What Is a Dental Hygienist?

Dentistry skills extend well beyond teeth cleaning

Dentist and patient in dental office

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Introduction

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 educate patients on good dental care.

The profession was formally started in 1913 by Dr. Albert Fones as an extension of what was then called dental nursing. Today, over 200,000 dental hygienists are actively practicing in the United States, 95 percent of whom work in dental offices.

In addition to performing dental evaluation 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 practice.

Broadly speaking, the scope of a dental hygienist's practice is to provide a regular cycle of therapeutic and preventive services to optimize a person's oral health. In most states, this is not accomplished by the dental hygienist alone but involves some or all of the members of the dental team, most specifically the dentist.

A typical day for a dental hygienist includes meetings, treating patients, and overseeing tasks such as equipment maintenance and inventory. Each scheduled appointment would involve updating the patient's health history, discussing symptoms, performing X-rays, charting changes in gum and bone health (periodontal charting), and the actual cleaning of the teeth. Any findings would be reviewed before or after the cleaning.

Dental Assessment

One of the core responsibilities of today's dental hygienist is the screening and identification of dental concerns, 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)

In most states, a separate examination by a dentist is required in addition to the dental hygienist's preliminary assessment.

In advance of the dentist's exam, the hygienist will review any findings with the dentist and offer recommendations. Doing so helps streamline the dental exam and allows the dentist to see more patients during the course of a day.

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:

  • 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 such 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) 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 also authorized to diagnose oral diseases and outline a treatment plan within limitations

    Subspecialties

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

    Alaska, Minnesota, Maine, and Vermont are the four main states that advocate for the inclusion of dental therapists in a dental practice. Licensing requirements vary by state.

    Training and Certification

    In the United States, there are over 300 colleges, technical schools, and universities that offer associate and bachelor's degree programs in dental hygiene. Degree programs should be accredited by the Commission on Dental Accreditation (CODA). A bachelor’s or master’s degree is usually required for research, teaching, or clinical practice in public schools.

    An associate degree in dental hygiene—the most common designation—involves 86 credit hours and takes around three years to complete. Entrance requirements typically include a high school diploma or GED with a minimum grade point average of 2.0 (C).

    As part of the program curriculum, you must complete 40 hours of prerequisite humanities studies, including mathematics, science, language, political science, history, and sociology. Dentistry-specific courses include physiology, nutrition, radiography, pathology, medical ethics, anatomy, patient management, and periodontics.

    Every state requires dental hygienists to be licensed. In most states, you would need a minimum of an associate degree to take the licensure exam. Almost all states 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.

    To maintain licensure, hygienists must complete continuing education courses. Contact your state’s board of dental examiners for specific details.

    Appointment Tips

    The role of a dental hygienist extends well beyond teeth cleaning and today encompasses 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, symptoms, changes in medications, or scheduled medical procedures.

    Do not hesitate to bring along lab reports and a complete list of drugs you are taking. These days, dental offices maintain comprehensive electronic health records (EHR) in the same way that medical practices do.

    In the end, you don't have to wait to share these details until the dentist arrives. Not only are dental hygienists highly skilled in making assessments, they are most often tasked with compiling and reviewing health data in advance of the dentist's exam.

    It also helps to actively participate in your care by asking relevant questions, such as:

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

    It also helps to check whether any recommended treatments are 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 unexpected out-of-pocket expenses.

    A Word From Verywell

    Dental hygiene can be rewarding and fun career for people who are social, have an exacting nature, and possess exceptional manual dexterity, Most dental hygienists work in clean, well-lit offices, either on a full-time or part-time basis.

    The flexibility of scheduling is one of the major draws to the career. Because dental hygienists are in such high demand (with an annual job growth rate of 20 percent, according to the Bureau of Labor Statistics), employees can often shift from full-time to part-time work and back if needed.

    Moreover, since many dental practices operate standard office hours, you won't have to work nights or weekends like other health professionals do.

    According to the Bureau of Labor Statistics, the median annual income for dental hygienists in 2017 was $74,740 (more or less the same income that an audiologist with a doctoral degree would expect to earn).

    The highest 10 percent of earners achieved a median income of $101,330 per year. Benefits can vary by employer and usually are limited to dental hygienists who work full-time.

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