The professional licensing process for dental hygienists has been complex throughout the profession’s 109-year history. To be licensed and practice dental hygiene, a clinician must (1) graduate from a CODA (Commission on Dental Accreditation) accredited program, (2) pass a national board written examination, (3) pass a state licensing clinical exam (objective and structured patient clinical exam [OSCE], or dummy), and (4) pass a state precedent exam regarding each licensing state’s regulations. No state currently participates in dual dental hygiene licensure.
A clinician must test and apply for licensure in each state to provide care in multiple states. The requirement to be licensed in several states has created a barrier to licensing for practicing dental hygienists. This is a major problem for many hygienists, especially those who live close to national borders. Fortunately, other healthcare professions, such as nursing, medicine, physiotherapy, occupational therapy, speech therapy and others have solved this problem with license portability (LP). LP is the ability of a healthcare professional to transfer their license from state to state to continue their professional practice.
There are few differences in basic educational requirements between states. CODA, which has the same curriculum content requirements for dental hygienists across the country, must accredit all dental hygiene programs. However, there are discrepancies regarding scope of practice and accepted testing criteria for licensure between states. In dentistry, several testing agencies (ADEX, CDCA, CRDTS, SRTA, and WREB) offer clinical testing to providers who have successfully completed their studies. Some states accept results from all agencies, while others are specific to certain regions.
The positive impacts of the LP
Many aspects of dental hygiene would be positively affected by an increase in LP. It would be easier for dental hygiene programs to recruit applicants from out of state, opening up opportunities for students to get their training in more places.
The US Health Resources and Services Administration reported 6,898 areas of shortage of dental health professionals in the United States as of March 15, 2022. You can download the latest information at data.hrsa.gov. Additionally, due to COVID-19, many clinicians have abandoned dental hygiene, increasing the number of people with limited access to dental care. LP would contribute to increasing provider mobility. Dental practices located near state lines or whose geographic location makes it difficult to attract dental hygienists to their community would be more likely to find providers. Additionally, areas that temporarily experience problems accessing care due to natural disasters may be able to employ dental hygienists in the same way as traveling nurses.
The public does not have strong convictions on the LP. It is primarily dental providers who have strong opinions about licensure. Some believe that LP would create new competition in the dental hygiene job market, driving down wages when out-of-state hygienists move into an area. This has not been the case in other professions. The main obstacles preventing LP are the individual boards of dentistry that determine the scope of practice laws in each state. This begs the question, why not have dental hygienists respect a state’s scope of practice, but make their license portable?
Lagging dental hygiene
Most professions have identified the importance of self-governance as a key element of license portability. California is currently the only state to self-govern the hygiene profession. The American Dental Hygienists Association (ADHA) has studied the creation of a dental hygiene board separate from the board of dentistry to help advance the profession; however, the high cost of autonomy goes hand in hand with a higher management cost. Self-government does not seem feasible at present, and changing license portability laws requires multiple states to cooperate and lobby together, which requires funding.
Another license portability option has gained momentum in the United States. The Interstate Licensing Compact (ILC) creates a new way to expedite the licensing of medical providers already licensed to practice in one state and seeking to practice medicine in multiple states. Nursing, medicine, physiotherapy, emergency medical services (EMS), occupational therapy and speech therapy use such compacts. An ILC allows states to retain control but also provide portability without changing the scope of practice. The movement has gained support through the involvement of the Council of State Governments (CSG) and the Department of Defense, which have shown support due to the effect of license portability on the spouses of service members who practice . Support for the Interstate Licensing Compact cites uniformity in licensing, guidance, training, and scope of practice for dental hygienists.
A change is envisaged for our profession. A state-to-state licensing pact is being developed for dental hygiene. Challenges for the pact include getting consensus on the first bill. State licensing agreements will use ADHA communications for their stakeholder review of the first draft of the bill, and dental hygienist participation will be significant. Going forward, we need to stay up to date on current legislation and use our political influence as providers to advance our licensing potential.