The Professional Practice Environment of Dental Hygienists in the Fifty States and the District of Columbia, 2001

April 2004

This study was funded by the National Center for Health Workforce Analysis, Bureau of Health Professions, Health Resources and Services Administration, under Contract
# HRSA 230-00-0099

Table of Contents (for on-line viewing only) Printer-friendly Adobe .pdf (1MB)

Preface | Executive Summary | Chapter 1 | Chapter 2 | Chapter 3 | Chapter 4 Factors Related to the DHPPI | Chapter 5 Fieldwork | Chapter 6 Access to Care | Appendix A. Project Advisory Committee | Appendix B. Questions for Meetings at ADHA Conference and Other Field Work | Appendix C. Detailed DHPPI Calculations |
Appendix D. Field Work Details | Appendix E. Background Charts and Tables |
Appendix F: Bibliography

Preface

The primary goals of this study are to: document the professional practice of dental hygienists in the fifty States and DC in 2001; to assess the extent to which the professional practice environment is related to numbers of practitioners, selected characteristics of practitioners, oral health outcomes, and utilization of oral health services; and to assess the impact of dental hygienists on access to care for underserved populations. A variety of data sets have been compiled to explore these issues, including statutes and regulations from the 50 States, estimated numbers of practitioners, oral health status indicators, oral health utilization statistics, and numbers of oral health education programs and graduates. These data have been supplemented by fieldwork and interviews conducted with practitioners from 26 States.

To document the professional practice of dental hygienists in the 50 States and the District of Columbia, the Health Resources and Services Administration (HRSA) commissioned this study by the Center for Health Workforce Studies at the School of Public Health at the University at Albany.

The Center for Health Workforce Studies is a not-for-profit research center operating under the auspices of the University at Albany of the State University of New York and Health Research, Incorporated (HRI). The views expressed in this report are those of the authors and do not necessarily represent the views or positions of the State University of New York, the School of Public Health, HRI, HRSA, or the subcontractors.

Executive Summary

This chapter presents an overview of the study and this report. It includes the following sections:

• Introduction
• Key Findings
• Discussion

• Legal and regulatory environment. Various factors in the legal and regulatory environment were addressed including governance of the profession, the composition of the State regulatory boards, the conditions for licensure in the State, and any required relationship between patient and dentist that might affect provision of hygiene services.
• Supervision in different practice settings. The supervision section of the document scored dental supervision requirements across a range of health settings including private dental practice and other non-traditional settings such as schools, nursing homes, long term care facilities, and correctional institutions.
• Tasks permitted under varying levels of supervision. In the section of the instrument addressing tasks allowed in legislation, services that are fundamental to hygienists such as prophylaxis were considered as well as the ability to provide expanded functions such as local anesthetics or placement of amalgam restorations.
• Reimbursement. The final category examined the reimbursement environment in the State and the manner in which payment to hygienists is addressed.

The criteria for the DHPPI were selected to represent the characteristics of an “ideal” professional practice for DHs. By strictly applying the scoring rules for each of the criteria to the statutes and regulations in each State, the resulting index provides a basis for comparing the legal scope of practice across the States.

The DHPPI reflects the ways in which DHs can practice and be paid in the different States. Scores were determined only by options found in legislation or regulation as of December 31, 2001; variations in actual practice not supported by laws or regulations were not considered. If a specific scoring component was not addressed in legislation or regulation, no score was awarded.

Higher scores on the DHPPI are generally associated with broader sets of tasks, more autonomous practice environments (i.e., less direct oversight by dentists), and greater opportunities for direct reimbursement for services.

• There are significant differences in the legal practice environment (as reflected in the DHPPI) across the 50 States and the District of Columbia.
• The DHPPI was not significantly correlated with the numbers of DHs per capita or dentists per capita across the 50 States as of 2001.
• The DHPPI was significantly positively correlated with the salaries of DHs as of 2001, indicating that DH salaries were higher in States permitting DHs more tasks and more professional autonomy.
• The DHPPI was also significantly and positively correlated with a number of indicators of utilization of oral health services and oral health outcomes, including percentages of people visiting the dentist in the past year and percentages of people having their teeth professionally cleaned in the past year.

1. The DHPPI could be revisited in 2006 to track changes in legal practice environments; growth in numbers of practitioners; and changing demographic characteristics, practice patterns, contributions to care, and roles in improving access to care.
2. A pilot study could be considered in two or three States to count/estimate the numbers of DHs who work in shortage areas, and assess their roles in providing care to underserved populations in rural communities, urban neighborhoods, community health centers, and institutions serving special populations.
3. Financial incentives could be created to encourage DHs to practice with underserved populations. Options include: direct payment by State Medicaid programs, loan forgiveness/repayment programs, etc.
4. To help improve access to dental care, an effort could be made to permit practice with remote supervision in more non-traditional settings, including schools and pre-schools, nursing homes, home health agencies, and prisons. Expansion of oral health services in traditional medical settings (e.g., pediatrician offices) should also be considered.

Chapter 1. Study Overview

This chapter presents an overview of the study and this report. It includes the following sections:

• Introduction
• Study objectives
• Study components
• Remainder of report

1. Create a Dental Hygiene Professional Practice Index (DHPPI) with numerical scores for each of the 50 States and the District of Columbia in 2001 that reflects key aspects of the professional practice environment for dental hygienists in the respective States;
2. Compile data on the numbers of individuals licensed as DHs in each State in 2001 and in prior years;
3. Assess the extent to which the professional practice environment for DHs improved in the 50 States in the 1990s; and
4. Estimate the extent to which the 2001 DHPPI is related to a variety of other statistics related to oral health in the 50 States, including: the numbers of DHs and dentists, oral health status indicators, other characteristics of DHs, and measures of access to health care in underserved areas.

1. Review statutes and regulations governing DHs in the fifty States (plus the District of Columbia) and create a statistical professional practice index (referred to as the Dental Hygiene Professional Practice Index) that reflects the practice environment for DHs in 2001;
2. Compile data on the trends of the numbers of individuals licensed as DHs and dentists in each State over the past decade to provide a statistical perspective on the changing numbers of practitioners in the oral health professions;
3. Conduct a series of statistical analyses to assess the extent to which the DHPPI is related to the numbers of DHs and dentists, selected measures of oral health status, access to dental services, and a number of other statistics across the 50 States;
4. Conduct fieldwork in several States to gather qualitative information about the professional practice of dental hygienists to supplement the data gathered for the study.
5. Assess the impact of differences in scope of practice laws and regulations governing DHs on access to oral health services in underserved areas; and
6. Prepare report(s) for HRSA and articles for peer-reviewed journals to disseminate the findings and conclusions of the study.