Advanced dental hygiene practitioner

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geometric-pain

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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
 
Why doesn't the ADA summarize this for me and put it on the front page of the ADA news? Isn't nonsense like this why we pay dues? I'm sick of seeing headlines about Give Kids A Smile on every other page of the newsletter. I hope they stand up for us on this and it doesn't become another Alaska.
 
Members don't see this ad :)
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.
 
Why doesn't the ADA summarize this for me and put it on the front page of the ADA news? Isn't nonsense like this why we pay dues? I'm sick of seeing headlines about Give Kids A Smile on every other page of the newsletter. I hope they stand up for us on this and it doesn't become another Alaska.

Couldn't agree more. We got an email today about it, but this needs national attention.

Here's the email from the legislative committee in Minnesota Dental Association.

Dental access legislation moves ahead
On Monday, March 3, 2008, both the MDA dental access bill (HF3254/SF3122) and the Advanced Dental Hygiene Practitioner (ADHP) bill (HF3247/SF2895) were heard in the Senate Health Housing and Family Security Committee. Sen. John Marty (DFL-Roseville) chaired the committee and was gracious with his committee’s time. He gave ample time to all oral healthcare stakeholders that evening to share their support or opposition to both legislative bills.
The committee took up the ADHP bill first and Sen. Lynch, author of the bill, was gracious, too, in that she let the opposition to her bill, which was the MDA, testify first as to our concerns to her bill. Testifying in opposition to the bill for the MDA were Dr. Robert Brandjord, Dr. Scott Lingle, Dr. Donna Stenberg, Dr. Joe Grayden (Community University Health Care Clinic) and three University of Minnesota dental students, Patty Stone, CJ Nelson, Lisa Abeln.
Our testimony in strong opposition to the ADHP was very compelling. This was the second time some of presenters had testified, so they were well-prepared for questions and made convincing arguments. Interestingly, two Senators who were originally supporters of the ADHP bill spoke up just before the recorded vote to say they had problems with the bill. One was Sen. Prettner-Solon (Duluth) and the other was Sen. Wergin (Princeton). Sen. Wergin was the MDA’s hero that evening as she asked Senator Lynch many pointed, tough questions about the bill. Sen. Wergin had received many calls from dentists in her district that day, which allowed her to have a better understanding of some of the MDA’s serious concerns with the bill.
The proponents spoke after we finished. The committee members heard from the community clinics, specifically, Mike Scandrett and Dr. Tony DiAngelis from HCMC. Other testifiers included a dental hygienist from Sen. Lynch’s district of Rochester and several others from the “Safety Net Coalition.”
About 75 U of M dental students packed the large hearing room, many of them in their bright-colored scrubs. Their visibility definitely had impact, as two Senators, Torres-Ray and Erickson-Ropes, addressed them briefly during their committee comments against the ADHP. It was standing room only for the three-plus hours of testimony and the students were fabulous, staying until the bitter end, reinforcing to committee members how serious they took this legislation and the Senators’ actions.
In the end, the ADHP bill did move to the next level, but as proof that there are still many issues of grave concern, the committee passed the bill to Sen. Linda Berglin’s Finance Committee to allow for further discussion, even though there is no fiscal impact to the bill. The Senators were giving the stakeholders a message – work something out or we will work it out for you.
At this juncture, we’re still working as hard as we can, educating and lobbying legislators of our concerns on the many sections of the ADHP bill, including the issues of access, supervision, program accreditation and liability.
The MDA dental access bill also was heard Monday night, and it, too was moved to Sen. Berglin’s Finance Committee after being amended. It does have fiscal impact for the scholarship portion of the bill, and money will be required for a study on the proposed uniform single-administrator for dental programs. The Senators stripped out the Community Dental Health Coordinator (CDHC) and the uniform single-administrator initiative (the “carve out”).
The good news on the MDA dental access bill is that it was also heard in the House, on the very next night, Tuesday, March 4, in the Health and Human Services Committee. The scholarship section stayed in, allowing foreign-trained and existing dentists to be eligible for scholarship money, as did the CDHC. The committee also put in language that would allow for a study of our uniform single-administrator initiative.
For more information on this or how you can help contact your legislators, please contact [email protected]. We appreciate the efforts of all of you who are helping the MDA and in so many ways.
 
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


That's how I read it too.
The legislatures might as well just shorten the DDS program in U of M to 2 years and accept students straight out of CC.



http://www.adha.org/media/backgrounders/adhp.htm
Basically, they want to be a "dentist". Well if they are so willing to help the public and get their hands on those advanced dental procedures, what don't they just go to dental school. I mean with such passion I'm sure they would make it in.
 
from the ADHA.org website regarding advanced dental hygiene practitioners:

Q: Who has or will be joining ADHA in this project?

A: We expect that a number of like-minded organizations interested in increasing the public’s access to oral health care will be interested in working with ADHA.

In October 2004, ADHA announced its support of actions taken by the American Dental Association (ADA) that demonstrated its openness to the ADHP as an ADHA-initiated solution to the severe oral health care access crisis in the U.S. These actions included the ADA’s House of Delegates’ referral of three ADHP-related resolutions proposed by its Board of Trustees at the ADA’s annual meeting.


I doubt that the ADA house of Delegates referrals included what is currently on the table in Minnesota. All the older information sounds like it was supposed to be like a PA or Nurse Practitioner in medicine, which I assume means under the responsibility of a dental practitioner. However, the new amendments make it out to be a bit different than that.
I think that access to care is very important, but if you look at what happened in medicine (the PA was initially intended to serve in undeserved areas and now they are everywhere) I don't know that this is the right way to go about it. Ask an MD if the PA was good for his or her career. I would be curious to know the answer to that one.
 
Hopefully my nominal donation to ADPAC will not go to waste...

My understanding of the situation is that if this goes through, ADH's will be able to practice in areas without access to care problems. I don't know what makes people think that ADH's will run out into undesirable areas to make less money...if dentists don't do it, why would they?
 
Hopefully my nominal donation to ADPAC will not go to waste...

My understanding of the situation is that if this goes through, ADH's will be able to practice in areas without access to care problems. I don't know what makes people think that ADH's will run out into undesirable areas to make less money...if dentists don't do it, why would they?
Shameless power grabs don't generally go over well when you portray them for what they are. People respond much more favorably when you dress them up in a sham costume of selfless nobility; even if the costume is threadbare & transparent, very few people pay enough attention to notice.
 
I don't know much about dentistry (I'm a PA) but the idea is similar to that of the physician assistant concept, and we PAs have been around for 40 years. It's going to ruffle some feathers but there are likely many situations and practice settings in which an advance practice hygienist would be able to extend dentistry services where either a dentist is unavailable or overtaxed (rural, inner-city, etc, same concept as PA/NP really).
 
I don't know much about dentistry (I'm a PA) but the idea is similar to that of the physician assistant concept, and we PAs have been around for 40 years. It's going to ruffle some feathers but there are likely many situations and practice settings in which an advance practice hygienist would be able to extend dentistry services where either a dentist is unavailable or overtaxed (rural, inner-city, etc, same concept as PA/NP really).

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?
 
If the state legislatures let this nonsense go through, send each of these "advanced dental hygiene practitioners" to every freaking Give Kids a Smile location featured in the ADA news. Two birds, one stone.
 
I don't know much about PA's but it is my understanding that they generally work under the authority of a practicing MD or DO in some capacity. Is this correct?

These new "super-hygienists" will not be restricted to practice in any rural or underserved community nor will they have to practice under the supervision of a DDS or DMD. Right now there is not a shortage of dentists in Minnesota, as a matter of fact, many 4th year U of MN students are having a very difficult time finding jobs.

The access to care issue is more of a reimbursement issue. If the Minnesota government compensated dentists a reasonable wage so they wouldn't lose money treating M.A. patients, there wouldn't be near the access problem there appears to be.

Another way to handle a problem like this is to make mandatory but a decent salaried GPR's a requirement for licensure. That would make many dental students unhappy, but it is probably better than the alternative.
 
Members don't see this ad :)
Even cleaning itself should be done under the supervision of the dentist since patients usually need an overall oral checkup done along with the cleaning on their visit.
If the hygenists were to open their own office, it would be very inefficient as the patients would have to waste double of their time and money as they would need to visit the dental clinic for a check up and the hygenist clinic for teeth cleaning.
If hygenists are previliged to do even check ups and diagnosis which is one of the most important steps of the overall oral treatment, the legislatures are definitely overestimating them.
 
I'm currently attending the U of M and I've been writing numerous letters opposing this new legislation. We would very much appreciate complaints/concerns raised by dental students in other parts of the country written up addressing how completely ridiculous this new bill is. At the very bottom is a list of the people on the finance committee (next stage of voting in the near future on the bill) and what some of their positions are.

Here's a somewhat condensed summary of the bill. Please get involved...I have no doubt this will spread to other states if it's passed - Minnesota loves being the guinea pig for such nonsense.

Advocates for the bill are promoting the idea that this bill will allow more access to dental care in underserved areas. However, they are not planning to define what ‘underserved' communities consist of. This means that ADHP's will be allowed to open a dental clinic anywhere in Minnesota, not just in an underserved area. As stated, they will be capable of the following treatments:

*Render a final diagnosis

*Prepare treatment plans

*Prepare and restore primary and permanent teeth using direct placement
of appropriate dental materials

*Place preformed crowns

*Perform pulpotomies on primary teeth and direct and indirect pulp
capping in primary and permanent teeth

*Place atraumatic temporary restorations

*Perform extractions of primary and permanent teeth

*Prevent or intercept potential orthodontic problems and parafunctional
habits by early identification, space maintenance, and appropriate referral

*Provide reparative services to patients with defective prosthetic
appliances

*Supervise registered and unregistered dental assistants

*Prescribe, administer, and dispense legend drugs.

They can do all of these treatments WITHOUT:
The patient first being examined by a licensed dentist
The presence of a licensed dentist
A treatment plan and diagnosis from a licensed dentist

They may basically do EVERYTHING we, as dentists (and dental students), have gone to school for four years to become educated in.

Finance Committee:

Chair: Linda Berglin (Big Proponent)
651.296.4261

Vice Chair: Ann Lynch (Co-Author and Proponent)
651.296.4261 [email protected]

Ranking Minority Member: Michelle L. Fischbach
651.296.2084 [email protected]


Members: Sharon L. Erickson Ropes (Voted as a Proponent... may be persuaded
otherwise)
651-296-5649 [email protected]

Paul E. Koering (Opponent)
651-296-4875 [email protected]

Tony Lourey (Proponent)
651-296-0293 [email protected]

Mary A. Olson
651-296-4113 [email protected]

Yvonne Prettner Solon (Undecided)
651-296-4188 [email protected]

Julie A. Rosen
651-296-5713 [email protected]

Kathy Sheran
651-296-6153 [email protected]
 
I don't know much about PA's but it is my understanding that they generally work under the authority of a practicing MD or DO in some capacity. Is this correct?

Actually, not always..
Some PAs seem to run their own clinic. A friend of mine who came from a country where there are no PAs, went to a PAs office one time thinking that it was a physician's office.. but when she found out through an assistant there that she was going to meet a PA after waiting for almost an hour, she said she was shocked and just walked out of the office in anger.
As she was unfamiliar with the PA profession, it seemed that she saw it as some kind of a technician or assistant. She said at first she thought PA stands for some kind of a specialty and the others in the office probably all thought the PA was a doctor of some kind but she was the only one lucky enough to catch it. It seems that oftentimes people out of the health profession get confused in the different kinds of professions within it. I may be guessing wrong, but after hearing this story from that friend I guess the PAs can run their clinic but they might usually choose to work at a physician's office because they could get a high salary without dealing with these kinds of patients and the high overhead.
 
Another way to handle a problem like this is to make mandatory but a decent salaried GPR's a requirement for licensure.
I agree. If we can only get a single standardised licensure exam (no more different regional boards) and every single state took NY example with the pgy1 year requirement. Then open up more GPR/AEGD programs in rural/areas of need. :thumbup:
 
I don't know much about dentistry (I'm a PA) but the idea is similar to that of the physician assistant concept, and we PAs have been around for 40 years. It's going to ruffle some feathers but there are likely many situations and practice settings in which an advance practice hygienist would be able to extend dentistry services where either a dentist is unavailable or overtaxed (rural, inner-city, etc, same concept as PA/NP really).


Yes, and the numerous number of PAs that work in the city is what makes me believe that these hygenists will follow the same path. You really think all those pre PAs are all applying for the program to head out to the undeserved areas? Every single pre PA I've met say that they are applying to the program just because they don't have to take the MCAT, it's shorter than med school and the salary is pretty good.
 


It's hard to understand why those people in Alaskan villages are complaing about the once a year dental treatment they get when the dentists come to their village for the annual check up.
It just amazes me that they think the dentists have to move into their village for them when they could just come down once or twice a year for check ups and treatments. Why don't they start complaing that they don't have Walmart in their villages.
 
Is someone asking for a free..I mean a cheap ride to becoming a dentist?
 
It's hard to understand why those people in Alaskan villages are complaing about the once a year dental treatment they get when the dentists come to their village for the annual check up.
It just amazes me that they think the dentists have to move into their village for them when they could just come down once or twice a year for check ups and treatments. Why don't they start complaing that they don't have Walmart in their villages.

I read the article and didn't see any quotes from Alaska Natives complaining about the dental treatment they receive.

What needs to be realized is that many of the places where dentists arrive for annual care are in locations which require an airplane to reach. It's not exactly like they can just hop in the car for 2 hours to get their dental exam.

But, I agree that it is B.S that this MN bill does not require these advanced hygienists to practice in underserved areas. The argument, to be consistent, should either be 1) Slightly sub-par dental treatment is better than no treatment at all or 2) Properly trained advanced hygienists are as adequately prepared to offer these services as are dentists, and thus there is no justification for the state to grant dentists a monopoly on providing these services.
 
Maybe not precisely in this post but in I've read before in other articles related to this topic that there are many complaints. How else would this issue been initiated and the bill passed?
Not only Alaska but even people in other rural areas that could drive out are complaining to the legislatures.

Yes, I totally agree on the need of GPR in undeserved regions
and understand the inconveniences in living in undeserved areas.
But apart from these aspects, the general public in the US including those people in those rural areas just seem to think that they are in Sweden or North Korea only when it comes to health care.
I guess I see this in a different view as I'm more used to seeing people not taking health care as granted. I've seen people on islands in rural Japan and South Korea fly or ship out once or twice a year to get their checkups and but I never saw them complaing since they probably predicted that kind of a lifestyle before they moved out.
 
Maybe not precisely in this post but in I've read before in other articles related to this topic that there are many complaints. How else would this issue been initiated and the bill passed?
Not only Alaska but even people in other rural areas that could drive out are complaining to the legislatures.

Yes, I totally agree on the need of GPR in undeserved regions
and understand the inconveniences in living in undeserved areas.
But apart from these aspects, the general public in the US including those people in those rural areas just seem to think that they are in Sweden or North Korea only when it comes to health care.
I guess I see this in a different view as I'm more used to seeing people not taking health care as granted. I've seen people on islands in rural Japan and South Korea fly or ship out once or twice a year to get their checkups and but I never saw them complaing since they probably predicted that kind of a lifestyle before they moved out.

As far as how it became a political issue: Personal experiences of dentists treating these patients and academic literature supporting the assertion that the Alaskan Native population is not receiving adequate dental treatment, despite the best efforts of the IHS dental corps in Alaska.

In regards to your second sentence which I bolded, most Alaskan Natives do not make an active decision to live in a rural area, most/all of them were born there. Naturally they are free to move, which some do, but for many the family ties and connections act as strong ties which anchor them to the area (not to mention the fact that living under such conditions as a child tends to normalize the experience of living in such areas as adults).
 
Maybe not precisely in this post but in I've read before in other articles related to this topic that there are many complaints. How else would this issue been initiated and the bill passed?
Not only Alaska but even people in other rural areas that could drive out are complaining to the legislatures.

Yes, I totally agree on the need of GPR in undeserved regions
and understand the inconveniences in living in undeserved areas.
But apart from these aspects, the general public in the US including those people in those rural areas just seem to think that they are in Sweden or North Korea only when it comes to health care.
I guess I see this in a different view as I'm more used to seeing people not taking health care as granted. I've seen people on islands in rural Japan and South Korea fly or ship out once or twice a year to get their checkups and but I never saw them complaing since they probably predicted that kind of a lifestyle before they moved out.
 
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

Many people that would go for this have been working as hygienists in homeless shelters, community clinics and FQHC's. They have a passion to serve those who are on MA or uninsured. Many dentists don't have this passion. In fact, working for an FQHC will give you more reimbursement than working for a private clinic if you were a dentist. Many dentists don't realize this but I think the culture in dentistry is to make as much money as you can. . there isn't much passion or will to serve low-income, disadvantaged populations. So, these hygienists see that there are no dentists serving this population, have advocated for dentists, and feel they can help out more by advancing their skills. Keep in mind that most people who would do this, will go BACK to working at the homeless shelters; something that most dental students out of dental school wont do. Also, Many of hygenists have gone back to get their DDS and go back to working in these areas. It is not a question of they don't want to get their dentistry degree, it is a question of dental schools accepting more than 20-40 students a year. I think dental schools across the nation NEED to address the access issue and the public health issue of serving all populations including the uninsured, those with disabilities, and those who are low-income.
 
There are going to be some amendments from what I hear and the MDA, School of Dentistry and others are working together to make the legislation better. I think it is about time dentistry came into the Public Health world!
 
Many people that would go for this have been working as hygienists in homeless shelters, community clinics and FQHC's. They have a passion to serve those who are on MA or uninsured. Many dentists don't have this passion. In fact, working for an FQHC will give you more reimbursement than working for a private clinic if you were a dentist. Many dentists don't realize this but I think the culture in dentistry is to make as much money as you can. . there isn't much passion or will to serve low-income, disadvantaged populations. So, these hygienists see that there are no dentists serving this population, have advocated for dentists, and feel they can help out more by advancing their skills. Keep in mind that most people who would do this, will go BACK to working at the homeless shelters; something that most dental students out of dental school wont do. Also, Many of hygenists have gone back to get their DDS and go back to working in these areas. It is not a question of they don't want to get their dentistry degree, it is a question of dental schools accepting more than 20-40 students a year. I think dental schools across the nation NEED to address the access issue and the public health issue of serving all populations including the uninsured, those with disabilities, and those who are low-income.

And even more who go from this will have no desire to serve in a shelter, rural clinic or FQHC. Last time I checked, hygienists were people as well, and are thus subject to all the same wants and desires as dentists. Unless you legally require ADHP to practice in underserved areas, I can guarantee you'll see the same percentage practicing in these areas as the percentage of dentists who practice there.

The solution to the access problem isn't "we need more dentists." What could work is to make rural and urban practice more enticing. If the government expanded the NHSC to the level of funding the army get for the HPSP programs, you would have a dentist in every rural clinic across the country.
 
There are going to be some amendments from what I hear and the MDA, School of Dentistry and others are working together to make the legislation better. I think it is about time dentistry came into the Public Health world!


You need to realize that dentists are not social workers but they are health practitioners that require a compensation for the health services they provide. This is the same for any other profession and there is absolutely nothing wrong with expecting a recompensation for ones work in a capitalist society. And just as there are a number of hygenists within their profession that are willing to work for the public, there are also dentists that devote their time on community service. But you should remeber that these services are not an obligation.
 
i love how people tend to think that health professionals should feel obligated to work for the poor or for free since health professionals tend to make a bit more than the average joe. dont get me wrong, i think working in low income areas and whatnot is very admirable and a great thing to do. but when people say that health professionals make too much and are only concerned with money they tend to forget a few things....

while they (we will call them average joe) were working a job and being paid / getting married starting life / having kids / partying / remodeling the new house / getting paid / getting paid / getting paid / etc..., us health profession students were working low paying jobs all crazy hours of the day/night just so we could studying chemistry, biology, etc, and get the difficult and demanding degrees (e.g. not business, or arts, or quasi-sciences)....and after that were we in debt? yes....had we ever gotten paid? no.... even then did we go to work and get paid? no. we had to go on to professional school for 4 more years and get in debt up to our ears. then after at least 7-8 (thats without a residencey for medis) years of not getting paid and probably putting normal life on hold, you get to start your life....oh wait....maybe not... then you have to pay off all the debt you got into, start a practice, etc. then when you finally do start making some money the rate at which you are taxed compared to average joe is criminal. its like the old saying goes those that work hard are taxed hard, and the squeaky wheel gets the grease. so joe may not make as much as me, but he has a huge head start in life...and to top it all off...if he wanted to make more...no body forced him not to go without and go to school like i did.
health professionals work very hard for a very long time for a chance to make someones life better, so we deserve what we get paid. if people want to pay less for health care. make medical/dental school a vo-tech high school program.

(these statments come from someone who didnt have any parental help at all.... ever.....if you did maybe you didnt/wont have it as rough)

no but i totally agree that health professions are paid way too much and only concerned with money. damn! we need to get off our high horses!!! :laugh:
 
The solution to the access problem isn't "we need more dentists." What could work is to make rural and urban practice more enticing. If the government expanded the NHSC to the level of funding the army get for the HPSP programs, you would have a dentist in every rural clinic across the country.

Exactly. Although if they did that then the Army and Navy will have even more trouble filling their HPSP slots. Another option would be to increase funding for salaries to make them more comparable to a private practice income. Either way though the problem boils down to spending more money on the issue (which many would argue should not be the role of government/taxes)
 
So what is the compelling argument that will make the law makers wake up and fully understand? We as a profession can not just complain to each other about how hard we have it and so we deserve to make money to pay back our debt. That is not going to make a politician shed one tear for us. We need to email these people that were mentioned earlier in the thread with better alternatives than what they have on the table - such as monetary incentive for a dentist to volunteer time (ie loan forgiveness) or increased medicare/aide payments and let them get an idea as to what a financial burden student have now. The days of getting a DDS/DMD for 50Gs is over and I don't know that they fully understand the debt load that we come out of school with. I have no problem treating people who are uninsured or whatever, but the reality is I will graduate close to $400,000 in debt (I go to Nova and I have undergrad debt). Make it financially beneficial (or required in the GPR case) and undeserved areas will get care. Thats the capitalistic way. Until we become a socialist republic, money talks!
You can bet I will be emailing those lawmakers about my feelings!
 
First off, my question is if the state of Minnesota allows this ADHP thing to go through, why not put a absolute designation on where these dental student wannabes should practice. Since their arguement is about lack of access in these underserved areas, the government should put them in those areas and let them eat their words. And I'll bet anyone that these wannabes will start begging for working rights in all areas. They (those who never made it to dental school or think they can't get in or don't work hard enough to get in) should make a better arguement. Why won't they just flat out say they want a life of a dentist but are too ******ed to go to dental school. It's so true that dental HYGIENE should be all about hygiene. Everyone knows that a dentist just like their couterparts in the medical profession (MD's) have a broad-based education. We go through undergrad and them some 4 or more years in PROFESSIONAL school. So if these hygienist want to become ADVANCED, sure get better at cleaning. That should just be it. What these people are essentially asking for is to perform the same tasks as a general dentist. Heck, to prove that they are not adequate in terms of knowledge to provide the services they proclaim they can do, why not have them take the same boards as we dental students do, and have them take the same state licensing exams. I guarentee more than 95 percent of those ADHP peeps would not past.

But if all else fails. Guest what, we dental students and dentist shouldn't have to worry, because the only reason a consumer would ever go to these ADHP people is if they don't have access to a regular dentist. Common sense tells anyone that if they have the money or dental insurance, they are only going to go to a ADHP if they can't access a dentist or if the ADHP charges their services at a much lower price than a dentist. But guess what these ADHP people are not going to by any means charge at a lower price. The only reason there in this position is to make money quick and easy. So rest assure we as true dental professionals will not lack patients or income. Everyone knows the difference between a fine Mexican restuarant and a Taco Bell. Same goes for a dentist and a ADHP.

And watch when these ADHP people start seeing patients with numerous health probelms, their going to be opening up a big can of worms and then rest assure the government will step in some how.
 
What is wrong with this picture?

I go to the ADA website, I poke around at the main page, the "professionals" section, run a search for "Minnesota" and get nothing on this issue from them

I go the ADHA (american dental hygiene association) website, and right there on the front page is information and a link to the Minnesota info. They even go to say "The legislation is a direct response to recent events and research which highlight the difficulties Minnesotans and Americans face in accessing oral health care services—particularly children, the elderly, and minority populations."

What recent events are they talking about? If dental students from MN can't find jobs when they graduate, why is there such an access to care issue in MN? No offense, but "children, elderly and minority" sound like populations that can't really afford dental care in the first place, again it all boils down to $$$. Hygienists are so not going to be treating children, elderly, and minorities if this goes through.

:mad:

Although I must say that part of what is going to make this fail in real life is that no matter who is pulling teeth and shoving fillings, overhead is not going to change whether the hygienist or the dentist is running the practice. So if the hygienists want to take a stab at running a dental office (which is a lot of work itself) and make a lower percentage of overhead, I can't see a lot of them having the initiative and time to really go for it. I believe Colorado has allowed hygienists to practice on their own for years now and I don't know that a lot have actually set up private hygiene practices even though they can.
 
So what is the compelling argument that will make the law makers wake up and fully understand? We as a profession can not just complain to each other about how hard we have it and so we deserve to make money to pay back our debt. That is not going to make a politician shed one tear for us. We need to email these people that were mentioned earlier in the thread with better alternatives


True.. So what do you all think is a good option that we could suggest to them? And what are some major points that should be strongly indicated in these emails?

For myself, I plan to cover in my email the points that:

-As many have mentioned above, I think we should inform them with the option of starting a new GPR system and sending the dental grads out to rural areas where populations are below a certain number.

I've lived in a country with a similar system where army is mandatory and physicians and dentists are obligated to serve within bases or public hospitals in rural areas after graduation or residency. I've seen that this doesn't completely solve the shortage problem but it does help greatly in resolving this problem.

-As advanced hygenists will be previliged to practice a similar range of procedures to dentists without any supervision, it would only be reasonable that they recieve the same or similar amount of education as dentists. A minimun of 4 years should be required for this program for the enhancement of the scientific background of these professionals as the majority of them do not hold a BS or BA degree but in avearge have only completed 2 years of college work at a community college.

-Setting an absolute designation of where these hygenist can practice (determined not by a fixed boundry line but through a population census, as there could always be a fluctuation of population growth or reduction within a certain region)

Anything else to add?
 
90% of them will be working for corporate dental offices in metro areas. Any takers on that? If the state is so worried they should increase funding at the dental school to open an equivalent number of seats for new dentists. Makes a lot more sense than spending money on "almost" dentists.
 
Advanced Hygienist Program to serve those in need and underserved areas??
Sounds more like a fast track DDS/DMD program to me. :rolleyes:


Since these super, CC grad hygienist think they could learn everything that a dentist has got to learn in 2 years...
How about if the Dental Assistant Association starts to push for a 1 year Advanced Dental Assistant Program so they could triple their income!
I bet these assitants can master their cleaning skills within a time of weeks wondering what the whole point of going through a 2 year DH program is..
I think I've heard that there is a shortage on dental hygienist in rural areas?
We need to get another bill passed for this crisis!
 
I swear Minnesota is one of the most ******ed states when in comes to dental licensure.

They made licensing for foreign trained dentists much easier than about any other state because they thought there was this big access to care issue here. Of course ,they didn't limit where they could practice and there is actually a much higher percentage of foreign trained dentists practicing in the twin cities metro (non-underserved) areas than US trained dentists.

What makes them think the ADHP's are gonna be any different?
 
This thread captures the big problem in health care.

1.) Midlevels wringing out every practicing right away from physicians and now dentists. For example, the CRNA (Certified Registered Nurse Anesthesiologist) goes to two years of CRNA school and makes about $90k starting. Hospitals get to pay this person less than a physician anesthesiologist, the job gets done for the largest part, and hospitals save money ... until an unsolved problem happens where a DO or MD anesth. should have been there. Actuaries calculate the average settlement, frequency per patients seen, and salary dollars saved by having less DO's and MD's on staff. The dollar makes the decision, obviously patient care suffers.

2.) Physician Assistants (PA) replaced the Family Medicine doctor. I love PA's and the jobs they do, but this supports the trend (defending PA's, they are always highly-supervised and are a huge help to patients and the very fragmented medical situation).

A couple things to be mindful of:

-Unmeasurable high rate of baby boomers retiring, leaving many jobs vacant, and people to take care of. Perhaps the demand will be such that this midlevel scare will be insignificant.

-People want proper care, and are ready to wait and pay for it. People want physicians, dentists, licensed therapists ... not midlevels pushing their abilities to a level dangerous to practice. Look at how our country lives, we drive Escalades to go buy postage stamps, nine-year-old kids have Blackberries, and seventeen-year-old kids have new Dodge Ram trucks. The gluttonous public will wait, pay, or throw a huge tantrum to see the doctor to treat them.

-Many things in dentistry are elective, cosmetic, and are often put off by people who want to not spend money on their health care, but spend it on fancy cell phone, smokes, and low-mpg SUV. Maybe dentists will continue doing the fee-for-service or paying customer practices, while emergency and more public health services will use midlevels. Ever wonder why England and their failed infamous National Health Service (NHS) is made fun of by British folks with horrible teeth?

-Given the drastic separation of wealth (2% of world's population has 98% of the capital), tantrum-throwing babyboomers, and vain costmetic demand from patients (while they ignore their huge overweight a**es), I think dentistry will keep ITSELF at the steering wheel, and not be asleep at the wheel like medical doctors have been since the 60's when it went socialized.

-Many of my friends used the golden trick "I want to work in a small town in the middle of no where, yes I will be happy to wait 4-6 weeks to order my new socks in the mail," to get into their medical or dental schools, which hold lofty mission statements about providing doctors for rural places. Lying through their teeth, they sit in class and plan Bahama vacations, drive Porsche's, and are scouting the up-and-coming subdivisions in the nearest big city. Unfortunately, the goal of flooding doctors into rural communities WILL NEVER HAPPEN. The socialization of medical education shows us the bright lights, Vale Colorado, and fancy crap that we will drive ourselves into the ground to own and flaunt. The doctors per 100,000 people is a positive correlation, and even if you drag together a class of rural hillbillies, they will go for the good life.

Midlevels will do the same. The incentive to manipulate admissions committees is too great for these very intelligent and $ is one hell of a motivator.
 
90% of them will be working for corporate dental offices in metro areas. Any takers on that? If the state is so worried they should increase funding at the dental school to open an equivalent number of seats for new dentists. Makes a lot more sense than spending money on "almost" dentists.


I agree that 90% of these "almost" wannabe dentists will be working in the metro areas, but I'm not sure whether it'll be in corporate dental offices..

Since most corporate dental offices obviously wouldn't be giving these almost dentists a higher salary than associates.. if these "almost" dentists figure that running their own practice by hiring the regualar hygienists and dental assistants is more profitable, why work under the "real" dentists getting a lower salary when they too are "almost" dentists.
And believe it or not, as mentioned above..this might actally work out because the majority of the public are not quite familiar with the different profession within health care.. As long as these "almosts" keep quiet and work hard.. quite a few number of patients might think that they are at some kind of a dental clinic seeing those chairs and people in scrubs..
 
I swear Minnesota is one of the most ******ed states when in comes to dental licensure.

They made licensing for foreign trained dentists much easier than about any other state because they thought there was this big access to care issue here. Of course ,they didn't limit where they could practice and there is actually a much higher percentage of foreign trained dentists practicing in the twin cities metro (non-underserved) areas than US trained dentists.

What makes them think the ADHP's are gonna be any different?


How involved have the dentists in Minnesota and MDA been in these issues?
 
Physician Assistants (PA) replaced the Family Medicine doctor. I love PA's and the jobs they do, but this supports the trend (defending PA's, they are always highly-supervised and are a huge help to patients and the very fragmented medical situation).

I totally agree... but at least in medicine, the majority of physicians specialize.. whereas in dentistry the majority of dentists practice general dentistry..
And as mentioned, most PA's work for and under the supervision of physicians.. they benifit the patients, the physician and themselves..
The DH use examples of PAs to support their program but when you go into the specifics..they are asking for something else.
PAs are working as PAs but these DHs are asking to become dentists..
They don't want to be supervised by dentists!
 
The thought of this ADHP just makes me laugh at how stupid our politicians are. Why in the hell world would these pretend dentists want to work in areas that dentists don't want to work. And lots of times, it's not that dentist don't want to work in those areas, it's that those areas aren't the kind of places where you can pay off your $250,000 loans and put food on the table. And even after that, heck, after 7-8 years of education beyond the high school level, come on, we as dentists have to be compensated for our services. It's true that the bottom line is $$$$. The government feels this is the cheap way to do it because they feel that these low-level providers will fill up the access issues with good enough care. But guest what, reality check, these phonies are by no means adequate to provide anything but cleanings. To say that they are "advanced" is also misleading. They should be called quackdentists. I could care less about these quazzis, lets allow them to go to school for some 2 additional years. It's just gonna be a waste of their time because if the word spreads out that they're not dentists, the only people who will go to them is the ones who are on medicaid or some other form of governmental funding. Hey that sounds like a brilliant idea because that is exactly what the government wants. But that's not exactly what the ADHP's want. They want the convertables, the big houses, the bling blings. Too bad most people with disposable income won't fall for the "almost" dentists.
 
What sort of involvement does the ADA have with all this? Besides all the shameless power grabbing and what not, I would think that they would be concerned about the idea of these insufficiently trained people actually treating patients. Lets just imagine that the whole access to care crisis is as bad as they will have us believe it is (its not), what kind of argument is it that if you can't afford dentistry you should get it from second rate practitioners. On another note, I can't imagine a better turn of events for dental malpractice lawyers...
 
There are going to be some amendments from what I hear and the MDA, School of Dentistry and others are working together to make the legislation better. I think it is about time dentistry came into the Public Health world!


This is like asking for free food at a restraunt or free gasoline at a gas station.. Doesn't every have a right to eat decent food and shouldn't we all take transportation for granted? You'd be lucky if they don't kick you out for that.

And no, not everybody goes into dentistry to provide social service..
In fact, I even said during my dental interview that I would like to devote only a "part of" my time as a dentist on public services.. I really didn't want to make any promises that I can't keep.. And I even mentioned that even that portion of time I will be spending will be spent only on patients that I feel are really in need of help.
 
There's a big difference in these roles. First off, these ADHP's want nothing to do with dentists. They want to distant themselves from them and be a different segment away from the traditional dental model. Believe me, even if this crap goes through, most people will not go to these people except for cleanings. Dental treatments such as fillings and crowns are IRREVERSIBLE procedures. Most patients are aware of this and will never seek those procedures from a fake dentist. It doesn't matter if it's heart surgery or an enamelplasty, a irreversible procedure done under someone who is not properly trained is a dangerous thing. People might argue that if these people can do the same procedures as dentists then allow them to. But guess what, people are not products and things such as teeth can't be replaced if the tooth structure is iatrogenically damaged. Now what's next, ADHP's can start placing implants and performing root canal therapy. There's got to be a stop to this phony crap. The reason NP"s and PA's are still around is because they don't perform anything irreversible. If they had, we would be seeing lawsuits up the roof. Due to the nature of their work, it's very difficult to detect the mistakes and misjudgements that they do due to lack of training. Now when fillings and crowns starts popping out, we'll see the difference of care. Another point to mention is that in this era and the coming era, more and more people are going to visit their dentist with multiple health issues that can affect dental treatment. Things such as osteoradionecrosis. Without the broad-based knowledge like what dentist have, those ADHP's will be overwhelmed and doomed for disaster.

One thing to keep in mind is that just because there is an access issue, that does not justify bringing in some low-level provider. Would if a scenario arises that a lot of people are suffering from heart attacks due to fat deposits in the coronary arteries, and that there are very few cardiologists. Now does it make sense to start training nurses to perform stents and such? Now would it be right to start setting up schools to perform stents? If we let this crap continue, people will start setting up technical schools around the nation to learn individual procedures. Pretty soon there's going to be an open heart surgery class as a elective in a technical school. I guarantee people that if I sat in a medical practice and saw a hundred heart transplants, I can probably perform that procedure. But now just because I can do it, does it make it right for me to do it? That's the big problem, just because I can do something doesn't make it possible for me to get a license because there is a big difference between doing something and knowing all the complications of doing something and then knowing how to treatment plan in case of the uncertain. I can probably train a monkey to cut a prep, but now should they be licensed to start cutting preps? The moral is that there is more to just cutting preps, there is a big part prior to that and that is DIAGNOSIS, which I believe cannot be taught to people who don't have the biomedical sciences in their curriculum. And please don't give me crap that hygiene schools do teach biomedical sciences, because that is bo because everyone knows the difference between a doctor's biomedical class versus a tech school biomedical class.
 
Will these ADHP's take the same licensure exams we dental students take? Will they be held to the same standard of care as we future dentists? If not then why the f*ck are they allowed to perform the same procedures?
 
These dental midlevels will follow the same path that NP's and CRNA's have taken. They will eventually want autonomy.

The day will come where they will open up their own "cleaning clinics" with no dentists on site. They will clean and x-ray. If they find a cavity that needs drilling, they will "refer" these patients to a dentist. Problem is, cleaning is a major part of the dental business.

The first step is to repulse these efforts through political and legislative means. The second step is to not hire these individuals. Hiring these dental midlevels en masse will ruin dentistry as you know it. Learn the lessons from the NP's and CRNA's.
 
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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.
 
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