The discrimination dental hygienists face when expanding their scope in dentistry

Dental hygienists have been the frontline of preventive oral care for decades—educating patients, detecting disease early, and maintaining periodontal health. Their role is essential and transformative, reducing the burden of oral disease and improving health outcomes across populations.

Yet despite their education, skill set, and value to the health-care system, dental hygienists around the world continue to face barriers when attempting to expand their scope of practice. These barriers are often not based on law, competence, or evidence, but rather rooted in systemic discrimination, gender bias, and an outdated understanding of professional hierarchies in dentistry.

The scope of dental hygiene practice: More than meets the eye

Dental hygiene education is rigorous and grounded in biomedical sciences and applied clinical care. Dental hygienists around the world hold either a bachelor’s of oral health or attended an advanced diploma program. These programs include subjects such as anatomy, microbiology, pharmacology, pathology, radiography, and advanced periodontal therapy. They also include placing temporary restorations and engaging in oral health promotion at the community level.

In Australia, New Zealand, and the UK, dental hygienists can administer local anesthesia during their initial studies, and in some other jurisdictions, additional training is needed to allow hygienists to administer local anaesthesia.

Despite this, many dental hygienists report being confined to a narrow role that focuses primarily on scale and polish services, often under tight time constraints and limited autonomy.¹ The reality is that hygienists are trained to do more but are routinely underutilized.

In progressive regions such as British Columbia, Colorado, Australia, UK, and New Zealand, legislation allows dental hygienists to practice independently or in collaborative practice models, delivering cost-effective care in schools, elderly care facilities, rural clinics, and underserved communities. These models have been shown to enhance patient access and reduce oral health inequities.^2-4

Discrimination by design: A systemic issue

The barriers to expanding scope are not always overt. In many cases, they are systemic, cultural, and reinforced by outdated policies or professional protectionism.

Professional gatekeeping: While laws may allow expanded practice for dental hygienists, workplace policies often impose unnecessary restrictions. Hygienists may require a dentist’s “permission” or supervision for procedures they’re legally allowed to perform independently. This can result in delays in care, disempowered professionals, and confusion about roles.⁵

Some dental practices intentionally limit hygienists’ autonomy, viewing their increased independence as a threat to the traditional business model rather than a complement to patient care.

Undervaluing clinical judgment: Hygienists are educated to assess periodontal health, diagnose gingivitis and periodontitis, and implement evidence-based treatment plans. Yet many report being overruled or second guessed by supervising dentists, even in areas where hygienists are the subject matter experts.⁶

This undermines professional confidence and can lead to moral distress, a condition in which practitioners know the right course of action for their patients but are unable to act due to institutional constraints.

Lack of clear career pathways: Unlike other health-care fields such as nursing, physiotherapy, or pharmacy, dental hygiene often lacks structured career progression pathways, research funding opportunities, or recognized specialties. This limits the potential for advancement, academic contribution, and representation in policy-making spaces.⁷

As a result, experienced hygienists may feel compelled to leave the profession prematurely or take on roles outside of clinical practice to find fulfillment.

Gender and economic bias: Dental hygiene is a female-dominated profession. Globally, women account for more than 95% of the workforce in dental hygiene. Historically, female-dominated professions have been undervalued and underpaid compared to male-dominated counterparts, even when they require similar levels of education and responsibility.⁸

This gendered lens contributes to a perception of hygiene as “support work” rather than as a clinical, autonomous, and preventive health discipline in its own right.

Patient outcomes at risk

The implications of underutilizing dental hygienists aren’t just professional, they’re deeply human. When hygienists are empowered to operate to their full scope, patients benefit from:

• Earlier diagnosis of periodontal and systemic diseases
• Continuity of care for maintenance patients
• Increased access to services in underserved areas
• Greater health literacy through education and counseling
• Cost savings for both patients and the broader health system

According to the World Health Organization in 2021, oral diseases affect nearly 3.5 billion people globally and remain a major public health burden.⁹ With the global oral health workforce stretched thin, failing to utilize hygienists to their full potential is not only inefficient, it is irresponsible.

A new vision for collaboration

To dismantle systemic discrimination, a cultural and structural shift must occur in the dental profession. Here’s what that might look like:

Clearer legislation and policy reform: Countries and states should ensure that legislation clearly defines hygienists’ scope and protects their right to practice without unnecessary supervision. Regulatory bodies must also support models of independent and collaborative care.

Interprofessional education: Dental schools should incorporate interprofessional education (IPE) where dentists, hygienists, therapists, and other oral health professionals are trained together. IPE promotes mutual respect, reduces hierarchy, and fosters a team-based approach to patient care.¹⁰

An example of this is at the University of Melbourne, where Associate Professor Rosin McGrath, a dental hygienist and dental therapist, has been leading the way in incorporating shared classes for dentists and oral health therapists and offering opportunities to collaborate within the student dental clinic

More leadership and academic roles: Hygienists must be encouraged to take on roles in teaching, research, advocacy, and governance. With more hygienists in leadership positions, policies and education will better reflect real-world practice and patient needs.

Public awareness campaigns: Patients should be educated about what dental hygienists can do. Increased visibility and trust in hygienists will reduce resistance to expanded practice and foster a more empowered profession.

Respecting the scope, respecting the profession

Discrimination against dental hygienists, whether institutional, cultural, or economic, stifles the growth of a profession that has so much more to offer. By limiting the scope of dental hygienists, we not only discredit their expertise, but we compromise patient outcomes and the evolution of dental care itself.

It’s time for the profession to embrace a more inclusive, evidence-based model of care where each member of the dental team is respected and utilized to their fullest potential. Dental hygienists aren’t just “cleaning teeth.” They’re saving lives. Let’s give them the recognition and scope they deserve.

Author’s note:
This article was written with the assistance of artificial intelligence for the use of formatting, spelling and rephrasing.

References

1. Coplen AE, Bell KP, Smith M. ‘You’re just the hygienist’: A qualitative study exploring how dental hygienists experience and navigate professional invisibility. J Dent Educ. 2020;84(8):852-859.
2. Dental hygienists’ scope of practice by state. American Dental Hygienists’ Association. 2023. https://www.adha.org
3. Independent practice and dental hygiene in Canada: Position statement. Canadian Dental Hygienists Association. 2020. https://www.cdha.ca
4. Mertz E, Wides C, Kottek A, Calvo J, Gates P. Collaborative practice and dental hygiene: the role of dental hygienists in expanding access to oral health care. J Pub Health Dent. 2016;76(4):307-315.
5. Slack-Smith LM, Durey A. Barriers and enablers for oral health care among Indigenous Australians. Austral Dent J. 2010;55(2):204-213.
6. Nash DA. Developing a workforce for innovative dental practice models. J Dent Educ. 2009;73(11 Suppl):S65-S74.
7. Battrell A, Lynch A, Stein M, Wrightson A. Expanding dental hygiene scope of practice: overcoming professional barriers. J Dent Hyg. 2021;95(2):6-12.
8. Daly M, Greene J, Healy J. The gender pay gap and undervaluation of female-dominated professions in health. Health Socio Rev. 2020;29(2):182-195.
9. Global strategy on oral health. World Health Organization. 2021. https://www.who.int/publications/i/item/9789240036573
10. Formicola AJ, Bailit HL, D’Abreu KC, Stavisky J, Bau I, Treadwell H. The interprofessional role of dental hygienists in improving access to oral health care. J Dent Educ. 2021;76(8):983-991.