When Regulations Block Access to Oral Health Care, Children at Risk Suffer
A strong research base finds that dental sealants are highly effective in preventing tooth decay. Sealants can reduce the risk of decay in permanent molars—the teeth most prone to cavities—by 80 percent in the first two years after application and continue to be effective after more than four years.
Yet most low-income children—who are least likely to receive routine dental care—lack sealants. According to the most recent data, 61 percent of low-income 6- to 11-year-olds (6.5 million) lacked sealants.2 A recent study found that if all 6.5 million low-income children who lacked sealants were to receive them, it would prevent 3.4 million cavities over four years.3 With this strong evidence of sealants’ effectiveness, the Centers for Disease Control and Prevention, the Association of State and Territorial Dental Directors, the American Association of Public Health Dentistry, and numerous other health organizations recommend sealant programs in schools, especially as an optimal location to provide low-income children with preventive care.4 Yet a 2015 Pew report found that such programs are in fewer than half of high-need schools in 39 states…
…State practice acts might include requirements that dentists examine children before a hygienist can seal their teeth in school, that dentists be present while a hygienist performs this service, or that private dentists cannot employ hygienists working in schools. They may also include rules that set very low limits on the numbers of school-based hygienists that any one dentist can supervise. In describing dental hygiene scope of practice rules, a 2016 report from the national Oral Health Workforce Research Center stated, “State-based regulatory constraints for dental hygienists may impede access to care as much as the economic and logistical barriers that are known to prevent some patients from obtaining oral health services.”5 In more recent research, the center found that a “more autonomous dental hygienist scope of practice had a positive and significant association with population oral health in both 2001 and 2014.”