Governor's Report

By Christine Nathe, RDH, MS

The new year brought us an exciting development in the public health arena. In January, the National Governor's Association (NGA) published a report that focused on the utilization of dental hygienists to delivery primary dental care. Although the NGA is not a federal governmental agency, it is the collective voice of the nation's governors. This type of political voice can help promote our profession and the important niche dental hygienists can fill to improve the nation's oral health.

The NGA has a Center for Best Practices Health Division, which provides information, research, policy analysis, technical assistance, and resource development for governors and their staff across a range of health policy issues.1 This division covers issues in the areas of health care service delivery and reform, including payment reform, health workforce planning, quality improvement, and public health and behavioral health integration within the medical delivery system.1 Other focus areas include Medicaid cost containment, state employee and retiree health benefits, maternal and child health, prescription drug abuse prevention, and health insurance exchange planning.1


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The report titled "The Role of Dental Hygienists in Providing Access to Oral Health Care" focused on the variations in policies affecting dental hygienists and describes models and legislation that states have enacted to leverage dental hygienists in an expanded capacity. Expanding the settings where dental hygienists can provide care is discussed as well as expanding procedures that dental hygienists may provide to patients. Another area addressed focused on the variations in supervision of dental hygienists in states. The informational sidebar with this article was informative and depicted common supervision definitions and how states vary in "supervision" of dental hygienists.

The report highlighted states that have expanded the use of dental hygienists. The report also discussed barriers that currently limit dental hygiene practices. These limitations include reimbursement policies that prohibit dental hygienists from directly receiving payment from Medicaid. Additionally, some experts question the equity of limiting the work of dental hygienists based on practice settings and that barring dental hygienists from providing direct-access services for subsets of patients can be considered unfair trade restricition.Yet another limitation can be inadequate education and experience in business and financial management.

As a profession, reports such as this one highlight and promote the potential future of dental hygiene to expand, with a goal of providing care to a larger group of the population. It is important for the profession to help limit the barriers felt by dental hygienists, when expanding our practice. Education should focus on ensuring graduates have the fundamentals to change laws and restrictions to our practice.

Additionally, dental hygiene programs should be teaching students skills that are needed to start and operate a dental hygiene practice. Hiring entrepreneurial dental hygienists as faculty is a great way to tap into an existing resource.

In the end, it is all about increasing the number of individuals who receive routine preventive care and practice optimum oral health daily! 

Supervision Levels Defined

Direct supervision: The dentist is physically present.
General supervision: The dentist has seen the patient or specifically authorized the hygienist to provide service to that patient.
Direct access: The hygienist initiates the service without authorization from the dentist. In some cases, the hygienist is required to have a relationship with the dentist; in two states, he or she can practice independently.
Source: The Role of Dental Hygienists in Providing Access to Oral Health Care, National Governor's Association


1. National Governor's Association: The Role of Dental Hygienists in Providing Access to Oral Health Care. Washington DC: 2014. Retrieved from http://www.nga.org/files/live/sites/NGA/files/pdf/2014/1401DentalHealthCare.pdfon March 27, 2014. Information from this column came from this report and there is more interesting information for entrepreneurial hygienists here as well!

CHRISTINE NATHE, RDH, MS, is director at the University of New Mexico, Division of Dental Hygiene, in Albuquerque, N.M. She is also the author of “Dental Public Health Research” (www.pearsonhighered.com/educator), which is in its third edition with Pearson. She can be reached at cnathe@salud.unm.edu or (505) 272-8147.

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