Objectives: Direct access is a term that describes the ability of patients to seek healthcare from midlevel dental providers (MLDPs) without first seeing a dentist. Theobjective of this study was to synthesize the evidence for the effects and costs ofdirect access to MLDPs in a primary dental care environment and assess the attitudesof various stakeholders to this method of care delivery.Methods:The literature was examined for descriptive, observational, and experi-mental study designs to examine the evidence for direct access in dentistry. Elec-tronic searches were undertaken of the Database of Abstracts of Reviews ofEffectiveness, bibliographic subscription databases, open access databases, and thegray literature.Results:The search identified 371 records, although the extent of experimental evi-dence was limited. The majority of included studies were descriptive and recordedthe subjective views of different stakeholders, following the introduction of thepolicy.Conclusions:The limited extent of experimental evidence regarding direct access toMLDPs contrasts with their widespread use across Europe, the United States, andthe southern hemisphere. Suggestions are made for a research program to improvethe evidence base for direct access
