states require an associate degree in Dental Hygiene, successful completion of a state licensure examination, as well as a clinical examination also typically administered by the state. Dental hygienists school programs usually require both general education courses and courses specific to the field of dental hygiene. General education courses important to dental hygiene degrees include college level algebra, biology, and chemistry. Courses specific to dental hygiene may include anatomy, oral anatomy, materials science, pharmacology, radiography, periodontology, nutrition, and clinical skills. A Bachelor of Science in Dental Hygiene is typically a four-year program. Students entering a bachelor's degree program are required to have a high school diploma or equivalent, but many dental hygienists with an associate degree or certification enter the bachelor's degree programs to expand their clinical expertise and help advance their careers. Graduate degrees in the field of dental hygiene are typically two-year programs and are completed after the bachelor's degree. Common graduate courses in dental hygiene include Healthcare Management, Lab Instruction, and Clinical Instruction. In addition, the American Dental Hygienists' Association has defined a more advanced level of dental hygiene, the Advanced Dental Hygiene Practitioner otherwise known as a dental therapist. Dental hygienist students perform practical oral examinations free of charge at some institutions which have expressed a shortage in recent years. Direct access to care with a dental hygienist The dental hygienists in some parts of North America can provide oral hygiene treatment based on the assessment of a patient's needs without the authorization of a dentist, treat the patient in absence of a dentist, and also maintain a provider-patient relationship. India The Dental Hygienist Course in India is a full-time 2-year diploma course. The Dental Hygienist course is regulated and controlled by the Dental Council of India. After completion of the course a dental hygienist should register with a state dental council. Any person who is a registered dental hygienist in a one state may practice as such in any other. The Federation of Indian Dental Hygienists Association is the primary national body representing the dental hygienist profession in India, however some state dental hygienist associations also work at state level. In India, dental hygienists do not need to be employed by a dentist but can have their own clinic. Canada British Columbia 1995 - A client must have seen a dentist within the previous 365 days in order for the hygienist to provide dental hygiene