Making a diagnosis in Oregon

Aug. 1, 2005
Earlier this year, the Oregon Board of Dentistry ruled that “a dental hygienist may not diagnose and treatment plan other than for dental hygiene services.

Earlier this year, the Oregon Board of Dentistry ruled that “a dental hygienist may not diagnose and treatment plan other than for dental hygiene services.” This will allow dental hygienists to make diagnoses after authorization by a supervising dentist. However, they will still be required to review the diagnosis and treatment plan and receive the dentist’s authorization before proceeding.

Diagnosis by a dental hygienist has always been a big sticking point in the growth of the profession. Dental hygienists need to determine what they are treating before they treat it, since they treat each client individually. Some people argue that a dentist should make a diagnosis and assign the dental hygienist appropriate treatment. However, several inconsistencies with that philosophy interfere with quality care.

The generally accepted philosophy is that dentists have more expertise than dental hygienists because they hold at least a doctoral degree, while dental hygienists’ entry level is an associate’s degree.

When looking at expertise, one needs to look at the specific knowledge rather than the level of knowledge. Dentists who perform even a small portion of the work specific to their dental hygiene training would have little time to perfect skills. Thus, although most dentists have more expertise than dental hygienists regarding the mouth as a whole, most hygienists have more expertise than dentists regarding the work of dental hygienists, similar to the way that physicians have more expertise than dentists regarding disease. However, dentists have more expertise on diseases of the mouth.

The primary goal of dental hygienists is prevention of disease, particularly those of the mouth. Dental hygienists look at clients from the point of view of a preventive specialist. Hygienists educate clients how to keep healthy, and perform relatively non-invasive techniques to help clients practice what they have been taught. In contrast, dentists correct the problems that are beyond the control of dental hygienists. Prevention and correction are valuable to consumers. However, consumers get the best service when providers do not overshadow one another.

Dental hygienists may practice under general supervision in 42 states, and 19 states allow additional unsupervised practice under some circumstances. Since there are many cases in which dental hygienists make treatment recommendations without a supervising dentist, it is only fair to consumers that an appropriate recommendation be made with a diagnosis as justification for that recommendation.

Dental hygienists may work in settings other than a dental office, so some supervisors will not be dentists. A manager in a spa, a nurse in a hospice, or a superintendent of public schools may be the supervisor. The majority of people in these roles do not have the expertise to make therapeutic decisions. Their supervision should be limited to business needs and multidisciplinary needs of the client rather than defining the dental hygienist’s justification for treatment recommendations.

The United States has a history of supporting free market enterprise. We like capitalism for good reasons. A free market’s value to the community is striking because of the way it serves consumers. Businesses and industries that face competition produce better quality work at better prices and convenience. This is the reason we have antitrust regulations. The primary goal of the Federal Trade Commission is to protect consumers. The FTC states, “Competition benefits consumers by keeping prices low and the quality of goods and services high.”

The FTC has a second mandate under the Act that created it “to guard the marketplace from unfair methods of competition [which thereby] fosters opportunity for businesses by ensuring a level playing field among competitors.” The question is whether the legal restriction against dental hygiene diagnosis is fair. I believe the Oregon ruling will serve as a test.

The Oregon Board of Dentistry’s recent ruling that allows dental hygienists to make a diagnosis with a dentist’s supervision will be a major development in dental hygiene. Although many dentists may say, “Not in my office,” or may authorize the dental hygienist’s act of diagnosis then overrule it, they will have to justify their actions. This pressure will lead to more thoughtful diagnoses, informed consumers, and a better choice of offices for dental hygienists, which will help eliminate the prophy mill hygiene departments.


Federal Trade Commission. (n. d.). Promoting competition, protecting consumers: A plain English guide to antitrust laws. Retrieved May 23, 2005 on

Oregon Board of Dentistry. (2005, January 20). Rule changes concerning the practice of dental hygiene. [OAR 818-035-0025(1)]. Retrieved May 23, 2005 on

Howard M. Notgarnie, RDH, MA, practices dental hygiene in Colorado and has eight years experience in official positions in dental hygiene associations at the state and local levels. He can be contacted at [email protected].