Preparedness of Dental Hygiene Students for Clinical Practice: A Scoping Review

ABSTRACT

Introduction

Dental hygienists (DHs) play a crucial role in promoting oral health and prevention of dental diseases. Dental hygiene educational programs must ensure that the future workforce is prepared for delivering effective and high‐quality oral care to communities.

Objectives

The aim of this scoping review is to explore the published literature to identify gaps in the preparedness of dental hygiene students.

Methods

Following the Joanna Briggs Institute (JBI) methodology and PRISMA‐ScR guidelines, a comprehensive search was conducted across PubMed, Google Scholar, ProQuest Central, CINAHL, and Embase, covering studies published from 1st January 2000 to 31st December 2025. Keywords and MeSH terms related to preparedness, dental hygiene students, and clinical practice guided the search. Data were synthesised narratively.

Results

Ten studies published between 2012 and 2023 were identified from Canada (30%), the United States (30%), Finland (10%), Australia (20%), and New Zealand (10%). Both qualitative and quantitative methodologies were employed. Studies focused on a wide range of attributes of dental hygiene students including clinical skills (70%), communication skills (80%), cultural competence (30%), adaptability (50%), professional resilience (30%), and policy use and advocacy (40%). Gaps were noted in research use, policy engagement, and advocacy, with graduates reporting low confidence in these areas. Baccalaureate programs provided broader preparation than diploma programs, though both lacked sufficient applied learning experiences.

Conclusions

The review highlighted several gaps in the teaching and training of dental hygiene students in multiple countries. The findings underscore the need for educators and regulators to address these educational shortfalls to facilitate a smooth transition of dental hygiene students into professional practice.

1. Introduction

Dental hygienists (DHs) are oral health care professionals who promote preventive oral care as part of overall wellness [1]. The profession, which began in 1906, has evolved from apprenticeships to structured programs offering associate, bachelor's and master's degrees [2]. The scope of practice of DHs has expanded significantly in the last two decades. This expansion reflects growing recognition of the role of oral health in maintaining general health, increasing population demands, and the need for accessible oral healthcare services [3]. Consequently, clinical practice regulations in dental hygiene practice have evolved, allowing dental hygienists to take on greater responsibilities in patient care [4]. At the same time, accreditation standards have become more stringent, ensuring that dental hygiene programs equip graduates with the skills and competencies required for safe and effective clinical practice [5].

Globally, the Canadian Dental Hygienists Association (CDHA) has been at the forefront of advocating for education frameworks that meet these evolving demands. In its Policy Framework for Dental Hygiene Education, the CDHA emphasises the need to adapt to the expanding theoretical knowledge, shifting demographics, changing disease patterns, and the increasing demand for high‐quality oral health services [6]. Dental hygiene education must therefore equip graduates with the skills to take on additional responsibilities in clinical practice. The Framework for Action on Interprofessional Education and Collaborative Practice by the World Health Organization (WHO) also highlights the importance of collaborative care across disciplines, ensuring healthcare providers, including DHs, work together to improve patient outcomes and provide comprehensive care for diverse populations [6].

DHs have access to diverse career paths, including roles in general dental practice, community clinics, hospitals, military services, academia and research. The scope of practice for DHs has broadened significantly in response to evolving healthcare needs, enabling them to take on increased responsibilities in clinical care and public health. These developments reflect global efforts to empower oral health professionals to address the growing demand for comprehensive patient care. DHs are recognised as integral members of healthcare teams, contributing to both preventive and therapeutic oral healthcare across various settings.

Expansion in the scope of practice for DHs is a positive development and underscores the importance of DHs in oral healthcare services. However, the transition from student to professional DH poses significant challenges, and new graduates often encounter uncertainties and complexities as they navigate the demands of clinical practice [7]. A key component of preparedness is the ability to apply theoretical knowledge, practical skills, and professional behaviours in clinical settings [8].

DHs, as adult learners, are expected to demonstrate proficiency in technical, communication, and critical thinking skills upon completing their education [9]. The curriculum design, teaching strategies, and assessment methods in dental hygiene education aim to enhance the preparedness of graduates. This involves not only imparting knowledge but also fostering practical skills and professional behaviours through comprehensive training and hands‐on experiences [10, 11]. The growing public expectations from oral healthcare professionals' patients further emphasise the importance of graduating competent dental hygienists who can meet the expectations of society [12].

The aim of this scoping review is to explore the published literature to identify gaps in the preparedness of dental hygiene students. By synthesizing findings from existing studies, this review may inform further development of educational programs to enhance the preparedness of dental hygiene graduates for professional practice.

2. Materials and Methods

The proposed scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and reported following the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews (PRISMA‐ScR) guidelines [13, 14].

2.1. Information Sources and Search Strategy

A preliminary search of the Cochrane Database of Systematic Reviews was conducted, and no current or ongoing systematic reviews of the topic were identified. A thorough electronic search was conducted across PubMed, Google Scholar, ProQuest Central, CINAHL and Embase databases, targeting literature pertaining to the preparedness of dental hygiene graduates for clinical practice. Using specific search terms ‘preparedness’ OR ‘readiness’ OR ‘Self‐Confidence’ AND ‘dental hygiene graduates’ OR ‘Oral Health Graduates’ ‘dental hygienists’ AND ‘clinical practice’ ‘Independent Practice’ OR ‘Alternative clinical setting’ studies published between 1st January 2000 and 31st December 2025 were sought, resulting in the identification of 319 initial records.

2.2. Eligibility Criteria

The inclusion criteria for this scoping review encompassed primary research studies that evaluate the preparedness of dental hygiene students or graduates for clinical practice. It also included studies that share assessments from various stakeholders, such as students, graduates, educators, employers and consumers, on dental hygiene education and the preparedness of graduates. Additionally, studies that evaluated dental hygiene graduates' self‐confidence ratings in meeting competency standards were included. Only studies published in English and those published up until February 29, 2024, were considered. The exclusion criteria eliminate studies with populations other than dental hygienists, such as dental or medical students, as well as opinion articles, including editorials, reviews and letters to editors.

2.3. Research Question

What evidence exists regarding the preparedness of dental hygiene students and graduates for clinical practice?

2.4. Data Selection and Data Extraction

The publications were imported into EndNote, version 20.4.1 (Clarivate plc, London, UK), Clarivate Analytics, resulting in a total of 319 references. After eliminating 13 duplicates manually and 36 duplicates identified by EndNote, 107 references were marked as ineligible by automation tools provided by Covidence (Veritas Health Innovation Ltd., Melbourne, VIC 3000, Australia), and can be accessed at https://www.covidence.org. This left 163 studies for title and abstract screening, which was performed by two independent reviewers. Any disagreements were resolved through mutual discussion, with a third reviewer moderating any residual differences to achieve consensus. Following the title and abstract screening, 43 studies were identified for full‐text screening. Through this rigorous process, studies with irrelevant study designs, populations, comparator, interventions, outcomes, and settings were excluded, resulting in the inclusion of 10 studies that aligned with the research question and inclusion criteria for this scoping review. The results of the search and the study inclusion process are presented in the PRISMA‐ScR flow diagram (Figure 1).

FIGURE 1.

PRISMA 2020 flow diagram for scoping reviews which included searches of databases [15].

3. Results

The scoping review synthesised findings from 10 studies published between 2012 and 2023, focusing on various dimensions of clinical dental hygiene education [16, 17, 18, 19, 20, 21, 22, 23, 24, 25]. The studies reviewed varied widely in methodology and objectives as summarised in Table 1. Of the ten studies included in this review, three studies were conducted in Canada, three in the United States of America, two in Australia, one in New Zealand, and one in Finland. The research methodologies employed varied across these studies, with a mix of qualitative and quantitative approaches. Qualitative methods, including semi‐structured interviews, were utilised in four studies [18, 19, 20, 23]. These studies relied on in‐depth interviews to gather rich, detailed insights from participants. On the other hand, quantitative approaches were employed by six studies which utilised survey instruments and quantitative analysis to investigate areas such as students' self‐confidence ratings and educational preparedness [16, 17, 21, 22, 24, 25].

TABLE 1.

Characteristics of included studies.

Author and year	Country	Objective	Population	Study design and sample size
Pang et al. (2012) [24]	New Zealand	Employment pathways, workplace readiness	2009 BOH graduates, employers, and dental therapists who hosted BOH students on clinical placement since 2009	Open ended survey‐based qualitative research n = 24
Vannah et al. (2014) [22]	USA	Identification of educational gaps and recommendations	Maine Independent Practice Dental Hygienists (IPDHs)	Mixed Methods (open and close‐ended questionnaire), n = 6
Capozzi et al. (2018) [20]	Finland	Educators' perspectives on dental hygienist education	Lead educators of dental hygienists from the four Finnish education units	Qualitative, n = 13
Jokiaho et al. (2018) [19]	USA	Students' experiences treating culturally diverse refugee patients	Senior dental hygiene students (DHS) in their second semester of clinical instruction in the Bachelor of Science program	Qualitative, n = 18
Szabo et al. (2018) [18]	USA	Preparedness for providing care to older adults in alternative settings	Dental hygienists working with older adults in alternative dental practice settings across the U.S.	Qualitative phenomenological, n = 15
Sunell et al. (2019) [17]	Canada	Self‐confidence ratings of CDHA's baccalaureate competencies	Graduating dental hygiene students, University of British Columbia	Longitudinal study, n = 17
Sunell et al. (2020) [25]	Canada	Self‐confidence ratings of CDHA's baccalaureate competencies	Graduated dental hygiene students, University of British Columbia from 2017 to 2019	Cross‐sectional study, n = 30
Sunell et al. (2021) [16]	Canada	Self‐confidence ratings of CDHA's baccalaureate competencies	Fourth‐year dental hygiene students, University of British Columbia	Longitudinal study, n = 54
Mariño et al. (2022) [23]	Australia	Readiness for practice, perspectives of stakeholders	Australian dental council newly qualified dental professionals, educators, employers, consumers	Qualitative, n = 19
Katwe et al. (2023) [21]	Australia	Preparedness for treating deaf patients	Dental, oral health therapy, and dental hygiene students from 13 accredited Australian tertiary institutions	Cross‐sectional survey n = 271

This scoping review identified several studies focusing on preparedness of dental hygiene students for clinical practice. The core attributes identified include clinical skills and preparedness, communication skills, cultural competency, adaptability, and professional resilience. Table 2 summarises the key findings, educational gaps, and implications on transition of dental hygiene students into professional practice. Core attributes related to preparedness for clinical practice were identified across the included studies and are summarised in Table 3.

TABLE 2.

Key findings and implications for dental hygiene education.

Author and year	Key findings and gaps	Implications for practice	Recommendations
Pang et al. (2012) [24]	Need for better preparation in both dental therapy and hygiene practice	Enhance clinical exposure and training for dual‐scope graduates	Improve integration of practice scopes
Vannah et al. (2014) [22]	IPDHs felt underprepared for alternative practice, lacking public health exposure, business skills, and communication training	Expand dental hygiene education to include more exposure to public health, business ownership, and underserved populations	Offer elective courses for students interested in alternative practice and business ownership
Capozzi et al. (2018) [20]	Students initially felt confident but later realised the need for more education and experience	Increase clinical exposure to culturally diverse populations	Incorporate cultural diversity training
Jokiaho et al. (2018) [19]	DHs' skills are underutilised, especially in health promotion and orthodontics	Reassess the scope of DHs' clinical work to fully utilise their skills in practice	Improve clarity in the division of labour, especially in periodontal therapy
Szabo et al. (2018) [18]	DHs were not adequately prepared to care for older adults in alternative settings	Incorporate hands‐on experiences with older adults into curricula	Enhance clinical experiences with older adults
Sunell et al. (2019) [17]	High confidence in clinical therapy (100%), collaboration (100%), and oral health education (90%); low confidence in policy use (20%) and advocacy (11%)	Focus on curriculum revisions to strengthen policy use and advocacy	Include policy use and advocacy in curriculum
Sunell et al. (2020) [25]	High confidence in collaboration, communication, and clinical therapy (all 100%); low confidence in health promotion (50%), advocacy (22%), and policy use (0%)	Provide additional support for graduates in areas of policy use and advocacy	Emphasise leadership, policy use, and advocacy in training
Sunell et al. (2021) [16]	High confidence in clinical therapy, collaboration, disease prevention, and professionalism (all 100%); lower confidence in research use (73%), health promotion (70%), leadership (67%), policy use (20%), and advocacy (11%)	Curriculum revisions are needed in the domains with lower confidence; consider some competencies for graduate studies	Develop transition support for graduates entering practice
Mariño et al. (2022) [23]	Graduates are theoretically prepared but need further training in specific skills	Provide training programs to develop resilience	Implement resilience training
Katwe et al. (2023) [21]	Significant gaps identified in cultural competence among students, particularly in managing deaf patients	Incorporate more cultural competence and communication training related to managing deaf patients into the curriculum	Provide Auslan or equivalent sign language training in dental programs

TABLE 3.

Core attributes of dental hygiene graduates.

Attribute	Capozzi et al. (2018)	Jokiaho et al. (2018)	Katwe et al. (2023)	Mariño et al. (2022)	Pang et al. (2012)	Sunell et al. (2019)	Sunell et al. (2020)	Sunell et al. (2021)	Szabo et al. (2018)	Vannah et al. (2014)
Clinical skills		☑		☑	☑	☑	☑	☑	☑	☑
Communication skills	☑	☑	☑	☑		☑	☑	☑		☑
Cultural competency	☑		☑
Adaptability	☑		☑	☑		☑	☑	☑	☑	☑
Professional resilience				☑	☑	☑	☑	☑
Business skills				☑						☑
Advocacy						☑	☑	☑
Policy use		☑				☑	☑	☑
Research skills						☑	☑	☑

3.1. Clinical Skills

Clinical skills and preparedness were the most frequently discussed attributes and featured in seven studies which focused on core clinical skills such as medical history‐taking, instrumentation, and patient education. Dental hygiene students generally expressed confidence in their clinical skills, especially in areas like clinical therapy and disease prevention [16, 17, 25]. However, a significant gap was identified in the preparedness of students to provide care for older adults. One study specifically focused on the challenges dental hygienists face in geriatric care and reported that current educational programs often lack the necessary focus on adapting clinical skills to meet the needs of elderly patients in alternative settings [18].

Dental hygiene graduates generally reported satisfaction with their clinical training, particularly in their ability to practice both dental therapy and dental hygiene [24]. However, a significant concern raised was the challenge of maintaining proficiency in both scopes of practice simultaneously. Some participants reported a lack of opportunities to perform complex restorative procedures during their education, which was confirmed by employers. It was reported that while graduates possessed strong foundational skills, there was a clear need for more exposure to complex clinical cases to ensure they were fully prepared for professional practice.

In addition to foundational clinical skills, respondents in other studies linked leadership to their ability to make evidence‐informed decisions, an essential aspect of clinical preparedness. Although graduates initially felt confident in their ability to make evidence‐based decisions, this confidence often declined with practice experience, starting as early as the second year and continuing throughout their careers [25]. Notably, practitioners with postgraduate credentials, particularly those with master's and doctoral degrees, reported higher levels of confidence in evidence‐informed decision‐making. However, despite this link between advanced education and confidence, graduates expressed less confidence in the research use domain, particularly in areas related to statistical tests, assumptions and biases, theoretical frameworks, and oral health strategies [16, 17, 25].

3.2. Communication Skills

Communication skills were addressed in eight studies, with a focus on both general communication and the specific challenges associated with interacting with diverse patient populations. The general communication skills of dental hygiene students were found to be relatively strong, with most studies reporting high levels of self‐confidence among students [16, 17, 25]. However, significant gaps were noted in communication with culturally and linguistically diverse populations. Dental hygiene students also reported challenges when communicating with deaf patients, attributing these difficulties to a lack of training in Auslan and Deaf sign language [21]. Students also struggled to communicate effectively with refugee patients, pointing to a broader need for improved training in cultural and communication competencies [20].

3.3. Cultural Competency

Cultural competency was a recurring attribute in the literature, with two studies focusing on specific patient populations: refugees and deaf individuals. Cultural competency of dental hygiene students in treating refugee populations was also explored and it was observed that many students felt underprepared to provide culturally sensitive clinical care [20]. These findings highlighted the need for dental hygiene programs to incorporate more extensive training on the cultural and social determinants of health, particularly for marginalised groups. Significant deficiencies were also reported in the abilities of dental hygiene students' understanding of deaf community culture and communication strategies [21]. There is a need to integrate oral management of deaf people into the dental hygiene curricula to ensure that graduates are equipped to deliver equitable and effective oral care to deaf individuals [21].

3.4. Adaptability and Professional Resilience

Jokiaho et al. explored the alignment between dental hygiene education and professional practice from the perspective of educators in Finland, revealing that while the education of dental hygienists generally meets professional demands, there were concerns about adequate utilization of their skills in clinical settings [19]. Educators highlighted the need for further development in areas such as health promotion and orthodontic measures, suggesting that graduates need to be more adaptable to fully utilise their competencies in a clinical environment [19]. Similarly, Mariño et al. examined the perspectives of educators, employers, and consumers on the readiness of newly qualified dental professionals, identifying the need for graduates to develop clinical entrepreneurship, communication and interprofessional skills, and protective mechanisms to manage the stressors of practice [23]. The ability to adapt to diverse clinical environments and maintain professional resilience was seen as crucial for providing high‐quality care in evolving healthcare settings. A recent study investigated the post‐graduation pathways of University of Otago Bachelor of Oral Health (BOH) graduates and highlighted the importance of exposure to complex clinical cases during education to build attributes such as adaptability and confidence [24]. Both graduates and employers noted that while foundational skills were strong, the ability to adapt to the demands of complex cases developed gradually, often requiring additional support and continuing education.

3.5. Policy Use

Three studies by Sunell et al. reported that dental hygiene graduates struggled with the application of policy and understanding political processes. Graduates expressed difficulty in navigating complex policy frameworks, particularly when it came to changing public health policies or working with government officials [16, 17, 25]. For example, some respondents noted they could follow existing policies within their clinical practice but lacked the skills and confidence needed to initiate policy change [16, 17, 25]. Gaps were identified between what graduates learn during their education and their preparedness to apply policy‐making skills in real‐world settings.

3.6. Research

The use of research emerged as another domain in which students and recent graduates expressed low confidence and reported difficulties to interpret statistical tests, understand theoretical frameworks, and apply evidence‐based practices [17, 25]. There were calls from students for greater integration of research skills within the curriculum to improve their ability to engage in evidence‐informed decision‐making. While some respondents acknowledged the value of research, many felt that their exposure during their education was insufficient to foster confidence in applying these skills effectively in practice [16, 25]. The complexity of research use in health professions was highlighted, with students expressing a need for ongoing support and professional development to sustain these skills throughout their careers.

3.7. Advocacy for Oral Health

Advocacy was identified as one of the most challenging domains for students and recent graduates. While respondents felt comfortable advocating for individual patients through referrals and client‐centred care, they struggled with cause advocacy that is advocating for broader health initiatives or influencing policy [16, 17, 25]. Many respondents acknowledged the difficulty in understanding political processes and felt unprepared to take leadership roles in advocacy efforts. The challenges of balancing clinical care with health promotion also emerged, with some graduates felt more confident in their clinical abilities but had fewer opportunities to engage in advocacy at a community or population level [25].

4. Discussion

The primary goal of dental hygiene education is to prepare competent graduates who can deliver safe and effective oral health services to the communities. This scoping review systematically explores the existing literature to identify the key attributes essential for the preparedness of dental hygiene students for clinical practice. The focus remains on understanding how education prepares graduates to deliver safe, effective patient care in clinical settings. While some studies mention alternative settings or independent roles, the review primarily emphasises attributes necessary for readiness for clinical practice.

The concept of ‘preparedness for practice’ in the health professions encompasses not only professional competence but also readiness to function independently across diverse work environments [26]. Thus, being prepared for practice is not restricted to clinical competence but also encompasses a wide range of cognitive and behavioural attributes to ensure a smooth transition from the temporal confines of a university setting into the work environment to provide clinical services. Considerable research on preparedness of dental graduates has been published in recent years, and education providers of dental hygiene education need to mirror the same to gain a deeper understanding of preparedness of DH [23, 27]. This notion becomes particularly relevant as the scope of practice for allied dental professionals, including dental hygienists, continues to expand [28]. Despite the emphasis on preparedness, the literature suggests that many newly graduated dental hygienists feel under‐prepared for the transition into clinical practice [29, 30].

The American Dental Education Association policy statement of Guidelines and Recommendations for Academic Dental Institutions states that educational institutions are encouraged to prepare students for the evolving workforce models. Dental hygiene education has witnessed a shift towards development of competency‐based curricula to ensure that dental hygiene students and graduates are able to meet the demands of clinical practice and adapt to varying dental workforce models. Similarly, the Canadian Dental Hygienists Association introduced the Canadian Competencies for Baccalaureate Dental Hygiene Programs in 2015 to elevate dental hygiene education standards, yet there is limited evidence to suggest that graduates have effectively acquired these competencies [17]. Surveys conducted by Sunell et al. unveiled varying levels of self‐confidence among graduating dental hygiene students, highlighting the need for curriculum enhancements, particularly in areas such as policy use and advocacy [16, 17, 25]. Our findings are in accord with a previous study by Coplen and Bell that identified several challenges faced by dental hygienists, including deficiencies in practice management skills, billing, coding, prescription‐writing, and navigating the public health delivery system [30].

Deficiencies in the knowledge and skills of dental hygienists identified by the studies included in this scoping review are summarised below.

4.1. Oral Healthcare of Elderly and Special Needs Population

Capozzi et al. reported that dental hygienists working in practice felt underprepared to manage geriatric patients [20]. These findings highlighted the challenges of oral health management of the aging population compounded by underlying medical conditions, a variety of physical and mental disabilities, polypharmacy, and higher risks of complications following clinical interventions.

Dental care remains the most prevalent unmet need among the special needs population, partly due to the complex dental requirements associated with their underlying systemic conditions or acquired anomalies [31, 32, 33]. Studies indicate that dentists often feel unprepared to treat these patients, attributing their reluctance to inadequate education on managing special needs individuals [34, 35, 36]. Although CODA's 2004 standard mandates curriculum inclusion for special needs patients, it does not specify beyond didactic learning [37]. A recent study in Australia identified insufficient knowledge and cultural competency among dental students regarding the deaf population, thus emphasizing the need for comprehensive training in communication strategies and cultural competence within dental hygiene education to ensure inclusive care for all patient populations [21].

4.2. Cultural Competence

With globalization, there is a growing population of immigrants, particularly in the West, which warrants educational interventions to enhance the cultural competence of healthcare professionals including doctors and dentists [38]. In addition, there is a societal push to improve health services for indigenous populations that are often marginalised with poor access to healthcare [39, 40]. The dental hygiene literature lacks clarity on the most effective methods for Cultural Competence Education (CCE), despite its incorporation into the Dental Hygiene (DH) education standards in 2013 [18]. This standard emphasises the importance of interpersonal and communication skills in interacting with diverse population groups and healthcare team members [9]. While didactic courses in dental hygiene education aim to prepare students for clinical practice, a study showed that second‐year dental hygiene students, following semi‐structured group interviews before and after treating a culturally diverse patient, expressed a lack of confidence in their ability to provide care [18]. This lack of confidence stemmed from a heightened awareness of the barriers and challenges involved in meeting patient needs, highlighting the need for deeper education and experiential learning in cultural competence within dental hygiene curricula [41, 42, 43, 44]. Suboptimal oral healthcare for immigrants and indigenous population groups contributes to racial inequalities and must be addressed through targeted education and training of dentists and dental hygienists [39].

4.3. Transition Into Professional Practice

Literature suggests that dental hygienists working outside traditional private practice require additional skills beyond what is typically provided in standard education programs. For example, independent practitioners in Colorado and Maine have identified gaps in public health knowledge, business management, and communication skills, emphasizing the need for coursework in areas like accounting, marketing, and management to support their independent practice [22, 45]. These findings align with recommendations for dental hygiene programs to incorporate elective courses on alternative practice and business ownership to better equip graduates for diverse career paths. However, it remains unclear where the responsibility lies for ensuring adequate training in these areas, as there is no standardised approach across states or educational institutions [22].

Challenges faced by dental hygiene graduates during their transition into professional practice are highlighted in several studies [19, 24]. Discrepancies between educators' perceptions and graduates' readiness underscore the need for stronger collaboration between academia and clinical service providers. Educators have expressed concerns about the underutilization of dental hygienists' competencies in clinical settings, where they are often assigned tasks that do not fully leverage their skills [19]. This mismatch between duties and competencies, coupled with unclear role definitions, can limit the effectiveness of dental hygienists in promoting oral health [46, 47]. To address these challenges, participants in various studies have recommended enhancing collaboration between dental hygiene and dental students to foster a better understanding of each other's roles and competencies [24, 48]. Integrating training across these disciplines could improve collaborative practice, which is essential for delivering comprehensive patient care in diverse settings.

4.4. Policy Use, Research and Advocacy for Oral Health

Policy‐use emerged as particularly challenging, with students expressing uncertainty about navigating policy‐making processes and applying government policies to healthcare settings. Many respondents viewed policy use as being relevant primarily to public health or government work and felt unprepared to influence policies beyond following clinical protocols [16, 25]. The lack of practical experiences during their education left many students feeling underprepared to engage in policy advocacy or participate in policy reform efforts, reflecting a gap in their educational experience.

In the domain of research use, graduates reported difficulties with critiquing statistical methodologies, interpreting theoretical frameworks, and applying evidence‐based findings to clinical practice [16, 17, 25]. While students recognised the importance of research in healthcare, they noted that their education focused more on the research process rather than on practical applications. Many respondents indicated that their confidence in research‐related competencies improved only after gaining work experience post‐graduation, suggesting that further support is needed to bridge the gap between theory and practice.

Advocacy also posed significant challenges, with many students expressing confidence in individual client advocacy but struggling with cause advocacy advocating for broader public health initiatives or policy changes [16, 17, 25]. As students noted, engaging with the political process and understanding how to influence policy can be overwhelming without practical experience. These findings align with previous research in other health professions, which found that political astuteness that is, the awareness of legislative processes and advocacy skills, remains a barrier for healthcare providers [49].

The challenges identified across these domains reflect a need for curricular revisions that provide more hands‐on opportunities to build students' confidence in policy use, research, and advocacy. Dental hygiene programs could benefit from integrating experiential learning activities, such as community outreach projects, collaborative policy simulations, and applied research opportunities, to better prepare students for these roles [50, 51, 52].

4.5. Differences in Educational Preparation: Diploma Versus Baccalaureate Programs

The review also revealed differences in the preparation provided by diploma/associate programs compared to baccalaureate programs. Diploma and associate programs tend to focus on individual patient care and clinical readiness, with limited exposure to policy use, research, and advocacy [53, 54]. These programs prepare graduates to advocate primarily at an individual level, ensuring competency in patient‐centred care and referrals [55, 56].

In contrast, baccalaureate programs offer more comprehensive training, emphasizing community‐level health promotion, policy engagement, and advocacy for groups or populations [56]. However, despite this broader scope, many students in baccalaureate programs still reported low confidence in these areas, suggesting that much of their exposure remains at the level of theoretical knowledge rather than applied experience [16, 17, 25]. Additionally, the boundary between baccalaureate and master's level education remains unclear. Some advocacy and research competencies appeared to be more appropriate for master's level programs, raising concerns about the expectations for baccalaureate graduates [57]. This ambiguity highlighted the need for better‐defined competencies at each educational level to ensure that students are neither overwhelmed nor underprepared [58].

Despite the rich data obtained, certain gaps persist in the existing literature that warrant further investigation. The predominance of short‐term studies without longitudinal follow‐up failed to capture the long‐term evolution of professional skills and competencies after qualification [24, 25]. The reliance on self‐assessment tools introduces potential biases, with inconsistencies noted between self‐reported confidence and actual competence [16, 17]. Most importantly, the absence of standardised measures for assessing preparedness across studies complicated comparisons and the identification of overarching trends [19, 25]. Non‐clinical skills, such as leadership, business management, and adaptability, were underrepresented, leaving gaps in understanding the full spectrum of competencies necessary for modern practice [22, 23]. These limitations underscore the need for more comprehensive, long‐term, and standardised research to fully grasp the concept of preparedness of dental hygienists and to inform 1development of more effective educational strategies.

5. Strengths and Limitations

To the best of authors' knowledge, this scoping review is the first to map studies using the PRISMA‐ScR model to provide a comprehensive exploration of the gaps in the preparedness of dental hygiene students. While two studies mentioned alternative settings or independent roles, the review primarily emphasises attributes necessary for general clinical readiness. It is important to note that most studies included in this review were conducted in the USA, Canada, Australia, and New Zealand. No studies from African or Asian countries were identified, which is significant as preparedness and clinical practice experiences can vary greatly between different regions. This geographic limitation suggests that the findings may not be generalizable to all global contexts. Additionally, a key limitation of this review is that it was restricted to primary research articles published in English, and only peer‐reviewed articles were included in the analysis, which may have further limited the scope of our findings.

6. Conclusions

The review highlighted several gaps in the teaching and training of dental hygiene students in multiple countries. The findings underscore the need for educators and regulators to address these educational shortfalls to facilitate a smooth transition of dental hygiene students into professional practice. Future research should explore the preparedness of dental hygiene students and new graduates against the program learning outcomes and competency framework by professional dental hygienist associations. Qualitative research methodologies may also facilitate a deeper understanding of the views of various stakeholders and provide meaningful insights into the existing gaps in education and training and identify appropriate strategies to address these gaps. Addressing these gaps is crucial to ensure that dental hygiene education meets the evolving oral health needs of the population and facilitates the delivery of high‐quality oral health care services.

7. Clinical Relevance

Scientific rationale for study: effective delivery of clinical dental services depends on the preparedness of the future workforce. Despite advances in dental hygiene education, it remains uncertain if existing programs fully prepare graduates for the workplace.

Principal findings: this review identified gaps in clinical preparedness of dental hygiene students, related to clinical skills, communication, cultural competence, adaptability, and professional resilience, research use, policy engagement, and advocacy.

Practical implications: further enhancements in education and training of dental hygiene students are required to bridge the existing gaps to better equip graduates for effective delivery of oral and dental hygiene care.

Author Contributions

All three authors have made substantial contributions to the conception and design of the study, acquisition of data, analysis, and interpretation of data, drafting of the article and revising it critically for important intellectual content, and final approval of the version to be submitted.

Funding

The authors have nothing to report.

Ethics Statement

As this was a scoping review and no new data was collected, ethics approval was not required.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request. The data that support the findings of this study are openly available in Open Science Framework at https://osf.io/9b2rv/, reference number DOI: 10.17605/OSF.IO/9B2RV.