Does Occupational Licensing Impact Access to Dental Care?

There is a need in the United States for greater access to dental and oral health services. As of 2018, over five thousand three hundred dental Health Professional Shortage Areas had been identified nationwide. Nearly fifty-four million people live in those shortage areas, and the Bureau of Health Workforce estimates that almost ten thousand additional practitioners are needed to meet their needs. Occupational licensing rules likely are contributing to this shortage as they often prevent mid-level dental-care providers, such as dental therapists and dental hygienists, from performing low-risk, non-invasive procedures without supervision by a licensed dentist. According to occupational licensing research, such restrictions may shrink the available pool of dental-care providers and increase the cost of receiving those procedures. For example, teeth cleaning sometimes is restricted to the practice of dentistry despite its low risk. Not only do independent dental therapists and hygienists have the ability to perform these services, but evidence in occupational licensing literature suggests that the quality of care provided is on par with that of supervised professionals. This research-in-focus piece examines existing research on occupational licensing with specific emphasis on aspects that relate to dental care. We first highlight the need for accessible dental care. We then examine the effect of occupational licensing on access to dental care, specifically focusing on how it impacts quality, cost, and availability. We explore how mid-level providers may expand access to care, and we end with a conversation about reforming occupational licensing laws. Our key finding is that reforming laws that limit access to mid-level dental-care providers could reduce dental costs and provide more opportunities for Americans to receive dental care.

Brian Isom and Jacob M. Caldwell

Center for Growth and Oppurtunity

August 7, 2019

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