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A Comparison of Nursing and Dental Hygiene
In part 1 of this series the authors look at the early beginnings of dental hygiene and how the profession attempts to parallel the growth and autonomy of nursing.
Regarding the history of the dental hygiene profession, it does seem that, in many ways, it paralleled the development of general nursing in the sense that both began with a general concept that took many years to mature and become established practice. And yet the profession of nursing has expanded far and away beyond that of dental hygiene.
Although modern registered nurses (RN) and registered dental hygienists (RDH) share almost identical general education prerequisites and core curricula specific to their field, RNs are licensed and regulated through their own professional board, have more autonomy, a broader scope of practice, and less restrictive practice acts than licensed dental hygienists. It is reasonable to question this discrepancy and ask, can dental hygiene ever catch up?
Most people think the nursing profession began with the work of Florence Nightingale. However, the concept of formalized nursing began as early as the late 1700s when some physicians initiated courses for women interested in caring for patients. It wasn’t until 1854, when Nightingale led a group of women to the Crimea to deliver nursing services to British soldiers, that she confirmed that a corps of educated women informed about health and the ways to promote it, could improve the care of patients based on a set of particular principles.
By 1873, there were 3 educational nursing programs established in the U.S.based on Nightingale’s ideas.The success of the schools led to a proliferation of similar nursing programs and by 1900 there were somewhere between 400 to 800 nursing programs operating in the country.1 However, there were no consistent training standards in place and many of the programs varied from 6-week to 3-year programs. Most of the programs were located in hospitals, schools, private residences, or through correspondence schools.2
In comparison, the concept of dental hygiene as a profession didn’t emerge until 1902, when Dr. C.M. Wright published the article, "A Plea for a Sub-Specialty in Dentistry.” Dr Wright stated “the time has arrived when I believe we should make it possible for, and encourage, a specialty within a specialty devoted to the polishing of teeth and caring of the gums.” The article called for dental colleges to provide the education and training and grant a certificate of competence to graduates. Dr Wright went on to emphasize that graduates of the program could be employed by dentists, practice at offices of their own, or at the homes of patients. In addition, he urged dentists to use their influence to recommend the new specialists, “just as physicians and surgeons recommend and insist upon the services of the trained nurse.” Dr Wright’s article was the first of many to advocate not only for the profession of dental hygiene, but also for the recognition of this as a specialty within the wider frame of oral health, with its own experts established as independent practitioners.
In 1906, Irene Newman became the first dental hygienist and began providing prophylactic work for the patients of Dr. Alfred Fones. By 1916, dental hygiene education was formalized by its establishment in institutions of higher education.2 Although nursing organized 2 major professional associations in the late 1890s, it wasn’t until 1923 that dental hygiene organized on a national level by founding the American Dental Hygienists' Association (ADHA). It took another 34 years for dental hygienists to receive the title of Registered Dental Hygienist in 1940.
Advocating for Regulation and Licensure:
When nursing organized in the late 1890s, the primary objectives were to establish some control over the profession and stem the growth of substandard nursing schools. State licensure seemed to be a reasonable mechanism to achieve these goals as physicians were already registered in all states and the Union. The United States Supreme Court had ruled that occupational licensure was a legitimate function of the police powers of the states.Thus the model was available and the way cleared for nurses to seek licensure.4
To facilitate the registration campaign, nurses organized to set up constituent state groups with local memberships lobbying for registration acts. By 1923, all 48 states had passed some form of nursing licensure legislation.2 Although medicine was in a monopoly position, each state eventually had a nursing board composed of both nurses and physicians.4 In 1978, the National Council of State Boards of Nursing (NCSBN) was created to manage the nurse-licensing examination which consisted of a representative from each state board, an executive director, and the staff. The purpose of the change was to relieve the American Nurses Association (ANA) from management of the licensing examination and give state boards ‘‘autonomous control over the entire licensure process.’’2 Thus the profession of nursing became self-regulated.
In comparison, it wasn’t until 1951 that all 50 states required licensure and regulation of dental hygienists. However, unlike nursing, dental hygienists were licensed and regulated by state dental boards comprised only of dentists. California is the only state to have its own dental hygiene board.
Although dental hygiene has advanced since its inception in the early 1900s, nursing has far surpassed dental hygiene in practice acts and autonomy. Advanced practice nurses have achieved general supervision for most of the specialties they provide and are widely recognized as delivering more efficient, less costly and safer health care services. How about dental hygiene? Can we really say that dental hygiene mirrors nursing with similar advancements? Are we, like nurses, beginning to achieve the status of a full profession and does our educational level make a difference in the practice of dental hygiene?
In Part 2 of this series of articles, we will evaluate how nursing and dental hygiene have undergone a progression of academic and career ladders along with advancement in new types of healthcare providers who specialize in different settings and how grassroots advocation for one’s profession makes a difference.
