The NCSL Blog


By Erik Skinner

On a bright autumn morning in Tampa, Fla., a group of more than 30 state lawmakers from around the country gathered in a small unassuming hotel conference room. As coffee cups clinked and the excited chatter faded away, the group of lawmakers settled in for a discussion on the oral health of mothers and children.

Child in dentist's chairWith COVID-19 dominating legislative priorities over the last two years, national experts acknowledged the difficult balance between responding to a pandemic and not losing ground in preventing or managing chronic conditions—a potentially costly outcome for payers and health systems.

For example, mothers and children missed preventive oral health appointments, which can lead to higher level services at a later stage of disease with poorer health outcomes and higher health care costs.

Each expert panelist represented a different perspective of pediatric, dental and health services research: Dr. Jane Grover, director, Council on Advocacy for Access and Prevention, American Dental Association; Dr. Patricia Braun, director, Rocky Mountain Network of Oral Health Integration; and Dr. Amy Martin, professor, Medical University of South Carolina’s College of Dental Medicine.

Braun noted that, as a pediatrician, chronic dental disease is, by far, the most common condition she sees. While highly prevalent, chronic oral health conditions are preventable. Prenatal checkups and well child visits present opportunities as key touch points in the health care system to deliver preventive oral health services, the panelists highlighted.

The panel also examined how the integration of oral health services—such as physically co-locating oral health and primary care services—can improve the health of maternal and child populations.

Participants explored actions that address the integration of maternal and child oral health services through policies like teledentistry and leveraging mid-level providers like dental therapists.

They also discussed whether state dental practice acts provide the necessary flexibility to address access or other policy challenges. While these policies are not necessarily directly related to integration, they can act as technological, workforce and statutory tools to address oral health service integration.  

Representative Deborah Ferguson (D-Ark.), a dentist, shared recent efforts in Arkansas that addressed dental hygienists as well as the promotion of oral health screenings in well-child visits. Senator Judy Lee (R-N.D.) provided an overview of dental therapy and other efforts to improve access and reduce costs in North Dakota.

Some state legislatures have enacted legislation relating to oral health providers like dental hygienists and dental therapists to address existing workforce shortages that can hamper access to oral health services. Currently, 42 states permit direct access for dental hygienists, which means they can initiate treatment without specific authorization from a dentist. There are 13 states with a dental therapy program.

NCSL will continue to support state legislative efforts on oral health and foster connections between members and with national oral health leaders.

For related information and inquiries about state policy on oral health, contact Erik Skinner in NCSL’s Health Program.

Additional Resources

NCSL would like to acknowledge the Health Resources and Services Administration and the CareQuest Institute for Oral Health for supporting the Summit preconference.

Erik Skinner is a policy associate in NCSL’s Health Program.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.