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Table of Contents   
ORIGINAL RESEARCH  
Year : 2020  |  Volume : 31  |  Issue : 1  |  Page : 57-60
Dental hygienist job autonomy depends on the period of dental hygiene education


1 Department of Dental Hygiene, The Graduate School, Yonsei University, Seoul, Wonju, Republic of Korea
2 Department of Dental Hygiene, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea

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Date of Submission11-Mar-2018
Date of Decision04-Apr-2018
Date of Acceptance16-Jul-2018
Date of Web Publication02-Apr-2020
 

   Abstract 


Context: Independent dental hygiene practice is critical in regions with low accessibility to dental services, as well as for preventing and managing oral diseases among children and the elderly from low-income families, as these individuals are highly vulnerable to oral diseases. Aims: We investigated whether the job autonomy of dental hygienists has been maintained, in accordance with the guidelines of the International Federation of Dental Hygienists (IFDH). Settings and Design: This study comprised a cross-sectional literature review. Subjects and Methods: We reviewed national reports and articles published in 23 countries selected for analysis to determine the degree of dental hygienist job autonomy, based on the extent of dental hygiene education. We divided the countries into two groups, based on the historical length of dental hygienist education. Statistical Analysis Used: We classified education as direct access, indirect supervision, and direct supervision. Two researchers reviewed and revised the classification results to ensure reliability. The Kappa value was 0.96 points. Statistical analysis was performed by PASW statistics 23.0 program (SPSS Inc., Chicago, IL, USA.). Results: Countries with >40 years of educating dental hygienists exhibited more independent dental hygienist practices than those with less than 40 years of educating dental hygienists. Conclusions: Countries with >40 years of experience in educating dental hygienists largely guarantee independent dental hygiene practice for dental hygienists, in accordance with IFDH guidelines. The society's need for dental hygienists is fulfilled and professional competency is maintained in these contexts; thus, it should be required for dental hygienists to maintain independent dental hygiene practices.

Keywords: Dental hygienists, independent dental hygiene practice, job autonomy

How to cite this article:
Jang YE, Kim NH. Dental hygienist job autonomy depends on the period of dental hygiene education. Indian J Dent Res 2020;31:57-60

How to cite this URL:
Jang YE, Kim NH. Dental hygienist job autonomy depends on the period of dental hygiene education. Indian J Dent Res [serial online] 2020 [cited 2021 May 10];31:57-60. Available from: https://www.ijdr.in/text.asp?2020/31/1/57/281802



   Introduction Top


The International Federation of Dental Hygienists (IFDH) announced new policies, suggesting that dental hygienists can work autonomously as oral health care professionals.[1] This emphasizes the improved social responsibility and capacity of dental hygienists. The original purpose of the dental hygienist is the provision of oral health care for communities. Importantly, educated dental hygienists consider job autonomy critical to achieving the goal of providing oral health care with social responsibility for the community.[2],[3] Therefore, dental hygienist job autonomy is changing.[4]

For dental hygienists, job autonomy can be further classified into direct supervision, indirect supervision, general supervision, direct access, and independent practice.[5],[6],[7] Independent dental hygiene practice is the extent to which a job allows hygienists the autonomy to schedule work and make decisions, and can exist in three forms:[8],[9] autonomy in decision-making (the opportunity to be creative and form judgments); autonomy in work style (independence and freedom to choose the manner in which they perform their tasks); and autonomy in scheduling (freedom to make decisions regarding work order and schedule).[2]

Notably, independent hygiene practices provide the economic benefit of reducing dental care costs[7],[10],[11] and the health benefit of increased service accessibility.[12] Within the workplace, independent dental hygiene practice increases efficacy,[13],[14] job satisfaction, and professional competency.[5] However, independent dental hygiene practice brings specific responsibilities, which must be considered. Questions regarding changes in independent dental hygiene practice and the professional competence of dental hygienists, how to respond to complex situations at work, how to ensure patient safety, and how to assume legal responsibilities for the outcomes of independent dental hygiene practice should be considered.[15],[16]

According to the IFDH, independent dental hygiene practice is critical in regions with low accessibility to dental services, as well as for preventing and managing oral diseases among children and elderly from low-income families, as these individuals are highly vulnerable to oral diseases.[7],[12] Therefore, we investigated whether dental hygienist job autonomy was maintained according to the IFDH goal.


   Subjects and Methods Top


This study comprised a cross-sectional literature review. Data were obtained from 23 of the 30-member countries of the IFDH. Latvia, Malta, and Nepal were excluded because they provided no data in English. Fiji and Portugal were excluded because they did not have a dental hygienist association website, or because access to the website was impossible from a foreign country. The accessed websites and dates on which they were accessed for this study are listed in [Table 1]. To ensure accuracy of the data, we collected information from articles and reports published in each country using keywords such as “dental hygienist,” “duty,” “direct supervision,” “indirect supervision,” “general supervision,” “direct access,” “independent dental hygiene practice,” and “job autonomy.” We used Beatty's classification method for comparison with previous studies that used different standards for classifying the job autonomy of dental hygienists.[2] This constituted direct access, indirect supervision, and direct supervision. Indirect supervision and general supervision (when dental hygienists and dentists work together) were classified as forms of cooperation. Two researchers reviewed and revised the classification results to ensure reliability. The Kappa value was 0.96 points. Statistical analysis was performed using the PASW statistics 23.0 program (SPSS Inc., Chicago, IL, USA).
Table 1: Route and date of data access for each country

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   Results Top


Of the 23 IFDH member countries studied, 18 countries permitted independent dental hygiene practice for dental hygienists; >50% reported independently working dental hygienists [Figure 1]. In Korea, Japan, Israel and Ireland, dental hygiene practice must be performed under direct supervision. Canada and the United States reported different policies by province or state.
Figure 1: Period of dental hygiene education by job autonomy in 23 countries

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   Discussion Top


In our study, we found that the autonomy for dental hygienists differed within each country. Countries with more than 40 years of history in dental hygienist education permitted greater autonomy, whereas countries with shorter histories of education did not. However, Asian countries required supervision in spite of an extended period of dental hygienist education. Several countries were attempting to determine the uniqueness of dental hygiene practice.

The US and Canada, which have more than 40 years of history in educating dental hygienists, rigorously manage the quality of education and policies regarding dental hygienists to ensure sufficient professional competence and to efficiently provide dental services for the community. Although independent dental hygiene practice was not guaranteed from the beginning, these two countries strive to ensure that dental hygienists attain professional competence and develop a sense of responsibility. The US operates an Advanced Dental Hygiene Practitioner (ADHP) system to assume responsibility for the outcomes of independent dental hygiene practice.[17] The Canadian Dental Hygienist Association has developed a standardized national certification process to assess the competence of dental hygienists[18] and endeavours to aid the development of professional identities for dental hygienists via strict education policies.[19]

Some countries contradicted the general finding, including Korea and Japan, and do not ensure independent practice despite more than 40 years of history in providing dental hygiene education. In these countries, dental hygienists perform all tasks under dentist supervision, regardless of the clinic or public field task being performed. This restriction of independent practice may be a result of differences in social security between Asian and European countries, or in the healthcare policies of Korea and Japan, in which the government controls and manages national health services and healthcare providers. Thus, some cultures tend to focus on controlling the negative effects of independent dental hygiene practice and assuming responsibility for these effects, rather than considering the positive effects. Furthermore, in these two countries, there is no basis on which to prioritize increasing access to dental services and no solid counterplan for persuading interest groups, such as dentists, that oppose the community's demands.[5]

To fulfil the goal of training and utilizing dental hygienists to provide oral care for the community, independent dental hygiene practice must be ensured. This is especially critical for dental hygienists in regions with low accessibility to dental services, as well as those who are responsible for preventing and managing oral diseases among children and elderly from low-income families, as these individuals are highly vulnerable to oral diseases.[7],[12] It is necessary to fully understand and be prepared for these consequences before the adoption of independent dental hygiene practice, which is accompanied by reasonable responsibilities as in all professional occupations. High levels of education and training, as well as sophisticated quality control, are necessary for independent dental hygiene practice.

The present study has a number of limitations. Data was collected from the websites of dental hygienist associations in each country and, thus, may lack reliability. In addition, we could not reliably determine the most recent data on each website. To overcome these limitations, we have examined as many journals as possible. Though we have not identified an ideal method to overcome these limitations, this study is meaningful in that it investigated the status of job autonomy of dental hygienists in 23 IFDH countries.


   Conclusions Top


Countries with more than 40 years of dental hygienists guarantee independent dental hygiene practice for dental hygienists, in accordance with the IFDH goal. Society's need for dental hygienists is fulfilled and professional competency is maintained; thus, it should be guaranteed that dental hygienists maintain independent dental hygiene practices.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
IFDH. New Policies; 2017. Available from: http://www.ifdh.org/policies.html. [Last accessed on 2017 May 01].  Back to cited text no. 1
    
2.
Beatty CF. Community Oral Health Practice for the Dental Hygienist. 4th ed. St. Louis, MO: Elsevier; 2017.  Back to cited text no. 2
    
3.
American Dental Hygienists' Association. 100 Years of Dental Hygiene; 2017. Available from: http://www.tiki-toki.com/timeline/entry/55646/100-Years-of-Dental-Hygiene/#vars!date=1820-02-01_01:42:11. [Last accessed on 2017 Mar 01].  Back to cited text no. 3
    
4.
Johnson PM. International profiles of dental hygiene 1987 to 2006: A 21-nation comparative study. Int Dent J 2009;59:63-77.  Back to cited text no. 4
    
5.
Reinders JJ, Krijnen WP, Onclin P, van der Schans CP, Stegenga B. Attitudes among dentists and dental hygienists towards extended scope and independent practice of dental hygienists. Int Dent J 2017;67:46-58.  Back to cited text no. 5
    
6.
Adams TL. Attitudes to independent dental hygiene practice: Dentists and dental hygienists in Ontario. J Can Dent Assoc 2004;70:535-8.  Back to cited text no. 6
    
7.
Edgington E, Pimlott J. Public attitudes of independent dental hygiene practice. J Dent Hyg 2000;74:261-70.  Back to cited text no. 7
    
8.
Galletta M, Portoghese I, Battistelli A. Intrinsic motivation, job autonomy and turnover intention in the Italian healthcare: The mediating role of affective commitment. J Manag Res 2011;3:E7.  Back to cited text no. 8
    
9.
Hackman JR, Oldham GR. Motivation through the design of work: Test of a theory. Organ Behav Hum Perform 1976;16:250-79.  Back to cited text no. 9
    
10.
Fortner HS. A CDT code for hygienists. RDH 2008;28:28. Available from: http://www.rdhmag.com/articles/print/volume-28/issue-23/feature/a-cdt-code-for-hygienists.html. [Last accessed on 2017 Feb 01].  Back to cited text no. 10
    
11.
Sisty-LePeau N, Nielsen-Thompson N, Lutjen D. Use, need and desire for pain control procedures by Iowa hygienists. J Dent Hyg 1992;66:137-46.  Back to cited text no. 11
    
12.
Adams TL. Inter-professional conflict and professionalization: Dentistry and dental hygiene in ontario. Soc Sci Med 2004;58:2243-52.  Back to cited text no. 12
    
13.
DeAngelis S, Goral V. Utilization of local anesthesia by arkansas dental hygienists, and dentists' delegation/satisfaction relative to this function. J Dent Hyg 2000;74:196-204.  Back to cited text no. 13
    
14.
Harris RV, Sun N. Dental practitioner concepts of efficiency related to the use of dental therapists. Community Dent Oral Epidemiol 2012;40:247-56.  Back to cited text no. 14
    
15.
Plager K, Conger MM. Advanced practice nursing: Constraints to role fulfillment. Internet J Adv Nurs Pract 2007;9:1-12. Availaable from: https://www.print.ispub.com/api/0/ispub-article/3418. [Last accessed on 2017 Feb 01].  Back to cited text no. 15
    
16.
Swanson Jaecks KM. Current perceptions of the role of dental hygienists in interdisciplinary collaboration. J Dent Hyg 2009;83:84-91.  Back to cited text no. 16
    
17.
American Dental Hygienists' Association. Competencies for the Advanced Dental Hygiene Practitioner. ADHA; 2008. Available from: https://www.adha.org/resources-docs/72612_ADHP_Competencies.pdf. [Last accessed on 2017 Mar 01].  Back to cited text no. 17
    
18.
Brownstone EG. A Qualitative Study of the Occupational Status and Culture of Dental Hygiene in Canada (Doctor’s Dissertation).Department of Sociology. Winnipeg, Manitoba: University of Manitoba; 1999.  Back to cited text no. 18
    
19.
Canadian Dental Hygienists Association. Dental Hygiene Profession in Canada. CDHA; 2016. Available from: http://www.dentalhygienecanada.ca/. [Last accessed on 2017 Mar 01].https://www.adha.org/resources-docs/72612_ADHP_Competencies.pdf. [Last accessed on 2017 Mar 01].  Back to cited text no. 19
    

Top
Correspondence Address:
Nam-Hee Kim
Department of Dental Hygiene, Wonju College of Medicine, Yonsei University 20 Ilsanro, Wonju, Gangwondo 26426
Republic of Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_212_18

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