2024 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 public health dental hygienist (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 2024 calendar year, Illinois had 219 certified PHDHs 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 2024, 10,453 children, adults, seniors (65 years and older), individuals with developmental disabilities, and families below 300% of the poverty level were served by PHDHs in various settings. In 2024, 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.

* A PHDH may be providing services in one or more public health settings.

** The Illinois Dental Hygienist Association’s Public Health Dental Hygienist (PHDH) Certification Program confirms the cumulative number of certified PHDH reported for 2022 was 133. In 2023, 194 certified PHDH were confirmed, reflecting a 46% increase in certified PHDHs. The cumulative number of certified PHDH reported for 2024 reached 219, marking another increase in this important effort to expand access to care through this workforce model.

When comparing PHDH services between 2023 and 2024, service encounters increased across all pediatric age groups:

• Birth to 5 years + 123 encounters
• 6-13 years +292 encounters
• 14-18 years +284 encounters

The increases highlight the growing impact of PHDH’s expanding access to oral health care for children. However, a need to focus on expanding the PHDH model access to care for those 19- 65+ years of age, including those living in long-term care facilities.

The 2024 PHDH Activity Reports slightly decrease with 10,453 encounters compared to 10,900 in 2023, which is attributed to 2024 being a license renewal year and a delay in applying for the PHDH program after September 30, 2024. However, in 2024, the total number of PHDH’s providing care increased to 71 from 42 in 2023, reflecting a 41% increase in the number of PHDH’s providing care in the public health setting.

Several strategies still 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 employee’s 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 completing a PHDH Certification Program.
• Direct Medicaid reimbursement to PHDHs, thereby increasing the number of Illinois Medicaid providers.

Many Illinois communities, particularly rural areas, face challenges 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, 79 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 and cost for oral health services continue to rise, and the state’s most vulnerable populations will face ongoing challenges in accessing necessary oral health care.

The 2024 PHDH Activity Report highlights the continued success of the PHDH model in improving early oral health care access for low-income, uninsured, or Medicaid-insured individuals across Illinois’ most vulnerable populations. Continued efforts are needed by health care professionals to strengthen and expand this critical workforce model.