Strive-National Dental Hygiene Licensure: Why Can't Dental Hygienists Practice Anywhere in Our Country?

December, 2011 edition  

National Dental Hygiene Licensure: Why Can't Dental Hygienists Practice Anywhere in Our Country?

By Hadeel Ayoub, MSDH

Life as we know it is changing; technology is improving access to information and people, and populations are becoming more knowledgeable, diverse and connected. The dental hygiene profession is advancing in roles, scope of practice and contributions to society; therefore, dental hygienists must stay up to date to provide quality care to people globally. The annual, or biannual, renewal criteria for the dental hygiene license aids in ensuring that every practitioner can safely continue to practice.

So why does every region in the U.S. have its own licensing requirements? Obtaining a license is not only about passing examinations for that jurisdiction, but the license renewal requirements differ, too. For example, each jurisdiction requires a specific number of continuing education courses, the conditions for taking these courses (i.e., online or onsite), and the protocols for the examinations. Also, the scope of practice as reflected in the law and state dental board interpretation of the law varies among legal jurisdictions. Despite these variations, the role of the dental hygienist, for the most part, includes a standard core of competencies.

The fragmented approach to state licensure and licensure renewal raises the question, “Do patients receive different quality of treatment by area of the country?” This system makes less sense when practitioners have graduated from an American Dental Association Commission on Dental Accreditation (ADA CODA) accredited program, and passed the National Board Dental Hygiene Examination (NBDHE) and regional examination for licensure. The purpose of the NBDHE is to assist state boards in determining qualifications of dental hygienists who seek licensure to practice dental hygiene. The examination assesses the ability to understand important information from basic biomedical, dental, and dental hygiene sciences and the ability to apply such information in a problem-solving context. But requiring a different examination for each region of the United States suggests that dental hygienists’ responsibilities or competencies vary. People’s oral health care needs are similar, the dental hygienists’ roles are similar, and dental hygienists should provide optimal care wherever they practice within the scope of dental hygiene.

People move from region to region for personal and professional reasons. When dental hygienists move, most will need to obtain new licensure to practice within that region. The license is a burden/barrier on the practitioner in terms of cost, time, and job security and availability, and on the public in terms of their access to dental hygiene care. The burdens of having to obtain another license can sometimes cause dental hygienists to choose alternative careers just to avoid these expenses.

Alternatives can be used to ensure that the dental hygienist is fully qualified to practice regardless of region, e.g., holding a national license that reflects competence in the core dental hygiene responsibilities would be more efficient than the regional licensing system. This national approach to licensure maintains validity and reliability, and ensures that the same quality of treatment will be given to all, regardless of jurisdiction. This approach might also encourage retired dental hygienists to volunteer once they relocate to retirement communities.

American dental hygienists are known internationally for the quality of the education that they receive and the quality of services that they provide. They can practice all over the world using their license, yet they cannot do the same in their own country. The dental hygiene profession would contribute to the health of society when all dental hygienists hold a standard licensure credential that has portability across jurisdictions. U.S. dental hygienists can be working to serve all populations, wherever they may be.

Hadeel Ayoub, MSDH, graduated from King Saud University, Riyadh, Saudi Arabia in 2006 with a bachelor’s degree in dental hygiene. After graduation, Ayoub worked in Riyadh as a teaching assistant at the Dental Health Department, College of Applied Medical Sciences and volunteered in the dental hygiene clinic at the King Abdulaziz University Hospital. Ayoub is an active member of the American Dental Hygienists’ Association and Saudi Dental Society, and is currently a graduate student at Old Dominion University Gene W. Hirschfeld School of Dental Hygiene. Her career goal is to be a dental hygiene educator and researcher. Her research interests are in the area of tobacco cessation.

Strive-Over Tested? The Issue of Clinical Board Examinations

By Amanda Kimball, MSDH

Are dental hygiene students over tested to become licensed? Absolutely! Dental hygienists, dentists, barbers and cosmetologists are the only professionals/occupations who require live patients to determine minimal practitioner competence. A surgeon is not required to obtain a qualifying patient to perform one surgery to become a licensed surgeon. They progress through medical school, internships and residencies, yet no one questions why they do not take a clinical examination to determine minimal competence.

The American Dental Association Commission on Dental Accreditation (CODA) serves to ensure standardized, quality dental hygiene education to protect the public and the student. CODA guides dental hygiene program development, stimulates improvement of established programs, and establishes standards for the evaluation of new and established programs. These goals align with the goals of the clinical board examination of the regional testing agencies. Throughout dental hygiene programs, students are tested on core competencies, health promotion, disease prevention, community, the process of care, evidenced-based interventions, professionalism, and ethical and evidence-based decision making. Accredited dental hygiene schools prepare the dental hygienist for safe practice to protect the health and welfare of the public.

The National Board Dental Hygiene Examination tests students on basic dental hygiene knowledge in biomedical, dental and dental hygiene sciences. This examination also requires the dental hygienist to apply information in a problem-solving context. Critical thinking is elicited and evaluated without the use of a patient. Having a patient in a clinical examination treats the patient as a means to an end. Contrary to most patient care philosophies, during clinical board examinations, the patient is not the focus of the appointment—the test and the candidate’s performance are. This examination is unfair to the patient as well as the student. The anxious student is unable to provide the best patient care possible, and the patient is treated as a qualifying mouth. Moreover, each patient presents a unique set of conditions and behaviors making the testing situation a unique, rather than the same experience, for each candidate.
Allowing graduates of accredited dental hygiene programs to take a national standardized examination should be adequate for national licensure. If the student successfully completed the accredited program and passes the national examination, he/she is a competent beginning dental hygienist. As in other health disciplines such as nursing and physical therapy, the national board can be used to determine entry-level competence and critical thinking ability for dental hygiene practice, at a cost-effective level. It is time for change.

In 2011, Amanda Kimball, MSDH, graduated from Old Dominion University, Norfolk, Va. with a bachelor’s degree in dental hygiene. Kimball is currently seeking her Master of Science in Dental Hygiene at the Old Dominion University Gene W. Hirschfeld School of Dental Hygiene where she is also a graduate teaching assistant. Kimball is an active member of the American Dental Hygienists’ Association and her career goal is to become a dental hygiene educator and researcher. Her research interests are in early oral cancer detection and hookah smoking cessation.

The faculty mentors for this edition of Strive were Michele L. Darby, BSDH, MS; and Gayle B. McCombs, RDH, MS.