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Expanded scope hygienists?

Discussion in 'Dental' started by Dr.Millisevert, Mar 2, 2007.

  1. Dr.Millisevert

    Dr.Millisevert Senior Member
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  3. Abakua

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    In my opinion this is a win win situation for dentists AS LONG as they have to practice in conjunction with dentists. What should never be permitted is for hygienes to establish their own prophy clinics or something of this nature.

    From a patient perspective, more services could be provided by relatively qualified personnel achieving our most important goal: To improve oral health.

    From a business perspective, we could see a higher volume of patients delegating this procedures to the hygienist as needed, charge regular fees for the procedure and pay the hygienist an hourly rate.

    Having said that, they hygienist that work at the clinic where Im working now really SUCKS, extremely poorly trained.

    What I dont agree with is for hygienist to give local anesthesia and much less to give NITROUS, are they crazy. True anyone could do it, the issue is to know how to handle the complications.
     
  4. Dr.Millisevert

    Dr.Millisevert Senior Member
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    What about hygeinists cutting class I cavities, or doing simple temp restorations?
     
  5. Dr.Millisevert

    Dr.Millisevert Senior Member
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    I agree.

    In some states though, can't some people who aren't dentists own practices now though?
     
  6. IndianaOD

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    Welcome to the pains suffered by optometry!:thumbdown:
     
  7. Lidopaine82

    Lidopaine82 Senior Member
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    This is all a bad idea. These hygienists and EFDAs will turn dentistry into what medicine is. We all need to pay our dues to ADA and hope they protect us.
     
  8. Dr.Millisevert

    Dr.Millisevert Senior Member
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    What do you mean?

    I know that a lot of optometrists want to do lasik surgery and the like, but... when you study "opto = eye metry=measurement". You're not really qualified to do surgery. If you knew you wanted to be able to do surgery why didn't you apply for med school and do an opthom residency?
     
  9. Dr.Millisevert

    Dr.Millisevert Senior Member
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    True.. again.. if you want to cut teeth, do perio surgery, or run a dental practice.. then apply to dental school.
     
  10. IndianaOD

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    I'm talking about other professional groups going after your bread and butter. IE our constant battle with opticians and ophthalmologists. Just be lucky dentristy only has one group to battle and not some MDs saying "if you want to do oral surgery go to med school"

    True but what would be wrong with a surgical model similar to dentistry? Couldn't ODs do surgical residencies just like some dentists choose to? Seems more efficient to learn about the eye from the get go. Yeah we take all the systemic physiology and pharmacology too. Hey we even dissected cadavers, woohoo.

    I'm not really getting the gist of the name breakdown. If it would make you happy a surgically trained Optometrist could have a different name. Does dentist mean "teeth" "surgeon"? Guess not.
     
  11. Jaybe

    Jaybe Lazy Tongs
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    Actually, I am quite sure that your average optometrist knows more about the eye than your average ophthamologist. At best, an ophthamologist may know AS MUCH as an optometrist. An optometrist knows infinitly more than a Medical graduate about the eye.

    Yes, you heard me correctly. I realize Ophthamologists do spend about 4 years in residency, learning about eyes. But in med school they probably only spend about 3 months.

    Optometrists spend four years learning the physics of optics and tons of stuff about general and ocular pathology.

    Sadly, due to turf wars, MDs have basically prempted surgical scope of practice in optometry.
     
  12. IndianaOD

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    My posts on the dental forum are to warn you to support the ADA and keep your profession strong. In the past organized dentristry has done an excellent job protecting the profession and your livelyhood. Much better than the AOA. In many states the Optometric scope of practice is pitiful compared to the amount of training ODs recieve. I just don't want dentristry going down the same road and battles that Optometry has. I have a lot of DDS friends from undergrad that I stay in frequent contact with.

    I just see expanding hygenists and commercial dentristy and red flags go off.
     
  13. gryffindor

    Dentist 10+ Year Member

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    What happens when that innocuous looking class I lesion is opened with a 169, you hit a huge pile of mushy dentin going straight to the pulp and now you need endo? Now this will get messy since it can be a live nerve, bleeding canals, you have to get the anesthesia out, etc. etc. So much for a tiny class I restoration you intended to fill with flowable.

    Same with the temp restorations. If the cavity was prepped by the dentist and temped on Tuesday and the temp falls out on Thursday, then sure the hygienist could replace it until the patient returns next week for the definitive restoration. But a lot of times when an amalgam or composite has fallen out, there is all kinds of recurrent decay and often even decay into the pulp, and there is the root canal again. Where do you draw the line?

    If they want to expand their scope, go to dental school.
     
  14. docj1

    docj1 Walleye Whacker
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    I agree with gryffindor. There are many times when you may think it will be a nice easy class I restoration and you find a "rotten avocado". If someone is going to cut into a tooth they better be prepared and trained to remove all pathology, this may include at minimum a pulpotomy. My view is if you couldn't extract or pulp it you probably shouldn't cut on it.

    Also, IndianaOD, DDS stands for doctor of dental surgery. Dentists are trained as soft and hard tissue dentoalveolar surgeons. OMFS are trained to perform surgery on the head and neck region as well as their training in dentoalveolar surgery. Some are even trained in plastics.

    Bottom line is if you want to do dentistry, be a dentist, if you want to practice dental hygeine, be a hygeinist, if you want to practice opthamology be an opthamologist
     
  15. docj1

    docj1 Walleye Whacker
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    Just as a side note. My brother is an optometrist and he has told me of the difficulties in the profession as far as which states allow you to treat certain conditions(ie Glaucoma etc).
     
  16. aphistis

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    Just reading this is giving me nightmare flashbacks to my NERB exam today.

    Just like gryffindor suggests here, I started out planning a simple class II amalgam that, according to 3 radiograph views, reached barely past the DEJ. Imagine my surprise, then, when I had to request permission from the examiners to deepen the prep in the direction of the pulp. Imagine my further surprise, and rather sudden distress, when my prep started bleeding from the middle.

    Now, you have a hygienist trying to manage a carious pulp exposure--is it OK for them to do that, too? If you think so, you're essentially saying that dentistry is a profession that can be competently practiced with an associate's degree education. Nobody should be performing any procedure who isn't trained to handle the complications that may arise from it. That means no operative hygienists.

    This is 100% on the money. I couldn't agree more.

    (Incidentally, after spending a few minutes talking to the examiners, I think I still passed the NERB today. :p I'll update on Monday when I find out for sure.)
     
  17. Dr.Millisevert

    Dr.Millisevert Senior Member
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    much agreed :thumbup:
     
  18. psiyung

    psiyung 1K Member
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    good luck, Bill
     
  19. Dr.Millisevert

    Dr.Millisevert Senior Member
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    Reviewing the document I posted.
    Which states do you think we should be worrying about here?
     
  20. Jaybe

    Jaybe Lazy Tongs
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    Guys, I really don't think this is too much to be alarmed about. As long as your Dental Board is handling it properly. Let me tell you about my state. The Hygienists and Assistants are only allowed to do Reversible Procedures, and only under the supervision of a dentist. They can't go start up their own practice and take your patients with them after doing the 6 weeks of CE.

    In my state, we are now doing expanded function assistants. These people have to do quite a bit of CE to get certified, and even then, we are not certifying them to make clinical judgements. We are NOT allowing tooth preparation!!! We DO allow local anesthesia to be given by Hygienists, but NOT assistants. This merely facilitates everything by preventing the dentist from having to walk in, say HI, wash, glove, inject, deglove, wash, and walk out.

    I see this as allowing the dentist to delegate more tasks, and thereby allowing the dentist to see more patients. I guess you could say giving anesthesia is an irreversible procedure, but dental hygienists are only allowed to do this under the direct supervision of a dentist. None of the tasks delegated to Assistants are irreversible. We let them place and carve amalgams, after the dentist preps it. We let them take Master Impressions. This is barely different than what we did before: we would let the assistant HOLD the master impression in place for five minutes while it sets, AFTER the dentist placed it in the mouth. This is really just to help dentists treat more patients by giving them the right to delegate a few additional, time consuming and reversible tasks.

    The only downside for dentists: It costs a couple of thousand dollars to get your Assistant trained, and afterwards the assistant will probably be able to command a higher wage. So the drawback is higher overhead.

    Don't get too bent out of shape on this. You'll be fine as long as your Dental Board is still requiring DA's and DH's to practice under the supervision of a licensed dentist.
     
  21. IndianaOD

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    So what's the difference between a DDS and a DMD?
     
  22. docj1

    docj1 Walleye Whacker
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    From what I know older dental schools typically are DDS programs. DMD=DDS
     
  23. docj1

    docj1 Walleye Whacker
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  24. aphistis

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    Ack, please please please check the FAQ.

    Cliff's Notes version: There's no difference whatsoever. The degrees are identical in every respect.
     
  25. Dr.Millisevert

    Dr.Millisevert Senior Member
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    What about dental therapists?

    http://dentaltherapists.ca/index.html

    http://dentaltherapists.ca/scope/#Anchor-Operative-11481

    Operative Dentistry
    Dental therapists are trained to restore teeth to proper form, function and esthetics, perform uncomplicated extractions, recognize and manage dental/medical emergencies, post-extraction complications, and provide local anesthetics to manage pain to restore and maintain the health of the dental patient.

    Restorative Dentistry

    restore teeth to proper form, function and esthetics
    select appropriate materials and techniques
    assess the need for, select and place appropriate space maintainers to reduce the impact of premature space loss
    take impressions and fabricate study models
    perform vital pulp therapy on primary teeth
    manage dental emergencies to alleviate pain
    Local Anesthesia

    select the appropriate agent and technique to achieve local anesthesia to manage pain and minimize patient anxiety
    prevent, anticipate, recognize and manage medical emergencies or complications related to the use of local anesthetics, should they occur
    Oral Surgery

    plan and perform extractions of primary teeth and uncomplicated extractions of permanent teeth
    place and remove sutures
    manage common intra-operative and post-extraction complications




    Dental Therapists are actively involved in the oral health of First Nations and Inuit Communities throughout Canada. We also work in private practice settings in the provinces of Manitoba and Saskatchewan. Many Dental Therapists maintain dental offices in schools, health centres and community health facilities. There are travelling dental therapists who service smaller and remote communities with limited access to dental services.
     
  26. InMyCrossHairs

    InMyCrossHairs #1 GUNNER
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  27. IndianaOD

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    I know they are identical, I was just giving the above poster grief since DMD does not have "surgery" in the name. Just pointing out that your title doesn't dictate your profession.
     
  28. aphistis

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    Nope. I told a CFE, who brought the chief examiner over. He asked me how I planned to manage the exposure (Dycal & Vitrebond), and then he cleared me to proceed. After I based the prep, they graded it like normal and I was allowed to place the permanent restoration.

    I know what you mean, though. There are a million things that can go wrong during a test like that, and any one of them can be enough to ruin your day.
     
  29. Jaybe

    Jaybe Lazy Tongs
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    Well, I don't really believe in the concept of "Dental Therapists". These individuals aren't qualified to operate independently of a dentist's direct supervision, in my opinion. I realize that Canada has made this legal (from reading your posted links) and I know there is some movement in this direction in Alaska (although I don't know where that stands currently).

    I am strongly committed to Access to Care, as long as that Care being Accessed is determined to be at the Standard of Care. I have also posted some comments on another thread opposing the notion that Pediatricians should be making dental judgments and conducting non-invasive dental care on patients. This is also a Standard of Care issue.

    However, I don't see a problem with expanded function Assistants or Hygienists as long as they aren't endosed to perform irreversible procedures or to operate outside the direct supervision of a licensed Dentist.
     
  30. johntara04

    johntara04 Member
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    That sucks. Sounds like you did great. I am sure you will pass. Good Luck.
     
  31. docj1

    docj1 Walleye Whacker
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    Definition of Dentistry
    Dentistry is defined as the evaluation, diagnosis, prevention and/or treatment (nonsurgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent and associated structures and their impact on the human body; provided by a dentist, within the scope of his/her education, training and experience, in accordance with the ethics of the profession and applicable law. (As adopted by the 1997 ADA House of Delegates)

    Therefore DMD does imply surgery by definition

    Sorry I tried to be more tactful with my post when I cited the website to show the definition of DDS/DMD. I could have just said they are the same Dumba$$ but that wouldn't have been nice.LOL
     
  32. RDHwife

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    I'm a hygienist and have absolutely no desire to prep teeth. I do however give ansethesia, and the Dr. loves it. While he's doing an exam, I'll run in and numb his patient so he can go right in and start working. Also...some states, such as Colorado, hygienists are able to open their own practices for prophy only. Again, I have no desire to do so and after talking to hygienists, many feel the same way. There's a reason why we stopped at hygiene school. Its way less stress.
     
  33. IndianaOD

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    Nevermind. I knew the whole time they were identical, and yes I know what a dentist does. The poster above said that optometrists shouldn't do surgery because the name means "to measure the eye". Thanks though, I don't think I'd be smart enough to look up the definition of a DMD or DDS. :rolleyes: 9 years of post high-school education and high honors just won't quite get me there.
     
  34. docj1

    docj1 Walleye Whacker
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    Sorry, I wasn't trying to aggrevate or demean you in any way. Like I said my brother is an optometrist and he is alot smarter than I am. I suspect he would make a great opthomologist if he decided to go to med school and do a residency.
     
  35. Dental Dork 09

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    From the link:

    "Hygienists continuously remark that they are highly educated in prophylaxis and that they spend more time in an educational curriculum that teaches those skills than even dental students. They are concerned that the quality of services provided by assistants trained by dentists..."

    Are they out of their minds?
     
  36. johntara04

    johntara04 Member
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    I think that is a true statement. What about it do you not agree with?
     
  37. Dental Dork 09

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    Because this "skill" that apparently I'm lacking because dental schools don't train me right can be taught in about 1 hour to a monkey

    Doing prophys is not hard at all and to use that as an arguement that you can do a restoration is mind blowing. They are trying to say they have such great training that it is only logical for them to procede to something a doctor is trained to do.

    Let them do a restoration, I'm fine with that. But don't try to do it by strectching the truth to con some lawmaker into making it happen
     
  38. OceanDMD

    OceanDMD Rather be fishing
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    DO you really think that you could perform a prophy or SRP the same speed and quality as a hygienist, say 2 years out? Repitition creates greater efficiency and increased quality (most of the time). Hygienists perform hundreds of more of these procedures than the dentists.
     
  39. Dental Dork 09

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    I guess us dentist are just stupid and also can't read.

    I'm not arguing that they aren't better. I'm saying they are trying to take one of the easiest procedures in our field and make it sound like only a few in the world can perform it, therefore that makes them qualified to do more advanced procedures.

    Listen, let them learn/train to do a restoration in school, but get rid of the AA program. Make it a manadtory BA/BS degree and I will not have an issue paying them $50 an hour and doing restorations. And also add a NERB/WREB style exam to the requirement to get a DH license
     
  40. S Files

    S Files Member
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    yes they perform prophy and SRP admirably. now, when they push their scope of practice into areas they're not trained appropriately, that's when problems start.
     
  41. OceanDMD

    OceanDMD Rather be fishing
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    Am I missing something here. Maybe my reading comprehension needs help and I am STUPID, but my take is this is about assistants performing hygiene duties like CORONAL POLISHING, not placing composites or prepping teeth.
     
  42. Dental Dork 09

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    Sorry I snapped man, just getting pissy that my part one score isn't in yet

    I took that from a greater section justifying why they are capable of placing a restoration.
     
  43. OceanDMD

    OceanDMD Rather be fishing
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    Im sure you did fine. As far as any type of justification of placing a restoration, they are probably capable, just like expanded duty assistants. I personally like to put myself in the patients shoes. If you are spending $600 on a quad of dentistry, and you see the dentist for 15 minutes( which is completely reasonable once you get your speed up to prep 3 teeth), and the hygienist or assistant steps in and spends 45 minutes restoring the teeth, how would you feel? Regardless of whether or not you can justify hygienists placing restorations, the dentist should prep and restore. Unless of course you live in a state like Kentucky:) :) :)
     
  44. Dental Dork 09

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    I do agree. the PA profession shares the same pain in medicine. My brother went to an ER after a quad accident and was seen by a PA. She did the whole work up, diagnosis, and was about to send him on his way, which is fine. He then wanted it all to be re-reviewed by a physician because, although the PA to his satisfaction did do a good job, he wanted a Doctor to look at him. So he got his way and he wasn't charged more

    It might be the same for us. Maybe the DH will do this, but the patient's will demand to be seen by a dentist. So where does that leave us? How do we charge?

    We'll see where the future goes.
     
  45. DiveMD

    DiveMD Giggity giggity!!!
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    OK, post deleted....
     
  46. aphistis

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    Take this stuff somewhere else, please.
     

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