The question is: Are dental hygienists alive or dead? As I feel the rhythm of my heart beating, I recognize that I, indeed, am not dead. I ask each and every one of you who holds a license to practice dental hygiene to check your own pulse to detect if you, in fact, feel the blood coursing through your arteries and veins. Because you are reading this article, I am assuming that you are alive. I am going to spend the next thousand words or so delving into the meaning of "Live Free or Die," and hopefully raise some awareness and stimulate questions you may have asked yourself before.

This is a story of money, power, and politics, and precisely where you, as a dental hygienist, stand. I will be focusing on concepts such as freedom, personal responsibility, ownership, and the discipline of dental hygiene.

Legislation History
In December 2005, the New Hampshire Dental Hygienists' Association (NHDHA) was contacted by Representative Paul Mirski (R), a member of the New Hampshire House of Representatives, about supporting a bill he was introducing relevant to the independent practice of dental hygiene. Representative Mirski felt strongly that dental hygienists are capable of practicing within their own scope of practice because they have passed rigorous educational standards and licensure. He felt we are, as we have historically been, treated like indentured servants, a direct result of our supervision and lack of rule making status.

The NHDHA saw merit in his proposal and began a campaign of support. We contacted our membership, mobilized a grassroots network, formulated our salient points as to why this bill had merit, and assembled a team of leaders to testify. We chose 5 topics to highlight when testifying in favor of the bill:

1. Independent practice and freedom of choice for patients (testimony issued from Wendy St. Cyr, RDH, BS, former independent practitioner and council member, American Dental Hygienists' Association [ADHA])

2. Direct access to cost-effective dental hygiene services for patients (testimony issued from Ashley Grill, RDH, BS, MPH, past president, NHDHA)

3. Removing restrictive supervision barriers for dental hygienists (testimony issued from Joan Fitzgerald, RDH, past president and legislative chair, NHDHA)

4. Comprehensive didactic and clinical education with competency testing (testimony issued from Kristine Hodsdon, RDH, BS, past president, NHDHA and former member, NH Board of Dental Examiners)

5. Dental hygiene is a unique, separate, research-based discipline (testimony issued from Sherri Collis, RDH, past president, NHDHA)

As one might imagine, the very word independent began the age-old stirring of the powers that be in organized dentistry to rally in opposition to such an outrageous and bold proposition. The only people to testify in opposition of the bill, when it came before the Committee on Executive Departments and Administration on January 5, 2006, were 5 dentists who repeatedly spoke about their education level and their scope of practice and how we could not be trusted to practice within our scope of practice independently. According to their testimony, the dentists' viewpoint and recurrent theme was something along the lines of a dental hygienist, with such "limited education," would never be capable enough to practice on her or his own.

The committee chair, after being inundated with letters and e-mails before the hearing, stated that this would indeed go to the subcommittee on licensing even before we all completed our testimony.

In terms of money, power, and politics, we experienced firsthand just how the system works. The subcommittee met 2 weeks later, asked more questions, and heard more testimony including a hygienist who independently testified and happened to introduce herself as a member of the Board of Dental Examiners. She informed the subcommittee on the efforts to develop the Advanced Dental Hygiene Practitioner (ADHP) on a national, not state level. She also said that when this new level of practitioner becomes a reality (perhaps 10 years in the future) may be a better time to address any issues around independent practice. The subcommittee voted 4 to 1 to send the bill to interim study for 1 year. The NHDHA was pleased with the decision of the subcommittee and felt that this bill would come out of the study committee stronger and more amenable to all parties.

Our pleasure was short lived, however, as we were informed the following evening that the full committee met the next day and decided to code the bill "Inexpedient to Legislate." In other words, "kill the bill." The committee explained that upon learning of the possible national development of the ADHP through a Master's Degree program and the time it could take for the degree to become accepted, they believed it was better to kill this bill and wait. The committee also noted that they were hoping for a collaborative agreement between hygienists and dentists. In just a short 24 hours, the bill was dead on arrival.

Our Call to Action
Was this a tough break, an unfortunate circumstance, or money, power, and politics at play? If you believe as I do that there are very powerful forces working tirelessly to prevent your independence, then I submit the following explanation. These powerful forces have money to spend on key politicians and the ability to work behind the scenes to prevent our autonomy and freedom of choice regarding where we practice. This experience taught us that, in the absence of regulating our profession and establishing the autonomy of dental hygiene practice as in the nursing profession, our ability to practice dental hygiene wherever it serves the public good will not happen with the current climate of a dentists' right to use "professional privilege."

Let's examine this notion of "professional privilege." A dentist, or specialist, has the right to own your time, talents, and expertise as well as the income these generate. In other words, a vast majority of dental hygienists are employed in private practices that are owned by dentists. These very dentists serve on regulatory boards that make up the rules that govern your practice. These dentists also form political action committees (PACs) that are funded by the income that you, with your time, talent, and expertise, produce for these owners/dentists. This is the very essence of a conflict of interest.

Let me ask you these questions:

1. Are you a licensed dental hygienist capable of practicing within your scope of practice in any setting?

2. Are you dead yet?

If you answered a resounding "yes" and "no" respectively, then I remind you that it is time to step forward and challenge the status quo (the owner/servant relationship), which has been the standard for nearly the past 100 years. I humbly submit the following important recommendations:

1. Negotiate profit sharing in your employment. Use your profit to advance the art and science of dental hygiene.

2. Understand the consequences of only attending employer-sponsored continuing education courses and events that pad the American Dental Association and constituent coffers. Clearly understand that most dentists have enjoyed "professional privilege" for a very long time and that they require advanced communication to remind them that you are not an entity that they, themselves, own. Be bold enough to question your employers on their PAC contributions and their intentions to prevent the autonomy of dental hygiene practice.

3. Understand the consequences of your decision to avoid membership in the ADHA. Your dues and membership numbers are critical for you to count in any legislation that provides autonomy. It is absolutely essential that you participate as an active member and attend continuing education that is sponsered by your own professional association. Benjamin Franklin once stated: "We must hang together; else, we shall most assuredly hang separately."

4. Begin to shift your focus from wages to profits. Motivational speaker Zig Ziglar said, "Money isn't everything, but it ranks right up there with oxygen." If we become responsible enough to own our discipline, then we can truly be free to create myriad possibilities for preventive oral health care in the marketplace. We, too, subscribe to a code of ethics.

5. Control your own destiny. Be responsible for all your actions. Dr. Joe Rubino, author of the groundbreaking books The Power to Succeed, Volumes 1 and 2, stated, "Whenever we justify what we do, we lose our ability to act independently of circumstances. To say that you did anything because of something else is not only untrue, but makes you dependent on external forces. You give up your autonomy in an attempt to come up with an explanation. This mode of thinking is so deeply ingrained in our culture that we have trained ourselves to expect an explanation or a because for all our behavior….You give your power away when you assign responsibility to some outside force." The next time you are tempted to say "I'm not political" or "I'm not getting involved," check your pulse.

Please understand that I am not suggesting that all dental hygienists change their existing delivery of services in the business model of employee. I am only advocating that other business models, born from the freedom of choice, can complement the existing majority and provide an opportunity to serve greater numbers of people. And isn't that what our founding fathers and mothers fought for—a land of opportunity, a land of freedom?

"A free people [claim] their rights as derived from the laws of nature, and not as the gift of their chief magistrate."

—Thomas Jefferson

The time has come for the freedom to stimulate creativity in preventive oral health and the personal responsibility to truly own the discipline of dental hygiene. This is our birthright. You choose: Live Free or Die.