States Could Expand Dental Care Access with Midlevel Providers
One solution to state oral health care provider shortages is giving dentists greater discretion to use dental therapists and dental hygienists.
Lawmakers in Connecticut and Georgia have so far failed to vote on legislation to expand opportunities for midlevel dental providers to treat patients under the general supervision of licensed dentists.
Midlevel providers working under “general supervision,” as opposed to “direct supervision,” would be allowed to perform a contractually limited range of procedures without their supervisors being physically present.
Connecticut Senate Bill 40 would let dental therapists obtain licenses and treat patients as employees of public health facilities and under general supervision by licensed dentists. Health Care News publisher The Heartland Institute testified in support of the bill on February 22 to the Joint Committee on Public Health, which has not voted on the bill.
A therapist would have to hold dual licensure as a dental hygienist, have completed a dental therapy program of at least three academic years, and have worked 1,000 hours of direct patient care under direct supervision by a dentist, according to a draft of the bill obtained by Health Care News.
Georgia House Bill 154 would have let dentists permit their employed hygienists to perform more procedures than the state currently allows, under general supervision. The legislative session expired on March 30, without a Senate vote on the bill, which the House had passed on February 10.
The two states have shortages of dental health professionals relative to their population density. Connecticut had 36 federally designated dental health professional shortage areas (HPSAs) as of January 1. Georgia had 189 HPSAs.
Marie Paulis, dental hygiene program director at the University of New Haven, says the effects of dental provider shortages grow more expensive the longer patients go untreated.
“A lack of dental care providers presents economic problems for the state,” Paulis said. “People in pain present in hospital emergency rooms, where their problem is not completely addressed, and they are provided with palliative care like opioid painkillers, which are known to cause more problems than solutions.”
Kelly McCutchen, president of the Georgia Public Policy Foundation, says reducing restrictions on hygienists is a good start that lawmakers should build on.
“We are very pleased to see Georgia expanding the safety net settings under which dental hygienists can practice, but the state still has far to go,” McCutchen said. “We believe all health care professionals should be allowed to practice to the fullest extent of their education and training.”
GPPF Vice President Benita Dodd says a bill proposed in Georgia in 2016 would have expanded opportunities for hygienists to treat Medicaid patients.
“The bill died in committee, fought by the Georgia Dental Association,” Dodd wrote in an op-ed for The Columbia County News-Times in February.
Opposition from the American Dental Association (ADA) could prevent dental therapists from treating patients in Connecticut, Paulis says.
“There are dentists in the state of Connecticut who support the implementation of the dental therapist [legislation], although most are afraid to say that publicly, for fear of being ostracized by the ADA and not getting referrals from other dental specialists,” Paulis said.
Matthew Glans (firstname.lastname@example.org) is a senior policy analyst at The Heartland Institute.
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