prevention capability, tooth decay -- which
is an infectious transmissible disease -- still affects more
than half of all children by second grade. Clearly, more
must be done to increase children’s access to oral health
care services.
 In most states dental hygienists practice under what is
known as general supervision. This means that a dentist
has authorized a dental hygienist to perform procedures
but need not be present in the treatment facility during
the delivery of care.
 In Georgia, dental hygienists are required to practice
under direct supervision. This means the dentist must
be present in the office while the care is being provided.
 The Surgeon General’s Report on Oral Health identified
barriers which keep people from needed care—inability to
pay for care and inability to travel or physically access the
places where care is delivered, or a lack of dentists
practicing in the area.
 Dental hygienists can play a role in resolving these
 Regrettably, the experience, education and
expertise of dental hygienists are now
dramatically underutilized.
 ADHA wants to be part of the solution to the
current problems of oral health disparities and
inadequate access to oral health services and
ADHA believes that increased utilization of
dental hygienists is an important part of that
Due to the proliferation of dental hygiene
programs in Georgia and the restrictive
rules governing our practice, there is a
ready workforce of dental hygienists who
are ready to meet this health care need.
ADHA advocates that the services of dental
hygienists who are graduates from an accredited
dental hygiene program can be fully utilized in all
public and private practice settings to deliver
preventive and therapeutic oral health care safely
and effectively.
“Licensed dental hygienists, by virtue of their
education and clinical preparation, are well
prepared to deliver preventive oral health care
services to the public, safely and effectively,
independent of direct supervision.”
 If improvement in the nation’s health care
system is to occur, more equitable access to basic
quality oral health care at affordable costs is
 Licensed dental hygienists are educated and
qualified to perform oral health care services,
furthermore, dental hygienists serve as an
efficient pipeline for identifying and sending on
those who need the care of a dentist.
Dental hygienists are competent to provide
services in a variety of settings more
accessible to patients—residences of the
homebound, public health and school
based programs, community clinics, and
To increase access to oral health care, the American Dental
Hygienists’ Association recommends the following:
 That oral health care providers continue to educate the public about the need to
maintain their oral health and the importance of preventive care.
 That dental hygiene education programs provide dental hygiene students with the
knowledge and skills necessary to deliver oral health care services in a variety of
practice settings and encourage the utilization of externships in underserved areas.
 That federal government funding/grant programs (Title VII and VIII of the Public
Health Service) include dental hygiene provisions.
 That partnerships be developed among health care organizations, state and federal
government, and other interested groups to educate the public on the importance of
oral health and the integral role of oral health in total health.
 That licensed dental hygienists be recognized by the state and federal government as
Medicaid providers.
 That state governing bodies eliminate statutory/regulatory language that restricts the
public’s access to oral health care services provided by licensed dental hygienists.