FUTURE OFDENTISTRYDental boards in a number of states are working
to address concerns raised by state medical boards
about oral and maxillofacial surgeons who provide
head and neck cosmetic procedures that have been
traditionally defined under the state's "practice of
medicine" statutes and regulations.
Another challenge facing dental boards is the
issue of "dual degrees." Dental boards are strug-
gling to define the scope of practice of oral and
maxillofacial surgeons, for example, that have a
dental degree and a medical degree but are licensed
only under a medical degree. With the M.D. degree,
the specialty graduate applies for a medical license
and does not fall under the statutes and regulations
governing dentistry in that state. The medically
licensed oral and maxillofacial surgeon then per-
forms procedures that are defined in the dental prac-
tice act as the "practice of dentistry." Dental boards
across the country are developing new rules and reg-
ulations to address such dual-degree issues.
ALLIED DENTAL HEALTH PRACTICE
The three nationally and professionally recog-
nized allied dental health fields are dental hygiene,
dental assisting, and dental laboratory technology.
To protect the health and safety of the public, licens-
ing jurisdictions regulate certain tasks performed by
allied dental personnel. Nowhere are the regulation
and licensure and certification of dental personnel
more varied from state to state than in the allied fields.
The competent performance of any allied profes-
sional who works under the supervision of the dentist is
ultimately the responsibility of the supervising dentist.
Dental Hygiene
Most state dental statutes and regulations define
the scope of practice for dental hygienists, who must
be licensed to practice. The dental hygienist (except
in Alabama) must be a graduate of an accredited
educational program. There are 255 dental hygiene
programs accredited by the Commission on Dental
Accreditation (CDA) (ADA, 2001).
The scope of practice for dental hygiene varies
from state to state. Although basic functions are
universal, in some states expanded functions may be
permitted if proof of additional education and train-
ing is accepted by the licensing jurisdiction.
Many states also allow for indirect or general
supervision of dental hygienists by dentists. This
means that dental hygienists can provide services for
patients without a dentist being present during the
procedure as long as the dentist has directed that the
procedure is appropriate. Each state establishes its
own limitations and parameters. A few states allow
the independent practice of dental hygiene.
The demand for dental hygienists has increased as
consumers seek more preventive dental services.
However, because of the differences in licensure from
one state to another, it is often difficult for a hygienist
trained in one state to transfer to another state. The
need for more licensed dental hygienists has prompted
many states to seek nontraditional educational path-
ways to increase the number of practicing hygienists.
States must consider these factors as they address
the freedom of movement for dental hygienists, a
greater uniformity in their scope of practice, and,
most importantly, patient protection concerns.Dental AssistingDental assistants are not licensed. The majority of
state dental statutes and regulations do not define "den-
tal assisting." Assistants are permitted to perform serv-
ices specifically defined by each state dental practice act.
The procedures allowed are always procedures that are
reversible and do not fall under the definition of the
practice of dentistry or dental hygiene. In all jurisdic-
tions, a dental assistant's duties must be performed
under the supervision of a licensed dentist.
Voluntary national certification programs have been
established for dental assistants, and the CDA conducts
site visits and accreditation reviews for most dental
assisting programs. There are 258 accredited programs
for dental assisting (ADA, 2001). However, since nei-
ther formal education nor certification is required many
dental assistants are not formally educated, but are
trained while employed by a licensed dentist.Dental Laboratory TechnologyThe expansion of the predoctoral dental curricu-
lum limits the amount of time dental schools have to
teach their students the laboratory skills that were
traditionally taught in the past. The aging of the
population creates an increased demand for fabrica-
tion of fixed and removable prostheses to replace
teeth and related dental structures. Dental labora-
tory technicians are helping to meet this demand,
aided in part by more efficient laboratory proce-
dures, materials and equipment.Licensure and Regulation of Dental Professionals