Expanding oral care opportunities: direct access care provided by dental hygienists in the United States

J Evid Based Dent Pract. 2014 Jun:14 Suppl:171-82.e1. doi: 10.1016/j.jebdp.2014.04.003. Epub 2014 Apr 5.


Dental hygienists expand access to oral care in the United States.

Background: Many Americans have access to oral health care in traditional dental offices however millions of Americans have unmet dental needs. For decades dental hygienists have provided opportunities for un-served and under-served Americans to receive preventive services in a variety of alternate delivery sites, and referral to licensed dentists for dental care needs.

Methods: Publications, state practice acts, state public health departments, the American Dental Hygienists' Association, and personal interviews of dental hygiene practitioners were accessed for information and statistical data.

Results: Dental hygienists in 36 states can legally provide direct access care. Dental hygienists are providing preventive services in a variety of settings to previously un-served and under-served Americans, with referral to dentists for dental needs.

Conclusion: Dental hygienists have provided direct access to care in the United States for decades. The exact number of direct access providers in the United States is unknown. Limited research and anecdotal information demonstrate that direct access care has facilitated alternate entry points into the oral health systems for thousands of previously un-served and underserved Americans. Older adults, persons with special needs, children in schools, pregnant women, minority populations, rural populations, and others have benefited from the availability of many services provided by direct access dental hygienists. Legislatures and private groups are becoming increasingly aware of the impact that direct access has made on the delivery of oral health care. Many factors continue to drive the growth of direct access care. Additional research is needed to accumulate qualitative and quantitative outcome data related to direct access care provided by dental hygienists and other mid level providers of oral health services.

Keywords: ADHA; Business of Dental Hygiene; Dental Hygiene Collaborative Practice; Dental Hygiene Direct Access; Dental Hygiene Independent Practice; Dental Hygiene Practice Acts.

MeSH terms

  • Adult
  • Aged
  • Child
  • Delegation, Professional / legislation & jurisprudence
  • Dental Care for Aged
  • Dental Care for Disabled
  • Dental Care* / economics
  • Dental Care* / legislation & jurisprudence
  • Dental Hygienists* / education
  • Dental Hygienists* / legislation & jurisprudence
  • Female
  • Health Services Accessibility* / economics
  • Health Services Accessibility* / legislation & jurisprudence
  • Humans
  • Medicaid / economics
  • Medically Underserved Area
  • Minority Groups
  • Needs Assessment
  • Pregnant Women
  • Professional Practice
  • Referral and Consultation
  • Rural Health Services
  • School Dentistry
  • United States