New ADA policies empower states to alleviate dental workforce shortage

ADA cites urgency, flexibility, commitment to high standards in response to American Dental Hygienists’ Association

The ADA House of Delegates passed a series of resolutions that aim to address the dental workforce shortage, an issue ADA leaders say is among their top priorities. With an insufficient workforce, the ADA said, care cannot be delivered to patients.  

Included are three resolutions that cover allowing internationally trained dentists a path to U.S. licensure; letting active dental students and residents practice hygiene if they’ve met certain competency requirements; and increasing the number of faculty and students in allied dental education programs.  

In a Nov. 1 letter to ADA President Brett Kessler, D.D.S., Erin Haley-Hitz, American Dental Hygienists’ Association President and registered dental hygienist, expressed concern about the three resolutions’ potential effect on patient safety, educational standards and professional integrity.  

“Such changes fail to address oral-systemic health and the underlying issues that are driving many dental hygienists to leave the profession. The measures proposed in these resolutions — whether intended or not — threaten professional integrity and patient outcomes and fundamentally undermine the dental hygiene profession,” Ms. Haley-Hitz wrote in the letter.  

In a Nov. 14 response to Ms. Haley-Hitz, Dr. Kessler reassured her that the ADA remains committed to the highest standards of education and patient safety in dentistry. 

“These resolutions were developed with a careful eye toward addressing the workforce shortages that are impacting patient access to care, while also maintaining licensure and practice standards,” reads the letter. “In short, our goal is to find practical and responsible solutions to fill critical staffing gaps with qualified, well-trained individuals — without compromising on the standards that our patients deserve.” 

The letter goes on to state that the resolutions help address the workforce shortage by allowing dental professionals a voice in working towards better access to oral health care. Although the ADHA expressed concern specifically regarding resolutions 401H-2024, 513H-2024 and 514H-2024, the ADA said each one upholds stringent licensure standards and ensures only qualified professionals practice in roles that match their training.

“The ADA also shares ADHA’s commitment to enhancing workplace culture, professional development, and support for all members of the dental workforce. These resolutions are intended not only to help address the staffing shortage, but also to reduce the strain on current dental teams,” wrote Dr. Kessler.

ADA Health Policy Institute survey data tracks dental team recruitment challenges. In the third quarter of 2024, for instance, 33.9% of dentists indicated they were currently recruiting or had recruited a dental hygienist in the prior three months. Among those dentists, 91.7% indicated recruitment was very challenging or extremely challenging.

“We value and respect the essential role of dental hygienists in providing quality care, and we see these new policies as ways to complement — not replace — the vital role of hygienists on the dental team,” the ADA letter reads.

Under 514H-2024, the ADA would encourage states to adopt policies allowing dentists who have completed a dental education program outside the U.S., subject to state licensing board requirements, to obtain a license to practice dental hygiene. Dr. Kessler reiterated in his letter that the ADA would not encourage states to adopt any policy allowing internationally trained dentists to work as dental hygienists unless that policy required applicants to pass board examinations demonstrating their competency. 

The ADA said this new policy would allow it to give dentists a seat at the table on dental workforce issues, as some states already license internationally trained dentists as dental hygienists and other states are considering similar legislative proposals.

Under 513H-2024, the ADA would encourage states to adopt policies allowing active dental students and residents who have completed all their required hygiene competencies to practice dental hygiene, or to practice as other dentist-supervised allied dental team members, subject to state licensure requirements. Dr. Kessler noted in his response that any policy under consideration would have to require dental students to meet state licensure requirements for hygiene before the ADA would encourage states to allow them to be licensed to practice hygiene.

Under 401H-2024, the ADA urges the Commission on Dental Accreditation to revise the accreditation standards for each of the allied dental education programs regarding faculty-student ratios to align with the accreditation standards for predoctoral dental education programs. Dr. Kessler said updating the standard would allow allied dental training programs more flexibility to increase class sizes, which are currently restricted due to the need to hire additional faculty.
 
Shane Ricci, D.D.S., chair of the ADA Council on Dental Practice, said he looks forward to addressing workforce challenges in the coming months. 
 
“The Council on Dental Practice is eager to collaborate with other stakeholders to expedite priorities outlined in the ADA’s Strategic Forecast which include multifaceted opportunities to address workforce challenges,” he said.