Dental hygienist vs dentist — what's the difference?

At Smile Solutions your dental needs are often managed by more than one professional, because each practitioner has their own area of expertise. Seeing different practitioners is how you get the right level of care for each part of the work. The clinical team is listed by name, and registered specialists are identified as such.

If what you actually want to know is what happens in the chair, your Smile Solutions dental hygienist visit: what to expect walks through the appointment itself. Dental cleans and hygienists is the service page.

The dental hygienist

The main treatment you receive from a hygienist is preventative.

Hygienists undertake oral assessment, review your dental history and overall health, and evaluate the condition of your gums, teeth and mouth to help prevent oral disease. What does a dental hygienist do? covers the day-to-day detail.

They can make decisions and devise a treatment plan within their scope of practice. They are, however, required to have a referral and consultative relationship with a general dentist at minimum.

Qualification: typically an Advanced Diploma or a Bachelor of Oral Health.

A hygienist is not the same as a dental therapist, and the two are frequently confused — what is the difference between a dental therapist and a dental hygienist? sets out where the scopes diverge.

The dentist

Dentists complete significantly different training — a five-year degree, and often postgraduate study. That higher qualification enables more intricate and in-depth dental work.

So when a dentist treats you, they can not only assess but diagnose and treat problems such as cavities and tooth fractures — see general dentistry, how does tooth decay develop? and what should I do if I have a chipped tooth?. They:

• perform fillings and extractions — tooth fillings, why do I need a filling?, wisdom teeth
• write prescriptions for certain medications — antibiotics, analgesics, prescription-only mouthwash. Antibiotics in particular are not a treatment for toothache on their own: I have a toothache. Should I see my GP for antibiotics?

A hygienist cannot do any of that. If your appointment turns up decay, a crack or an abscess, the work moves to a dentist — why are dental abscesses so painful? and emergency dentistry if it cannot wait.

What the regulator requires of both

Underneath the practical differences sits one rule that applies to everybody in the building. The Dental Board of Australia's Scope of practice registration standard applies to all practitioners registered with the Board, and "requires dental practitioners to practise within the scope of their education, training, and competence at all times".

That is the legal basis for the handovers described on this page: a hygienist passes decay to a dentist rather than treating it, and a dentist refers an advanced gum case to a periodontist rather than persevering with it. It is not office etiquette; it is a registration standard.

Each of these roles — dentist, dental hygienist, dental therapist, oral health therapist and dental prosthetist — is separately registered under the Dental Board, and every practitioner appears on the AHPRA public register showing the division they are registered in. You can check any of them yourself, free, at ahpra.gov.au. If a title is unfamiliar, the register is the quickest way to find out what it means.

Specialists sit on top of that. The Board recognises 13 dental specialties in Australia, approved by the Australian Health Workforce Ministerial Council, and nobody enters one straight from university: an applicant must hold general registration in the division of dentists and have "completed a minimum of two years general dental practice" first. So a periodontist you are referred to has worked as a general dentist before specialising.

How the two work together

Most general dental patients have their care managed by both.

The dentist is the primary care provider and is responsible for your oral health. They also act as a treatment coordinator, arranging appointments with the hygienist and with specialists where needed — why would I need to see a dental specialist? and specialist care.

The hygienist is not a cheaper substitute for the dentist — the two roles cover different ground. A hygienist appointment does not include an examination for decay, and an examination by a dentist does not include a clean. Published fees for each are in the price guide, and understanding your treatment explains how a plan is put together and quoted.

What to bring

• If you have a complex medical history or take medications, bring a full list of current diagnoses and medications. Several conditions change what happens in the mouth — diabetes and oral health is the clearest example, and many common medications cause dry mouth, which raises decay risk sharply.
• If you have had recent dental treatment or X-rays at another clinic, obtain those records and bring them — how safe are dental x-rays? explains why repeating imaging unnecessarily is worth avoiding.

Both save time and avoid repeating imaging you have already had.

What happens at the appointment

The assessment

After reviewing your information, the hygienist classifies your periodontal health and checks:

Stain build-up — levels vary with smoking, diet, and the type of bacteria present. What impact does wine have on my teeth? and the effects of vaping on your oral health cover two of the common contributors.

Tartar (calculus) deposits — these increase with the mineral content of your saliva, and with appliances such as braces, plates, grinding splints or dentures.

Plaque — the amount increases with the types of food you eat and how much water you drink. How does your diet affect your teeth?

That last set of factors is worth noting: two people with identical brushing habits can build calculus at very different rates, because saliva chemistry differs.

One point underlies the whole appointment. Plaque is a biofilm — a structured, adherent bacterial community, not loose debris. Only mechanical disruption removes it. Rinses and mouthwashes act on what brushing and flossing leave behind; they do not replace them. Once plaque mineralises into calculus, no brush will remove it at all, which is the reason the appointment exists. What is the ideal daily routine for oral hygiene? is the home half of the same job.

The gum assessment

A periodontal probe is used to measure:

• the pocket depth around each tooth
• the level of gum recession
• any bleeding points
• mobility of teeth

Most people find this comfortable. You may feel some sensitivity where the gum is not perfectly healthy — which is itself information.

The numbers being called out matter more than they sound. Floss reaches roughly 3mm below the gum margin. A pocket of 5mm or more is periodontitis, and it is past the point where any home routine can clean it — that is professional treatment, not better brushing. Periodontal (gum) disease and what is gum disease? explain the disease; when do you need deeper cleaning? explains what treatment below the gumline involves. Bleeding gums is usually the first sign anything is wrong.

The clean

Once the results are explained, if your gums are healthy and stable you will have a scale and clean to remove plaque and calculus:

1. An ultrasonic machine, which sprays water and vibrates
2. Hand instruments afterwards, where needed
3. Polishing with a minty paste
4. A fluoride treatment — best done at this point, with everything clean, to strengthen the teeth. The benefits of fluoride explains what it is doing.

The advice

At each appointment you get guidance on maintaining oral health at home, based on your gum assessment and your current routine. The hygienist may:

• point out areas to improve
• demonstrate brushing and flossing technique — is flossing really that important?
• recommend products such as an electric toothbrush or interdental brushes — which toothbrushes do dentists recommend? and selecting a toothpaste: fluoride or non-fluoride

Three pieces of advice recur, because they are the ones that change outcomes:

• Twice a day, two minutes, soft bristles. More is not better, and harder is worse — over-brushing causes recession that does not grow back.
• Spit, don't rinse. Rinsing with water straight after brushing washes away the fluoride you just applied.
• Wait about an hour after anything acidic before brushing, because acid temporarily softens enamel — brushing your teeth: before or after breakfast?

How often should I see the hygienist?

Standard recall is every six months where all factors are controlled. This keeps a healthy mouth healthy and free of problems. How often should I go to the dentist? covers the examination interval, which is a separate question.

If there are complicated gum problems that a general scale and clean cannot address, your hygienist will discuss a treatment plan. That might mean:

• additional appointments for deep and heavy cleans
• referral to a periodontist (gum specialist) for further treatment — periodontists

Six months is a default, not a rule. Patients with periodontal disease, diabetes, dry mouth or orthodontic appliances usually need shorter intervals. Diabetes Australia makes the same point from the medical side: people with complications from diabetes may need to return more often than the standard interval, and oral health advice should be provided to everyone with diabetes.

Common questions

How do I check for myself that someone is registered — and what does the register actually tell me?

Go to ahpra.gov.au and search the name. The Dental Board of Australia states that "Ahpra publishes an online register of all dental practitioners that provides the profession and the public with up-to-date information about a dental practitioner's registration status," and that the register "also includes details of the specialty or specialties for dentists who hold specialist registration." It is free, it is public, and you do not need a reason to look.

What it will tell you: whether the person is currently registered, which division they are registered in — dentist, dental hygienist, dental therapist, oral health therapist or dental prosthetist — whether they hold specialist registration and in which of the 13 recognised specialties, and whether there are conditions, undertakings or reprimands recorded against the registration.

What it will not tell you is just as worth knowing. The register does not rank anyone, does not record how long an individual appointment takes, does not list fees, and does not tell you whether a particular practitioner is a good fit for the work you need. It is a floor, not a recommendation. Two practitioners with identical entries can practise very differently.

One practical note: a title that sounds like a specialty is not the same as specialist registration. If the wording matters to your decision, look the person up rather than reading the wording.

I only want the clean. Do I have to have an examination as well?

They are two different services and neither contains the other, which is the part that surprises people when they see the invoice.

A hygienist appointment assesses and treats the gums and removes plaque and calculus. It is not a search for decay, and a hygienist is not registered to diagnose or restore a cavity. The Dental Board's scope of practice registration standard requires every dental practitioner to "practise within the scope of their education, training, and competence at all times" — so a hygienist who finds something suspicious refers it, rather than treating it. Hygienists are also required to have a referral and consultative relationship with a general dentist at minimum.

The practical consequence: if you only ever book cleans, nobody is systematically checking for decay, cracks or anything on the soft tissues. Decay between teeth in particular is generally not visible by looking and is found on a radiograph. That is not an argument for having everything every time — it is an argument for knowing which of the two you have actually booked, and asking when the other was last done.

Whether you can book a hygienist directly, and what that appointment includes, is a practice-level question rather than a regulatory one. Ask when you book. Published fees for each appointment type are in the price guide.

Nothing hurts and my teeth look fine. Can I leave it a while longer?

The difficulty is that the most common reason to come is one you cannot feel. Gum disease is typically painless until it is advanced, and the damage it does — loss of the bone and ligament holding the tooth in — does not grow back.

It is not a rare problem. The review Periodontitis and diabetes: a two-way relationship (Preshaw et al., published in Diabetologia) describes periodontitis as "highly prevalent (severe periodontitis affects 10–15% of adults)" and notes it "has multiple negative impacts on quality of life." The same review reports that "susceptibility to periodontitis is increased by approximately threefold in people with diabetes," with a clear relationship between the degree of hyperglycaemia and the severity of the gum disease.

So the honest answer depends on who you are rather than on how your teeth look. If you smoke, have diabetes, have a dry mouth, are pregnant, or have had gum treatment before, the interval that suits somebody else does not apply to you. If none of those apply and your last assessment was clear, a longer gap is a reasonable conversation to have — but have it with the practice rather than deciding alone, because the measurements from last time are the thing that settles it.

A salon offered to whiten my teeth. Is that actually allowed?

It depends entirely on the concentration of the product, and this is set in law rather than by professional preference.

The Australian Dental Association's policy statement on teeth whitening explains that "Schedule 10 specifically states that teeth whitening products containing more than 6% hydrogen peroxide or 18% carbamide peroxide may only be sold, supplied and used by registered dental practitioners as part of their dental practise," and that these provisions "are formalised in all state and territory poisons legislation." Lower-strength products — hydrogen peroxide 3–6% and carbamide peroxide 9–18% — sit in Schedule 5, which requires stipulated safety warnings on the label and can be sold direct to consumers.

The ADA also records the practical problem directly: "Teeth whitening services are now also increasingly offered by unregulated, unqualified non dental practitioners in settings such as beauty and hair salons, shopping mall kiosks, dedicated teeth whitening salons, or via mobile services that travel to a location convenient to the consumer."

Two things follow. If a non-dental operator is using a product above those thresholds, that is a poisons-legislation matter, not a matter of taste. And nobody outside a dental setting has examined your teeth first — whitening applied over untreated decay, a cracked tooth, exposed root surfaces or existing crowns and fillings does not produce the result people expect, because restorations do not change colour with the natural tooth. Difference between pharmacy whitening kits and dentist whitening? goes through the comparison properly.

If I am unhappy with treatment, who do I actually raise it with?

There is a real pathway, and it is worth knowing the order.

Start with the practice itself — most problems are a misunderstanding about what was agreed, and the treating practitioner is the person who can put clinical matters right. Ask for it in writing if it matters.

Beyond that, the Australian Dental Association's own policy statement lists the mechanisms that protect patients in Australia: "Patients' rights are protected by the Board, ADA Branch peer review and conciliation services, State health complaint authorities, and common law." In practice that means a concern about a practitioner's conduct, health or performance goes to Ahpra and the Dental Board; a concern about the service or the handling of a complaint goes to your state's health complaints body; and the ADA branch peer review and conciliation services sit between the two for clinical disagreements. Registered practitioners in Australia are also required to hold professional indemnity insurance.

One honest gap: none of those bodies adjudicates whether a fee was reasonable. A submission to a 2017 Commonwealth parliamentary inquiry into private health insurance and out-of-pocket costs made exactly that point, noting the absence of a national dental fee schedule and that "there is no public body for patients to complain to about Australia's high dental fees." Fees are therefore a matter to settle before treatment, not after. Ask for a written quote with item numbers, and take it to your health fund before you proceed. See understanding your treatment.

Related reading

• What is the difference between having your teeth cleaned by a dentist and a dental hygienist?
• What does a dental hygienist do?
• Dental therapist vs dental hygienist
• 3 oral hygiene tips you need to know
• The truth and myths about mouthwashes
• Health problems linked to poor oral hygiene
• The importance of dental hygiene — a window onto your overall health
• 5 questions you've always wanted to ask your dentist

Practical details

We have registered specialist periodontists on site for referral where gum treatment goes beyond a hygienist's scope. Specialist registration can be verified on the AHPRA register, or by calling 1300 419 495.

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — getting here. Phone 13 13 96, contact us, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. Published fees are in the price guide.

Published 1 November 2018. General information only; it does not replace advice from your treating practitioner.

Smile Solutions trades under ABN 28 193 514 103.