Charles Arlinghaus’ recent column calling for the addition of a new type of dental provider in New Hampshire is off base when he cites the need to relax scope-of-practice laws to improve care. As a veteran dentist who began her career as a dental hygienist, I understand firsthand the need for clear scope-of-practice laws and disagree that this new category of provider is right for New Hampshire. It is not.
The bill Arlinghaus mentions in his column would create a new class of dental practitioners who would undergo three years of education after high school and be able to perform dental surgery — drilling and extracting teeth. I began my career as a dental hygienist. By attending dental school and receiving an additional four years of education and clinical training after receiving a four-year bachelor’s degree, I was able to experience just how different a licensed dentist is from a dental hygienist who specializes in prevention.
The truth is that those with an associate’s degree plus a short 9-to 12-months of additional training simply do not have the skillset and background necessary to perform invasive surgical procedures on patients. This isn’t a matter of economics, as Arlinghaus holds, but of patient safety.
Instead, we need to work to properly direct patients through the existing public health system. The causes of the dental crisis are varied and complex, and a myriad of factors can prevent patients from being able to see a dentist. New Hampshire dentists are working to address those barriers head-on.
For instance, a number of dentists are partnering with health professionals around the state to refer patients who visit the emergency room for dental pain to the dentist’s chair, where they can treat the source of the pain. We’re also developing programs to help those patients navigate their options within the private/public safety net to get them proper dental care. Additionally, many New Hampshire dentists are going into schools to provide screenings for children and to educate them about preventive practices so that our state’s youth can follow a path of proper dental health throughout life.
New Hampshire has taken significant strides to improve an already good oral health care system. A recent Pew study found New Hampshire to be the fourth-best in the nation in terms of oral health. We are ranked first in the country for the fewest number of third graders with untreated tooth decay and are one of only 11 states in the country to provide dental care to at least 50 percent of Medicaid-eligible children.
Additionally, our state continues to attract more and more dentists. The Board of Dental Examiners recently recorded approximately 1,000 actively licensed dentists in the state, which is a sizable increase over the past 10 years.
Understanding that health care changes and evolves, new scopes of practice are consistently reviewed to ensure we’re serving the needs of patients appropriately. In the past two years, New Hampshire dentists have worked with many stakeholders to establish two new dental workforce providers: the Certified Public Health Dental Hygienist and the Expanded Function Dental Auxiliary (EFDA). These providers more than adequately address the barriers patients most often face to getting dental care.
In addition to the preventive services, certified public health hygienists provide relief to patients through temporary fillings, nutritional counseling, limited x-rays and other services in the community public health setting. When a patient at a school-based clinic has a cavity, a certified public health hygienist can immediately apply a temporary filling that protects the tooth from further damage until the child can receive a permanent filling from a dentist.
An EFDA is another proven model of provider, used in 30 states, adding additional efficiencies to public health clinics and dental practices. With the integration of these expanded services, we are addressing the needs of residents who may have trouble accessing oral health services. These new workforce models will make a difference, but we need to give them a chance to succeed and have an impact on patients before we introduce yet another model.
The point is simple: the new dental provider touted by Arlinghaus fails to address the many obstacles New Hampshire families face in getting the dental care they need. It does not address lack of dental insurance or transportation, cultural and language barriers, diminished state public health programs, and a lack of understanding about who should care for children’s teeth in ways that can prevent disease.
New Hampshire dentists are working to address these issues in multiple ways. Let’s focus first on expanding what’s been proven to address barriers to care before playing with patient safety and adding a mid-level provider to the team.
Public education, community water fluoridation, using the current workforce to its full potential where there is existing capacity to serve more patients — these are the factors that will close the dental divide. This is where the focus should be.
Sarah A. Finne is a dentist in Hampstead.