Access to oral health care is one of the highest priorities of ADHA. Direct Access refers to 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.

It is the position of ADHA that oral health care—a fundamental component of total health care—is the right of all people. Lack of access to oral health care is a critical issue in the United States due to disparities in the health care delivery system. Dental hygienists must play a vital role in the solution to eliminate these disparities and assure quality oral health care for all.


The Progression of Direct Access

  • Direct Access 2008

    28 States

    direct access map 2008
  • Direct Access 2011

    34 States

    Direct Access map 2011
  • Direct Access 2017

    40 States

    direct access map 2017
  • Direct Access 2021

    42 States

    direct access map 2021
  • States that permit direct access to dental hygienists