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Hot Topic: Should dental hygienists be allowed to do more?

There is a fierce debate in the Legislature about a proposal to license a new position called dental hygiene practitioner, which would allow hygienists, with more training, to perform a broader range of services for dental patients. The New Hampshire Dental Society opposes the bill, but at least one dentist has broken ranks. The Senate is expected to vote today. Here are two views, from two dentists:

Give New Hampshire dentists the option

Senate Bill 193 authorizing the expansion of licensed New Hampshire dental hygienists to provide restorative and other minor dental procedures needs to pass. There is no justification to deny dentists living in our state who wish to reach out to expand their capacity to care for citizens. The hard-working families who cannot leave work to transport their families to dental offices need to be reached at times other than normal business hours presently available.

Do not deny New Hampshire dentists the option of being able to hire an expanded duties member of the dental health team. Give dentists this tool so that they can expand their outreach of care to their communities. These expanded duties trained hygienists will be an integral part of the dental team having proven their capabilities prior to moving into providing the dental care under indirect supervision. The dentist remains as the chief and responsible member of the team. The public will still be protected. No dentist would approve of having an unprepared expanded duties team member working without previously proving his or her worthiness.

Support SB 193 so dentist have the option to staff their teams to better meet the needs of our citizens.

Dr. ROBERT C. KEENE

Etna

(The writer is a pre-dental adviser at Dartmouth.)

Untimely and divisive

On behalf of the more than 750 members of the New Hampshire Dental Society, I write in opposition to SB 193, relative to dental hygiene practitioners and access to oral health care. The Dental Society opposes this legislation because it is untimely, unnecessary and divisive.

Two new dental workforce providers were instituted in 2012: certified public health hygienists and expanded function dental auxiliaries. These new workforce members will add another layer of depth to the dental team. Curriculum is being finalized to train these providers. We do not yet know the impact these providers will have on access to care. Before creating yet another new provider, we should analyze the effectiveness these two new expanded models have on the oral health care delivery system in New Hampshire.

The majority of private and public dental clinics in our state report having existing capacity (i.e. open chairs) in their offices. Proponents of this bill believe there is a shortage of dentists and other oral health care providers. However, there are many offices that have the space and ability to treat more patients than they currently see. Even providers and programs that offer free dental care to patients report having open chair time.

There is no data from Alaska or Minnesota (the only states where dental therapists currently practice) that shows these providers can deliver care at a reduced care. In fact, a few of our members traveled to Minnesota and spoke to doctors in the clinics where the dental therapists practice. They learned that the fee charged to the patient was the same whether the dentist or the dental therapist provided the care.

Lastly, SB 193 would license a mid-level provider with only 18 months additional training to perform duties such as extractions and other irreversible restorative procedures. This is not comparable to other mid-level providers. The populations that this new practitioner is aimed to treat are often the most difficult to treat. The elderly, medically compromised and developmentally disabled often need the most specialized and high level care that can only be provided by a dentist, pediatric dentist or oral surgeon.

SB 193 is untimely and unnecessary. This debate, spearheaded by a national foundation, has created division among oral health stakeholders and partners that have worked together for years to improve the state’s oral health. New Hampshire, in many national benchmarks, leads the nation in terms of oral health care.

The New Hampshire Dental Society believes that the work and strategies devised at the local level have worked best in expanding access to oral health statewide and will continue to support those efforts.

Dr. PUNEET KOCHHAR

Rochester

(The writer is president of the New Hampshire Dental Society.)

The Need for Denturists and Other Trained and Educated Alternative Oral Healthcare Providers Our focus is multi-population, primarily focused on people who are destitute and dealing with disparities associated with economics, accessibility, and disabilities. This includes people who are veterans, seniors, people living on Indian reservations and convalescent/retirement/rehab centers, homeless people, and people who will not step over a dental office threshold, knowing or thinking they can not afford the services being provided. The denturist profession is regulated in six states with a proven record of oral healthcare service to those in need along with referral services. It is important to recognize the affects of oral and dental pain or being edentulous due to periodontal disease or drug abuse and the impact on a person’s self-esteem. A person’s self-confidence is down because they can't find a job due to not having teeth or unsightly decayed teeth. The affect of their over all health which includes behavioral health due to nutrition deficiencies because of oral pain, infections, and missing teeth.

Fragment the Dental Professions to Meet the Oral Healthcare Needs of Americans Too many Americans deal with little or no oral healthcare until the onset of aggressive periodontitis and pain; limiting their treatment options. We need dental hygienists at schools and public health facilities. We need independent practices for dental hygienists nationally, so hygienists can have the freedom to work independently on the public health level providing services where needed, especially for oral health education in the early years of the public school systems. We need dental therapists/dental health aide therapists for extended hands on dental procedures through dental teams working convalescent/retirement facilities, prisons, and Indian reservations. We need denturists, providing removable oral prostheses care and referral services; freeing up dental chairtime for children, emergency, and restorative care. We need more rural community health/dental clinics including mobile dental units traveling to rural areas. We need ADA to change its existing ill-fated and outdated polices currently in place on workforce issues and exchange them for common sense policy recommendations by the U.S. Surgeon Generals and other oral health organizations. Gary W. Vollan L.D. State Coordinator, Wyoming State Denturist Association, www.wysda.org https://twitter.com/denturist2th

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