A bad toothache makes a person feel bad all over. "That's because oral health is an integral part of general health," explains Colleen Brickle, who teaches in the dental hygiene program at Normandale Community College. "And oral disease is linked to chronic conditions like diabetes and heart disease."

Unmet Needs

Yet, according to information compiled by the American Dental Hygienists Association , over 45.6 million Americans live in areas where dental care is not readily available.

Nationwide, many dentists are reaching retirement age, while dental schools are producing fewer graduates. The number of dental hygienists, however, continues to rise. As the need for dental care intensifies among underserved populations, the role of the hygienist is gradually expanding.

Collaborative Agreement

In 2001, the Minnesota Legislature ratified a law that allowed dental hygienists to enter into a written "collaborative agreement" with a dentist. Under the agreement, the hygienist can examine and assess patients in out-of-office settings, like public health facilities, schools and nonprofit organizations that serve uninsured individuals or enrollees in public programs such as Medicaid.

Now the legislature is considering an expanded scope of practice that would allow hygienists to fill cavities and extract teeth.

New Programs

To prepare hygienists for these new roles, Metropolitan State University and Normandale Community College have partnered to create two new programs. The first allows hygienists with an associate degree to complete a Bachelor of Science in Dental Hygiene, with an emphasis on collaborative practice.

The second provides additional education for hygienists with four-year degrees who want to expand their skills. A Master of Science Degree in Dental Hygiene, which will focus on advanced dental hygiene practice, will be offered beginning in the fall of 2009.

According to Brickle, the advanced dental hygiene practitioner will be a dental version of the nurse practitioner. "The role of the nurse practitioner was first developed to meet the needs of the public," she says. "We're starting out in the same way."

Nancy Giguere is a freelance writer from St. Paul who has written about healthcare since 1995.