Dental hygienists can see many parallels to exercise physiology regarding opportunities and barriers to growth. Like the relationship between exercise physiology and sports medicine, dental hygiene’s code of ethics differs from that of dentistry. Recognizing the distinction of dental hygiene will help the profession grow and allow consumers to compartmentalize different facets of their health care, feel more comfortable with preventive procedures, and understand that there are a variety of ways to approach their health-care needs.
As a profession, dental hygiene is unusual. In most jurisdictions, hygienists are regulated more by dentists than by themselves. Unfortunately, many hygienists consider the profession an auxiliary of dentistry rather than a profession unto itself. Furthermore, hygienists are required to practice under a dentist’s supervision in most locations. While these things lend credence to the question of whether hygiene is a profession, I believe that this is a normal part of any profession’s development. The culture of a profession evolves, along with its growth in rights and responsibilities.
As an example, Boone1 describes the developing profession of exercise physiology in ways that will seem familiar to dental hygienists. Exercise physiologists typically viewed themselves as working “within the context of sports medicine” rather than as a separate profession alongside sports medicine. However, the American Society of Exercise Physiologists’ (ASEP) code of ethics differs significantly from that of sports medicine, particularly in its focus on “health and fitness, educational, preventive, rehabilitative, and/or research services.”2
In contrast, the American College of Sports Medicine (ACSM), which represents a wide variety of health professionals, focuses on maintaining standards of quality using scientific principles, and is more general in its promotion of “improving both the health and well-being of the individual and the community.”3 While the codes are compatible, the ASEP recognizes exercise physiologists’ need for more specific guidelines.
Boone explains the need for his profession to achieve cohesion so that members may develop innovative ideas that lead to “better jobs, credibility, and professional status.”1 He explains the need for exercise physiologists to define themselves in terms of academic credentials and expertise in a variety of techniques, so as not to be cornered into providing the lone service of cardiopulmonary rehabilitation under a physician’s watch, a service that may be provided by several other professions.4
Dental hygienists can see many parallels to exercise physiology regarding opportunities and barriers to growth. Like the relationship between exercise physiology and sports medicine, dental hygiene’s code of ethics differs from that of dentistry. But for a disagreement concerning the role of the dental hygienist’s rightful authority to practice, the codes are compatible. The dental hygiene Code of Ethics in the United States is multifaceted and recognizes seven core values that are applied “to the prevention of disease and the promotion and improvement of the public’s health.”5 Similarly in Canada, dental hygienists apply five principles to provide optimal “oral health care for all” as an integrated part of “overall health, well-being, and quality of life.” The dental hygienist’s primary duty is to the client (pp. 1-3).6
While the American Dental Association accepts similar principles, more of its code addresses issues of competition with other professionals and designations of expertise than does the hygienists’ code.7 The Canadian Dental Association’s (CDA) code is simpler, addressing six principles, five of which directly involve patient concerns. The CDA stresses, “The dentist’s primary responsibility is to the patient.”8 According to Quinton, CDA Public Information Coordinator, “It supports the delivery of dental care in a team setting led by a dentist.”9 Although a dentist and dental hygienist might have different opinions regarding diagnosis and treatment, these differences are not due to differences in the Code of Ethics; however, resolution will depend on which Code is followed.
The majority of hygienists focus on a single role - cleaning teeth - under a dentist’s supervision. To many laypersons, our role in the health-care system is difficult to distinguish from that of a dentist or dental assistant. Many people do not realize that except for legal restrictions, our clinical work does not generally require the presence of a dentist. Like Boone, the ADHA10 expresses concern that work best done by dental hygienists might be done by other health professionals if members do not take a large role in defining their profession (p. 20).
Dental hygiene is more mature than exercise physiology. There is more cohesion in what dental hygienists define as their role toward clients, and in the education required for entry-level positions. Yet there is still a narrow model into which dental hygienists generally fit in practicing their profession; the Bureau of Health Professions11 indicates a lack of standardization of permitted skills by dental hygienists (pp. 25-28); and there is much disagreement regarding the amount of autonomy dental hygienists believe is appropriate for the profession.
Just as exercise physiology is less mature than dental hygiene, psychology is more mature, yet still faces turf battles and internal dissent. Kayo, Ballard, and Segal12 argue in favor of expanding the scope of practice for psychology in prescribing psychotropic medications. There are many psychologists and psychiatrists opposed to this expansion. Arguments include:
• There is risk that someone without a medical degree may not know how to prescribe drugs correctly.
• The profession will lose its distinct identity.
• Those who want prescriptive authority are trying to become miniaturized versions of psychiatrists, and instead should get their credentials in medicine and psychiatry.
Research demonstrates that psychologists are competent in diagnosing psychological disorders for which psychotropic medications may be useful, and are at least as competent in making the appropriate prescription as most other practitioners. People in favor of prescribing authority point out that other nonphysician practitioners are competently prescribing medications.
Kayo, Ballard, and Segal stress that although some psychologists have earned prescriptive authority by earning a second degree as nurse practitioners, this method creates undue hardship on the practitioners. Finally, the authors argue that society’s understanding of mental health, treatment, and limitations in access to care for some populations make the expansion of psychologists’ practice options valuable for the community. The ability to prescribe would remain a credential beyond entry-level educational standards.
This description of psychology’s evolution in the community is similar to that of dental hygiene. Motley13 noted the difficulty some professionals have with change. In the 1980s, there were different opinions among delegates of the ADHA and between ADHA and ADA members regarding independent practice, supervision, and regulation of the profession (pp. 26-28). The ADHA lists 36 states in which dental hygienists were authorized to administer local anesthetic injections by the end of 2004, while 10 years earlier only 18 states, and 20 years earlier only 12 states, permitted such injections.14 Likewise, the ADHA reports comparable increases in the number of states that:
• Permit dental hygienists to practice “in all allowed settings” under general supervision
• Permit dental hygienists to administer nitrous oxide
• Require continuing education,15 a responsibility that goes along with the authority to practice
Now that dental hygienists are gaining authority to practice their profession more freely, there are two key developments designed to increase the stature of dental hygiene. One is developing the Advanced Dental Hygiene Practitioner (ADHP) curriculum, which would enable dental hygienists with ADHP certification to provide more services. The other is self-regulation, which the Bureau of Health Professions11 says would remove some of the limitations that are slowing the profession’s progress and restricting consumers’ health and access to care (pp. 28-37) at the command of another profession (p. 59). These developments will allow more people to receive dental hygiene care through the expansion and availability of hygiene services, and integration of dental hygiene into the larger health-care system (p. 4).10
Jaffe16 describes “an institutional theory of the development of trade associations,” which shows that dental hygiene, like its counterparts, is progressing normally as a profession. In this theory, there are eight stages of development that are measured by interactions within the professional association and between the association and the community. Stages may be concurrent. See Table 1.
Recognizing the distinction of dental hygiene will help the profession grow and help the community. Consider when someone sits in your chair and declares, “I hate the dentist!” If you consider yourself an auxiliary of the dental profession, you are apt to apologize and make things as comfortable as possible for your client. If you feel distinct as a dental hygiene professional, you are more likely to point out that you are not a dentist, and that your work will greatly reduce your client’s need for a dentist. This distinction will allow consumers to compartmentalize different facets of their health care, feel more comfortable with preventive procedures, and understand that there are a variety of ways to approach their health-care needs.
1 Boone T. Rising to the level of “profession.” Professionalization of exercise physiology. Feb. 1999; 2(2), Accessed Nov. 6, 2005, on http://faculty.css.edu/tboone2/asep/feb1.htm.
2 American Society of Exercise Physiologists. Code of Ethics. 2002; Accessed Nov. 6, 2005, on http://faculty.css.edu/tboone2/asep/ethics.htm.
3 American College of Sports Medicine. Code of Ethics. 2003; Accessed Nov. 6, 2005, on http://www.acsm.org/membership/code_of_ethics.htm.
4 Boone T. Exercise physiology professionalism: myth or reality? ASEP Newsletter July 1998; 1(11), Accessed Nov. 6, 2005. on http://faculty.css.edu/tboone2/asep/pro.htm.
5 American Dental Hygienists’ Association. Code of Ethics for Dental Hygienists. 1995; Accessed Nov. 13, 2005, on http://www.adha.org/aboutadha/codeofethics.htm.
6 Canadian Dental Hygienists Association. Code of Ethics. March 23, 2002; Ottawa, Ontario: Canadian Dental Hygienists Association.
7 American Dental Association. Principles of Ethics and Code of Professional Conduct. Jan. 2005; Accessed Nov. 13, 2005, on http://www.ada.org/prof/prac/law/code/ada_code.pdf.
8 Canadian Dental Association. Code of Ethics. 1997; Accessed Nov. 20, 2005 on http://www.cda-adc.ca/en/cda/about_cda/code_of_ethics/index.asp.
9 Quinton V. Nov. 21, 2005; E-mail correspondence.
10 American Dental Hygienists’ Association. Focus on Advancing the Profession. Chicago: American Dental Hygienists’ Association, June 2005b.
11 U.S. Department of Health and Human Services Bureau of Health Professions (April 2004). The Professional Practice Environment of Dental Hygienists in the Fifty States and the District of Columbia, 2001.
12 Kayo R, Ballard DW, Segal S. Advancing the profession: a prescription for success. Winter 2002; Accessed Nov. 13, 2005, on http://www.apa.org/apags/profdev/advancingprof.html.
13 Motley W. (1986) History of the American Dental Hygienists’ Association 1923-1982. Chicago: American Dental Hygienists’ Association.
14 American Dental Hygienists’ Association (2005c) Local Anesthesia Administration by Dental Hygienists State Chart, Accessed Nov. 20, 2005, on http://www.adha.org/governmental_affairs/downloads/LocalAnthsiachart.pdf.
15 American Dental Hygienists’ Association (2005a, July 27) Dental Hygiene Legislative Activity 1993-2005. Accessed Nov. 20, 2005, on http://www.adha.org/governmental_affairs/downloads/legactivity.pdf.
16 Jaffe AJ. Toward an evolutionary theory of trade associations: the case of real estate appraisers. AREUEA Journal 1988; 16(3): 230-256.