Editor's note: This letter from Dr. Lisa Bosch is written in response to an article that appeared earlier on DrBicuspid.com, where Tracee Dahm, MS, RDH, listed some reasons why she believed that oral preventive assistants would not be good for the dental industry.
Dear Hygienists,
You are correct. Oral preventive assistants (OPAs) will not solve the dental hygiene workforce shortage. It is only one angle of many that dentists and dental associations are working on to address a complex issue with no one, single solution.
The OPA position will have many applications, none of which are to replace the procedures performed by a dental hygienist. An OPA is only permitted to remove supragingival calculus, with a dentist or hygienist removing any remaining calculus, as well as doing an exam and periodontal charting.
Dr. Lisa Bosch.
The OPA position is meant to supplement the prophylaxis procedure of the dentist or hygienist. Each state will have its own rules and regulations, but in many states, and here in Missouri, a dental hygienist will also be able to supervise an OPA.
Some scenarios in which the OPA can be utilized are with assisted hygiene, where the dental hygienist has a dedicated OPA who can remove supragingival calculus before the hygienist completes the prophylaxis. This is often done with the hygienist working two columns in hygiene shortage areas.
I know of many offices where the dentist can only hire one hygienist, sometimes only part time at that, and is performing most or all of their hygiene procedures. This means that emergency procedures and/or new patients cannot be seen on the schedule or are put off for excessive periods of time.
Another scenario where an OPA can be used is pediatric offices, where it is very expensive or difficult to hire a dental hygienist to perform child-only prophies. The dentist can use an OPA and then explore and remove any subgingival calculus that remains, which is the requirement for a prophylaxis to be performed legally.
Again, in any scenario an OPA is utilized, it is never to replace the knowledge and educated skills of a dental hygienist. The curriculum in Missouri was created by dentists and dental hygienists together to ensure the technical skills of removing supragingival calculus … the calculus you can see only, leaving behind subgingival calculus to be removed by the supervising dentist or hygienist. OPAs are not performing patient-centered oral hygiene instruction, intra or extraoral exams, dietary or caries risk assessments, or the like.
In addition, it is a top priority for dentists and dental organizations to support the continued funding and potential expansion of dental hygiene programs across the country. At no point have dentists not recognized the importance of dental hygienists and supported their growth and practice at the top of their scope, especially here in Missouri, where we just passed local anesthesia under general supervision for dental hygienists.
Lastly, please know that dentists hold the importance of periodontal health within the same paradigm as decay. We are not of the mindset that the foundation of the teeth we are restoring is of so little importance that we are substituting the education and standards of a dental hygienist with the education of an OPA.
I was a dental hygienist for nearly 15 years before returning to school to be a dentist. I know the educational requirements, as many of my dental colleagues do as well, but I also lived them.
My wish is that dental hygienists would see that the OPA position is a support position, not in opposition to the services a dental hygienist provides, and that hygienists could see the true benefit to patients, that we are all oral health professionals trying to serve to the best of our abilities.
I hope these statements have answered your questions and cleared up some of your concerns. Please do not hesitate to reach out to me or other dentists in support of OPA supportive services. We are all in this together -- not in opposition -- here to serve patients at a time when they need all of us to work together the most.
Dr. Lisa M. Bosch, RDH, MPH is a private practice dentist in rural Missouri. She is passionate about serving her rural community and advocating for underserved populations through promoting community water fluoridation, child and maternal services, and rural dentistry support systems.
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.
