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Proposal to expand hygienists’ role met with opposition from dental society

74-year-old Carmela Harris from Contoocook gets her teeth cleaned by Dental Hygienist student Shari Rouleau. Shari, a Troy, New Hamphire resident will graduate in May. 
October 26, 2005
(Concord Monitor photo/Javier Manzano)

74-year-old Carmela Harris from Contoocook gets her teeth cleaned by Dental Hygienist student Shari Rouleau. Shari, a Troy, New Hamphire resident will graduate in May. October 26, 2005 (Concord Monitor photo/Javier Manzano)

One year after New Hampshire lawmakers passed a bill expanding the role of some dental hygienists, another bill proposes further reform of the state’s oral health system.

It’s a proposal some say could improve access to dental care before problems become crises. The New Hampshire Dental Society, however, says the proposal is wrongly focused on restorative work when what is needed is more education and coordination.

The bill, which has had one hearing before the Senate Health, Education and Human Services Committee, would create the position of licensed dental therapist, a dental provider between a hygienist and a dentist.

Like a dental hygienist, a dental therapist would work under the supervision of a dentist. But where the hygienist performs basic cleaning and preventive care services, (and the certified public health hygienist created last year can place temporary fillings) a dental therapist would be allowed to read X-rays, drill and place temporary fillings and remove teeth in specific circumstances.

England, Australia and Canada provide licenses for dental therapists with varying levels of responsibilities. Minnesota and Alaska are the only U.S. states that do, though several states, including Vermont and Maine, are considering similar legislation this year.

In New Hampshire, dental hygienists must possess at least an associate’s degree. The dental hygiene program at NHTI, for example, is a three-year program. The proposal would allow a dental hygienist to become a dental therapist after an additional year of training.

With communities in 9 of 10 counties in the state considered dental professional shortage areas, “we hear the stories about kids who aren’t getting services. They’re in pain and not able to concentrate,” said Erika Argersinger, public policy director for the Children’s Alliance of New Hampshire, during a meeting with the Monitor’s editors.

Children’s dental care is covered by Medicaid, but according to a 2011 report from the Pew Charitable Trusts’ Center for the States, only 54 percent of enrolled children regularly received dental care.

“The problem is some combination of not having a dentist available, or if there is, only about half of dentists in the state accept Medicaid,” Argersinger said. “If they do (accept Medicaid), they might have a long waiting list, or the closest dentist that accepts Medicaid might be far away.”

The problem of access may only get worse with time: In a 2010 study by the New Hampshire Center for Public Policy Studies, 4 out of 10 New Hampshire dentists were at or near retirement age.

“This is not the only thing we need to do to address that, but this is one way to get the services to kids where they are. We see a real access problem, and see this as part of the solution,” she said.

The New Hampshire Dental Society testified to the committee last month that other methods of addressing oral health are more urgently needed.

“This would add a new person to the team we don’t feel will add anything,” Executive Director James Williamson said in a meeting last month.

“There are studies we’ve done recently that tell us we don’t need people doing more restorative work, more extractions. . . . Our need is to connect people in need to those that can provide the service.”

Medicaid for adults covers only prescription medication, such as pain relievers, and emergency extractions. Of the 17 sliding-fee clinics in the state that provide low-cost dental care for adults, seven responded to a dental society survey that they are operating below capacity, Williamson said.

“We have people ready, willing and trained to give care but they don’t have the patients,” he said.

Instead of supporting the addition of more providers, the society is working with American Dental Association grant funds to relieve pressure on hospitals from patients requiring emergency services, to encourage more dental society member dentists to accept Medicaid, to involve more dentists in oral health programs in local schools and to educate pediatricians on oral health care for infants and toddlers.

“Dentists are not worried about the economic impact on them, there’s so much need out there. It’s not a turf battle,” Williamson said.

The Senate Health, Education and Human Services Committee is expected to vote on the bill before the end of the month.

Two of the five committee members are sponsors of the bill. Sen. Molly Kelly, a Democrat from Keene, said yesterday her primary concern is the balance between access and safety.

“We heard some compelling testimony of how this is working in other states, and I’ve had a couple dentists from my district contact me with some support for maybe looking at adjusting or amending some of the responsibilities, but they were open to the idea,” Kelly said.

“Change isn’t easy, but we want to make sure the language of the bill is appropriate,” she said. “The most important piece is that they would be working under the guidance and authority of a dentist, the way the medical profession is set up.”

(Sarah Palermo can be reached at 369-3322 or
spalermo@cmonitor.com or on Twitter @SPalermoNews.)

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