A new study from the Pew Charitable Trusts finds that restrictions on the ability of dental hygienists to practice in public schools has negative effects on the oral health of poorer children.
This brief describes a range of state-based regulations or policies that either limit or prohibit dental hygienists from sealing children’s teeth at school, or create financial burdens that work against the expansion of school sealant programs. Research and experience find that these rules and policies do not have the effect of protecting the public from unsafe dental practice, nor do they promote the efficient use of public resources. Information was compiled from interviews with state dental directors, Medicaid officials, school sealant providers, and other state-level oral health stakeholders.
The report says that while “[r]esearch and experience find that…rules and policies do not have the effect of protecting the public from unsafe dental practices,” giving sealants to all of the 6.5 million low-income children without them could prevent up to 3.4 million cavities over four years.
What are the regulations that prevent access to basic dental care without any clear benefits? In addition to problems related to Medicaid reimbursement, hygienists’ hands are tied because approval from a dentist is necessary before providing sealants.
State practice acts might include requirements that dentists examine children before a hygienist can seal their teeth in school, that dentists be present while a hygienist performs this service, or that private dentists cannot employ hygienists working in schools. They may also include rules that set very low limits on the numbers of school-based hygienists that any one dentist can supervise. In describing dental hygiene scope of practice rules, a 2016 report from the national Oral Health Workforce Research Center stated, “State-based regulatory constraints for dental hygienists may impede access to care as much as the economic and logistical barriers that are known to prevent some patients from obtaining oral health services.” In more recent research, the center found that a “more autonomous dental hygienist scope of practice had a positive and significant association with population oral health in both 2001 and 2014.”
Additionally, hygienists are subject to supervision either by government employees (like in Kentucky and Virginia) or dentists (as in Alabama and Mississippi). On top of this government-mandated hand-holding, some states have regulations limiting the number of hygienists a dentist can supervise.
Medical licensing and scope-of-practice restrictions drive up healthcare costs for everyone, but this study highlights a particularly egregious case of restricting access to a relatively simple medical procedure to a vulnerable population.