Dental hygiene: one profession, one license, one national clinical examination.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.
By Ameerah T. Givens, BSDH
Ameerah T. Givens, RDH, BS, is a master's degree candidate in the School of Dental Hygiene at Old Dominion University in Norfolk, Va.