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Korean Dental Hygienists’ Job Description Based on Systematic Review
J Dent Hyg Sci 2020;20:187-99
Published online December 31, 2020;  https://doi.org/10.17135/jdhs.2020.20.4.187
© 2020 Korean Society of Dental Hygiene Science.

Sun-Mi Kim1 , Eunsuk Ahn2 , Soo-Jeong Hwang3 , Soon-Jeong Jeong4 , Bo-Ra Kim5 , and Ji-Hyoung Han6,†

1Department of Dental Hygiene, Wonkwang Health Science University, Iksan 54538, 2Department of Dental Hygiene, Daejeon Institute of Science and Technology, Daejeon 35408, 3Department of Dental Hygiene, College of Medical Science, Konyang University, Daejeon 35365, 4Department of Dental Hygiene & Institute of Basic Science for Well-Aging, Youngsan University, Yangsan 50510, 5Department of Dental Hygiene, College of Medical and Health Sciences, Cheongju University, Cheongju 28503, 6Department of Dental Hygiene, Suwon Science College, Hwaseong 18516, Korea
Correspondence to: †Ji-Hyoung Han, https://orcid.org/0000-0003-1613-2879
Department of Dental Hygiene, Suwon Science College, 288 Seja-ro, Jeongnam-myeon, Hwaseong 18516, Korea
Tel: +82-31-350-2418, Fax: +82-31-350-2075, E-mail: hanjh@ssc.ac.kr
Received November 23, 2020; Accepted December 3, 2020.
Abstract
Background: Korean dental hygienists perform various tasks under the supervision of dentists in addition to the tasks listed in the law. Many meaningful studies have been conducted to determine the actual tasks of dental hygienists, but these studies did not show common results due to the differences in research methods or designs. Hence, this study aimed to review the reported data on the tasks of dental hygienists in Korea and to clarify them based on a systematic literature review.
Methods: For the literature search, the COre, Standard, and Ideal model presented by the National Library of Medicine was referenced. Seven databases were searched for literatures published in Korea, including PubMed, and Google Scholar. Of the 352 studies found using key words, titles, and abstracts, 46 were finally extracted based on the first and second exclusion criteria. After confirming the tasks of Korean dental hygienists in 46 literatures, 136 tasks were listed and calculated as appearance rate in the literature.
Results: The most common tasks in 46 studies were fluoride application (67.2%), radiography (65.4%), scaling (65.4%), sealant (60.7%), patient management and counseling (56.7%), tooth-brushing education (52.2%), impression taking with alginate (50.1%), and making temporary crowns (47.9%). The most mentioned tasks of dental hygienists in public health centers were fluoride application (100%), sealant (100%), oral health education (71.4%), public oral health program evaluation (71.4%), school fluoride mouth-rinsing program (71.4%), water fluoridation (57.1%), tooth-brushing education (57.1%), school oral health programs (57.1%), and public elderly oral health programs (57.1%).
Conclusion: This study showed that Korean dental hygienists had 136 tasks by reviewing 46 related studies and that the main job of Korean dental hygienists was oral disease prevention including scaling, sealant, and fluoride application.
Keywords : Dental hygienists, Job description, Systematic review
Introduction

The oral health workforce in Korea is composed of dentists, dental hygienists, and dental technicians, and dental hygienists contribute to the improvement of the publics oral health by providing treatment that prevents oral diseases1). Dental hygiene education in Korea began in 1965 and has made rapid progress since 2004, including the establishment of a 4-year curriculum2) and the world’s first doctoral course in dental hygiene3). The tasks of dental hygienists were legally prescribed in the Medical Technicians Act of 1973 and include promotion of oral health and prevention of oral diseases; however, in reality, dental hygienists perform various tasks in dental clinics such as dental treatment assistance and business management support. In the task description reported in 2000, the tasks of dental hygienists are divided into six classifications: oral health education, preventive dental treatment, dental treatment cooperation, public health business, business management support, and professional improvement4). As such, dental hygienists perform various tasks under the direction and supervision of dentists in addition to the tasks listed in the law. In the last decades, some dentists delegate their duties to dental hygienists to ensure the continuous performance of their tasks. However, it is not clear whether the task is legitimate or not5). In some cases, the tasks are not recognized as legitimate, and dental hygienists are oftentimes subject to administrative disposition. As a result, dental hygienists in Korea experience a feeling of deprivation along with a decrease in job satisfaction, and sometimes pursue a new career as they tend to have a negative perception about their job6-8). Therefore, it is necessary to clearly confirm the tasks actually performed in the dental medical environment and conduct a job analysis accordingly. Based on this, the dental community should discuss the actual tasks performed by dental hygienists, and provision of institutional support is essential to ensure that the tasks performed are legitimate. In the meantime, many meaningful studies have been conducted to examine the actual tasks of dental hygienists in Korea, and many reference data have been obtained in order to establish an effective policy. These studies reflect the dental medical environment at the time of the investigation and propose the actual scope of responsibilities of dental hygienists. Nevertheless, it was not possible to reach a comprehensive conclusion as the finding of related research were consistent. Therefore, this study aimed to review the reported research data on the tasks, duties, and scope of tasks of dental hygienists in Korea and to clarify the tasks of dental hygienists based on a systematic literature review. Moreover, this study aimed to ensure that the tasks performed by dental hygienist are within their legal scope of practice and to our findings will serve as a basis for establishing policy agreements on the legal tasks of dental hygienists.

Research Methods

1. Literature search

For literature search, the COSI (COre, Standard, Ideal) model presented by the National Library of Medicine was referenced9). Based onthe results of the discussions of researchers, PubMed (http://www.pubmed.gov), and Google Scholar (https://scholar.google.co.kr), which is a foreign database that can be used for general literature search; another five databases, where literature published in Korea can be searched; and their own journal sites related to dental hygiene that are recognized in Korea, were used for the study. Selected domestic databases include Korean academic information (http://kiss.kstudy.com), academic research information service (http://www.riss.kr), paper search (http://www.papersearch.net), Academic Education Center (https://www.earticle.net), DBpia (www.dbpia.co.kr), Journal of Dental Hygiene Science (http://www.jkdhs.org), and Korean Dental Hygiene Society (http://www.jksdh.or.kr). In order to select the appropriate keywords to be used in the literature search, some previous studies were analyzed, and the first keyword was selected through a meeting with all of the researchers. After searching the literature using the primary keyword, the secondary keyword was extracted through deletion or correction of duplicates when searching the literature (Table 1).

Keywords Used in Literatures Search

Priority Primary keyword Secondary keyword
1 Dental hygienist task Dental hygienist task
2 Dental hygienist job Dental hygienist job
3 Dental hygienist job scope Dental hygienist task scope
4 Dental hygienist task scope Dental hygienist job scope
5 Role of dental hygienist Role of dental hygienist
6 Dental hygienist task area Dental hygienist medical cooperation
7 Dental hygienist medical cooperation Dental hygienist medical assistance
8 Dental hygienist medical assistance Dental hygienist core competency
9 Dental hygienist core competency Dental hygienist medical personification
10 Dental hygienist medical personification Dental hygienist medical practice
11 Dental hygienist business management support Dental infection/Prevention of infection
12 Dental hygienist medical practice Dental hygienist awareness
13 Dental infection/prevention of infection Dental hygienist image
14 Dental radiation safety Dental hygienist recognition
15 Dental hygienist job analysis Dental medical dispute
16 Dental hygienist awareness Dental hygienist performance
17 Dental hygienist image
18 Dental hygienist recognition
19 Medical law revision
20 Dental medical dispute
21 Oral health education
22 Health promotion
23 Preventive dental treatment
24 Dental hygienist performance


2. Paper extraction

The literature search was only conducted from 2000 to 2019 to reflect the recent trend, and a total of 39,188 articles were searched. The numbers of searches by keyword were as follows: 18,024 (46.0%) for dental hygienist role, 4,635 (11.8%) for dental hygienist tasks, 2,508 (6.4%) for dental hygienist Jobs, and 2,368 (6.0%) for dental hygienist image. After screening the titles and abstracts of each article, those that did not match the research purpose were initially excluded; as a result, only 352 articles were extracted. Afterward, duplicate literatures and literatures that did not provide sufficient data on the tasks of dental hygienists were excluded during the 2nd and 3rd exclusion processes. Over 83 studies were extracted during the third selection process, and 37 studies that were judged to be insufficiently related to this study after screening the original text and reviewing the consensus of the researchers were further excluded (Fig. 1)10). A total of 46 literatures were finally selected (Table 2), of which 19 were conducted before 2010 and 27 after 2010. Of the total selected literature, 22 were journals (47.8%), 19 were dissertations (41.3%), and 5 were reports (10.9%).

The 46 Literatures Selected Finally for Tasks Analysis of Korean Dental Hygienists

Number Main author Publication year Title Publisher or journal URL
1 JH Sung 2000 A study on the roles of dental hygienists at the public health centers in Korea Journal of Korean Academy of Dental Hygiene http://kadh.or.kr/index.php?mid=board_CnLa25&category=2291&document_srl=2330&listStyle=list
2 MY Hwang 2002 A study on the Curriculums for the Department of Dental Hygiene - Based on the Tasks of Hygienists and the Couses For the National Qualification Ecamination Bulletin of Dongnam Health University https://kmbase.medric.or.kr/Main.aspx?d=KMBASE&i=0974620020200020123&m=VIEW
3 JH Yoo 2003 Usefulness of dental hygiene education curriculum in the public oral health service performance Yonsei University https://ir.ymlib.yonsei.ac.kr/bitstream/22282913/128826/1/T008015.pdf
4 EH Kim 2004 A study on the work of dental hygienists and nurse aides Inje University http://imgsvr.riss4u.net/contents3/td_contents8/09865/664/09865664.pdf
5 JR Park 2004 A research on the expansion of dental hygienists’ work Korean Dental Hygienists Association https://www.kdha.or.kr/news/report.aspx
6 MH Lim 2004 A Study on Dentists' Awareness About Dental Hygienists’ Works and Duty Division Journal of Korean Academy of Dental Hygiene http://kadh.or.kr/index.php?mid=board_CnLa25&category=2293&document_srl=2385&listStyle=list
7 PK Cho 2004 An analsysis of the job performance in operative restoration by dental hygienists Journal of Korean Academy Dental Hygiene Education http://www.jksdh.or.kr/view/CHOSAB-04-2-11.pdf
8 KJ Won 2005 A empirical study on job education of dental health administrative personnel Gangneung National University http://www.riss.kr/search/detail/DetailView.do?p_mat_type=be54d9b8bc7cdb09&control_no=9af4767c6610fe8d
9 SY Kim 2006 (A) Study on the curriculum for dental hygienist education Dankook University http://www.riss.kr/search/detail/DetailView.do?p_mat_type=be54d9b8bc7cdb09&control_no=a1fd5bff7709a242ffe0bdc3ef48d419
10 SS Bae 2006 Development of role model for dental hygienist in the changed environment medical service Yonsei University http://www.riss.kr/search/detail/DetailView.do?p_mat_type=be54d9b8bc7cdb09&control_no=b90c1a558a6d1a6dffe0bdc3ef48d419
11 YS Ahn 2006 Comparison of job description and turnover trend among dental hygienists and assistant nurses in dental clinics Journal of Korean Academy of Oral Health http://210.101.116.28/W_files/kiss61/21101049_pv.pdf
12 SJ Shin 2007 A study on the estimation of the number of dental hygienist and their practice Journal of Dental Hygiene Science https://kmbase.medric.or.kr/KMID/1023420070070010025
13 SH Shim 2007 A study on the job awareness of dental hygienists and their job performance Journal of Korean Society of Dental Hygiene http://kiss.kstudy.com/thesis/thesis-view.asp?key=2853967
14 YA Cheng 2007 A predictive study on the role and function of the dental hygienist in Taiwan International Journal of Dental Hygiene https://doi.org/10.1111/j.1601-5037.2007. 00236.x
15 YJ Kang 2008 An analysis of the completion and recognition of preceptorship course for fresh-dental hygienists Gyeongsang National University https://dcollection.gnu.ac.kr/public_resource/pdf/000000011540_20201116132226.pdf
16 YS Kim 2008 A study on the current state and weight of dental hygienists’ works Journal of Korean Society of Dental Hygiene http://www.jksdh.or.kr/view/CHOSAB-08-3-08.pdf
17 SS Park 2008 A Study on Elaboration of Dental Hyenists’ Participated Items in Implant Treatment Gyeongsang National University http://www.riss.kr/search/detail/DetailView.do?p_mat_type=be54d9b8bc7cdb09&control_no=8121c9e1bb4df2d4ffe0bdc3ef48d419
18 MS Wang 2008 The roles of dental hygienist in Korea Dankook University http://lib.dankook.ac.kr/dcollection/public_resource/pdf/000000032005_20201116133237.pdf
19 YH Cho 2008 Recognition of the job jurisdiction and job satisfaction of the dental hygienists and nursing aids Kyungwon University http://gachon.dcollection.net/public_resource/pdf/000000305245_20201116141741.pdf
20 YN Park 2010 Dental office manager current conditions by scale of Korean dental clinic The Journal of the Korea Contents Association https://www.dbpia.co.kr/journal/articleDetail?nodeId=NODE01543074&nodeId=NODE01543074&language=ko_KR
21 JH Park 2010 Dentists’ opinions for dental hygienists’ roles in Korea Journal of Korean Academy of Oral Health http://journaleng.kstudy.com/ISS_Detail.asp?key=2844604&tname=kiss2002&code=YqldZWtoSqVtJTNENnAlOCUmN/B%20Z%20xLJTNEVHJpZQ==
22 YJ Song 2010 The working range analysis for the dental hygienists’ education program and legal system improvement Yonsei University https://ir.ymlib.yonsei.ac.kr/handle/22282913/137418
23 MO Ha 2010 A study on the job analysis of dental hygienist in Gwangju Journal of Korean Society of Dental Hygiene http://kiss.kstudy.com/thesis/thesis-view.asp?key=2884088
24 GA Kang 2011 A Study of Influential Factors on Dental Hygienists’ Duties and their Job Satisfaction Journal of Korean Academy of Dental Hygiene http://kadh.or.kr/index.php?mid=board_CnLa25&category=2274&document_srl=2640&listStyle=list
25 HJ Noh 2011 A Study on the Realization of Work of Dental Hygienists in Public Health Centers Korean Dental Hygienists Association https://www.kdha.or.kr/news/report.aspx
26 JR Park 2012 The 2nd Job Analysis Study of Dental Hygienist Korea Health Personnel Licensing Examination Institute https://kiss.kstudy.com/public/public3-article.asp?key=60013748
27 YS Cho 2011 Review: Clinical Dental Hygiene Education and Practice based on Dental Hygiene Process Journal of Dental Hygiene Science http://kiss.kstudy.com/thesis/thesis-view.asp?key=2935724
28 YL Kwak 2013 Dentists’ awareness of Dental hygienists’ work KyungHee University
http://khu.dcollection.net/public_resource/pdf/200000063746_20201116154712. pdf
29 JH Kwon 2013 The management efficiency between the oral health clinic and oral health center system Dankook University http://lib.dankook.ac.kr/dcollection/public_resource/pdf/000000176872_20201116154906.pdf
30 SY Ahn 2013 Some dental hygienist by career expectations regarding clinical work done in the field of business studies Journal of Korean Society of Dental Hygiene http://www.dbpia.co.kr/Journal/articleDetail?nodeId=NODE08990380
31 SK Park 2015 Educational Needs on National Oral Health Project among Community Dental Hygienists Yonsei University https://dcollection.yonsei.ac.kr/public_resource/pdf/000000137689_20201116161546.pdf
32 SS Bae 2015 The standard of Dental hygienists’ clinical job Korean Dental Hygienists Association https://www.kdha.or.kr/news/report.aspx
33 JY Kim 2016 Associations of performance and perception on preventive dental care tasks with job satisfaction among some dental hygienists Chosun University http://chosun.dcollection.net/public_resource/pdf/200000266188_20201116162347.pdf
34 JS Lee 2016 Organization Structure of Dental Hospital and Job Analysis of Dental Hygienists Namseoul University http://nsulib.dcollection.net/public_resource/pdf/200000196894_20201116162505.pdf
35 SH Chae 2016 Research on dental hygienists' clinical skill proficiency in core dental hygiene competency Journal of Korean Society of Dental HygieneJ https://doi.org/10.13065/jksdh.2016.16.05.651
36 Virtanen 2016 The professional role of a dental hygienist in Finland – educators’ views International Journal of Dental Hygiene https://doi.org/10.1111/idh.12166
37 CH Kim 2017 The awareness of dental hygienist regarding the content of clinical practice education and importance of duty Journal of Korean Society of Dental Hygiene https://doi.org/10.13065/jksdh.2017.17.06.1067
38 SE Moon 2017 A study on the validity of the range of periodontal treatment by dental hygienists Korean Dental Hygienists Association https://www.kdha.or.kr/news/report.aspx
39 YH Ha 2017 Mongolian and Korean dentists’ opinions about the role of dental auxiliary workforce Dankook University http://lib.dankook.ac.kr/dcollection/public_resource/pdf/000000188553_20201116163918.pdf
40 SM Bae 2018 Evaluation of Dental Hygienist Job Validity according to Judgment Standard of Medical Practice in Medical Law Journal of Dental Hygiene Science https://doi.org/10.17135/jdhs.2018.18.6.357
41 CY Kang 2019 Dental Hygienist’s Professionalism and Health Insurance in Korea Yonsei University https://dcollection.yonsei.ac.kr/public_resource/pdf/000000518344_20201116171430.pdf
42 KJ Kim 2019 A survey of the working scope understanding between dental hygienists and chair-side dental assistants among dental students in Seoul Seoul National University https://dcollection.snu.ac.kr/public_resource/pdf/000000155246_20201116171600.pdf
43 AO Kim 2019 A comparison of dental hygienists’ legal duties among nations: Korea, USA and Canada Journal of Korean Society of Oral Health Science http://www.riss.kr/search/detail/DetailView.do?p_mat_type=1a0202e37d52c72d&control_no=9f0d6c37c49e012ab36097776a77e665
44 JW Yun 2019 Improvement of legal system regarding the scope of practice of dental hygienist Dongeui University http://dongeui.dcollection.net/public_resource/pdf/200000227795_20201116192350.pdf
45 YK Han 2019 A survey of dentists’ opinions on the performance of dental hygienists Journal of Korean Academy of Dental Administration https://www.dbpia.co.kr/journal/articleDetail?nodeId=NODE09260727
46 SJ Hwang 2019 Frequency and time of actual duties of some dental hygienists Journal of Korean Academy of Dental Administration https://www.dbpia.co.kr/journal/articleDetail?nodeId=NODE09260728

Fig. 1. Process of selection and exclusion of papers modified from PRISMA 2009 flow diagram10).

3. Presentation of data

After confirming the tasks of Korean dental hygienists in 46 literatures, each task was listed in specific terms. Then, a mark was applied when the dental hygienist's tasks appeared in each article, and the appearance rate in the entire literature was calculated. Most dental hygienists in Korea work in dental clinics, but more than 1,500 dental hygienists work in public health centers and implement public oral health programs. Therefore, it is necessary to classify the tasks of dental hygienists working in dental clinics and those working in public health centers. Of the 46 studies that were finally selected, 39 evaluated the tasks of clinicians, 6 evaluated the tasks of a public health center, and 1 evaluated the tasks of a clinical and dental hygienist at the same time. Therefore, based on 40 studies, including the tasks of a clinical dental hygienist and 7 literatures including the tasks of a health center dental hygienist, the rates of the appearance of the tasks of a clinical dental hygienist and a public health center dental hygienist were presented, respectively.

Results

A systematic literature review found that dental hygienists performed up to 136 tasks (Table 3). The most common tasks reported in 46 studies were fluoride application (67.2%), radiography (65.4%), scaling (65.4%), sealant (60.7%), patient management and counseling (56.7%), tooth-brushing education (52.2%), and impression taking (alginate) (50.1%). Preventive treatment-related tasks such as fluoride application, scaling, and sealant appeared more frequently, and oral health education tasks such as patient management and counseling, and tooth-brushing education also frequently appeared. In addition, studies related to general dental treatments such as alginate impression taking, temporary crowns making, setting of temporary crowns, and application of temporary filling were investigated in the literature. More than half of the 40 studies studied on clinical dental hygienists included scaling, internal/external radiography, temporary crowns making, sealant, tooth-brushing education, and temporary filling as the tasks of dental hygienists. The task with the highest frequency was scaling (74.4%), followed by Intraoral radiography and panorama taking (71.8%), patient management and counseling (64.1%), and fluoride application (61.5%). In more than half of papers, impression taking (alginate, 56.4%), temporary crowns making (53.8%), setting of temporary crowns (53.8%), sealant (53.8%), tooth-brushing education (51.3%), and temporary filling (51.3%) were reported as the tasks of dental hygienists. In seven studies on dental hygienists working in public health centers, fluoride application and sealant accounted for 100% of the tasks performed by dental hygienists, oral health education, school fluoride mouth-rinsing program, public oral health program evaluation accounted for 71.4%, and tooth-brushing education, education to use oral health products, oral examination, public elderly oral health program, water fluoridation, school water fluoridation, school oral health program accounted for 57.1%. Dental hygienists working in public health centers perform 67 out of 136 tasks, and they are conducting oral disease prevention tasks as well as planning, execution, managing, and evaluation oral health programs in the community. Of the 67 tasks performed by dental hygienists in public health centers, 33 tasks were not performed by clinical dental hygienists.

Frequency of Appearance of Literature on Each Task of Dental Hygienists




Number Task Appearance rate (%)

Total Clinical dental hygienists Public dental hygienists
1 Fluoride application 67.2 61.5 100
2 Intraoral radiography and panorama taking 65.4 71.8 28.6
3 Scaling 65.4 74.4 14.3
4 Sealant 60.7 53.8 100
5 Patient management and counseling 56.7 64.1 14.3
6 Tooth-brushing education 52.2 51.3 57.1
7 Impression taking (alginate) 50.1 56.4 14.3
8 Temporary crowns making 47.9 53.8 14.3
9 Setting of temporary crowns 47.9 53.8 14.3
10 Temporary filling 45.8 51.3 14.3
11 Diet education 43.5 43.6 42.9
12 Impressions taking (precision) 41.4 46.2 14.3
13 Health insurance claim 41.4 46.2 14.3
14 Oral health education 39.0 33.3 71.4
15 Prevention of infection in the dental clinic 37.1 43.6 0
16 Equipment and material management 37.1 43.6 0
17 Tooth prophylaxis 37.0 38.5 28.6
18 Removal of excess cement 37.0 41.0 14.3
19 Materials/document management 34.9 38.5 14.3
20 Treatment assistance 34.8 35.9 28.6
21 Taking the medical history 32.8 38.5 0
22 Gingival cord packing 32.8 38.5 0
23 Surgery preparation (extraction and implants, oral and maxillofacial minor surgery) 32.8 38.5 0
24 Preparation of medical equipment 32.7 35.9 14.3
25 Teeth whitening 32.7 35.9 14.3
26 Application of rubber dam 32.7 35.9 14.3
27 Education to use oral health products 32.5 28.2 57.1
28 Vital sign check 30.6 35.9 0
29 Application of the matrix band 30.6 35.9 0
30 Orthodontic wire ligation 30.6 35.9 0
31 Model making 30.5 33.3 14.3
32 Radiographic management 28.3 30.8 14.3
33 Manegement and disinfection of instruments 28.3 30.8 14.3
34 Manpower training and management 28.3 33.0 0
35 Oral examination 28.2 23.1 57.1
36 Root planing 26.2 30.8 0
37 Probing periodontal pocket 26.2 30.8 0
38 Application of orthodontic Elastics 26.2 30.8 0
39 Fabrication of tooth whitening tray 24.0 28.2 0
40 Instrument polishing 24.0 28.2 0
41 Cement mixing 24.0 28.2 0
42 Restorative material mixing 24.0 28.2 0
43 Individual tray making 24.0 28.2 0
44 Medical waste management 24.0 28.2 0
45 Oral hygiene treatment plan 23.9 25.6 14.3
46 Emergency treatment in the dental clinic 21.8 23.1 14.3
47 Intramuscular injection 21.8 25.6 0
48 Periodical oral health care 21.8 23.1 14.3
49 Cavity filling 21.8 23.1 14.3
50 Bite registration 21.8 25.6 0
51 Assistance of extraction, implants, and oral and maxillofacial minor surgery 21.8 25.6 0
52 Precautions delivery before and after surgery 21.8 25.6 0
53 Receiving dental expenses 21.8 25.6 0
54 Arrangement of equipment 21.8 25.6 0
55 Topical anesthesia 19.7 23.1 0
56 Preparation for local anesthesia 19.7 23.1 0
57 Sensitive tooth treatment 19.7 23.1 0
58 Care of sedated patients 19.7 23.1 0
59 Seperating 19.7 23.1 0
60 Reception of target person 19.6 20.5 14.3
61 Medical record management 19.6 20.5 14.3
62 Oral microbial test 19.5 15.4 42.9
63 Bad breath measurement 19.5 17.9 28.6
64 Dental caries activity test 19.5 17.9 28.6
65 Taking cephalometric radiography 17.4 20.5 0
66 Usage of intraoral camera 17.4 17.9 14.3
67 Education of stretching head and neck muscles for TMD patients 17.4 20.5 0
68 Intraoral and extraoral inspection 17.4 20.5 0
69 Removal of Implant prosthetic screw 17.4 20.5 0
70 Bonding of orthodontic bracket 17.4 20.5 0
71 Disinfection of the surgery area 17.4 20.5 0
72 Education of orthodontic devices usage 17.4 20.5 0
73 Dental plaque index measurement 15.2 15.4 14.3
74 Professional dental plaque management 15.2 12.8 28.6
75 Deciduous teeth extraction 15.2 12.8 28.6
76 Removal of fixed orthodontic device 15.2 17.9 0
77 Precaution education after treatment 15.2 17.9 0
78 Taking facial photograph 13.1 15.4 0
79 Infiltration anesthesia 13.1 15.4 0
80 Attachment/removal of periodontal pak 13.1 15.4 0
81 Electric test of pulp vitality 13.1 15.4 0
82 Education for dental disease prevention 13.0 12.8 14.3
83 Making oral health education materials 12.9 7.7 42.9
84 Suction 10.9 12.8 0
85 Preparing for mini screw placement 10.9 12.8 0
86 Stich-out 10.9 12.8 0
87 Smoking cessation guidance 10.9 12.8 0
88 Public elderly oral health program 10.7 2.6 57.1
89 School fluoride mouth-rinsing program 10.6 0 71.4
90 Public oral health program evaluation 10.6 0 71.4
91 Computed tomography taking 8.8 10.3 0
92 Guide to unit chair 8.8 10.3 0
93 Oral hygiene management record 8.8 10.3 0
94 Use of light curing unit 8.8 10.3 0
95 Tooth shade selection 8.8 10.3 0
96 Dressing after removing healing abutment 8.8 10.3 0
97 Final polishing after occlusal adjustment 8.8 10.3 0
98 Radiograph reading 8.8 7.7 14.3
99 SP crown mounting 8.8 10.3 0
100 Public oral health program for the disabled 8.6 2.6 42.9
101 Water fluoridation 8.5 0 57.1
102 School water fluoridation 8.5 0 57.1
103 School oral health program 8.5 0 57.1
104 Other roles related to oral health care 6.6 7.7 0
105 Management the record and works related to dental technician 6.6 7.7 0
106 Administrative management 6.5 5.1 14.3
107 Public oral health promotion program 6.5 2.6 28.6
108 Establishment of community oral health plan 6.4 0 42.9
109 Survey of community oral health program 6.4 0 42.9
110 Public oral health program for the infants 6.4 0 42.9
111 Removal of exogenous pigmentation 4.3 5.1 0
112 Conservatory treatment 4.3 5.1 0
113 Application of liner 4.3 5.1 0
114 Block out with wax to the interdental area 4.3 5.1 0
115 Impression coping connection 4.3 5.1 0
116 Biopsy preparation 4.3 5.1 0
117 Public sealant program 4.3 0 28.6
118 Public oral health program for the pregnant women 4.3 0 28.6
119 Handling laser equipment 2.2 2.6 0
120 Ultrasound/ physical treatment and hot pack for TMD patients 2.2 2.6 0
121 Apply adhesive inside the tray 2.2 2.6 0
122 Interdental cleaning 2.2 2.6 0
123 Sedation anesthesia (N2O gas) management 2.2 2.6 0
124 Inlay setting 2.2 2.6 0
125 Public oral health center installation 2.1 0 14.3
126 Administrative work for public oral health program 2.1 0 14.3
127 Oral health statistics 2.1 0 14.3
128 Survey for community oral health 2.1 0 14.3
129 Evaluation of community oral health program 2.1 0 14.3
130 Public oral health program using vehicles with dental unit-chair 2.1 0 14.3
131 Customized oral health program with visiting 2.1 0 14.3
132 School tooth-brushing program 2.1 0 14.3
133 Public oral health program connected with other health programs 2.1 0 14.3
134 Public oral disease prevention program 2.1 0 14.3
135 Other medical treatment program 2.1 0 14.3
136 Other administrative civil affairs 2.1 0 14.3

TMD: temporomandibular joint dysfunction, SP: stainless steel primary.


Discussion

Clarifying the tasks of dental hygienists ensured that these tasks are efficiently performed, and a high-quality dental medical service is provided by accurately indicating the dental hygienists scope of responsibilities in each job. Objective and scientific evidence and analysis related to the scope of tasks of dental hygienists are required to promote the public oral health. Therefore, this study conducted a systematic review based on the evidence provided in the literature on the tasks of dental hygienists. As a result of the systematic review, dental hygienists performed 136 tasks. The tasks of dental hygienists most discussed in the study were fluoride application, scaling, sealant, and oral health education, such as patient management and counseling, and tooth brushing education.

Among the 136 dental hygienist tasks identified during the literature review, most of the tasks were within the legal scope of their practice, while some were not considered legitimate. In some cases, the tasks that had been performed by dental hygienists were interpreted as illegal tasks, and those that were performed in the past were no longer allowed in current practice. The remarkable development of the dental health industry would have changed the perception of the dental hygienist’s job, but the professionalism and autonomy of dental hygienists are still limited. Therefore, an effort must be made to standardize the tasks of a dental hygienist in order to improve the oral health of the public.

If the legality of a dental hygienist’s job is not guaranteed, professionalism can be undermined. This will reduce the dental hygienist’s job satisfaction and increase the turnover rate. Such situation will become an obstacle in the use of dental hygienists as part of the oral health workforce and will inhibit the improvement of dental treatment. Therefore, the standard tasks of dental hygienist that reflect the current dental medical environment should be established.

Although the boundary for the distinction between root planing and calculus removal is unclear, root planing is not currently recognized as a legal dental hygienist job. Probing, calculus removal, and root planing cannot be separately considered as tests and treatments to maintain periodontal health. Therefore, they must all be recognized as legal tasks. Implant treatment was rapidly popularized as it was recognized as a medical care benefit item covered by the health insurance. Accordingly, the proportion of implant-related tasks of dental hygienists is increasing. Dental hygienists not only assist with implant surgery, but also perform tasks before and after implant surgery and prosthetics such as removal of implant prosthetic screws, dressing after removal of healing abatement, and removal of sutures. Therefore, it is necessary to recognize the tasks that reflect this situation. In orthodontic treatment, wire removal was included in the tasks of a dental hygienist in the revised Medical Engineers Act, but the interpretations of other tasks remain unclear. Under the guidance of a dentist, dental hygienists are allowed to remove orthodontic brackets, orthodontic elastic application, and seperating. Therefore, other orthodontic treatment items, except for bracket mounting, which greatly influence the results of orthodontic treatment, need to be recognized as part of the dental hygienist’s tasks. The application of anesthesia is recognized as the task of a nursing assistant in the general medical field, whereas the application of anesthesia is not recognized as the task of a dental hygienist in the dental field. The administration of anesthesia should also be recognized as a dental hygienist's task, considering the difficulty and risk of the task. With the rapid development of medical technology, the number of equipment used in dentistry is expanding. Various radiological diagnostic imaging devices and equipment, such as laser and ultrasound, are widely used in dental hospitals and clinics. Dental hygienists are responsible for handling and maintaining of these equipments. The tasks of dental hygienists in providing dental medical services are not fixed and constant. Hence, it is necessary to expand the dental hygienists’ scope of responsibilities based on the current dental care environment.

The future-oriented tasks of dental hygienists include reading radiographs, prescribing medicines and supplies, examining patients for oral cancer, and managing eating and swallowing disorders. Since radiography is essential in dental hygiene assessment and is used as a tool for imparting oral health education to patients, it can be included as a legal work of dental hygienists under the guidance of a dentist. Prescribing appropriate drugs or supplies for each patient during oral health management should be included in the task of a dental hygienist to provide quality dental services and to improve the oral health of visiting patients. In addition, as the oral cancer test kit is continuously developed, it is simpler and easier to use. Dental hygienists can identify oral cancer by conducting an examination during the period of oral health management, hence, the oral cancer test should be part of the task of a dental hygienist.

The difference between the legal duties of dental hygienists prescribed in the current Medical Engineers Act and in the Enforcement Decree and the actual work performed by dental hygienists is that a dental hygienist is an unlicensed medical practitioner and infringes on the public’s right to receive a safe oral health care. Therefore, most of the tasks performed by dental hygienists are dental medical practices and should be performed in accordance with the relevant laws and enforcement decrees in order to protect the public health rights to quality and safe oral health care.

Dental hygienists must be oral health care professionals who perform dental hygiene practices with independence, self-determination, and autonomy. Therefore, it is necessary to revise the law according to the frequency, difficulty, importance, and urgency of performing the tasks of a dental hygienist to maintain a high level of professionalism. This does not mean simply expanding the task of a job. Revising the law will improve the efficiency of dental treatment, provide high-quality oral treatment, and enable the public to receive legally safe oral treatment from dental hygienists. Therefore, it is necessary to expand the area and to determine the scope of responsibilities of dental hygienists for the promotion of public oral health.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Ethical approval

This study is a review-based study and does not require an IRB review.

Author contributions

Conceptualization: Ji-Hyoung Han, Sun-Mi Kim, Eunsuk Ahn, Soo-Jeong Hwang, Bo-Ra Kim, Soon-Jeong Jeong. Data acquisition: Ji-Hyoung Han, Sun-Mi Kim, Eunsuk Ahn, Soo-Jeong Hwang, Bo-Ra Kim, Soon-Jeong Jeong. Formal analysis: Eunsuk Ahn, Ji-Hyoung Han, Sun-Mi Kim, Soo-Jeong Hwang, Bo-Ra Kim. Supervision: Ji-Hyoung Han, Eunsuk Ahn, Soo-Jeong Hwang. Writing—original draft: Ji-Hyoung Han, Eunsuk Ahn, Sun-Mi Kim, Soo-Jeong Hwang. Writing—review & editing: Ji-Hyoung Han, Eunsuk Ahn.

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Funding Information
  • Korean Dental Hygienists Association