Memphis Dental Hygienists' Association

2012 Legislation

An Act to Increase Access to Oral Healthchemas-microsoft-com:office:office" />

 HB 2775/ SB 2618

 “An Act to Increase Access to Oral Health”

This legislation allows registered dental hygienists to practice in alternative settings without the direct supervision of a dentist. 

Summary:  This legislation allows registered dental hygienists to practice in accordance to a written collaborative agreement with a dentist in accordance with section 63-5-108 (c) Because the services of a dental hygienist and a dentist are already covered under Tennessee law this bill would increase access to preventive care at no additional cost to the state.

Bill Analysis: 

The Pew foundation recently gave the state of Tennessee a grade of “C” meeting only 4 of the 8 benchmarks set by the foundation.  Pew calculates that almost 20 percent or 1.2 million of the state’s residents are underserved by dentists, and at least 230 additional providers are needed.  Currently there is no public mandate for the Department of Health to provide dental services and only children under the age of 21are covered under the Tenncare and Coverkids programs.  In Tennessee grants are only given for emergency (extraction) services.

According to the Center for Disease Control in 2004 alone, 48% of individuals making under $15,000 were not able to go to a dentist.  This CDC statistic is evidence of a larger trend where access to preventive care is tied to finding a dentist’s office willing to accept minorities, the poor, the uninsured, the chronically ill, the elderly, and those in rural parts of the state.  Studies show that for every $1 dollar spent in providing preventive treatments to lower income individuals, a state saves between $8-$50 dollars in more expensive restorative dental care.

Under present law, dental hygienists can only deliver services under the supervision of a dentist, typically in a dental office. However, 22 states presently allow registered dental hygienists to treat patients in alternative settings without a dentist’s supervision. Practicing with the collaborative practice agreement, during an examination by a registered dental hygienist, all abnormalities will be referred to a practicing dentist for an oral examination, diagnosis, and treatment, as needed.  Even with expanded scope of practice for hygienists there is no substitute for seeing a qualified dentist.

•  Dental hygienists are licensed, preventive oral health care professionals who provide educational, clinical, research, administrative, and therapeutic services to support overall health by promoting optimal oral health.

•   Dental hygienists are required to graduate from an accredited 2 year dental hygiene program.

•   After completion of the accredited program housed in a college or university, the graduate is then qualified to take the required National Dental Hygiene Board as well as a Regional written and didactic licensing examination.

•  The dental hygiene curriculum not only encompasses general education, biomedical sciences, dental and dental hygiene sciences but also asks the students to assimilate knowledge requiring judgment, decision making skills and critical analysis.

•  According to the accreditation standards for dental hygiene education programs, these subjects prepare dental hygiene students to communicate effectively, assume responsibility for individual oral health counseling, and participate in community health programs.

•   The accreditation standards also require that dental hygiene students be prepared to assume responsibility for the assessment, planning and implementation of preventive and therapeutic services.

•  Dental hygienists are required to be licensed in the State in which they work and practice in accordance with the States’ regulatory laws and dental hygiene practice acts

Oral Health Workforce in the United States

According to the federal government, in the United States, there are 140,750 licensed dental hygienists and 130,836 dentists. Since 1990, the number of dentists per 100,000 U.S. population has continued to decline. This decline is predicted to continue so that by the year 2020 the number of dentists per 100,000 U.S. population will fall to 52.7. However, since 1990, the number of dental hygiene programs has increased by 27%. In addition, from 1985–86 to 1995–96, the number of dental hygiene graduates has increased by 20%, while the number of dentist graduates has declined by 23%.

The Bureau of Health Professions National Center for Health Workforce Information and Analysis which is a component of The United States Resources and Services Administration has studied dental and dental hygiene workforce issues. Two of the regional centers for health workforce studies have cited and made policy recommendations to consider expanding the role of dental hygienists to include the delivery of oral health care services in shortage areas and to children on Medicaid. 

It is clear that the numbers of dental hygiene programs and graduates are increasing and that licensed dental hygienists are well educated to provide preventive and therapeutic services to the public. The American Dental Hygienists’ Association believes that dental hygienists who are graduates of accredited dental hygiene programs are competent to provide these services without direct supervision.

Health Promotion/Disease Prevention

Oral health is an important component of an individual’s overall health. Research has linked periodontal disease to heart and lung disease; diabetes; pre-mature, low-birth weight babies; and a number of other systemic diseases.  The first-ever Surgeon General’s Report on Oral Health has called attention to this important connection and states, that if left untreated, poor oral health is a “silent X-factor promoting the onset of life-threatening diseases which are responsible for the deaths of millions of Americans each year.” 

The early detection and treatment of oral disease is critical to saving lives. During oral health examinations, dental hygienists can detect signs of many diseases and conditions like HIV, oral cancer, eating disorders, substance abuse, osteoporosis, and diabetes. In addition, dental hygienists can communicate with patients’ the treatment plans that will assist in the management of oral diseases to help encourage an individuals’ overall well-being.

Barriers to Care

State regulatory laws restrict access to care opportunities by limiting the types of practice settings and imposing restrictive supervisory requirements. In Tennessee dental hygienists practice under what is known as general supervision. This means that a dentist has authorized a dental hygienist to perform procedures but need not be present in the treatment facility during the delivery of care. General supervision can be a positive aspect in increasing access to the underserved populations, however, the Tennessee definition is restrictive in that dental hygienists are limited to a 15 day period without Dental supervision and the patient must be a patient of record within the past 7 months.

Conclusion

The recent Surgeon General’s Report on Oral Health identified several barriers which prevent people from accessing needed oral health care.  The inability to pay for care, the inability to travel or physically access places where oral healthcare is delivered, and the inability to access an oral healthcare professional.

 Dental hygienists can play an active role in resolving these issues.  The American Dental Hygienists’ Association advocates that the services of dental hygienists who are graduates from an accredited dental hygiene program be fully utilized in all public and private practice settings.  Licensed dental hygienists, by virtue of their comprehensive education and clinical preparation, are well prepared and willing to deliver preventive oral health care services to the public, safely and effectively, independent of direct dental supervision.

Dental hygienists are also able to provide services in a variety of settings more accessible to patients—residences of the homebound, public health, school based programs, community clinics, and more.  The ultimate goal of any program is to achieve public health objectives and sustainability.