Journal Articles

Moore J., Goodwin N. Expanding Access to Care with Scope of Practice. Dimensions of Dental Hygiene. 2019; 17  (3):12-14

Online version available soon

There has been longstanding concern about uneven access to oral health services, particularly for some groups, including children, the elderly, racial/ethnic minorities, and the economically disadvantaged.  Stakeholders with an interest in expanding access to care and improving the oral health status of the underserved are driving efforts to identify and adopt innovative strategies to improve population oral health. Dental hygienists (DHs), who are considered experts in prevention education and services, often play important roles in programs that improve access to needed oral health services

State-based laws and regulations define legal scopes of practice (SOP) for health professionals within a state. This contributes to variation in what DHs in different states are legally allowed to do. It is challenging to systematically describe these SOP differences, assess their impacts on population oral health and translate this into policy-relevant information. With support from HRSA’s National Center for Health Workforce Analysis, researchers at the Oral Health Workforce Research Center (OHWRC), Center for Health Workforce Studies (CHWS), developed a professional practice index to describe DH SOP across states and studied impacts of this variation on state oral health outcomes. Subsequently, researchers developed an infographic based on this work to depict state-level variation in DH SOP to help oral health advocacy groups, policy makers and other stakeholders better understand these issues.

Moore J. Health Professions Regulation in the United States. J Health Law (Revista de Direito Sanitario). October 2018;19(2):131-155.
Available at:

In the US, states are primarily responsible for the regulation of health professions. The structure and content of state-specific health professions regulation has significant impacts on the delivery of health care services. This is particularly important given that health reform initiatives are designed to improve population health through the provision of accessible, high quality, and affordable basic health services. There is concern that existing state-based, profession-specific regulatory structures cannot easily support the workforce innovations necessary for health reform. Aspects of the current system that constrain the effective and efficient use of the health workforce include mismatches between professional competence and legal scopes of practice, lack of consistency in legal scopes of practice across states, limited flexibility to support overlap in scopes of practice across professions, and the slow and adversarial process for changing scope of practice rules.

Langelier M, Surdu S. Dental hygiene scope of practice regulation significantly impacts oral health outcomes in state populations. Perspectives on the Midlevel Practitioner (Dimens Dent Hyg suppl). October 2017;4(10):18-21. Available at:

Rapid changes in health care systems during the first decades of the 21st century have significantly affected the delivery of oral health care services. In the policy arena, the new emphasis on high-quality, value-based services;1 improvements in diagnostic and treatment technologies and materials; proliferation of information systems and health information exchanges; team-based service delivery models; and integration of primary care and oral health care2 has influenced the deployment of health and oral health workforces. The move toward prevention and management of oral disease and away from the historical treatment paradigm requires the engagement of a comprehensive professional team.3 Dental hygienists are well positioned to contribute to improvements in access to preventive oral health services and, ultimately, to oral health outcomes.3

Mertz E, Spetz J, Moore J. Pediatric Workforce Issues. Dent Clin N Am. 2017;61(3):577-588.

According to the US Surgeon General, dental disease is among the most prevalent health conditions for children, and large disparities in oral health status and access to oral health services exist among children in the United States. In 2003, the National Call to Action to Promote Oral Health outlined the need to increase the diversity, capacity, and flexibility of the dental workforce in order to better meet children’s oral health needs and reduce disparities. Assessing progress toward the Call to Action, in 2009 the authors found only modest gains in workforce strategies focused on pediatric patients, and major challenges remaining. In 2009 the Institute of Medicine held a workshop on the sufficiency of the oral health workforce for the coming decade, which outlined the status of the dental workforce, and highlighted for the first time the multitude of new workforce models being proposed and tried. A special issue of the Journal of Public Health Dentistry entirely focused on the contributions of workforce innovations to delivery system redesign followed, with one of the key messages being that workforce design should be tied directly to meeting the patient care needs, with special attention to reducing disparities in oral health care, and in oral health. As 2017 begins, progress has been documented in children’s use of care primarily because of improvements in coverage through Medicaid, the Children’s Health Insurance Program (CHIP), and the Affordable Care Act (ACA). This article updates and synthesizes the evidence on clinical pediatric workforce models and discusses future directions and implications for health policy.

Langelier M, Continelli T, Moore J, Baker B, Surdu S. Expanded Scopes of Practice for Dental Hygienists Associated With Improved Oral Health Outcomes for Adults. Health Affairs. 2016;35(12):2207-2215.

Dental hygienists are important members of the oral health care team, providing preventive and prophylactic services and oral health education. However, scope-of-practice parameters in some states limit their ability to provide needed services effectively. In 2001 we developed the Dental Hygiene Professional Practice Index, a numerical tool to measure the state-level professional practice environment for dental hygienists. We used the index to score state-level scopes of practice in all fifty states and the District of Columbia in 2001 and 2014. The mean composite score on the index increased from 43.5 in 2001 to 57.6 in 2014, on a 100-point scale. We also analyzed the association of each state’s composite score with an oral health outcome: tooth extractions among the adult population because of decay or disease. After we controlled for individual- and state-level factors, we found in multilevel modeling that more autonomous dental hygienist scope of practice had a positive and significant association with population oral health in both 2001 and 2014.

Mertz EA, Wides CD, Kottek AM, Calvo JM, Gates PE. Underrepresented Minority Dentists: Quantifying Their Numbers and Characterizing the Communities They Serve. Health Affairs. 2016;35(12):2190-2199.

The underrepresentation of Blacks, Hispanics or Latinos, and American Indians or Alaska Natives among dentists raises concerns about the diversity of the dental workforce, disparities in access to dental care and in oral health status, and social justice. We quantified the shortage of underrepresented minority dentists and examined these dentists’ practice patterns in relation to the characteristics of the communities they serve. The underrepresented minority dentist workforce is disproportionately smaller than, and unevenly distributed in relation to, minority populations in the United States. Members of minority groups represent larger shares of these dentists’ patient panels than of the populations in the communities where the dentists are located. Compared to counties with no underrepresented minority dentists, counties with one or more such dentists are more racially diverse and affluent but also have greater economic and social inequality. Current policy approaches to improve the diversity of the dental workforce are a critical first step, but more must be done to improve equity in dental health.

Moore J, Continelli T. Racial/Ethnic Pay Disparities among Registered Nurses (RNs) in US Hospitals: An Econometric Regression Decomposition. Health Services Research. 2016;51(2):511-529.

 There is growing recognition of the importance of health workforce diversity in improving cultural competence in health care and reducing health disparities. Registered nursing, like many other health professions, is not a racially and ethnically diverse as the country’s population. Cross-sectional data were analyzed using multivariate regression and regression decomposition to detect the presence of racial and ethnic pay disparities between minority and white hospital RNs using a national sample.

Langelier MH, Glicken AD, Surdu S. Adoption of Oral Health Curriculum by Physician Assistant Education Programs in 2014. J Physician Assist Educ. 2015;26(2):60-69.

This study was undertaken to ascertain the number of PA programs teaching oral health topics and to evaluate the content of instruction and implementation strategies. A previous study in 2008 found that PA education program directors generally understood the importance of teaching about the linkage of oral health with systemic health; yet, few programs had actually integrated oral health instruction into the PA curriculum. The purpose of the study was to describe inclusion of didactic and clinical instruction in oral health in physician assistant (PA) education programs in 2014.

Boulton ML, Beck AJ, Coronado F, et al. Public health workforce taxonomy. American Journal of Preventive Medicine, 2014; 47(5):S314-S323.

Thoroughly characterizing and continuously monitoring the public health workforce is necessary for ensuring capacity to deliver public health services. A prerequisite for this is to develop a standardized methodology for classifying public health workers, permitting valid comparisons across agencies and over time, which does not exist for the public health workforce. An expert working group, all of whom are authors on this paper, was convened during 2012–2014 to develop a public health workforce taxonomy.

Abramson EL, McGinnis S, Moore J, Kaushal R. A statewide assessment of electronic health record adoption and health information exchange among nursing homes. Health Services Research. 2014;49(1pt2): 361-372.

A cross-sectional study was designed to assess level of EHR implementation, automation of key functionalities, participation in HIE, and barriers to adoption in New York State nursing homes.