Same competencies, different practices: dentists vs hygienists in whitening and sealant management

OBJECTIVES: The ongoing evolution of dentistry and oral health requires a reassessment of professional roles in order to ensure high-quality care. The integration of dentists and dental hygienists within the dental team can improve service efficiency through a more rational distribution of competencies.
However, evidence regarding the clinical management of shared procedures, such as tooth whitening and fissure sealant application, is still limited. The aim of this study was to investigate, through a questionnaire, the organization and clinical management of these treatments.

MATERIALS AND METHODS: An electronic questionnaire was developed using the Qualtrics platform and structured into two sections dedicated to tooth whitening and fissure sealants. Participation was voluntary and anonymous. After approval by the Bioethics Committee of the University of Bologna, the survey was distributed through professional channels. Data regarding
demographic characteristics, preventive measures, clinical protocols, and post-treatment management were collected and analyzed.

RESULTS: A total of 396 professionals participated in the study. Tooth whitening was most commonly requested by patients aged 30-50 years and was predominantly performed by dental hygienists. Most professionals carried out fewer than 10 whitening treatments per month, and tooth sensitivity was the most frequently reported symptom. Approximately half of respondents took pre- and post-treatment photographs, while fewer than 40% routinely scheduled follow-up visits. Nearly all respondents (99%) reported a high level of attention to oral health prevention. Molar sealants were mainly applied by general dentists (48%), followed by pediatric dentists (24%) and dental hygienists (28%), with operator selection primarily based on scheduling availability and professional experience. Most sealants were resin-based and applied to fully erupted teeth.

CONCLUSIONS: Although both dentists and dental hygienists are qualified to perform tooth whitening and fissure sealant application, these procedures are distributed differently in clinical practice. Sealants remain predominantly dentist-led, whereas whitening is more frequently performed by dental hygienists. The observed variability in clinical protocols highlights the need for greater standardization and harmonization of training pathways.

CLINICAL SIGNIFICANCE: The results highlight the need for greater standardization of clinical practices between dental hygienists and dentists, particularly for treatments such as tooth whitening and sealants. A more balanced distribution of these procedures between the two professional roles could improve clinical workflow efficiency and promote a more appropriate use of resources.

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