Report Recommends Policy Changes to Improve the Oral Health Workforce

Richard Gawel


As healthcare models continue to evolve in the United States, George Washington University’s Health Workforce Institute (GWHWI) has issued a report that profiles how health workforce needs are changing—and what needs to be done to adapt to emerging needs in the 21st century. Among other areas, the report notes key adaptations that its authors say will help the dental profession better serve its patients, particularly underserved populations.

“The report will help health policy leaders identify new strategies for increasing access to healthcare, especially in remote or isolated regions of the United States,” said Patricia Pittman, PhD, co-director of the GWHWI. “Telehealth, nurse-led clinics, and Medicaid-financing of graduate medical education are just a few of the ways healthcare leaders can ensure that the US workforce is prepared for the future.”

For example, the report spotlights the need to integrate oral health into primary care teams, citing 8 case studies from the State University of New York (SUNY) Albany that documented the efforts of Federally Qualified Health Centers (FQHCs) to do so. Keys to this integration include integrated electronic health records and inclusion of new patient health information forms that ask patients about their history of dental disease and access to a dental home. Some FQHCs even embed a dental hygienist in offsite primary care practices to provide preventive and educational oral health services.

Next, the report associates less restrictive dental hygienist scopes of practice with better oral health. It says that dental hygienists are in a prime position to contribute to the transformation of oral healthcare due to their training and experience. Noting the significant changes in dental hygienist roles during the past decade, SUNY Albany has updated its matrix for assessing scope of practice laws for dental hygienists, enabling the university to demonstrate that states with less restrictive laws for dental hygienists had better oral health outcomes.

With this expansion in mind, the report cites 3 states—Minnesota, Alaska, and Maine—that license dental therapists to increase access to dental services in underserved communities. These professionals are known as “midlevel” providers because they can substitute for and supplement practice by a dentist in restorative therapy. SUNY Albany profiled an FQHC in Minnesota where the use of a dental therapist allowed greater flexibility for task shifting, such as performing simple restorations when a demanding emergency case was diverted to the dentist.

Dental assistants, meanwhile, face challenges. Typically involving clinical and administrative duties, dental assistant positions require middle to low levels of skill. However, training varies, ranging from on the job preparation to formal accredited education programs culminating in an associate’s degree. Allowable tasks also differ by state and sometimes are decided by the dentists who employ these personnel. Some but not all states recognize expanded function dental assistants, requiring extra training and competency testing for tasks such as applying sealants or performing dental radiography.

Outside of dentistry, SUNY Albany found that appropriate physician assistant training also can improve oral health. Currently, 3 out of 4 physician assistants received didactic and/or clinical instruction in oral health during their training. Also, physician assistants who received education in oral health and disease were nearly 3 times more likely to provide oral health services than those who did not receive any education in oral health competencies.  

Meanwhile, technology can play a greater role in reaching underserved communities. Sites approved by the National Health Service Corps in states with more favorable telehealth coverage and reimbursement policies were more likely to use telehealth, including teledentistry, as were providers located in states with telehealth grant funds. SUNY Albany prepared 6 case studies of teledentistry programs that outlined strategies for increasing access to general and specialty dental services using remote technology.

Finally, FQHCs require personnel to operate if they’re going to reach underserved populations. SUNY Albany found that dental student externships and dental residencies can serve as a pipeline for FQHCs to hire new dentists. According to the report’s authors, it appears that participation in these clinical rotations is alleviating some of the difficulties that FQHCs face in recruiting dentists to work in the safety net.

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