RDHAPs Provide Alternative to Traditional Dentists

Beth Wilson, RDHAP and president of the California Dental Hygienists’ Association (CDHA) provided the following interview.  In addition to representing the interests of its members the organization is committed to the following mission statement.

The Mission of the California Dental Hygienists’ Association:

• Advance the art and science of dental hygiene

• Increase the public’s awareness of the cost effective benefits of prevention

• Ensure access to quality oral health care

• Promote the highest standards of dental hygiene education, licensure and practice

• Promote dental hygiene research

• Promote the interests of dental hygienist


Question: What is the biggest challenge that faces your profession?

Answer: The biggest challenge that faces this profession is being recognized as a valid preventive oral health care provider. Many lay people do not understand what the dental hygienist is in their own dental offices or what the difference is between an assistant, dental hygienist or even the dentist.

In the professional world we struggle with insurance companies and other professionals understanding that we are providers and should be recognized and paid as such. The Registered Dental Hygienist in  Alternative Practice (RDHAP) or (AP) professional sometimes is not paid for procedures that are within  their scope of practice especially by the biggest payer of most RDHAPs, Denti-Cal.   This struggle makes it  difficult for RDHAPs to operate a business.


Question: How does one find a RDHAP?

Answer: There are a couple of different ways to locate a RDHAP. We are now listed on the Denti-Cal website, if a Denti-Cal provider, and also on CDHA.org.  Many APs can be connected with on CDHA Alternative Practice Facebook page also.

Question: What are the pre-qualifications and education requirements to become an RDHAP?

Answer: You must first be a dental hygienist with experience prior to becoming a dental hygienist in alternative practice. The licensing requires 2000 clinical hours before you can apply to become an AP hygienist. Dental Hygiene education is usually a four-year course of study: two years prerequisites and two years of dental hygiene education once accepted to a dental hygiene school.


Question: Does an RDHAP work independently of a dentist?

Answer: A Registered Dental Hygienist in Alternative Practice does work indepen must have an established relationship with a dentist for referral when applying for a AP license.


Question: When did the California legislature allow RDHAPS to practice?

Answer: The California Legislature allowed Dental Hygienists in Alternative Practice to begin in 1998.


Question: Do RDHAP have stand alone practices and if so, what services do they provide?

Answer: Some dental hygienists have stand-alone practices in California if they practice in a Dental Health Professional Shortage Area. There are about eight in California currently. They are allowed to provide all dental hygiene services within their scope of practice such as teeth cleanings, scaling and root planning, oral hygiene education and fluoride application. The pricing is comparable to a dental office except that the patients are not charged for a dental exam or dental x-rays when seeing an AP hygienist. Some traveling AP hygienist charge a mobile fee on top of the dental care fee provided to travel to a site. This could be the patient’s home, residential care facility of where the patient resides.


Question: If an RDHAP doesn’t stand alone, then where do they perform services and for whom?

Answer: Dental Hygienists in Alternative Practice who do not provide care in a Dental Health Shortage Area can only practice mobile dentistry by traveling to the patients such as Skilled Nursing Facilities, Residential Care Facilities, Schools and homebound patients. Most of these patients are the frail and elderly or special needs patients. Also, many some hygienists work with low socio-economic populations of children.


Question:  How does California compare to other states when it comes to the ration of dentist to patient and percentage of the population that regularly receives preventive dental services:

Answer:   It really depends on which population of patients you are referring to.   Private dentists are usually abundant and able to see privately insured or cash paying patients. Patients who are on California State Medicaid have a very different scenario. Most areas in California, especially rural areas, do not have dentists who accept Denti-Cal.  It is shown that only 1/3 of the children with Denti-Cal are actually being seen and for adults the number is even smaller. Most Denti-Cal clinics are overbooked and closed to accepting new patients. California ranks in the bottom third of States in the US that are providing dental care to its poor and vulnerable population.