Abstract

Dental hygiene education has evolved dramatically through evidence-based science, neuroscience-informed pedagogy, and public-health integration. Predoctoral dental education, however, remains anchored in a restorative, hierarchical model that privileges surgical and prosthodontic procedures over preventive care. Drawing on Brookfield’s1 concept of hegemony—the internalization of dominant norms that appear natural or inevitable—this paper argues that structural power in oral-health education sustains dentist control and undervalues preventive science. The result is a curriculum imbalance that limits innovation, perpetuates inequity, and hinders the modern oral-health workforce.

The advancement of dental hygiene science

Dental hygiene education has moved far beyond its auxiliary origins. Guided by CODA’s 2024 standards, hygienists are now trained in comprehensive assessment, diagnosis, planning, and evaluation of nonsurgical periodontal therapy for all levels of disease severity. Programs emphasize evidence-based practice (EBP), advanced instrumentation, local anesthesia, and silver diamine fluoride (SDF) applications.

Educationally, hygiene curricula employ adult-learning frameworks such as self-directed reflection, metacognitive journaling, and competency-based evaluation. Taylor and Marienau describe such designs as “brain-aware learning,” allowing students to integrate technical skills with reflection and emotion. This pedagogical sophistication demonstrates that hygiene education has become both scientifically rigorous and educationally progressive.

Dental curricula and the limits of incremental change

By contrast, the predoctoral dental curriculum remains largely organized around the restorative model. The CODA (2022) standards describe prevention in conceptual terms—students must “promote oral health”—but lack measurable outcomes for nonsurgical therapy or behavioral-change communication.

Surveys of US dental schools show that students receive fewer than 100 clinical hours in nonsurgical periodontal therapy, compared with 400–600 hours in hygiene programs.The pedagogical focus remains procedural: caries removal, fixed prosthodontics, endodontics, and surgical exposure. Reflection, patient communication, and prevention are often relegated to brief modules or community rotations.

This imbalance is not simply curricular drift—it represents a deeper hegemonic preservation of the dentist’s traditional role as the “operator” and the hygienist as “auxiliary.”

Hegemony in oral-health education

Brookfield defines hegemony as the subtle process through which individuals internalize dominant ideologies, believing them to be natural, inevitable, and even beneficial.1 In professional education, hegemony manifests when power structures are normalized through curriculum design and credential hierarchies.

In dentistry, this takes several forms:

• Curricular invisibility: Preventive science and nonsurgical therapy are treated as subordinate competencies—reinforcing the belief that “real dentistry” means drilling and filling.
• Credential hierarchy: Despite hygienists’ scientific expertise, only the dental degree authorizes diagnostic and treatment autonomy, maintaining control through licensure and regulation.
• Pedagogical dominance: Dental curricula are designed and governed primarily by dentists, limiting hygiene educators’ influence on academic decision-making.

Students—both dental and dental hygiene—learn to accept these power arrangements as the natural order of the profession. This is the essence of hegemonic education: It reproduces hierarchy while appearing to teach neutrality and science.

Comparative standards and their power implications

Thus, the structure of accreditation itself reveals hegemonic dynamics: the profession that controls accreditation defines what counts as “advanced knowledge.”

How hegemony masks stagnation

Hegemony is powerful precisely because it appears rational. The restorative focus of dental education seems justified by patient demand, insurance structures, and tradition. Yet this logic conceals systemic inequities: millions lack preventive care; dental-hygiene scope remains limited in many states,; and access to affordable maintenance therapy is constrained.

When dental students are trained primarily as restorers rather than health promoters, the profession reproduces a system where disease—and the procedures to fix it—remain in the economic and cultural center of dentistry. This pedagogical bias sustains the dentist’s authority while constraining public health innovation.

Brookfield would describe this as learned oppression: educators and students unconsciously participate in systems that limit professional imagination.1 Hygienists internalize secondary status; dental students inherit managerial authority without equivalent prevention training; faculty replicate curricula that mirror their own formation.

Pedagogical resistance and counter-hegemonic models

Contemporary dental hygiene education offers a model of counter-hegemonic pedagogy. Its learning design reflects transformative education rather than transmission.

1. Critical reflection: Students analyze social determinants of oral health and their professional role in addressing inequity.
2. Collaborative inquiry: Small-group problem-based learning replaces top-down instruction, empowering learners to co-construct knowledge.
3. Competency-based evaluation: Progress is measured by performance and reflection, not procedural quotas.

These methods align with Freire’s notions of praxis —action informed by reflection—and represent a quiet revolution in health education. Where dental curricula still reward compliance, hygiene education increasingly rewards critical consciousness.

The professional cost of hegemony

Maintaining hegemonic structures has tangible workforce consequences. The US dental workforce faces both shortages and maldistribution. Hygienists could alleviate access gaps, yet restrictive supervision laws—rooted in outdated perceptions of competence—limit their capacity to practice.

Moreover, failing to update dental education weakens the entire profession’s preventive infrastructure. New graduates are less prepared for interdisciplinary care, public-health initiatives, or alternative practice models such as teledentistry and direct access. The field risks obsolescence as global health systems shift toward prevention and minimally invasive care.

Toward an equitable knowledge partnership

Rebalancing oral-health education requires acknowledging that knowledge production has diversified. Hygienists are not ancillary technicians but cocreators of preventive science. A reformed dental curriculum would:

• Incorporate hygiene faculty as equal partners in curriculum design and accreditation review.
• Expand behavioral and public health sciences throughout the four-year sequence.
• Redefine clinical competency to include mastery of prevention metrics and motivational interviewing.
• Reward reflective teaching and faculty development in adult-learning theory.

Such integration dismantles the hidden curriculum that equates authority with the dental degree. Instead, it models shared professional ownership of oral health.

Conclusion

The story of dental hygiene’s educational evolution reveals more than curricular progress—it exposes how power operates within professions. As Brookfield notes, hegemony endures “not by force but by consent,”1 through what educators and students accept as normal. Dental hygiene education has outgrown its subordinate origins, yet dental education has not reciprocally evolved to honor that advancement.

Bridging this divide demands more than updated syllabi; it requires critical awareness of the hegemonic patterns that define who leads, who teaches, and whose knowledge counts. Until dental curricula embrace prevention, reflection, and educational science with the same rigor that hygiene programs have achieved, the profession will continue to reproduce the very hierarchies that limit its collective potential.

References

1. Brookfield SD. Powerful Techniques for Teaching Adults. Jossey-Bass; 2013.

Brockett RG. Teaching Adults: A Practical Guide for New Teachers. Wiley; 2015.

2. Accreditation standards for predoctoral dental education programs. Commission on Dental Accreditation (CODA). American Dental Association.2022.

3. Accreditation standards for dental hygiene education programs. Commission on Dental Accreditation (CODA). American Dental Association. 2024.

4. Herz MM, et al. Student-performed periodontal therapy: A retrospective analysis. J Dent Educ.2025 .

5. Taylor, K, Marienau, C. Facilitating Learning with the Adult Brain in Mind. Jossey-Bass; 2016.