2023 Public Health Dental Hygienist Activity Report

Oral health is a crucial part of an individual’s overall health. Good oral health can improve overall health by lowering the risks and complications from several serious diseases, such as diabetes, cardiovascular disease, and preterm or low-weight births. In many regions across Illinois, limited access to oral health care leaves numerous individuals with untreated conditions. This lack of care contributes to chronic illness among various populations and places a significant burden on the health care system, underscoring the importance of early access to preventive services.

A PHDH is a registered dental hygienist who can provide early care to patients in a public health setting, such as a federally qualified health center (FQHC); a federal, state, or local public health facility; Head Start; a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) facility; a certified school-based health center; or at school-based oral health program. In 2023, legislation added the public health settings to include prisons, skilled nursing, and long-term care facilities. Illinois public health settings continue to adopt the PHDH model to increase access to care, providing opportunities for prevention and early intervention in the disease process.

A PHDH has at least two years of dental hygiene experience or the equivalent of 4,000 clinical hours as a dental hygienist. In addition, 42 hours of continuing education are required in advanced areas specific to public health dentistry. Twenty-nine hours must be in medical emergencies in the dental office, pediatric dentistry, pharmacology, medical record-keeping, oral pathology, and geriatric dentistry. Five hours (of the individuals’ choice) must be in geriatric dentistry, cultural competency, nutrition for geriatric and special needs patients, communication techniques with non-English speaking patients, and teledentistry. Additionally, an eight-hour in-person review course and PHDH certification exam are required. At the end of the 2023 calendar year, Illinois had 194 certified PHDHs, many of whom are actively working to expand and improve access to care across the state.

 When a PHDH works collaboratively with a dentist, they expand their scope of practice, allowing the PHDH to improve access to care for the most vulnerable and underserved populations. In 2023, 10,900 children, senior citizens, individuals with developmental disabilities, and persons and families falling below 300% of the poverty level were served by PHDHs in various settings. In 2023, the school-based programs were the top entity to utilize the PHDH model, followed by FQHCs and local health departments.  WIC programs and other state-licensed facilities have also shown benefit from the further expanded use of the PHDH model.

* The Illinois Dental Hygienist Association, Public Health Dental Hygienist (PHDH) Certification Program confirms the cumulative number of certified PHDH reported for 2022 was 133. Reporting in 2023, 194 certified PHDH were confirmed, reflecting a 46% increase in the PHDH model.

** (225 ILCS 25/18.1)Dental Practice Act- Each public health dental hygienist who has rendered services under subsections (c), (d), and (e) of this Section must complete an annual summary report to the Illinois Department of Public Health at the completion of a program.

In 2023, children 6-13 years of age showed a greater increase in access to services by a PHDH, followed by birth to 5 years of age. Individuals 19-64 years of age and older and 14-18 years of age have also shown an increase in care.

 The PHDH Activity Report in 2022 revealed 8,219 encounters compared to10,900 encounters in 2023 indicating a 33% increase in overall PHDH encounters. The data clearly demonstrates the PHDH model continues to improve early access to dental care for all age populations.

Several strategies need to be considered to increase access to oral health care through the PHDH model:  

• Increasing education and recruitment for PHDHs at dental and dental hygiene schools.
• Increasing awareness and adoption of PHDHs by leaders in public health settings.
• Increasing the rate of pay for the PHDH when working in a public health setting.
• Expanded hours for the PHDH model to increase appointment availability.
• Employer reimbursement for the PHDH Certification Program.
• Direct Medicaid reimbursement for the PHDH model, thereby increasing the number of Illinois Medicaid providers.

Many Illinois communities, particularly rural areas, face challenges in recruiting and retaining oral health care providers. Even in more densely populated areas, there is often a lack of dental providers willing to participate in the Medicaid Program. According to the IDPH Office of Rural Health, 75 of the 102 counties in Illinois are designated as Health Professional Shortage Areas (HPSAs), primarily due to a shortage of oral health providers serving low-income and Medicaid-eligible residents.

As people live longer, the demand for oral health services will continue to rise, and the state’s most vulnerable populations already struggle with limited access to care. This 2023 PHDH Activity Report highlights the continued success of the PHDH model. Public Health Dental Hygienists are improving early oral health care access for low-income, uninsured, or Medicaid-insured individuals for Illinois’ most vulnerable and at-risk populations.