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Dental Hygiene Practitioner: What Expanding Roles Mean for Patients

Dec 19, 2016

Author: Sharon Boyd, RDH, BS

In May of 2016, the Massachusetts state Senate unanimously approved an amendment that calls for the expanded role of the advanced dental hygiene practitioner (ADHP/DHP), reports Health Care for All. The position is described as a mid-level oral health care provider. According to Dimensions of Dental Hygiene, already, many states and over 50 countries have benefited from the advanced education and expertise of dental hygiene practitioners. But how can this position affect your dental practice? Read on to learn more about why DHPs are so valuable to patients and dental offices alike, and why some professionals are apprehensive about the new position.

Why Have a Mid-Level Practitioner?

This newly created role helps bridge the gap between dentists and underserved populations, especially those utilizing government-run health plans. In Massachusetts, DHPs could potentially reach the nearly quarter million people who don't have access to a general dentist, primarily due to financial restraints. In states like Minnesota, childhood poverty is higher than the national average, and only about 42 percent of public health program recipients have access to dental care, according to Minnesota State Colleges and Universities. To try to alleviate some of that strain, Minnesota's legislature — the first in the country — voted to create this new role in 2009, according to the American Dental Hygienists Association (ADHA).

Alaska is perhaps one of the most progressive states when it comes to implementing alternative dental care. The state hosts a specialty called dental health aid therapists (DHATs). DHATs provide care to tribal populations in remote areas where dentists cannot be reached, according to the ADHA. Their scope of practice includes dentist-taught restorative techniques that are high-quality and cost-effective. There is not necessarily a need like this in every community, but it's an example of how a mid-level oral health provider can provide care to underserved groups.

How Do DHPs Help Dentists?

DHPs do not replace dentists. Rather, they help meet an unmet demand and supplement access to essential care that people aren't already getting. Adding a DHP to a private dental practice could also potentially save dental employers an estimated $50,000 per year when compared to hiring a new dentist, says NYU. Advanced dental hygiene practitioners also allow dentists to focus on larger and more complex cases, while delegating others to the DHP. For example, in Minnesota, DHPs with a bachelor's degree are allowed to "provide restorative and surgical procedures under the indirect supervision of a dentist," according to Dimensions of Dental Hygiene. With a master's degree, and the completion of 2,000 work hours, they can also add "oral evaluations and assessments, treatment planning, nonsurgical extractions of class 3 or class 4 periodontally involved teeth, and the ability to provide, dispense, and administer certain medications under general supervision (without a dentist on-site)."

Additionally, one of the reasons some private practices may choose to not serve Medicaid patients is because Medicaid reimbursements are low. It becomes extremely difficult, if not impossible, to yield a profit without sacrificing quality of care and the time that dental professionals can spend with their patients. However, if a DHP performs the same procedures, it can become cost-effective for the practice to open its services to more Medicaid patients as this generates income.

What Are the Arguments Against Mid-Level Oral Health Providers?

There are some who are still apprehensive about mid-level oral health providers. Some claim that the care provided by DHPs is unsafe and jeopardizes the well-being of patients. However, according to the ADHA, to date, pilot programs have shown safe and effective outcomes.

Some dentists may argue that DHPs will eliminate income generation for future dentists in the field. But, the additions of nurse practitioners and physician assistants to practices have not eliminated the need for medical doctors. Instead, the medical team works together and can improve access to care.

Public health standards dictate the rigorous training and education of DHPs. In addition to holding a bachelor's degree and thousands of hours of clinical experience, to advance in this position, you must also complete a master's level DHP program. It should be noted that states like Colorado already allow independent hygiene practice outside of the oversight of a dentist, and California has a Registered Dental Hygienist in Alternative Practice (RDHAP) program to practice outside of a traditional dentist office, including schools and nursing homes with a specialized license. However, there is still a need in rural areas where neither traditional or nontraditional dental practices exist.

Which States Are Taking Action?

The DHP could make it possible for at-risk and low-income individuals to obtain care that they currently have little to no access to. Approximately 20 states are pursuing or exploring licensed mid-level practitioner legislation, according to Dimensions of Dental Hygiene.


  • Findings indicate that mid-level oral health practitioners deliver safe care to underserved populations that cannot access care by dentists.
  • Employing a DHP could save offices approximately $50,000 per year.
  • Services provided by DHPs have been shown to be safe and effective in pilot programs.

Why It's Important

Dental hygiene practitioners serve as mid-level providers who are necessary to bridge the gap between dentists and underserved populations, especially those on government-run health plans, meaning better dental health across your community.

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