Which states collude with dentists and force hygienist to work under
dentists thus creating the high U. S. dental prices indicated in
medicalcountries.com. Dental Hygienist believes they can clean your
teeth in their own office at a lower total cost. Now, the Hygienist
will take up to an hour to clean your teeth for $50.00+ (much of this
money goes to the dentist) and then the dentists comes in, after
cleaning, and claims they must inspect your teeth, and charges you
$25.00 for 2 of three minutes of looking. That?s an hourly rate of up
to $750.00 for the dentist and $20+ hourly for the Hygienist. Many
people let their teeth rot in their mouth because they cannot afford
the dentist?s high prices. Car manufactures say that $1,500.00 of the
cost of a car is medical costs and this is one thing that prevents
U.S. car and other companies from being able to compete with many
country?s manufactures. Blocking of competition is democracy only for
those who pay off the legislature and this hurts the citizens and
leads to the destruction of nations by professions who misuse their
government to gain their own personal welfare at the expense of all of
us. A Root Canal, in India, costs $48.00 and in the U. S. the same
quality root canal costs from $500.00 to $2000.00+. Something must be
done!!!  Hygienist must stand up for their rights!!!!!!!!

Dear ed777, 

" Most dentists oppose independent practice for hygienists because
they feel hygienists are not trained to diagnose and treat oral
diseases, and they fear that independent practice will erode their
patient base but will not adequately treat patients. Although
hygienists are trained to clean teeth and can apply sealants and
fluoride, they can do little more than refer to a dentist those
patients who need further help.

On the other hand, the American Dental Hygienist Association (ADHA)
strongly supports expanding the use of dental hygienists. The most
commonly cited benefit of expanding hygienists' role is that they can
provide high-quality preventive services to underserved patients.(19)
Although it is not ideal to provide dental hygiene without the
services of a dentist on site, the ADHA feels it is better for
low-income patients to receive patient education, cleaning, fluoride
and sealants than nothing at all. Under recent state practice site
expansions, hygienists are able to go to schools, nursing homes, and
other public health facilities to provide preventive services to the
most vulnerable and underserved populations. Another argument states
use to support expanded use of hygienists is that if they provide more
preventive services, they can free time for restorative procedures by
dentists who see publicly funded patients. The shortage of dentists
who care for low-income patients makes this an attractive prospect for
states."
(SOURCE:  Shelly Gehshan, Paetra Hauck, and Julie Scales, "Increasing
Dentists' Participation in Medicaid and SCHIP",
<http://204.131.235.67/programs/health/Forum/oralhealth.htm>).

I'm afraid, Ed, that your question should have been "what states do
allow hygienists to work independently".

State Requirements from Hygienists
==================================

"Presently, Colorado is the only state that has independent practice.
There are no restrictive guidlines or other qualifications for
independent practice in the state of Colorado. The only requirement is
state licensure for dental hygiene. However, there are states that
permit hygienists to perform without supervision in institution such
as, nursing homes, community centers and other undeserved institutions
where there is a need for oral health care [...]: Connecticut,
Washington, California, Oregon and Nevada" (SOURCE: Research On Issue
of Preceptorship (1999), <http://www.amyrdh.com/preceptorship.html>).
States the *allow* hygienists to work independently in some settings
are marked here by **, the rest do not.

Now for the states and their regulations: 

Alabama - Direct supervision in all settings. 
<http://www.legislature.state.al.us/CodeofAlabama/1975/34-9-27.htm> 

Alaksa - General supervision in all settings. 
In addition, "The State of Alaska is asking for federal funding and
legislation that will send Native Alaskans to New Zealand for such
training [of a "dental assistant, performing independent procedures].
They will then be placed in remote Alaskan villages where they will be
permitted to perform simple extractions and restorations with only a
yearly supervisory visit from a dentist. The ADA strongly opposes the
part of the program that permits the irreversible procedures."
(SOURCE:  Mel B. DeSoto, "AAO President-Elect's Report",
<http://www.swso.org/winter-04-spring-05/01.html>).

Arizona - General supervision in all settings. 

Arkansas - Indirect supervision. However, " In some States, such as
Arkansas, restrictions are so explicit that hygienists are confined
for most services to direct supervision in a dental office" (SOURCE:
"The Professional Practice Environment of Dental Hygienists in the
Fifty States and the District of Columbia, 2001",
<http://bhpr.hrsa.gov/healthworkforce/reports/hygienists/dhc.htm>).

*California - Indirect supervision. There is a special status, though,
of a RDHAP. RDHAP (Registered Dental Hygienist in Alternative
Practice) may have an independent practice: "Prior to the
establishment of an independent practice, an RDHAP shall provide to
the board documentation of an existing relationship with at least one
dentist for referral, consultation, and emergency services" (SOURCE:
Dental Board fo California,
<http://www.dbc.ca.gov/chapter-3-regulations-article-5.htm>). Read
more at:
Kate Zimmermann, "Working", ADHA,
<http://www.adha.org/publications/working/working12.htm>).

**Colorado - no supervision, except in state institutions. Read also: 
ADHA?s Response to ADA Study: The Economic Impact of Unsupervised
Dental Hygiene Practice and its Impact on Access to Care in the State
of Colorado
<http://www.adha.org/news/archives/2005/012805-study.htm> 

*Connecticut - general supervision, except in schools, where no
supervision is required.
"Connecticut has introduced House Bill 6819, which would allow
registered dental hygienists to administer local anesthesia.
Unfortunately, the lawyer who drafted the bill did not understand
dental terminology; as it is worded, the bill would allow a dental
hygienist to perform only infiltration. The Connecticut Dental
Hygienists' Association, along with the Connecticut Dental
Association, will propose a change to the language at the next public
hearing. Since both associations want the change, it will probably be
made." (SOURCE: ADHA Stateline News,
<http://www.adha.org/governmental_affairs/stateline.htm>).

Delaware - General supervision in all settings. 

District of Columbia - General supervision in all settings. 

Florida - Direct/General supervision, depends on the setting. 

Georgia - Direct supervision only

Hawaii - Mostly general supervision, in clinics, direct supervision. 

Idaho - general supervision in all settings
Read more here : Senate Health & Welfare Committee
<http://www.legislature.idaho.gov/sessioninfo/2004/standingcommittees/shelmin.html>
(search for hygienist)

Illinois - Direct Supervision in most settings 

Indiana - Direct supervision except in schools (no supervision). 
"A licensed dental hygienist may provide dental hygiene instruction
and in-service training without restriction on location. Dental
hygienist may also provide dental prophylaxis for children up to and
including grade 12 without supervision if the hygienist is employed by
the state department of health, the state department of education or
an elementary or secondary school. In any public health setting, may
also do screenings and referrals." HealthINchools,
<http://www.healthinschools.org/sh/policy_app1.asp>).

Iowa - General supervision in all settings 

Kansas - Direct supervision in all settings. 

Kentucky - Direct supervision in all settings. 

Louisiana - Direct supervision in all settings 

Maine - General supervision in all settings. 
"A dental hygienist may practice in a public or private school,
hospital or other non- traditional practice under "public health
supervision status" granted by the dental board on a case-by-case
basis. The hygienist may perform the duties they can do under general
supervision. The dentist should have specific orders and procedures to
be carried out, although the dentist need not be present when the
procedures are being performed. A written plan for referral or an
agreement for follow-up shall be provided by the public health
hygienists, recording all conditions that should be called to the
attention of the dentist. The supervising dentist shall review a
summary report at the completion of the program or once a year. A
dentist hygienist must apply to the board to practice under general
supervision providing such information the board deems necessary. The
board must take into consideration whether the program will fulfill an
unmet need, whether a supervising dentist is available and that the
appropriate public health guidelines and standards of care can be met
and followed." (SOURCE: HealthINchools,
<http://www.healthinschools.org/sh/policy_app1.asp>).
Maine Dental Hygienists' Association
<http://www.mawaonline.org/mdha/getArticleDetails.asp?lngMessageIdQuery=319> 
In addition: "House Bill 1023 (Legislative Document 1461) has been
introduced in Maine, which would create the position of an Expanded
Function Dental Assistant (EFDA), which would require dental assisting
certification. Under direct supervision of a dentist, the EFDA could
perform reversible intraoral procedures including, but not limited to,
placing and removing rubber dams and matrices; placing and contouring
amalgam, composite, and other restorative materials; applying
sealants; supragingival polishing; and other reversible procedures
that are not designated to be performed only by a dentist or dental
hygienist." (SOURCE: Linda Belaus, "Legislative Update from Around the
Country", <http://www.gdha.org/Legislative/LegisUpdate_6-05.htm>).

Maryland - General supervision, direct in clinics and insitutional clinics

Massachusetts - Direct supervision in all settings. "Massachusetts
finalized regulations to obtain a certificate to perform local
anesthesia. To obtain a certificate, a dental hygienist must meet the
following requirements.
1. The applicant must be licensed as a dental hygienist in
Massachusetts and provide the board with documentation demonstrating
current certification in Basic Life Support and/or CPR.
2. The applicant must successfully complete a training program or
course of study in a formal program in the administration of local
anesthesia, which shall be a minimum of 35 hours of instruction,
including no less than 12 hours of clinical training, conducted by an
educational institution accredited by the Commission on Dental
Accreditation of the American Dental Association (ADA CDA).
3. The applicant must successfully complete a written examination in
the administration of local anesthesia administered by the Northeast
Regional Board of Dental Examiners (NERB) or any successor agency
approved by the board.
4. Instructors must be licensed in Massachusetts." (SOURCE: ADHA
Sateline, <http://www.adha.org/governmental_affairs/stateline.htm>).

Michigan - General supervision in all settings. 

Minnesota - Dierct supervision in most settings. "In Minnesota, the
governor has signed Senate Bill 1498, which allows dental hygienists
to administer injections of local anesthetic agents or nitrous oxide
inhalation analgesia as specifically delegated in a collaborative
agreement with a licensed dentist. The dentist need not first examine
the patient nor be present. If the patient is considered medically
compromised, the collaborative dentist shall review the patient
record, including the medical history, prior to the provision of these
services. These changes are allowed only under a collaborative
agreement in health care settings and are not allowed in private
practice at this time." *(SOURCE: ADHA Sateline,
<http://www.adha.org/governmental_affairs/stateline.htm>).

Mississipi - Direct supervision in all settings. 

Missouri - General supervision in all settings. 

Montana - General supervision in all settings. 

Nebraska - General supervision in all settings. "A late February
committee hearing was set for Nebraska Legislative Bill 182, which
would permit dental hygienists who have accumulated 3,000 clinical
practice hours in the last five years to practice without supervision
in a number of non-office settings. These settings would include
hospitals, nursing homes, assisted living facilities, tribal clinics,
and public or private schools or preschools. The measure also permits
some additional services within the dental hygiene scope. Among these
is the authority to prescribe, as well as apply or dispense,
antimicrobial rinses, fluorides, and other anticariogenic agents."
(SOURCE: ADHA Sateline,
<http://www.adha.org/governmental_affairs/stateline.htm>).

*Nevada - "A dental hygienist who has special board authority may
perform services in a health facility, school, or place designated by
the board without supervision." (SOURCE: HealthINchools,
<http://www.healthinschools.org/sh/policy_app1.asp>).

New Hampshire - General and Direct supervision. 
"Under "public health supervision" dental hygienists may provide
procedures authorized by a dentist in a public or private school,
hospital or institution, provided the dentist reviews patient records
once in a 12 month period."  (SOURCE: HealthINchools,
<http://www.healthinschools.org/sh/policy_app1.asp>).

New Jersey - "At present, NJ has Direct Supervision in private dental
offices. The dentist MUST be on the premises at all times that the
hygienist is working. General Supervision means that the dentist is
aware of and authorizes the treatment to be performed but does NOT
have to be on the premises at all times. This allows greater
flexibility accommodating patients. Independent Practice by dental
hygienists is not permitted in NJ. (NJSA 45:6-64)" (SOURCE: New Jersey
DHA, Legislation <http://www.njdha.org/nj_legislation.htm>).

New Mexico - General supervision in all settings.

New York - "Recently confusion has arisen regarding the appropriate
level of dental supervision for the practice of dental hygiene in New
York State. In an effort to provide some clarity, this article
examines the supervision requirements and discusses what those
requirements mean for every day practice. As a general statement, the
confusion arises, in part, due to the flexible nature of the
supervision standards set by regulation. Ultimately, the appropriate
level of supervision is up to the individual dentist and depends on
the circumstances of a given situation. Despite the recent
controversy, the existing supervision requirements have been in place
since at least 1971 and nothing has changed the supervision
requirements established under N.Y.S. law and regulations since then."
(SOURCE: DHASNY, <http://www.dhasny.org/main_04sop.html>).

North Carolina - Indirect Supervision in most settings. 
NC Dental Hygiene Association - Policy Statement
<http://www.ncdha.org/membership/policy_statement.html> 

North Dakota - Usually, general supervision. See: 
State Statute - North Dakota Century Code 43-20-01-43-20-12 - Hygienist (PDF)
<http://www.nddentalboard.org/law/Hyg-43-20.pdf> 

Ohio - Indirect supervision in most settings. 

Oklahoma - General supervision. 

**Oregon - "Employees in this class are authorized by the Oregon Board
of Dentistry to practice dental hygiene on a patient under the
authorization of a supervising dentist. Employees in this class
receive general supervision from a licensed dentist who daily reviews
the hygienist's work through patient review, charts, and informal or
formal meetings with the employee. Work is evaluated for
professionalism, thoroughness, compliance with professional standards
such as those of the American Dental Association, and effectiveness of
treatment as reflected in patient's well-being." (SOURCE: University
fo Oregon System, <http://www1.ous.edu/owpd/plsql/owpd_pos_desc?p_pos_id=248>
"Independent Practice
A Dental Hygienist who holds a Limited Access Permit (LAP) may provide
most dental hygiene services without the supervision of a dentist. The
provision of services under a Limited Access Permit is limited to
patients or residents of the following facilities or programs who, due
to age, infirmity or disability, are unable to receive regular dental
hygiene care"
(SOURCE: Board of Dentistry, State of Oregon,
<http://www.oregon.gov/Dentistry/dental_hygienists.shtml>).

Pennsylvania - " A dental hygienist is prohibited from establishing or
maintaining an office or other workplace for the provision of dental
hygiene services separate or independent from the office or other
workplace in which the supervision of a dentist is provided." (SOURCE:
§ 33.205. Practice as a dental hygienist.
<http://www.pacode.com/secure/data/049/chapter33/s33.205.html>

Rhode Island - General supervision in all settings.

South carolina - General supervision in most settings.

South Dakota - General supervision in all settings. 

Tennessee - Indierct supervision in  most settings.

Texas - General supervision in all settings. 

Utah - General supervision in all settings. 

Vermont - General supervision in all settings. 

Virginia - Dierct supervision in all settings.

*Washington - No supervision in clinic and other settings. Read: 
Sunrise Review: Oral Health Professionals Omnibus Proposal 
<http://students.washington.edu/kunal/uwasda/sunrise1.htm> 

West Virginia - Dierct supervision in all settings. 

Wisconsin - General supervision in all settings.

Wyoming - Dierct supervision in all settings. 

Further Reading
===============
The Professional Practice Environment of Dental Hygienists in the
Fifty States and the District of Columbia, 2001
<http://bhpr.hrsa.gov/healthworkforce/reports/hygienists/dhdef.htm> 

 American Dental Hygienists? Association
<http://www.adha.org/> 

I hope this answers your question. Please contact me if you need any
clarification on this answer before you rate it. Search strategy:
[hygienist dental supervision], 
[hygienist "Independent Practice" dentists] + [name of each state/DC].

Good research by you researcher!!!!!!!
Google’s research shows Dentist have colluded with all states, except
Colorado, and prevented hygienist from working alone, and experience
in 19 states, (which allow hygienist independent practice in schools
and public treatment centers) has empirically proved that the
hygienist perform well, working independently. If the legislators
don’t understand this and keep our medical costs high by eliminating
competition, the people will create law, in their referendums, that
allows hygienist independent practice. Or, other countries and U.S.
business people, a mentioned in medicalcountries.com, will be
motivated to have hospital ships, off our borders, that escape our
despotic legislators and treat our citizens at reasonable costs.

In the 1980s states moved to reduce capacity at dental schools and
some schools closed. Thus the competition that keeps prices low was
eliminated. As a result, the ratio of dentists to population has
dropped. In the following 20 years, given the age of dentists then in
practice and estimates on when they would retire, more dentists would
leave the profession (85,000) than would enter it (81,000). High
demand for care and decreasing numbers of dentists relative to the
population have meant that dentists' practices are full without their
participation in public programs and as the dentists have
legislatively eliminated their competition, they are free to charge
over $1000.00 per hour, in some case, for their work. My root canal by
the pleasant, efficient, U.S. dentist took 25 minutes at a charge of
$670.00. His hourly wage rate calculates to be $1620.00. This means
that the minimum wage worker must work 259 hours for one hour of work
by this dentist and the college professor must work 46 hours for one
of the dentists, even though the professor has had more education than
the dentist. This same root canal costs $48.00 India. Would a
compassionate person not think about the effect of their behavior,
their greed?

      American Dental Hygienist Association (ADHA) strongly supports
expanding the use of independent dental hygienists. The
      benefit of expanding hygienists' role is that they can provide
high-quality preventive services at lower cost. Poor children are
      more than twice as likely as their more affluent peers to have
dental caries, and their disease is more likely to go untreated
      "Presently, Colorado is the only state that has independent
practice. There are no restrictive guidelines or other qualifications
      for independent practice in the state of Colorado. The only
requirement is state licensure for dental hygiene. However, there are
      States that permit hygienists to perform without supervision, in
institution such as, nursing homes, community centers, and
      other undeserved institutions where there is a need for oral health care.

      Gail Gilman, RDH, a California Health Manpower Pilot Project
(Independent Practice participant for 9 years), says: “ It angers
      me to see these ads (by the dental profession) that insinuate
hygienist aren’t qualified to treat the public unsupervised. It is
      already legal to work unsupervised in nursing homes, schools,
hospital, home health agencies and public health clinics. It
       makes no sense that hygienists can work on sick people, old
people, migrant workers, school children and American Indians,
       but not on the general public. Where’s the logic here?” 

       The goal of ADHA and its state constituents is to increase the
public’s access to the preventive and therapeutic services provided by
dental hygienists. Colorado Department of Regulatory Affairs in July
1985 stated that not only is the unsupervised practice of dental
hygienists safe for consumers, but it also provides the public with
the option to visit with a dental hygienist    exclusively for
preventive oral care and recognizes that dental hygienists are
educated to refer patients to a qualified dentist, as needed.
Additionally, the report reinforces that unsupervised practice should
be all-inclusive in all settings, (not just in nursing homes, schools,
hospital, home health agencies and public health clinics and school).
As otherwise this would violate the equal protection clause in both
the U.S. and Colorado constitutions stating that similarly situated
people must be treated equally. But when are the hygienist, and the
public going to get a backbone and stand up to the legislators and
dentists in a referendum and correct this injustice?

Thank you for the rating and the tip, I wish you success in your campaign.