Dental Hygienists' Attitudes and Experiences with Public Health Supervision in Iowa

J Dent Hyg. 2021 Dec;95(6):23-30.


Purpose: Iowa is one of 42 states with a direct access dental hygiene workforce model. Public health supervision (PHS) in Iowa allows dental hygienists (DH) to provide services in community settings without a prior examination from a dentist. The purpose of this study was to assess the current PHS workforce in Iowa and add to the body of evidence on direct access DH care.Methods: A 40-item mixed-mode survey was administered to all DH working under PHS in Iowa (n=126). Consent letters were mailed with directions to an online survey. Follow-up letters were sent to non-responders with an enclosed paper copy of the survey. Univariate analyses were performed to analyze the data.Results: The response rate was 52% (n=62), with 69% (n=42) of participants currently providing services under PHS. The most common employer categories were local public health agencies (59%), community health centers (CHCs) (20%), and nonprofit clinics (10%). The most common types of services provided under PHS were dental screenings (95%), fluoride varnish (91%), and sealants (50%). The majority of supervising dentists worked in private practice (61%) and CHCs (27%). Most supervising dentists (71%) accepted some referrals; however, a majority of PHS participants (71%) reported that it was somewhat or very difficult to find dentists to accept patient referrals.Conclusion: Most PHS DHs were employed by government agencies, however the majority of supervising dentists worked in private settings. Although most supervising dentists accepted at least some patient referrals, PHS DHs still experienced a high degree of difficulty referring patients for care.

Keywords: access to care; direct access; health disparities; oral health; public health dental hygienists; workforce models.

MeSH terms

  • Attitude of Health Personnel
  • Dental Hygienists*
  • Dentists
  • Humans
  • Iowa
  • Professional Practice
  • Public Health*
  • Surveys and Questionnaires