June 2013
Volume 34, Issue 4

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Hygiene at the Forefront

“A clean tooth never decays.” This simple slogan was created in the late 19th century after W.D. Miller determined that acids produced when oral bacteria fed on food particles led to tooth decay.1 As ideas about oral health began to take shape, a new movement quickly began to form.

The dental hygiene profession can trace its roots to the efforts of Bridgeport, Connecticut dentist Alfred Civilion Fones, who recognized the importance of the routine removal of stains and deposits from the teeth. After training his assistant, Irene Newman, to perform prophylactic procedures on patients, Fones began to notice that his patients had less decay and healthier gingiva. To demonstrate the success of this approach to the dental community, Fones opened the first dental hygiene school in the world with 34 women in 1913.2

“Fones developed his own teaching materials and slides used in the education of women who chose this profession for themselves,” says Marcia H. Lorentzen, RDH, MSEd, EdD, Dean and Director of Clinical Affairs at Fones School of Dental Hygiene in Bridgeport.

Fones called his graduates dental hygienists, saying the term described “one who is versed in the science of health and the prevention of disease.”3 It was his belief that dental hygienists should work in private dental offices with patients who could afford its services, but should also provide outreach services to patients who could not afford dental care. Today, the profession continues to incorporate these tenets of prevention and access to care for all.4

The school graduated three classes of women, many of whom later worked in Bridgeport Public Schools. In 1916, Fones closed the school to travel, lecturing to dental groups and presenting data about this work. As a result, many dental hygiene schools were later established. In 1949, 33 years after the first school closed, Fones School of Dental Hygiene was reopened at the University of Bridgeport (UB) due to the efforts of the Connecticut Dental Association.2

“The UB program has achieved national and local recognition and the respect of the dental profession and continues to contribute multiple benefits to those it serves,” says Janet Carroll-Memoli, RDH, MS, Associate Professor and former Dean of Fones. “The past 100 years have been a remarkable journey.”

In 1915, the first dental hygienist was employed outside of a public school setting in New Haven Hospital,3 and Connecticut passed the first regulation of dental hygienists. This act protected patients by ensuring that hygienists did not perform functions for which they were not trained.3

A banner year for the profession, it was in 1917 that Fones’ assistant, Irene Newman, received the first dental hygiene license and became president of the first dental hygiene association, the Connecticut State Dental Association. It was also the year that marked the opening of the Forsyth School for Dental Hygienists in Boston.3

A Better Way: 1920s and 1930s

By 1920, six states, including Connecticut, Massachusetts, and New York, had licensed dental hygienists.3

In September 1923, the American Dental Hygienists’ Asso­ciation (ADHA) was formed, with the intent of developing “a better way for dental hygienists to communicate and cooperate.”5 By 1926, 30 states allowed licensed dental hygienists to practice.

The University of Michigan began offering a baccalaureate degree in dental hygiene in 1939.

During this time, many Americans did not brush their teeth,6 most likely because they did not have tools to facilitate this task. Early toothbrushes were often made of course materials such as boar bristles.

The nylon toothbrush was introduced to the market in 1938 as the first with synthetic brushes.3 This meant toothbrushes could take new shapes, and their store packaging touted these new plastic brushes as having “anti-soggy bristles.”6

Oral Health Innovations: 1940s

On January 25, 1945, Grand Rapids, Michigan became the first city to add fluoride to its water. The National Academy of Sciences’ National Research Council (NRC) subsequently reported a dramatic decline in tooth decay in the Grand Rapids children. Six years later, the NRC declared water fluoridation safe and effective.7

In the late 1940s, Clayton Gracey, the periodontist who identified periodontal disease as the cause of tooth loss, partnered with Hu-Friedy’s founder, Hugo Friedman, to create scaling tools. They developed Gracey curettes, a series of 14 single-ended instruments for the removal of deposits from root surfaces.8

Hygiene Education Expands: 1950s and 1960s

In 1947, minimum standards for dental hygiene programs were adopted by the American Dental Association House of Delegates. By 1952, all states allowed licensed dental hygienists to practice, and accreditation of dental hygiene programs began.3

By the mid-1950s, the first clinically proven fluoride toothpaste was available for consumers. Then, in 1957, DENTSPLY introduced the first standalone dental ultrasonic scaler,9 a device used only for heavy supragingival calculus that had to be manually tuned and operated, using three electronic vacuum tubes.3

In 1958, Dr. Esther M. Wilkins, Margaret Bailey, Janet Burnham, and Evelyn Mass, who were members of the Section on Dental Hygiene Education of the American Dental Education Association, founded Sigma Phi Alpha,3 the national honor society of the dental hygiene profession.10

The first edition of Wilkins’ textbook, Clinical Practice of the Dental Hygienist, was published the next year. This seminal work, considered by many in the profession to be the Bible of dental hygiene, is now in its 11th edition.11 As Lorentzen observes, “Graduates of dental hygiene schools always say, ‘What is the color of your Wilkins text?’” a reference to the different color of the cover of each edition.

Hygiene education made great strides in the 1960s. In 1960, Columbia University became the first school to offer a master’s degree in dental hygiene, and in 1965, Jack Orio became the first male member of the profession when he graduated from University of New Mexico.3

Enhancing the Dental Practice: 1970s

In 1971, Washington became the first state to allow dental hygienists to administer local anesthesia with direct supervision. In 1973, the Iowa Expanded Functions program was established.3

The Forsyth Experiment reported that a practitioner using hygienist teams to provide quality restorative care could improve the cost effectiveness of the practice with no loss of quality.12

By the end of the decade, many dental hygienists were on the state board of examiners, and in 1979, the first “Health Objectives for the Nation” appeared in the Surgeon General’s Report on Health Promotion.3

Expanding Professionalism: 1980s and 1990s

The first air-polishing system was introduced by DENTSPLY in 1980, facilitating biofilm and stain removal.9

Washington became the first state with unsupervised practice allowed in hospitals, nursing homes, and other specified settings.3 In 1985, the first National Dental Hygiene Week celebration was held. Colorado passed the first law that allowed unsupervised practice for all dental hygienists in all settings.3

The early 1990s included more advances in the hygiene professionalism. The ADHA advocated continuing education “for all dental hygienists to expand scientific knowledge and enhance practice modalities.” 3 On March 6, 1992, OSHA’s final rule on Occupational Exposure to Bloodborne Pathogens became effective.3 The following year, the National Center for Dental Hygiene Research was created through a 3-year grant from the U.S. Department of Health and Human Services.3

In 1994, New Mexico was the first state to have a self-regulatory dental hygiene committee.3

The California state legislature created the Registered Dental Hygienist in Alternative Practice (RDHAP), enabling dental hygienists to provide unsupervised oral care and preventive services to special populations in alternative settings and to own alternative practices. New Mexico was the first state to pass a law that allowed dental hygienists to practice according to a collaborative agreement with a dentist, rather than under supervision.

The Meaning of Oral Health: The 2000s and Today

In 2000, the U.S. Department of Health and Human Services published Oral Health in America: A Report of the Surgeon General.3 The report alerted Americans to the full meaning of oral health and its importance to general health.

At that time, more than half of states allowed dental hygienists to administer local anesthetic to patients.3 In 2004, the ADHA House of Delegates adopted a policy to pursue the Advanced Dental Hygiene Practitioner, a midlevel oral health provider functioning similarly to the nurse practitioner.3 The ADHA described the position as “a primary care dental professional able to deliver care in a capacity in between that of a dentist and dental hygienist.”13 These positions require master’s degrees and education in a full range of preventive oral healthcare services.

In 2009, Minnesota became the first state to pass legislation allowing two new oral healthcare practitioners—the dental therapist and advanced dental therapist. Today, more than 50 countries, including the United Kingdom and Canada, allow midlevel practitioners to practice oral health.13

In the United States, dental hygiene is one of the fastest growing professions in the country. In 2010, almost 181,000 dental hygienist jobs were in the U.S. The profession’s growth rate is expected to be 38% by 2020.

“Knowing the history of the profession—where one has been and the paths that have been traveled to get to the current day—is extremely important.We do not live in isolation. Individuals, working singly and in groups, effect change, sometimes an imperceptible ripple that makes a tremendous wave later on,” Lorentzen says.

“Let us not repeat ineffective practices but build on successes made known through documentation and proclamation.The celebration of 100 years allows time to reflect on the sacrifices made, revel in the accomplishments realized, and integrate new processes that show promise for a brighter future in the dental field. With technology so advanced in all aspects of our lives, the dental hygienist of the future will be more than we can imagine today.”


1. Sgan-Cohen HD. Oral hygiene: past history and future recommendations . Int J Dent Hygiene. 2005;3:54-58.

2. University of Bridgeport Web site. History of Fones School of Dental Hygiene. http://www.bridgeport.edu/academics/fonesschool/history.aspx. Accessed May 7, 2013.

3 . American Dental Hygienists Association. 100 Year Timeline http://www.adha.org/100-timeline/timeline.html. Accessed May 7, 2013.

4. Connecticut Dental Hygienists’ Association, Inc. Web site. http://www.cdha-rdh.com/home/historyofdentalhygiene.html

5. American Dental Hygienists Association Web site. Mission & History. http://adha.org/mission-history. May 7, 2013.

6. Kennedy P. Who made that? (Toothbrush). New York Times Magazine. February 17, 2013,19.

7. Centers for Disease Control and Prevention. CDC honors 65 years of community water. http://www.cdc.gov/fluoridation/65_years.htm. May 7, 2013.

8. Hu-Friedy corporate overview. More than 100 years of helping dental professionals perform at their best. Web site. https://www.hu-friedy.com/products/index.php/mastercontrol/index/file/id/126.

9. Cavitron®. Dentsply Caulk Web site. http://www.professional.dentsply.com/cavitron/history.cfm. Accessed May 7, 2013

10. Sigma Phi Alpha Web site. History. http://www.sigmaphialpha.org/about/history.htm. Accessed May 7, 2013

11. Flaherty J. By the Book. now.tufts.edu/articles/book. March 13, 2012. Accessed May 7, 2013.

12. Lobene R, Kerr A. The Forsyth Experiment: An Alternative System for Dental Care. Cambridge, MA: University Press; 1979.

13. American Dental Hygienists Association. Facts about the dental hygiene workforce in the United States [press release]. http://www.adha.org/resources-docs/75118_Facts_About_the_Dental_Hygiene_Workforce.pdf. Accessed May 7, 2013.

14. U.S. Bureau of Labor Statistics website. http://www.bls.gov/ooh/healthcare/dental-hygienists.htm. Accessed May 13, 2013.

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