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My Turn: Let’s expand the dental team

Many of our neighbors around the northern part of the state are forced to visit expensive hospital emergency rooms for dental problems that are mostly preventable. In many cases, these ER trips reflect the difficulty they have getting regular, routine dental care because they live far from the nearest dentist or cannot afford dental care.

As a dentist, I find myself asking, “Why not apply the medical model of adding nurse practitioners, physician assistants and others to my own profession and expand the dental team to help solve this problem?”

Orthodontists have been using expanded duties staff members for years. Senate Bill 193, currently being considered by the New Hampshire Legislature, would do just that.

Several states have already legislated such models. Specifically trained dental assistants and hygienists with advanced training are now able to deliver clinical care directly to both children and adults in clinics or dental offices under the direct and indirect supervision of licensed dentists. This allows the dentists to practice at the top of their licenses, meaning they can focus on the most complex procedures. It also allows for routine dental care to be delivered at less cost and in clinics more suitably located where the traditional dentists do not practice. The technology available today makes it possible for a supervising dentist to review, answer questions and view patients remotely when necessary to manage their care.

This concept has been met with resistance by the American Dental Association and some state dental societies. Why? Is this action prompted by turf control and not by a reasonable look at solving an access and cost containment problem? Many dentists, including me, believe our profession should lead the way to help make sure we can get care to more people without compromising the quality of care.

In those settings where expanded duties dental personnel are being used, the sky is not falling. The dentists are able to supervise the care of more patients. They are capable of enhancing their income stream even as the cost to patients is reduced and help keep people out of emergency rooms. Best of all, auxiliary personnel have more to inspire them to advance in their respective professions.

Over my 40 years of private practice there were many qualified dental assistants who, with additional training, I would have loved to have on our team to expand the outreach in caring for under-served citizens here in northern New Hampshire.

Gearing up to handle the proper training and implementation of the medical model to the dental profession is already being done in this country. I urge the professional organizations in my field to come to the table, continue to speak out for high quality care, and give dentists another tool to get their care to more people by supporting Senate Bill 193.

Training professional community members to deliver routine basic therapeutic and restorative care to their citizens with the virtual remote supervision and guidance of a dentist would provide a solution to the dental health crisis in New Hampshire. Dental disease is easily preventable. Placing trained personnel within undeserved areas of our state and having them connected to supervising offices would be a way to reach citizens in rural areas. Such a system just might “through its members insure the oral health of the people of New Hampshire,” which is a stated goal of New Hampshire Dental Society.

This is a paradigm shift of dental care delivery whose time has come in dentistry. We have seen it work for our sisters and brothers in the medical profession. Let’s pitch in and make it work for our patients’ sake and for our dental profession.

(Dr. Robert C. Keene of Etna is the pre-dental adviser to Dartmouth students as an adjunct professor in Anatomy at the Gisele School of Medicine at Dartmouth College.)

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