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PSU SHC 414

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NOTE TO MODS: This is NOT a double-post... just a FYI for people in this forum who have not ventured over to the "Dental" forum.

Friends,

I don't know how many predents out there are aware, or have even ever heard of, this initiative (advocated by dental hygienists, specifically the ADHA) to establish a mid-level (Master's-level education) dental provider comparable to that of a nurse practitioner (NP) in medicine. These providers, termed "ADHPs" (Advanced Dental Hygiene Practioners), are being proposed as a solution to the access to (oral health) care problem that currently pervades the U.S. This initiative has gained a lot of steam recently due to the unfortunate story of the Maryland child who died as a result of an untreated abscessed tooth.

As it stands now (in Minnesota), the scope of practice of these ADHPs has been designated to be "in underserved areas" - "This practitioner will have an expanded role in treating patients by providing diagnostic, preventive, prescriptive, therapeutic and restorative services directly to the public, focused on the underserved." Also, while ADHPs must enter into a written agreement with a licensed dentist, they will be under only "general supervision" by the dentists meaning that they can diagnose, create patient treatment plans, and perform procedures (of which there are MANY, see the attached file below for details) WITHOUT the presence of a licensed dentist.

View attachment Q & A on the ADHP MN facts & ADHP Fact Sheet.doc

While the notion and rationale for the creation of the ADHP role is certainly a noble one, I think all future dentists need to take careful heed of this issue as they embark on their dental careers, since this is clear evidence that the dental profession is drastically changing as we speak (i.e. the "golden era", as some have described it, of dentistry is coming to a drastic halt). Many proponents of the ADHP will claim that their intentions are NOT to encroach upon the role or importance of the DMD/DDS in providing oral health care, but it is only a matter of time before these ADHPs will want to broaden their scope of practice outside of "underserved" areas, and increase their autonomy and perceived level of expertise by possibly pushing for the creation of a "doctoral" ADHP degree. Look at what has happened to medicine as a result of the creation of the Nurse Practitioner (NP) role.

Please note that this is not just an "idea" that's being thrown around. Legislation has ALREADY BEEN PASSED in the state of Minnesota allowing for the creation of these mid-level dental providers:
http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=2928
http://www.mndha.com/Legislative.html (scroll to the bottom for links to the actual legislation)

Furthermore, it should be noted that rather than the title of "Advanced Dental Hygiene Practioner" (which could make many patients in the general public highly skeptical of receiving care from an "advanced" Dental Hygienist rather than a "doctor"), proponents of the bill have changed the terminology to now read "Oral Health Practitioner". Now I'm in no position to speak to the rationale of why exactly this change in terminology was proposed, but you're all fairly intelligent people, so I leave it to you to speculate on your own. I know what I'm thinking...

I'm urging all of you predents to become well-informed and knowledeable about this initiative since it could have SIGNIFICANT implications on the livelihood of your future careers as DMDs/DDSs. There's plenty of information on-line. Talk to your own dentists about what they think about this. Many of them probably are even UNAWARE (or if they're near retirement age... APATHETIC to) of this initiative. Case in point: when this legislation was being introduced in the Minnesota State Legislature back in Feb/Mar 2008 and the MDA (Minnesota Dental Association) was trying to lobby against it, representatives in the Dental Associations of other states claimed they had never even heard of the concept of an "ADHP"!!! The Minnesota Dental Hygienists Association has jumped the first (and most difficult) hurdles to achieve this unprecendented legislation, and it will only be a matter of time before other states begin to jump on the wagon... and we can all assume that it will be a much easier-fought battle for subsequent states to follow suit. While there is nothing that dentists can really do to prevent the spread of the creation of this role, there ARE things they can do to make sure that the specifics of this ADHP position are well-definied (i.e. contact their state Congressmen to make sure that: ADHP practice is limited to underserved areas, procedures that ADHPs can perform are very specifically defined and limited, written agreements with a licensed dentist are required along with the ability of dentists to exercise discretion as far as supervision is concerned, etc.).

I know it's pretty easy right now as a PREdent to be thinking purely from a humanitarian standpoint with the mindset of "this is a great thing for our patients... this won't affect me... thumbs up here!", but I think you'll all be singing a completely different tune when your practice is being adversely impacted and your role as a dentist has been completely redefined from what we know it to be today. By then, it'll be too little too late. If left unchecked, ADHPs could potentially have an adverse impact on dentists. Don't get me wrong here... I believe that ADHPs will provide a very necessary and valuable role in helping to improve this nation's current crisis with regard to oral health care, but we also need to make sure that we (as dentists and future dentists) are actively involved in the creation of this new role so that we don't suffer the same fate that current physicians face today.

Thanks for reading... this is IMPORTANT!!!
 
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jaypea65

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I have mixed feelings about your post. On one hand, the humanitarian in me tells me this is not a bad idea. In medicine, physician assistants are able to practice in underserved areas without a physician being present. I do not think that this has enabled PA's to practice medicine at will unsupervised throughout the country. The fact is that people of underserved areas are not receiving adequate health care, and an unwillingness of practitioners to locate to these areas for various reasons does not solve the problem.

I do have reservations about the idea though. I would hope that the scope of their practice would be limited, and confined to underserved areas of the country. There is a whole host of other questions that need answered before I could give my complete blessing.
 

AlwaysImproving

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I am an underprivileged person and receive free government health care. I go to a free clinic for underprivileged people. There, the physician assistant is my doctor, we all call her doctor even though she is not an MD.
I live in FL and went to Univ. of South FL for my undergrad. I have gone many times to the clinic for routine and non-routine health care. I have never once seen the Doctor that is in charge of overseeing the PA.


I don't know if all this is a good or bad thing. What I do know is that I had my ear drum perforated and when this happens, I cannot undergo ear lavage (they put a liquid to remove ear wax so that the PA can see my ear clearly with the otoscope). What I do know is that I warned the PA that I cannot undergo ear lavage bec/ I had a perforated ear drum and that I saw online that it would burn me. She told me to trust her and do it anyway. I did (and now I regret it). It burned me so badly:(. Anyway, She said sorry and that she didn't know. I then consulted the free ENT at my university and he said it's protocol not to do ear lavages in patients with perforated ear drums.

All in all, I am thankful for being able to receive free medical care even though it might or might not be the same quality as a MD would give me. I don't want to seem ungrateful or complain, I am just giving a testimony of what happened to me, just giving the facts. I just thought I could give my personal experience. Obviously, there were bad times and good times but no matter what, I am extremely grateful of receiving valuable health care. When I become a dentist, I will also help out communities that are in need just like I received help :D
(sorry for the long post, :D hehehe)
 
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klutzy1987

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This worries me a little also. If these ADHP's become the equavalent of RN or PA it spells less patients and money for us dentists.
 

PSU SHC 414

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I am an underprivileged person and receive free government health care. I go to a free clinic for underprivileged people. There, the physician assistant is my doctor, we all call her doctor even though she is not an MD.
I live in FL and went to Univ. of South FL for my undergrad. I have gone many times to the clinic for routine and non-routine health care. I have never once seen the Doctor that is in charge of overseeing the PA.


I don't know if all this is a good or bad thing. What I do know is that I had my ear drum perforated and when this happens, I cannot undergo ear lavage (they put a liquid to remove ear wax so that the PA can see my ear clearly with the otoscope). What I do know is that I warned the PA that I cannot undergo ear lavage bec/ I had a perforated ear drum and that I saw online that it would burn me. She told me to trust her and do it anyway. I did (and now I regret it). It burned me so badly:(. Anyway, She said sorry and that she didn't know. I then consulted the free ENT at my university and he said it's protocol not to do ear lavages in patients with perforated ear drums.

All in all, I am thankful for being able to receive free medical care even though it might or might not be the same quality as a MD would give me. I don't want to seem ungrateful or complain, I am just giving a testimony of what happened to me, just giving the facts. I just thought I could give my personal experience. Obviously, there were bad times and good times but no matter what, I am extremely grateful of receiving valuable health care. When I become a dentist, I will also help out communities that are in need just like I received help :D
(sorry for the long post, :D hehehe)


Thanks for your post... it's always great to hear from a perspective like yours.

Your point is an extremely valid one. In fact, it's probably the biggest question that opponents of the ADHP legislation bring up - Is the level and quality of care that ADHPs provide going to be comparable to that of dentists, or will they make many more mistakes (which will then fall onto the shoulders of dentists to resolve)? And if it turns out that ADHPs are not able to provide the same standard of care as dentists, do we invest more time/effort into training ADHPs? And if yes, where do we draw the line between the amount of training that ADHPs receive vs that of dentists? (See where this is potentially headed???)

It'd be completely unreasonable to assume that ADHPs are going to be flawless in the care that they deliver since dentists make their own fair share of mistakes, but will this turn into a situation where they do more harm than good where many cases that were handled by an ADHP have to be "fixed" by a dentist? Who knows... only time will tell.


As many currently praciticing dentists have expressed, rather than creating a new mid-level dental practitioner position (which, I think, opens up a huge door for a lot of potential problems and issues) to solve the access to care issues, I think that state legislatures need to reexamine the issue of Medicaid reimbursement rates that dentists currently receive. For any of you who are well-informed about Medicaid, you know that for many dental procedures, government Medicaid reimbursement rates are so piss poor that dentists actually LOSE money by treating Medicaid patients. Or rather than losing money, the profit is so low that it's not worth the paperwork and hassle required for reimbursement, not to mention the possibility of lost revenue (since that appointment slot could've been filled by a "regular" patient) due to missed appointments ... which are notoriously high among underprivileged people, for understandable reasons.

I think it's very easy at this point in our lives as PREdents to say "Yes, I want to devote my practice to helping the underserved, and use my skills to provide care to less fortunate communities". But when Medicaid reimbursement rates are as low as they are, you'll end up driving your practice to bankrupty through your benevolence.

As DrJeff has mentioned, in the state of Connecticut, the state legislature, rather than creating legislation for the creation of ADHPs, increased Medicaid reimbursement rates, and subsequently, Medicaid participation by dentists in that state jumped from ~10% to ~50%.

Here's a question for everyone. If ADHPs were created to treat underserved populations, and state legislatures have up to this point been unwilling to increase Medicaid reimbursement rates for dentists, where exactly is the money going to come from to reimburse ADHPs for treating Medicaid patients? Let's be transparent here and be completely clear that most ADHPs will eventually be in private practice (with a staff of multiple Registered Dental Hygienists and Dental Assistants) on their own, and like dental practices now, they will be looking to profit. You can be as good-hearted as you want, and while patients always come first (if you are an ethical practitioner), as a dental practitioner, don't forget that you are still running a small BUSINESS. So if dentists are currently unwilling to see Medicaid patients because reimbursement rates are so low, what makes you think that ADHPs will be willing to settle for less???? (maybe since their cost of education is less?? but how long do you think this "humanitarian" mindset will last???) So if one day, ADHPs aren't willing to see Medicaid patients for the same reasons that dentists don't want to now, where exactly do you think they'll be turning for their patient pool?? This is why it's essential that current dentists AND dental students take a firm stance on this to make sure that it is CLEARLY defined that ADHPs should be limited to practicing in underserved areas. This is not to say that dentists should be completely relieved of their ethical duties to help the underserved, but if ADHP-proponents are using the "underserved" card to demonstrate the necessity for creating this position, I think we need to make sure they are sticking to that...
 
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klutzy1987

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I have an idea,

let these ADHP's treat medicaid/care patients only wherever they may be. That way these ADHP will not take patients away from the real dentists and they will definitely be limited to serving the underrepresented. This may also increase the number of people that register for medicaid.
 

Pat Kelly

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Thanks for your post... it's always great to hear from a perspective like yours.

Your point is an extremely valid one. In fact, it's probably the biggest question that opponents of the ADHP legislation bring up - Is the level and quality of care that ADHPs provide going to be comparable to that of dentists, or will they make many more mistakes (which will then fall onto the shoulders of dentists to resolve)? And if it turns out that ADHPs are not able to provide the same standard of care as dentists, do we invest more time/effort into training ADHPs? And if yes, where do we draw the line between the amount of training that ADHPs receive vs that of dentists? (See where this is potentially headed???)

It'd be completely unreasonable to assume that ADHPs are going to be flawless in the care that they deliver since dentists make their own fair share of mistakes, but will this turn into a situation where they do more harm than good where many cases that were handled by an ADHP have to be "fixed" by a dentist? Who knows... only time will tell.

Why would you possibly think that a potential ADHP is not going to provide the same standard of care as dentists? It's not like they will pick some guy off the street to train them to be an ADHP - the people that will be enrolled in this program are probably people who have extensive work done in the dental office as a dental hygienist - otherwise more capable to do the tasks outlined than you will be when you enter dental school. Come off your elitist dentist attitude - especially when you are not accepted into one yet. :rolleyes:

How exactly will this effect you? Not much. First of all, it takes time for this to pass through legislature in many other areas. Second of all, it takes time to develop a program that will be up to standard and produce ADHPs. It takes years before these ADHPs are ready to serve, and even then, it's not like they will charge half of what you will charge in order to undermine the importance of your practice. So in 20 years, maybe there will be 3 or 4 schools producing a class of 20 ADHPs each year - it will not greatly affect your search for a job or your place in healthcare.
 

PSU SHC 414

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Why would you possibly think that a potential ADHP is not going to provide the same standard of care as dentists? It's not like they will pick some guy off the street to train them to be an ADHP - the people that will be enrolled in this program are probably people who have extensive work done in the dental office as a dental hygienist - otherwise more capable to do the tasks outlined than you will be when you enter dental school. Come off your elitist dentist attitude - especially when you are not accepted into one yet. :rolleyes:

How exactly will this effect you? Not much. First of all, it takes time for this to pass through legislature in many other areas. Second of all, it takes time to develop a program that will be up to standard and produce ADHPs. It takes years before these ADHPs are ready to serve, and even then, it's not like they will charge half of what you will charge in order to undermine the importance of your practice. So in 20 years, maybe there will be 3 or 4 schools producing a class of 20 ADHPs each year - it will not greatly affect your search for a job or your place in healthcare.


I completely agree that dental hygienists are experts and very good at their craft - which is preventative dentistry. What I'm concerned about is the broadened scope of ADHPs (if you read the Word link I posted in my initial post, you'll see that many of the procedures that ADHPs will now be able to perform have always been limited specifically to dentists)... can you guarantee me that after a 2-yr masters level training program, ADHPs will be able to handle extractions, fillings, and other procedures with the same competence as dentists? I'm sure that the discrepancy won't be huge, and I'm confident that ADHPs will be fully capable, but what happens when complications occur (which they WILL NOT be trained to handle)?

And in Minnesota, this legislation was just passed a few months ago, and they've already set the inaugural class to start in Spring 2009... so it doesn't take nearly as long as you think to implement something like this...

One more thing... I don't have an elitist attitude at all. I've explicitly stated in my posts that I think the ADHP concept is a noble one - I started this thread for the sole purpose of EDUCATING pre-dents about what is to come for dentistry, not to impose my opinions on others. All of the hypothetical questions, skepticism, and concerns I've presented are just reiterations of what current oponents of this idea (mostly licensed dentists) have expressed. I'll admit that I am putting a spin on everything in favor of dentists, but I'm certainly entitled to my own opinion, right?
 
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Pat Kelly

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I completely agree that dental hygienists are experts and very good at their craft - which is preventative dentistry. What I'm concerned about is the broadened scope of ADHPs (if you read the Word link I posted in my initial post, you'll see that many of the procedures that ADHPs will now be able to perform have always been limited specifically to dentists)... can you guarantee me that after a 2-yr masters level training program, ADHPs will be able to handle extractions, fillings, and other procedures with the same competence as dentists? I'm sure that the discrepancy won't be huge, and I'm confident that ADHPs will be fully capable, but what happens when complications occur (which they WILL NOT be trained to handle)?

And in Minnesota, this legislation was just passed a few months ago, and they've already set the inaugural class to start in Spring 2009... so it doesn't take nearly as long as you think to implement something like this...

One more thing... I don't have an elitist attitude at all. I've explicitly stated in my posts that I think the ADHP concept is a noble one - I started this thread for the sole purpose of EDUCATING pre-dents about what is to come for dentistry. Yes, I'm putting a spin on everything in favor of dentists, but I'm allowed to express my opinion, right?

Why do you think that a 2 year training won't be enough for the ADHPs to be as good as the dentists when it comes to extraction, restoration, or other procedures? When you look at many dental school's curriculum, they don't teach extraction or restoration all year long for four years - in fact, when you add all the module times up, it won't come up to two full years worth of training because they have to fit in other courses like basic sciences, endo, ortho, prostho, patient assessment, and all the other fun stuff. I know some D3s who are doing direct bonding veneers in the morning and partial dentures in the afternoon, and maybe squeeze in a patient in the late afternoon for a class 3 - whereas the ADHP will probably spend all day doing extraction or restoration training for a long time in the program.

So yes, I think with proper training, there's no reason why ADHP won't be as good as the dentists in providing the standard of care needed for restorations or extractions.

You say that Minnesota has just been granted to create ADHP programs, but do you know how much time they spent lobbying before they had a chance to pass this? It's not like they can put together a proposal and get enough backing within a couple of years - it takes time for the process to come together. Dentists as a profession have a pretty strong influence, so if you think that this will pass in all the states within the next 25 years, and schools are popping out of nowhere and a busload of applicants are eager to go through the program, then that's your opinion - but not a realistic projection of what the job market will be like.

Let me put it to you another way - how is this new program any different than an existing dental school taking in 10 new students per year, or a new dental school like Midwestern creating 40 new dentists per year? Aren't those your competition too? Why don't we just ask all the dental schools to stop accepting new students or broadening their class size so that you can have all the job opportunities you want when you get out of school? Isn't that the same idea?
 

armorshell

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Why do you think that a 2 year training won't be enough for the ADHPs to be as good as the dentists when it comes to extraction, restoration, or other procedures? When you look at many dental school's curriculum, they don't teach extraction or restoration all year long for four years - in fact, when you add all the module times up, it won't come up to two full years worth of training because they have to fit in other courses like basic sciences, endo, ortho, prostho, patient assessment, and all the other fun stuff. I know some D3s who are doing direct bonding veneers in the morning and partial dentures in the afternoon, and maybe squeeze in a patient in the late afternoon for a class 3 - whereas the ADHP will probably spend all day doing extraction or restoration training for a long time in the program.

So yes, I think with proper training, there's no reason why ADHP won't be as good as the dentists in providing the standard of care needed for restorations or extractions.

I agree, with proper training an ADHP could be as good as a dentist. That training modality already exists, and it's called dental school.

The potential ADHP curricula have already been published. The proposed curriculum is 37 credits, many of which are not clinically or pre-clinically related. This is only slightly more than the number of credits in a single quarter of dental school.

Not to mention that despite dental students "spreading themselves out" over several disciplines, there isn't a single one which doesn't affect the other. Everytime I learn something in Endo, it affects the way I do operative. Things I learned in dental anatomy and fixed prosthodontics affect the way I do extractions. Detailed knowledge of occlusion affects every single aspect of what I do clinically.

Just for fun, in the most recent JADA a study was published comparing chart notes between alaskan dentists and dental therapists (similar to ADHP). The dental therapists were much more likely to diagnose disease and perform procedures with clinically inadequete radiographs and had a 4x as many post-operative complications (that they recorded in the chart notes). Take it for what you will.
 
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jay47

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I am not sure that I would support something like this, and thanks Armorshell for bringing up the subject of dental therapists in Alaska, I remember reading about that earlier this year.

My reasoning for not supporting this is as follows:

I know many fellow students at my school (large school in Texas) are not going to get into dental school. It's just a matter of fact that not everyone who wants to be a dentist can be; that's okay, there are many other professions out there. I can see their work ethic as well as critical reasoning skills in class and they are, to say the least, poor. If this legislation becomes widespread, many of those people who could not get into dental school will simply do the ADHP thing, assuming they can do essentially the same things as a dentist. I would not want to be under the care of some of my fellow classmates as I know some of them are not competent enough to take care of me. However, standards for the ADHP would likely be lower and allow less qualified people in. What results is a system where less qualified people are getting much less training and still able to practice the same things as dentists. Sure, the "law" says they can only do certain things, but when it comes to practicality, they will most likely do all the same things a dentists does. Heck, most underpriveledged people don't even know dentists are doctors (I know this, I've heard them say it many times before) simply because they are unaware of the training a dentist goes through.

Now here's the kicker, of course it is possible that ADHPs can give the same level of care a DDS can, except that their knowledge of the body, their training, and they overall competency (this is generalized of course) is likely to be much lower. Dentistry is more complex than most people imagine, and to be able to provide effective care that will take care of patients is difficult. As PSU SHC 414 pointed out, their "percieved" knowledge will equivalent to a dentist's, but their actual knowledge will be much less.

Okay, so how will this affect underserved populations? I really don't know, but what we need, instead of ADHP, is for dentists who really care about underserved populations to start practicing in smaller areas. Texas is 39th in all the states in ability of people to access care; large cities have a dentist on every corner, but rural areas of hundreds of miles have one dentist. We need to continue to practice free care events like Texas Missions Of Mercy (TMOM) to provide care, quality competent care by actual dentists, instead of lowering standards to extend care.

Kudos to Armorshell [a real dental student] for pointing out that every discipline in dentistry affects another. Without a variety of perspectives and much training to understand these perspectives, you cannot provide quality care.

I don't think that ADHPs would pose a threat, business wise, to dentists; however, we cannot afford to provide substandard care to anyone. Lawyers, and hence malpractice insurance, could shoot up dramatically once people feel like a little pain at the dental office calls for a lawsuit. I hate lawyers btw.

Hope my perspective will help someone formulate their own mindset regarding this issue.
 

glk2101

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How are ADHP's different from EFDA's?(Expanded function Dental Assistant)

I know they are using these in Pennsylvania as part of medicaid reform, but hadn't heard of ADHP
 

rdhdds1

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I completely agree that dental hygienists are experts and very good at their craft - which is preventative dentistry. What I'm concerned about is the broadened scope of ADHPs (if you read the Word link I posted in my initial post, you'll see that many of the procedures that ADHPs will now be able to perform have always been limited specifically to dentists)... can you guarantee me that after a 2-yr masters level training program, ADHPs will be able to handle extractions, fillings, and other procedures with the same competence as dentists? I'm sure that the discrepancy won't be huge, and I'm confident that ADHPs will be fully capable, but what happens when complications occur (which they WILL NOT be trained to handle)?

And in Minnesota, this legislation was just passed a few months ago, and they've already set the inaugural class to start in Spring 2009... so it doesn't take nearly as long as you think to implement something like this...

One more thing... I don't have an elitist attitude at all. I've explicitly stated in my posts that I think the ADHP concept is a noble one - I started this thread for the sole purpose of EDUCATING pre-dents about what is to come for dentistry, not to impose my opinions on others. All of the hypothetical questions, skepticism, and concerns I've presented are just reiterations of what current oponents of this idea (mostly licensed dentists) have expressed. I'll admit that I am putting a spin on everything in favor of dentists, but I'm certainly entitled to my own opinion, right?

It is preventive not preventative. Preventative is a perversion of the word preventive.

Secondly, the same can be said of dentists who attempt to complete prophys, SRP's and debridements without the aid of a DH. :( The thoroughness is a apprehensable. I have seen dentists do prophy's in 20 minutes and SRP's in 30 for 2 quads. And they have been trained for 4 years.:eek:


But alas you have stated/imposed your own opinions and views. I am not condemning you because it is hard not to voice ones opinion/view on this matter.

Finally, I see both sides of the coin. I am for and against the ADHP/OHP. As a DH myself I can see the benefits of the concept and embrace the possibilities of DH's being a more integral part of the treatment of patients no matter where they might be.

Please do not get the OP wrong and please do not take everything to heart. Just as there are dentists who oppose the idea there are those dentist that support it. Case in point. The bill in MN that passed would not have been passed if dentists were not behind it. This is undebateable since DH's are governed and regulated by state boards (yes) but ultimately dentists.

An example of the narrowness of this is simple. There are 35 states that allow dental hygienists to administer local anesthesia and 21 states they can administer nitrous oxide. DH's have been administering aneshesia for years and the idea was started much like the MN bill for the ADHP/OHP by the ADHA and the ADA suppoting the initiative. :cool:

As for the states that do not allow DH's to administer anesthesia. I can not speak to all of them but I know that one state board believes that DH's are not capable to handle the responsibility. What?:confused:

No matter what the outcome of the ADHP/OHP it's gonna happen sooner or later. The education (and I have not been able to find the proposed curriculum) will essentially comprise of two years of dental school course work/clinic time.

At least that is my understanding.
 
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rdhdds1

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How are ADHP's different from EFDA's?(Expanded function Dental Assistant)

I know they are using these in Pennsylvania as part of medicaid reform, but hadn't heard of ADHP

EFDA's are taking on more of the DH role by doing scaling above the gumline, coronal polishing and the like (depending on the state).

ADHP's would be writing scripts (in some states they already have limited ability), cut teeth for simple restorative procedures (eg 1,2,3 surface fillings), uncomplicated (simple) extractions and have the legal right to diagnose.

As a DH I am concerned at the lack of education that the EFDA's need in order to provide some fo the services that they do. I am in no way against the idea as long as they have the proper education and pass the appropiate tests/boards. I embrace and relish the opportunity to help them through the transition by being a mentor.
 

rewJW

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It is preventive not preventative. Preventative is a perversion of the word preventive.

Sorry, but I had to comment on this because I overheard a patient freak out at one of our hygienists for explaining preventative care. The patient corrected her, saying the word was indeed preventive and he wished people would stop screwing up the English language. However, preventative is indeed in the dictionary as an acceptable variation of preventive, not just in dictionaries such as Merriam-Webster, but also in the OED.
 

rdhdds1

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Sorry, but I had to comment on this because I overheard a patient freak out at one of our hygienists for explaining preventative care. The patient corrected her, saying the word was indeed preventive and he wished people would stop screwing up the English language. However, preventative is indeed in the dictionary as an acceptable variation of preventive, not just in dictionaries such as Merriam-Webster, but also in the OED.

Agreed. However, here ya go:

Preventative
Pre*vent"a*tive\, n. That which prevents; -- incorrectly used instead of preventive.



Webster's Revised Unabridged Dictionary, © 1996, 1998 MICRA, Inc
 

cobalt31

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Agreed. However, here ya go:

Preventative
Pre*vent"a*tive\, n. That which prevents; -- incorrectly used instead of preventive.



Webster's Revised Unabridged Dictionary, © 1996, 1998 MICRA, Inc

interesting! i did not know this! good to know.

also, if you type in "preventative medicine" into wikipedia, you will be redirected to the article on "preventive medicine" :cool:
 

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I agree, with proper training an ADHP could be as good as a dentist. That training modality already exists, and it's called dental school.

The potential ADHP curricula have already been published. The proposed curriculum is 37 credits, many of which are not clinically or pre-clinically related. This is only slightly more than the number of credits in a single quarter of dental school.

Not to mention that despite dental students "spreading themselves out" over several disciplines, there isn't a single one which doesn't affect the other. Everytime I learn something in Endo, it affects the way I do operative. Things I learned in dental anatomy and fixed prosthodontics affect the way I do extractions. Detailed knowledge of occlusion affects every single aspect of what I do clinically.

Just for fun, in the most recent JADA a study was published comparing chart notes between alaskan dentists and dental therapists (similar to ADHP). The dental therapists were much more likely to diagnose disease and perform procedures with clinically inadequete radiographs and had a 4x as many post-operative complications (that they recorded in the chart notes). Take it for what you will.

Which article are you referring to?

Bolin, K.A. (2008). Assessment of treatment provided by dental health aide therapists in Alaska: A pilot study. J Am Dent Assoc. 139(11), 1530-1539.

This article stated that the adequacy of radiographs was higher among patients treated by dentists than among those treated by dental health therapists. However the author concluded that there was no significant evidence to indicate that irreversible dental treatment provided by dental health therapists differs from similar treatment provided by dentists. This was just a pilot study and was performed by auditing dental records, so further studies are needed to determine the long term effects of irreversible procedures performed by nondentists (dental health therapists in this case).
 

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It is preventive not preventative. Preventative is a perversion of the word preventive.

Secondly, the same can be said of dentists who attempt to complete prophys, SRP's and debridements without the aid of a DH. :( The thoroughness is a apprehensable. I have seen dentists do prophy's in 20 minutes and SRP's in 30 for 2 quads. And they have been trained for 4 years.:eek:


But alas you have stated/imposed your own opinions and views. I am not condemning you because it is hard not to voice ones opinion/view on this matter.

Finally, I see both sides of the coin. I am for and against the ADHP/OHP. As a DH myself I can see the benefits of the concept and embrace the possibilities of DH's being a more integral part of the treatment of patients no matter where they might be.

Please do not get the OP wrong and please do not take everything to heart. Just as there are dentists who oppose the idea there are those dentist that support it. Case in point. The bill in MN that passed would not have been passed if dentists were not behind it. This is undebateable since DH's are governed and regulated by state boards (yes) but ultimately dentists.

An example of the narrowness of this is simple. There are 35 states that allow dental hygienists to administer local anesthesia and 21 states they can administer nitrous oxide. DH's have been administering aneshesia for years and the idea was started much like the MN bill for the ADHP/OHP by the ADHA and the ADA suppoting the initiative. :cool:

As for the states that do not allow DH's to administer anesthesia. I can not speak to all of them but I know that one state board believes that DH's are not capable to handle the responsibility. What?:confused:

No matter what the outcome of the ADHP/OHP it's gonna happen sooner or later. The education (and I have not been able to find the proposed curriculum) will essentially comprise of two years of dental school course work/clinic time.

At least that is my understanding.


Thanks for the clarification on preventive vs preventative. I had thought that these two were interchangeable, but obviously, I was mistaken.


I certainly respect your point of view - ultimately at the end of the day, we're all here because we have a vested interest in promoting and improving human (oral) health. And just as I can understand the rationale and utility for creating the ADHP/OHP position, I would think that you'd find it understandable why so many dentists and dental students are taking such a defensive and skeptical stance on this issue. The fact of the matter is that most people don't like change, especially if the change creates more problems in the end. Frankly, I've never been afraid of change, but you could argue that I also wouldn't know otherwise (as far as dentistry is concerned) since I haven't even gone through dental school yet. Agreed. I am, however, about to commit to investing significant time, effort, and money into a dental education, so obviously I'm going to be naturally biased against anything that might potentially contribute to making me regret my decision (just look at the recent article on cnn.com about family practice phyisicans).

That said, though, I'm all for change in dentistry if it means that it'll allow more people to get proper oral care - I'm sure that there are thousands of other stories in the U.S. each year like that of the Maryland child who died, and it's heartbreaking to know that in a country like this one, there are still millions of people who don't get adequate medical care. But with the creation of new mid-level position such as this one, I think most dentists and dental students are just apprehensive about the potential for issues and complexities that arise as a result when there are alternatives to the access-to-care issue (like increased Medicaid reimbursement for dentists) that are much less "disruptive" to all groups involved. And I'm personally still going to be skeptical about the training that ADHPs receive, despite all of the published studies that have shown the comparability of care provided between dentists and other mid-level providers, since as amorshell stated previously, "That training modality already exists, and it's called dental school..." And just as you've stated, after 4 years of intense comprehensive training, there are many dentists who still exhibit inadequacies. As jay47 implied, many people seem to underestimate the complexities of what seem to be very straightforward procedures. Hell, when I shadowed my endodontist, he made an apicoectomy look like it was hardly anything at all (I know this is irrelevant to the ADHP issue)...

rdhdds1 - Any thoughts about the Medicaid reimbursement questions I asked in the bottom of my previous post (Post #5)?

Here's a pdf that details competencies for the ADHP (scroll to page 20 for more detailed coursework info). I personally haven't had a chance to read/review this, so I'll leave it all of you to debate how "comprehensive" the curriculum is:

View attachment competencies.pdf
 
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armorshell

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Which article are you referring to?

Bolin, K.A. (2008). Assessment of treatment provided by dental health aide therapists in Alaska: A pilot study. J Am Dent Assoc. 139(11), 1530-1539.

This article stated that the adequacy of radiographs was higher among patients treated by dentists than among those treated by dental health therapists. However the author concluded that there was no significant evidence to indicate that irreversible dental treatment provided by dental health therapists differs from similar treatment provided by dentists. This was just a pilot study and was performed by auditing dental records, so further studies are needed to determine the long term effects of irreversible procedures performed by nondentists (dental health therapists in this case).

Given the small sample size, the 4 fold difference I mentioned before wasn't statistically significant using the statistical analysis the author did, but also note that there was no randomization used, and the conclusions the author draws from the research are invalid given the dynamics and scope of the study.
 

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Or you could hire them to work under you and increase your payroll....

just sayin
 

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Interesting read, as a pre-dent, I'm not too experienced to know if it's for better or worse
 

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Here's a pdf that details competencies for the ADHP (scroll to page 20 for more detailed coursework info). I personally haven't had a chance to read/review this, so I'll leave it all of you to debate how "comprehensive" the curriculum is:

View attachment 11366


So I just briefly skimmed through the ADHP coursework that is detailed in this PDF, and before I give my (inexperienced) opinion, I'm wondering if there are any dental students or currently practicing dentists who would be willing to give their take on this curriculum?

It looks like only 16 credit hours of the 37 total are clinically-based, and only 1 credit is dedicated to "Managing Dental Emergencies and Urgent Care"...
 
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Or you could hire them to work under you and increase your payroll....

just sayin


True, but if you were an ADHP and the law stated that you could practice independently, how long do you think you would want to work under the wing of a dentist? Isn't professional autonomy a big reason that many people cite for wanting to go into dentistry?

I'm sure many ADHPs starting off will want to work under an established dentist to learn how to run a dental office and gain more clinical experience, but eventually they'll want to run their own show (does this sound similar to say... ahem ahem... associates?).
 

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Interesting read, as a pre-dent, I'm not too experienced to know if it's for better or worse


I agree, and I'm in the same boat as you are (obviously leaning towards "for worse"), but regardless pre-dents still need to be INFORMED about this and other trends in their chosen profession.

To put it bluntly, I think many of us are being way too apathetic about issues like this saying "oh it won't really affect me for another 20 years when I'll be near the end of my career", and I don't think that's the right attitude at all...
 

achilles2

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True, but if you were an ADHP and the law stated that you could practice independently, how long do you think you would want to work under the wing of a dentist? Isn't professional autonomy a big reason that many people cite for wanting to go into dentistry?

I'm sure many ADHPs starting off will want to work under an established dentist to learn how to run a dental office and gain more clinical experience, but eventually they'll want to run their own show (does this sound similar to say... ahem ahem... associates?).

The professional world lives and dies off of referrals and the cost to startup an independent practice is daunting.....if a person without a Dr. in front of their name can overcome both of these, then well hot dog I'll be impressed.

Anyway the future of dentistry is not independent solo practice if you still think this your playing in the stone age and will be extinct in no time. Unless your so well nitched into a specific area that you can get unlimited referrals for complex cases.

Anyway the future of dentistry is one building with everything in house (specialists, lab tech, etc)
 

rdhdds1

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Thanks for the clarification on preventive vs preventative. I had thought that these two were interchangeable, but obviously, I was mistaken.


I certainly respect your point of view - ultimately at the end of the day, we're all here because we have a vested interest in promoting and improving human (oral) health. And just as I can understand the rationale and utility for creating the ADHP/OHP position, I would think that you'd find it understandable why so many dentists and dental students are taking such a defensive and skeptical stance on this issue. The fact of the matter is that most people don't like change, especially if the change creates more problems in the end. Frankly, I've never been afraid of change, but you could argue that I also wouldn't know otherwise (as far as dentistry is concerned) since I haven't even gone through dental school yet. Agreed. I am, however, about to commit to investing significant time, effort, and money into a dental education, so obviously I'm going to be naturally biased against anything that might potentially contribute to making me regret my decision (just look at the recent article on cnn.com about family practice phyisicans).

That said, though, I'm all for change in dentistry if it means that it'll allow more people to get proper oral care - I'm sure that there are thousands of other stories in the U.S. each year like that of the Maryland child who died, and it's heartbreaking to know that in a country like this one, there are still millions of people who don't get adequate medical care. But with the creation of new mid-level position such as this one, I think most dentists and dental students are just apprehensive about the potential for issues and complexities that arise as a result when there are alternatives to the access-to-care issue (like increased Medicaid reimbursement for dentists) that are much less "disruptive" to all groups involved. And I'm personally still going to be skeptical about the training that ADHPs receive, despite all of the published studies that have shown the comparability of care provided between dentists and other mid-level providers, since as amorshell stated previously, "That training modality already exists, and it's called dental school..." And just as you've stated, after 4 years of intense comprehensive training, there are many dentists who still exhibit inadequacies. As jay47 implied, many people seem to underestimate the complexities of what seem to be very straightforward procedures. Hell, when I shadowed my endodontist, he made an apicoectomy look like it was hardly anything at all (I know this is irrelevant to the ADHP issue)...

rdhdds1 - Any thoughts about the Medicaid reimbursement questions I asked in the bottom of my previous post (Post #5)?

Here's a pdf that details competencies for the ADHP (scroll to page 20 for more detailed coursework info). I personally haven't had a chance to read/review this, so I'll leave it all of you to debate how "comprehensive" the curriculum is:

View attachment 11366

The italics: I do understand and accept the apprehension amongst the dental community with regard to the ADHP/OPH. Any new creation, without a proven track record, is going to be suspect. But with respect to all those who are fighting tooth and nail against something that has already passed in MN (and will be coming to a state near you) give the new creation a fricken chance. Just liek the medical community did with the NP/PA's and look how well it worked for them.

I know that someone will cite the example from above about lavage and the girls ear. *****s and incompetent providers live amongst all of us, in all professions. Hell I have seen dentsits who have been practicing for 20+ years miss an interproximal carious lesion (cavity between the teeth).
Now, I am not saying that he/she was incompetent just stating case in point.

The potential of anything happening is always going to be there. Even when I give local to a patient prior to SRP and/or a restorative procedure (for the doctor) there is potential for harm. The pt could have an unexpected reaction, hyperventilate due to anxiety and the list can go on. Does this mean that I am putting the patient at more of a risk than the dentist? I think not. Agreed, that teh potentisl will always be there for any practitioner of any profession regardless of the "level" of teh individual. The best and most that we (society) can hope for is that the providers, whoever they are, receive adequate and sufficient education and training for that given profession and are competent and caring enough to do no harm.

As for the competencies.

The competencies as listed in the DHA report were incomclusive in my opinion. So I have requested a proposed curriculum work sheet from the ADHA that was available to hygienists a year or so ago and if/when I receive it I shall post it.

With regard to the medicaid reimbursement. Where exaclty is the money going to come from? Expect your taxes to go up! Besides there is so much red tape to get anything done it might happen in the next decade. I do, however, believe that an increase is in order only in hopes of attracting more providers. The majority of providers that do not accept public assistance patients cite the lack of reimbursement (lack of money made).

Here is my opinion. One should accept public assitance patients only if they are willing to provide a much needed service to those in need with no regard to how much money they make. My esperience with PAP's is that they are low income (which means they can not/reffuse to make up the difference to the doctor for the difference being charged and reimbursed), uncommited to treatment, typically only come in for immediate pain/procedures and never return for follow-up care and one could cite a list a mile long.

A better solution would be to open more outreach clinics that do a sliding scale and have dentists volunteer their time. They wold not have to be worried about reimbursement (how much am I gonna make) and they can truly give of themselves to those that need it the most.
 
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Didactic Courses (21 credits)
Theoretical Foundations of Advanced Dental Hygiene Practice (3)
Translational Research (3)
Healthcare Policy, Systems and Financing for Advanced Practice Roles (3)
Management of Oral Healthcare Delivery (3)
Cultural Issues in Health and Illness (3)
Advanced Health Assessment and Diagnostic Reasoning (3)
Pharmacological Principles of Clinical Therapeutics (3)

Advanced Practice Clinical Courses (16 credits)
Community-based Primary Oral Healthcare I-IV (12)
Management of Dental Emergencies and Urgent Care (1)
Capstone Community Practice (3)



Dentist

Freshman Year
Courses Credit Hours
Behavioral Sciences......................................4
Biochemistry.................................................8
CPR...............................................................1
Community and Preventive Dentistry...........4
Dental Anatomy............................................9
Dental Materials..........................................10
General/Head & Neck Anatomy.................23
Histology and Embryology.........................16
Physiology....................................................9
Nutrition........................................................2
Occlusion......................................................5
Periodontology............................................ 2
Introduction to Computing.......................... 1
Diagnosis/ Radiology....................................3
97

Sophomore Year
Courses Credit Hours
Diagnosis and Radiology..............................4
Endodontics...................................................7
Fixed Prosthodontics...................................15
Infection Control...........................................1
Operative Dentistry.....................................17
Oral Hygiene.................................................1
Pain Control..................................................3
Pathology....................................................17
Pedodontics-Orthodontics.............................7
Periodontology..............................................4
Microbiology...............................................10
Removable Prosthodontics....................... 14
100

Junior Year
Courses Credit Hours
CPR...............................................................1
Community and Preventive Dentistry...........3
Diagnosis and Radiology..............................8
Endodontics...................................................6
Fixed Prosthodontics...................................11
Operative Dentistry.....................................15
Medically Compromised Patient...................2
Oral Surgery..................................................5
Clinic Activity.............................................16
Pedodontics-Orthodontics...........................15
Periodontology..............................................9
Pharmacology...............................................8
Practice Management....................................2
Removable Prosthodontics..........................10
Research Methods.........................................2
TMD Disorders.............................................2
Patient/Cultural Sensitivity...........................2
117

Senior Year
Courses Credit Hours
Behavioral Sciences/Ethics...........................4
Community and Preventive Dentistry...........1
Diagnosis and Radiology..............................6
Endodontics...................................................6
Fixed Prosthodontics.....................................8
Implantology.................................................3
Operative Dentistry.....................................12
Oral Surgery..................................................6
Clinic Activity.............................................16
Pharmacology...............................................1
Pedodontics-Orthodontics...........................11
Periodontology..............................................7
Practice Management....................................5
Removable Prosthodontics.......................... 7
Oral Pathology..............................................2
Esthetic Dentistry..........................................3
98

I'd sure as hell never let an ADHP do work on me.
 

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I am an underprivileged person and receive free government health care. I go to a free clinic for underprivileged people. There, the physician assistant is my doctor, we all call her doctor even though she is not an MD.
I live in FL and went to Univ. of South FL for my undergrad. I have gone many times to the clinic for routine and non-routine health care. I have never once seen the Doctor that is in charge of overseeing the PA.


I don't know if all this is a good or bad thing. What I do know is that I had my ear drum perforated and when this happens, I cannot undergo ear lavage (they put a liquid to remove ear wax so that the PA can see my ear clearly with the otoscope). What I do know is that I warned the PA that I cannot undergo ear lavage bec/ I had a perforated ear drum and that I saw online that it would burn me. She told me to trust her and do it anyway. I did (and now I regret it). It burned me so badly:(. Anyway, She said sorry and that she didn't know. I then consulted the free ENT at my university and he said it's protocol not to do ear lavages in patients with perforated ear drums.

All in all, I am thankful for being able to receive free medical care even though it might or might not be the same quality as a MD would give me. I don't want to seem ungrateful or complain, I am just giving a testimony of what happened to me, just giving the facts. I just thought I could give my personal experience. Obviously, there were bad times and good times but no matter what, I am extremely grateful of receiving valuable health care. When I become a dentist, I will also help out communities that are in need just like I received help :D
(sorry for the long post, :D hehehe)

GO BULLS!!!!:thumbup:
 

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i have a few thoughts, but no i am not in dental school yet.

the link says that this will be about a 2 year program and compares them to nurse practitioner's....my problem with this is that a nurse practitioner has gone though 4 years of nursing school and then 2 years of additional training.... this equals at least 6 years of medical training while this ADHP is only DH + 2 years...does not sound too good to me... or comparative to NP.

so as to someone trying to get into dental school, why would I want to have gone though a very hard undergrad, studied my butt off for the DAT, and go though 4 years of insanly difficult and expensive dental school, come out several hundred thousand dollars in debt; just to have someone do 2 years of clinical training and be able to perform many of the same procedures...?

the link says that ADHP's will have "a primary focus on the underserved, referring more serious needs to dentists". How long do you think it will be before that the 'primary focus' will be expanded slowly into more and more areas overlapping what a dentisit does?

look what has happened to Anesthesiologists (MD's) with the introduction of Nurse Anesthetist (CRNA) . Orininally, CRNA's were only supposed to practice under the supervision of MD's. Now, they can practice independently. there are places where CRNA's have practically taken over and there are almost no Anesthesiologists. So basically, hospitals, insurance's.ect... would rather pay a CRNA 150K per year than pay an Anesthesiologist $300K per year. But is that best for the patient?

At least these Nurse Practioners and CRNA's have 4 years of medical/clinical training and then an additional 2 years of specialized training....from what I read in the word doc link, ADHP's do not have 4 years of medical/clinical training, just DH training....which is great for what they do, but I have had many DH's tell me that they have no idea what goes on back there (in the procedure rooms).

Anyway, I dont mean to keep going on as Im sure everyone can tell my opinion on it, but years down the road I think people will look back and remember how great it used to be a dentist and how it was worth all the sacrifice it took to get there.... just like MD's remember how great it used to be a physician
 
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