Americans are not able to take care of their teeth like they should, and it has severe consequences. Dental hygienists can help address this problem, but only if state policymakers consider common-sense reform.
The problem with access to dental care is particularly acute in rural areas. A recent survey notes that 40 percent of Americans in rural areas have not received dental care for a year or more, and much of the public debate on this issue centers on the demand side.
Dental care may become an essential health benefit (EHB) for health insurance plans for adults offered through the Affordable Care Act in the near future. But insurance will not help if there is a dearth of providers. Policymakers should also be exploring reforms on the supply side as well, expanding access to care across America by increasing the number of providers.
How? Here’s one example: 12 states have now authorized dental therapists—the newest category of dental care provider—to begin working. California is not one of them.
It is also important to fully utilize existing dental care workers. Dental hygienists could do more in several states, and my recently published research (with co-authors Jie Chen and Chad Meyerhoefer) illustrates some of the key benefits.
In some states, dentists have to see every patient treated by a dental hygienist. Of course, this has implications for the cost of dental care. Time spent with dentists is much more expensive than time spent with dental hygienists. The median dentist’s salary in the United States is nearly $160,000—about twice as much as the median dental hygienist salary.
Our analysis focuses on the effects of changes in dental hygienist autonomy from 2001 to 2014. During this time period, 15 states granted dental hygienists more flexibility in providing treatment to patients. These states either allowed dental hygienists to enter into contracts or collaborative practice agreements to treat patients independently, or offered dental hygienists full independent practice with no contractual agreement with a dentist.
When we estimate the effects of this policy change, we find evidence of increased dental care utilization. More specifically, we estimate that preventive dental visits increase by 4.7% when dental hygienists are granted more flexibility to provide care to patients.
Today, most states grant dental hygienists some autonomy, but there are still improvements to be made. Some may argue that there are simply not enough dental hygienists, and it is certainly true that there is a shortage. But granting dental hygienists more autonomy may increase job satisfaction. And, certainly, more entrepreneurial dental hygienists, if legally allowed to do so, may enjoy the flexibility of working independently of dentists.
Colorado, in many respects, is ahead of the curve. Since 1987, dental hygienists in the Centennial State have had the ability to own their own practices. Some hygienist practices even offer patients the opportunity to book Saturday appointments.
Having healthy teeth can sometimes be overlooked, but access to dental care is important for overall health. Like many other issues in healthcare, it is important to consider both sides of the market—supply and demand. Giving dental hygienists the flexibility to work more independently of dentists seems to have important and measurable benefits for patients.
Policymakers should consider any and all common-sense solutions for increasing the supply of healthcare providers. Public health depends on it.
Edward Timmons is a service associate professor of economics and director of the Knee Regulatory Research Center at West Virginia University.
