Lois Chandler-Cousins RDH
Dental hygiene practice is typically regulated under the auspices of the dental practice acts that are administered by governing boards. The boards are composed primarily of dentists with little representation from the dental hygiene profession. Dental hygiene is a licensed profession, but dental hygienists are not a self-governing body.
Dental hygiene is an anomaly in a world of more than 800 self-governing, allied health professions. Dental hygiene is unique in that it is not self-regulated. More than 600 of these licensed professions have an associate degree for licensure, so it has no correlation with length of education.
What is regulation, and why are professions regulated? The purpose of regulation is to protect the health, safety, and welfare of the public by making sure that only those practitioners who are qualified are allowed to treat patients. The role of a dental board is to protect the public from incompetent practitioners and regulate the profession - not to restrict safe, competent practitioners from offering their services to the public.
Does self-regulation mean shedding oppression?
Self-regulation is a term for an occupation controlling its own education, licensure, and practice. Self-regulation, as it is applied to dental hygiene, generally refers to two components:
- A dental practice act that spells out what dental hygienists are allowed to do by law.
- A dental hygiene board that administers the statute.
In most states, dental hygienists are regulated by dentists, and most states` statutes keep dental hygienists on a tight leash. The method behind how dental hygiene practice is regulated by dental governing boards is unique. The inherent problem is that dentists are the primary employers, forcing hygienists to accept only one option - employment by a dentist. Dentists who are representatives on dental governing boards have a vested self-interest in defining, regulating, and controlling dental hygiene practice.
Benjamin Shimberg, PhD, who has studied licensing and certification for 30 years, borrows a term from labor history to describe the hygienists` situation. "Hygienists enter into a yellow dog contract. Yellow dog contracts are entered into under duress and put one party at a severe disadvantage." When hygienists initially obtain licensure, they know they could not get it without, in a sense, acquiescing to the power of the dentists. Dentists turn dental hygiene into a subservient occupation always under dentists` economic power.
Have dental hygienists` civil rights been violated because of oppression by a dominant profession? P. Feire states, "Groups are said to be oppressed because they have been controlled by forces outside themselves that have greater prestige, power, and status, and they exploit the less powerful group." The view of the dental hygiene profession as being oppressed is supported by the fact that most dental hygienists lack autonomy, accountability, and control over their profession.
Disliking each other instead of oppressors?
Dental hygienists, like other oppressed groups, can exhibit conflict and dislike for other dental hygienists which may result in divisiveness and a lack of cohesiveness within the group. This represents "horizontal violence," a safe way to release tension when actual aggression is meant for the oppressor. Lack of participation in professional organizations can be viewed as evidence of lack or pride in one`s group and a desire not to be associated with it.
The issue of self-regulation is one of dental hygiene growth and development as a profession. Self-regulation is one of the characteristics of a true profession.
Cynthia Vogler-Henry, a RDH from Oklahoma, states: "We consider that introducing self-regulation here is our best protection for what we consider the two main pillars of our profession - our accreditation and our legal scope of practice. And we have considered that those have been challenged for several years especially here with rumblings of preceptorship and consideration of major revisions in the practice act."
After all, this entire issue is one of control. It is difficult for a dominating party to relinquish even a little control because of fear of losing ultimate control. Some factions believe the "dental team concept" is at stake if self-regulation spreads. What dentistry does not reveal is the basic reason for opposition to autonomy - economics.
Dentistry and dental hygiene are separate professions. It is the dental hygiene profession that specializes in education and prevention. Most dental education addresses restorative procedures. So dentists specialize in secondary prevention instead of primary prevention. With the restructuring of the health care delivery system, dental hygienists would naturally fit into the arena of primary prevention. With increased awareness of prevention, there is a growing interest in keeping one`s own teeth for a lifetime. The hygienist, not the dentist, is better trained in primary prevention, and this creates a demand for dental hygiene services.
This present day delivery mode of dentists being both the employers of dental hygienists and competing providers of dental hygiene services is not attracting 50 percent of the public. Through legislative action, the infrastructure of the dental hygiene profession can change, thus offering an opportunity to deliver more care and benefit to larger segments of the public. An example would be the elderly in long-term care facilities, whose access to dental care is limited by their lack of mobility.
Self-regulation can be frightening, especially when hygienists have been led to believe that it is a natural expectation for dentistry to maintain control of the entire dental field. Heidi Emmerling Jones, RDH, states, OThe paradox of the situation is that failing to take responsibility for the future and failing to take risks, we face the greatest risk of all: the decline of our profession.O
Lois Chandler-Cousins, RDH, BS, is enrolled in the graduate program at the University of North Carolina while working full-time in private practice and teaching part-time.
