In 2011, the Arkansas General Assembly passed ACT 89 which created Collaborative Practice Dental Hygienists who work under collaborative care permits with licensed dentists for the purpose of expanding dental services to underserved areas of the state.
What is the Public Health Issue?
At the request of the 2007 Arkansas General Assembly, a needs assessment entitled, “The Need for Dental Education in Arkansas,” was conducted. From this study, it is apparent that an Arkansas dental workforce shortage exists now and will worsen in the next 10 years.
The overall shortage of dentists in Arkansas is further exacerbated by geographic mal-distribution of existing dentists and persistent socio-economic barriers. Arkansas has a total of 75 counties, 54 of which are rural. Sixty percent of the state’s dentists practice in just eight of the state’s 75 counties, although these eight counties have only 40% of the state’s population. Nineteen Arkansas counties are designated whole or in part Dental Health Professions Shortage Areas (HPSA) (Figure 2). Five counties have no dentists at all.
Under these conditions, how do we address the lack of access to dental care? How do we grow our workforce? We delegate responsibilities to educated, available, and well-prepared professional healthcare providers able to expand preventive dental services to underserved areas.
- Collaborative agreements, required by ACT 89, are written agreements between licensed dentists and licensed dental hygienists. Under these agreements, the dental hygienists can provide prophylaxis, fluoride treatments, sealants, dental hygiene instruction, and assessment of a patient’s need for further dental treatment. Such services must be provided in public settings but can be provided without the supervision or presence of the dentist or the prior examination of the patient by the dentist.
- Public settings are defined as: adult long-term care facilities; charitable health clinics; community health centers, county jails, facilities serving developmentally disabled persons; Head Start programs; local health units; school in rural counties; and state correctional institutions. Services may also be provided in the homes of homebound patients who qualify for in-home medical assistance.
- Consulting dentists and collaborative care dental hygienists must apply with the Office of Oral Health in the Arkansas Department of Health for permission to practice collaborative care in qualifying underserved areas. That permission must be confirmed annually.
- The Office of Oral Health is required to develop and maintain a list of communities and/or rural areas prioritized as to need for dental services, so that collaborative services can be directed to those areas in greatest need. Prioritization is based on access to care and limited to public settings (i.e., those settings itemized above). Schools are to be prioritized according to two factors: a low full-time dentist to population ratio and the percentage of students participating in the federal school lunch program (i.e., free and reduced meal program) of the school or school district. Six tiers are specified, ranging from 50% of students receiving free and reduced lunches to 90% of students receiving free or reduced lunches.
Making It Happen
Those hygienists wishing to practice Collaborative Practice Dental Hygiene in conjunction with their consulting dentist must apply for permits from both the Arkansas State Board of Dental Examiners and the Office of Oral Health of the Arkansas Department of Health. It is strongly advised that the dental practice act and the rules and regulations of the Board of Dental Examiners and the Board of Health be read carefully.
Arkansas State Board of Dental Examiners