Dentists Opposed to Greater Independence for Dental Hygienists

Post your comments about dental hygienists to our blog. Read the dental hygiene survey press release.

81% of dentists do not support expanding the role of dental hygienistsIn this poll, we asked dentists: Do you support expanding the role of dental hygienists as independent practitioners?

Four out of five dentists don't think hygienists should have greater independence. A full 81% of dentists responded, "No – many of these proposed changes would harm dental practices and offer patients a lower standard of care." Only 19% replied, "Yes – Granting dental hygienists greater autonomy would improve access to care for patients across the country."

Read the dentists' comments

The most significant factor in determining a dentist's vote was geographic location. Rural dentists were four times more likely than their urban or suburban colleagues to support greater independence for hygienists. As rural areas are more likely to suffer from a shortage of dentists, it may be that rural dentists see hygienists as a way to improve access to care for rural patients.

Specialists were completely (100%) opposed to granting hygienists more independence. While most general dentists were in agreement, one in
five general dentists (21%) did favor greater rights for dental hygienists.

Rural dentists were dramatically more likely to favor a more independent role for dental hygienists. In fact, a majority (58%) voted "yes" on this question, as compared to only 12% of urban and 15% of suburban dentists.

This difference suggests that rural areas face access-to-care issues. With many rural locations suffering from an acute shortage of dentists, some doctors feel that allowing dental hygienists more independence could improve rural Americans' access to dental care.


Specialists were in complete agreement on this question – 100% voted against expanding the role of dental hygienists. Four out of five general dentists voted the same way. Only one in five general dentists support a more independent role for hygienists.

Gender differences here were minimal. Women were slightly more in favor of expanding the role of dental hygienists, but the difference may not be
statistically significant.

At least one female dentist who responded to our survey reported that she began her dental career as a hygienist. She indicated that the time she spent as a hygienist gave her a greater appreciation for the responsibilities and importance of dental hygienists.

For detailed geographic results, just mouse-over this interactive map. (Flash required)

For more insight into what our respondents are thinking, check out their comments!

You'll notice a few comments from dental hygienists. Though our comments are open to all, our final numbers are tallied using only the votes of actual dentists.

Go to Dental School

  • “If hygienists want to practice dentistry, go to dental school.” (suburban Illinois)
  • “If they want to expand their services, they should go to dental school.” (suburban Texas)
  • “Hygienists would be great independent practitioners upon graduating dental or medical school.” (suburban Connecticut)

There’s No Replacement for a Dentist’s Supervision

  • “Expanded roles would be great within a dental practice. Dentists are the physicians of the masticatory systems, and expanded roles for hygienists can improve patient access, but it should be done in a team setting. I was a dental assistant, then dental hygienist, then dentist; I have seen all sides of the chair and still feel this way. It is not a matter of money – it is a matter of complete and thorough care for all folks.” (Urban Florida)
  • “My positive answer is a qualified one – I feel strongly that expanding the role of hygienists MUST ensure that patients do not receive fragmented care – i.e., they must be continually encouraged to seek complete care, not just hygiene care.” (rural New Hampshire)
  • “I support the hygienist's ability to perform many expanded functions when properly trained. Functioning as independent practitioners is a
    totally different question. I do not support the independent practice of dental hygiene. I am a dentist and former hygienist.” (urban Minnesota)

What About the Business Model?

  • “Come on, the business model doesn't make sense anyway… Hygienists generally do low-profit procedures; the overhead would kill them.” (urban Arkansas)
  • “We have it in Colorado and it has had absolutely no impact. Hygienists are not the autonomous entrepreneurial sort. They like the security of getting $40+/hr without any risk.” (urban Colorado)
  • “It will reduce dentists' income.” (rural Indiana)
  • “There is no money in prevention so these hygiene offices would go out of business. They would make less than they do in a dental office.” (urban California)
  • “Look at Sweden – they are losing dentists! Socialism and government mandates on health care ultimately lower the quality and standard of care. Somebody has to pay for a $50,000 panoramic machine. When are people going to learn that there's nothing free? They'll pay either through taxes or by getting treatment from someone who has no &@!$% idea what they are doing.” (urban Wisconsin)

Standards of Care Must Be Maintained

  • “My concern is the insurance industry will find it easy to set up hygiene clinics that promote minimal care, not optimal.” (urban North Carolina)
  • “This gives patients of these hygienists the illusion of receiving a checkup and everything is healthy. Only a dentist can diagnose decay and periodontal disease. Colorado has granted independent licensure and has yet to make a significant difference in the access to care.” (suburban Washington)
  • “NO – Nothing further to be said! GP's don't even understand who to diagnose, treat and refer periodontal cases properly. If this happens, watch out!!” (Periodontist, rural Pennsylvania)
  • “The question is not about autonomy. The central question is getting any providers to areas with most significant access issues. The government needs to step up to the plate and fund these programs, support education efforts, support the social piece (oral health treatment is not important to many, except at the moment it is bothering them). The providers will come. Teaching hygienists to extract teeth and do pulpotomies is not the answer without these other solutions.” (Periodontist, suburban New Hampshire)
  • “After 25 years of periodontal practice the mean reason that I need to do more surgery then would have been necessary is poor root planing by hygienists that when redone by me noted completely untreated roots more then 2-3 mm subgingival.” (Periodontist, urban Iowa)

In Defense of Dental Hygienists

  • “Hygienists need to have more freedom to look after what is best for their patients, especially in the areas of low income and of great need. Our hands are tightened by the politics of those who look after their best interest and not the patient's… It is us, hygienists, who have the potential to overlook dollar signs in our patients and do the right thing. Hygiene is very demanding physically and emotionally. Dentists take us for granted… We lack the freedom to perform to our best potential in tremendous ways.” (Hygienist, suburban California)
  • “I am a hygienist with 35 years of practice in the field of dentistry. I wish when I was a ‘young’ hygienist that duties would have been expanded… The duties for nurses have been expanded. Why can the field of dental hygiene not take advantage of the educational resources and provide future training? I see many more people that have health care needs, not fewer people.” (Hygienist, suburban Texas)
  • “I think that it would be great for hygienists to work on their own. I think that in some cases they have a better eye for things than
    the doctor. I know that the doctor I worked for previously would not mention to patients if there were open margins on crowns. Each of our hygienists would see that and be lost. How do you tell a patient about something that the doctor does not acknowledge?” (Not a dentist, suburban Illinois)

Alaska Says It's the Wave of the Future

  • “For a number of years, dentists have been trying to protect their turf by restricting or denying auxiliaries the ability to provide services. Dentistry's obstinacy has resulted in denturists working either wholly or substantially outside the structure of dentistry. This is now happening in Alaska where dental health aid therapists are working outside the regulation and licensing of dentistry. We need to wake up and be more receptive to auxiliaries doing portions of patient care and be in control of the education, licensing and regulation of these auxiliaries. It will happen with us or without us. Dentists should spend more time being doctors and less time being technicians. In the long run, the vast majority of the patient care provided by these auxiliaries has been to a patient population we are not serving anyway. Obstinacy just brands us to the public as selfish, spoiled and overpaid.” (suburban Alaska)

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