Lawmakers are considering legislation to allow dental hygienists to open their own practices.
Advocates say the move could expand access to dental care – particularly in rural parts of the state.
But many dentists disagree, and have been vocally opposing such bills here and in other states.
They argue that hygienists don’t have enough training or expertise to treat patients independently.
NHPR’s Dianne Finch reports.
(Ambi of dental clinic… )
At the New Hampshire Technical Institute’s dental clinic in Concord, dental hygiene students are learning how to x-ray, clean, polish and rinse.
One of those students, Barbara Stowers, expects to graduate in May.
She’s excited about the potential of owning her own practice one day. But she’s also realistic.
STOWERS: “As I get out there for a few years and you develop your clientele and you have your patients you see on a regular basis..I think when I was ready for that next challenge that would definitely be something that would intrigue me to say the least.”
Stowers’ view that she needs solid experience before going independent is common among hygienists in the state.
That’s according to Joan Fitzgerald. She’s the vice president of the New Hampshire Dental Hygienist Association.
She says that independent hygienists, as imagined by the legislation, would still rely on dentists and refer patients to them for anything beyond preventative care.
And Fitzgerald emphasized that giving hygienists the freedom to reach patients who otherwise go untreated would benefit everyone – including dentists who will get more referrals.
But, she said, the New Hampshire Dental Association continues to oppose such legislation.
Fitzgerald: I think they’re afraid of thinking outside of the box - because they’ve been in a particular pattern of thinking for so long that they actually believe that if we have freedom to practice within our scope of practice anyplace that we see fit to do that they’ll lose our support”
But dentists say that they aren’t afraid of losing money or the support of hygienists.
They’re concerned about patients, says Jim Williamson, the executive director of NHDA.
Williamson: “There’s a real chance that a more serious diagnosis or something might be missed. You know oral cancer is very prevalent today.
If you don’t have full scientific training to diagnose disease there is a
danger that something like that would be missed.”
Williamson feels that hygienists simply don’t have the training to leave the dental office team.
Williamson: “The dentist has to be a graduate of college and then go through a minimum of four years of dental school. Very often they will go through a general practice residency after dental school for a year or two. And the hygienist is basically an associates degree.“
But lawmakers supporting such legislation say its purpose is not to break up the team – but to remodel it to expand access to care.
Senator Kathleen Sgambatti co-sponsored one of the bills.
Sgambatti: “It is not intended to substitute for checkups with dentists and full care. It’s to make sure that people are able to access the very early cleanings, checkups, x-rays - and clearly there are issues going forward that have to be resolved. But I think it’s time we begin to at least explore honestly different models of practice.”
Sgambatti added that legislation would require creation of an advisory board made up of dentists, hygienists and others who would work out many issues – such as how much clinical experience is needed before hygienists can be on their own.
Barbara Stowers, the student from NHTI, says she’s hopeful that dentists will eventually buy in.
Stowers: “It seems the younger generations are all about OK you can do whatever you can do to help me. Whereas the older school, if you will pardon the expression -they’re not used to that and it’s difficult for that change.”
Regardless of whether these bills make it into law - dental schools are seeing declining enrollments nationwide – and dentists are in short supply in many rural areas.
And that may be why as many as 19 states have already passed laws allowing hygienists to practice with little or no supervision.
In New Hampshire, there are two bills under consideration that call for the independent practices.
But so far, they don’t seem to be making much headway.
For NHPR News, I’m Dianne Finch
HELLO FROM A COLORADO RDH WHO OWNS HER OWN PRACTICE
I live in Colorado and have been a registered dental hygienist for 35 years. I graduated from Westbrook College in Portland , ME( now College of NE),am from MA, and so I know that there are many rural areas in New England that are underserved in therapeutic and preventive dentistry and dental hygiene. I have owned and operated my own independent dental hygiene clinic in Winter Park, for 14 years. It is a 4 chair clinic, and we have over 2000 active patients that come to see us because they want to prevent dental disease. Our emphasis is on education and prevention. We do thorough health histories, take blood pressure and pulse, we do an extraoral and intraoral head and neck exam to check for suspicious cancerous lesions and other abnormalities on EVERYONE. I have many patients who say they have NEVER had an oral cancer screening done by their dentist. It is not my job to diagnose, but if I see something that looks abnormal( sorry dentist community but we have plenty of educational background in pathology/radiology), I REFER to a dentist or a physician,dermatologist, or a nurse practitioner. Have found thyroid cancer, basal and squamous cell carcinomas, and melanomas. I referred, diagnosis was made, treatment given, lives saved. We have a wide network of health providers to whom we refer and confer with, and lo and behold I get calls from patients' physicians and nurse practitioners to discuss our patients cases. I have more contact with dentists than I did when I worked for dentists. They were always too busy or kept me too busy to discuss patients. Now it is a matter of course. We also provide dental prophylaxis(cleaning) on our healthy patients, and also provide periodontal therapy if a patient's gums are infected, and they are loosing bone around their teeth. We also do sealants on teeth that do not have decay, and do fluoride treatments and varnish to help keep our patients from developing decay. We take xrays and yes we read them, and if we see something "suspicious" we refer to the dentist. We still cannot say the word cavity as this is a "diagnosis", so we deliver a dental hygiene assessment. Silly isn't it? I have been reading xrays for 35 years+, and I know what decay, abscesses, bone loss, tumors of the bone, etc look like. Many of us have taken the same radiology classes as the dentists in the larger colleges and universities. I would put most rdhs I know next to a dentist at an xray view box, and they would provide as thorough, if not more thorough assessment of the xray.
Two years ago, we passed Senate Bill 212 in Colorado, which allows dental hygienists who own their own practices, to rent space to dentists and specialists to create access to care for patients in rural areas. Believe me, these docs love having the dental hygienist carry the financial burden of running the practice, and they can actually accomplish more for our patients. My office is in a small community 70 miles NW of Denver. I currently have an orthodontist and a periodontist coming to my office, and they are busy. It is difficult for a working parent to take a weekday off from work, drive over a mountain pass in the middle of winter, to bring their child for a 15 minute orthodontic adjustment! Our patients are so grateful that we provide this access to quality care. The docs that come to my office are my colleagues and we work closely to provide quality dental care. Of this I am extremely proud. We see Medicaid patients( I am the only provider in the County). I have begged the local dentists to sign up as most of the kids are in pretty bad shape and beyond my scope of practice, but none want to "deal with the paperwork". I coordinate the dental personel for our annual health fair, and have for 20 years. We provide school screenings, and we just completed an urgent needs clinic for some young kids whose parents just could not afford the much needed treatment. I was fortunate to have our local docs in on this and it was a great day, hopefully the first of many.
So please, pass this on to the NH State Legislators. Independent or Direct Access Dental Hygiene has been legal in Colorado since 1986. California had a limited pilot program in the 80's, but CO was the first to allow rdhs to have a free standing clinic without a dentist on the premises. There has not been one complaint from a patient against an rdh filed with the State Board of Dental Examiners, to my knowledge. There have been no law suits either. Other than the fact that the hygienist business owners and even some of the dentists who work in collaboration with these rdhs, have been harrassed unmercifully by the dentists and the dental association, we still prevail. We are doing no harm, and do much to promote dental and whole body health in our communities. There will always be practitioners in every health care field who practice substandard care. It is just the way it is. If the dentists would support and work with the dental hygienists, they all could create a better health care system that will be good for everyone-patients and practitioners. Most rdhs who open their own practices are the cream of the crop...committed to lifelong learning, hard working, and with the patient's best interest at heart. Believe me, I refer to many dentists, it is my responsibility to do so, and they appreciate the business. If there is a dental hygienist in his/her own pratice who does harm to a patient, they will be held accountable by the State Board of Dental Examiners. That is why these boards are created in the first place-to protect our citizens.It is not the job of the dental associations to police dental hygiene practices. They really need to be looking in on some of their own, who don't even take the time to review their patients' health status, do oral cancer screenings, or who don't even own a periodontal probe, and wouldn't use one if they did. It is only a matter of time before dental hygiene practice is the norm in our country, and the dental hygiene practice will be the HUB of dental care. Please urge the Citizens of NH to support this very worthwhile legislation...just for the health of it!
Sincerely,
C.S. RDH
C.S:
I am currently involved in a study that is looking at ways to expand the hygienist profession even further in CO and I would greatly appreciate an opportunity to talk with you about your experience and ways CO can improve/broaden its scope of practice.
The issue of independent dental hygienist practice is a touchy one for many dentists. My husband, Ken, is a registered dental hygienist and we have been exploring this option for ourselves and being asked many questions by the dentists he currently works with. The benefits of preventive dental care for a wider population should be a motivation for the dental establishment to push for RDH independent practice. What we are finding by being in the field is a desire by dentists to own their practice, employ hygienists thirty two hours per week or less, work no evenings, weekends, or holidays, and a Monday through Thursday schedule. Very nice if you're the dentist. Benefits for employees are avoided with part-time employees only and the schedule is great. Dentists are not the only ones with an entreprenurial spirit and the times of such limited availability of hygiene services (including oral cancer screening for which hygienists are thoroughly trained) are most thankfully coming to an end. Nationwide the effort to serve, without the cushy traditional time frame and and meet people's needs when they have time rather than not interfereing with the three day weekend, is snowballing and dentists will not have a pure motive to stand on.
Respectfully, Jeanette D. Anderson, LPN