FTC Supports Easing Dental Hygienist Restrictions, Increasing Access to Underserved

The Federal Trade Commission (FTC or Commission) released a statement on January 29 in support of a Georgia state bill that would further relax supervision requirements for dental hygienists. The proposed bill would expand the safety-net settings where Georgia dental hygienists may work without the direct supervision of a dentist and provide that dental hygienists would no longer require direct supervision to perform dental screenings. Such provisions would benefit underserved populations with limited access to dental care through enhanced competition for the provision of preventive dental care, according to the FTC. The FTC’s statement continues the Commission’s advocacy for less restrictive supervisory requirements for health professionals, including dental hygienists and advanced practice registered nurses.

Aside from a few exceptions, current Georgia law requires dental hygienists to work under the direct supervision of a licensed dentist. In Georgia, “direct supervision” means that a licensed dentist is “in the dental office or treatment facility, personally diagnoses the condition to be treated, personally authorizes the procedures and remains in the dental office or treatment facility while the procedures are being performed by the dental hygienist and, before dismissal of the patient, examines the patient.” The law thus restricts a dental hygienist to practicing only where a dentist is physically present, which disproportionately impacts underserved populations in dental health professional shortage areas.

Georgia law does not require direct supervision when dental hygienists provide care at approved dental facilities of the Department of Public Health, county boards of health, or the Department of Corrections. The proposed state bill would expand these exceptions to additional settings: nonprofit clinics, health care facilities, long-term care facilities, and school-based programs. At these locations, state regulations will require a dentist to authorize the dental hygienist’s services but the dentist will not need to be present.

Georgia law also prohibits dental hygienists from providing dental screenings—visual assessments of the oral cavity to determine whether a dentist should provide a more thorough examination—except at enumerated public settings, including schools, hospitals, and clinics. The proposed bill would allow dental hygienists to provide dental screenings in any setting without direct supervision.

The FTC voiced support for the proposed bill, stating that the law would reduce the barrier to preventive oral care created by direct supervision requirements, which tend to restrict trade unnecessarily. The FTC buttressed its position by citing an Institute of Medicine statement that direct supervision requirements “are often unrelated to competence, education and training, or the safety” of the services provided by dental hygienists. The Commission believes that such a change would increase the availability of dental hygienists, creating greater competition in the provision of preventive dental care and alleviating limited access to preventive dental care in underserved communities.

The Commission’s statement, signed by the FTC’s Office of Policy Planning, Bureau of Economics, and Bureau of Competition, can be found here.

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