Ga. dental board mulls direct supervision of hygienists

2009 10 28 09 40 23 4 Woman Dentist 70 V2

The Georgia Board of Dentistry wants to adopt a proposal requiring that hygienists who provide basic preventive dental services in schools, community health centers, and prisons must now be under the direct supervision of a dentist.

But the Georgia Dental Hygienists' Association (GDHA) and the Federal Trade Commission (FTC) oppose the change, saying it would limit access to care, especially for children in rural and low-income communities.

The board is expected to vote on the proposal September 9.

The proposed change was originally introduced in January but was tabled after the board heard extensive testimony opposing the change from the FTC, the Georgia Department of Community Health, district health directors, the American Academy of Pediatrics' Georgia chapter, and other community groups.

Currently, hygienists are permitted to work at dental facilities regulated by the state and county agencies without direct supervision of a dentist. The proposed rule change would require direct supervision by a licensed dentist who has personally diagnosed the patient's condition and authorized the treatment. It also stipulates that the dentist must be present at the facility and examine the patient before he or she leaves.

“The proposed change will create an unnecessary obstacle for children receiving treatment at Head Start centers and in school settings.”
— Janeime Asbury, RDH, president,
     Georgia Dental Hygienists'

The proposed changes do allow hygienists to apply fluoride varnishes or rinses without a prior examination by a dentist.

The GDHA asserts that the restrictions would be a barrier to dental care, especially for schoolchildren.

"The proposed change will create an unnecessary obstacle for children receiving treatment at Head Start centers and in school settings for kids who are already in dire need of dental care," Janeime Asbury, RDH, president of the association, told

Access to critical preventive services provided by hygienists in school-based programs and community health centers helps prevent decay and other oral health problems in thousands of children and adults every year, and saves taxpayers millions of dollars annually in dental emergency room visits and extractions, she said.

The Georgia Dental Association expressed concern over the proposed change in a January 5 letter to the dental board. The group urged the board to allow hygienists to be supervised by a dentist who has given either written or oral instructions for patient treatment, but the dentist need not be present at the facility.

The FTC also opposes the change, saying it would likely would raise the cost of dental services and reduce the number of people receiving dental care, according to a recommendation sent January 5 to the Georgia dental board.

"There is no evidence that such supervision is necessary to prevent harm to dental patients," stated the FTC, noting the restriction "would harm the state's most vulnerable consumers."

The lack of dental care is a particular problem for children in rural and low-income communities, and dental hygienists play an important role in delivering care to these communities, the FTC noted.

Additionally, the proposed amendment cites no evidence that allowing hygienists to continue to perform these types of dental services in facilities without direct supervision has harmed or will harm patients, the FTC said.

Board President Isaac Hadley, DMD, could not be reached for comment.

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