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67a38df02f901ebbc6ce9622 Dental Hygiene Autonomy

Breaking chains: The case for dental hygienists' autonomy

Feb. 7, 2025
Are you ready to spark bold and informed conversations, disrupt entrenched norms, and drive meaningful systemic change? Then don't miss this upcoming series of articles in RDH magazine about hygienists' autonomy.

With recent policy statements from the American Dental Association (ADA) and the American Legislative Exchange Council (ALEC), and the efforts of state boards to undermine the profession of dental hygiene, discussions surrounding hygienists' autonomy are gaining significant attention.

In the April issue of RDH magazine, I will launch a six-part series titled “Breaking chains: The case for dental hygienists’ autonomy,” which will offer an in-depth exploration of this critical issue.

This is a bold series designed to challenge the status quo of dentistry. I will methodically examine the systemic flaws that sustain the subordination of dental hygienists, including pervasive power dynamics, economic exploitation, and critical gaps in education and oversight. Exposing dentistry’s overdependence on restorative care at the expense of prevention will reveal how this imbalance undermines public health while prioritizing profits. 

The series offers a pointed critique of the ADA’s historical and ongoing shortcomings and confronts the significant gaps in dental education. By positioning dental hygienists as specialists in prevention and advocating for independent practice, these articles call for a fundamental transformation of the profession. 

Drawing on real-world examples, I’ll challenge educational institutions, policymakers, and practitioners to reimagine the future of oral health care. The series seeks to spark bold and informed conversations, disrupt entrenched norms, and drive meaningful systemic change for the benefit of providers and the public.

Part 1: Defining the paradigm

The first article explores the fundamental conflict between prevention-focused care led by hygienists and restoration-driven dentistry, highlighting how the success of restorative care depends on prevention's failure. It also addresses previously overlooked issues surrounding potential FTC violations by dental boards and the ADA.

Part 2: Historical barriers to hygienists' autonomy

Part 2 investigates the historical roots of dentists' supervision over hygienists, uncovering how systemic sexism and entrenched power dynamics have created significant barriers to hygienists' professional independence. It critically analyzes the language used in state dental codes and statutes, highlighting its role in perpetuating these outdated structures.

Part 3: The economics of dentistry

This article assesses the current business model of dentistry and evaluates the potential impact, both pros and cons, of independent hygiene practice on workforce dynamics, liability, employment laws, and patient care. It critiques dentistry’s heavy reliance on restorative care as the cornerstone of its business model, exposes its detrimental effects on public health, and highlights exploitation concerns surrounding financial incentives that drive overtreatment and prioritize profits over tooth preservation. This is supported by current news articles and emerging trends.

Part 4: The education and credentialing gap

Part 4 reveals critical deficiencies in dentists’ education regarding prevention, exposing the fallacy of their claims as all-encompassing oral health authorities and the harm this poses to the public. It reviews dental hygienists’ position as specialists in preventive care and as patient advocates. It draws comparisons to medical education, emphasizing the need for required residencies or supervised clinical hours for both dentists and hygienists in any procedure they have the legal authority to perform.

Part 5: Lessons from the past

This article reveals the ADA's flawed positions on workforce shortages, drawing parallels to the documented harm caused by unregulated dental labs while critically examining their current proposals for oral preventive assistants (OPAs), foreign-trained dentists, and dental students. It uncovers a troubling disregard for patient safety, exposing a concerning coverup by the ADA.

Part 6: Charting a path forward

Part 6 challenges hygienists’ attachment to the current subordinate system as a parallel to Stockholm syndrome. It advocates for a shift in recognizing their training and capability to operate independently as preventive care providers. It examines how new models of genuine autonomy could be implemented, emphasizing the responsibility of educational institutions to reframe hygienists' roles as providers rather than subordinates. It also draws insights and critiques from the successes and lessons of the Colorado experiment to highlight the viability and benefits of independent practice.

Watch for issues of RDH magazine starting next month for this timely series of articles!

Disclaimer: While the author is an active leader in the ADHA and president-elect of Virginia’s chapter, the research and views expressed in this series, though they may align with the association’s policies, do not officially represent the ADHA or its tripartite structure.

About the Author

Derik J. Sven, MBA, MPH, RDH, CDT, FADHA

Derik J. Sven, MBA, MPH, RDH, CDT, FADHA, has nearly two decades of experience as a board-certified lab tech and restorative hygienist. He holds undergraduate degrees in dental hygiene and health care administration, as well as master’s degrees in public health and business administration. He’s currently pursuing his doctorate in health science at George Washington University School of Medicine in Washington, DC, where his research focuses on advancing the autonomy of dental hygienists and the broad integration of dental therapists into the health-care system. He’s an inaugural fellow of the ADHA and president-elect of Virginia's chapter.