Dental Hygiene Practitioners

[Dr.SpongeBobDDS]

---

Members don't see this ad.

Thought maybe I'd see how everybody feels about this:

"Following an almost unanimous vote, the ADHA House of Delegates
officially adopted resolutions to create an "advanced dental hygiene
practitioner" position, an ADHA-developed educational curriculum for
this position and an official definition of this position to be added to
ADHA's policy manual.

"The dental hygiene profession, on the frontline of defense
against oral disease, is uniquely qualified and positioned to meet the
oral health needs of the un-served. ADHA is taking the lead in answering
this considerable need by creating the advanced dental hygiene
practitioner who will provide diagnostic, preventive, restorative and
therapeutic services directly to the public," said Helena Gallant Tripp,
RDH, ADHA president.

more info here

Basically, a license to practice dentistry without messing with that whole pesky dental school business. Whaddya think, good idea?

 

[texas_dds]

restorative???

arent they part of the ADA? our national boards are administered by the same people...
i cant believe i haven't heard about this already! thanks for the heads up

 

[powermd]

I'm not sure what they mean by "restorative" but I've always wondered what legitimate argument could be made for DHs not being able to open their own offices to offer cleanings. There's no good reason why a DH should get paid $25/hour when the dentist bills $75 for his or her work. It's not like doing a dental cleaning is a such a risky activity that it demands immediately available backup from a DDS. I wouldn't be in favor of DHs taking over the work of dentists- if you want to be a dentist, go to dental school. I do, however, support the right for DHs to practice their work independently (as they do in CA).

 

[toothcaries]

my guess is the arguement for restricting dental hygienists is similar to the arguements MDs use to restrict the practice of cRNAs..


part of it is $$$$
...and part of it IS protecting the patient.
😉

jmho

 

[Dr.SpongeBobDDS]

I'm not sure what they mean by "restorative" but I've always wondered what legitimate argument could be made for DHs not being able to open their own offices to offer cleanings. There's no good reason why a DH should get paid $25/hour when the dentist bills $75 for his or her work. It's not like doing a dental cleaning is a such a risky activity that it demands immediately available backup from a DDS. I wouldn't be in favor of DHs taking over the work of dentists- if you want to be a dentist, go to dental school. I do, however, support the right for DHs to practice their work independently (as they do in CA).

__________________



For the same reason that nurses can't operate independently to give check-ups and physicals. A two year junior college degree does not provide the education necessary for appropriate diagnosis and patient counseling. Though it generally takes the most time, the "cleaning" is really not the important part of the visit.

BTW, the going rate in most parts of the country for an experienced hygienist is ~$35-40/hr. Add in the taxes the employer has to pay, benefits and unemployment insurance and you are easily looking at a cost of $50+/hour to the dentist. The ADA estimates a cost of ~$10 for sterilization and disinfection for each patient. THen you have equipment, supplies, radiographs, rent - easily another $15-20+/patient. The average hygienist only sees about 8 pts/day.

As you can see, many dentists actually LOSE money on their hygiene departments. Many dentists long for independent hygiene laws in their states so they can get rid of their "pumice queens". The truth is that even when these laws exist most hygienists will choose NOT to open up independently. The cold, hard economic facts are that hygiene is not a financially self-sustaining profession unless they are pumping the patients through like cattle through a chute - which defeats the entire purpose of a thorough cleaning by the hygienist anyway.

 

[toothcaries]

interesting article considering that there is a severe shortage of dental hygienists in many parts of the country...
i'm starting to think that maybe dental hygiene preceptorship programs would be a good solution...

i mean....if this is all about meeting unmet patient oral health needs.....
🙄

 

[Dr.SpongeBobDDS]

I think it's often hard for people to understand how incredibly expensive it is to run a dental office. For example, when a patient has a procedure done in the hospital, the patient receives a bill from the doctor performing the procedure, a bill from the anesthesiologist, and another one from the hospital for the cost of the room, equipment and support staff. The dentist assumes all these roles along with the cost and liability of each; the patient sees the bill and assumes the dentist is taking it all home and buying himself a new bimmer. "Geez, this guy is ripping me off."

Sadly, it doesn't work that way.

 

[Dr.SpongeBobDDS]

interesting article considering that there is a severe shortage of dental hygienists in many parts of the country...
i'm starting to think that maybe dental hygiene preceptorship programs would be a good solution...

i mean....if this is all about meeting unmet patient oral health needs.....
🙄

I'm with you there, brother.

 

[ItsGavinC]

I have no problems with this proposal. The key lies in this statement: "State practice act changes that would permit, for example, alternative models of delivery of needed care for underserved populations, such as low-income children or institutionalized persons, would allow a more flexible and efficient workforce"

I had an in depth discussion with the president of the Arizona Dental Association about this topic, and this class of hygienists would merely be taking health care to the populations that 99% of us won't/can't/don't care to reach.

In the vein it is currently in, it wouldn't affect incomes or practices of dentists. What DOES worry me, however, is that the new hygiene laws could easily be manipulated in the future to infract upon current dental practices.

 

[c132]

The dental hygiene profession is a great tool for the dentist, but should NOT go beyond that. I don't think the ADA will let this go through, or if they do, they will not be able to do much, and people will not want to waste their time with them!

 

[no2thdk999]

I have no problems with this proposal. The key lies in this statement: "State practice act changes that would permit, for example, alternative models of delivery of needed care for underserved populations, such as low-income children or institutionalized persons, would allow a more flexible and efficient workforce"

I had an in depth discussion with the president of the Arizona Dental Association about this topic, and this class of hygienists would merely be taking health care to the populations that 99% of us won't/can't/don't care to reach.

In the vein it is currently in, it wouldn't affect incomes or practices of dentists. What DOES worry me, however, is that the new hygiene laws could easily be manipulated in the future to infract upon current dental practices.

Are hygienists really going to want to practice in places where dentists don't want to? Most places are underserved because either nobody wants to live there or the local population doesn't value oral health at a level that could support a dentist. I know an RDH can usually command a pretty penny and cushy hours. Will an appreciable number of new grads want to give that up for the isolation and risk of a solo practice in an underserved area? Will they want still want to after 2-3 years?

JMHO
Rob

 

[DrJeff]

__________________





BTW, the going rate in most parts of the country for an experienced hygienist is ~$35-40/hr. Add in the taxes the employer has to pay, benefits and unemployment insurance and you are easily looking at a cost of $50+/hour to the dentist. The ADA estimates a cost of ~$10 for sterilization and disinfection for each patient. THen you have equipment, supplies, radiographs, rent - easily another $15-20+/patient. The average hygienist only sees about 8 pts/day.

As you can see, many dentists actually LOSE money on their hygiene departments. Many dentists long for independent hygiene laws in their states so they can get rid of their "pumice queens". The truth is that even when these laws exist most hygienists will choose NOT to open up independently. The cold, hard economic facts are that hygiene is not a financially self-sustaining profession unless they are pumping the patients through like cattle through a chute - which defeats the entire purpose of a thorough cleaning by the hygienist anyway.

I beg to differ with the statement that many dentists loose money on their hygenists. on the contrary, if you as a dentist is loosing money of your hygiene department, a couple of things must be seriously wrong. Either your fees are way to low, your front desk is awfull at keeping your hygenists schedule full, or your front desk is horrible at collections 😱

The "loose" rule of thumb about hygiene salary/total compensation is that its 1/3 to 1/2 of their average hourly production. When you then factor in the overhead expenses, your still bring home plenty of extra $$ Then, also remember that all those extra patients that your hygensist see every day that you'd not be able to see on your own are being "screened" for future work that will soon be in your schedule 😀 Alos, remember that for most associateship buy-ins are done using deferred hygiene profit income from you as the buy-in doc to the senior partner(s).

I'll also add that in my office that our hygiene team adds well into the 6 figures to the office profit for my partner and I each year

 

[groundhog]

While most RDH's likley support the resolution in principle, I doubt that many would opt to rush out and open their own practices. Any RDH is already a very competitive potential dental school applicant. Yet, very few choose to acquire the additional academic prereqs that they would need in order to qualify for admittance to dental school. Why? I think that most actually prefer not to take on the added responsibilites that go along with owning and/or managing a private practice and consequently choose dental hygiene rather than dentsitry as a career. In fact, getting accepted to dental hygiene school can be more competitive than getting accepted to dental school (especially for women) in some parts of the USA.

So, I surmise that there are a few true believers in the RDH ranks who really feel a need to be freed in order to treat the underserved. Maybe there are even some with a keen business sense who have noticed the referral kickbacks that flow from the specialists to the GP's and see a new cash flow opportunity for RDH's in private practice. I bet most, however, prefer the status quo.

 

[lnn2]

Thought maybe I'd see how everybody feels about this:

"Following an almost unanimous vote, the ADHA House of Delegates
officially adopted resolutions to create an "advanced dental hygiene
practitioner" position, an ADHA-developed educational curriculum for
this position and an official definition of this position to be added to
ADHA's policy manual.

"The dental hygiene profession, on the frontline of defense
against oral disease, is uniquely qualified and positioned to meet the
oral health needs of the un-served. ADHA is taking the lead in answering
this considerable need by creating the advanced dental hygiene
practitioner who will provide diagnostic, preventive, restorative and
therapeutic services directly to the public," said Helena Gallant Tripp,
RDH, ADHA president.

more info here

Basically, a license to practice dentistry without messing with that whole pesky dental school business. Whaddya think, good idea?

Man, this idea stinks! This whole proposal is b.s. If it happens then I would get my plastic surgery done by a nurse; it'll be cheaper!
If "the dh profession is on the frontline of defense against oral disease" then where do dentists stand? sideline? Throwing in "to meet the oral health needs of the un-served" makes it seem very noble but I still call b.s. A dh class size is about 1/3 to <1/2 comparing to a dental class. If we're having problems meeting the oral health needs of the unserved by dentists then how r they going to do that w. dh? I used to volunteer at a free dental clinic and mission trips, most of the volunteers were dentists, 99%. I only saw a few dh. How many of them actually taking a paycut from $60-80$K/yr to do that?

If they want to do diagnostic and restorative, fine. Change the cirriculum, add pre-clinic into didactic, add on another 2yrs of patient care, increase tuition to >$50K/yr, pass national dental boards I &II, take Western/NERB board, (oh, wait, I think that it's called Dental School 😀 )then they can diagnose and restore all they want.

"advanced dental hygiene practitioner" how advanced can it be? another 6months on top of those 2 yrs? A few months of practicing drilling? nuts!
Also most of DH do not have an undergrad degree. Most come right out of High School 😱 Ms. Tripp is tripping 😀 I wonder what she meant by "therapeutic services" ? sounds very kinky 😀

On a postive note, I think dh should be able to open their own practice for ONLY cleanings if they choose to do so. They're entitled to do it. How can they afford to open/run it is another story. If I'm not mistaken, dh are not allowed to administer anesthetic. How can they do Scaling/RP? They'll have to change that too.

 

[lnn2]

In fact, getting accepted to dental hygiene school can be more competitive than getting accepted to dental school (especially for women) in some parts of the USA.

Please tell me that you're just messing w. my head 😕

 

[groundhog]

Inn2,
Not messing with your head. In some regions, getting into a community college based DH school is a highly political as well as academic game. University based DH programs are more above board and transparent in their admittance process. However, university based programs do not exist in all regions and they tend to be state schools which must offer acceptance priority to state residents.

 

[toothcaries]

preceptorship .
perceived problem solved.

Inn2,
Not messing with your head. In some regions, getting into a community college based DH school is a highly political as well as academic game. University based DH programs are more above board and transparent in their admittance process. However, university based programs do not exist in all regions and they tend to be state schools which must offer acceptance priority to state residents.

 

[eric275]

Also most DH do not have an undergrad degree. Most come right out of High School 😱

In Oregon all DH schools have pre-req's ( Chemistry, Biology, Anantomy and Phys, etc.)

If I'm not mistaken, dh are not allowed to administer anesthetic. How can they do Scaling/RP? They'll have to change that too.

In Oregon, DH's are anesthesia certified. I thought that they were in all states, but apparently by your statement I guess not. Just sharing info.

My wife is DH and has no desire for the kind of stuff that Ms. Tripp is talking about. She is more than happy to work her 3 days a week making $31/hr with bonuses of $700-800 a month and no responsibility at the end of the day. Also so who's to say that the DH's are going to rush to underserved areas once they get thier ticket punched? Their going to be opening up shop in the most client rich environments to make the most money possbile. Not that there's anything wrong with that, but come out and say it. They are only trying to mask their motives and say that they are doing it for "humanitarian" reasons so that they can get this BS passed just like the nurses have done. "We only want to help the underserved" give me break. If you want the ability to perform more procedures than your job entails, go to dental school and quit complaining about it. Otherwise pick teeth and be quite!

 

[groundhog]

Eric275's reference to his RDH spouse is only anecdotal, but does confirm my belief that few RDH's have a burning ambition to work independently of a dental practice. The RDH's that I have met (all women) tend to be pretty sharp and have exceptional work ethics. I'm confident a majority of them would have proven to be successful dental school applicants if they had actually desired to choose DDS/DMD rather than RDH as a career path.

 

[ItsGavinC]

From the Academy of General Dentistry (http://www.agd.org/GP_Update/july04/practitioner.html). Underline added for emphasis.

-----------------------------
AGD responds to ADHA resolution to create an "advanced dental hygiene practitioner"

On July 8, the American Dental Hygiene Association posted a news release announcing that the 2004 ADHA House of Delegates had officially adopted resolutions to create an "advanced dental hygiene practitioner" position, an associated ADHA-developed educational curriculum, and an official definition of this position.

According to the news release, the basis for these actions included "the critical shortage of licensed dentists" and the call for increased access to oral health care in the 2000 Surgeon General's Report on Oral Health.

In the press release, ADHA President, Helena Gallant Tripp, RDH, said that the advanced dental hygiene practitioner would provide "diagnostic, preventive, restorative and therapeutic services directly to the public."

Ms. Tripp also said, "It is ADHA's objective to answer the unmet oral health needs of the public by providing cost-effective, easily accessible primary care through the advanced dental hygiene practitioner, which is similar to the public health need that fueled the development of a nurse practitioner position." The AGD Executive Committee questions the assumptions behind the ADHA actions and whether they are compatible with optimal oral health in the American public. Consequently, they have charged the AGD Councils on Dental Care and Legislation and Governmental Affairs with developing appropriate position papers and an action plan on this issue at their October meetings.

?We?re going to address this issue aggressively on behalf of the general dentists,? said AGD president Tom Howley, DDS, MAGD, ?because we have an obligation as general dentists to ensure the public has access to appropriate care. We are concerned about creating a two-tiered healthcare system."

Your comments on this issue are welcome and may be forwarded to these councils by e-mailing the AGD at [email protected]

 

[mike3kgt]

From the Academy of General Dentistry (http://www.agd.org/GP_Update/july04/practitioner.html). Underline added for emphasis.

-----------------------------
AGD responds to ADHA resolution to create an "advanced dental hygiene practitioner"

On July 8, the American Dental Hygiene Association posted a news release announcing that the 2004 ADHA House of Delegates had officially adopted resolutions to create an "advanced dental hygiene practitioner" position, an associated ADHA-developed educational curriculum, and an official definition of this position.

According to the news release, the basis for these actions included "the critical shortage of licensed dentists" and the call for increased access to oral health care in the 2000 Surgeon General's Report on Oral Health.

In the press release, ADHA President, Helena Gallant Tripp, RDH, said that the advanced dental hygiene practitioner would provide "diagnostic, preventive, restorative and therapeutic services directly to the public."

Ms. Tripp also said, "It is ADHA's objective to answer the unmet oral health needs of the public by providing cost-effective, easily accessible primary care through the advanced dental hygiene practitioner, which is similar to the public health need that fueled the development of a nurse practitioner position." The AGD Executive Committee questions the assumptions behind the ADHA actions and whether they are compatible with optimal oral health in the American public. Consequently, they have charged the AGD Councils on Dental Care and Legislation and Governmental Affairs with developing appropriate position papers and an action plan on this issue at their October meetings.

"We're going to address this issue aggressively on behalf of the general dentists," said AGD president Tom Howley, DDS, MAGD, "because we have an obligation as general dentists to ensure the public has access to appropriate care. We are concerned about creating a two-tiered healthcare system."

Your comments on this issue are welcome and may be forwarded to these councils by e-mailing the AGD at [email protected]

Good post! I sat back reading the original post from the ADHA and initially thinking... "well, that's kinda cool, we'll give more americans access to high quality dental care." Howerver, when rational thought actually crept in (it IS summer here, it's an excuse 😀) I knew that the topic may be cause for concern. The ADHA uses politically correct spin to put a positive feeling on this decision, however, one knows that if this were to come, we could very well have a flood of hygienists entering shopping malls around the country opening little boutique shops where they'd still charge $100 bucks per visit. Can you imagine a hygiene kiosk right next to one that has those annoying little cars?

I understand the hygiene groups out there want independence and the ability to give access to good dental care, but we must ask what's best for our patients! Most nurse practitioners work in the same offices under a physician. There is no doubt nurse practitioners are extremely qualified for the services they provide, but a majority of them have direct access to a physician in case a difficult case were to arise. Will this be true for hygiene practitioners?

 

[ItsGavinC]

The ADHA uses politically correct spin to put a positive feeling on this decision, however, one knows that if this were to come, we could very well have a flood of hygienists entering shopping malls around the country opening little boutique shops where they'd still charge $100 bucks per visit. Can you imagine a hygiene kiosk right next to one that has those annoying little cars?

Exactly. The "providing access to underserved populations" is a spin that everybody (dentists included) likes to use. Some would probably utilize their new degree for that, but the majority would probably be found making a quick buck and fighting over people who already have plenty of access to oral care but are just too lazy to do anything about it.

 

[Dr.SpongeBobDDS]

Exactly. I think it's pretty naive to assume that hygiene practitioners would be any more willing to work in underserved areas than dentists are.

And the whole comparison to nurse practitioners is a pretty poor analogy. Nurses serve a very similar role to that of doctors in providing health care. They are often the ones to carry out the doctor's orders. They have participated first hand in caring for nearly all aspects of patient care; experienced nurses are often a resource for new docs who may be a little unsure of what to do in a new situation.

Most hygienists, on the other hand, have no real clue what goes on outside their own chairs. They aren't involved in the restorative aspects of dentistry at all. I'm not saying that what hygienists do isn't important, but it is completely different from what the dentist does all day. It would actually make more sense to grant restorative privileges to assistants with significant training and experience than to hygienists.

Dental school is only four years; it makes no sense to risk creating a two-tiered level of care and exacerbating the hygiene shortage when there are already programs in place (dental schools) that provide more than enough graduates to meet the country's dental needs.

 

[ItsGavinC]

when there are already programs in place (dental schools) that provide more than enough graduates to meet the country's dental needs.

True. And, people really need to explain what the hell they are talking about when referring to our nation's dental needs. It is completely true that there are not nearly enough dentists to handle the needs of the nation's population. But it is also totally true that no matter how many dentists you throw out there, probably 30% of the country still isn't going to visit the dentist. So providing better access merely through upping numbers isn't the way to go. People reallly need to be educated, and once again, upping the numbers doesn't do that either.

I'm sure that it sure as hell makes beureaucrats feel better though.