State Spotlight on Utah: Direct access and the dental hygienist

Editor’s note: Join us for the final installment in our series highlighting direct access to dental hygiene services. Over the last year, we have journeyed across the country discovering the many types of nontraditional and independent roles dental hygienists can hold. Today, we turn the spotlight on Utah where recent legislation allows dental hygienists to provide direct services in collaboration with a dentist. To learn more about the ways in which dental hygienists are providing direct services in your area and throughout the country, visit the National Mobile Dentistry Conference website at nmdconference.com. 

The American Dental Hygienists’ Association (ADHA) defines direct access as the ability of a dental hygienist to initiate treatment based on their assessment of a patient’s needs without the specific authorization of a dentist, treat the patient without the presence of a dentist, and maintain a provider-patient relationship.¹ 

When was the last time you told your story?

There is power in telling a story. Some stories fill up our history books and many are passed down from generation to generation, becoming deeply embedded in our personal practices and community traditions. For as long as humans have existed, we have told stories in order to remember the past, understand the present, and shape the future.

Over the course of the last year, RDH magazine has invited me to help dental hygienists from across the country tell their stories about providing direct access to dental patients in previously unconsidered contexts. These stories were often filled with passion and sometimes pain, but most of all they demonstrated the incredible ability of dental hygienists to discover personal happiness and professional fulfillment beyond the walls of the traditional operatory. We hope that as you listen to the stories shared here in this series, you might be inspired to consider new ways to explore your own story—and courageously shape the future of your career.

One of the most frequent questions dental hygienists ask me is if it is possible to provide direct care in their state, and if so, how can they get started. To help answer this question, let’s listen to Staci Stout, BSDH, RDH, (figure 1) tell the story in her own words of how she began her journey, inspiring many and becoming a pillar in Utah’s direct access movement.

What inspired you to begin a journey of providing direct access to care? 

In 2014, I was nominated president-elect of the Utah Dental Hygienists’ Association (UDHA). That year, we prepared a bill to change the Utah Dentist and Dental Hygienist Practice Act to allow for direct access to dental hygiene services. Because we faced opposition from the dental association, we hired a lobbyist and started collaborating with other allies. During my presidency the next year, we were able to pass the legislation! 

This new legislation allowed the dental hygienist to work under a collaborative agreement with a licensed Utah dentist. Thanks to this, I began a quest to educate our state’s professionals to help direct access become a reality for underserved communities.

In the fall of 2015, we offered our very first dental hygiene clinic in an elementary school—a pivotal moment for us! We treated 64 patients and provided dental hygiene assessments, oral health education, oral cancer screenings, periodontal care, and fluoride applications. More than half of the patients had untreated decay, 12% had urgent needs such as pain or active infection, and some had never seen a dentist before. This was a huge success and proved how integral our care was for the community. 

At that point, I was invited to speak at the Utah Assisted Living Association’s annual conference and was subsequently approached by a facility that wanted me to set up an oral health program for its residents. It was then that I applied for and won my first grant, the ADHA Institute for Oral Health (IOH) Wrigley Company Foundation Community Service Grant. With this funding, I was able to provide oral health care to facility residents, educate the administration and staff on the importance of oral health, collect data to help improve access legislatively, and help dental hygienists learn to provide place-based care.

During that year, we provided care to 54 residents and found that 65% had untreated decay in addition to broken teeth, root fragments, periodontal infection, and tooth abscesses. Not surprisingly, almost 70% of the residents did not have regular access to an oral health-care provider due to mobility issues. At the close of the project, a dental hygienist was assigned to the assisted living residence to continue care. The bottom line is we now have strong evidence that this population, among others, is being neglected when it comes to oral health care. 

In 2017, I was able to secure a second Wrigley grant to provide care in subsidized senior housing. We collaborated with Senior Charity Care Foundation and brought in dental hygienists from the UDHA to provide preventive care to 48 residents, supplementing the mobile restorative program already in place. Thanks to the success of these two programs, the Utah Department of Health approached me to collaborate with Senior Charity Care Foundation on a large grant to provide a year of preventive and restorative oral health care to 10 nursing homes and 600 residents. 

That same year, I also created a school-based oral health program. To launch the program, we partnered with the school administration, the United Way community coordinator, and a dentist from a nearby dental assisting school. After agreeing to complete two pilot programs the first year, we then expanded into four elementary schools, a middle school, and a high school. In this program, dental hygienists provide preventive services to students, a dentist completes an exam via teledentistry, and we provide oral health education in the classroom. It is encouraging to know we will have an impact on these children for their entire school experience. 

I’m excited to share my story and more about the logistics of our operations at the National Mobile Dentistry Conference. I am presenting with Dr. Tanner Clark on the relationships of collaborative practice and streamlining the mobile dental hygiene practice to increase efficiency and production.

Why is it important for dental hygienists to provide direct care to patients? 

As an educator, I understand what is required of a dental hygiene graduate. Dental hygiene students learn necessary skills to provide place-based care, treat advanced periodontal disease, educate different patient populations, and handle a medically compromised patient. Sadly, after students become licensed, they are often underutilized and lose many of their best skills. I think it’s important for dental hygienists to have opportunities to use what they know in any setting they desire. It’s a win-win for the professional and for the populations that need the care. 

Can you own a dental business?