Full Title: Dental Hygiene and Direct Access to Care: Past and Present

Authors: Cynthia C. Gadbury-Amyot, MSDH, EdD, FADHA, Melanie L. Simmer-Beck, MS, PhD, Ann Lynch, BA, Lisa J. Rowley, RDH, MS

JDH Issue: October 2023

Program Track: Research

Abstract: The American Dental Hygienists’ Association (ADHA) defines direct access as the ability of a dental hygienist to initiate treatment based on their assessment of patient’s needs without the specific authorization of a dentist, treat the patient without the physical presence of a dentist, and maintain a provider-patient relationship. In 2000 there were nine direct access states; currently there are 42 states that have authorized some form of direct access. The ADHA has been instrumental in these legislative initiatives through strong advocacy efforts. While research and data support the benefits of direct preventive/therapeutic care provided by dental hygienists, many barriers remain. This paper chronicles key partnerships which have influenced and advocated for direct access and the recognition of dental hygienists as primary health care providers. The National Governors Association (NGA) released a report in 2014 suggesting that dental hygienists be “deployed” outside of dental offices as one strategy to increase access to oral health care along with reducing restrictive dental practice acts and increasing the scope of practice for dental hygienists. The December 2021 release of the National Institutes of Health report, Oral Health in America, further supports greater access to dental hygiene preventive/therapeutic care. This paper also reflects on opportunities and barriers as they relate to workforce policy, provides examples of effective state policies, and illustrates an educational curriculum specifically created to prepare dental hygienists to provide oral health services in settings outside of the dental office. Dental hygiene education must ensure that graduates are future-ready as essential health care providers, prepared to deliver direct access to dental hygiene care.

Learning Objectives:

• Compare and contrast the barriers that have resulted in widespread variation across the US when it comes to direct access to dental hygiene preventive/therapeutic oral health care services.
• Differentiate between the American Dental Hygienists’ Association definition of direct access, and direct access as defined in state practice acts across the US.
• Identify research outlined in this paper that shows positive associations between less restrictive statutes regulating dental hygienists’ scope of practice and direct access with improved patient outcomes.

CE Credit Hours: 2.0

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The American Dental Hygienists’ Association is an approved provider of dental continuing education as recognized by the Dental Board of California, Provider #5238.