Strive-The Student View
September-October, 2009 edition  

Dental Hygiene: One Profession, One License, One National Clinical Examination

By Ameerah T. Givens, BSDH

Earning and maintaining a license to practice dental hygiene is considered one of the strongest forms of regulation. So why do state practice acts and their interpretations create barriers prohibiting licensed hygienists from working in any U.S. legal jurisdiction?

Currently, a dental hygienist’s pathway to licensure requires graduating from a formal educational program accredited by the American Dental Association Commission on Dental Accreditation (ADA CODA) and offered within an accredited institution of higher education, passing a written national examination and completing a state or regional clinical examination. Even though dental hygienists complete the necessary clinical and didactic requirements through their educational institutions and pass two examinations at a minimum, they are still not eligible for initial licensure in any U.S. jurisdiction.

Founded in 1883, the American Association of Dental Examiners (AADE) is composed of boards of dentistry from each state, the District of Columbia, Puerto Rico, Virgin Islands and other specialty dental boards. Admirably, AADE upholds its obligation of protecting the public from incompetent practitioners. AADE argues that a clinical licensure examination is necessary because it evaluates the competency of the individual. AADE believes that an unbiased, effective clinical outcome assessment must be in place in order to certify a dental hygienist as a qualified professional.

A national clinical dental hygiene examination, if developed collaboratively, could provide one valid and reliable measure that could qualify dental hygienists to work in any U.S. legal jurisdiction. For society, national licensure would expand access to dental hygiene care; for dental hygienists, it would expand job access nationwide at a lower cost than our current system of state-by-state licensure. Currently, the licensed professional must face new and expensive state practice act hurdles each time he or she relocates. This archaic practice is not in the best interests of the state, the practitioner or the patients who need care.

The American Student Dental Association and the American Dental Education Association (ADEA) believe that graduates of dental education programs accredited by the CODA should not be required to pass a clinical licensure examination in order to be eligible for initial dental licensure. Both organizations believe that the completion of an accredited program in an institution of higher education already assures the public of an educated, competent and safe practitioner.

Since AADE believes that a clinical examination should still be in place, why not establish a national clinical examination? Already, the International Federation of Dental Hygienists has initiated dialog for global dental hygiene education standards, so national standards for clinical competence and evaluation should be doable. Currently, five U.S. regional testing agencies evaluate the competency of candidates for licensure, so it seems cost-effective to establish one national examination that bridges legal jurisdictions. One clinical examination would validate a scope of dental hygiene practice and limit confusion among states that require various credentials and endorsements for licensure. A national examination would be accepted in all states and initial licensure and licensing renewal fees would be consistent. In addition, passing this one examination would expand job access for individuals who want to move to another legal jurisdiction immediately after graduation, helping both potential employees and employers. Individuals would not have to take any additional examinations to practice in different states. One universal standard would measure competence. This approach would remove barriers among states and facilitate practice at a time when our citizens are in need. Most important, it may free up resources so that more emphasis can be placed on maintaining competency over the practitioner’s lifetime. In the end, many individuals and agencies benefit with one national licensure examination, but the biggest beneficiary is society.

Ameerah T. Givens, RDH, BS, is a master’s degree candidate in the School of Dental Hygiene at Old Dominion University in Norfolk, Va.

An International Dental Hygienist in America

By Vanessa A. Fernandes, BS, MS(c), RDH – New Zealand

Everyone has a dream. This might sound like a cliché, but it’s true. Love is an ironically tiny word made up of euphoria, pain and a few other attached complications. So what does love have to do with this? I unexpectedly fell in love eight years ago. I fell in love with the profession of dental hygiene.

I grew up in Kuwait, in a moderately tolerant Portuguese-Indian family and attended an English medium Indian school. Life was safe, so I hadn’t really given much thought to the world outside my little box.

It wasn’t until eight years ago that I started to understand what I wanted in life. I knew that I wanted to make a difference working with people, while simultaneously making a difference in me. I also knew that I wished to have a portable degree so that I could travel wherever it may take me.

Like a detached autumn leaf, the ‘wind’ directed me, and I enrolled in the dental hygiene program at The University of Otago in Dunedin, New Zealand to obtain my bachelor’s degree. I was now working towards a degree that excited me!

Even though I studied at a New Zealand university, I learned from American textbooks, and I have found the curriculum to be parallel. In fact, I have even talked with a director of a dental hygiene program, and she concluded that my bachelor’s degree was equivalent to a dental hygiene program in the United States that is accredited by the Commission on Dental Accreditation. This finding was backed up by a report from the World Education Services (WES), which completed a general comparison of my degree with the bachelor degree program in dental hygiene offered in the United States.

Unfortunately, for me (and other internationally educated dental hygienists) to take the National Board Dental Hygiene Examination, there are a few “hoops and hurdles” to get through in order to gather enough endorsements for submission to the American Dental Association (ADA) and the respective boards of dentistry. These mandatory procedures listed on the ADA Web site include letters of recommendation from the dean of an accredited school or director of an accredited dental hygiene program, which includes a letter of verification for my courses, and a letter of recommendation from the secretary of a board of dentistry of a U.S. licensing jurisdiction.

In 2005 and 2006, I composed and sent emails requesting a chance to obtain the endorsements. None of the secretaries of the boards of dentistry that I got in touch with from the 50 states were able to help me in any way.

We must begin to wonder why dental hygienists from all over the world, including North America, practice in my home country (New Zealand), but this opportunity is not reciprocated for a dental hygienist from New Zealand or other comparable countries? Opportunities exist for internationally prepared dentists, physicians and nurses to practice in the United States, yet this has not become a clear pathway in dental hygiene.

The International Federation of Dental Hygienists (IFDH) comprises 25 member countries, including New Zealand. If these countries have partnered to collaborate and respect each other in that association, then why can’t comparable degrees from those countries be recognized within U.S. legal jurisdictions?

I have met with dentists from all over the world who have been able to easily translate their qualifications to become dental hygienists in the United States. Similar guidelines for international dental hygienists need to be developed and operationalized.

I would urge ADA, the American Dental Hygienists’ Association, the American Dental Education Association and IFDH to work together to open doors for international hygienists. The access to care problem is global. If overseas dental hygienists with equivalent credentials are given a chance to take the National Board Dental Hygiene Examination and regional clinical board examinations to prove that they are knowledgeable and safe practitioners, it would help the citizens and dental hygienists of the world.

Even with these obstacles, like any passionate hygienist, I love my profession, as I have had a chance to meet new people and to strive toward achieving optimal clinical outcomes. There have been a few ups and downs, but I think that it’s all part of my huge learning curve in the real world In addition to periodontal treatment, my scope of practice allowed me to administer local anesthetic agents and carry out orthodontic services as well.

I have had the chance to improve my communication skills while presenting options to my patients, so that they are able to make an informed and independent decision about their oral health. I have gained more courage to talk to peers and patients from an evidence-based perspective. I love receiving unexpected hugs, gifts and ‘thank yous’ from patients that I treat!

I was lucky enough to get accepted into the Master of Science degree program at Old Dominion University in Norfolk, Va., and I embrace this opportunity. I would like to actualize my opportunity as a clinician in the United States. Although I miss my home, I wish to make my dreams a reality and to practice dental hygiene with no geographical boundaries!

I end this with a quote of my own: “Don’t be afraid of the space between your dreams and reality. If you can dream it, you can make it so!”

Vanessa A. Fernandes, BS, MS(c), RDH – New Zealand is a master’s degree candidate in the School of Dental Hygiene at Old Dominion University in Norfolk, Va.

The faculty mentor for this edition of Strive was Michele Darby, RDH, MS.