Changes in dentist and dental hygienist numbers in the European Union and economic area.

AIM: To investigate the extent to which changes in the numbers of dental hygienists and dentists have occurred in the Member States of the European Union and Economic Area (EU/EEA) during the last ten years and discuss the changes in relation to the possibilities of sharing tasks between the two groups. METHODS: Numbers for active dentists, registered hygienists and EU/EEA member state populations in 2007 were taken from the website of the Council of European Chief Dental Officers (CECDO) (www.cecdo.org) and from CECDO records for the EU/EEA member states in 1998 and for the new EU member states (who joined in 2004 and 2007) in 2000. From these data, population: active dentists, population: registered dental hygienist and active dentists: registered dental hygienist ratios were calculated together with percentage changes in the number of dentists and dental hygienists by member state, between 1998 and 2007 for the old and between 2000 and 2007 for the new EU member states. RESULTS: In 2007, there were a total of 343,922 active dentists and 30,963 registered dental hygienists in the 30 EU/EEA member states plus Switzerland. The mean population to dentist ratio was about 1500:1 and the mean population to dental hygienist ratio (in the 25 states where dental hygienists were registered) was 13,454:1. During the study period, the population of the EU/EEA plus Switzerland increased by less that 3%, the number of dentists increased by 13% and the number dental hygienists by 42%. The overall ratio of active dentists: dental hygienists changed from 18:1 to 11:1. In six of the 30 member states plus Switzerland the population to dental hygienist ratio was between 2000:1 and 6000:1 and the dentist: dental hygienist ratio less than 1:3. CONCLUSIONS: Although, most member states educate dental hygienists and their numbers in the EU/EEA during the last 10 years have risen more than the dentist numbers, there are still only a handful countries where the hygienist numbers are great enough to make a significant difference to the delivery of oral health care.

Dental hygienists in Europe: trends towards harmonization of education and practice since 2003.

AIM: The aim of this study was to investigate the trends in dental hygienists' education and regulation in the European Union (EU) and European Economic Area (EEA) to examine whether, since 2003, there has been harmonization in dental hygiene education. METHODS: Information and data were obtained via piloted questionnaires and structured interviews with delegates from the International and European Dental Hygienists' Federations and representatives of the Council of European Chief Dental Officers and by literature review. RESULTS: In the EU/EEA, dental hygienists are legally recognized in 22 countries. Since 2003, there has been an increase in the number of Bachelor degree programmes and in autonomous practice. Entry to the profession is now exclusively via a Bachelor degree in five EU/EEA Member States and pending in two more. Ten Member States have adapted their degree programmes to the European Credit Transfer System. Two Member States combine education for dental hygienists and dental therapists. However, dental hygienists are not recognized by EU law and in five Members States, the introduction of the profession has been opposed by dental associations. CONCLUSIONS: For the reasons of wide variations in the standards of preventive care and periodontal therapies, the formal recognition of the dental hygiene profession by EU legislation and agreement on a pan-European curriculum for dental hygiene education leading to defined professional competencies and learning outcomes is required. To achieve this, there is a need for a better collaboration between competent authorities including governments, universities and dental and dental hygienists' associations.

Dental hygiene education in Nepal.

AIM: This article provides information about the history, recent curriculum changes and the legal status of the dental hygiene education in Nepal. It also intends to show, how, even in a poor developing nation, the personal drive of a native Nepalese citizen with a vision and the proper connections can lead to the establishment of a new profession, until then unknown. METHOD: Data were obtained from the founder of the first dental hygiene school in Nepal through qualitative interviews, and through personal visits to two Nepalese dental hygiene schools in Kathmandu and in Pokhara. Since 2006, the first author serves as curricular advisor, allowing him access and input to drafts of the development of current curricular changes. RESULTS: In 2000, the first dental hygiene course started in Kathmandu. Since then, dental hygiene education has been going through different stages of development and professionalization. In 2005, the programme was changed to 3 years in length in order for students to obtain an academic Certificate in Dental Hygiene. In 2006, the Nepalese Dental Hygienists Association was founded, resulting in greater recognition of the profession, especially by the powerful Nepalese Dental Association. Obscure rules and legislation results in eclectic specifications governing dental hygiene practice. Future challenges for the schools and the dental hygienists association are issues of quality insurance and scope of practice suitable for a developing country. Currently, Nepal is the only country worldwide with an almost equal gender distribution in the dental hygiene profession.

Dental hygiene in Slovakia.

This article reports on the development of the dental hygiene profession in Slovakia from a global perspective. The aim is to inform about current developments and to examine, how access to qualified dental hygiene care might be improved and how professional challenges might be met. For an international study on dental hygiene, secondary source data were obtained from members of the House of Delegates of the International Federation of Dental Hygienists (IFDH) or by fax and e-mail from experts involved in the national professional and educational organization of dental hygiene in non-IFDH member countries, such as Slovakia. Responses were followed-up by interviews, e-mail correspondence, visits to international universities, and a review of supporting studies and reference literature. Results show that the introduction of dental hygiene in Slovakia in 1992 was inspired by the delivery of preventive care in Switzerland. Initiating local dentists and dental hygienists strive to attain a high educational level, equitable to that of countries in which dental hygiene has an established tradition of high quality care. Low access to qualified dental hygiene care may be a result of insufficient funding for preventive services, social and cultural lack of awareness of the benefits of preventive care, and of limitations inherent in the legal constraints preventing unsupervised dental hygiene practice. These may be a result of gender politics affecting a female-dominated profession and of a perception that dental hygiene is auxiliary to dental care. International comparison show that of all Eastern European countries, the dental hygiene profession appears most advanced in Slovakia. This is expressed in high evidence-based academic goals, in extensive work with international consultants from the Netherlands and Switzerland, in annual congresses of high professional quality, and in the establishment of a profession, which has not been introduced in all Western EU countries.

Dental hygiene in Australia: a global perspective.

AIM: This article reports on the practice of dental hygiene in Australia from a global perspective. The aim is to examine how access to qualified dental hygiene care could be improved and how current professional challenges might be met. METHOD: Secondary source data were obtained from a survey questionnaire presented to members of the House of Delegates of the IFDH or by fax and e-mail to experts involved in the national professional and educational organization of dental hygiene in non-IFDH member countries. Responses were followed-up by interviews, e-mail correspondence, visits to international universities, and a review of supporting studies and reference literature. RESULTS: The introduction of dental hygiene in Australia was inspired by the delivery of preventive care in Great Britain. Today dental hygiene is a paramedical profession, generally studied at institutions of higher education. Study duration is 2 (diploma and associate degree programmes) and 3 years (Bachelor of Oral Health Programs). A recent trend to combine dental therapy and dental hygiene education poses the challenge to maintain a stand-alone degree in dental hygiene as it is practiced worldwide. Low access to qualified dental hygiene care may be a result of insufficient funding for preventive services, social and cultural lack of awareness of the benefits of preventive care, and of limitations inherent in the legal constraints preventing unsupervised dental hygiene practice. These may be a result of gender politics affecting a female dominated profession and of a perception that dental hygiene is auxiliary to dental care. Changes are expected to reflect the global trend towards a decrease in supervision and towards higher education. An example of innovative practice of public health is the involvement of dental hygienists in the educational process of aboriginal health workers in order to promote access to oral health education for indigenous populations.

The effects of gender disparities on dental hygiene education and practice in Europe.

In Europe, over 96.5% of dental hygienists are women. The objective of this report was to examine the impact of gender role stereotyping on the image of the dental hygiene profession and on disparities in educational attainment and work regulations within Europe. Data pertaining to regulated or non-regulated dental hygiene practice in 22 European countries were analysed according to possible gender impact on access to education and on the structure of the delivery of care. It was examined whether there is a correlation between national differences found in the dental hygiene profession and gender related disparities found in other work-related areas. Results show that the gender bias in the dental hygiene profession has an effect on equal access to education, and on equal occupational opportunities for dental hygienists within the European Union (EU) and beyond. In northern Europe, higher educational attainment in the field of dental hygiene, more extensive professional responsibilities and greater opportunities for self-employment in autonomous practice tend to correlate with greater equality in the work force. In eastern Europe, lower educational and professional opportunities in dental hygiene correlate with greater gender disparities found in other work-related areas. In some western European countries, the profession has not been implemented because of the political impact of organised dentistry, which expects financial loss from autonomous dental hygiene practice. In order to fulfil mandates of the EU, initiatives must be taken to remove the gender bias in the delivery of preventive care and to promote equal access to educational attainment and to professional development in the whole of Europe for those who choose to do so.

Dental hygiene in Hong Kong: a global perspective.

PURPOSE: This article examines how dental hygiene status in Hong Kong compared to global developments of the profession. The aim is to address access to cost-effective, qualified preventive care. METHODS: Information for this study was obtained using questionnaires and followed up by e-mail correspondence with International Federation of Dental Hygienists (IFDH) delegates and additional experts, supporting studies and reference literature. All experts consulted are involved in the professional and educational organisation of dental hygiene on a national level. RESULTS: Results show that dental hygiene is practised in about 30 countries, generally as a licensed profession, studied at institutions of higher education. Average study duration is 3 years. Globally, low access to qualified dental hygiene care tends to be a result of a lack of social and cultural awareness of the benefits of preventive care and insufficient funding for preventive services as well as supervision requirements, which tie dental hygiene care to private practice dentistry settings. In several countries, a reduction of supervision requirements has opened the door to provide care at alternative settings and public health institutions. CONCLUSION: In Hong Kong, owing to a small number of practising dental hygienists, access to qualified preventive care is scarce. Public awareness of the benefits and cost-effectiveness of preventive measures need to be raised to achieve higher acceptance of the profession. Global and scientific developments mandate an extension of study duration. Access to qualified care could be addressed by public health initiatives, which utilise the expertise of dental hygienists in setting and attaining preventive health goals.

Origins and benefits of dental hygiene practice in Europe.

Origins and benefits of the practice of dental hygiene were investigated in order to provide guidelines to countries where initiatives are being taken to introduce the profession. In Europe, so far the profession has been introduced in the Czech Republic, Denmark, Great Britain, Finland, Italy, Latvia, Lithuania, the Netherlands, Norway, Portugal, Sweden, Switzerland and Spain. Programmes in Ireland, Poland, and Romania are not presented in this article. Information for this study was obtained using questionnaires and followed up by e-mail correspondence with additional experts, supporting studies and reference literature. All experts consulted are involved in the professional and educational organisation of dental hygiene in their countries. Results show that dentists and dental hygienists who had been inspired by the delivery of preventive care in the US, initiated the European dental hygiene movement. In some countries, opposition of organised dentistry had to be overcome. In countries where the population has limited access to qualified dental hygiene care, such as in Austria, Belgium, Germany and France, a high prevalence of untreated periodontal disease has been reported. There, the lucrative practice of delegating dental hygiene tasks to dental assistants without qualifying education has slowed efforts to implement the profession and resulted in negative health and vocational outcomes. This leads to the conclusion that an implementation of legislation governing the practice and the educational process of dental hygiene in the EU and beyond would contribute to an equitable standard of health care as well as to equal opportunities in education and employment.