The American Dental Association (ADA) has initiatives that address some gaps in the dental industry, yet they won’t address the true disorder in the sector. The ADA's actions are not in good faith for the dental industry or the communities it serves. Improvements in data and strategy are imperative to encourage a collaborative existence among all entities to work together as a unified sector of the dental workforce.
The dentist, dental hygiene, and dental assisting professions have specialized certifications for different purposes. Propositions of the ADA are moving away from supporting critical specialties. This leads to failure to provide a strategic workforce development flow and increasing employee numbers without demonstrated commitment or interest. Short-term Band Aids to produce immediate increases in workforce don’t lead to a quality workforce. Quick certification programs leave learners to cultivate further understanding of the certification topic at their own discretion.
The importance of hygiene education
“Intentionally shortening and fragmenting educational and personal development in the name of bolstering economic productivity now is shortsighted and does a catastrophic disservice to individuals.”1 History shows that easy-to-attain certifications and quick educational programs are aimed at students with low socioeconomic status, promising fulfilling and competitive work that offers opportunities in growth and pay. As many have found, jobs in dentistry can be a dead end with a low ceiling and high rate of burnout.
Rather than supporting education that helps people find meaningful employment in the dental industry, this is an attempt to lower current standards. Instead, the ADA should remarket the value of the certified and licensed roles that are essential to keeping our workforce functioning. Commercializing the educational need for the workforce will bring about value and excitement and draw people into jobs in the dental industry again.
“Privileging short-term job training over demanding educational experiences associated with high levels of intellectual, personal, and social development is a bad idea.”1 There’s a need to not only have staff for the demands of today but also staff who are prepared to shift and learn as the industry changes over time.
The ADA is exploring whether dental assistants can take on some dental hygiene responsibilities by allowing scaling of healthy or reversible gingivitis. According to the CDC, about 47.2% of American adults aged 30 and older have some stage of gum disease, and 60% of adults over age 65 have periodontal disease. The same statistics show that 65% of 15-year-old adolescents have some form of gum disease.2 Gingivitis is a gateway disease that if not appropriately treated will progress into periodontal disease.
Though gingivitis is preventable, dental hygienists’ training to review patients is much more complex than the ADA is alluding to. They must identify risk factors from a thorough review of health histories and identify medication side effects, malocclusion, and underlying systemic conditions. They must also review nutrition, socioeconomic risk factors, BMI, ethnicity, and hormonal changes. All of this is part of dental hygiene education before they must complete extensive assessments on the health of a patient's gums and evaluate bone levels on x-rays that correlate to periodontal disease.
Using dental hygiene education, including adult learning theories and program development, is greatly beneficial to patients who need structured goals and motivation. During a dental hygiene program, students are challenged in critical thinking skills, community service, and intensive writing classes. Such high impact education and challenges create the foundation for lifelong learning.
The need for a more autonomous workforce
Providing more opportunities will lead to a more autonomous hygiene workforce, many of whom are more than willing to work in underserved areas. Allowing them to practice independently and provide necessary treatments will benefit the population and retain the interest of future dental hygienists. Increasing scope of practice in all states will allow RDHs as licensed and certified individuals to use their training in identifying and diagnosing patients' periodontal classifications.
Breaking out of traditional practice can create more opportunities for dental hygienists, such as implementing and managing preventive oral health programs in schools, hospitals, medical clinics, and long-term care homes. This would make a greater impact on interest in dental hygiene careers and positively benefit the health of the population. Increasing insurance coverage for the assessments and services of RDHs that currently are not paid for would improve the high overhead of dental offices.
The ADA is also inserting foreign-trained dentists into the dental hygiene workforce. Many countries do not have preventive oral health education, which is the foundation and focus of dental hygiene in the US. A fast track in education is a feasible option, as foreign-trained dentists should already be educated in biology, pathophysiology, pharmacology, dental anatomy, and more.
If no additional education is mandated, there should be a title other than registered dental hygienist. RDHs graduate from a program accredited by the Commission on Dental Accreditation (CODA), and they pass clinical exams for licensure.3 However, if necessary, embracing foreign-trained dentists into the dental hygiene community would add advocates in the future of the dental hygiene profession as they would experience firsthand the education dental hygienists must acquire.
Positive change will happen only when the ADA actively involves all groups in the dental sector, not just dentists. We should have active participation from all entities, respecting them and proceeding as a unified voice going forward.
Until then, dental hygienists must work to be seen and educate their communities about what sets them apart from dentists and dental assistants. RDHs should volunteer in hospitals and medical clinics to demonstrate the need for preventive services, assessments, and oral health education to patients at a level only dental hygienists can provide.
References
- Kuh GD. Why skills training can’t replace higher education. Harvard Business Review. October 9, 2019. https://hbr.org/2019/10/why-skills-training-cant-replace-higher-education
- About periodontal (gum) disease. Centers for Disease Control and Prevention. May 15, 2024. https://www.cdc.gov/oral-health/about/gum-periodontal-disease.html
- Becoming a dental hygienist. American Dental Hygienists’ Association. 2025. https://www.adha.org/membership/students/becoming-a-dental-hygienist/
