Should Hygienists Practice Independently in Underserved Areas?

Could the oral health of underserved communities be improved by allowing hygienists to provide preventative care without the oversight of a dentist? A new study suggests that many hygienists feel qualified to provide prophylactic cleaning, sealants, and fluoride varnishes without the direct oversight of a dentist, and that permitting this in underserved communities could be beneficial.

This idea is somewhat controversial, as many dentists feel that permitting patients to see only a hygienist amounts to an unacceptable risk of delaying needed treatment or missing a diagnosis of oral pathology. Furthermore, many states have regulations stating that hygienists cannot practice without a treatment plan, exam or recommendation by a licensed dentist. To do so regardless of regulatory standards may be considered unprofessional conduct under the law.

However, many hygienists argue that in practice they are instructed to bend the regulations anyway, especially if the patient is waiting or the dentist is busy. Starting a cleaning, taking x-rays or doing periodontal charting before the dentist has documented authorizing it may technically violate these regulations. Despite this, many feel that in practice this improves efficiency and actually leads to better patient care.

These regulations vary by state, with different jurisdictions allowing different levels of hygienist autonomy. According to the American Dental Hygienists' Association (ADHA), so-called "direct access" states allow hygienists to initiate treatment based on their assessment of a patient's needs without the specific authorization of a dentist. Some of these states include stipulations that patients must be seen by a dentist within a certain time period before or after visiting the hygienist, but have seen a degree of success in increasing the availability of basic oral health services in poor and underserved communities.

Allowing hygienists to practice independently in poor and rural communities could help improve oral health and reduce barriers to care such as cost and location. Hygienists could also opt to open solo offices or support extended hours at their current practice for patients in need of a cleaning and rudimentary exam who otherwise would not see a dental professional at all.

American Dental Hygienists' Association. (2016). Direct Access States. Retrieved October 04, 2016 from

Gutkowski, S. (n.d.). When Push Comes to Shove. Retrieved October 4, 2016, from

Pablos, T. (2016, September 27). Study: Hygienists feel ready to practice independently. Retrieved October 04, 2016, from

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