a

1. Who In the World Are Dental
Hygienists?
A study of six countries
By Kathleen Young

2. • Dental hygienists are known worldwide as preventive care
specialists.
• How did the profession start?
• How has the profession progressed?
• How is it different in various countries?
This power point presentation will provide some insight into
the dental hygiene profession throughout the world.

3. In the beginning…
• Dr. Alfred C. fones was an American dentist who has been called
the founder of the dental hygiene profession, which began in
1906 when he trained and hired his cousin to clean teeth and
perform preventive treatments for children.
• Irene Newman became the world’s first dental hygienist.
• 27 students graduated from the first class of dental hygiene in
1915. (Wikipedia, Alfred Fones)
• Let’s look at the expansion of dental hygiene worldwide since its
humble beginnings. I have limited myself to six countries which
show the wide variety in dental hygiene throughout the world.

4. United States
• In the United States, the basic educational
requirements involve a high school
diploma, college entrance exams and
prerequisite courses before the dental hygiene
program.
• Once in a dental hygiene program students will
typically have 1000 hours or more of classroom
instruction and over 600 hours of pre-clinical
and clinical instruction.
• Three states have now authorized preceptor or
« on the job » training. These states are
Kansas, Alabama and Texas. These preceptor
trained hygienists are only able to perform
prophlaxix above the gumline. (Mingee, 2003)

5. United States
• The United States has both diploma (AS) and degree
(BS, MS) programs. As of 2007 there were 253
diploma programs and 33 degree programs.(Johnson, 2009)
• Currently there are more dentists that
hygienists, but this will change soon since there are
now fewer dental schools and more dental hygiene
schools.
• Is the glass half full or half empty?
– Depends on how you look at things-
Trish O’Hehir sees it as an opportunity for
hygienists to provide care for the 50% of the
population that doesn’t receive regular dental
care. This will be accomplished by changing the
way we are able to perform our services.

6. How are we doing?
• Less than ½ of the dental hygienists in the United States are
members of their national professional organization! (Johnson, 2009)
• Efforts have been underway since 2003 to increase the scope of
practice and provide an Advanced Dental Hygiene Practitioner
(ADHP) This has been difficult since individual states have
different requirements for licensure and not all states offer
reciprocity. Therefore… changes have to be made legislatively
on a state by state basis. (Gadbury-Amyot and Brickle, 2010)
• Minnesota serves as an example to other states about what can
be accomplished through the legislative process.

7. Minnesota
• For a period of four years the Minnesota Dental
Hygiene Association worked with the university
system, the Minnesota Health Care Safety Net
Coalition (SNC), the health department, dental
board and others.
• Eventually on May 13, 2009 a bill was signed
into law establishing a Dental Therapist and
Advanced Dental Therapist. The name change
from ADHP to Dental Therapist helped to
satisfy the dental community. (Gadbury-Amyot and
Brickle, 2010)
• Hooray for democracy!!

8. Japan
• The first formal training for dental hygienists began in Tokyo in
1949. It was a one year course and originally fell under the
category of “vocational training”.
• There are now 136 dental hygiene schools and over 7000
students enrolled. Since 2001 the program has increased from
two years to three and in 2004 the first four year course was
started. ( Yoshida, Endo & Komaki, 2004)
• The dental hygiene workforce has steadily increased and
currently there are more hygienists than dentists. 40% of
graduated hygienists are working and less than half are
members of their national organization. (Johnson, 2009)

9. Japan
Most dental hygienists in Japan work in private
dental offices (89.7%) A small number work in
nursing homes (0.07%). 5.3% work in hospitals
and 3.01% work in public government facilities.
550 hygienists work at schools of dental
hygiene. ( Yoshida, Endo, & Komaki, 2004)
The legal duties of dental hygienists in Japan are
divided into three main parts:
1. Dental Prophylaxis
2. Dental Assisting, which involves assisting in the dental
practice, subgingival scaling, root debridement and
placement of temporary restorations.
3. Dental health education
Dental hygineists in Japan are not allowed to take x-rays.

10. Australia
• Dental hygiene was started by a group of dentist that had
worked in the United States and Britain. They appreciated
working with dental hygienists ( oh, yeah!) so when they returned
to Australia, they began the process of introducing legislation to
allow dental hygiene practice. This was first enacted in
1972, but it was not until 1996 that it took effect in all states
on the mainland. Tasmania was included in 2001.
• Curriculum for the first course was patterned after the US and
British dental hygiene curricula. The first course was 12 months
and its graduates earned a certificate in dental hygiene.

11. Australia
• Currently there are 2 two year programs (associate degree) and
three 3 year programs which offer a BOH- Bachelor of Oral Health.
• Students can also choose to study dental hygiene through the
Australian Defense Force. They offer a certificte in dental hygiene
which involves five months of training with an additional year of
preceptorship training. These hygienists are only allowed to work in
the defense force.
• Australia has a two tier system which involves “Dental Therapists”
who can provide dental treatment to children, but only in public
institutions. Many dental therapists go on to become dental
hygienists which enables them to provide dental care to children
and adults in private settings. (Luciak-Donsberger & Aldenhoven, 2004)

12. Australia
Hygienists in Australia must practice only under
direct supervision, except for South
Australia, which in 1992 changed the law to
allow dental hygienists to provide care in
nursing homes and long term care facilities. (
Luciak-Donsberger & Aldenhoven, 2004)
There are currently 325 female and 5 male
hygienists. This in a country of 19 million
people!
182 of those work full time and 100 work part
time. Most of them (274) work in private
offices while 8 of them work in the public
sector.
Current salary is between $50,731 and $97,964

13. Germany
• Structured dental hygiene did not begin in Germany until 1999.
This was surprising to me, as Germany is typically a very
advanced country. A US hygienist submitted a petition to the
German Parliament in 1997. Beate Gaterman, the president of
the German Dental Hygienist Association, states that the
purpose of the petition was to legalize the profession of dental
hygiene in Germany and achieve state recognition. The
establishment of this law is being deterred by the German
Dental board and the National Health Department. (Gaterman, 2004)
• The German Dental Board has established “advanced training
courses” where dental assistants continue their education to
become dental hygienists. (at least that is what they are told…)

14. Germany
In September 2004 Germany attempted to begin
its first « authentic dental hygiene education »
course in association with a Swiss school. It
was to be a three year program with
international standards. As of 2009 it is still a
Continuing Education model for dental
assistants, with no diploma or bachelors
awarded. (Luciak-Donsberger & Eaton, 2009)
Currently there are 150 dental hygienists with
international qualifications working in Germany
(all foreign trained). Hygienists working full
time get an initial salary of up to 3000
Euros, full social and insurance benefits and
after working 1 year they get 4 weeks paid
vacation. (DDHV, 2011)

15. Germany
• An example of an advanced training course is one started in
2000 called the Munster hygiene education program. It is a 6
month program. 400 hours are devoted to clinical training and
550 to academics. At the end of the course there is a six hour
written exam, a 30 minute oral exam and a practical exam.
• Persons who complete these “continuous education programs” are
NOT board certified. The certificate is recognized only by the
German Dental Board. They are not licensed OR registered
dental hygienists.

16. Netherlands
• Dental hygienists in the Netherlands are paramedicals with
independent status. ( EU Manual of Dental Practice:version 4, 2008)
• Of the 2000 hygienists in the Netherlands, about 800 of them
are in private practice and 200 in public intstitutions. 680
dental hygienists own their own practices. There are 40 dental
hygiene educators and less than 25 hygienists work as
administrators or consultants. (IFDH, 2008)
• Hygienists who choose to practice independently must have their
patients referred by a qualified dentist. They may also practice
pediatric dentistry such as fillings and extractions after
referral from a dentist. ( EU Manual of Dental Practice:version 4, 2008)

17. Netherlands
• The Netherlands has four dental hygiene schools, all leading to a
degree. They also have a Masters program for dental hygiene.
• 87% of the hygienists in the Netherlands are members of their
professional organization! (Johnson, 2009)
• Now, what does that tell you?

18. Nepal
Nepal is a small country, bordered by China and
India. The average yearly income is $250/year.
Only $3 per capita is spent publicly on health.
To receive basic dental hygiene services would
cost a patient about 800 Nepal rupees ($11 US)
which is food money for a month! Often these
services are ineffective because of lack of
compliance regimes.
In Nepal, there are Primary Health Care Workers
who offer a « Basic Package of Oral Care »
This includes:

19. Nepal
 Oral health promotion
 Arrest of caries technique (using silver
fluoride or silver diamine fluoride and
stannous fluoride to stop the progress of
caries.)
 Atraumatic restorative technique (using glass-
ionomer cement and hand instruments for single
surface restorations and sealants.)
 Oral urgent treatment
Many people are too poor to even pay the 50 Nepal
rupees (0.70 US) for these services. The
Nepalese people visit dental clinics primarily for
pain relief. (Knevel, 2005)

20. Nepal
• Dental hygiene education first began in Nepal in 1997 with the
formation of the Kantipur Dental Hospital. A Japanese NGO
supported the establishment of this dental hospital, which currently
only runs a dental hygiene program.
• There is a two year program and a three year diploma program.
• For both of the courses the students must complete a 5 or 6 month
on the job training toward the end of the course.
• The school provides free care for the poor. Students from rural
areas can receive scholarships to attend school with the hope they
will return to their villages to provide much needed service.

21. Nepal
• In 2005 there were about 250 dental hygienists in Nepal. The
school graduates 40 students each year and they work in dental
clinics, hospitals and other community settings, or are self
employed. (Knevel, 2005)

22. Conclusion
This brief overview of a few countries gives us a glimpse of the
variety of situations dental hygienists around the world find
themselves in. Although dental hygiene has been around for 105
years in the US, we are still fighting for independent practice.
Other countries, like the Netherlands have independent practice and
can provide basic pediatric dental services. Countries like Germany
have not even recognized dental hygiene as a legitimate
profession, while Nepal has a degree program. It is difficult to
understand what makes the difference, but if I were to make a
guess, one thing would be personal support of the national
organization which works to enhance the opportunities for dental
hygienists. We ARE the world's oral health care specialists!

23. References
• ADHA-Number of Dental Hygiene Education Programs Offered by State. (n.d.). Retrieved February 2011, from ADHA web
site: www.adha.org/downloads/edu/Ed_Program_Map.pdf
• DDHV. (2011). Retrieved April 12, 2011, from German Dental Hygienist Association: http://www.ddhv.de/en/
• (2008). EU Manual of Dental Practice: version 4 .
• Gadbury-Amyot, C., & Brickle, C. (2010). Legislative Initiatives of the Developing Advanced Dental Hygiene Practitioner.
Journal of Dental Hygiene , 110-113.
• Gaterman, B. (2004, August). Letter to the Editor. International Journal of Dental Hygiene .
• IFDH. (2008). Retrieved April 12, 2011, from International Federation of Dental Hygienists:
www.ifdh.org/workabroad/netherlands.shtml
• International Federation of Dental Hygienists. (2008). Retrieved April 7, 2011, from Australia:
http://www.ifdh.org/workabroad/australia.shtml
• Johnson, P. M. (2009). International profiles of dental hygiene 1987 to 2006: a 21 nation comparative study. International
Dental Journal , 63-77.
• Knevel, R. (2005). Dental hygienists on top of the world: supporting oral health education in Nepal. International Journal of
Dental Hygiene , 205-212.

24. References, cont’d.
• Luciak-Donsberger, C., & Eaton, K. (2009). Dental hygienists in Europe: trends toward harmonization of
education and practices since 2003. International Journal of Dental Hygiene , 273-284.
• Luciak-Donsberger, L., & Aldenhoven, S. (2004). Dental hygiene in Australia: a global perspective.
International Journal of Dental Hygiene , 165-171.
• Mingee, T. (2003). Changes in the Dental Hygiene Profession. RDH , 20-25.
• O'Hehir, T. (2003). More hygienists than dentists. RDH , 18-19.
• Pay Scale. (2011). Retrieved April 7, 2011, from
www.payscale.com/research/AU/Job=Dental_Hygienist/Hourly_Rate
• Petersilka, G., Neuhoff, D., & Flemmig, T. (2004). Establishing dental hygiene education in Germany:
current facts and future perspective. International Journal of Dental Hygiene , 86-92.
• Salary.com. (n.d.). Retrieved April 12, 2011, from http://www1.salary.com/Dental-Hygienist-salary.html
• Wikipedia, Alfred Fones. (n.d.). Retrieved February 2011, from en.wikipedia.org/wiki/Alfred_Fones
• Yoshida, N., Endo, K., & Komaki, M. (2004). Dental Hygiene education in Japan: present status and future
directions. International Journal of Dental Hygiene , 179-184.