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My Turn: New Hampshire doesn’t need dental hygiene practitioners

I write in response to a recent column calling for legislators to approve Senate Bill 193, which would add dental hygiene practitioners to the list of dental providers in New Hampshire (“Let’s expand our ability to deliver dental care,” Monitor Forum, Nov. 8).

If this bill passed, it would make New Hampshire only the third state to allow such practitioners. The others are Minnesota and Alaska, which offer far different geographical barriers and spend a lot more for dental services than New Hampshire has ever done. Incidentally, bills similar to this one have been defeated in many states over the last few years, including in Maine and Vermont. In addition, this proposal offers a possible solution that would take years to implement and resources that the state currently does not have.

One of the greatest challenges of heath public policy is staying focused on today and tomorrow. The dental community in our state has been hard at work to address barriers to access. While about 2 percent of our population still has challenges in accessing dental care, we have come a long way.

New Hampshire’s oral health system is ranked near the top in the nation, according to a 2013 report from the Pew Center on the States. The Centers for Disease Control rank us as one of only five U.S. states where 75 percent of the adult population visited a dentist in the past year.

According to the state Department of Health and Human Services, children on Medicaid have better access to a dentist than almost anywhere else in the country.

Special interest groups are coming into New Hampshire and saying we need a new “dental hygiene practitioner” position: basically a trained hygienist with 10 or more months of additional study who could perform irreversible dental procedures without direct dental supervision. This model has been applied only in the most remote areas of Alaska and Minnesota and supported with significant state subsidies.

As this bill again winds its way through Concord, our concern is very simple: Why chase an unproven concept when so many simpler and more immediate steps have yet to be taken? The best way to increase access to oral health care is to promote public awareness, recruit more dentists to rural areas, improve transportation, increase fluoridation, and financially sustain dental clinics.

A recent study of Dental Therapists in Minnesota by Community Catalyst found that so far, 60 percent of their work has been preventive work, which is more than twice the restorative demand they see. As one of the top states in the nation in terms of access, one has to question if we should put scant resources into a new provider model which ends up doing mostly work than can be done already by approved providers.

Today in New Hampshire we have two new members of the dental team: a new expanded function dental assistant and a certified public health hygienist to help close the access gap. These new roles need to be given time to make a difference. To aid their efforts, we should launch a statewide public education effort on oral health and address the lack of transportation to help families get to the dentist in rural areas. Fluoride can also be added to public drinking water.

The answers are here today, and the gap is closing thanks to the efforts made by members of the dental team. Let’s find a New Hampshire solution that addresses the challenges we face today – not the ones we might face in 2025.

(Dr. Puneet Kochhar is president of the New Hampshire Dental Society.)

Legacy Comments2

I disagree with changeisgood - dental offices do operate that way now - dentists already have hygienists and dental assistants who do that - and they are open to help you. But, like a nurse - they do not do surgery. Do you want someone with 18 months or less of training doing work that is irreversible on your or your family? It is not apples to apples.

I disagree with the NH Dental Society here and wonder why there is such pushback. Since doctor's offices added nurse practitioners and PA's, I can call in the morning and be seen that very day. The time I get with that nurse or PA is far more than with the doc, and I feel I'm getting appropriate and cost-effective care to common ailments. And when there's something more complex, I'm assured the doc's time isn't unavailable because she's busy looking at someone else's hangnail. I don't see why dental offices would operate any differently.

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