Another year has come and gone as we get ready to say goodbye to 2023. The year may have sped by, so hopefully you didn’t miss the exciting changes that transpired for dental hygienists across the country! While there is a lot to celebrate, there have also been some setbacks.
Examining the advancements made by fellow hygienists in their respective states is always advantageous. By doing so, we foster the growth of our profession and advocate for additional responsibilities and skill development.
For decades, dental hygiene students had to successfully navigate both a national board and a clinical board to secure their license. Prior to the use of manikins in 2020, students were tasked with locating patients who met strict criteria outlined by the clinical board. Hygienists often recount the stress of examining numerous strangers, covering their accommodation costs, and relying on them to actually show up on time for the exam.
Hygienists often debate why a clinical board is even necessary. A valid argument considering other professions, such as nursing, are not required to “prove” their skill set after graduating from an accredited program and passing a national written board. California is the first state to test this theory, as it will not require a clinical board for dental hygiene students graduating and working in the state of California!
This is the statement released from the California Dental Hygiene Association: “California dental hygiene students no longer have to take the clinical board exam! As of January 1, 2024, any California dental hygiene program graduate within the last 3 years can be licensed without taking the clinical board exam. The DHBC conducted a comprehensive review of the last 10 years and found that the test was not a valid assessment of clinical skill and posed multiple ethical and equity issues. However, out of state applicants and graduates going out of state will still need to take a clinical exam.”
Only two states currently allow dental hygienists to administer Botox under the direct supervision of a dentist. Three cheers to Kansas and Oklahoma for being the pioneering states! In August 2022, the Kansas Dental Board granted approval for dental hygienists to administer Botox under the direct supervision of a dentist. Oklahoma followed suit in 2023.
Though the number of dentists who administer Botox has increased significantly over the last decade, dental hygienists have not made much progress on this front. Several states have proposed legislation or tried to initiate a rule change by the dental board with little success. Those in favor of dental hygienists administering Botox argue that the similarity in education between a registered nurse and a registered dental hygienist is obvious.
Notably, many states allow nurses to administer Botox; however, unlike nurses, dental hygienists must have detailed knowledge of head and neck anatomy upon graduation. In most states, dental hygienists are very comfortable performing intraoral injections, which is a skill most nurses do not have. With additional time and advocacy, there is optimism that dental hygienists can secure the opportunity to nationwide expansion of our skill set to include Botox administration.
Delaware is close to being the only state to not allow dental hygienists to administer local anesthesia! As of July, Mississippi now allows hygienists to administer local anesthesia to patients under the direct supervision of a licensed dentist after completing all requirements. Texas, with the passage of HB 3824 in September, now allows dental hygienists by delegation and direct supervision of a dentist to administer infiltration anesthetic. The Texas State Board of Dental Examiners is working on creating the rules and requirements for those dental hygienists wishing to administer local anesthesia to their patients.
This has been a long time coming, considering the first state to allow dental hygienists to administer local anesthesia was Washington in 1971!
Despite many positive accomplishments for dental hygienists this year, there have been some setbacks along the way. In an effort to address workforce shortages of dental hygienists in urban and rural underserved areas, Illinois passed a new law effective January 1, 2023. The bill allows dental assistants to perform coronal scaling above the gum line on children up to 17 years old (prior age limit was 12 years) who qualify under one of the following provisions: on Medicaid, uninsured, or whose family household income is not higher than 300% (previously was 200%) of the federal poverty level. The legislation also increased the training required from 16 hours to 32 hours for dental assistants to provide this limited service.
This is a huge blow to dental hygienists considering they undergo years of clinical and didactic coursework. Allowing dental assistants to treat our youngest patients without a license or a college degree is unacceptable. It insinuates that being 19 and under does not entitle you to the same level of care as older patients.
2023 has ushered in significant positive advancements for the dental hygiene profession. There remains considerable untapped potential, however, that our career can still achieve and evolve into. Cheers to my fellow hygienists across the country, and Happy New Year. Bring on 2024!
Mendoza Nicolas, Michelle, et al. “The Buzz About Botox: What Dental Hygienists Need to Know.” RDHMag.Com, 7 Aug. 2023,
Hatfield, Spring. “Proposed Illinois Legislation Will Allow Dental Assistants to Scale – Opposition Opinion.” TodaysRDH.Com, 27 Jan. 2022,
Dental Assisting National Board. “3 Takeaways From Recent Changes in State Dental Assisting Requirements.” DANB.Org, 15 June 2023,
California Dental Hygiene Association, cdha.org/.