Direct access to midlevel dental providers: An evidence synthesis

Objectives: Direct access is a term that describes the ability of patients to seek health care from midlevel dental providers (MLDPs) without first seeing a dentist. The objective of this study was to synthesize the evidence for the effects and costs of direct access to MLDPs in a primary dental care environment and assess the attitudes of various stakeholders to this method of care delivery. Methods: The literature was examined for descriptive, observational, and experimental study designs to examine the evidence for direct access in dentistry. Electronic searches were undertaken of the Database of Abstracts of Reviews of Effectiveness, bibliographic subscription databases, open access databases, and the gray literature. Results: The search identified 371 records, although the extent of experimental evidence was limited. The majority of included studies were descriptive and recorded the subjective views of different stakeholders, following the introduction of the policy. Conclusions: The limited extent of experimental evidence regarding direct access to MLDPs contrasts with their widespread use across Europe, the United States, and the southern hemisphere. Suggestions are made for a research program to improve the evidence base for direct access. © 2014 American Association of Public Health Dentistry.