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The Dentists’ View of Dental Hygienist Duties in Korea
J Dent Hyg Sci 2020;20:34-43
Published online March 31, 2020;  https://doi.org/10.17135/jdhs.2020.20.1.34
© 2020 Korean Society of Dental Hygiene Science.

Yang-Keum Han1 , Ji-Su Yu2 , Seung-Hee Kim3 , Jin-Young Yang4 , Soo-Myoung Bae5 , and Soo-Jeong Hwang6,†

1Department of Dental Hygiene, Daejeon Health Institute of Technology, Daejeon 34504,
2Department of Dental Hygiene, Gumi University, Gumi 39213,
3Department of Dental Hygiene, Gwangju Health University, Gwangju 62287,
4Department of Dental Hygiene, Daejeon Institute of Science and Technology, Daejeon 35408,
5Department of Dental Hygiene, College of Dentistry, Research Institute of Oral Science, Gangneung-Wonju National University, Gangneung 25457,
6Department of Dental Hygiene, College of Medical Science, Konyang University, Daejeon 35365, Korea
Correspondence to: Soo-Jeong Hwang, https://orcid.org/0000-0003-4725-1512
Department of Dental Hygiene, College of Medical Science, Konyang University, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Korea
Tel: +82-42-600-8444, Fax: +82-42-600-8408, E-mail: denthwang@konyang.ac.kr
Received February 19, 2020; Revised March 1, 2020; Accepted March 4, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: The number and curriculum of dental hygienists in Korea have dramatically increased. Controversies have since resulted from insufficient job descriptions of the work performed by a dental hygienist. A dentist's perception was examined to legally reflect the actual work of dental hygienists.
Methods: Four hundred and nineteen dentists were surveyed about the duties of a dental hygienist. Their views on the career and availability of each job were examined. The duties of the dental hygienist include 13 items in dental treatment preparation, 14 items of radiography, 21 items of preventive dentistry, 6 items of periodontal treatment, 12 items of oral medicine, 12 items of conservative dentistry, 8 items of prosthetics, 10 items of orthodontics, 7 items of oral and maxillofacial surgery, 6 items of implantation, 6 items of impression taking and model fabrication, 5 items of anesthesia and injection, 11 items of management and administrative, and 3 items of self-development.
Results: Most of the duties were doable by a dental hygienist. Many dentists reported that managing implants, oral hygiene of special patients, some duties in oral medicine, teeth brightening, making temporary crowns, making individual trays, selecting shades, ligaturing, and precision impressions need ≥3 years of experience. Duties perceived by dentists not to be performed by dental hygienists were reading radiographs (55.4%), suture and stitch out (48.0%), intramuscular injection (36.0%), root planning (27.2%), cementation and removal of prostheses (23.2%), and examining pulp vitality (22.0%).
Conclusion: Current laws are to be revised to include, the care provided by dental hygienists and under a physician’s supervision. Flexibility is also needed to cope with rapidly changing dental technology.
Keywords : Dental hygienists, Dentists, Task performance and analysis
Introduction

Korean dental hygienist education, which began in 1965, has improved for the past 50 years; it has been organized into a three-year professional and a four-year Bachelor’s degree curriculum. In 2020, the number of licensed dental hygienists reached 89,993. In addition, the quality of education improved after a Master and Doctorate degrees in dental hygiene were initiated. In order to enhance the professionalism and job of dental hygienists, the dental hygiene education community has been working to establish new educational goals and standardized curricula1,2).

Despite the development of the education system for dental hygienists, controversies over their duties continue. Dental hygienists should perform only the tasks specified in the Act for medical technicians. However, Korean dental hygienists perform medical and dental support services in addition to those specified under the law and in addition to those done under the direction and supervision of a dentist. Since these are not specified in the law, the criteria for judging the legitimacy of the relevant actions are ambiguous, and in fact, the number of administrative determinations has increased3). In addition, the inconsistency between the duty actually performed by the dental hygienist at the dental clinic or hospital and that performed by the dental hygienist prescribed in the law can lead to an increase in work stress and turnover in the dental field4-7).

Korean dentists and hygienists are experiencing chronic labor shortages3). Thus, most private dentists require that a dental hygienist be able to perform basic dental care preparation, consultation and guides for patients, perform intra- or extra-oral x-ray imaging, and provide preventive dental care and routine chair-side dental assistance8). However, there are objections to this from academic professors and dentists who oppose such transfer of duties to the hands of dental hygienists. This disagreement can be a barrier for revising the existing law regarding the role of dental hygienists in practice. In addition, previous research has reported that the role of dental hygienists is not systematic, and therefore, there is a lack of awareness on the part of dentists regarding the scope of a dental hygienist duty8-11). Due to insufficient legal description of the role of dental hygienists, potential conflicts between patients and dentists are bound to occur. Furthermore, in some cases, the Ministry of Health and Welfare had to obtain a vote on defining the role of dental hygienists. The purpose of this study was to examine the opinions of dentists on the role of dental hygienists. The data obtained can be used as a basis to enact revisions to the existing laws on the role of dental hygienists.

Materials and Methods

1. Research subject

We planned to investigate about 500 dentists through stratified sampling by region and institution. Because it was difficult to get the cooperation of the society for dentists, we proceeded with the convenience extraction method by using seven researchers who included three dentists and four dental hygienists. Korea was divided into the metropolitan area, Gyeongsang area, Jeolla area, Chungcheong area, and Gangwon area, and designated each area. The initial survey method was e-mail; however, the response rate by researchers was only 3 to 8%. Then, face to face surveys were added, and the response rate went up to about 30 to 40%. The total number of response was 419. The general characteristics are shown in Table 1. The questionnaire was identified as selecting non-response items that were considered difficult for personal information or judgment, and no response was included in the analysis.

General Characteristics of the Dentist Studied

Variable Category n (%)
Working place College hospital 26 (6.2)
General hospital 16 (3.8)
Private dental hospital 45 (10.7)
Dental clinic 324 (77.3)
Public health left 2 (0.5)
No response 6 (1.4)
Sex Male 333 (79.5)
Female 79 (18.9)
No response 7 (1.7)
Position Owner 286 (68.3)
Employee of private dental clinic or hospital 65 (15.5)
Official or employee of college or general hospital 41 (9.8)
No response 27 (6.4)
Age 20s 20 (4.8)
30s 81 (19.3)
40s 114 (27.2)
50 years old or older 132 (31.5)
No response 72 (17.2)
Area Metropolitan city 252 (60.1)
Small cities 143 (34.1)
Rural area 9 (2.1)
No response 15 (3.6)
Location Seoul, Incheon, Gyeonggi area 161 (38.4)
Gyeongsang area 39 (9.3)
Jeolla area 44 (10.5)
Chungcheong area 115 (27.4)
Gangwon area 32 (7.6)
No response 28 (6.7)
Specialist training Yes 185 (44.2)
No 210 (50.1)
No response 24 (5.7)
Degree Bachelor 121 (28.9)
Master 143 (34.1)
Doctor 132 (31.5)
No response 23 (5.5)
Total 419 (100)


2. Questionnaire content

The survey was conducted on the duties of dental hygienists extracted from the 2nd job analysis of dental hygienists at the Korea National Institute of Health in 201212). The dental hygienist's duties include dental treatment preparation, radiography, preventive dentistry, oral medicine, periodontal treatment, conservative dentistry, prosthetics, orthodontics, oral and maxillofacial surgery, implantation, impression taking and model, anesthesia and injection, management and administrative, and self-development. Some jobs had overlapping classifications, making the description vague. In order to strictly follow the classification of the 2nd job analysis of the dental hygienist, the classification was used for the investigation without modification according to the intention of this researcher. The response was to write on whether dental hygienists could perform each duty and how much experience was required. We surveyed the necessary clinical experience for duty performance because it could represent insufficient training in the curriculum of dental hygiene or indicate the necessity of conservative education due to each task' difficulty and professional dental hygienist system. We showed the overall opinion of dentists about the duties of dental hygienists. The data was entered into Excel 2010 (Microsoft, Redmond, WA, USA) and frequency analysis was performed.

Results

With respect to jobs related to dental treatment, more than half of the respondents were able to perform their jobs, including beginners (Table 2). With regards to radiography tasks, 55.4% of the dentists answered that reading radiography was not the job of a dental hygienist and more than half of the dentists answered that radiography jobs, except special patients, could be done by beginners (Table 3). With regards to preventive treatments, more than half answered that most of the tasks could be performed by beginners except managing eating or swallowing disorders (43.2%), managing multiple dental caries (39.9%), managing implants (32.0%), and oral hygiene of special patients (35.6%) (Table 4). Between 12.2 to 18.6% of the dentists answered that all tasks in oral medicine could not be performed by a dental hygienist except for a hot pack (Table 5). In the case of root planning, 34.1% of respondents answered that the dental hygienists with more than 3 years of experience could perform the task, while 27.2% responded that it was not a task meant for dental hygienists (Table 6). With regards to the duties of conservative dentistry, 22.0% and 17.9% of the respondents responded that examination of pulp vitality and treatment for teeth whitening were not tasks for dental hygienists (Table 7). In prosthetic dentistry, 16.9 to 23.2% of the dentists responded that making individual trays, selecting tooth shades, and attaching and removing prostheses were not tasks meant for dental hygienists (Table 8). More than 10% of respondents responded that orthodontic diagnosis procedure, separating for band, and using elastics were not tasks meant for dental hygienists (Table 9). With regards to Oral and Maxillofacial Surgery (Table 10), 48.0% of dentists said that suturing and stitching out were not tasks meant for a dental hygienist. More than half of the respondents responded that all jobs related to implants are available for beginners (Table 11). Most respondents responded that precision impression and digital impression required more than three years of experience (Table 12). Meanwhile, 36.0% of the respondents stated that intramuscular injection was not their job, while the highest percentage of respondents stated that emergency treatment is possible over three years (Table 13). Most respondents stated that dental hygienists with more than three years of experience could claim national insurance and counsel patients, and those with more than 5 years of experience could manage employees in a dental clinic (Table 14). With regards to self-development jobs, the response rate that beginners could perform such duties was highest for one or more years of experience (Table 15).

Dentist’s View of the Duties of Dental Hygienists in Dental Treatment Preparation

Duty Clinical experience required Possible in the future Impossible No response

Beginners available 3 years or more 5 years or more
Receiving patients 314 (74.9) 71 (16.9) 21 (5.0) 1 (0.2) 8 (1.9) 4 (1.0)
Adjusting position of patients 309 (73.7) 89 (21.2) 15 (3.6) 1 (0.2) 4 (1.0) 1 (0.2)
Dealing with infectious diseases 238 (56.8) 142 (33.9) 23 (5.5) 4 (1.0) 9 (2.1) 3 (0.7)
Managing clinical clothes 335 (80.0) 63 (15.0) 12 (2.9) 1 (0.2) 3 (0.7) 5 (1.2)
Personal protection 305 (72.8) 91 (21.7) 18 (4.3) 1 (0.2) 3 (0.7) 1 (0.2)
Managing preoperative operators and assistants 259 (61.8) 133 (31.7) 20 (4.8) 1 (0.2) 3 (0.7) 3 (0.7)
Managing preoperative patients 250 (59.7) 144 (34.4) 19 (4.5) 1 (0.2) 3 (0.7) 2 (0.5)
Preventing equipment infection 336 (80.2) 73 (17.4) 8 (1.9) 1 (0.2) 0 (0.0) 1 (0.2)
Disinfection 381 (90.9) 31 (7.4) 5 (1.2) 1 (0.2) 0 (0.0) 1 (0.2)
Sterilizing the operating room 309 (73.7) 92 (22.0) 13 (3.1) 3 (0.7) 1 (0.2) 1 (0.2)
Using the sterilizer 328 (78.3) 77 (18.4) 10 (2.4) 1 (0.2) 2 (0.5) 1 (0.2)
Using chemical disinfectants 324 (77.3) 76 (18.1) 12 (2.9) 0 (0.0) 4 (1.0) 3 (0.7)
Disposal of medical waste 330 (78.8) 78 (18.6) 9 (2.1) 0 (0.0) 1 (0.2) 1 (0.2)

Dentist’s View of the Duties of Dental Hygienists in Radiography

Duty Clinical experience required Possible in the future Impossible No response

Beginners available 3 years or more 5 years or more
Preparing for intraoral radiography 394 (94.0) 20 (4.8) 2 (0.5) 1 (0.2) 1 (0.2) 1 (0.2)
Taking peri-apical radiography 373 (89.0) 37 (8.8) 2 (0.5) 1 (0.2) 5 (1.2 ) 1 (0.2)
Taking bite-wing radiography 323 (77.1) 73 (17.4) 5 (1.2) 1 (0.2) 13 (3.1) 4 (1.0)
Taking occlusal radiography 306 (73.0) 84 (20.0) 8 (1.9) 1 (0.2 ) 15 (3.6) 5 (1.2)
Taking radiography of special patients 184 (43.9) 167 (39.9) 33 (7.9) 3 (0.7) 20 (4.8) 12 (2.9)
Localization radiography 226 (53.9) 136 (32.5) 20 (4.8) 3 (0.7) 17 (4.1) 17 (4.1)
Preparing for extraoral radiography 369 (88.1) 33 (7.9 ) 3 (0.7) 0 (0.0) 7 (1.7) 7 (1.7)
Taking panorama radiography 364 (86.9) 37 (8.8) 4 (1.0) 1 (0.2) 12 (2.9) 1 (0.2)
Taking cephalometric radiography 274 (65.4) 78 (18.6) 10 (2.4) 6 (1.4) 36 (8.6) 15 (3.6)
Taking computed tomography 241 (57.5) 85 (20.3) 15 (3.6) 16 (3.8) 48 (11.5) 14 (3.3)
Developing films 358 (85.4) 26 (6.2) 2 (0.5 ) 0 (0.0) 16 (3.8) 17 (4.1)
Managing radiographs 367 (87.6) 30 (7.2) 3 (0.7) 0 (0.0) 8 (1.9) 11 (2.6)
Dealing with digital radiation devices 323 (77.1) 72 (17.2) 8 (1.9) 1 (0.2) 6 (1.4) 9 (2.1)
Reading radiographs 51 (12.2) 69 (16.5) 50 (11.9) 12 (2.9) 232 (55.4) 5 (1.2)

Dentist’s View of the Duties of Dental Hygienists in Oral Disease Prevention

Duty Clinical experience required Possible in the future Impossible No response

Beginners available 3 years or more 5 years or more
Charting preventive treatment records 291 (69.5) 97 (23.2) 7 (1.7) 5 (1.2) 14 (3.3) 5 (1.2)
Examining dental plaque 279 (66.6) 106 (25.3) 8 (1.9) 3 (0.7) 18 (4.3) 5 (1.2)
Examining oral bacteria 223 (53.2) 109 (26.0) 13 (3.1) 9 (2.1) 60 (14.3) 5 (1.2)
Examining dental caries activity 226 (53.9) 119 (28.4) 16 (3.8) 4 (1.0) 46 (11.0) 8 (1.9 )
Managing oral hygiene by subject 263 (62.8) 127 (30.3) 7 (1.7) 3 (0.7) 10 (2.4) 9 (2.1)
Professional tooth brushing 245 (58.5) 129 (30.8) 16 (3.8) 2 (0.5) 21 (5.0) 6 (1.4)
Managing hypersensitivity 229 (54.7) 125 (29.8 22 (5.3) 5 (1.2) 34 (8.1) 4 (1.0)
Flouride application 326 (77.8) 74 (17.7) 12 (2.9) 2 (0.5) 2 (0.5) 3 (0.7)
Sealants 221 (52.7) 127 (30.3) 34 (8.1) 8 (1.9) 26 (6.2) 3 (0.7)
Smoking control 227 (54.2) 108 (25.8) 25 (6.0) 16 (3.8) 38 (9.1) 5 (1.2)
Consulting diet 235 (56.1) 108 (25.8) 24 (5.7) 14 (3.3) 33 (7.9) 5 (1.2)
Managing eating or swallowing disorder 181 (43.2) 129 (30.8) 31 (7.4) 16 (3.8) 51 (12.2) 11 (2.6)
Oral muscular exercise training 243 (58.0) 111 (26.5) 15 (3.6) 12 (2.9) 25 (6.0) 13 (3.1)
Managing multiple dental caries 167 (39.9) 161 (38.4) 42 (10.0) 10 (2.4) 32 (7.6) 7 (1.7)
Scaling 336 (80.2) 61 (14.6) 10 (2.4) 2 (0.5) 5 (1.2) 5 (1.2)
Using manual scaler 268 (64.0) 118 (28.2) 17 (4.1) 3 (0.7) 10 (2.4) 3 (0.7)
Using ultrasonic scaler 347 (82.8) 55 (13.1) 9 (2.1) 1 (0.2) 3 (0.7) 4 (1.0)
Managing implant 134 (32.0) 191 (45.6) 40 (9.5) 10 (2.4) 39 (9.3) 5 (1.2)
Oral hygiene of special patients 149 (35.6) 188 (44.9) 56 (13.4) 5 (1.2) 13 (3.1) 8 (1.9)
Oral prophylaxis 279 (66.6) 109 (26.0) 13 (3.1) 1 (0.2) 12 (2.9) 5 (1.2)
Managing scaler or curette 246 (58.7) 122 (29.1) 23 (5.5) 2 (0.5) 20 (4.8) 6 (1.4)

Dentist’s View of the Duties of Dental Hygienists in Oral Medicine

Duty Clinical experience required Possible in the future Impossible No response

Beginners available 3 years or more 5 years or more
Managing the TMD patients 127 (30.3) 176 (42.0) 37 (8.8) 13 (3.1) 54 (12.9) 12 (2.9)
Physical therapy on head and neck 165 (39.4) 135 (32.2) 35 (8.4) 19 (4.5) 53 (12.6) 12 (2.9)
Hot pack on head and neck 200 (47.7) 120 (28.6) 27 (6.4) 19 (4.5) 39 (9.3) 14 (3.3)
Ultrasonic therapy on head and neck 157 (37.5) 123 (29.4) 30 (7.2) 16 (3.8) 78 (18.6) 15 (3.6)
Exercise training of TMD patients 151 (36.0) 147 (35.1) 35 (8.4) 17 (4.1) 51 (12.2) 18 (4.3)
Managing bruxism 138 (32.9) 151 (36.0) 40 (9.5) 20 (4.8) 57 (13.6) 13 (3.1)
Managing snore 131 (31.3) 151 (36.0) 40 (9.5) 18 (4.3) 65 (15.5) 14 (3.3)
Managing oral soft tissue disease 124 (29.6) 147 (35.1) 42 (10.0) 16 (3.8) 74 (17.7) 16 (3.8)
Managing dry mouth 132 (31.5) 154 (36.8) 38 (9.1) 15 (3.6) 63 (15.0) 17 (4.1)
Treating bad breath 159 (37.9) 132 (31.5) 35 (8.4) 12 (2.9) 66 (15.8) 15 (3.6)
Understanding maxillofacial pain 105 (25.1) 152 (36.3) 52 (12.4) 15 (3.6) 78 (18.6) 17 (4.1)
Handling laser equipment 140 (33.4) 152 (36.3) 28 (6.7) 9 (2.1) 70 (16.7) 20 (4.8)

TMD: temporomandibular disorde.


Dentist’s View of the Duties of Dental Hygienists in Periodontal Treatment

Duty Clinical experience required Possible in the future Impossible No response

Beginners available 3 years or more 5 years or more
Managing individual oral hygiene 275 (65.6) 103 (24.6) 12 (2.9) 2 (0.5) 15 (3.6) 12 (2.9)
Examination of periodontal pockets 203 (48.4) 124 (29.6) 18 (4.3) 11 (2.6) 5 (1.2) 5 (1.2)
Root planing 110 (26.3) 143 (34.1) 27 (6.4) 20 (4.8) 114 (27.2) 5 (1.2)
Managing periodontal patients 187 (44.6) 172 (41.1) 24 (5.7) 3 (0.7) 26 (6.2) 7 (1.7)
Assisting periodontal treatment or surgery 259 (61.8) 130 (31.0) 15 (3.6) 2 (0.5) 9 (2.1) 4 (1.0)
Application of periodontal pack 192 (45.8) 148 (35.3) 12 (2.9) 5 (1.2) 55 (13.1) 7 (1.7)

Dentist’s View of the Duties of Dental Hygienists in Conservative and Pediatric Dentistry

Duty Clinical experience required Possible in the future Impossible No response

Beginners available 3 years or more 5 years or more
Rubber dam application 251 (59.9) 103 (24.6) 11 (2.6) 6 (1.4) 42 (10.0) 6 (1.4)
Matrix application 228 (54.4) 108 (25.8) 12 (2.9) 9 (2.1) 49 (11.7) 13 (3.1)
Temporary filling 248 (59.2) 111 (26.5) 15 (3.6) 6 (1.4) 34 (8.1) 5 (1.2)
Assisting conservative treatment 298 (71.1) 90 (21.5) 10 (2.4) 1 (0.2) 14 (3.3) 6 (1.4)
Examining pulp vitality 182 (43.4) 118 (28.2) 15 (3.6) 7 (1.7) 92 (22.0) 5 (1.2)
Assisting endodontic treatment 297 (70.9) 83 (19.8) 12 (2.9) 1 (0.2) 19 (4.5) 7 (1.7)
Teeth brightening 137 (32.7) 158 (37.7) 33 (7.9) 9 (2.1) 75 (17.9) 7 (1.7)
Assisting extraction of deciduous teeth 334 (79.7) 50 (11.9) 7 (1.7) 2 (0.5) 19 (4.5) 7 (1.7)
Assisting SS crown treatment 291 (69.5) 90 (21.5) 13 (3.1) 2 (0.5) 17 (4.1) 6 (1.4)
Assisting window opening 278 (66.3) 100 (23.9) 14 (3.3) 1 (0.2) 16 (3.8) 10 (2.4)
Explaining preventive orthodontic treatment 237 (56.6) 133 (31.7) 21 (5.0) 4 (1.0) 17 (4.1) 7 (1.7)
Assisting control of pediatric patient behavior 250 (59.7) 132 (31.5) 18 (4.3) 2 (0.5) 10 (2.4) 7 (1.7)

SS: stainless steel.


Dentist’s View of the Duties of Dental Hygienists in Prosthetic Treatment

Duty Clinical experience required Possible in the future Impossible No response

Beginners available 3 years or more 5 years or more
Gingival retraction 194 (46.3) 172 (41.1) 15 (3.6) 5 (1.2) 29 (6.9) 4 (1.0)
Making temporary crown 170 (40.6) 185 (44.2) 22 (5.3) 11 (2.6) 26 (6.2) 5 (1.2)
Assisting crown & bridge treatment 283 (67.5) 107 (25.5) 13 (3.1) 2 (0.5) 8 (1.9) 6 (1.4)
Assisting denture treatment 268 (64.0) 114 (27.2) 20 (4.8) 1 (0.2) 8 (1.9) 8 (1.9)
Making individual tray 117 (27.9) 174 (41.5) 31 (7.4) 14 (3.3) 77 (18.4) 6 (1.4)
Selecting tooth shade 127 (30.3) 150 (35.8) 51 (12.2) 9 (2.1) 71 (16.9) 11 (2.6)
Cementation and removal of prostheses 152 (36.3) 126 (30.1) 26 (6.2) 11 (2.6) 97 (23.2) 7 (1.7)
Managing prostheses 210 (50.1) 150 (35.8) 26 (6.2) 6 (1.4) 17 (4.1) 10 (2.4)

Dentist’s View of the Duties of Dental Hygienists in Orthodontic Treatment

Duty Clinical experience required Possible in the future Impossible No response

Beginners available 3 years or more 5 years or more
Understanding orthodontic diagnosis process 158 (37.7) 138 (32.9) 52 (12.4) 6 (1.4) 48 (11.5) 17 (4.1)
Photo taking for orthodontic patients 231 (55.1) 130 (31.0) 22 (5.3) 1 (0.2) 19 (4.5) 16 (3.8)
Using elastic seperator 166 (39.6) 139 (33.2) 21 (5.0) 5 (1.2) 69 (16.5) 19 (4.5)
Assisting orthodontic treatment 237 (56.6) 126 (30.1) 19 (4.5) 3 (0.7) 20 (4.8) 14 (3.3)
Ligaturing 148 (35.3) 181 (43.2) 30 (7.2) 4 (1.0) 40 (9.5) 16 (3.8)
Assisting mini-screw application 238 (56.8) 126 (30.1) 19 (4.5) 3 (0.7) 18 (4.3) 15 (3.6)
Using elastics 183 (43.7) 140 (33.4) 24 (5.7) 3 (0.7) 50 (11.9) 19 (4.5)
Managing orthodontic pliers 286 (68.3) 92 (22.0) 13 (3.1) 1 (0.2) 13 (3.1) 4 (1.0)
Managing orthodontic patients 241 (57.5) 126 (30.1) 20 (4.8) 3 (0.7) 14 (3.3) 15 (3.6)
Managing oral hygiene of orthodontic patients 284 (67.8) 94 (22.4) 11 (2.6) 1 (0.2) 11 (2.6) 18 (4.3)

Dentist’s View of the Duties of Dental Hygienists in Oral and Maxillofacial Surgery

Duty Clinical experience required Possible in the future Impossible No response

Beginners available 3 years or more 5 years or more
Assisting tooth extraction 376 (89.7) 34 (8.1) 3 (0.7) 0 (0.0) 2 (0.5) 4 (1.0)
Assisting biopsy 262 (62.5) 105 (25.1) 14 (3.3) 0 (0.0) 26 (6.2) 12 (2.9)
Assisting oral and maxillofaical surgery 263 (62.8) 129 (30.8) 15 (3.6) 0 (0.0) 7 (1.7) 5 (1.2)
Managing patients with cleft lip and palate 127 (30.3) 169 (40.3) 49 (11.7) 11 (2.6) 45 (10.7) 18 (4.3)
Managing patients with jaw reconstruction 113 (27.0) 154 (36.8) 70 (16.7) 15 (3.6) 51 (12.2) 16 (3.8)
Managing patients with oral cancer 92 (22.0) 134 (32.0) 91 (21.7) 20 (4.8) 64 (15.3) 18 (4.3)
Suture and stitch out 107 (25.5) 75 (17.9) 15 (3.6) 14 (3.3) 201 (48.0) 7 (1.7)

Dentist’s View of the Duties of Dental Hygienists in Implant Treatment

Duty Clinical experience required Possible in the future Impossible No response

Beginners available 3 years or more 5 years or more
Understanding implant procedure 279 (66.6) 117 (27.9) 10 (2.4) 0 (0.0) 7 (1.7) 6 (1.4)
Assisting implant surgery 270 (64.4) 130 (31.0) 13 (3.1) 0 (0.0) 2 (0.5) 4 (1.0)
Assisting bone augmentation 217 (51.8) 172 (41.1) 17 (4.1) 2 (0.5) 6 (1.4) 5 (1.2)
Assisting implant prostheses 235 (56.1) 154 (36.8) 22 (5.3) 0 (0.0) 4 (1.0) 4 (1.0)
Managing implant instrument 233 (55.6) 158 (37.7) 21 (5.0) 0 (0.0) 3 (0.7) 4 (1.0)
Managing oral hygiene of implant patients 232 (55.4) 157 (37.5) 15 (3.6) 1 (0.2) 8 (1.9) 6 (1.4)

Dentist’s View of the Duties of Dental Hygienists in Impression Taking, Model Fabrication, and Cement Mixing

Duty Clinical experience required Possible in the future Impossible No response

Beginners available 3 years or more 5 years or more
Bite registration 195 (46.5) 162 (38.7) 14 (3.3) 3 (0.7) 41 (9.8) 4 (1.0)
Alginate impression 305 (72.8) 93 (22.2) 10 (2.4) 2 (0.5) 6 (1.4) 3 (0.7)
Rubber impression 129 (30.8) 198 (47.3) 29 (6.9) 5 (1.2) 53 (12.6) 5 (1.2)
Digital impression 104 (24.8) 184 (43.9) 34 (8.1) 13 (3.1) 67 (16.0) 17 (4.1)
Mixing cement or filling material 350 (83.5) 59 (14.1) 4 (1.0) 1 (0.2) 3 (0.7) 2 (0.5)
Model fabrication 267 (63.7) 111 (26.5) 8 (1.9) 6 (1.4) 25 (6.0) 2 (0.5)

Dentist’s View of the Duties of Dental Hygienists in Anesthesia, Injection etc.

Duty Clinical experience required Possible in the future Impossible No response

Beginners available 3 years or more 5 years or more
Topical anesthesia 330 (78.8) 46 (11.0) 9 (2.1) 3 (0.7) 27 (6.4) 4 (1.0)
Preparing local anesthesia 368 (87.8) 35 (8.4) 5 (1.2) 2 (0.5) 7 (1.7) 2 (0.5)
Intramuscular injection 103 (24.6) 99 (23.6) 21 (5.0) 33 (7.9) 151 (36.0) 12 (2.9)
Dealing with emergency in dental clinic 92 (22.0) 146 (34.8) 85 (20.3) 16 (3.8) 73 (17.4) 7 (1.7)
Dealing with dental emergency 92 (22.0) 151 (36.0) 85 (20.3) 12 (2.9) 70 (16.7) 9 (2.1)

Dentist’s View of the Duties of Dental Hygienists in Management and Administration

Duty Clinical experience required Possible in the future Impossible No response

Beginners available 3 years or more 5 years or more
National insurance claim 120 (28.6) 189 (45.1) 87 (20.8) 4 (1.0) 14 (3.3) 5 (1.2)
Maintaining facilities 246 (58.7) 111 (26.5) 22 (5.3) 3 (0.7) 34 (8.1) 3 (0.7)
Maintaining equipments 245 (58.5) 110 (26.3) 25 (6.0) 4 (1.0) 32 (7.6) 3 (0.7)
Managing prothesis 269 (64.2) 128 (30.5) 17 (4.1) 1 (0.2) 2 (0.5) 2 (0.5)
Managing materials 289 (69.0) 110 (26.3) 15 (3.6) 1 (0.2) 2 (0.5) 2 (0.5)
Managing purchase 273 (65.2) 122 (29.1) 18 (4.3) 1 (0.2) 2 (0.5) 3 (0.7)
Managing documents 236 (56.3) 135 (32.2) 40 (9.5) 2 (0.5) 4 (1.0) 2 (0.5)
Infection control 236 (56.3) 144 (34.4) 31 (7.4) 1 (0.2) 4 (1.0) 3 (0.7)
Patient consultation 138 (32.9) 173 (41.3) 103 (24.6) 2 (0.5) 1 (0.2) 2 (0.5)
Clinic promotion 169 (40.3) 135 (32.2) 79 (18.9) 5 (1.2) 28 (6.7) 3 (0.7)
Managing employee 100 (23.9) 110 (26.3) 188 (44.9) 3 (0.7) 14 (3.3) 4 (1.0)

Dentist’s View of the Duties of Dental Hygienists in Self Development

Duty Clinical experience required Possible in the future Impossible No response

Beginners available 3 years or more 5 years or more
Understanding professionalism 238 (56.8) 118 (28.2) 48 (11.5) 5 (1.2) 6 (1.4) 4 (1.0)
Gaining new knowledge and skills 257 (61.3) 105 (25.1) 44 (10.5) 3 (0.7) 6 (1.4) 4 (1.0)
Social contribution 300 (71.6) 60 (14.3) 36 (8.6) 9 (2.1) 9 (2.1) 5 (1.2)

Discussion

The role of a dental hygienist was created for the purpose of preventing oral disease and promoting oral health care and education. However, in Korea, unlike in Europe or the United States, dental hygienists performed more dental assistance and dental clinic management duties8,13). Kim and Kim6), in a survey of 214 dental hygienists, found that the most common duty was dental treatment assistance. Choi et al.14) surveyed 612 dental hygienists and found that their duties included, from most common to least, dental clinic management, oral disease prevention, patient consultation & reception, and dental treatment assistance. Kim et al.15) noted that the highest frequency of duties was dental clinic management in a survey of 144 dental hygienists, followed by preventive treatment, dental treatment assistance, and oral health education. Kwon and Lee16) also reported that dental hygienists with more than 11 years of experience performed a lot of managerial duties, and those with 6 to 10 years of experience usually provided dental treatment assistance. In the same context as in their previous studies, this study included not only oral disease prevention and education as the original duties of dental hygienists but also the duties related to the clinical field.

The dentists who participated in this study stated that most of the duties, from preventive treatment to dental treatment assistance, are can be performed by dental hygienists. In some cases, the current legal duties of a dental technician, radiologist, or physiotherapist were recognized as equal to that of a dental hygienist work. Many respondents recognized that dental computed tomography, digital radiography, and oral scanners should be performed by dental hygienists. The dentists thought that dental hygienists should oversee dental laboratories, radiography, and physical therapy in the dental clinic. Lee et al.3) said that the need for range expansion of dental hygienists’ work was agreed by 91.1% of dentists and 95.5% of dental hygienists. As for the detailed duty items that need to be expanded, both dentists and dental hygienists responded in the order of temporary crown making and setting, surgery assistance, and dental treatment assistance. Han et al.17) noted that some dentists insisted that the current legal practice of dental hygienists does not fit the time and tasks that can be performed through education and training are often excluded from legal work.

The duties of dental hygienists not perceived by the dentists were reading radiography (55.4%), suture and stich out (48.0%), intramuscular injection (36.0%), root planning (27.2%), cementation and removal of prostheses (23.2%), examining pulp vitality (22.0%), etc. In a study by Hwang et al.18), the tasks considered by dentists not to be the duty of dental hygienists included infiltration anesthesia investigation, filling in cavities, intramuscular injection, canal irrigation, setting crown and bridge, and making individual tray. This result is similar to our survey.

Although this study has a limitation of convenience extraction that does not consider the area or age group, it can be said that this study has a significant number of dentists who surveyed opinions on the duties of dental hygienists. In this study, there were certain tasks whereby the opinions of the dentists were different; however, most of the tasks were thought could be performed by dental hygienists. Hwang and Han19) stated that it is necessary for the law to include the duties that many dental hygienists perform under the supervision of a dentist. Han et al.17) insisted that the law should state the duties that dental hygienists should not do, not those which they could do. Considering the rapidly changing dental equipment and the contribution of dental hygienists in the field, a more careful listing of the legal duties of dental hygienists is expected to be amended. Therefore, there is a need for flexibility when such amendments are made, especially for dental hygienists who can keep up with the rapid changes in dental technology.

Notes

Conflict of interest

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

Ethical approval

This study was approved by the Institutional Bioethics Committee of Daejeon Health Institute of Technology in 2017 (IRB no. 1041490-20170118-HR-001).

Author contributions

Conceptualization: Yang-Keum Han. Data acquisition: Yang-Keum Han, Ji-Su Yu, Seung-Hee Kim, Jin-Young Yang, Soo-Myoung Bae, Soo-Jeong Hwang. Formal analysis: Ji-Su Yu, Soo-Jeong Hwang. Funding: Korea Dental Hygienists Association. Supervision: Yang-Keum Han. Writing-original draft: Ji-Su Yu, Soo-Jeong Hwang. Writing-review & editing: Yang-Keum Han, Ji-Su Yu, Seung-Hee Kim, Jin-Young Yang, Soo-Myoung Bae, Soo-Jeong Hwang.

This research was supported by Korea Dental Hygienists Association in 2017.

We appreciate Professor Eung-Kwon Kim at Suwon Science College surveying the opinions of dentists in metropolitan area.

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