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Dental Hygienist Scope of Practice and Access to Oral Health

posted on Wed, Sep 30 2015 1:47 pm by The Network for Public Health Law

The Network recently received a request from an individual in North Carolina who asked a number of questions regarding dental hygienists and the laws governing their scope of practice that state. The questions related to state laws governing the direct supervision of dental hygienists, practice arrangements where indirect supervision is permitted, as well as rules dealing with the operation of dental practices.

Dental hygienists clean teeth, examine patients for signs of oral diseases, and educate patients on oral health, among other tasks. The capacity of dental hygienists to work independently of dentists is an interesting question in public health law, as there is some evidence to suggest that expanding their capacity to practice improves access to care, leading to better oral health outcomes.

In North Carolina, a dental hygienist must practice with a dentist physically present, but with the following exceptions:

North Carolina Gen. Stat. Gen. Stat. § 90-233(a) deems the “supervision” requirement to be met where dental hygienists are employed by or under contract with certain governmental agencies and programs, are working in that capacity under the direction of a licensed dentist who is also employed by a government agency or program, and have been trained as public health hygienists.

North Carolina Gen. Stat. § 90-233(a1) permits dental hygienists who meet certain criteria to practice without a licensed dentist being physically present so long as:

  1. a licensed dentist directs in writing that the hygienist perform the functions;
  2. the licensed dentist has examined the patient according to the requirements specified in the statute;
  3. this examination occurred within 120 days prior to the time the dental hygiene functions are carried out; and
  4. the services are performed at certain locations, including “rural and community clinics operated by North Carolina Board of Dental Examiners-approved nonprofits; rural and community clinics operated by federal, state, county, or local governments; and any other facilities identified by the Office of Rural Health and approved by the Board as serving dental access shortage areas.”

Under North Carolina law, a dental hygienist cannot operate or own a dental practice.

Currently Alaska, Maine and Minnesota allow dental hygienists with additional training, called dental therapists, to perform certain services without the direct supervision of a dentist. A number of other states are considering similarly expanding the scope of practiced for dental hygienists. The general idea is that requiring hygienists to practice under a dentist makes accessing routine dental care such as cleanings more expensive. Furthermore, dental therapists can provide care in rural or other areas where there may be a shortage of dentists.

For much more on this, please see the Network brief, Access to Oral Health Care: Science and Law, and for a breakdown on North Carolina-specific law, see the Network’s North Carolina Dental and Oral Health Fact Sheet.

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