Online Program

State Policy, Access and Oral Health: The case of dental hygiene and Federally Qualified Health Centers

Wednesday, November 4, 2015 : 11:10 a.m. - 11:30 a.m.

Hannah Maxey, PhD, MPH, RDH, Department of Family Medicine, Indiana University School of Medicine, Indianapolis, IN

Federally Qualified Health Centers (FQHCs), important to America’s oral health safety-net, are subject to standard federal criteria, but deliver care in underserved communities with workforce policy environments that vary from state to state.  Variations in dental hygiene regulation and policy correlate with access to dental care at the state-level, but impact on underserved communities is unknown. This study seeks to determine whether and to what extent such variations affect availability, access, and oral health at FQHCs. 


Dental service utilization data for 1,135 FQHCs that received community health center funding from 2004 to 2012 were analyzed.  Dental Hygiene Professional Practice Index (DHPPI) served as a baseline indicator of the state policy environment. The influence of grantee and state level characteristics and the economic recession were considered.  Mixed effects models account for correlations introduced by the multiple hierarchical structures of the data.


FQHCs located in states with highly restrictive policy environments were 72% less likely to deliver dental services and, those that do, provided care to 7% fewer patients and reported 3% more emergency encounters than those located in states with more supportive policy environments. 


These findings suggest state workforce policy has a significant role in access and oral health among Americas underserved. They point to the need for enhanced and ongoing policy evaluation.  The framework developed for this study should be considered for the evaluation of other policies.

Learning Areas:

Other professions or practice related to public health
Provision of health care to the public
Public health or related public policy
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe a framework for studying the relationship state policy, access, and oral health

Keyword(s): Oral Health, Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a licensed oral health professional since 2000. I hold a PhD from the Department of Health Policy and Management at the Indiana University School of Public Health. My research focuses on health workforce policy and access to care. I have been involved in numerous health workforce research and evaluation projects.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.