Spotlight on Maryland Practice Act Study

March 10, 2014
I think most dental hygienists remember the tragic death that occurred in Maryland, when a 12-year-old boy died from a brain infection caused by bacteria from untreated dental decay.

By Christine Nathe, RDH, MS

I think most dental hygienists remember the tragic death that occurred in Maryland, when a 12-year-old boy died from a brain infection caused by bacteria from untreated dental decay. We obviously know that dental decay can be prevented. If it does occur, a simple dental restoration can restore the loss of tooth and alleviate infection.

For this reason, the Maryland General Assembly unanimously passed the Public Health Dental Hygiene Act in 2008. This law was enacted to improve access to oral health care of children in Maryland. Recently, a study was conducted to evaluate the impact of this law, specifically studying the practice act change for dental hygienists in Maryland.


Consider these articles by Nathe


This impact study was funded by the American Public Health Association, as a joint project with the Centers for Disease Control and Prevention (CDC). The findings showed that a majority of public health dental facilities in Maryland did not change their general supervision procedures as result of the legislation. Most respondents indicated that they felt that many providers and administrators did not know about the changes for dental hygiene practice in their state, and that is why they thought changes had not been implemented.

Although the study revealed that many public health facilities do not operate under general supervision, those that do unanimously expressed its positive outcomes, including:

  • Increase in the number of children screened in schools
  • Increase in the number of children in schools who receive sealants and/or fluoride varnish
  • Increased sense of value felt by dental hygienists
  • Increased value placed on dental hygienists by dentists, administrators, and the general public
  • Increased restorative care services provided by dentists
  • Increased number of oral cancer screenings conducted for seniors
  • Decreased spending on services that can now be administered by hygienists, as opposed to dentists
  • Increased number of patients (of all ages) seen by a dentist and/or a dental hygienist.1

Additionally, the study included recommendations that the Maryland Office of Oral Health and significant stakeholders educate the dental community about the changes and further define and publicize definitions such as public health dental hygienists and public health dental facility. Another recommendation was to develop a how-to guide to discuss ways in which a clinic and community could benefit from the dental hygiene supervision changes. Education of the public health dental community -- especially dentists and hygienists -- about the legislation was paramount.

Although positive outcomes where realized, it seems not to the extent hoped. Further infrastructure revisions and promotion of this new concept are reasonable solutions to increase the use of dental hygienists. An important component of public health is the promotion of prevention. By implementing these recommendations, it seems likely that the availability of preventive dental care can be increased in the populations in need within Maryland.


1. Levy, D. Maryland Public Health Dental Hygiene Act: Impact Study. Maryland

Department of Health and Mental Hygiene, Office of Oral Health. Baltimore, Maryland, 2013. Retrieved from http://phpa.dhmh.maryland.gov/oralhealth/Documents/EvaluationReport.pdf on January 3, 2014.

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 [email protected] or (505) 272-8147.

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