On-the-Job Training:
A Dangerous Proposition

What exactly is preceptorship?
The word preceptorship comes from the word “preceptor,” which means teacher or instructor. But as it is used in relation to dental hygiene, it means to have a practicing dentist train a worker on the job to perform dental hygiene duties, instead of going through a two-to-four-year formal, accredited education program and national and regional examinations to obtain a license.

How will consumers be affected by on-the-job training programs?
On-the-job training is just not adequate to prepare dental hygienists to provide safe patient care. Providing a complete prophylaxis (teeth cleaning) that prevents oral disease is a complicated skill using a razor-sharp instrument. An unskilled and inexperienced oral health care worker runs a greater risk of jeopardizing a patient’s health.

This is especially important because the bacteria in gum disease has been linked to life-threatening diseases and conditions such as heart disease, diabetes, respiratory ailments, and pre-mature, underweight babies. For example, oral bacteria can spread throughout the body, inflaming coronary arteries and causing changes in blood pressure, heart rate, heart function, and promoting blood clots, which can lead to heart attacks and strokes.

How do you know dentistry is in favor of on-the-job training?
Organized dentistry has been trying to give on-the-job training programs for dental hygienists a foothold for more than 10 years now, but recent actions taken by ADA’s House of Delegates show that the dental association is intensifying its efforts to make on-the-job programs a reality. In recent years, ADA’s House of Delegates--its policy-making and governing body--voted to support the Alabama Dental Hygiene Program (ADHP), an on-the-job program that trains individuals to perform traditional dental hygiene duties. The delegates also voted to provide assistance to state dental societies that are trying to change laws to make such programs legal, and to urge state dental boards to accept on-the-job programs as adequate preparation for direct patient care.

And this is just the federal activity. On the state level, last year Kansas passed a law to allow dental assistants to clean teeth above the gumline, a cosmetic procedure that does nothing to prevent periodontal disease and stop the threat of bacteria spread throughout the body.

Why would dentists support something that could harm patients?
We can’t speak for dentistry, but some dentists, clearly unhappy about the ADA actions, have suggested that it’s a financial and political issue.

Many dentists have long been afraid that dental hygienists will open up their own practices and deliver care directly to patients, thus becoming “gate-keepers” to dental care.

While this is clearly not the desire of most dental hygienists, many dentists continue to cling to the fear.

How are dental hygienists educated now?
Dental hygienists typically spend 1,000 hours of classroom instruction in a college setting, including more than 600 hours of pre-clinical and clinical instruction, under the supervision of dental hygiene educators. Then, they take a national written exam and state or regional clinical exam in order to earn a license to practice dental hygiene and the “registered dental hygienist” (RDH) credential.

What’s wrong with on-the-job training as long as dentists know what they’re doing?
That’s just the problem. Dentists don’t have the time to train a hygienist in the office, and typically they don’t know very much about the preventive skills in which dental hygienists specialize. Dentists specialize in restorative duties like filling cavities.

Usually dentists spend very little practice time on periodontics--the diagnosis and treatment of the gum and bones that support teeth. In fact, in many dental schools, it is dental hygienists who teach preventive procedures to dental students and preventive topics are a small portion of dental students' course of study.

Another problem is that patients won’t even know the trainees providing care are not fully qualified.

Is there a shortage of dental hygienists? I’ve heard that’s the reason dentists are in favor of reducing the time it takes to become a dental hygienist.
Dental groups who are in favor of shifting dental hygiene duties to other workers usually say they are doing it because they believe there is a national shortage of dental hygienists. However, such claims are not borne out by the statistics. In fact, the number of dental hygiene program graduates has exceeded dental school graduates for the past decade.

There are certain areas of the country, especially rural areas, where there aren’t enough dental hygienists, but then, these are the same areas that have too few dentists. Restrictive supervision laws for dental hygienists is the number one barrier to access to oral health care. Since dental hygienists must practice with dentists, they are forced to go where the jobs are instead of where patients need them.

If there is a shortage of dental hygienists and on-the-job training is not the solution, what is?
If restrictive practice laws were changed to allow dental hygienists greater freedom, they would be able to go where patients need care and currently don’t have access to it. If dentists were truly interested in increasing dental hygiene care, they would support changing restrictive practice laws that force dental hygienists to practice only in the presence of a dentist.

If on-the-job training is unsafe, why are dentists promoting it?
Some dentists do it for financial reasons. They think that if they can hire unskilled workers they can pay lower salaries and earn higher profits. According to the U.S. Department of Labor, Bureau of Labor Statistics, dental assistants earn approximately half of what licensed dental hygienists make. Other dentists just want workers who are easier to handle. Since many dentists are afraid that if practice laws are changed, dental hygienists will open up their own practices and take away their patients, they believe on-the-job-trained employees will be less likely to disagree with them or want more autonomy.

Will I be able to tell if a dental hygienist has been trained on the job instead of through formal education programs?
Yes, but the only way to know if you are receiving care from a registered dental hygienist who has completed a rigorous accredited program and successfully passed a national written and state or regional clinical exam will be to ask. ADHA urges all patients to ask questions about the educational preparation of the oral health care practitioners who are delivering care and demand to be treated only by genuinely educated and licensed professionals.

Will dental hygiene salaries be affected by on-the-job training programs?
Possibly, in some cases. But the real issue here is protecting the safety of patients who may not even know they are being treated by trainees if on-the-job training spreads.

Will cost savings be passed along to consumers?
There is absolutely nothing to indicate that any cost savings from hiring unqualified workers to take the place of formally educated dental hygienists will be passed along to patients, but there is no doubt that the risks will be passed along in the form of unsafe care.

What can I do to fight on-the-job training of dental hygienists?
Be aware! You should know who is working in your mouth. You and your family deserve to have only those oral health care workers who are fully prepared in an accredited education program and licensed as part of your professional oral health care team. Tell your dentist and your dental hygienist you want only a licensed dental hygienist to provide care to you.

Be aware of any legislation or initiatives that propose lowering educational standards for dental hygienists or allowing on-the-job training. Let your legislator know of your concerns and demand to be treated only by licensed dental hygienists.