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Dentists must fight superhygienist law
By Helaine Smith, DMD, MBA

October 30, 2008 -- Editor's note: Helaine Smith's column, The Mouth Physician, appears regularly on the DrBicuspid.com advice and opinion page, Second Opinion.

Organized dentistry has failed us one more time and degraded our doctorate degree and our profession. The new law taking effect in 2011 of a "midlevel practitioner" that the Minnesota Senate voted in -- due to organized hygienists and their ability to effectively lobby their cause -- is a huge step backward for dentistry and dentists. It exploits the poor and undeserved residents of Minnesota.

How come a group of hygienists could organize and lobby before the legislators of Minnesota so much more effectively than dentists? Where was the ADA? Was it distracted by its effort to defend amalgam safety? I know several dentists from Minnesota and they are all upset. I empathize with the Academy of General Dentistry Minnesota President Mark Malterud, D.D.S., and his recent article, entitled "Lessons From Minnesota," in the AGD Impact October issue.

It is absurd to think that hygienists can perform at the level of a dentist. Where are the ethics? Do no harm? Also, isn't it standard of care that a general dentist must perform a specialty procedure at the same level of a specialist -- i.e., root canals or third molar extractions? Can a hygienist perform to the same level that we can? This is America, not a third world country. Yes, there are underserved people, but is providing care that could harm the individual solving the problem?

Lower income people often have complicated medical and dental problems. Can hygienists comprehend this without the education that we received? They lowered what we do to a blue collar level and make it sound like they can handle what we do without the training, and effectively sold this to the public and the legislators, who bought into this because they do not understand what we do.

When the patients are in pain, who will take the call? Most likely the emergency rooms. Allowing hygienists to practice will tax the system as poor people are accustomed to using the emergency room as a clinic. Now when the hygienists "fill" teeth I am sure many patients will end up with pain and go to the emergency room.

Oral surgeons and ENT doctors have misdiagnosed oral cancer and told patients to rinse with salt water instead of realizing the lesion was worthy of a biopsy. What will the diagnostic level be with hygienists? I feel they are not confident in their ability and this will severely impact treatment, even at the level of an occlusal restoration.

We have been more vilified in past Wall Street Journal articles than the Wall Street thieves responsible for the current financial crisis. The stereotype that we are money-hungry people is absurd. Our image needs to change, and until we have change at the ADA level, we will continue to be degraded. The lesson from Minnesota is a perfect example of this.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

Copyright © 2008 DrBicuspid.com

Minnesota hammers out regulations for superhygienists, October 29, 2008

Can the ADA do more to educate the public?, October 21, 2008

Let's be more than just tooth plumbers, October 1, 2008

Superhygienists a step closer, March 17, 2008

'Superhygienists' a threat to dentists? , March 6, 2008


Last Updated hh 5/11/2009 4:37:49 PM

13 comments so far ...
11/5/2008 5:02:08 PM
WhiteLake69
Re: Dental Therapists.
 
Dentistry will continue to be villified and ridiculed in the press untill we start using legitimate studies as a basis for criticism or opposition to dental therapists. Our constant ranting about poor quality, risks to the public and other completely unfounded claims only makes us look loke tradesmen attempting to protect our guild.
 
Is there anyone out there with one shred of evidence supporting a claim that dental terapists have been a threat to the public?
 
If we persist in oppositing any roles as leaders of teams which might include therapists, we increase the likelihood that someone else (Pediatricians) will assume that role. It may not be for everyone, but such personnel, working within well structured teams, may be the best chance we have to improve access at reasonable costs.
 
Anyone care to argue that?
11/5/2008 7:12:09 PM
Helaine Smith
Yes I can. Nurse practitioners already apply Fluoride in community health centers. Pediatricians are not going to assume the dental care of children. That is impossible.

The problem is staffing the team as you mention with a dentist. I have no doubt that a team could accomplish great care, but it must have a dentist leading the team.

Access to dental care is a major problem but dental therapists are not the answer. Nurse practitioners have a bachelors degree and a masters degree. They do not have their own practices and handle routine care. What degree does a dental therapist have?

You do not know what you do not know. You can cause harm to patients.

11/5/2008 7:20:45 PM
30+YrVeteran
[size=3]..."They lowered what we do to a blue collar level and make it sound like they can handle what we do without the training"...
[size=3] 
[size=3][font=tahoma]So are you saying even though [size=3]"ADHPs must not only be licensed dental hygienists, (and) would be required to obtain a master's degree specially designed for them and pass a comprehensive clinical examination developed in consultation with the Board of Dentistry" [size=3]that would make them a blue collar worker?
[size=3] 
[size=3]When did a B.S. /c M.S. in a health profession become blue collar?
11/5/2008 8:11:02 PM
WhiteLake69
The ADHP proposed by organized hygiene will most likely fail. Not because of an inability to perform at acceptable levels of quality, but due to high costs. The requirement for six years of training represents an enormous cost and time committment. Salaries would have to be close to that of dentists in order to make the position practical to pursue. 
 
The Alaska Native Tribal Health Consortium (ANTHC) has shown that six basic dental procedures can be safely and effectively provided by two year trained therapists, costing $30,000/yr to educate. The key is team development. The DHAT, as opposed to the ADHP, is team based, working with a telecommunicating supervising dentist, using state of the art systems, very much similar to data transmitted from paramedics to hospital based E.D. physicians. A recently awarded $1.6 million dollar Kellogg grant will determine much about clinical and behavioral outcomes.
 
I am sorry if Helaine continues to believe that therapists are likey to be harmful. There is no data to support her belief.
 
Sadly, organized dentistry has provided very little international and national information regarding dental therapists. Having site visted the Saskatchewan Dental Nursing program and the ANTHC dental therapist project, I can say with a high degree of certainty that team based dental therapists can be created for little compared to ADHPs and will almost certainly perform just as well. They have improved access dramatically, safely and have been well received by communities in which they have been assigned. Compare that to volunteer dentists who show up when they can or want to.
 
The ADA has recently endorsed the Community Dental Health Coordinator (CDHC), as a competitor to the ADHP and DHAT. At a cost of $5 million, it is probably the least useful of the three. Even so, I applaud any effort to try something new and hope that the profession will be open minded enoughh to accept the outcomes of scientific assessments.
 
It is good that this discussion is taking place. It should have begun 40 years ago, when the Sask. model was started.
11/5/2008 10:04:27 PM
Scottie
It might help others of us less informed, join in this discussion, if we knew a bit more what is going on.
What can a dental therapist do? Are they licensed in many States? When you talk about a team, who are all on the team? Do you have a dentist, hygienist, assistant, dental therapist?
And the "ADHP" is what now?
One of the conflicts between dentists and the hygiene board was that dentists wanted a two year program to train students to clean teeth. The hygiene board resisted that and wanted dental hygiene to be a four year degree program to maintain the status of the profession and also limit the supply of hygienists. Are dentists guilty of the same thing with dental therapists?
Maybe so. I wonder if dental therapists are trained to work in under served areas, but what is to stop them moving into the cities and setting up shop, when they get tired of working in outlying areas?
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