ADA seeks legislative solutions for dental workforce issues

Summary of what's happening nationwide

Workforce issues affecting dentistry, including recruitment of dental assistants and dental hygienists, student loan debt, license portability, scope of practice, provider shortage areas and the lingering impact of the COVID-19 pandemic continue to pose challenges for the profession.

The ADA and many other partner organizations at the national and state levels are working to solve these issues in the legislative arena. Proactive strategies to address workforce challenges include modernizing education models, incentivizing providers with loan repayment programs, adding new providers or changing the scope of existing positions, and improving license portability.

Listed here are current and recent efforts that seek to address workforce issues for the benefit of providers and patients.

Dentist and Dental Hygienist Compact

The Council of State Governments has partnered with the Department of Defense, the ADA and the American Dental Hygienists’ Association to support the mobility of licensed dentists and dental hygienists through the development of a new interstate compact — a legal agreement among states — that will create reciprocity among participant states and reduce the barriers to license portability.

A state must enact the Dentist and Dental Hygienist Compact model legislation to join. The model legislative language became available in January and was written by a team made up of experts, state officials and stakeholders, including dental boards and dental schools.

The compact will go into effect once enacted into law by seven states. The compact has become law in Iowa, Tennessee and Washington, and there are active bills in New Jersey, Ohio and Pennsylvania. Wisconsin is expected to introduce a bill shortly. More than 10 additional states have expressed interest in introducing the compact in 2024. The CSG is hosting a summit in September in Washington, D.C., for state dental and dental hygiene associations, state dental boards and state legislators to plan to advance the compact in the coming year.

State legislation

As the authorities on oral health issues in their states, state dental associations are pursuing legislative solutions to specific workforce challenges. Many of these efforts are conducted with the support of the ADA Department of State Government Affairs’ state public affairs program.

Arizona: A new law creates definitions for dental hygiene assessment and dental hygiene treatment planning.

California: A law, passed by the state assembly 78-0 and currently before the Senate, would streamline and shorten the in-office training process for dental assistants, allowing them to become registered dental assis-tants faster, allow out-of-state certified dental assistants to apply for registered dental assistant status if they meet certain standards and expand dental assistants’ scope of practice.

Connecticut: A new law allows dental assistants to take radiographs under direct supervision and develops an alternative to the Dental Assisting National Board radiology exam through the University of Connecticut, to be administered by the state dental association.

Hawaii: A new law adds community health centers, rural health clinics and mobile dental outreach programs to the list of eligible organizations at which persons with community service licenses may practice in Hawaii and allows the issuing of temporary community service licenses for professionals who have graduated from pro-grams that have a reciprocal agreement with the Commission on Dental Accreditation.

Maine: A new law expands the Maine Dental Education Loan Program to hygienists, therapists, expanded-function dental assistants and dental assistants.

Minnesota: A bill that died with-out action would have allowed assistants to be licensed in Minnesota if they are Dental Assisting National Board-certified or have graduated from a CODA-accredited program (current law requires both).

Mississippi: A bill that died in conference in March would have doubled the number of dentists eligible for the Rural Dentists Scholarship Program from three to six.

Nevada: A new law authorizes the practice of expanded-function dental assistants in Nevada.

New Jersey: A bill introduced in May would reduce the age of eligibility for radiology technicians to 16, provided the applicant is enrolled in a four-year secondary education program or its equivalent.

Oregon: A bill passed by both houses of the Oregon legislature and awaiting the governor’s signature would update requirements for dental assisting certification and direct the Board of Dentistry to establish a workgroup to study the workforce shortage and provide recommendations to the Board.

Texas: A new law allows hygienists to administer local anesthesia under direct supervision to patients 18 or older.

Vermont: This year’s state budget included $100,000 for the Dental Hygienist Forgivable Loan Program for hygienists who practice in Vermont for the same number of years for which they receive forgiveness and maintain enrollment at an eligible program and $3.8 million for Critical Occupations Scholarships, which includes dental hygienists, and provides funding for retraining and relocation incentives.

Washington: A new law eliminates the initial limited license for hygienists and creates a three-year temporary license, and another new law eliminates the requirement that a hygienist be in active practice in another state in order to acquire a temporary license in Washington.

Wisconsin: A bill before the state assembly requires the Department of Safety and Professional Services to issue preliminary credentials to a hygienist or expanded function dental assistant who has completed all educational requirements, and who has applied for/is awaiting full licensure from the department, a provision that already exists for dentists.

Legislation before Congress

Several pieces of legislation to address dental workforce issues are currently before Congress. Specifically, those bills/requests include:

Reauthorizing the Action for Dental Health Act workforce grants directed towards programs for dentists and other dental professionals; the bill unanimously passed out of the House Energy and Commerce Committee July 19, indicating strong bipartisan support.

S 862, the Restoring America’s Health Care Workforce and Readiness Act, which would double funding for the National Health Service Corps’ scholarships and loan repayment programs for health care workers, including dentists and dental hygienists, who serve in federally designated shortage areas.

Supporting S 704, the Resident Education Deferred Interest Act, which would address the difficulty, or inability, of those who must undertake several years of dental residency with very low pay to begin repaying student debt immediately.

Allowing dental professional student loan borrowers to modify the interest rate on student loans to the current applicable rate.

As shared in an ADA Action Alert in June, ADA is asking members to contact their Senators and ask them to support legislation that can help ensure there are enough dentists in underserved areas, members’ offices are fully staffed and more patients are able to receive dental care.

For the latest news on workforce advocacy, visit ADA.org/advocacy.