Dental Hygienists’ Contribution to the Oral Health Workforce in Supporting the Oral Health of People in the Kingdom of Saudi Arabia (KSA)

Abstract

Introduction The oral health workforce plays a central role in the World Health Organization's Global Strategy and Action Plan on Oral Health, which highlights the need for transformative changes in workforce models to address population oral health needs. In the Kingdom of Saudi Arabia (KSA), poor oral health is a significant public health concern alongside other non-communicable diseases. Despite advancements in healthcare aligned with Saudi Vision 2030, the oral healthcare system faces challenges, including workforce imbalances, limited preventive oral healthcare, and disparities in oral healthcare access. Globally, dental hygienists play a role in prevention and oral health education, significantly contributing to both clinical and community settings to enhance access to oral healthcare; however, in KSA, their capacity is limited, and their role are unclear. Research is needed to evaluate the current role of dental hygienists in KSA, identify barriers to their optimal integration into oral healthcare delivery, and explore opportunities to expand their contributions in line with national and international goals, for better oral health outcomes. Aim To explore dental hygienists’ current role and practice in the Kingdom of Saudi Arabia, and how this may possibly change in future to better support the oral health of the population as part of the oral health workforce. Methods A sequential mixed-methods approach was adopted, comprising a questionnaire survey followed by semi-structured interviews. Study 1 (Quantitative Survey): An online questionnaire was distributed to dental hygienists across KSA to collect data on their demographic profiles, working environments, service delivery practices, career motivations, and job satisfaction. Statistical analysis included tests like chi- 3 square tests, correlation coefficients, and binomial tests to identify key patterns and associations. Study 2 (Qualitative Interviews): Purposive sampling was used to recruit participants for virtual semi-structured interviews, including dental hygienists, dentists, and dental nurses. Interviews explored perceptions of the dental hygiene profession, its role in oral healthcare, and the barriers and facilitators to its integration into the healthcare system. Framework thematic analysis was applied to identify and interpret key themes. Findings of each study were reported separately and later integrated into the discussion. Results This study draws on diverse perspectives and shows trends within the dental hygiene workforce in KSA. While the survey response rate (9%, n=91) from dental hygienists and qualitative sample size (20) from dental team members present certain limitations, the findings still offer insights into the profession, highlighting areas for further exploration. A strong desire to work in healthcare, serve others, and contribute to public health motivated 97% of responding hygienists, while 51% of those for whom dental hygiene was their first career were influenced by early exposure to dental hygiene, either through personal dental care experiences or professional experience in the field. The findings from interviews highlighted the importance of informed decision-making in achieving career satisfaction, as participants pursued the profession seeking professional recognition, high-income potential, and job security. When these expectations were unmet, dissatisfaction and retention issues arose, with 58% of survey respondents considering leaving the profession. Findings suggested limitations in the scope and settings in which responding dental hygienists operate with a focus on the provision of oral hygiene instruction (95%) and scaling (87%), in predominantly urban locations (59%), hospital environments (86%), and public sector facilities (59%). Limited involvement in community-based care or with vulnerable groups restricts their contributions to broader public health goals. Fifty percent of the respondents to the survey were satisfied with their job, citing the extent 4 to which hygienists could fully utilise their skills as a key factor. Those working independently of dentists reported higher satisfaction levels. Findings from the interviews highlighted barriers that hinder the optimal utilisation of dental hygienists including limited skillsets, insufficient delegation of tasks by dentists, and inadequate access to essential resources. Participants proposed strategies to address these issues, such as enhancing undergraduate programmes, offering tailored continuous professional development, and fostering interprofessional collaboration through joint education and training. Developing a clearly defined scope of practice and establishing clear clinical guidelines were also recommended. Participants in the interviews, including hygienists, dentists, and dental nurses, perceived that the profession is underutilised but envisioned opportunities for growth. While individual views on specific areas of expansion varied, collectively, they pointed toward a more expanded role for dental hygienists. Proposed expansions included a stronger presence in primary oral healthcare, increased involvement in community settings, and broader responsibilities within dental practices. Participants recognised that achieving this requires improvements in both the profession and the healthcare system. For the profession, key areas include career counselling, standardised education and licensing, a comprehensive scope of practice, expanded training programmes, and leadership development. These measures would attract motivated students, strengthen professional identity, and sustain workforce commitment. For the healthcare system, strong governance is important, including a dedicated oral health department, data-driven planning, efficient resource allocation, preventive care pathways, policies addressing health risks, and improved oral health literacy. These initiatives would secure role for hygienists and enhance oral healthcare delivery in Saudi Arabia. Conclusion The findings suggest that while dental hygienists' current role, scope of practice and workplace locations in KSA are limited, opportunities exist to expand their role within the oral healthcare workforce to better support oral healthcare delivery which relate to careers, education and training, governance, care delivery and leadership. Expanding the role of dental hygienists aligning the oral health care system in KSA with global best practice is recommended.