There's a dental hygiene education myth perpetuated by the accreditation standards put in place by the American Dental Association (ADA) in 1947, which hold entry to practice at a two-year level, no matter how much the curriculum expands.1 This bias even persists among dental hygienists, as well as other health-care providers who do not recognize hygienists as equal colleagues, but instead look down on them as having only a two-year degree.
Accreditation is both the problem and the solution
There are two distinct types of educational accreditation: specialty and institutional. Dental hygiene education leads to a license, so it’s subject to specialty accreditation, which is generally provided by a profession’s association.2 This is true except for dental hygiene, which allows the ADA to control its education.
Degree completion programs do not lead to a license, so no direct program accreditation is required. Institutional accreditation is optional yet required for access to federally funded student loans. Institutional or regional accreditation, as it’s called, does not evaluate the quality of education provided, but rather the institutional buildings, parking lots, libraries, and more.3
Today, the Commission on Dental Accreditation (CODA) invites the American Dental Hygienists’ Association (ADHA) to submit additions and edits to the educational standards, while still holding fast to requirement of two-year degree entry to practice. This means many dental hygienists complete five years of college to earn a two-year associate degree (AA).4 This means dental hygiene remains an auxiliary to dentistry and not a true profession.
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Hygiene compared to other health-care fields
In other health-care fields, the increase in scientific information, clinical skills, and patient care responsibilities led to an expansion of education and elevation in the degree granted for entry to practice. Physical therapy, speech pathology, audiology, occupational therapy, and pharmacy all moved from a certificate or bachelor’s degree to a master’s degree, and for most, a doctorate is now considered the educational level for entry to practice.
While other health-care professions moved forward, for the past eight decades dental hygiene has remained locked at an AA degree level.4 In 1985, the ADA passed a resolution stating the maximum education needed for a dental hygienist was two years, conforming with 1947 standards.
With the expansion of the dental hygiene curricula to include the dental hygiene process of care, local anesthesia, comprehensive periodontal therapy, and more, it’s truly hard to believe the entry to practice level established nearly 80 years ago appropriately reflects today’s comprehensive education. Overall differences in courses offered between AA programs and bachelor programs are minimal. Accreditation standards from CODA require the same basic curriculum, regardless of the degree granted.5
What contributes to the myth?
Three aspects contribute to the two-year myth and explain the expansion of dental hygiene education without the commensurate degrees being granted: credit creep, course devaluation, and lower division versus upper division course numbering.4
Credit creep is the slow and continuous addition of new courses to a program without removing the old ones or elevating the degree granted.6 Many new courses have been added to dental hygiene education during the past eight decades, which demonstrates significant credit creep.
One approach to minimize the effects of credit creep is course devaluation, which occurs when contact hours exceed credits granted. The number of contact hours should equate to the number of credits granted.7 Three contact hours of lecture each week should equate to three credits for the semester, but this is not always the case. Dental hygiene clinical courses are significantly devalued, sometimes by a factor of four.
Unlike lecture courses, dental hygiene students take full responsibility for the care and well-being of patients while providing comprehensive and invasive assessment and treatment procedures. They must engage in the complete process of dental hygiene care and are required to plan treatment and oral health interventions that involve the study and integration of many other courses.
Clinical courses are also more difficult to teach than lecture courses and require an intense student-teacher ratio of one instructor to six students, according to CODA. Based on these facts, dental hygiene clinical courses should be granted at least one credit per contact hour, if not more. Many four-hour clinic sessions are only worth one credit.4 If the true number of credits were granted, hygienists would graduate with a master’s degree.
According to the US Dept of Education, community colleges offer introductory courses that are considered lower division subjects, and university classes for a course major are considered upper division.8 According to CODA, core requirements are the same for both AA and bachelor dental hygiene programs, with no mention of upper or lower division classification.
The course numbers may be different between AA and bachelor programs, but the content, textbook, and outcome measures are often the same. For example, local anesthesia is taught to the same level of competency in the community college and university despite a difference in course numbers. Both courses must meet accreditation standards and state licensing requirements.
This discrepancy and failure to acknowledge that AA dental hygienists complete upper division core dental hygiene courses creates the false impression that those who earn an AA require two more years of study to complete a bachelor’s degree, when the actual difference may be only a few elective credits.
Equal degrees should be awarded
The complex and interrelated aspects of oral and systemic health require dental hygienists and other health-care providers to work collaboratively to provide optimal care. To be viewed as equal colleagues, dental hygienists should have degrees at least equivalent to other health-care providers since the education required actually reflects a higher degree.4
Despite AA dental hygienists being only seven contact hours short of a master’s degree,4 efforts to establish a bachelor’s degree entry to practice were unsuccessful in 1931, 1984, 1986, 2000, and 2013.9, 10 Instead, the number of entry level programs at an AA or certificate level has increased to 276 programs, with just 54 at the baccalaureate level, according to the ADHA.
Changes recognizing the true level of education must come from a dental hygiene association that creates an accreditation model to replace CODA. If this had happened before today, entry to practice would be at a master’s or doctoral level, as we see with so many other comparable health professions that control their own education.
Dental hygiene education has grown and expanded significantly since 1947, surpassing the requirements for a two-year AA degree. It’s time for the dental hygiene profession to assume control of program accreditation to ensure dental hygienists receive the degrees earned, which also reflects the true educational foundation of the profession and end the two-year myth once and for all.
References
- Requirements for the approval of education and certification program for dental personnel. American Dental Association, Council on Dental Education.
- About CODA. Establishment of the commission. American Dental Association. http://www.ada.org/en/coda/accreditation/about-us
- Dennon A. What is institutional accreditation? And why is it so important? Accredited Schools Online. Updated September 20, 2023. https://www.accreditedschoolsonline.org/resources/institutional-accreditation/
- O’Hehir T. Dental hygiene education exceeds the degrees granted. Int J Dent Hyg. 2018;16(3):340-348. 10.1111/idh.12335
- Accreditation standards for dental hygiene education programs. American Dental Association. July 1, 2022. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://coda.ada.org/-/media/project/ada-organization/ada/coda/files/dental_hygiene_standards.pdf?rev=aa609ad18b504e9f9cc63f0b3715a5fd&hash=67CB76127017AD98CF8D62088168EA58
- Fain P. Credit creep. Inside Higher Ed. June 17, 2013. https://www.insidehighered.com/news/2013/06/17/associate-degree-program-requirements-typically-top-60-credits
- Guidance to institutions and accrediting agencies regarding a credit hour as defined in the final regulations. FSA Partners. October 29, 2010. https://fsapartners.ed.gov/knowledge-center/library/dear-colleague-letters/2011-03-18/gen-11-06-subject-guidance-institutions-and-accrediting-agencies-regarding-credit-hour-defined-final-regulations-published-october-29-2010
- Pritchard M, Lee L. What makes an upper-division course upper division? Differing perspectives of students and faculty. College Quarterly. 2011;14(4). http://collegequarterly.ca/2011-vol14-num04-fall/pritchard-lee.html
- Amyot C. The evolution of dental hygiene education. Dimen Dent Hyg. April 17, 2013. https://dimensionsofdentalhygiene.com/article/the-evolution-of-dental-hygiene-education/
- Stolberg RL, Tilliss T. The baccalaureate-educated dental hygienists. J Evid-Based Dent Prac. 2016;165:136-143. doi: 10.1016/j.jebdp.2016.01.025
Trisha O’Hehir, MS, RDH, graduated from the University of Minnesota with degrees in dental hygiene and higher education. Her five decades as a dental hygienist included private practice in the United States and Zurich, Switzerland, and faculty positions at the Universities of Minnesota, Washington, Arizona, and Louisville. In 2012, she founded O’Hehir University, an online university for licensed dental hygienists to complete a BS degree in oral health promotion. She also completed training in myofunctional therapy and Buteyko breathing.
