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Proposed Change In Dental Care Workforce Losing Steam

Michael Brindley

On Thursday, the New Hampshire State Senate is scheduled to vote on a bill that’s getting a lot of attention in the dental community. The measure would expand the role of some hygienists. Advocates say this could help increase access in the state, but dentists argue it’s a misguided solution for a problem that may not exist.

Much of the debate centers on whether or not there’s actually even is a shortage of dental coverage in the state.

Julie Stitzel with Pew Charitable thinks so. She says 29,000 Granite Staters live in areas with little dental access.

“And the New Hampshire dentist shortage is worse than it appears, because nearly 1-out-of-4 work only part time," says Stitzel.

And she says that with nearly half of the state’s dentists age 55 or older, the shortage is only going to get worse.

But dentists say otherwise. Rather than a shortage, they call it a maldistribution.

"The toothpaste is out of the tube, this is going to happen across our nation and within our health care system."

Sure, people in the North County may have to drive 20 miles for dental care…

“That’s true,” says Jim Williamson, Executive Director of the NH Dental Society. “But they also probably have to travel 20 – 25 miles to find a Walmart, to find a store, to find gas. Certainly to find a medical practice that would take them.”

His group strongly opposes a new bill that creates the new position of dental hygiene practitioner.

Under the plan, hygienists can seek an extra year of training, learning to do procedures like temporary crowns, cavity fillings and pulling baby teeth.

They could then travel to nursing homes, Head Start programs or other populations that sometimes have trouble finding a dentist.

Safety Concerns

Dr. Drew Wilson is finishing up a root canal and crown at his busy dental practice in Wilton.

He says that with half the training of licensed dentists, practitioners in the field could run into situations they can’t handle.

“The only simple extraction is the one that’s done. I’ve taken out a lot of baby teeth, that you look at an x-ray and think, 'gee, that is gonna be simple.' But you don’t see that there is a root hidden on the x-ray, then something breaks. What are we going to do in those cases?”

But advocates say there is a long history of these mid-level dental providers performing well.

More than 50 countries already have some type of practitioner. In 2009, Minnesota joined Alaska as the second state to approve an expanded dental team.

Christy Jo Fogerty became one of the first licensed practitioners in Minneapolis.

“I think that the access issue requires a great big toolbox. I’ve said it a million times: we are a not a silver bullet. But we are one more tool that we can have in that tool box.”

But the New Hampshire Dental Society says a practitioner isn’t the right type of tool. They’d rather see insurance reforms and increased awareness of the need for better oral health.

Jim Williamson says those are the key reasons for opposing practitioners. He stresses it has nothing to do with money, despite what the opposition may say.

“I haven’t talked to anyone in leadership or anyone of our members that think that this will be an impact on them financially, in any way.”

Julie Stitzel with Pew says adding a practitioner to the staff could actually increase a dental practices’ bottom line.

She says the dentists’ unwillingness reminds her of the battles between doctors and nurse practitioners a generation back.

“Oh, it is eerily similar. If you go back and take a look at what doctor’s were saying about nurse practitioners or physicians assistants, you could replace “doctors” with “dentists”."

Repeat Performance

Last year, the dental lobby successfully blocked a similar measure, instead giving the okay to a watered-down version.

Senator Peggy Gilmour is lead sponsor of this year’s bill. 

“Everybody goes to the dentist. I said to my colleagues, the pressure on you not to support this bill can be powerful, because we are talking about people who literally have the power to pull your teeth out.”

Extractions aside, it looks like the bill doesn’t have the votes to get through the State Senate. Gilmour says she is going to request that it be sidelined until next year. In the meantime, her efforts will continue.

“The toothpaste is out of the tube, this is going to happen across our nation and within our health care system.”

Just not anytime soon in New Hampshire. 

Initiatives are also pending in Vermont, Maine and a dozen more states.

Todd started as a news correspondent with NHPR in 2009. He spent nearly a decade in the non-profit world, working with international development agencies and anti-poverty groups. He holds a master’s degree in public administration from Columbia University.

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