Critics Renew Scrutiny of NC Dental Board Over Competition and Scope-of-Practice Battles
A decade after the United States Supreme Court rebuked the North Carolina Dental Board for anticompetitive conduct, critics argue the board continues to restrict competition, limit dental hygienists, and shape dentistry to protect entrenched interests.
More than 10 years after the United States Supreme Court ruled that the North Carolina State Board of Dental Examiners engaged in anticompetitive conduct, critics say the board continues to pursue policies that restrict competition and limit access to care. The 2015 decision stemmed from the board’s efforts to shut down nondentist tooth-whitening providers operating in malls and retail settings. The Supreme Court ultimately determined that the board, composed primarily of actively practicing dentists elected by peers, lacked immunity from federal antitrust laws because it was acting without sufficient state oversight.
Since then, critics argue little has changed. In recent years, the board has faced additional legal challenges related to its oversight of tooth-whitening services and has been accused of using regulatory authority to suppress lower-cost competition. Opponents also point to a failed 2025 proposal that would have required every dental office to designate a supervising dentist for all practitioners within a practice, including larger multilocation groups. Oversight officials ultimately rejected the proposal, concluding it would significantly alter the state’s dental practice landscape.
The debate extends beyond corporate dentistry and into dental hygiene practice. North Carolina continues to maintain some of the nation’s most restrictive dental hygiene regulations, including limiting dentists to supervising only two dental hygienists at a time and requiring physical dentist presence in most clinical settings. Advocates for expanded dental hygiene practice argue these restrictions worsen workforce shortages, increase appointment wait times, and reduce access to preventive care, particularly in underserved communities.
The board has also opposed broader licensure portability measures and maintained tight controls over teledentistry and unsupervised dental hygiene services. Supporters of reform argue modern dentistry has evolved and that restrictive regulations no longer reflect current workforce realities or patient needs.
The growing controversy raises larger questions about whether professional regulation is primarily serving public protection or protecting the market position of those already in power.
