Introduction
For a profession that is intimately connected with systemic health, it would seem obvious that higher level education above the existing entry level degree would be the standard to practice, just like that of any medical provider. Dental hygiene as a profession has certainly made strides since its first induction in 1915, however some would argue that it is lacking in educational advancement when compared to other healthcare disciplines. (1) Due to the current two-year training period of dental hygiene school, students are unable to explore alternative options for careers in dental hygiene outside of clinical practice and programs do not have enough time to adequately prepare students for graduate level education in dental hygiene. (2) In turn, if the value of a terminal degree in dental hygiene is given to entry level students and if the barriers that are keeping current and future hygienists from pursuing a Master’s degree are eliminated, then dental hygiene as a profession may start to move toward the terminal degree being the minimum standard to practice and access to care could be increased. (1)
Value of the Terminal Degree
Dental hygienists are an integral part of a comprehensive healthcare team and the time it takes to adequately prepare an oral healthcare provider needs to go beyond the two-year entry level degree. Dental hygiene school socializes students to careers in clinical practice and does not take into account students that may want to work in alternative settings like education, public health, or research. (2) Introducing hygiene students to opportunities outside of clinical practice will ultimately help increase access to care for the underserved. Healthy people 2030 identifies tooth decay as the most common chronic disease in children and adults in the United States and aims to focus on reducing this incidence by helping people get oral healthcare services. (3) In the terminal degree program, dental hygienists will not only expand on the foundational knowledge received in their undergraduate program, but will also become proficient in education, administration, public health, and will have increased opportunity for providing dental hygiene care outside of clinical practice. (4) This will ultimately aid in furthering access to care by getting more oral healthcare professionals with advanced education into communities. Graduate level education is imperative in order to expand the disciplines that dental hygienists can serve and placing value on this is necessary in undergraduate curricula. (4)
Barriers of the Terminal Degree
A number of barriers exist that keep hygienists from seeking out higher level education and inhibit governing bodies from standardizing the terminal degree as the minimum requirement to practice. Dental hygiene is one of the few professions that lacks autonomy and self regulation as a result of supervision requirements for practice. (1) Dental supervision is a significant barrier to increasing access to care due to dental hygienists' scope of practice being dependent on dentist availability. Based on societal needs, advanced level practitioners could provide direct access to care in public health settings without authorization from a dentist. This could help meet the needs of underserved populations and the dynamic between dental hygienists with the terminal degree and dentists or other healthcare professionals would shift to collaboration instead of authorization. (5) In order for this to be successful, hygienists with a terminal degree must be viewed as an allied health partner and hygienists in their entry level programs need to be made aware of these opportunities. Another barrier that exists is the various entry level degrees within dental hygiene. By making the baccalaureate degree the minimum degree requirement to practice versus a certificate or associate degree, students will be exposed to courses in public health, health care policy, research, and healthcare management. (4) The standard at which students are educated must be increased and the same goes for faculty. Faculty members educating at a university are required to possess at least a Master’s degree if not a doctoral degree, whereas at community colleges, the terminal degree is preferred but not required. (6) Faculty educating at this level need to have a higher level of education and experience in order to model for students existing career opportunities. (6) If faculty do not possess at least the terminal degree within the dental hygiene profession, how can student hygienists be encouraged to pursue higher levels of education to meet the needs of their communities? Lastly, making the terminal degree more accessible and attainable for working hygienists will be imperative to increase the number of advanced practitioners. Making more programs available online, alleviating financial strain, and increasing workforce opportunity with higher level education are a few barriers that, if eliminated, could move hygienists toward seeking the terminal degree. (6)
Conclusion
Establishing a standard for higher level education within dental hygiene will be crucial to advancing the profession and broadening the scope of practice so that access to care can be achieved. (4) Dental hygiene is an integral part of a patient’s overall health and should be held at a standard no less than that of other healthcare disciplines. It is clear that disparities in oral health care exist, which could be correlated with the fact that most hygienists work supervised in a dental practice setting and not enough are being integrated into various sectors of healthcare. (5) However, if barriers are eliminated so that hygienists can see the value in pursuing higher level education and advanced practitioners can provide direct access to care, then dental hygiene will be revered as an independent profession that is essential for achievement of whole body health. (5)
References
Battrell, A., Lynch, A., Steinbach, P., Bessner, S., Snyder, J., & Majeski, J. (2014). Advancing Education in Dental Hygiene. Journal of Evidence Based Dental Practice, 14, 209–221. https://doi.org/10.1016/j.jebdp.2014.02.005
Boyd, L. D., & Bailey, A. (2011). Dental hygienists' perceptions of barriers to graduate education. Journal of dental education, 75(8), 1030–1037.
Boyleston, E. S., & Collins, M. A. (2012, June 22). Advancing our profession: are higher educational standards the answer? Journal of Dental Hygiene, 86(3),168.
Darby ML. (2009). The Advanced Dental Hygiene Practitioner at the master’s-degree level: is it necessary? Journal of Dental Hygiene, 83(2), 92–95.
Oral conditions. Oral Conditions - Healthy People 2030. (n.d.). Retrieved February 18, 2022, from https://health.gov/healthypeople/objectives-and-data/browse-objectives/oral-conditions#cit3
Smith, A. N., Boyd, L. D., Rogers, C. M., & Le Jeune, R. C. (2016). Self-Perceptions of Value, Barriers, and Motivations for Graduate Education Among Dental Hygienists. Journal of dental education, 80(9), 1033–1040.
