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With a Single Stroke of the Pen: a New Reality for Dental Hygienists

Oct. 1, 2008
There are times that I remember, and times that I forget. I'm known for forgetting my glasses and having to resort to holding papers at arm's length, unable to clearly see something right before my eyes.
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A single signature

by Noel Kelsch, RDHAP

There are times that I remember, and times that I forget. I'm known for forgetting my glasses and having to resort to holding papers at arm's length, unable to clearly see something right before my eyes. But there are other things I remember with precise clarity. One such moment was when I sat on the left-hand side, in the third row, second from the end at the 2003 American Dental Hygienists Association's House of Delegates. In her president's address, Tammi Byrd shared the goals of our organization: 1) achieve autonomy of dental hygiene education, licensure, and practice, 2) promote consumer advocacy in oral health as part of total health, and 3) raise awareness of ADHA as the recognized authority for the profession of dental hygiene. These goals are still etched in my mind, and I was thrilled that they were such high-reaching goals and plans for the future of our association. Flash forward, and I'm even more thrilled to declare these dreams a reality for the Golden State.

On a very lucky Friday the 13th, in June 2008, Governor Arnold Schwarzenegger signed Senate Bill 853. This single act of pigment to pulp finalized a new law that will change the future of dental hygiene in California. It unleashed the dreams of access to care and unveiled the profession of dental hygiene in California. The measure creates the Dental Hygiene Committee of California (DHCC), an agency dedicated solely to overseeing the state's dental hygiene progression." This new regulatory body will replace the Committee on Dental Auxiiliaries and will be housed under the Department of Consumer Affairs in July 2009. With the governor's signature, California becomes the first state in the nation to establish a self-regulating agency charged with licensure, education, and enforcement of dental hygiene. In six short years from first bill to signature, California dental hygienists reached ADHA's goal of obtaining professional autonomy in education, licensure, and practice!

That single signature was the result of a process that took almost six years to complete. Each step that we took was outlined in the strategic plan for the California Dental Hygienists' Association. A group of determined professionals utilized all available resources to make a change in the very practice of dental hygiene in California. Some people lobbied, some wrote letters, and others simply paid their membership dues to help supply funds for this endeavor. All of these acts combined changed the future of dental hygiene and access to care for all. It was a journey, and it was worth every single step.

What is autonomy?

Autonomy means self-government. It contrasts with the term hegemony, which means the domination of one state or group by another. An autonomous profession is one in which the practitioner has the qualifications, responsibility, and authority for the provision of services which fall within its scope of practice.

Autonomy does not mean complete freedom from all monitoring and regulation. Even the most entrenched professions are closely scrutinized and their practices repeatedly reviewed by bodies established by federal and state statutes, accrediting agencies, consumer groups, and peers.

Dental hygiene in California will not be free from external review and regulation. The profession is responsible for formulating standards for independent practice, for the definition of the appropriate scope of its professional practices, and for the development of individual and institutional standards for the delivery of services to the public.

Is dental hygiene a profession or a career?

Professions tend to be autonomous, which means they have a high degree of control over their affairs: "professionals are autonomous insofar as they can make independent judgments about their work"1 This usually means "the freedom to exercise their professional judgment."2 However, it has other meanings. "Professional autonomy is often described as a claim of professionals that has to serve primarily their own interests ... this professional autonomy can only be maintained if members of the profession subject their activities and decisions to a critical evaluation by other members of the profession."3 The concept of autonomy can therefore be seen to embrace not only judgment, but also self-interest and a continuous process of critical evaluation of ethics and procedures from within the profession itself.

In California, the bill has been signed that changes dental hygiene to a true profession by virtue of its ability to regulate itself. Dental hygienists in California can now be recognized and categorized as midlevel practitioners.

There are times that we remember, and times that we forget. The goals of ADHA that Tammi shared so many years ago can help us all remember just what our dreams are — they are too important to forget. Just as I need my glasses to see clearly, it is my hope that dental hygienists will use the goals of their organization to clearly see the future for the profession of dental hygiene. Autonomy is a goal worth working for. Thanks to many of you, it has not been a pipedream.

About the author

Noel Brandon Kelsch, RDH, is a freelance cartoonist, writer, and speaker. Noel's cartoons can be seen in RDH magazine and her articles have been published in both dental and nursing trade magazines, as well as books. She has received many national awards, including Colgate Bright Smiles Bright Futures, RDH/Sunstar Butler Award of Distinction, USA magazine Make a Difference Day award, President's Service award, Foster Parent of the Year, and is a five-time winner of the Castroville (Calif.) Artichoke Cook-off! Her family lives in Moorpark, Calif. She can be contacted at [email protected].


1. Bayles MD, Professional Ethics, Belmont, Calif.: Wadsworth, 1981.
2. The World Medical Association Declaration of Madrid on Professional Autonomy and Self-Regulation, 1987.
3. Hoogland J & Jochemsen H, Professional Autonomy and the Normative Structure of Medical Practice, Theoretical Medicine, 21.5, Sept. 2000, pp. 457-475.

Ten most commonly asked questions

Since the law passed, there have been many questions. To clarify what this means to the dental hygienist and the consumer in California, here are the 10 most frequently asked questions:

1. What does this bill do for the consumer?

Self-regulation will allow the profession to determine the best consumer utilization of and access to dental hygiene services in California.

2. What does this bill change in the practice of dental hygiene? What does it mean to the dental hygienist?

Dental hygienists will have a greater voice in the regulation of clinical dental hygiene practice in California. Dental hygienists will be able to prioritize the dental hygiene legislative agenda in California. It does not change the scope of practice, levels of supervision, or the places where dental hygienists can legally practice.

3. Does this bill place dental hygienists in a different category of health-care professional than before the bill passed?

They can now be recognized and categorized as mid-level practitioners. The profession of dental hygiene, by virtue of its ability to regulate itself, can now be recognized as a true "profession."

4. Why did this bill take so long to pass?

The bill took less than six years.

5. Why did the bill include issues about dental assistants?

With the elimination of the Committee on Dental Auxiliaries, there was a need to preserve the limited authority of dental assistants, otherwise, there would be no entity with the sole responsibility of addressing dental assisting issues. The advancement and protection of dental assistants needed to be promoted.

6. Does this bill take work away from the dentist?


7. What department will the hygiene committee fall under?

The Department of Consumer Affairs.

8. Who will be on this committee? How are members chosen for this committee?

The nine-member committee will consist of four dental hygienists, four consumers, and one dentist. Applications are submitted to the governor's office for an extensive appointment process.

9. Who will administer the testing for licensing, intervention programs for drug and alcohol abuse, and continuing-education courses?


10. Does this bill mean that the fees for licensing will increase?

Language included in the bill suggests the fees will reflect the actual cost of licensing. There may be an increase. Statutory limit is $70, so it cannot exceed $70 without a legislative change.