Expanding the role of dental hygienists could be key to increasing access to high-quality oral healthcare, which experts say can offer safety net primary care for the poor. Dental providers often spot indications of cancer and HIV, and prevent the worsening of infections. Some argue that hygienists could provide services at a lower cost than dentists, making dental care more affordable to lower-income Americans.
Nadereh Pourat, a professor of health policy and management at UCLA, said every underserved community could benefit from expanding the role of dental hygienists to handle basic care. “If you had a hygienist that could do a little bit more ... it could address some of the shortages,” Pourat said.
But restrictive state scope-of-practice laws pose a challenge, said Sarah Happy at Temple University law school. State dental associations have fought to limit the scope of hygienists' practice, saying hygienists can't provide care as cost-effectively as dentists.
“Lack of access to oral healthcare contributes to profound and enduring oral health disparities in the United States,” according to a 2011 report by the Institute of Medicine and the National Research Council, which estimated 33.3 million Americans are underserved.
Happy and fellow Temple analyst Damika Webb produced a map describing hygienist scope of practice laws around the country. Their research found that 16 states and the District of Columbia prohibit hygienists from practicing independently. Kansas is the only state to allow scaling, and California, Kansas and West Virginia are the only states that allow hygienists to apply sealants and fluoride.
States with less restrictive laws, including New Mexico and Oregon, allow hygienists to write prescriptions for some drugs. Maine has been a particularly boisterous battleground. This summer, state lawmakers there debated a bill that would have allowed hygienists to practice independently, similar to Alaska and Minnesota.
Supporters of the Maine bill argued that expanding hygienists' scope of practice increases access to care. They said Maine's ratio of one dentist for every 2,300 residents is far less than the national average of one dentist for every 1,600 people.
But the Maine Dental Association lobbied hard against the bill, and it failed. John Bastey, director of government relations for the Maine Dental Association, said there are enough dentists to serve Maine's population. “We think it's really important that dentists should be making the decision in terms of cutting the living tissue and doing other surgery,” he said. Plus, he argued that having dental hygienists deliver more services would not produce cost savings for patients.
