Scope of Practice Statement

The Scope of Practice Statement is an interpretation of section 4 of the Dental Hygienists Regulation, which states:

A dental hygienist may practise dental hygiene.

The interpretation in this section has been developed to describe the range of services that may be provided by dental hygienists in British Columbia.

Dental Hygiene Defined

Dental hygiene is a health care discipline involving both theory and practice. The practice of dental hygiene can generally be defined as a collaborative relationship in which the dental hygienist works with the client, other members of the dental team and society in general, to achieve and maintain optimal oral health as an essential aspect of well-being.

Dental hygiene care is an integral part of comprehensive dental care. As such, the dental hygienist works in a collegial manner with other members of the client’s dental team.

The dental hygiene professional develops and implements health promotion, preventive and therapeutic interventions in a variety of settings.

The professional role of a dental hygienist is multi-faceted involving five primary responsibilities:

  1. Clinical Therapy
  2. Health Promotion
  3. Education
  4. Administration
  5. Research

The provision of dental hygiene services is a process, rather than a progression of procedures. Care is provided to clients, in all dental hygiene practice settings, in a problem-solving manner that is tailored to suit the special needs of each client. 

The process that guides the provision of dental hygiene services can be described from the viewpoint of all dental hygiene practice settings using the components of the problem-solving cycle. Dental hygienists assess information, formulate a dental hygiene diagnosis, plan the services to be provided in a consultative manner with the client, implement the plan, and evaluate the outcomes of the care provided. This problem-solving process is cyclical, in that evaluation involves a reassessment and the development of a further plan for on-going implementation.

Dental hygienists are expected to remain current. As new or alternate technologies or practices become available, they are incorporated into dental hygiene practice after the dental hygienist has obtained the appropriate education. Appropriate education has been defined by the College as “acquisition of the knowledge and skills required to provide specific dental hygiene services at an entry-level standard of competence.”  Appropriate education provides a theoretical and practical foundation for the registrant to practice in a competent, legal, ethical and professional manner that would be acceptable to the registrants’ peers.  For some services, appropriate education is the successful completion of a formal education course. For others, reading the literature or watching a demonstration video is considered appropriate. Professional judgment is required. 

If registrants are no longer able to provide a previously learned skill, or a new technology or practice, in a competent, legal, ethical and professional manner, they must abstain from providing that service to a client until appropriate education can be obtained.

Scope of Dental Hygiene Practice in each Responsibility Area

1. Clinical Therapy

“Clinical therapy refers to primary interceptive, therapeutic and maintenance procedures which enable the client to achieve optimal oral health and contribute to overall health.” (from Dental Hygiene Definition and Scope, 1994 CDHA)

In the clinical setting, dental hygiene assessment involves the gathering or updating of information relating to the client’s general and oral health, and the hard and soft tissues of the head, neck and oral cavity. The dental hygienist will obtain this information by performing some or all of the following assessment procedures:

  • medical and dental history
  • wellness habits, including (but not exclusively) nutrition and use of tobacco products
  • vital signs
  • head and neck examination
  • intra-oral soft tissue examination
  • periodontal examination
  • dental examination
  • occlusal examination
  • diagnostic tests, including (but not exclusively) pulp vitality tests, bacterial tests to determine caries risk and enzyme tests to determine periodontal disease
  • radiographic interpretation – including exposing and processing
  • impressions for study models
  • intra-oral and extra-oral dental photographs
  • preserving and packaging biopsy specimens for shipment

Once assessment data is gathered the dental hygienist critically analyses the data and formulates a dental hygiene diagnosis.

Planning involves the development of a dental hygiene treatment plan, with the mutual agreement and informed consent of the client. Goals and objectives for clinical therapy are identified, including a specific detailed plan for the provision of therapy which outlines the roles of the dental hygienist and the client. The dental hygiene treatment plan is part of an overall plan for the client’s dental care.

Implementation is the initiation of the plan. Dental hygiene services are provided according to the plan.  Revisions to the plan may occur, with the client’s informed consent. The dental hygienist provides services following current principles of infection control and dental hygiene practice:

  • managing client pain, anxiety and fears
  • providing oral health information and instruction relating to the teeth and periodontium, oral tissues, and dental restorations and appliances
  • providing nutritional counselling as it pertains to dental and oral health
  • providing information about the promotion of general health and wellness
  • debriding, scaling, root planing and irrigating supragingival and subgingival tooth surfaces
  • removing stain through various methods
  • recontouring and polishing restorations
  • applying anticariogenic and antimicrobial agents
  • applying fissure sealants and preventative resin materials
  • applying desensitising agents
  • applying and removing surgical dressings and removing sutures
  • placing and removing temporary restorations including provisional prosthodontic restorations (including the placement and removal of rubber dam, and matrices and wedges)
  • performing orthodontic procedures
  • polishing removable prostheses
  • performing first aid and other emergency procedures

Evaluation of dental hygiene therapy occurs at every appointment. The results of care are compared to the treatment plan and to the client’s goals and expectations. Changes in general and oral health status are assessed, using common measurements, and the dental hygienist develops a dental hygiene prognosis. The need for further care is discussed and planned, as well as the need for on-going maintenance and referral.

2. Health Promotion

“Health promotion refers to the process of enabling individuals and communities to increase control over and improve their health.” (From Dental Hygiene Definition and Scope, 1994, CDHA)

In health promotion (and in education, administration and research), the “client” may be an individual, family, group, community, facility or organisation.

The dental hygienist assesses baseline data as well as the needs of the client. This information may be obtained through questioning and discussion, surveys, statistical data, and/or literature review. Data is critically analysed against established measures of health, to identify program or activity priorities (dental hygiene diagnosis).

A plan is developed with the involvement and mutual agreement of the client to meet the client’s highest priorities. The dental hygienist consults with other health professionals to ensure an integrated plan, and a plan that is within the client’s budget.  A systematic approach is used to design a specific plan that is appropriate for the target group.

The plan is implemented using current and safe policies and procedures, and appropriate health promotion techniques.

The appropriateness and effectiveness of the program, and the client’s satisfaction, is evaluated through a discussion with the client of the implementation process and outcome data.  The dental hygienist and the client determine the need for program revision and for further health promotion activities or programs.

3. Education

“Education refers to teaching/learning; motivational and behavior modification processes which may occur in any dental hygiene practice setting.” (from “Dental Hygiene Definition and Scope, 1994, CDHA)

The need for dental hygiene education services is assessed through co-discovery with the client.  The education problem is defined as well as cause and effect relationships (dental hygiene diagnosis).

The plan involves the selection of teaching strategies appropriate for the client’s needs, interests and learning styles.  Mutual agreement is reached regarding desired outcomes, and a specific plan acceptable to the client is developed.  This plan includes goals, objectives, a sequence for activities and timelines.  Measurements to determine learning outcomes are also defined.

The plan is implemented, using current and safe policies, and appropriate educational strategies, motivational techniques and educational materials and resources.  Revision of the plan occurs as needed with the client’s mutual agreement.

Evaluation occurs through a measurement of the learning outcomes, and through a discussion with the client of the outcomes and the client’s perceptions of change.  A further plan is made, with the client’s consent, based on evaluation data and the client’s satisfaction.  The dental hygienist and the client determine the need for additional knowledge and alternative educational strategies.

4. Administration

“Administration refers to policy development and management processes which   may occur in any dental hygiene practice setting.”  (from Dental Hygiene Definition and Scope, 1994, CDHA)

Assessment occurs through the collection, analysis and interpretation of information related to the administrative practices of the practice setting.  Priorities are identified (dental hygiene diagnosis), with the mutual agreement of the client.

A plan is developed, with the client’s interests given the highest priorities.  This plan includes goals, components of the plan, a sequence for activities, and a means to determine how goal achievement is measured.

The plan is implemented, using current and safe policies and procedures.

Evaluation occurs with the client through discussion of the plan’s processes and the measured outcomes.  A further plan is made, with the client’s consent, based on evaluation data and the client’s satisfaction.  The dental hygienist and the client determine the need for additional administrative strategies and/or planning requirements.

5. Research

“Research refers to informal and formal scientific investigation, study and reporting which supplements, revises and validates dental hygiene practice.”  (from Dental Hygiene Definition and Scope, 1994, CDHA)

A research assessment occurs through literature review, discussion, questioning and critical thought.  The quantitative research problem/topic, and/or the nature of a qualitative research question, may then be identified (dental hygiene diagnosis).

A research project is planned, following quantitative or qualitative research or methodology.  A funding proposal is prepared, and consent is obtained from research subjects or co-researchers.

The research project is implemented following current and safe policies and procedures, and accepted research protocols.

Evaluation occurs through the comparison of results with other published studies, or through a discussion of emerging research themes with co-researchers and research colleagues.  Further research problems and/or questions are identified, and research findings and data are reported or published.  The dental hygienist applies current research information to dental hygiene practice.