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Jan. 1, 2019
The Board of Trustees of the American Dental Hygienists' Association (ADHA) recently adopted the Competencies for the Advanced Dental Hygiene Practitioner (ADHP)...

The Board of Trustees of the American Dental Hygienists' Association (ADHA) recently adopted the Competencies for the Advanced Dental Hygiene Practitioner (ADHP), which are available at The ADHP model has been created by ADHA in response to the oral health crisis in America. The ADHA's vision is that this new mid-level provider would safely and effectively provide quality diagnostic, preventive, therapeutic, and restorative services directly to the underserved public.

In 2003, the Surgeon General's Call to Action Report was published and called for an increase in the oral health workforce diversity, capacity, and flexibility. Then, in 2004, the ADHA House of Delegates recognized the need for ADHA to increase its efforts to address the public's unmet oral health needs and thereby approved the development of mid-level provider.

Subsequently, the ADHA appointed a task force, which included 10 dental hygiene educators from across the United States, to develop the educational competencies for this provider. Simultaneously, an ADHP advisory committee that consisted of representatives from 15 organizations was formed to provide feedback to ADHA regarding the concept of a dental mid-level provider and the ADHP competencies (Table 1).

In addition, the draft document was presented at various forums during the ADHA Annual Sessions; individuals were able to provide feedback and suggestions at these forums and online, where draft competencies were available. Additionally, the document was mailed to nearly 200 stakeholder groups requesting their comments prior to finalization. Essentially, the development of the ADHP competencies has been a transparent and collaborative endeavor.

The overall vision statement for the ADHP reads: Extending primary oral healthcare to all.

The mission statement reads:

To improve the underserved public's health, the advanced dental hygiene practitioner provides access to early interventions, quality preventive oral healthcare, and referrals to dentists and other healthcare providers.

The ADHA document presents the background of the ADHP. It discusses oral health in the United States, oral health disparities, the oral health workforce, effectiveness of non-dentist providers and the ADHP concept. The document also includes an educational framework for the ADHP, which includes the five educational domains with corresponding competencies and a sample curriculum.

The next step of development will undoubtedly occur in our individual states. Universities, state legislatures, and other government offices will be instrumental. Universities will be able to add this curriculum to their existing graduate programs or develop new master's-level programs in dental hygiene to establish the new provider. Each educational institution has the flexibility to develop its own ADHP curriculum based on the ADHA-defined competencies.

In order for ADHPs to practice, state legislatures will need to add this practice to their state dental statutes. State dental departments and Medicaid offices will need to set policy so that ADHP can help serve the citizens. At the national level, ADHA has been working to obtain funding for an ADHP demonstration project which will test the new provider model and collect data to determine the impact of the new provider on the populations it serves.

The development of the ADHP is a significant advancement for the dental hygiene profession, but most importantly it can help those populations that need dental care the most. Millions of Americans struggle to obtain access to oral health care services; the ADHP is a provider who will be able to provide a range of preventive, restorative, and prescriptive services that will help to alleviate patient's pain, manage their infections, and get patients in the pipeline for additional treatment, if necessary. ADHPs will work in synergy with other members of the dental team as well as other health care providers, taking a comprehensive approach to the delivery of care.

About the Author

Christine Nathe, RDH, MS, is a professor and graduate program director at the University of New Mexico, Division of Dental Hygiene, in Albuquerque, N.M. She is also the author of “Dental Public Health” (, which is in its second edition with Prentice Hall. She can be reached at [email protected] or (505) 272-8147.

Table 1
ADHP Advisory Committee Membership:

Academy of General Dentistry
(participated in one meeting)
American Academy of Pediatrics
American Association of Public Health Dentistry
American Dental Education Association
Association of State and Territorial Dental Directors
Hispanic Dental Association
Indian Health Service
Medicaid/SCHIP Dental Program Association
National Association of Community Health Centers
National Association of Dental Plans
National Association of State Health Policy
National Dental Association
National Dental Hygienists' Association
National Rural Health Association
Special Care Dentistry Association
American Academy of Periodontology
American Dental Association