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...dentists, the utilization of dental services, and selected oral health outcomes across the 50 states.
Methods. A Dental Hygiene Professional Practice Index (DHPPI) defines the professional status, supervision requirements, tasks permitted, and reimbursement options for DHs in each of the 50 states and the District of Columbia, as of December 31, 2001. Spearman rank order correlations between the DHPPI and numbers of oral health professionals, utilization of oral health services, and oral health outcomes in the 50 states are also presented.
Results. The analyses revealed that:
--There are significant differences in the legal practice environments (as reflected in the DHPPI) across the 50 states and the District of Columbia.
--Between 1990 and 2001, the number of DHs per capita increased by 46% in the United States, while the number of dentists per 100,000 population increased by only 10%.
--The DHPPI was not significantly correlated with the number of DHs or dentists in the 50 states in 2001.
--The DHPPI was significantly positively correlated with the salaries of DHs in 2001.
--The DHPPI was also significantly and positively correlated with a number of indicators of utilization of oral health services and oral health outcomes.
Conclusions. Both access to oral health services and oral health outcomes are positively correlated with the DHPPI. This suggests that states with low DHPPI scores would be logical candidates for revised DH practice statutes and regulations to accomplish these objectives.
Keywords: Scope of practice, dental hygiene, oral health outcomes, access to oral health services
Introduction
A major study of the legal scope of practice of dental hygienists (DHs) in the 50 states and the District of Columbia was conducted in 2002 and 2003. This article summarizes the key findings from the full report prepared as part of that study (1), and presents some conclusions for consideration by planners and policy makers interested in the evolving roles and responsibilities of DHs in the United States.
DHs played a much greater role in the oral health system in 2000 than they did a decade earlier. Some of the increase in roles and responsibilities was numerical, reflecting the significant increase in the number of DHs, from around 72,000 in
1990 to more than 120,000 in 2001 (Table I) (2, 3, 4). As important as was the growing number of DHs across the 50 states, much of the expansion in roles and responsibilities of DHs was qualitative, reflecting the increasing involvement of DHs in providing preventive and restorative oral health services. The contributions of DHs to both quality of care and access to care-and their potential for even greater contributions in the future-did not go unnoticed in state legislatures and governors' offices. Over the past decade, virtually every state expanded the legal scope of practice of DHs. DH roles, which were historically rooted in preventive care, have been slowly expanding into a variety of basic restorative services, stimulated in part by government and private initiatives to increase access to care for underserved population groups (5).
This expansion of the legal scope of practice was the subject of the larger study summarized herein. The larger study:
--created a Dental Hygiene Professional Practice Index (DHPPI) based on statutes and regulations for 2001;
--compiled a variety of statistics about DHs in the United States and several indicators of the oral health status of Americans and their access to oral health services; and
--performed a variety of statistical analyses to assess the extent to which the DHPPI is related to number of practicing DHs, number of practicing dentists, a number of oral health status indicators, and access to care for the underserved in the 50 states.
The DHPPI
To help planners and policy makers understand the extent of practice possibilities for DHs in each of the 50 states, a DHPPI was developed that assigned points for various practice options and possibilities deemed important by an advisory committee comprised of practitioners, researchers, educators, and regulators. The criteria in the index for 2001 were selected to represent the characteristics of an "ideal" professional practice for DHs, based on conversations with representatives of the...
NOTE: All illustrations and photos
have been removed from this article.
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