Midlevel Oral Health Providers Overview

Dental hygienists are oral health professionals working together with a dentist to provide preventative and routine care.  Since each state has its own specific regulations regarding the responsibilities of dental hygienists, the range of services performed varies from state to state.  The American Dental Hygienists Association reports approximately 200,000 dental hygienists currently working in the US.

Dental therapists are members of the dental team who provide preventative and restorative dental care, usually for children and adolescents. The precise role varies and is dependent on the therapist's education and the various dental regulations and guidelines. There is a growing professional association for dental therapists, the American Academy of Dental Therapy.  As this is an emerging field, and currently there are four states that certify and license dental therapists, there are currently few reliable estimates of the number of professionals serving in this capacity.

Dental hygienists and dental therapists practice in private settings, community-based clinics, and rural areas.  They all practice under varying levels of supervision by dentists, allowing the mid-level providers to meet needs in nontraditional, tribal, school based, and community settings.

The information on this site focuses on three areas of scope of practice for Mid-level Oral Health Providers: Ability of Dental Hygienists to practice outside the dental office, responsibilities of dental therapists, and prescriptive authority for dental hygienists.

According to the ADHA, direct access is defined 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. Some states require a dental hygienist practicing with direct access to have a collaborative agreement with a dentist that outlines certain policies and procedures. Other states require only certain educational and experience requirements before being allowed direct access. Some dental hygienists are allowed certain prescriptive authority for medications.

A few states have identified dental therapists as being an additional provider for dental services in the dental office or other practice sites.

The map on the right shows a comparison of all states and territories for these three areas. Choose a tab at the top of the map for different options. For more detailed information, please click on a state.

For information on nurse practitioners and physician assistants, please use the practitioner links below the map.

Interactive map: select a state to get more information.


  • Collaborative agreement required
    Dental hygienists are required to have a collaborative practice agreement with a physician which outlines procedures the dental hygienist is allowed to do and procedures for consulting with the physician.
  • Educational/practice hours required for direct access
    The dental hygienist must meet certain educational and/or practice hours requirements before being allowed direct access.
  • No direct access
    Dental hygienist is not allowed to practice with direct access.

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