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Dental Hygiene Preceptorship – More Harm Than Good?

What does dental hygiene preceptorship mean in practice and is it good or bad?

What is dental hygiene preceptorship, really? Are you a preceptorship trained ‘hygienist’? If not, do you know any? Have you ever worked with one? I work with them every day. I assure you that a preceptorship trained ‘hygienist’ is no less proud of her title than I am.

So who, would you say, should rightly bear the title ‘dental hygienist’? Do you even need a college degree to practice dental hygiene? I mean, it’s just cleaning teeth after all, right? I’ve taken the liberty to provide a few facts about the training received on both ends of the scale. Then I’ll let you decide for yourself whether preceptorship is good for dental hygiene or not.

U.S. dental hygiene degree facts

Would a real dental hygienist please stand up…?

Dentallynx International

To earn a U.S. dental hygiene associate degree, students must complete an average of 2,888 hours of curriculum, including 659 hours of supervised clinical instruction. Bachelor’s degree programs require an average of 3,129 hours. Some of the required subjects are ‘Gen Ed – English, Speech, Psychology, Sociology’, ‘Basic Science – General Chemistry’, ‘Anatomy and Physiology’ I and II, ‘Biochemistry’, ‘Microbiology’, ‘Pathology’, ‘Nutrition’ and ‘Pharmacology’. Download the fact sheet for more details about the many subjects covered in the curricula on pages 7 and 8. The fact sheet is available below.

ADHA Dental Hygiene Degree fact sheet

Dental hygiene course in Germany facts

Following is an example of the Bavarian Dental Board’s sponsored path to practicing dental hygiene via preceptorship, or an apprenticeship program (document in German). Applicants must be experienced dental assistants.

The dental hygiene course is weekend-only and lasts for 16 months, with 550 curriculum clock hours. Some of the courses are ‘Basic Natural, Medical and Dental Sciences’, ‘Anatomy’, Histology and Physiology’, ‘General Oral Pathology’, ‘Pharmacology’, ‘Dermatology’ and ‘The Pathogenesis and Etiology of Periodontal Disease’. Then, Germany (Bavaria) bestows upon these students the title of ‘dental hygienist’. You’ll find the course description in the flyer available (in German) to download below.

Bavarian Dental Board dental hygiene apprenticeship course flyer

How does dental hygiene preceptorship work?

Many of us have no experience with apprenticeships since this form of education is not as common in the U.S. these days. Here’s how it works in Germany:

  • The mandatory school period ends at the age of 16, or in the 10th grade. In this time, a career path (i.e. dental assisting) must be chosen.
  • The students must then apply to various companies or offices in order to land on-the-job training.
  • Once a company or office agrees to hire the students, they will be employed for four days per week, with one day off for school. This lasts for three years.
  • At the end of the three years, if the students have done well at work and studied well at school, they earn a ZFA certificate of completion and are officially dental assistants. They are normally 19 years of age when they end their training.
  • Dental assistants who seek to practice ‘dental hygiene’ first need one year’s work experience as a ZFA (certified dental assistant). Then, they can take a Basic Prophy course of 60 hours, as a bridge from assisting to dental hygiene. After this, they may take the ZMP course, which lasts a year and follows the same format of full-time work with one day for school. In practice, this ZMP course means that they become expanded duties assistants, with training to scale supragingivally.
  • Next, they must acquire one year’s work experience as ZMPs. Then, finally, they can take the 16-month dental hygienist course! This also follows the same format of full-time work with one day at school per week. The route takes about seven years to complete.

Learn more about what it’s like to work in a German dental practice

Is preceptorship really so harmful to the profession?

In short, it makes it very hard to be taken seriously when poorly-trained ‘hygienists’ have left their mark. For instance, the consensus here is that anyone can scale teeth. So, fair pay and a broader scope of practice are almost impossible to achieve and things which should already be a given, are always a battle. There is a direct link to dental hygiene preceptorship.

Read: Two big reasons why you really need a dental hygienist.

That said, after working closely with the local German ‘hygienists’, I no longer believe that preceptorship trained hygienists have horns and pitchforked tails. But they do have my pity!

A glass ceiling in dental hygiene

Since the 1990s, these ‘hygienists’—if I may—have worked tirelessly with their local dental boards to create a beautiful and ornate glass ceiling above their own heads. This glass ceiling is so precisely engineered that those trained under it will never be able to crack it. They will likely never earn the respect of their dentist peers because their learning potential has been capped by the dentists themselves. This, in my opinion, is their gravest mistake.

People in dental hygiene from a preceptorship background will likely never earn higher degrees in their own fields, as they are apprentices with no proper high-school diploma. So they will always have to rely upon their dentist’s knowledge. As such, they will likely never be leaders in dental hygiene, but consumers of the findings of the larger international dental community. Further, they will likely, never earn the respect of the international dental community.

Ironically, preceptorship trained dental hygiene professionals are not only proud of their profession but they are also keen to learn. You can see my review of a CE course for Prophylaxe Assistants and ‘hygienists’ that I took in Munich, here.

They are ‘architects of their own (mis)fortune’.

Appius Claudius Caecus

Local efforts toward standardization

The DDHV is a local group of hygienists in Germany whose members hold only internationally recognized hygiene degrees. This association formed in the 1990s and has worked tirelessly against the development of the German-based dental hygiene preceptorship and apprentice programs.

Learn more about the culture in Germany and Western Europe

If you are a dental hygienist practicing in Germany and would like to join the DDHV to help them fight for the standardization of dental hygiene education, you can find more here.

It remains to be seen if they can succeed in pushing the dental community to accept and establish an internationally recognized dental hygiene education standard in Germany. If so, what would happen to all of the apprenticeship diplomas being given out each year? The fate of the dental hygiene profession in Germany hangs in the balance.

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