Expanding the Scope of Dental Hygiene Practice: Improving Rural Oral Health Access in New Hampshire

Document Type

Presentation

Loading...

Media is loading
 

Publication Date

7-16-2026

Comments

Presentation: 26:54

Abstract

Rural oral health access remains a persistent challenge in New Hampshire despite a statewide dentist-to-population ratio above the national average (American Dental Association Health Policy Institute, 2025). The problem is most acute in the rural North Country, where geographic isolation, provider maldistribution, low Medicaid participation, and statutory supervision requirements limit access to preventive services. Recent workforce data report a 7.7% decline in dentist supply, regional variation in dentist availability, and longer rural wait times, despite rural dentists working more fulltime hours and participating in Medicaid at higher rates than non-rural counterparts (New Hampshire Department of Health and Human Services, [NH DHHS], 2024). These findings suggest the challenge reflects not only provider supply but also workforce distribution, capacity, and delivery-system design (NH DHHS, 2024). This capstone evaluates whether expanding dental hygienist autonomy represents a promising policy option for improving rural access under fiscal and workforce constraint. Using comparative policy analysis informed by published literature, state workforce reports, and statutory analysis, it evaluates alternatives by cost, scalability, feasibility, rural reach, and time to impact. Applying the Penchansky-Thomas (1981) and Levesque et al., (2013) frameworks, the study examines how provider availability, accessibility, affordability, accommodation, and patient-level factors shape rural oral health access in New Hampshire. Attention is given to accommodation, or how the organization of the delivery system, including statutory supervision requirements under RSA 317-A, may influence access to preventive care. The analysis then compares expanded hygienist autonomy with loan repayment, Medicaid reimbursement reform, mobile delivery models, and the status quo. This analysis suggests existing strategies, while important, have not yet fully addressed rural access barriers (NH DHHS, 2024). Evidence indicates supervision requirements may constrain preventive service delivery where dentists are scarce, while broader hygienist autonomy has been associated with increased preventive-service utilization elsewhere (Langelier, Continelli, et al., 2016). The capstone recommends a three-year pilot permitting independent practice dental hygienists to provide preventive services in federally designated Dental Health Professional Shortage Areas and selected school-based settings, with Medicaid billing authority, referral requirements, standardized reporting, and evaluation of structure, process, and outcome measures (Donabedian, 1988).

Language

English

This document is currently not available here.

Submit Feedback on Presentation

Share

COinS