Issue Background

Creating a Comprehensive Solution to Improve Oral Health in Massachusetts

For the 2017-2018 legislative session, The Massachusetts Dental Society (MDS) filed “An Act Relative to Graduate Education for Certain Professionals,” legislation which includes the creation of a Public Health Dental Practitioner (PHDP) position as part of a multi-faceted, comprehensive plan for improving access to oral health care.

This new practitioner, who would be directly supervised by a dentist, would be limited to providing care in designated dental shortage areas or at federally-designated health centers, following two years of post-baccalaureate education. Also included is a requirement that this new class of providers meets educational standards comprable to similar practitioners in primary care, such as nurse practitioners and physicians assistants.

Other components include:

Delegable Duties

  • All procedures of a registered dental hygienist.
  • The minimum competencies allowed within the CODA dental therapy standards, except extractions.


  • All procedures at the registered dental hygienist level shall be at the same supervision level as the registered dental hygienist.
  • All procedures above the level of the registered dental hygienist (CODA procedures) shall be performed under direct supervision.

Practice Areas

  •  The provider must practice in either a federally designated dental health provider shortage area or in a federally qualified health center.
  •  If practicing outside of a federally qualified health center, the provider must see 100% MassHealth patients.


  •  To ensure proper supervision this ratio is limited to one (1) dentist supervising at most two (2) midlevel providers.

 In addition, the MDS legislation proposes:

  • A mandate that all children in public schools receive a dental screening prior to entering kindergarten
  • That the Department of Public Health (DPH) annual hosts four to six community water fluoridation education seminars with local and regional health boards
  • A mandate that community health workers receive oral health training for geriatric patients and Medicaid recipients, among others
  • That DPH hires a Public Health Dental Hygienist coordinator

After years of studying this issue extensively, the MDS is confident that this comprehensive solution will expand access to care for Massachusetts patients by targeting multiple areas, while also maintaining a high level of training similar to that which is required of all health care providers.