Advanced dental hygiene practitioner

[Daurang]

What's up with MN? You just elected a comedian to be your senator so I'm not too hopeful more rational minds will prevail.

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[TempleDMDKrazd]

"Under the university's proposal, dental therapists could practice preventive care, such as applying sealants and fluoride, without a dentist on site. More complex procedures, such as pulling or drilling teeth, could be done by a therapist only under a dentist's supervision. And certain procedures would still be done only by dentists."

Not bad considering they need a dentist on site for extractions & stuff. So as long as they can't start popping out their own practices, I think it should be fine. Now we get our own PAs =D

what's going to stop dental mills/corps from opening offices with a senior dentist and hiring nothing but "dental therapists" to work under them for 60-70% the price of an associate if the dental therapist could "pull teeth, drill and fill and do other complex procedures"?

still bad in my book.
Dentists 0, DH 1

 

[NyCzPeter]

what's going to stop dental mills/corps from opening offices with a senior dentist and hiring nothing but "dental therapists" to work under them for 60-70% the price of an associate if the dental therapist could "pull teeth, drill and fill and do other complex procedures"?

still bad in my book.
Dentists 0, DH 1

Now that I think about it, you're right, PAs and NPs are screwing MDs in the A. Esp the primary care ones. I hope the ADA learns something from the AMA's mistake and start cracking down on these midlevels early. I'm hearing all sorts of stuff now like EFDA (expanded function dental assistant) who is basically an assistant that can do restorative, make temporary crowns etc, and then theres these new oral practitioners or something. I hope the ADA can do something about this madness.

 

[Guy Smiley]

Now that I think about it, you're right, PAs and NPs are screwing MDs in the A. Esp the primary care ones. I hope the ADA learns something from the AMA's mistake and start cracking down on these midlevels early. I'm hearing all sorts of stuff now like EFDA (expanded function dental assistant) who is basically an assistant that can do restorative, make temporary crowns etc, and then theres these new oral practitioners or something. I hope the ADA can do something about this madness.

Actually, I'd like to push for assistants to be able to do SC/RP. Not that I really want assistants to do SC/RP particularly; it would just make the ADHA more concerned with protecting their education and turf vs. trying to expand and encroach on the dentists' turf.

 

[DrJeff]

Thank you Minnesota.

4 years of education = mid-level practicing under the direct supervision of a dentist in a public health setting (80 -100k estimated in education costs for this person)

6 years of education = mid-level practicing under the indirect supervision via teleconferencing at a public health setting. ( 120-150k estimated in education costs for this person)

I can live with that, and heck I hope that in CT (where a mid-level bill was shot down in legislative committee last month) that the CT State Dental Association whole heartedly endorses an exact copy of the Minnesota bill

 

[britesmile16]

I guess the best sloution for this is to allow FOREIGN TRAINED DENTIST to take the state board exam without going back to school (IDP/IDS program). Most FTD's have quite an extensive clinical practice before coming to America as compared to DH. Come to think of it, would you rather be treated by a FTD or a DH who in the first are trained just to scale and polish? Legislators must try to look into this problem.

 

[Demeter]

So basically they can perform cavity preps, provide diagnosis, pulpotmony on primary teeth, pulp capping, prescribe meds, perform extractions, supervise dental assistants, place sutures, etc, as long as a licensed dentist is present..... if I am reading this correctly (correct me if I am wrong pls)....wow so we get to twiddle our thumbs... this will allow us to make more cheese by cutting our work out and delegating it to others... which works for me... however why wouldn’t this dental hygienist with an advanced masters degree just go to dental school and be able to dictate their own life... it seems like logic that if this passes it won't be too long before the hygienist will be able to run a practice....

I pray i read this wrong

How does it help any kids to perform a primary tooth pulpotomy without placing a SSC? A pulp without a SSC is basically guaranteed to fail.
SO either the pulp fails and will abscess in the future or the kid gets to see real dentist and get a 2nd shot and then receive the definitive care he should have had in the 1st place. What a waste of time and effort.

 

[BakedLays]

So as a predent, this worries me a little bit. Do you all think that dentistry is still a good field to enter considering the mid level?

 

[dentyne Ice]

substandard care? I worked as an assistant for years before hygiene school and I can tell you that majority of dentists let their assistants, who have no training or education background do polishing, fl, scaling, and even drilling in some cases. I know, because that's what I was expected to do as an assistant. Now that I have the indepth knowledge in oral anatomy, perio and such, I realize how so shockingly careless it was of the dentist to allow me to do 10+ polishings a day, without any knowledge of pulpal damage, tissue trauma, fl poisoning etc. just so he could increase his production?? and you're complaining about someone with 2-4yrs of clinical training and master's level education, calling that "substandard"?????

substandard to a DDS.

 

[DrJeff]

substandard to a DDS.

I hate to break it to you, but analysis of the care rendered by mid-level providers in places that currently have the mid levels treating patients, shows that the level of care rendered by the midlevel is equivalent to that of the average dentist.

Where the difference is though is in the speed that the dentist can deliver care vs. that of the mid-level provider, with the dentist be significantly quicker. How this becomes a factor is that under the current models of treatment for a mid-level they're designed to have mid-level providers working on the underserved, who more often then not are having their work done for medicaid level reimbursement fees, and at those fee levels speed = volume which is often the difference between being a financially viable clinic and a clinic that needs government support to stay open.

 

[dmd87]

I hate to break it to you, but analysis of the care rendered by mid-level providers in places that currently have the mid levels treating patients, shows that the level of care rendered by the midlevel is equivalent to that of the average dentist.

Where the difference is though is in the speed that the dentist can deliver care vs. that of the mid-level provider, with the dentist be significantly quicker. How this becomes a factor is that under the current models of treatment for a mid-level they're designed to have mid-level providers working on the underserved, who more often then not are having their work done for medicaid level reimbursement fees, and at those fee levels speed = volume which is often the difference between being a financially viable clinic and a clinic that needs government support to stay open.

with regard to speed, wouldn't a quicker procedure be of higher quality? I shadowed a few oral surgeons and they mentioned many times that atleast when it comes to wisdoms, oral surgeons are faster, allowing for less flap time, meaning less inflation and less pain. I would imagine that this would be try for many other procedures too.

 

[DrJeff]

with regard to speed, wouldn't a quicker procedure be of higher quality? I shadowed a few oral surgeons and they mentioned many times that atleast when it comes to wisdoms, oral surgeons are faster, allowing for less flap time, meaning less inflation and less pain. I would imagine that this would be try for many other procedures too.

Depends what procedure you're talking about. Remember, the way the mid-level provider is envisioned (and that's what this thread is about afterall), they'll be functioning similar to a GENERAL DENTIST as their primary role, and for most general dentists, what we do the most of all day long is restorative dentistry, and from a quality level standpoint, a mid-level can do just as good a #30 MO amalgam as the average dentist, but it might take the mid-level 40 minutes to complete the restorations vs. 25 for the dentist, and in restorative, where 99% of the time, vascular flaps aren't involved (thank goodness )time vs. quality isn't as much of an issue as time vs. financial viability.

 

[aphistis]

substandard care? I worked as an assistant for years before hygiene school and I can tell you that majority of dentists let their assistants, who have no training or education background do polishing, fl, scaling, and even drilling in some cases. I know, because that's what I was expected to do as an assistant. Now that I have the indepth knowledge in oral anatomy, perio and such, I realize how so shockingly careless it was of the dentist to allow me to do 10+ polishings a day, without any knowledge of pulpal damage, tissue trauma, fl poisoning etc. just so he could increase his production?? and you're complaining about someone with 2-4yrs of clinical training and master's level education, calling that "substandard"?????

When did an associate's degree become equivalent to a master's?

 

[mike3kgt]

...and from a quality level standpoint, a mid-level can do just as good a #30 MO amalgam as the average dentist,

After working with EFDAs (those allowed to place restorations) there are some great ones and some terrible ones... similar to dentists. For the most part, they are trained not to think but to do. Don't think I'm just blowing hot air... I have had significant experience working with EFDAs.

Why spend 4 years in professional school and study at the level of a doctorate education? Because it takes more than just "drilling" a tooth and "filling" a hole. It is beyond insulting that politicians believe that anyone can perform to the competency-level and standard of a recent graduate general dentist with such little education and at such a lower standard.

It is appalling that dentists can actually believe this non-sense and actually go to the level to publish their support in leading dental journals.

Winning the war of words regarding importance of education and knowledge of the whole body for performing irreversible dental procedures will be impossible with politicians because they all think our jobs are simplistic in nature. DrJeff is right in many ways that we need to be working with them to regulate the impact of a mid-level provider but not in the ways that many feel they need to be.

EFDAs who may place restorations (not extract, or prepare teeth) nationwide may be of some benefit to providing some facet of increased access to care in welfare or public health offices. But in our society, allowing deregulation of irreversible procedures is merely the beginning of the slippery slope. Give them a few years and it will become "well, this model works so great in welfare, we should be allowed to go wherever we want... this is America!!" Then they will be in right next door to the dentist or in the shopping mall right next to the bleaching kiosk providing "cosmetic makeovers for less!"

Fantastic... if that happens, I'll also be in that shopping mall... but working at the Starbucks stand.

 

[DrJeff]

After working with EFDAs (those allowed to place restorations) there are some great ones and some terrible ones... similar to dentists. For the most part, they are trained not to think but to do. Don't think I'm just blowing hot air... I have had significant experience working with EFDAs.

Why spend 4 years in professional school and study at the level of a doctorate education? Because it takes more than just "drilling" a tooth and "filling" a hole. It is beyond insulting that politicians believe that anyone can perform to the competency-level and standard of a recent graduate general dentist with such little education and at such a lower standard.

It is appalling that dentists can actually believe this non-sense and actually go to the level to publish their support in leading dental journals.

Winning the war of words regarding importance of education and knowledge of the whole body for performing irreversible dental procedures will be impossible with politicians because they all think our jobs are simplistic in nature. DrJeff is right in many ways that we need to be working with them to regulate the impact of a mid-level provider but not in the ways that many feel they need to be.

EFDAs who may place restorations (not extract, or prepare teeth) nationwide may be of some benefit to providing some facet of increased access to care in welfare or public health offices. But in our society, allowing deregulation of irreversible procedures is merely the beginning of the slippery slope. Give them a few years and it will become "well, this model works so great in welfare, we should be allowed to go wherever we want... this is America!!" Then they will be in right next door to the dentist or in the shopping mall right next to the bleaching kiosk providing "cosmetic makeovers for less!"

Fantastic... if that happens, I'll also be in that shopping mall... but working at the Starbucks stand.

The 3 key problems our profession has working against us with respect to mid-level provider formation

1) Plain and simple, we're likely dealing with the will of the UNEDUCATED (dentally definitely, in general, questionably) POLITICIAN who would be making the legislation to allow this to happen

2) The relative success of nurse practitioners amongst our medical colleagues (once again, to the uneducated politician who would be voting on the legislation if it works for medicine it should work for dentistry)

3) To the politician we're just the "rich dentists" and if we're so against it, to the politician it must be a good thing

 

[waltwhitman]

Stats show that cleaning and exams take up 76% of all dental services and are estimated to grow even higher in the future. Plus, the fake dentists are not limited only to these procedures.
Taurus had made a good point. We should learn from the NP case and not hire nor take any referrals from the cleaning clinics of these midlevels if that nonsense bill goes through.

Interesting

 

[TOOGOOD4HYG]

- and I apologize to all the hygienists I am about to offend -
Now imagine that these community college grads were set free on the public to perform surgical procedures



That's why the ADHP program is a MASTERS DEGREE PROGRAM.

 

[bsmcga0]

I hate to break it to you, but analysis of the care rendered by mid-level providers in places that currently have the mid levels treating patients, shows that the level of care rendered by the midlevel is equivalent to that of the average dentist.

Where the difference is though is in the speed that the dentist can deliver care vs. that of the mid-level provider, with the dentist be significantly quicker. How this becomes a factor is that under the current models of treatment for a mid-level they're designed to have mid-level providers working on the underserved, who more often then not are having their work done for medicaid level reimbursement fees, and at those fee levels speed = volume which is often the difference between being a financially viable clinic and a clinic that needs government support to stay open.

I have a feeling those studies are done by people who want mid-levels to get approval

 

[Dr Smee]

Oh my... I'm about to begin the most difficult and taxing journey of my life in pursuit of my dream to be a dentist, and here I read that some hygienists are attempting to create a new oral health position that can essentially fullfil the traditional role of the dentist, but with less education? You mean I can be a dentist and I don't have to sacrifice the next 3 years reparing my undergrad GPA, attending a Master's program, and then another 4 years after that in dental school? And then crushing loan debt?

Perhaps this idea bothers me for purely selfish reasons, but I feel they are legitimate reasons. Enter concern.

 

[Stroszeck]

Do they even consider that now most the adhp's are gonna end up in sunny So Cal and not go to so-called "areas of dental access shortage?" (as if so cal isn't already supersaturated). So now the few and far between associate dental jobs will be taken over by these cheaper laborers and the rest of us dentists will have to keep moving towards arizona and new mexico!

 

[Taurus]

Instead of starting another thread, I'll post it here.

Low-Cost Dental Care Ignites Wide Debate

By JOYCE COHEN
Published: November 1, 2010

In remote northwestern Alaska, where dental decay is rampant, some of Stephanie Woods's patients suffered from toothaches for months on end — "raging toothaches with swelling," she said in an interview, "something that you or I would go that day and have it taken care of."

But these patients just lived with the pain. "They thought it was part of everyday life," she said.

Ms. Woods is not a dentist. She is one of 14 certified dental therapists in Alaska, the only state where nondentists may perform extractions and administer fillings.

The therapists, who receive two years of training, help fill a vacuum: Alaska has long had trouble attracting and retaining licensed dentists. Sixty percent of Alaska Native children ages 2 to 5 have untreated decay, and 20 percent of Native adults over 55 have no teeth at all.

But the American Dental Association, the nation's leading dental society, opposes the use of nondentists for "irreversible procedures" — including drilling and extraction — citing patient safety.

"If you have a person suffering from pain, that person has advanced disease," said Dr. Raymond Gist, the association's president. "I would want that person to see a licensed dentist without delay."

Now a two-year foundation-supported study has reignited the debate over which practitioners are qualified to provide dental care, especially to underserved populations in high-poverty areas. It found that Alaska's dental therapists provide "safe, competent, appropriate" care. (The therapists refer cases beyond their scope to supervising dentists.)

The study, financed by the W. K. Kellogg, Rasmuson and Bethel Community Services Foundations, examined the work of dental therapists in five rural Alaskan communities. The positive results are consistent with findings from overseas, where dental therapy programs are well established, said Dr. Mary Williard, a dentist who directs the therapist training program for the nonprofit Alaska Native Tribal Health Consortium.

Ten other states, including Connecticut, are considering midlevel dental provider systems for underserved residents. These practitioners can be trained for relatively little money, said Dr. Allen H. Hindin, who is on the board of the Connecticut State Dental Association.

Partly for that reason, he said, the topic has become a "turf issue" — not just economic, but "intellectual and cultural."

Unlike Alaska, Connecticut has no shortage of dentists. But Dr. Bruce J. Tandy, the state association's immediate past president, agreed that dentists were wary of losing patients to midlevel practitioners. "Many dentists don't understand how these individuals are going to be used," he said, "so they feel threatened."

In fact, he said, the midlevel providers "can be trained to do certain simple procedures safely," and they would most likely work in public health clinics, seeing patients whom "most dentists will never see in their offices."

Still, the American Dental Association — which went to court five years ago in an unsuccessful attempt to block the Alaska program — is firm in its opposition. Dr. Gist, the group's president, rejected the accusation that dentists fear a loss of income or status if midlevel practitioners are widely allowed. "We don't consider that it has merit," he said.

He noted that the association favored increased Medicaid payments for dental work and said that dentists routinely donated services to needy populations.

The association says a better solution for the underserved population is its own new program of community dental health coordinators, who perform teeth cleaning and other noninvasive procedures, educate people about dental health and connect patients with licensed dentists for further care.

Moreover, the association argues, the Alaska study has little relevance for other states. Remote areas there are typically reached by airplane, boat or snowmobile; rural residents of other states, the association said in a statement, "are accustomed to driving hours to reach a shopping or entertainment destination and can be expected to travel similar distances to reach a dentist."

But Dr. Williard, in Alaska, called that argument misguided.

"Would I be satisfied to think that I would have to drive five hours with a 3-year-old in the car to get care?" she asked. "No, I would prefer to have care closer to home. I'm not sure that statement is really in touch with the populations in those areas."​

 

[dl9006]

the midlevel argument is bs.

i would have a hard time trusting a dental student to drill my teeth, let alone a hygienist.
i would never trust a mid level health provider to treat me and i'm sure most people would share this sentiment as well.

if hygienists want to do what dentists do, then they should have gone to dental school.
(i'm sorry but it's not our fault you chose the wrong career. stop trying to take a shortcut and go back to school.)


it's insulting because dentistry is trying evolve into medicinal dentistry and by allowing ADHP, the politcians are forcing our profession to take a step back and turning it into a community college apprenticeship

 

[DrJeff]

I have a feeling those studies are done by people who want mid-levels to get approval

Actually, the one that just came out is from about as reputable, unbiased firm as there is these days. And that info comes directly from one of the members on the ADA workforce taskforce committee whose job it is to look at access to care.

What dentists are having a tough time digesting about midlevel providers, is that ON A CLINICAL LEVEL, they can do basic dental procedures as well as a dentist can, thats what the research is showing now from multiple studies. What those studies don't show (and that's because they just been looking at clinical competency) is that can a midlevel provider be a financially viable model?? That's where the dentist wins out

 

[Taurus]

can a midlevel provider be a financially viable model?? That's where the dentist wins out

If you allow a dentist to "supervise" 4 cheaper midlevels who do fill and drills vs. hire new associates directly out of dental school, then the model is attractive. This will decrease demand for dentists no doubt. It then is only a matter of time before the midlevels demand autonomy.

Dentistry is at a critical junction in its history. Does it keep the traditional model or go down the same, regrettable road that medicine took? I don't know if organized dentistry can stop midlevels from entering the field. Once current dentists realize how much more money they can make by hiring midlevels, they will sell out the profession and leave future generations of dentists with a shell of a profession that once was.

 

[Lidopaine82]

If you allow a dentist to "supervise" 4 cheaper midlevels who do fill and drills vs. hire new associates directly out of dental school, then the model is attractive. This will decrease demand for dentists no doubt. It then is only a matter of time before the midlevels demand autonomy.

Dentistry is at a critical junction in its history. Does it keep the traditional model or go down the same, regrettable road that medicine took? I don't know if organized dentistry can stop midlevels from entering the field. Once current dentists realize how much more money they can make by hiring midlevels, they will sell out the profession and leave future generations of dentists with a shell of a profession that once was.

Yea thats already happening with EFDAs and it's disgusting.

 

[DrJeff]

If you allow a dentist to "supervise" 4 cheaper midlevels who do fill and drills vs. hire new associates directly out of dental school, then the model is attractive. This will decrease demand for dentists no doubt. It then is only a matter of time before the midlevels demand autonomy.

Dentistry is at a critical junction in its history. Does it keep the traditional model or go down the same, regrettable road that medicine took? I don't know if organized dentistry can stop midlevels from entering the field. Once current dentists realize how much more money they can make by hiring midlevels, they will sell out the profession and leave future generations of dentists with a shell of a profession that once was.

Yea thats already happening with EFDAs and it's disgusting.

This is why we have to stay involved. First off, there's a HUGE difference between a directly supervised EFDA and an indirectly supervised DHAT.


Secondly, whether or not it's fully legal in many states, plenty of docs are already using their assistants in EFDA rolls - that's just a fact of life and plain and simple there just aren't enough enforcement agents in various state department of health's and or the perception that an assistant making/cementing a temp crown or placing an amalgam, etc is such a dire threat to public health that the state department of health will send an enforcement agent out to an office on an unannounced check - they'll do a suprise check on the kitchen of a Taco Bell where a couple of folks get sick, but won't even remotely think of checking a dentists offices - right or wrong, that's the reality of the situation, especially in this time of widespread massive state budget deficits.

DHAT wise, this is where the overall data (both clinical and economic) will show that, clinically the model can work, BUT financially it will take a significant financial commitment from either the state or federal government to make it work, and that's a big issue! This is where, we as dentists have to first acknowledge that there is a potential issue to the legislative folks, and that in the big picture what we need to look at 1st, is what is the real UTILIZATION rate that the underserved will use potential services at?? In so many states, the difference between the system that's currently in place, UTILIZATION wise and the actual, full potential utilization isn't that much of a difference, so much that with just minor changes in the current systems, most states, WITHOUT having to create a new class of provider will be meet the actual utilization rates of the "underserved" In most states, this will work. In a few geographically vast states, Alaska being one, these might be a situation where the DHAT model will turn out to be the best one to get atleast some care to remote, landlocked populations

 

[yappy]

Where I live It's been my observation it's a financial barrier rather than a care giver barrier. I'm very invovled in a free clinic thats goal is to provide free care to people. From talking to these patients it's never a problem of finding a dentist and making an apointment - it's the money/lack of insurance that's the barrier.
When we are putting together schedules we wade through three pages of patients to fill one day. This is why I agree with the above poster; I wish that dentists would offer laws/programs with incentives (tax/education breaks) to get dents to practice on these patients at least part time & really solve the problem.
Also, will a filling done by a DHAT cost less than a filling done by a dentist? Does a family care MD cost less than a family care DNP? For many of these patients they need FREE not slightly less expensive if we're going to be realistic about them getting care.

 

[Taurus]

The press is probably the biggest cheerleader of midlevels.

Dental therapist fans smiling at results of study
Gail Rosenblum

Even scarier than how much candy our kids will consume this week is the thought that another Minnesota child will land in the emergency room, under costly and risky general anesthesia, for a procedure that should have been addressed years earlier in the dentist's chair. But it will happen.

Fortunately, this sad scenario probably will happen far less in coming years. Minnesota, which just a decade ago had the worst dentist-to-patient ratio in the nation, is now a national leader in innovative thinking, with the creation of a new oral health practitioner called a "dental therapist." This therapist, akin to a nurse practitioner, is licensed to perform duties such as filling cavities and extracting teeth, under a dentist's supervision.

It's a promising solution for the 350,000 low-income Minnesotans for whom regular dental care is a luxury they don't enjoy. Still, getting the bill passed was like pulling teeth. One proponent of the bill only half-jokingly refers to recurring post-traumatic-stress disorder. Results from a new study should ease his stress.

A two-year study of more than 400 indigenous Alaskans, commissioned by the W.K. Kellogg Foundation, found that dental therapists are safely and successfully performing cleanings, fillings and uncomplicated extractions. Patients, many of whom previously had to wait months or travel for hours to seek pain relief, were "highly satisfied" with the care.

The authors emphasize that Alaska has "some of the most severe oral disease in the country," and the program "has not had enough time yet to make a measurable impact on oral health." Still, it shows "incredible promise."

Lead dentist Mary Williard is "thrilled" by the results. She saw dental care, or the lack thereof, as she traveled to remote corners of Alaska to treat native patients. "We were failing to improve their health," she said. In some areas, she performed full-mouth restorations using general anesthesia on children as young as 2. Alaskan "dental health aid therapists," living and working in these communities, "made so much sense to me," Williard said.

The American Dental Association (ADA) differed vehemently, arguing that quality care could only be delivered by a trained dentist. The ADA sued the Alaska Native Tribal Health Consortium, and lost. "I can understand some of what they're saying," Williard said of the ADA. "Everybody should get safe, quality care. We were fighting for the same thing, but had different understandings about it."

The Dental Therapist Legislation, signed into law in 2009 by Gov. Tim Pawlenty, provides two tiers of providers. A dental therapist requires a bachelor's degree and will work with a dentist on-site.

An advanced dental therapist requires a master's degree and will work in community settings, such as nursing homes and Head Start programs, in collaboration with an off-site dentist supervisor.

The University of Minnesota Dental School and a Metropolitan State University-Normandale Community college partnership have developed programs; each dental therapist could provide at least 2,000 dental visits annually.

"We are seeing far more advanced dental decay in younger children, and serious gum problems," said Colleen Brickle, dean of Health Sciences at Normandale.

Not just children. Last summer, unemployed Minnesotans, veterans of Afghanistan and Iraq, and many elderly Minnesotans flocked to her teaching clinics for the first time. "People are losing their dental insurance," Brickle said. "There is such a need."

Joan Sheppard, president of the Minnesota Board of Dentistry, also sees dental therapists as a way to shatter barriers of language and culture, as well as lack of insurance or participating dentists. Yet, even as the first dental therapists prepare to graduate next spring, pushback remains.

"There is no need to compromise the quality, nor the principles of care, that only dentists can provide," said Dick Diercks, executive director of the Minnesota Dental Association. He'd rather see more efforts like Give Kids A Smile and other dental association programs that provide oral health care services to low-income patients, as well as sending dental hygienists into schools in collaboration with dentists to provide preventive care.

Jamie Sledd, past dental association president, concurs. "We have enough dentists in the state and a huge surplus of dental hygienists," she said. Her biggest concern is that "the individuals who would receive care from a mid-level provider are often the most vulnerable, and we're not teaching therapists how to deal with unexpected events that might occur. Is it really fair to the patient to receive care from a provider who does not have comprehensive dental knowledge?"

Nope. That's why dental therapists will receive extensive training but still be limited to routine primary care services, all under a dentist's supervision.

Here's my question:

Is it fair that poor kids in Minnesota are twice as likely as their more affluent peers to have untreated tooth decay?

With the Alaska results in, let's hope skeptics finally jump onto this moving train. "I do feel that when we have dental therapists in practice for a time," Sheppard said, "people will have a better perspective on how this is going to work."​

 

[Msmouth]

That is what the hygiene associations have been arguing but the comparison falls pretty flat. First of all - and I apologize to all the hygienists I am about to offend - hygiene education is not very broad-based. Hygienists are the dental equivalent of techs or phlebotomists; they are trained to do one task. They are trained to do that task very well, but their entire education is geared to the single task of cleaning teeth.

If phlebotomists were allowed to attend a 2 year community college program that would result in a PA degree the comparison would be valid. But that isn't how PA school works, is it?

Now imagine that these community college grads were set free on the public to perform surgical procedures (extractions) that commonly result in poorly controlled bleeding, perforation of the maxillary sinus, communication between the antrum and oral cavity and nerve damage. Do you want YOUR family treated by these people? Or do you think it might be more appropriate to be treated by professionals trained to manage these complications with the appropriate surgery and/or drugs?

I'm a bit offended as a practicing hygienist.
We take Anatomy Phys I and II, Microbiology, Chemistry, Biochemistry and all of the courses associated with dental knowledge. It does not compare to that of a dentist but it is more than just cleaning teeth.
If that was all we needed to learn, then we would just have hygiene clinic and be done with it.
We take dental pathology, histology, periodontology, nutrition, a statistics type course for dental, radiology, dental materials, .....that's off the top of my head from when i graduated in '96.
Unfortunately when you're a doctor you might find it easy to look down upon those who are less educated or assume we are just techs. The fact is we have a vast body of knowledge from our schooling and it just gets better with practice over the years.

 

[DrJeff]

I'm a bit offended as a practicing hygienist.
We take Anatomy Phys I and II, Microbiology, Chemistry, Biochemistry and all of the courses associated with dental knowledge. It does not compare to that of a dentist but it is more than just cleaning teeth.
If that was all we needed to learn, then we would just have hygiene clinic and be done with it.
We take dental pathology, histology, periodontology, nutrition, a statistics type course for dental, radiology, dental materials, .....that's off the top of my head from when i graduated in '96.
Unfortunately when you're a doctor you might find it easy to look down upon those who are less educated or assume we are just techs. The fact is we have a vast body of knowledge from our schooling and it just gets better with practice over the years.

Sometimes you need to take a step back and remember that many of the dental STUDENTS that post here have yet to realize that in a successfull general practice/pedo practice/perio practice/any practice that employs a hygienist(s) that a successful, SYMBIOTIC, relationship between the dentist and the hygienist is one of the key components (read as happy, returning patients who refer their friends to the practice and as a result help make $$ for the practice).

I strongly feel that the sooner a dental student/new dentist learns that ALL the employees of the practice make up a TEAM, and the smoother the TEAM works together, the better the patient experience. And more times than not, the better the experience the patient has, the more profitable that patient becomes to the practice (both in the form of work done on them/their family AND referrals to the practice). The dentist may be the leader of that team, but one also has to remember that a team is only as strong as its weakest member

 

[omaralt]

Sometimes you need to take a step back and remember that many of the dental STUDENTS that post here have yet to realize that in a successfull general practice/pedo practice/perio practice/any practice that employs a hygienist(s) that a successful, SYMBIOTIC, relationship between the dentist and the hygienist is one of the key components (read as happy, returning patients who refer their friends to the practice and as a result help make $$ for the practice).

I strongly feel that the sooner a dental student/new dentist learns that ALL the employees of the practice make up a TEAM, and the smoother the TEAM works together, the better the patient experience. And more times than not, the better the experience the patient has, the more profitable that patient becomes to the practice (both in the form of work done on them/their family AND referrals to the practice). The dentist may be the leader of that team, but one also has to remember that a team is only as strong as its weakest member

so true. and what compounds the problem is that in most dental schools the hygienists are the biggest b*tches in the world.. i graduated hating hygienists, and until i started working with my two existing hygienists i never knew how easy they can make your life. i definitely view my entire staff as a team; but i am the head of that team (and the only un-fireable one!) lol

 

[DrJeff]

so true. and what compounds the problem is that in most dental schools the hygienists are the biggest b*tches in the world.. i graduated hating hygienists, and until i started working with my two existing hygienists i never knew how easy they can make your life. i definitely view my entire staff as a team; but i am the head of that team (and the only un-fireable one!) lol

True. Just looking at my schedule today (and it's a pretty typical one for me), roughly 2/3rds of the treatment I'm doing today was picked up and diagnosed(and in most cases the "selling" of that needed treatment for the patient began long before I walked into my hygienist room to do my exam) at a hygiene visit. So not only as the dentist do you make $$ from the hygiene visit itself (the hygienist also pays for her/himself too - atleast if things go as they should), but you as the dentist also go a longway towards keeping your schedule full (and profitable) out of the hygiene room.

So the blanket generalization that some have of hygienists as an inferior part of the dental team just isn't the case. One is free to debate the scope of a hygienists practice all they want, but I honestly couldn't think of practicing without them, and dentistry as a whole realistically couldn't function without them in todays society

 

[wwdaffodils]

http://www.slate.com/id/2274428/

Just wanted to put this out there for discussion. Overall, incredibly slopping reporting, and but it's indicative of the public's current/future attitude towards mid-levels.

 

[hygienist2012]

If you really believe that hygienst only learn to clean teeth, then you are very confused.

 

[Shnurek]

If you really believe that hygienst only learn to clean teeth, then you are very confused.

 

[Jorbitok]

?

 

[Jorbitok]

?

 

[Jorbitok]

So you feel like you don't have to assume the same financial risk as everyone else? There is a lot more to being a dentist than just your proclaimed and untested ability to handle the academic rigors of dental school. If you don't have the gall to take the same financial and personal risks as everyone else in dental school than you should not be practicing dentistry. Many people in my class quit their jobs with kids and moved across the country to go to dental school. In fact there are two practicing hygienists in my class whom I have profound respect for. To say that ADHP's are the same stuff as dentists is lying to patients.

?

 

[Nymphicus]

Wow! I have read some pretty pathetic comments on here! All you guys are concerned about is $$$. What about the patient who doesn't have access to dental care or the patient who cant afford the outrageous prices of private practices?I haven't read one comment where the patient was the main concern. Not many dentists go out and provide care to under served areas so the ADHP is a necessity and I only see room for growth. This is an untapped market and could open up many opportunities for all of you future dentists if you would actually work together with the hygienist instead of opposing the ADHP. No, we don't have as much education as a DDS or a DMD but you don't need a doctorate to provide hygiene services which is all we're trying to do. It is a proven fact that prevention costs 10 times less than dental tx and I don't see any problem with that. I am in the process of becoming a ADHP and I can't wait to break free of all the politics and work for myself. Dentists are like a ball & chain to the hygienist!

Those nasty dentists. Always trying to poke me in the mouth with sharp objects. I hear these new dental therapists or whatever they are called are more holistic and care about the person and not just the tooth--probably because they provide your teeth with a more therapeutic experience. I, for one, am excited to be cared by someone with all the expertise of a dentist who can also offer the valuable experience of an advanced dental therapist.

 

[Jorbitok]

No one in their right mind would ever say or even hint that a dental hygienist should perform any tasks except dental hygiene.

?

 

[Jorbitok]

The next thing they'll do is to open their own "Dental Clinics"

It's just unfortunate that the public won't be able to distinguish between these mid-levels and actual dentists. It's a lot more important to address the public perception of dentists as a whole, rather than fighting these mid-levels. The ADHA will obviously want to push for the creation of a mid-level practitioner.

It's our duty as a profession, to stop that dead in it's tracts.

?

 

[Jorbitok]

Thoughts on this email being sent out?

Dear Friend:
Dentistry is under attack again!
The New Mexico Dental Hygienists' Association is introducing legislation to create an Advanced Dental Hygiene Practitioner (ADHP). After just two years of extra training, an ADHP would be allowed to perform surgical procedures, including drilling teeth and extractions, right here in New Mexico.
I am outraged by the audacity of the Hygienists' Association and their followers in Santa Fe to propose such an obvious and dangerous encroachment upon the profession of dentistry.
This hasty and drastic measure could put patients' safety at risk.
For my part, I have personally opened up my checkbook and given to the New Mexico Dental Association's Political Action Committee (NMDPAC).

?

 

[Jorbitok]

I have not done a lot of research on this subject, although now I definitely will be. So far, however, I have noticed that a lot of arguments have centered upon the hope that most patients will choose to go to a DDS over an ADHP if they have the choice (i.e. metro areas and non-underserved areas). Not only that, but the RDH's and ADHP proponents have been arguing on here that ADHP's will logically choose lower compensation as they are not as highly trained as dentists.

BUT, what happens when PPO/DHMO plans find out that an ADHP is charging lower fees than what they are allowing their DDS preferred providers charge? I can't predict the future, but I am pretty sure I understand the innate nature of insurance companies and they could lower their fee schedules OR just not raise the fee schedules until inflation allows the ADHP fees to catch up to their fee schedules. Granted, the DDS has two choices: take the hit on the fees to get insured patients through the doors, or quit accepting the insurance plan.

Obviously, we have already pointed out that DDS's will most likely have a HUGE disadvantage in terms of loan repayments after school. At this point, what do you do? We all know that a lot of times patients choose not only their provider but will change treatment plans based on what insurance dictates. Who is to say that an ADHD doesn't become a preferred provider and with less loans to pay off can accept the lower fee schedules and therefore the DDS's previous patients?

I know that I will get knocked for suggesting this, but I do want to point out that I am all for public service. I do not believe money=happiness, but I do want to be able to put food on the table, pay my bills, and live a semi-comfortable life after spending 8+ years after high school studying my rear end off. I also know that this is an exaggerated example of what could happen, but I just wanted to point out where insurance companies may start to jeopardize the situation even more.

?

 

[Jorbitok]

this is scary business. Legislation is like this is already in the works in other states like Maine, Arizona and few others.

The scariest part to me is this.

The services authorized under this subdivision
7.31and the collaborative agreement may be performed without the presence of a licensed
7.32dentist and may be performed at a location other than the usual place of practice of the
7.33dentist or dental hygienist and without a dentist's diagnosis and treatment plan, unless
7.34specified in the collaborative agreement.

Also, no where does it say that the ADA/CODA has to accredit these schools, (most likely community colleges) rather the hygiene board is responsible.

It passed 9 to 4 and there is a pretty good chance it may get through the financing committee.

This is really not good for dentistry.

?

 

[suarez 7]

The main responsibility of the ADHP is to provide preventative dental services to people who have limited access. You really think this is bad for dentistry? So it's better to let this part of the population who doesn't have access to care to receive no care at all?

If the government really wanted to help rural Americans get dental care, why not set up satellite clinics and give financial incentives for dentists to work in those areas (i.e. loan repayment)? It's a much cheaper option than creating, opening and maintaining a midlevel program that train subeducated individuals to perform limited procedures in dentistry.

 

[DrJeff]

We wouldn't have to do anything other than hygiene. 80% of the work performed at a dental office is hygiene...maybe more!

Really? Where do you get your data from?? I know that in my office, for a "small" data sample such as the last 11 years, that the annual amount of work that is generated in my office, both interms of total number of procedures and revenue generated (since revenue generation IS a factor, because this IS a business afterall and there is no such thing as "free" healthcare) is basically 2/3rds from the dentists and 1/3 from hygiene. And on average both interms of number of procedures and total revenue each dentist in my practice (and there's 2 of us) generates twice the volume of our hygienists, hence why we have basically 4 full time hygienists to 2 full time dentists.

No having talked with literally hundreds of dentists who are in practice all over this country, that ratio of 2/3rds dentist volume of production (# of procedures and $$ generated) to 1/3 hygiene is fairly consistant. Either that or there's a mega conspiracy by dentists and accountants all across the country to do some numbers manipulation to hurt the hygiene interest.

So please, lets keep the emotion out of the debate and lets just act like a professional and talk about facts. The facts are simply put that there are costs associated with a procedure. The materials used have a cost, the equipment needed has a cost, the building the procedure is perfomed in has either a rent and/or taxes associated with it. The electricity and water used in the building has a cost, and more than likely the OTHER people in the room aside from the person performing the procedure and the person the procedure is being performed on are expecting (and rightly so) to be compensated for their time there, so they have a cost (altruism is great, but it doesn't pay one's mortgage or student loans, or costs associated with operating the business). If there was truly no costs associated with a procedure, then "free" care could happen. That simply though isn't the case. It's time to stop trying and make excuses for everything and get to the main cause of the problem, which is you can't eliminate responsibility for one's actions, and that person shouldn't expect the results of their oown actions to be the responsibility of others to fix, rather than their own responsibility. Not everyone can "finish first", however the person that finishes last can end up finishing rather close to the person who finishes first if they try

 

[DrJeff]

If the government really wanted to help rural Americans get dental care, why not set up satellite clinics and give financial incentives for dentists to work in those areas (i.e. loan repayment)? It's a much cheaper option than creating, opening and maintaining a midlevel program that train subeducated individuals to perform limited procedures in dentistry.

Frankly, living in a semi rural area myself, there seems to be somewhat of a misconception by those that have never lived in a rural area about what is needed from a facilities standpoint for access.

Plain and simple, if you live in a rural area, you are quite used to, and expect to be driving a decent distance (even a few hours) to get to what many people consider routine, basic services such as grocery stores, clothing stores, healthcare, etc. Things that many people in an urban and/or suburban area can't imagine being more than say 5 or 10 minutes away. That's just the mentality of living in a rural area, and why living in a rural area isn't for everybody

Secondly, many of the so called "experts" who think that they know the answer for the problem actually don't treat, and never have actually treated a patient, so to look to them for answers would be akin to looking to someone to fix your car who's say read a bunch about cars, but never actually worked on an engine before.

Hands down, the biggest issue that needs to be addressed, that could help solve this "problem" essentially overnight, would be to have a fair fee schedule that covers realistic procedures. Mid-levels would have the same anemic fee schedule that the state and federal gov't offer now, mid levels will also have student loan repayments and also in many cases be expected to run a business which means that they themselves have to generate revenue in excess of their expenses to stay open and providing care. That last part seems to be lost on far too many people

 

[DrJeff]

The main responsibility of the ADHP is to provide preventative dental services to people who have limited access. You really think this is bad for dentistry? So it's better to let this part of the population who doesn't have access to care to receive no care at all?

The other responsibility of an ADHP is to if implimented to provide care in a cost effective (from a business operations standpoint) manor. If an ADHP, can't be self sufficient, than more of the LIMITED government funds that would in most case be used to reimburse for the procedures being performed will be spent on keeping a clinic open than actually used to provide care. If the patient isn't on an insurance plan, and are being treated in say a federally qualified healthcenter (FQHC) where often non insured patients have fees based on a sliding fee scale based on their income, then the baseline starting point for those sliding fees has to increase to help the ADHP become financially viable and not have funds that could be used for patient care going to business expenses.

The BIG issue of the business side of this debate CAN'T be avoided. And to infer that it is just a minor issue is just plain ignoring the facts and letting emotion dictate the conversation, which the vast majority of the time will end up only making things worse when reality has to be addressed

 

[tinman831]

Keep it civil please.