How Dental Therapists & Hygienists Increase Access to Care in the U.S.

Dental therapists and hygienists are in high-demand and lobbying to become more professionally independent in order to treat patients in underserved areas of the United States. Sometimes compared to rural nurses, dental therapists and hygienists can perform preventative and certain restorative dental procedures under the supervision of a dentist. Their increased professional autonomy is expanding oral healthcare options to regions of the country which lack oral healthcare services. The aim of direct access dental care is to expand preventative dental procedures to rural and low-income areas of the United States. This can improve the overall healthcare options for populations who cannot easily access dental clinics.

In recent years, the profession of dental therapy and hygiene has seen exponential growth in the United States. With a much faster than average growth rate of 20 percent (BLS, 2019) anticipated between 2016 and 2026, dental hygienists are in high demand—adding 40,900 new jobs across the country. Since the implementation of the Affordable Healthcare Act, dental coverage for children is legally required and the American Dental Association (ADA) estimates that since 2014, 8.7 million children in the United States have gained access to dental care—three million of which have gained coverage through the health insurance marketplace (ADA, 2019). This expansion of dental insurance coverage equates to a 55 percent increase in the number of children covered under a dental insurance plan. This is increasing the demand for highly-qualified and trained dental professionals.

Expanding Access to Dental Care Through Advocacy

As the dental therapy profession has grown, so too has the movement for professional autonomy. Legislative lobbying and advocacy for dental therapists’ and hygienists’ scope of practice to include routine preventative and some restorative procedures are well-supported by both national and state-level professional chapters of the American Dental Hygienists Association (ADHA). These national and state-level organizations have been actively involved in lobbying for the expansion of direct access care for the benefit of patients in underserved areas of the United States.

The ADHA defines direct access as “the ability of a dental hygienist to initiate treatment based on their assessment of a patient’s needs without the specific authorization of a dentist, treat the patient without the presence of a dentist, and maintain a provider-patient relationship” (ADHA, 2019). Each state has its own unique professional licencing requirements for dental professionals, but most states that have opted to allow direct access care have set standards which generally enable dental therapists and hygienists to perform routine procedures in areas that lack dental health services.

A defining feature of dental therapy is that it is performed in areas or neighborhoods of municipalities which lack oral healthcare facilities, including adult care facilities, tribal lands, prisons, and public schools. Dental therapists and hygienists can also help expand the clientele of a dental practice by connecting dentists with patients in rural and low-income areas in need of more advanced procedures. Practicing under a collaborative agreement, dental therapists and hygienists are commonly hired by dentists and their work is completed through supervisory oversight. Some states have legislative clauses saying dental therapists may practice without the supervision of a dentist if the patient has previously been seen by a dentist or the treatment procedure is preventative or within the restorative scope of care of the dental therapist (Dimensions of Dental Hygiene, 2018).

Read on to learn more about how states are benefiting from having increased access to oral hygiene and dental therapy program accreditation.

Dental Therapists vs. Dentists

The majority of work performed by dental therapists is preventative; however, some restorative treatments are also permitted per state licensing standards. The table below compares the professional qualifications of dental therapists and dentists. Dental therapists often have similar academic and professional qualifications as dental hygienists. Specific job responsibilities vary by state and this list is general and comprehensive in nature.

Dental Therapists Dentists
Professional cleaning (tartar and plaque removal) Professional cleaning (tartar and plaque removal)
Educate patients on home dental care Educate patients on home dental care
Take dental x-rays Take dental x-rays
Apply sealants and fluoride treatments Apply sealants and fluoride treatments
Apply tooth whitening treatments Apply tooth whitening treatments
Dental fillings Dental fillings
Baby tooth extraction Baby tooth extraction
Preformed crown placement on baby teeth Preformed crown placement on baby teeth
Treatment involving the nerve of an adult tooth (e.g. crowns, root canals)

States with Expanded Access to Direct Access

As of April 2018, there were 42 states that allow the ADHA’s definition of direct access care to be performed by dental therapists and hygienists (ADHA, 2018). States with direct access legislation have increased by 28 percent over a ten-year period: in 2008, only 28 states had approved legislation for direct access care (ADHA, 2018).

Each of the 42 states permitting direct access care under ADHA’s definition has a unique collaborative agreement stating requirements for dental therapists, including clinical hour minimums, limitations on types of treatment that can be performed without the supervision of a dentist, and professional settings where dental therapists are permitted to work. A complete list of the current ADHA direct access requirements for individual state requirements can be found on the ADHA website (ADHA, 2018).

Accreditation of Dental Therapy Programs

Dental therapists and hygienists are typically required to complete a two- or three-year degree program (including clinical hours) and obtain state-level professional licenses in order to be eligible to work in most dental clinics.

Licensure requirements vary by state and while most programs are regionally accredited, the Commission on Dental Accreditation (CODA) and the ADA have put together accreditation criteria for dental therapy programs. These accreditation standards for dental therapy programs help prospective students and educational institutions ensure that the highest educational standards are being met in this newly emerging field of autonomous dental hygiene (CODA, 2019).

Benefits of Expanded Access to Dental Care

Direct access to dental care by dental therapists began in New Zealand in 1921 and has since expanded to 54 countries around the world. Direct access in the United States began in tribal villages in Alaska in 2004 and, since then, direct access dental care services have expanded to nearly every state.

Numerous studies published by the National Institutes of Health and in other scholarly publications have been cited in support of the efficacy of the expansion of direct access programs. Dental therapists have proven their ability to provide safe dental care, extend oral healthcare services to underserved areas, improve the overall health of vulnerable populations (including children and aging adults), expand the clientele of dental practices, and empower patients to take an active role in their own oral and medical healthcare.

Rachel Drummond, MEd
Rachel Drummond, MEd Writer

Rachel Drummond has contributed insightful articles to since 2019, where she offers valuable advice and guidance for those pursuing careers in the healthcare field, combining her passion for education with her understanding of the critical role that healthcare professionals play in promoting physical and mental well-being.

Rachel is a writer, educator, and coach from Oregon. She has a master’s degree in education (MEd) and has over 15 years of experience teaching English, public speaking, and mindfulness to international audiences in the United States, Japan, and Spain. She writes about the mind-body benefits of contemplative movement practices like yoga on her blog, inviting people to prioritize their unique version of well-being and empowering everyone to live healthier and more balanced lives.