The American Dental Hygienists’ Association (ADHA) has released a white paper calling for changes to how the dental hygiene profession is governed and distinguishing professional self-governance from self-regulation.
“Dental Hygiene Self-Governance: An Ethical and Economic Imperative” was authored by Derik J. Sven, DHSc, MBA, MPH, RDH, CDT, FADHA, FAADH, an ADHA Fellow and president of the Virginia Dental Hygienists’ Association who worked with ADHA to develop the Dental Hygiene Modernization Act.
According to the paper, self-regulation refers to authority delegated by a state to oversee members of a profession within an existing system, while self-governance refers to authority to define scope, standards, educational expectations, and systems through which care is delivered. The paper argues that the current dental hygiene model provides partial oversight but insufficient authority for the profession to shape structures affecting access to preventive care.
The white paper examines nursing and physical therapy as comparisons. According to the release, nursing established a regulatory foundation through state boards of nursing and nurse practice acts, while full practice authority for nurse practitioners has been associated with improved access in underserved and rural areas and outcomes comparable to physician-led care. Physical therapy reached direct patient access in all 50 states in 2025.
The paper also discusses antitrust law, citing the U.S. Supreme Court's decision in North Carolina State Board of Dental Examiners v. Federal Trade Commission and noting what it describes as the risks associated with boards dominated by active market participants.
“Dental hygiene has operated under another profession’s authority for more than a century, even as the evidence for what hygienists can safely provide keeps growing,” said Dr. Sven. “Self-governance isn’t about independence for its own sake. It’s about aligning authority with the competence the profession already demonstrates.”
The white paper also addresses the economics of dentist-controlled governance. According to the release, it cites evidence that scope-of-practice restrictions on dental hygienists increase the price of basic preventive services by approximately 12%. It also cites an association between greater hygienist autonomy and more preventive visits and fewer restorative needs, with the effects most pronounced in dental provider shortage areas and low-income communities.
“Dental hygienists are preventive oral health experts, and the systems that govern our profession should reflect that expertise. Self-governance means aligning authority with education, competence, and accountability in service to the public. This white paper outlines a path to modernize dental hygiene governance, expand access to preventive care, and protect the public,” said ADHA President Jessica August, MSDH, RDH, CDA, FADHA.
The paper presents the Dental Hygiene Modernization Act framework as a model that ties expanded authority to licensure, education, experience, continuing competence, and independent oversight rather than unrestricted autonomy.
Its recommendations call for policymakers, regulators, and professional organizations to establish independent dental hygiene regulatory bodies with public representation; separate dental and dental hygiene practice acts to reflect two distinct professions; align scope of practice with education and demonstrated competence; expand direct reimbursement pathways in Medicaid and commercial payer systems; and replace mandatory supervision frameworks with collaborative practice models.
The white paper is available for download at https://www.adha.org/advocacy/adha-white-papers/.
Figures and Images
