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Allied dental professional scope of practice

Health Factors: Access to Care
Decision Makers: State Government Healthcare Professionals & Advocates
Evidence Rating: Some Evidence
Population Reach: 10-19% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

The roles of allied dental professionals can be expanded by increasing the scope of duties they are statutorily allowed to perform, decreasing dentist supervision requirements, or developing opportunities for mid-level professionals. Allied dental professionals include dental assistants, community dental health coordinators, dental hygienists, and dental therapists (Rodriguez 2013b). Allied dental professionals are often called dental auxiliaries (Dyer 2016). In partnership with dentists, dental auxiliaries increasingly provide care in community settings such as schools, nursing homes, community health centers, and Indian health centers (Naughton 2014). Dental therapists perform examinations, preventive services, local anesthesia, restorations, and extractions under the indirect supervision of dentists (Friedman 2014). Domestically, dental therapists currently practice only in Minnesota, Maine, and tribal areas of Alaska (ADHA-Provider models).

Expected Beneficial Outcomes

Increased access to oral health care
Increased availability of health professionals in underserved areas
Reduced cavities

Evidence of Effectiveness

There is some evidence that expanding the roles of allied dental professionals increases access to oral health care (Simmer-Beck 2015, Bailit 2012, Galloway 2002). A number of studies indicate that allied dental professionals who have been trained to perform restorations and other treatments can perform these treatments as well as dentists (Dyer 2016, Phillips 2013, Rodriguez 2013b, Naughton 2014, Bailit 2012, Galloway 2002). Additional evidence is needed to confirm effects and determine which role expansions best increase access to care (Naughton 2014, Dyer 2016).

Dental therapists provide care with indirect dentist supervision and have been shown to increase access to dental care and reduce cavities, especially via programs for low income school children (Bailit 2012, Simmer-Beck 2015). In Minnesota, dental therapists are required to serve underserved populations; early evidence suggests greater access to oral health care in rural and metropolitan areas (Blue 2016). Dental hygienists who serve in community settings under policies that support a similarly broad scope of practice (i.e., direct access policies) also appear to increase access to care for elderly individuals, those with special needs, children, minorities, and rural populations (Naughton 2014). Patients report satisfaction with care provided by dental auxiliaries (Dyer 2016).

Evidence regarding the effect of expanded function allied dental professionals on private practice income is mixed (Bailit 2012, Beazoglou 2012a, Beazoglou 2012b, Galloway 2002); financial effect appears to depend on the functions performed, office composition, and caseload (Rodriguez 2013b, Beazoglou 2012b). Studies in New Zealand, Australia, and Canada suggest that dental therapists can be cost effective, particularly when treating children (Friedman 2014); additional evidence is need to determine economic viability in the US (Phillips 2013).

Insurance reimbursement policies may not support expansion of auxiliary roles; for example, as of 2014, dental hygienists may be directly reimbursed as Medicaid providers in only 16 states (Naughton 2014).

Implementation

United States

Many states have revised or considered revising their dental scope of practice laws in the last decade (Elwood 2013). As of 2016, 39 states allow dental hygienists to initiate patient care outside of traditional dental offices, without the presence of a dentist (ADHA-Provider models) and as of 2014, 16 states allow dental hygienists to receive direct reimbursement for care provided to Medicaid eligible patients (Naughton 2014). As of 2014, only 15 states explicitly bar independent practice (LawAtlas-Dental hygienist). 

Dental therapists practice in more than 54 countries including Canada, Australia, and Great Britain (Blue 2016, Crosby 2012), and domestically in Minnesota, Maine, and Native American Alaskan villages (ADHA-Provider models, Friedman 2014).

Wisconsin

In Wisconsin, dental assistants are allowed by statute to provide coronal polishing (ADA-Dental assistants 2011), and dental hygienists may place temporary restorations (McKinnon 2007). Dental hygienists may be directly reimbursed as Medicaid providers (Naughton 2014). Dental therapists cannot practice in Wisconsin (Bailit 2012).

Implementation Resources

ADHA-Dental hygiene programs - American Dental Hygienists’ Association (ADHA). Education & careers: Dental hygiene programs. Accessed on June 2, 2016
DANB - Dental Assisting National Board Inc. (DANB). Meet state requirements. Accessed on December 8, 2015
LawAtlas-Dental hygienist - LawAtlas. Dental Hygienist Scope of Practice Laws Map. Accessed on May 20, 2016
MDA-Dental therapist - Minnesota Dental Association (MDA). Career Center: Dental Therapist. Accessed on June 2, 2016
ME-Ch 575 2014 - Eves M. Chapter 575: An act to improve access to oral health care H.P. 870 - L.D. 1230. Augusta: State of Maine Legislature; 2014. Accessed on December 30, 2015
Pew-Expand dental - The Pew Charitable Trusts (Pew). Expanding the dental workforce. Accessed on May 31, 2017

Citations - Description

ADHA-Provider models - American Dental Hygienists’ Association (ADHA). The benefits of dental hygiene-based oral health provider models. Accessed on June 2, 2016
Dyer 2016* - Dyer TA, Robinson PG. The acceptability of care provided by dental auxiliaries: A systematic review. Journal of the American Dental Association. 2016;147(4):244–254. Accessed on May 23, 2016
Friedman 2014* - Friedman JW, Mathu-Muju KR. Dental therapists: Improving access to oral health care for underserved children. American Journal of Public Health. 2014;104(6):1005–1009. Accessed on May 23, 2016
Naughton 2014* - Naughton DK. Expanding oral care opportunities: Direct access care provided by dental hygienists in the United States. Journal of Evidence Based Dental Practice. 2014;14(Suppl 1):171–182.e1. Accessed on May 23, 2016
Rodriguez 2013b* - Rodriguez TE, Galka AL, Lacy ES, et al. Can midlevel dental providers be a benefit to the American public? Journal of Health Care for the Poor and Underserved. 2013;24(2):892–906. Accessed on May 23, 2016

Citations - Evidence

Bailit 2012* - Bailit HL, Beazoglou TJ, DeVitto J, McGowan T, Myne-Joslin V. Impact of dental therapists on productivity and finances: I. Literature review. Journal of Dental Education. 2012;76(8):1061-7. Accessed on November 27, 2015
Beazoglou 2012a* - Beazoglou TJ, Chen L, Lazar VF, et al. Expanded function allied dental personnel and dental practice productivity and efficiency. Journal of Dental Education. 2012;76(8):1054–60. Accessed on December 1, 2015
Beazoglou 2012b* - Beazoglou TJ, Lazar VF, Guay AH, Heffley DR, Bailit HL. Dental therapists in general dental practices: An economic evaluation. Journal of Dental Education. 2012;76(8):1082-91. Accessed on December 7, 2015
Blue 2016* - Blue CM, Kaylor MB. Dental therapy practice patterns in Minnesota: A baseline study. Community Dentistry and Oral Epidemiology. 2016;1–9. Accessed on May 23, 2016
Dyer 2016* - Dyer TA, Robinson PG. The acceptability of care provided by dental auxiliaries: A systematic review. Journal of the American Dental Association. 2016;147(4):244–254. Accessed on May 23, 2016
Friedman 2014* - Friedman JW, Mathu-Muju KR. Dental therapists: Improving access to oral health care for underserved children. American Journal of Public Health. 2014;104(6):1005–1009. Accessed on May 23, 2016
Galloway 2002* - Galloway J, Gorham J, Lambert M, et al. The professionals complementary to dentistry: Systematic review and synthesis. London: University College London, Eastman Dental Hospital, Dental Team Studies Unit; 2002. Accessed on February 24, 2016
Naughton 2014* - Naughton DK. Expanding oral care opportunities: Direct access care provided by dental hygienists in the United States. Journal of Evidence Based Dental Practice. 2014;14(Suppl 1):171–182.e1. Accessed on May 23, 2016
Phillips 2013* - Phillips E, Shaefer HL. Dental therapists: Evidence of technical competence. Journal of Dental Research. 2013;92(7 Suppl 1):11S–15S. Accessed on May 23, 2016
Rodriguez 2013b* - Rodriguez TE, Galka AL, Lacy ES, et al. Can midlevel dental providers be a benefit to the American public? Journal of Health Care for the Poor and Underserved. 2013;24(2):892–906. Accessed on May 23, 2016
Simmer-Beck 2015* - Simmer-Beck M, Walker M, Gadbury-Amyot C, et al. Effectiveness of an alternative dental workforce model on the oral health of low-income children in a school-based setting. American Journal of Public Health. 2015;105(9):1763–1769. Accessed on February 24, 2017

Citations - Implementation

ADA-Dental assistants 2011 - American Dental Association (ADA). Expanded functions for dental assistants. Chicago: American Dental Association (ADA); 2011. Accessed on May 31, 2016
ADHA-Provider models - American Dental Hygienists’ Association (ADHA). The benefits of dental hygiene-based oral health provider models. Accessed on June 2, 2016
Bailit 2012* - Bailit HL, Beazoglou TJ, DeVitto J, McGowan T, Myne-Joslin V. Impact of dental therapists on productivity and finances: I. Literature review. Journal of Dental Education. 2012;76(8):1061-7. Accessed on November 27, 2015
Blue 2016* - Blue CM, Kaylor MB. Dental therapy practice patterns in Minnesota: A baseline study. Community Dentistry and Oral Epidemiology. 2016;1–9. Accessed on May 23, 2016
Crosby 2012 - Crosby J. Dental therapists bridge gap. Star Tribune. 2012. Accessed on December 8, 2015
Elwood 2013* - Elwood TW. Patchwork of scope-of-practice regulations prevent allied health professionals from fully participating in patient care. Health Affairs. 2013;32(11):1985–1989. Accessed on May 23, 2016
Friedman 2014* - Friedman JW, Mathu-Muju KR. Dental therapists: Improving access to oral health care for underserved children. American Journal of Public Health. 2014;104(6):1005–1009. Accessed on May 23, 2016
LawAtlas-Dental hygienist - LawAtlas. Dental Hygienist Scope of Practice Laws Map. Accessed on May 20, 2016
McKinnon 2007* - McKinnon M, Luke G, Bresch J, Moss M, Valachovic RW. Emerging allied dental workforce models: Considerations for academic dental institutions. Journal of Dental Education. 2007;71(11):1476–91. Accessed on February 29, 2016
Naughton 2014* - Naughton DK. Expanding oral care opportunities: Direct access care provided by dental hygienists in the United States. Journal of Evidence Based Dental Practice. 2014;14(Suppl 1):171–182.e1. Accessed on May 23, 2016

Page Last Updated

June 1, 2016

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