ADA Policies

Here are the actions taken by the American Dental Association that encourage state dental societies to change state laws to allow unlicensed office employees with a little or no formal education to provide services currently performed by licensed dental hygienists.

ADA Policy Positions Adverse to Dental Hygiene

1995 ADA distributes a draft report, The Dental Team in the Year 2020: Future Roles and Responsibilities of Allied Dental Personnel. The plan proposes that “auxiliaries” be organized into five categories. Dental hygiene would be split into two tiers--the dental hygienists in the lower tier restricted to practicing under a form of general supervision in the office and permitted to have less than a full accredited education. The upper tier could serve patients in other settings, but only with dental supervision and education beyond dental hygiene school.

Dental assistants would be organized as “dental assistants,” “restorative dental assistants” and “preventive dental assistants.” Following undefined educational preparation, the preventive dental assistant would be permitted to scale and polish.

Although never officially approved, or withdrawn, ADA HOD policies adopted in 1996, 1997 and 1998 seem to pave the path to implementation of the proposal.

1996
- ADA policy 45S-2 amends the ADA comprehensive policy on dental auxiliary personnel to oppose the administration of local anesthesia and also general supervision, which the ADA states “fails to protect the health of the public.”
- ADA policy 45S-113 urges constituent associations to develop new clinical responsibilities for dental assistants, to include coronal scaling and polishing under direct supervision.
- ADA policy 102-RCS-1 urges the ADA BOT to appoint a special committee to do a study on “existing alternative pathways for training dental hygienists” and report findings to the 1997 ADA HOD.

1997
- Report 9 (Alternate Pathways for Dental Hygiene Training), issued by the ADA BOT, described Alabama preceptorship as “an excellent model for a state desiring to increase its ratio of hygienists to dentists through a non-accredited, state dental board administered program.”
- ADA policy 99H urges CODA to establish additional standards, specifically directed to the recognition of non-traditional dental hygiene programs, which utilize “institutionally based didactic course work, in-office clinical training, and/or electronic distance education.”
- ADA policy 42 requests boards to review non-accredited programs, including those which utilize “in-office clinical training” for acceptance.

1998
ADA policy 31BS-1 asks the ADA BOT:
- to consider assistance to state dental societies to amend practice acts to allow “alternatively trained” dental hygienists to be licensed.
- to form a committee to develop “an easy to follow step-by-step workbook” to help other states create an alternative pathway type hygiene program.
- to make the workbook available to constituent and component dental societies, educational institutions and others “to provide the appropriate mechanism for meeting the personnel needs of the dental care delivery system.”
- ADA policy 59B requests ADA to urge its constituents to support high school level dental assisting programs approved through state vocational education recognition programs.
- ADA policy 73RC specifies the appropriate agencies of the ADA shall conduct an initial workforce assessment which will include current and projected auxiliary needs.
- ADA policy 80 amends the comprehensive policy on auxiliaries to clarify that although a two year accredited program for dental hygiene is “typical,” other programs, including those which use in-office clinical training, are acceptable.
- In Kansas, legislation (House Bill 2724, introduced and supported by the Kansas Dental Association) becomes law. Any dental assistant may coronal polish and dental assistants with a board approved course may scale above the gum line.

1999
- The Georgia Dental Association introduces a successful bill (House Bill 296) that permits dental hygiene schools to offer clinical training at “affiliated sites” with non-faculty dentists to supervise.
- The Joint Commission on National Dental Examinations, which operates under the auspices of the ADA, amends its policies to clarify that graduates of non-accredited dental hygiene schools may take the national board written exam if the board of dentistry in their state approves. Written justification for the policy change includes an explanation that the new language aligns joint commission policy more closely with ADA policy.
- The ADA Board of Trustees reviewed an Alternative Pathways Education Workbook for Dental Hygiene and commended the task force that compiled it. The Board voted to make the Alabama document available to constituent and component dental societies, educational institutions and others who wish to establish an alternative pathways dental hygiene program.
- The Board also directed the appropriate ADA agencies to develop a legislative packet designed to provide guidance to interested state societies on the mechanism of changing state dental practice acts to accommodate alternate dental hygiene programs.