BOSTON Dental hygienists with advanced training could perform certain procedures now reserved for dentists, including routine fillings and tooth extractions, under a bill that supporters believe would improve access to oral health care for low-income Massachusetts residents and underprivileged children.
The legislation would create a new, mid-level position called advanced dental hygiene practitioner, similar to a nurse practitioner in a physician’s office and comparable to dental therapists that operate in more than 50 other countries. The proposal is being viewed with some alarm by dentists, who are worried about patient safety and adequacy of the training requirements contained in the bill.
“We love our dentists. They do a good job, but there are not enough of them.”
“We love our dentists. They do a good job, but there are not enough of them,” said state Sen. Harriette Chandler, D-Worcester, who has sponsored the bill along with Rep. William “Smitty” Pignatelli, D-Lenox.
A dental practitioner would not supplant the traditional family dentist nor prompt any fundamental realignment of responsibilities in a typical dentist’s office, backers insist. In fact, the vast majority of people with dental insurance who see a dentist regularly for cleanings and other services would likely encounter no change in routine.
But for the poor, the uninsured and those who live in parts of the state where there are too few dentists, the advanced hygienist could provide access to preventative care that is otherwise not available.
“It is long overdue,” said Jacklyn Ventura, a dental hygienist who directs Mass Healthy Smiles, a private organization that offers screenings and other services, such as cleanings and fluoride, to children in community settings such as public schools and day care facilities.
“Dentistry is so expensive. When families have more than one child, it can put them back six months just to have regular visits,” Ventura said.
Supporters see the bill as a natural extension of a three-year-old Massachusetts law that allowed professionals like Ventura to provide typical dental hygiene services in public settings without direct supervision from dentists.
The legislation would take it a step further by allowing dental practitioners to perform non-surgical tasks, including the pulling teeth or filling small cavities – but only when such procedures do not require root canal, periodontal surgery or other more complex intervention.
“It would bridge that gap between what public health hygienists can do and what dentists can do,” said Katherine Pelullo, who chairs the Council on Regulations & Practice for the Massachusetts Dental Hygienists’ Association.
In more than half of the state’s 351 cities and towns, no dentists accept MassHealth, the state’s Medicaid program, and 53 percent of children in families eligible for MassHealth did not see a dentist in 2011, according to the association. Additionally, the group says, more than 600,000 residents live in areas of the state designated as having a shortage of dentists, and elderly in nursing homes often go without dental care.
The Division of Health Care Finance and Policy estimated that 31,000 hospital emergency room visits in 2011 resulted from preventable dental crises.
Supporters of the bill say they do not foresee a huge rush by current dental hygienists to become advanced practitioners. Achieving that designation would require an additional 12-18 months of study in a master’s level program, along with 500 hours of practice under the direct supervision of a dentist and other requirements.
Still, many dentists are wary.
“I have real concerns about safety of the public from someone who has only had 18 months of postsecondary education.”
“It clearly is a major change in the practice paradigm in oral health,” said Dr. Paula Friedman, president of the Massachusetts Dental Society and professor at Boston University’s Henry M. Goldman School of Dental Medicine.
“I have real concerns about safety of the public from someone who has only had 18 months of postsecondary education. The reality is that many people feel four years of dental school is not enough to teach people what they need to know,” Friedman said.
The dental society has yet to take a formal position on the legislation. Friedman says it needs more vetting. Chandler said lawmakers are prepared to address concerns about safety and training and fine-tune the bill if necessary.
“We have to guarantee the safety of our patients,” she said.
In 2009, Minnesota became the first U.S. state to license a similar category called dental therapists. In Alaska, dental therapists have provided care to native tribes for the past decade.
A number of states are weighing similar laws including New Hampshire, where a hearing was held this month on a bill allowing dental therapists.
The Massachusetts bill has been referred to the Legislature’s Committee on Public Health. No hearing date has been set.