Dental health is Key: Expanding Reach of Hygienists is A Wise Move

This article was originally published on post-gazette.com on September 19, 2017.

In 2007, Deamonte Driver, a 12-year-old in Prince George’s County, Md., died after a tooth infection went untreated and spread to his brain. His mother was poor and  uninsured and been trying to find a dentist for her other son when Deamonte fell ill. Expanding the reach of public health dental hygiene practitioners — a move Pennsylvania’s Board of Dentistry approved Friday— can help ensure that no tragedy of that kind ever embarrasses this state.

Currently, the practitioners — who receive certification after working a certain number of hours as hygienists and meeting other requirements — may work without a dentist’s supervision in a limited number of public settings, including elementary schools, correctional facilities, certain kinds of senior housing and federally qualified health centers. With the board’s vote, they will be able to work unsupervised in more places, including day care centers and pediatricians’ offices. They’ll be able to perform basic services, such as cleanings, but will have to refer patients to dentists for more advanced procedures.

The Pennsylvania Academy of General Dentistry and Pennsylvania Dental Association opposed the proposal. Critics said they fear it will lead to sub-par care. Also at play, one suspects, is some dentists’ fear of being cut off from a patient population, even one that might be unable to afford their services. 

If more dentists accepted Medicaid, there might be less need for a rule change letting hygiene practitioners do more on their own. That is not a knock on dentists. Their educations are expensive, they have practices to pay for, and Medicaid reimbursements are less than they should be for many kinds of health care.

It also bears noting that dentists across the country have been generous in providing free care to needy children and adults. For example, hundreds of people lined up in July for a two-day free dental clinic at Duquesne University, an event hosted by Face2Face Healing that would not have been possible if dentists and other dental health professionals had not volunteered their time and expertise.  

That said, there is no denying the need for better access to dental care. Cost is the big barrier — one that not even the Affordable Care Act has been able to beat back — but it is not the only one. “More than 48 million people in the United States live in areas with dentist shortages,” according to the Pew Charitable Trusts. “Access to care is also limited for the 72 million children and adults who rely on Medicaid and the Children’s Health Insurance Program: Only about one-third of U.S. dentists accept public insurance.”

While advocates in Pennsylvania championed the expanded use of public health dental hygiene practitioners to help all Pennsylvanians, the Gerontological Association of America has advanced a similar plan — use of “dental therapists” — to serve at-risk seniors in “alternative care settings.” That’s a good idea, too.

Dental care is so good these days that there’s no reason for a person to have a headful of bad teeth. This isn’t merely about aesthetics. As Deamonte’s death illustrated, there’s a direct link between dental care and overall health. A greater role for public health dental hygiene practitioners is good for Pennsylvania.