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HealthBeat

Expanded dental hygienist bill faces opposition in Senate

A group of 24 organizations announced yesterday they support a bill before the Senate to broaden the role of dental hygienists, a move the New Hampshire Dental Society opposes and says is an unnecessary distraction from the real barriers to dental care.

New Hampshire consistently ranks among the top states for access to dental care, being one of only five states to earn an A rating from the Pew Charitable Trusts’ Center on the States. More than 75 percent of high-need schools have programs providing dental sealants, and only 1 percent of the state’s population lives in an area without a dentist, fourth-lowest in the country, according to Pew.

The story is different for low-income families, however: more than 45 percent of children enrolled in Medicaid didn’t go to the dentist in 2009, according to a different Pew study.

The Senate is scheduled to vote on a bill Thursday creating dental hygiene practitioners, an expanded role for dental hygienists who pursue further education.

“In this economy, cost or fear of missing work is hindering a lot of us that don’t have a dentist from accessing care in a traditional setting. How does this bill help solve the problem? By bringing the chair and the care to the patient,” said Susanne Kuehl, a representative of the New Hampshire Dental Hygienists Association.

“Dental hygienists can work in federally qualified health centers, nursing homes and school-based programs, and this bill expands the provider care to include restorative care.”

Like a dental hygienist, a dental hygiene practitioner would work under the supervision of a dentist, although in some cases, indirect supervision where a dentist would review case files regularly but not observe actual work.

Where a hygienist performs basic cleaning and preventive care services – and a certified public health hygienist created in state law last year can place temporary fillings – a dental hygiene practitioner would be allowed to read X-rays, drill and place temporary fillings, and remove teeth in specific circumstances.

Sen. Peggy Gilmour, a Democrat from Hollis, has been the bill’s primary legislative champion since proposing it last January. As originally proposed, a person could pursue education as a dental therapist. The Senate Health, Education and Human Services Committee recommended amending it so only already-licensed hygienists can pursue the advanced training.

As a nurse practitioner, Gilmour equated the bill to legislation pursued years ago to expand the scope of practice for her profession.

“I have come to learn that change comes hard,” she said. “Fear still remains about the unknown. . . . But I did all the research that I could find to see all the safety records and the quality of care of people who were advanced hygienists doing advanced work, and I was satisfied to know this is safe.”

In their opposition to the bill, dentists have not questioned the abilities of hygienists to provide safe care but have said this move draws attention and resources away from initiatives that could more directly and quickly address oral health problems in the state.

“There is no evidence that adding a new provider will directly help lower tooth decay or guarantee more care in rural areas. What it will do is waste our resources on an out-of-state agenda that will take years to set up and drain funds today,” said Puneet Kochhar, president of the New Hampshire Dental Society.

“Access issues such as transportation, fluoridation and limited dental coverage for some New Hampshire residents need to be made bigger priorities at the local and state level,” he said.

At least one dentist has broken ranks with the society and appeared yesterday at the press conference supporting the bill.

Robert Keene, a semi-retired dentist from Etna, said the “feel-good” annual dental care events offered for low-income or uninsured people are note-worthy but don’t provide the ongoing care those patients really need.

While the bill won’t fix every problem in the state and will take time to be fully implemented, “it just makes sense to me,” he said.

“These expanded duty practitioners are going to have to be deployed in a different way than the 9-to-5 model that most dental practices are familiar with. They will need to be deployed so their outreach is happening at a time when the working poor can access it,” he said.

“It’s about education and outreach and empowerment; how to convey the simple things to empower people who don’t feel they have any power.”

The full Senate is scheduled to vote on the bill Thursday. The Health, Education and Human Services Committee recommended, 3-2, to adopt it as amended.

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

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