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My Turn: This is the wrong way to improve dental care

I am writing in response to several columns and letters published in the Monitor over the past few months concerning Senate Bill 193, which would implement a mid-level dental care provider (dental hygiene practitioner) in our state.

I appreciate the input from Mary Duquette, president-elect of the New Hampshire Dental Hygienists Association (“Let’s expand our ability to deliver dental care,” Monitor Forum, Nov. 8). She states that this mid-level provider is “already helping patients in Minnesota, Alaska and in 50 other countries.”

And that’s fantastic. But this is New Hampshire.

New Hampshire does not have remote areas of Native populations where physical access to the area is best accessed through air travel, such as in Alaska.

New Hampshire elects responsible and respectable members of our community to public office, such as Govs. Maggie Hassan and John Lynch, not a former professional wrestler such a Jesse “The Body” Ventura, who becomes a leading advocate for conspiracy theories behind 9/11, such as in Minnesota.

And, New Hampshire isn’t New Zealand, Australia or Malaysia. New Hampshire deals with our own problems in our own New Hampshire way. When outside influences, such as the president of the Minnesota Dental Therapy Association, start weighing in and pressuring our state legislators, the residents of New Hampshire should be startled and offended (“Misunderstanding dental therapists,” Monitor letter, Nov. 20).

As a dentist, I received eight years of post-high school education before I could interact with a patient on my own – eight years of developing critical thinking skills.

Dentistry is more than just filling holes in people’s teeth; it is treating the entire patient. It is understanding and responding to the possible side effects of the procedures we perform.

The mouth is the gateway to the rest of the body. Many systemic diseases manifest themselves through oral changes. The critical thinking skills I developed help me recognize these changes and take appropriate actions. In fact, many dentists receive training beyond dental school before opening up or joining practices.

Senate Bill 193 would require high school graduates to complete just three years of training before becoming a dental hygiene practitioner. The thought of an unsupervised 21-year-old being an integral part of a patient’s overall health care is alarming.

The president-elect of the New Hampshire Emergency Nurses Association recently wrote that “by expanding the dental team to allow another provider to be licensed, similar to nurse practitioners or physician assistants, patients would have better access to care at a more affordable cost” (“ER no place for dental issues,” Monitor letter, Nov. 27). However, a dental hygiene practitioner can in no way be compared with a nurse practitioner or a physician assistant. This typifies the quintessential apples and oranges argument.

Nurse practitioners need both a bachelor’s degree in nursing and a graduate degree. Most physician assistants also have their bachelor’s degree in addition to close to three years of training in their respective programs. Both undergo state licensing, continuing education and recertification.

Dental hygiene practitioners, after just three years of study (less than half the schooling a physician assistant or nurse practitioner receives), are performing irreversible procedures on patients. They are not ordering tests or assisting. They are performing things that cannot be undone. Is this what the residents of New Hampshire want?

A mid-level provider is not a magic wand that will solve the dental problems of New Hampshire residents. Dental disease is entirely preventable. This is where our focus should be. Having a dental hygiene practitioner will not magically make tooth decay disappear.

New Hampshire should focus on prevention and adequate fluoridation. Adding an additional, unsupervised and inexperienced member to our dental team is not New Hampshire’s answer.

Both proponents and opponents of dental hygiene practitioners make their arguments based on numbers and statistics, but with a patient’s long-term well-being and health in mind, I would strongly urge SB 193 be defeated.

(Dr. Charles Thomas is president of the Greater Concord Dental Society.)

Legacy Comments8

Clearly Dr. T has never been to Errol. 26 miles in either direction to the nearest dentist last time I checked. One way is through the 13-mile Woods, along the Androscoggin. Cars routinely zip off into the river in winter. Or you can go through Dixville Notch if you like to live dangerously in January and February. I'm assuming Colebrook has a dentist by now. It didn't really matter when I lived there because no one had the money to go to the dentist. Now that the logging industry has collapsed I imagine it's worse. The diet when I was growing up, day after day, was boiled hot dogs or cheap hamburger and boiled macaroni or potatoes. Nothing green most of the year. Dream on Dr. T. about a world in which you can't swing a dead cat without hitting a dentist. Many people in NH don't live there. And many more don't have the money to pay you and your colleagues.

actually lab bills are about 200 on crowns impression material to take just impression is about 20 the trays are a buck the gloves the staff had to wear to service you costs 2 the sterilization of the case and the instruments, and the pour up of the models is about 3. shipping 10 one way, too lets not forget filling out insurance forms about 10-30 dollars for just the accounting and billing and followup and data entry software the 8 yrs and extreme capital costs to set up a facility and hire the properly trained and even re-train to provide the replacement of a body part for 1500 is dirt cheap. 600, 40 yrs ago in 1983 is 1600+ today at a 2.5% inflation. no other part of health care rose only 2.5% yr over yr for 40 yrs. besides the impact a cleaning alone makes is like buying birthdays. go get your teeth cleaned

Dirt cheap? LOL. It was 30 years ago, not 40. In fact, in 2002 I paid $900 for a crown. In 1992 around $700. I have quite an investment in my mouth now, about $15,000. Why? Because my childhood dentist drilled my teeth too deep. Yes I have my teeth cleaned twice per year......had it done four times per year a few years ago.

I think that there is a lot of reform that needs to take place in the dental field. Back in the 1980's crowns would cost something like $600 and insurance would pay half. Today they cost $1500 and you are luck if insurance companies pay half. I needed a crown and a friend of mine had an uncle that ran a lab. The actual cost to make that crown was $20. Maybe now it is $50. Yet, the total service to replace one crown was 30 times the cost to produce th crown in the first place. Of course, then you need "build up" which is little bit of goop like material. Dental services today seem to be a total ripoff. Period. If someone who is a dental tech can do that same service for less then why not? It costs $130 to have a hygenist clean your teeth or $260 twice per year and if your insurance pays for x-rays, well, by god, they want to milk that insurance and do them as often as possible. The dentist comes in, looks at your teeth, scrapes a couple of times and the cleaning totals out at $180. I think that dentists are more worried about losing $$$$ than peoples health.

What is the matter Itsa? Suddenly you don't believe in capitalism. Do you now want big government to come in and control the cost of dental care? The dentist has to pay for all the education loans and equipment he uses. Or are you saying government should spend tax money to subsidize dentists?

I am just saying that UNLIKE health care, dental care is out of control. I don't want the government to come in and do anything and I certainly don't want to subsidize people like yourself and others.

You don't subsidize me. I work for a living. And I pay taxes that pay for people like you that don't want to pay their fair share to support the common good.

Yes, exactly.

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