Dental Hygienist: Expertise, Specialties, and Training

Dentist and patient in dental office

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A dental hygienist, sometimes referred to as an oral hygienist, is a licensed dental professional whose primary role is to clean teeth, examine for signs of oral disease, and provide education on good dental care. In addition to performing dental evaluations and therapeutic treatments, dental hygienists may assist dentists with more complicated procedures, including orthodontics and dental surgery.

Dental hygienists typically require an associate degree in dental hygiene to practice.

Dental hygienists should not be confused with dental assistants, the latter of whom do not perform direct dental procedures.

Concentrations

According to the American Dental Hygienists Association (ADHA), dental hygienists deliver clinical care under varying degrees of supervision. Each state has different laws detailing which services dental hygienists can perform, the settings in which they can practice, and the supervision under which they are allowed to do so.

The primary role of a dental hygienist is to provide a regular cycle of therapeutic and preventive services to optimize your oral health. The core responsibilities include the screening and identification of dental problems, both major and minor. These may include:

  • Bruxism (the grinding of teeth)
  • Caries (cavities)
  • Gingivitis (gum inflammation)
  • Gum recession
  • Halitosis (bad breath)
  • Hyperdontia (too many teeth)
  • Impacted teeth
  • Malocclusion (crooked teeth)
  • Mouth sores, including cankers, cold sores, and oral thrush
  • Oral cancer
  • Pulpitis (inflammation of the inner pulp of a tooth)
  • Periapical abscess (pus in the root of a tooth)
  • Peridontitis (advanced gum disease)
  • Other tooth or gum abnormalities, including cracks, discoloration, pain, and sensitivity

Under the laws of most states, a separate examination by a dentist must be performed in addition to the preliminary assessment by the dental hygienist.

Procedural Expertise

While many people assume that the sole function a dental hygienist is to clean teeth, they are tasked with other more in-depth duties as well:

  • Assessing the impact other diseases may have on oral health, such as diabetes, thyroid disease, iron deficiency, eating disorders, HIV, and temporomandibular joint disorder (TMJ)
  • Determining whether special precautions are needed to perform dental cleaning, including the use of antibiotics in people with a history of endocarditis or a congenital heart defect
  • Performing a head-to-neck exam to screen for oral cancer
  • Examining the teeth to look for signs of caries and periodontal disease
  • Checking the condition of dental appliances, such as braces, bridges, implants, and caps
  • Exposing, developing, and interpreting oral X-rays
  • Removing plaque (the sticky film around your teeth) and calculus (tartar) from above and below the gum line
  • Polishing the teeth and providing preventive fluoride treatment or pit-and-fissure sealants
  • Performing optional tooth whitening
  • Evaluating the need for dental implants or other dental procedures
  • Making dental impressions for temporary and permanent dental devices
  • Discussing any findings with the patient and offering dental care and maintenance recommendations

    In some states, dental hygienists can administer local anesthesia or nitrous oxide as well as polish and contour fillings.

    In California, Colorado, and Oregon, dental hygienists are authorized to diagnose oral diseases and outline a treatment plan within certain limitations.

    Subspecialties

    Some states allow hygienists who have completed additional training to work with an expanded scope of practice. The position, sometimes referred to as a dental therapist, may involve suture removal, the placement of crowns or fillings, and the extractions of the first teeth.

    Alaska, Minnesota, Maine, and Vermont are the four states that allow dental therapists to work in this capacity.

    Training and Certification

    In the United States, dental hygienists must complete either an associate or bachelor's degree program in a program accredited by the Commission on Dental Accreditation (CODA). An associate degree in dental hygiene—the most common designation—involves 86 credit hours of education and training and takes around three years to complete.

    Every state requires dental hygienists to be licensed. Almost all require candidates to pass the National Board Dental Hygiene Examination (NBDHE) in addition to passing the state licensure exam.

    Upon receipt of their license, dental hygienists may include the RDH (Registered Dental Hygienist) designation after their names.

    Appointment Tips

    The role of a dental hygienist extends well beyond teeth cleaning and today involves all aspects of good oral health. As your entry point to care, take the opportunity to update the hygienist about any changes in your health, including recent illnesses, changes in medications, or scheduled medical procedures.

    You don't have to wait to share these details until the dentist arrives. Not only are hygienists highly skilled in making dental decisions, but they are usually the ones tasked with compiling and maintaining the office's electronic health records (EHR).

    When meeting with a dental hygienist, it helps to ask questions to better understand treatment recommendations and any actions you need to take. Example include:

    • How often should you get a dental checkup?
    • What can you do to improve your oral health?
    • Is there anything you should tell your family doctor about?
    • Are there alternatives to the treatments they recommend?
    • Who should you call in case of an emergency?

    It also helps to check whether a recommended treatment is covered by your dental insurance before committing to treatment. The office manager should be able to check this for you so that you won't be hit with any unexpected out-of-pocket expenses.

    Never hesitate to ask how often the dental equipment is sterilized and what precautions are taken to prevent injury or infection. This is especially true if you are dental phobic, have sensitive teeth, or are immunocompromised.

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