Dental hygienists in The Netherlands: the past, present and future.

Dental hygiene education in the Netherlands started in 1968 after a long political debate about roles, functions and the working domain. From a slow start with five students in a school based on the American model with a 2-year curriculum, dental hygiene education is now a 4-year, higher professional education with an admission of 300 students annually who pursue the degree of Bachelor of Health at a University of Applied Sciences. In the 45 years of its existence, the dental hygiene profession has undergone a tremendous change. In the beginning, dental hygienists worked under the supervision of a dentist, which changed in 1992 to their working 'under referral' from a dentist, and again in 2006, when dental hygienists became directly accessible. One-third of the working force of approximately 2700 dental hygienists (2010) is now working in their own independent practice. The focus of professional practice has changed from the prevention of caries via periodontology to the relationship between dental health and general health and well-being. The profession, the education and the Dutch Dental Hygienists' Association (Nederlandse Vereniging van Mondhygiënisten) have matured, and its members are now serious partners in oral health care.