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An Innovative Solution For Reaching The Underserved

California’s Virtual Dental Home program is increasing access to care, while also providing opportunities for midlevel practitioners.

In 2011, I became an oral health advocate and provider for the underserved through the Virtual Dental Home (VDH) project in the greater Los Angeles area. The 3-year Health Workforce Project, initiated by California’s Office of Statewide Health Planning and Development, sought to evaluate the ability of teledentistry technology to alleviate access-to-care problems. The main objective was to increase access to dental care and to close the gap between health disparities that exist in California and throughout the United States.


Designed by Paul Glassman, DDS, MA, MBA—director of the Pacific Center for Special Care at the University of the Pacific Dugoni School of Dentistry in San Francisco—the VDH is a community-based oral health care delivery system. Registered dental hygienists or dental hygienists in alternative practice (RDHAPs) provide preventive and early intervention services in community locations near the homes, schools, or workplaces of vulnerable populations. At the community site, the dental hygienist decides which X-rays to take and creates a patient profile by collecting photographs and capturing radiographs. This information is then stored on a secure server for the dentist to access and examine from a remote office site. Collaborating via telehealth technology, the dentist makes recommendations to the dental hygienist who will deliver the necessary preventive services. If early caries is present, the dentist advises the dental hygienist to place an interim therapeutic restoration—a temporary filling that puts decay in a holding pattern and arrests the caries disease process until the patient is able to visit a dentist in person. The patient is managed and maintained by the dental hygienist remotely. When a patient is in need of extensive services, the dental hygienist provides a referral to a local provider. The importance of caries disease prevention and treatment are reinforced by the dental hygienist who provides oral health education to the patient and the parents or caregivers. The VDH promotes patient and provider accountability by addressing some of the obstacles many patients face in accessing traditional dental care, such as lack of transportation and the special needs of vulnerable patient populations.


Glassman has been working to improve the lives of individuals with disabilities and those with limited access to dental care for many years. He continues to implement projects to raise oral health awareness among the underserved. His passion for this issue was ignited when he provided dental care to hospital-based patients with complex medical problems and disabilities. In the early 2000s, Glassman began an online training program for RDHAPs so they could provide in-home hygiene services for people with disabilities in residential settings. This inspired his idea of using telehealth technologies to expand the care that could be provided in community sites where underserved children and adults received social, educational, and general health services. This was the beginning of the VDH.

In 2010, he applied for the Health Workforce Project #172, received approval, and the VDH project began. In 2013, Assembly Bill 1174 was introduced in the California legislature to make elements of the VDH project permanent. On September 27, 2014, the bill was signed into law. The new law adds teledentistry to a list of specialty health care services for which face-to-face contact is not required in order to claim reimbursement from Medi-Cal, California’s Medicaid program. The new law also expands the list of procedures that dental hygienists and certain dental assistants can perform without a dentist present on-site. For example, the new law authorizes “specified registered dental assistants in extended functions, registered dental hygienists, and RDHAPs to determine which radiographs to perform and to place protective restorations.”1


The VDH introduces a new business model that offers myriad opportunities for dental hygienists. Dental hygienists can work independently in collaboration with a dentist or potentially establish their own businesses. They are well suited to fill the midlevel practitioner role in VDHs. I received training at the University of the Pacific Dugoni School of Dentistry to place interim therapeutic restorations and implement caries disease management programs, as well as advanced radiology education. In the VDH project, I worked with multiple school districts and managed 15 schools in the metropolitan areas of Los Angeles County. My position encompassed more than providing hygiene services. I was also an oral health advocate, health care system navigator, educator, dental coordinator, oral health outreach specialist, and more. I assisted all VDH patients and their family members in obtaining access to dental care; provided preventive services; and educated patients, parents/caregivers, and staff on the importance of oral health and preventing and treating early caries.

Dentistry is entering an era of accountability, in which dental care providers are accountable for the health outcomes of their patients. The dental hygienist as a midlevel practitioner will be able to manage and meet the demands of this new era through advanced education and collaboration.


  1. California Legislative Information. Assembly Bill No. 1174. Available at: Accessed September 24, 2015.

From Perspectives on the Midlevel Practitioner, a supplement to Dimensions of Dental HygieneOctober 2015;12(10):44–45.

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