Allied dental professional scope of practice

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 (). Allied dental professionals are often called dental auxiliaries (). In partnership with dentists, dental auxiliaries increasingly provide care in community settings such as schools, nursing homes, community health centers, and Indian health centers (). Dental therapists perform examinations, preventive services, local anesthesia, restorations, and extractions under the indirect supervision of dentists (). Domestically, dental therapists currently practice only in Minnesota, Maine, and tribal areas of Alaska (ADHA-Provider models).

Expected Beneficial Outcomes (Rated)

  • Increased access to oral health care

Other Potential Beneficial Outcomes

  • 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 (, , ). 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 (, , , , , ). Additional evidence is needed to confirm effects and determine which role expansions best increase access to care (, ).

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 (, ). In Minnesota, dental therapists are required to serve underserved populations; early evidence suggests greater access to oral health care in rural and metropolitan areas (). 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 (). Patients report satisfaction with care provided by dental auxiliaries ().

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

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 ().

Impact on Disparities

Likely to decrease disparities

Implementation Examples

Many states have revised or considered revising their dental scope of practice laws in the last decade (). 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 (). 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 (, Crosby 2012), and domestically in Minnesota, Maine, and Native American Alaskan villages (ADHA-Provider models, ).

Implementation Resources

DANB - Dental Assisting National Board Inc. (DANB). Meet state requirements.

LawAtlas-Dental hygienist - LawAtlas. Dental Hygienist Scope of Practice Laws Map.

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.

Pew-Expand dental - The Pew Charitable Trusts (Pew). Expanding the dental workforce.

MDA-Dental therapist - Minnesota Dental Association (MDA). Career Center: Dental Therapist.

ADHA-Dental hygiene programs - American Dental Hygienists’ Association (ADHA). Education & careers: Dental hygiene programs.

Citations - Evidence

* Journal subscription may be required for access.

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.

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.

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.

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.

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.

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.

Phillips 2013* - Phillips E, Shaefer HL. Dental therapists: Evidence of technical competence. Journal of Dental Research. 2013;92(7 Suppl 1):11S–15S.

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.

Blue 2016* - Blue CM, Kaylor MB. Dental therapy practice patterns in Minnesota: A baseline study. Community Dentistry and Oral Epidemiology. 2016;1–9.

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.

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.

Citations - Implementation Examples

* Journal subscription may be required for access.

Crosby 2012 - Crosby J. Dental therapists bridge gap. Star Tribune. 2012.

LawAtlas-Dental hygienist - LawAtlas. Dental Hygienist Scope of Practice Laws Map.

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.

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.

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.

Blue 2016* - Blue CM, Kaylor MB. Dental therapy practice patterns in Minnesota: A baseline study. Community Dentistry and Oral Epidemiology. 2016;1–9.

ADHA-Provider models - American Dental Hygienists’ Association (ADHA). The benefits of dental hygiene-based oral health provider models.

Date Last Updated

Jun 1, 2016