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Study of Registration Practices of the
COLLEGE OF DENTAL HYGIENISTS OF ONTARIO, 2007

  1. 1. INTRODUCTION
  2. 2. BACKGROUND OF THE REGULATORY BODY
    1. a. Legislation
    2. b. Protected Titles
    3. c. Definition of the Profession
    4. d. Labour Market/Economic Trends
    5. e. New Developments Within the Profession
    6. f. Staffing
  3. 3. REGISTRATION PRACTICES
    1. a. Registration Requirements and Application Process
    2. b. Documentation Required from Internationally Trained Individuals
    3. c. Credential Assessment (Third Party and/or Internal)
    4. d. Academic/Program Requirements
    5. e. Work Experience Requirements
    6. f. Examinations
    7. g. Language Requirements
    8. h. Fees
    9. i. Third Parties
    10. j. Typical Length of the Registration Process
    11. k. Accredited Programs
    12. l. Internal Review/Appeal Process
  4. 4. BRIDGING PROGRAMS
  5. 5. MUTUAL RECOGNITION AGREEMENTS
  6. 6. APPLICANTS’ INTERACTIONS WITH REGULATORY BODY
    1. a. Nature and Frequency of Communication
    2. b. Backlogs
    3. c. Complaints Regarding the Registration Process
  7. 7. CHANGES SINCE THE 2005 SURVEY
  8. 8. REGISTRATION INFORMATION AND STATISTICS
  9. 9. SOURCES

ISBN 978-1-4249-6448-2 [HTML English version]


1. INTRODUCTION

The Office of the Fairness Commissioner (OFC) undertook a study of registration practices of Ontario's regulated professions during the fall and winter of 2007–2008. The purpose of the study was to understand each regulated profession's 2007 registration practices and to establish baseline data and information to enable the OFC to measure progress as it fulfills its mandate under the Fair Access to Regulated Professions Act, 2006.

This report reflects the registration practices of the College of Dental Hygienists of Ontario as of December 31, 2007. Information in this report was gathered from:

The College of Dental Hygienists of Ontario also provided registration information and statistics for 2005, 2006 and 2007 through a standard spreadsheet designed by the OFC.

An analysis and summary of the findings for all of the regulated professions is contained in the OFC's Ontario’s Regulated Professions: Report on the 2007 Study of Registration Practices.

2. BACKGROUND OF THE REGULATORY BODY

a. Legislation

The College of Dental Hygienists of Ontario (CDHO) operates in accordance with the Dental Hygiene Act, 1991 and the Regulated Health Professions Act, 1991. The CDHO’s registration regulation is Ontario Regulation 218/94, Part VII.

b. Protected Titles

The CDHO regulates “dental hygienists” in Ontario. Only registrants of the CDHO can legally use the title “dental hygienist” or any variation or abbreviation of it in the province.

c. Definition of the Profession

According to the CDHO website, a dental hygienist is a registered oral health professional who performs a variety of roles including clinical therapy, health promotion, education, administration and research in a variety of practice environments. In all roles and practice environments, the dental hygienist works with the client/patient and other health professionals and, using a problem-solving framework, bases all decisions, judgments and interventions on current dental hygiene research and theory. As a registrant of a self-regulating profession, a dental hygienist must practise safely, ethically and effectively for the promotion of the oral health and well-being of the public of Ontario.

In accordance with the Dental Hygiene Act, 1991, which relates to the regulation of the profession of dental hygiene in Ontario, the practice of dental hygiene is the assessment of teeth and adjacent tissues and treatment by preventive and therapeutic means and the provision of restorative and orthodontic procedures and services.

d. Labour Market/Economic Trends

There are approximately 9,600 registered dental hygienists in Ontario (148 are internationally trained individuals) — more hygienists than there are dentists. The private dental hygiene programs graduate on average two classes per year. The dental hygiene programs in the community colleges graduate one class per year. Since 2001, 24 private dental hygiene educational institutions have opened.

There are regional disparities in the concentration of dental hygienists across Canada, with apparent shortages in Alberta and British Columbia. More than half of Canadian dental hygienists live in Ontario. The job market has long been tight in Windsor, Ontario.

e. New Developments Within the Profession

Until recently, the majority of dental hygienists would have worked in dental practices under dentists or dental specialists (who are doctors). However, the changes to the Dental Hygiene Act through the Health System Improvements Act, 2007 (Bill 171) that came into effect on September 1, 2007, allow dental hygienists to work independently of traditional dentist-owned practices. This legislation removed restrictions that prevented members of the public from having their teeth cleaned by a dental hygienist without becoming patients of a dentist. These changes will greatly assist large components of the population who had difficulty obtaining routine oral health care and will increase dental hygiene services in areas where there is a shortage of dental hygienists and dentists.

However, not all dental hygienists registered with the CDHO are certified to self-initiate oral health care, as they must first be approved by the CDHO. To date, approximately 10 per cent of registered dental hygienists are certified to have a self-initiated practice. On October 15, 2007, the CDHO announced that the first 250 dental hygienists were assessed and granted the right to self-initiate under the new legislation and standards of practice permitting the public direct access to oral hygiene care without a dentist’s referral. By December 7, 2007, the number had risen to 875 dental hygienists authorized to self-initiate.

In recent years, private colleges have entered the educational arena for dental hygiene education. Historically, dental hygiene programs have been in universities and community colleges. Educating dental hygienists has become a competitive business in Ontario. The result is an increase in the number of registered dental hygienists in Ontario.

f. Staffing

The CDHO’s staff consists of 11 full-time employees and one contract information technology specialist. Six of these employees are involved in the registration process: two are totally dedicated to it, while the other four are involved in some aspects.

3. REGISTRATION PRACTICES

a. Registration Requirements and Application Process

i. Classes of Registration

Three classes of certificates of registration are offered by the CDHO:

ii. Registration Requirements

Applicants to the CDHO must hold a certificate issued by the National Dental Hygiene Certification Board (NDHCB), the national body responsible for assessing current dental hygiene competencies. Applicants earn this certificate by passing the National Dental Hygiene Certification Examination. Applicants who are not eligible to sit this examination may request the Registration Committee to review their documentation. If the documentation meets the registration requirements of the CDHO, then applicants will be permitted to take a written certification examination set or approved by the CDHO’s Registration Committee. Graduates of accredited dental hygiene programs are automatically eligible to take the NDHCB exam without the need to have their credentials evaluated.

iii. Application Process

The application process is initiated when an applicant, domestic or internationally trained, submits a written request to the CDHO for an application package. This written request must also include the name of the educational institution where the applicant studied. The CDHO accepts and processes applications from outside Canada.

The following documents must be submitted in order for the applicant to be considered eligible to register with the CDHO:

The main entry-to-practice requirement of the CDHO is completion of a two-year dental hygiene program accredited by either the Commission on Dental Accreditation of Canada (CDAC) or the American Dental Association Commission on Dental Accreditation (ADA/CODA). Most candidates enter the profession of dental hygiene in Ontario through one of two streams toward registration with the CDHO. The first stream is for graduates of accredited programs, who are automatically eligible to take the national examination of the NDHCB. The second stream is for graduates of non-accredited dental hygiene programs.

Graduates of non-accredited schools must first have their course of study assessed by the NDHCB to determine eligibility to write the national examination. If an applicant is not eligible to sit the NDHCB examination and wishes to proceed with an application to the CDHO, the application would be referred to the Registration Committee of the CDHO to consider whether the applicant’s course of study meets the educational requirements of the CDHO. In this process, the CDHO conducts its own assessment of applicants separate from the NDHCB assessment process. The candidate must arrange for all original documentation, including transcripts and course descriptions, to be sent directly to the CDHO for evaluation.

Course descriptions must include:

The Registration Committee takes approximately three months to assess a non-accredited candidate’s course of study and come to a decision once it has received a completed application and all supporting documentation. The assessment costs $250. If the application is successful, the CDHO will credit this amount toward the applicant’s fee for initial certification of registration.

b. Documentation Required from Internationally Trained Individuals

i. Standard Documentation

An internationally trained applicant must submit the same documents required of applicants who were trained at non-accredited Canadian institutions. Additionally, internationally trained applicants must submit an evaluation by a credential assessment agency, such as World Education Services (WES) or International Qualifications Assessment Service (IQAS), when they submit their application to the National Dental Hygiene Certification Board. If an applicant’s documents are not in English or French, notarized translations must be submitted.

ii. Options for Applicants with Unavailable/Destroyed Documents

If an applicant does not have all the documents required for registration, requests for special consideration can be made directly to the Registration Committee of the CDHO. The CDHO will address applicants facing this problem on a case-by-case basis. “Reasonable efforts” to locate the documents must be made before the Registration Committee will consider the case.

c. Credential Assessment (Third Party and/or Internal)

Graduates of accredited dental hygiene programs are automatically eligible to sit for the NDHCB exam without the need to have their credentials evaluated.

All graduates of non-accredited dental hygiene programs, including internationally trained applicants, are directed to credential assessment agencies such as WES or IQAS to have their diplomas/degrees assessed for equivalency with diplomas/degrees provided by Canadian academic institutions. The NDHCB, on the other hand, assesses the content of an applicant’s degree to determine if it is equivalent to accredited dental hygiene programs in Canada.

d. Academic/Program Requirements

To be a dental hygienist in Ontario, an applicant must have completed a two-year dental hygiene program that at the time of the applicant’s graduation was accredited by either the Commission on Dental Accreditation of Canada (CDAC) or the American Dental Association Commission on Dental Accreditation (ADA/CODA).

For graduates of non-accredited dental hygiene programs, including internationally trained applicants, to be considered eligible to sit the NDHCB examination, they must have their educational credentials assessed by a panel of the Registration Committee as “substantially equivalent” to those of a graduate of a dental hygiene program accredited by the CDAC.

A dental hygienist must be able to fulfill responsibilities in these areas:

The curriculum must include foundational knowledge in these areas:

Once an applicant’s course of study is approved by the CDHO, he or she will also be required to attend a jurisprudence presentation, which will provide an overview of the rules and regulations which govern dental hygiene in Ontario.

e. Work Experience Requirements

No work experience is required for registration with the CDHO beyond the practical/clinical work built into the course of study of accredited dental hygiene programs. Typically, accredited dental hygiene programs contain approximately 480 hours of scaling and root planing. Work experience is not considered a substitute for training in a formal educational supervised setting.

f. Examinations

Applicants’ course of study must meet the educational requirements of the CDHO before they can be deemed eligible to take the national or provincial examinations.

i. National Dental Hygiene Certification Examination

The National Dental Hygiene Certification Examination (NDHCE) is the national examination administered by the NDHCB. There are multiple paths to eligibility to write the NDHCE, and applicants should visit the NDHCB website for a more extensive explanation of the multiple ways to become eligible. The following types of candidates are eligible to write the NDHCE:

The NDHCE is a multiple-choice case-based examination. Successful completion of the NDHCE results in the issuance of the National Certificate. This enables the holder to obtain registration or licensure to practise dental hygiene in Ontario, providing all other requirements imposed by the CDHO are met.

How international dental hygiene applicants fared on the NDHCE, 2003–2007
Year Applicants evaluated for eligibility Applicants found eligible % found eligible Applicants who took the exam Applicants who passed % who passed
2003

8

5

62.5%

14

3

21.4%

2004

8

5

62.5%

11

6

54.5%

2005

13

10

76.9%

11

8

72.7%

2006

21

14

66.7%

11

10

90.9%

2007

11

10

90.9%

15

6

40.0%

Total 2003–2007

61

44

72.1%

62

33

53.2%

ii. CDHO Examinations: Clinical Competency and Written Certification

To ensure that applicants have sufficient dental hygiene knowledge and in the interest of public safety, applicants must successfully complete a written certification examination before taking the clinical competency assessment. The written exam is a standardized multiple-choice case-based exam that is offered on an as-needed basis. Applicants may prepare for the written certification examination by using a combination of self-study materials and refresher courses offered at academic institutions or given by approved educators on an individualized basis.

Applicants whose course of study and application are approved by the NDHCB would be eligible to sit the CDHO's clinical competency assessment without further assessment of their course of study.

The clinical competency assessment tests applicants’ technical skills in client management and in the implementation of the Dental Hygiene Process of Care in a clinical setting on a live subject. Applicants must find their own test subjects for this component of the examination, based on specific criteria.

The clinical competency assessment is administered by the CDHO and must be offered at least once yearly. It is currently offered approximately three times per year, each time six to eight weeks after the NDHCE. Applicants usually turn to individual educators if they wish to have their individual deficiencies targeted for improvement in preparation for the clinical component.

The clinical competency assessment is usually carried out at rented premises which have the necessary clinical facilities to carry out the assessment. In the past, the CDHO has carried out clinical competency assessments at George Brown College in Toronto and on-site at other dental hygiene educational institutions.

An applicant who fails the examinations may apply for re-examination twice and may take them within two years of the failure without the need to demonstrate remediation and upgrading to the Registration Committee. An applicant who fails on a third attempt of the examinations may retake an examination if the Registration Committee has approved the candidate’s remediation and upgrading courses. An applicant who fails on a fourth attempt of the examinations is not eligible to retake the examinations again until the applicant has obtained another diploma from a dental hygiene program acceptable to the Registration Committee. Therefore, applicants may be granted up to four opportunities to carry out either the practical or the written component of the provincial examinations each time they obtain a diploma from a dental hygiene program acceptable to the Registration Committee.

How International Dental Hygiene Applicants Fared on the CDHO Exams 2003–2007

Of the 21 internationally educated assessment candidates, six failed the clinical competency assessment once and two failed twice. Nine of the 21 candidates were not eligible for the National Dental Hygiene Certification Examination and instead took the CDHO provincial written examination. All nine passed the written assessment the first time.

g. Language Requirements

The CDHO does not directly test candidates for language proficiency, nor does the CDHO require candidates to submit language-testing scores. However, the CDHO does require candidates for registration to be reasonably fluent in English or French. This fluency is informally assessed through the components of the written and/or clinical examinations.

h. Fees

The fees listed below do not include applicable GST.

Initial application fee

$75

Assessment of Course of Study Fee[1]

$250

CDHO Provincial Written Certification Examination

$75

CDHO Clinical Competency Assessment

$350

Annual certification fee – General Certificate

$250

Annual certification fee – Specialty Certificate

$250

Annual certification fee – Inactive Certificate

$50

National Dental Hygiene Certification Examination

$500

National Dental Hygiene Certification Examination rewrite fee

$400

i. Third Parties

Name of Third Party Relationship to Regulatory Body

Commission on Dental Accreditation of Canada (CDAC)

The CDAC is a national body that determines which educational institutions in Canada offer accredited dental hygiene programs.

National Dental Hygiene Certification Board (NDHCB)

The NDHCB sets and administers the national examination for dental hygienists.

American Dental Association Commission on Dental Accreditation (ADA/CODA)

The American counterpart to the CDAC, it accredits dental hygiene programs in the United States.

j. Typical Length of the Registration Process

The length of the registration process is determined by how long it takes a candidate to meet all the requirements for registration and assemble and provide all the documents to the CDHO. The registration process can take as little as 10 business days for applicants whose applications are complete. Graduates of non-accredited dental hygiene programs will take a little longer to complete their registration because they require an assessment of their course of study either by the NDHCB or the CDHO and must also successfully complete a clinical assessment.

Candidates who have submitted supporting documentation relevant to their course of study and who have allowed their registration process to lapse for more than one year will be contacted by the CDHO to confirm their intentions to continue with the process.

k. Accredited Programs

The Commission on Dental Accreditation of Canada is the national body that accredits dental hygiene programs across Canada. All community colleges in Ontario that offer dental hygiene programs are accredited by CDAC. A number of private colleges offer accredited dental hygiene programs; however, not all private colleges offering programs in dental hygiene have been accredited. The Ontario Ministry of Training, Colleges and Universities website lists the 18 unaccredited programs in Ontario.

The following dental hygiene programs in Ontario have been accredited by the CDAC:

These dental hygiene programs are currently listed with the CDAC as “Program Status Under Review”:

All applicants who have graduated from a non-accredited dental hygiene program are required to successfully complete a provincial clinical competency assessment that is set or approved by the Registration Committee of the CDHO.

l. Internal Review/Appeal Process

Graduates from non-accredited dental hygiene programs who are deemed ineligible to write the national examination may request assessment of their academic credentials by the Registration Committee of the CDHO. The Registration Committee has two public members and four professional members, two of whom are currently dental hygiene educators. If the Registration Committee rules that an applicant’s course of study is not equivalent to an accredited program, the applicant can request a review of the decision from the Health Professions Appeal and Review Board (HPARB). This information is not provided on the CDHO website, but is provided on an individual basis.

4. BRIDGING PROGRAMS

The CDHO does not have a bridging program per se; however, applicants who have not practised dental hygiene in a recognized jurisdiction within the three years prior to registering with the CDHO must complete a refresher course or professional competency assessment before participating in the clinical competency assessment examination. A roster of educators is available, and some educators offer the theory portion of the course online. Refresher courses are individualized and applicants must incur the expense for working with a private educator. Applicants should contact the CDHO before participating in a refresher course to ensure that it is approved.

5. MUTUAL RECOGNITION AGREEMENTS

The CDHO is a signatory to a mutual recognition agreement that establishes the conditions under which a dental hygienist who is licensed, certified or registered in one Canadian jurisdiction will have his or her qualifications recognized in another Canadian jurisdiction which is a party to this agreement. The following additional competencies may be required in the noted jurisdictions:

The regulatory organizations in New Brunswick, Quebec and Nunavut are not signatories to the agreement.

Applicants who do not hold a diploma or degree in dental hygiene, but who held registration in a Canadian jurisdiction on January 1, 2004, qualify under the grandparenting clause in the CDHO’s registration regulation.

The labour mobility of dental hygienists across Canada is upheld through the NDHCB and the CDAC. Together these two bodies ensure that dental hygienists across Canada operate according to similar professional standards. The NDHCB offers a credential, based on national practice and education standards, that provides for portability of licensure or registration between provincial and territorial jurisdictions.

6. APPLICANTS’ INTERACTIONS WITH REGULATORY BODY

a. Nature and Frequency of Communication

For the most part, communication between an applicant and the CDHO is initiated by the applicant.

The CDHO will take the initiative to follow up with applicants who have submitted documentation for an assessment of their course of study if the files have been inactive for a long time.

Applicants who do not meet the CDHO requirements for registration are provided with a copy of the Registration Committee’s review sheets, which explain why they did not meet the requirements.

All new registrants receive a CDHO Registrant’s Handbook.

b. Backlogs

Currently, the CDHO does not have any backlogs in the processing of applications for registration. It closes files that have been inactive for more than one year.

c. Complaints Regarding the Registration Process

Complaints regarding the registration process that are received by the CDHO will be forwarded to the Registration Committee for consideration. Ultimately, however, applicants who are unable to resolve their issues with the Registration Committee may appeal to the HPARB.

7. CHANGES SINCE THE 2005 SURVEY

The Ministry of Citizenship and Immigration conducted a survey in 2005 to collect information about occupational regulatory bodies in Ontario.

Some of the changes implemented since the 2005 survey include:

8. REGISTRATION INFORMATION AND STATISTICS

Definitions used in these tables:

Alternative class of licence: a class of licence that enables its holder to practise with limitations; additional registration requirements must be met in order to be fully licensed. The College of Dental Hygienists of Ontario has no alternative classes of licence of this kind.

Applicant: a person who has applied to start the process for entry to the profession.

Applicant actively pursuing licensing: an applicant who had some contact with the CDHO within the year specified.

Inactive applicant: an applicant who had no contact with the CDHO within the year specified.

Member: a person who is currently able to use the protected title or professional designation “dental hygienist.”

Languages in which application information materials were available
Language 2005 2006 2007
English

Yes

Yes

Yes

French1

Yes

Yes

Yes

Other(s)

1 Available only upon request.

Countries where internationally educated applicants were initially trained in dental hygiene
Applications received 2005 2006 2007
Largest number

Colombia

Colombia

United Kingdom

Second-largest number

Romania

Pakistan

Israel

Third-largest number

Israel

Israel

Lebanon

Fourth-largest number

 

 

Japan

Fifth-largest number

 

 

India

Staff employed by the College of Dental Hygienists of Ontario
Number of staff 2005 2006 2007
Involved in registration process

4

4

5

Involved in appeals process

2

2

2

Jurisdiction where members were initially trained in dental hygiene (before they were granted use of the protected title or professional designation in Ontario)
Members Ontario Other Canadian Provinces USA Other International TOTAL
Total members

8,499

368

633

148

9,648

Non-practising members

389

55

55

20

519

Applicants processed by the College of Dental Hygienists of Ontario in 2005

 

Jurisdiction where members were initially trained in dental hygiene (before they were granted use of the protected title or professional designation in Ontario)
In 2005 (Jan. 1 to Dec. 31) Ontario Other Canadian Provinces USA Other International TOTAL
New applications received

534

15

7

5

561

Applicants actively pursuing licensing

0

1

0

10

11

Inactive applicants

0

0

1

0

1

Applicants who met all requirements and were authorized to become members but did not become members1

33

2

1

3

39

Applicants who became members

507

11

7

4

529

Applicants who were authorized to receive an alternative class of licence but were not issued a licence

N/A

N/A

N/A

N/A

N/A

Applicants who were issued an alternative class of licence

N/A

N/A

N/A

N/A

N/A

1 Applicants with completed applications who chose to wait until the following year to be registered.

Applicants processed by the College of Dental Hygienists of Ontario in 2006

 

Jurisdiction where members were initially trained in dental hygiene (before they were granted use of the protected title or professional designation in Ontario)
In 2006 (Jan. 1 to Dec. 31) Ontario Other Canadian Provinces USA Other International TOTAL
New applications received

687

19

7

7

720

Applicants actively pursuing licensing

0

0

1

6

7

Inactive applicants

3

2

1

0

6

Applicants who met all requirements and were authorized to become members but did not become members1

27

0

0

3

30

Applicants who became members

684

22

6

5

717

Applicants who were authorized to receive an alternative class of licence but were not issued a licence

N/A

N/A

N/A

N/A

N/A

Applicants who were issued an alternative class of licence

N/A

N/A

N/A

N/A

N/A

1Applicants with completed applications who chose to wait until the following year to be registered.

Applicants processed by the College of Dental Hygienists of Ontario in 2007

 

Jurisdiction where members were initially trained in dental hygiene (before they were granted use of the protected title or professional designation in Ontario)
In 2007 (Jan. 1 to Dec. 31) Ontario Other Canadian Provinces USA Other International TOTAL
New applications received

942

19

10

3

974

Applicants actively pursuing licensing

0

3

2

5

10

Inactive applicants

0

1

0

2

3

Applicants who met all requirements and were authorized to become members but did not become members1

64

2

0

1

67

Applicants who became members

857

17

9

9

892

Applicants who were authorized to receive an alternative class of licence but were not issued a licence

N/A

N/A

N/A

N/A

N/A

Applicants who were issued an alternative class of licence

N/A

N/A

N/A

N/A

N/A

1 Applicants with completed applications who chose to wait until the following year to be registered.

9. SOURCES

College of Dental Hygienists of Ontario website: http://www.cdho.org/. Last accessed: January 31, 2008.

College of Dental Hygienists of Ontario. “A Guide to the Process of Being Registered as a Dental Hygienist in Ontario: For Graduates of Non-accredited Dental Hygiene Programs.” September 2007.

College of Dental Hygienists of Ontario. “Registration Committee’s Process Respecting the Standards for Recognizing Equivalence of Courses of Study in Dental Hygiene to a Course in Dental Hygiene Currently Being Taught in Ontario.” Registration Committee Review, October 2006.

College of Dental Hygienists of Ontario and the Ministry of Citizenship and Immigration, Ontario. “Access to the Dental Hygienists Profession in Ontario.” Ministry of Citizenship and Immigration website: http://www.citizenship.gov.on.ca. Last accessed: January 31, 2008.

International Federation of Dental Hygienists website: http://www.ifdh.org/. Last accessed: February 8, 2008.

Mutual Recognition Agreement Between the Jurisdictional Regulatory Organizations for Dental Hygienists in Canada, December 5, 2003.

National Dental Hygiene Certification Board website: http://www.ndhcb.ca. Last accessed: February 7, 2008.

Representatives of the College of Dental Hygienists of Ontario met with staff of the Office of the Fairness Commissioner on December 7, 2007, to provide further information for this study.



[1] If the application is successful, the CDHO will credit this amount toward the applicant’s initial certification of registration fee.