Dental Hygiene and Direct Access to Care: Past and present.

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.

Gadbury-Amyot CC ，Simmer-Beck ML ，Lynch A ，Rowley LJ ... -  《-》

Dental hygiene and direct access to care: Past and present.

Gadbury-Amyot CC ，Simmer-Beck ML ，Lynch A ，Rowley LJ ... -  《-》

The American Dental Hygienists' Association Leads the Profession into 21st Century Workforce Opportunities.

With the dental hygiene profession undergoing tremendous transformation as greater and more diverse workplace opportunities present themselves, the American Dental Hygienists' Association (ADHA) is leading the effort to ensure that dental hygienists are prepared to take advantage of these growing opportunities in today's constantly evolving health care landscape. ADHA's vision statement calls for the integration of dental hygienists into the health care delivery system as essential primary care providers to expand access to oral health care. This article discusses changes in dental hygiene curriculum, as well as how changes in the health care environment and legislative outcomes are impacting workplace opportunities for dental hygienists in the 21st century. Research from ADHA's Transforming Dental Hygiene Education and the Profession for the 21st Century white paper and other oral health-related literature, ADHA policies, and ADHA survey research describe the evolving dental hygiene workplace environment. The article discusses trends in education, health care, legislative and regulatory practice, and societal need that are creating new workforce opportunities for the dental hygiene profession. With rapid change in both the oral and overall health care environments, transformation in dental hygiene curriculum and competencies, and more states allowing the public to have direct access to dental hygienists, dental hygiene professionals are expanding their presence into all aspects of the health care system. ADHA is leading this effort to help dental hygienists provide that care by expanding workforce opportunities and allowing dental hygienists to practice to the full extent of their scope. The dental hygiene profession must be prepared and ready to embrace these opportunities. In doing so, new career pathways will be available for dental hygiene professionals that will also improve the public's access to oral health care.

Battrell A ，Lynch A ，Steinbach P 《-》

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

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

Naughton DK 《-》

A Mid-Level Dental Provider in Oregon: Dental hygienists' perceptions.

Purpose: Many states are exploring alternative provider models and examining the role of the dental hygienist to address access to care challenges as the United States continues to face increasing demands for oral healthcare services. The purpose of this study was to assess dental hygienists' opinions in the state of Oregon regarding the current limitations of dental hygienists' scope of practice, perceived need for a mid-level provider in Oregon, and personal interest in becoming a mid-level provider.Methods: In December 2013 a survey was mailed to a sample of 1,231 dental hygienists registered in Oregon representing 30% of the licentiates. All licentiates holding expanded practice permits (EPP) were included in the sample (n=351). The following categories were included in the 32-question survey: scope of practice, mid-level provider, current practice, and demographics.Results: A total of 440 surveys were returned for a response rate of 36%. Of the EPP holders, 51% responded to the survey. Over half of respondents (59%) believe that a mid-level provider is needed in the state. Respondents holding membership in the American Dental Hygienists' Association, as well as EPP holders, were significantly more likely to respond that a mid-level dental provider was needed in the state (p<0.0001). Ninety-one percent (n=400) of respondents agreed or strongly agreed that if a mid-level provider was introduced in Oregon, the new provider should be a registered dental hygienist model. Forty-three percent (n=186) of respondents were interested in becoming mid-level providers and 47% (n=203) of respondents believed that the minimum education for a mid-level provider should be a bachelor's degree. The majority, 74% (n=137), of those interested in becoming a mid-level provider indicated a preference in completing their education through online teaching combined with a clinical internship.Conclusion: There is strong support from dental hygienists in Oregon that a need exists for a mid-level dental provider and that this provider model should be dental hygiene based. Individuals interested in developing a curriculum for a mid-level provider should consider including online teaching components with a clinical internship component.

Coplen AE ，Bell K ，Aamodt GL ，Ironside L ... -  《-》