PUBLIC HEALTH SUPERVISION

 

Dental hygienists are licensed healthcare professionals who provide educational, clinical, preventive, and therapeutic services that support total health by promoting optimal oral health. (www.adha.org). A registered dental hygienist must graduate from an accredited dental hygiene program. These programs are located in institutions of higher learning and award either associate, certificate or baccalaureate degrees.  Each program has a minimum of two years of didactic and clinical education. The dental hygiene curriculum encompasses general education, biomedical sciences, dental sciences, and dental hygiene sciences. According to the accreditation standards for dental hygiene education programs, these subjects prepare dental hygienists to communicate effectively, assume responsibility for individual oral health counseling, and participate in community health programs. The accreditation standards also require that dental hygienists be prepared to assume responsibility for the assessment, planning and implementation of preventive and therapeutic services.

 

What dental hygienists can do for Vermont:

 

The Vermont Dental Hygienists’ Association is looking toward the leadership of this state to take action to increase Vermonters access to dental services by allowing dental hygienists to have direct access to public health settings. Allowing dental hygienists access to underserved populations is just one way in which we as healthcare professionals can do our part to attain some equity in the distribution of health services. We acknowledge that a dental home is the preferred location for preventive, comprehensive and continuous care for all populations. This proposal is for access to dental services where other options are not available or feasible. This change is not only socially responsible, but fiscally prudent, to increase access to preventive services. 

 

Models and Results:

 

Access to public health settings with less restrictive or no supervision is already legal in 20 states. 

 

·         Connecticut (1999): Public health hygienists provided nearly 7000 prophys/fluorides, 5800 sealants and 15,000 exams over the course of one year

·         Iowa (2004): 3100 sealants, 11,000 screenings, 1600 fluoride treatments and 5000 oral hygiene education/instructions were done in a year

·         Maine (2001): Between March 2002 and October 2004, 5500 people were provided dental services in over 400 clinics

·         Missouri (2001): The sealant program has grown from one school district to cover eight districts. Over 2500 sealants were placed.

·         Nevada (1998): Registered hygienists provide services in 18 public health locations.

·         New York (2005): Over 1500 sealants were placed in schools in rural upstate New York

·         Washington (2001): Over 16,717 people received dental services over 2.5 years.

 

Recommendations:

To increase access to oral health care in Vermont, the Vermont Dental Hygienists’ Association recommends the following:

·         That oral health care providers continue to educate the public about the need to maintain their oral health and the importance of preventive care

·         That federal government funding/grant programs (Title VII and VIII of the Public Health Service) include dental hygiene provisions

·         That partnerships be developed among health care organizations, state and federal government, and other interested groups to educate the public on the importance of oral health and the integral role of oral health in total health

·         That licensed dental hygienists be recognized by the state and federal government as Medicaid providers

·         That state governing bodies evaluate statutory/regulatory language that may restrict the public’s access to oral health care services provided by licensed dental hygienists

Vision for Vermont in regard to dental hygiene and public health supervision:

• That licensed dental hygienists are able to perform all services they have been trained to perform in public health settings under public health supervision 
• That dental hygienists employed in these settings must meet a criteria consisting of a minimum of 3 years clinical practice
• That decisions concerning a hygienist’s eligibility to fulfill this role be based on an application process
• That all patients treated by hygienists in these settings must be informed of the status of their oral health, referred at each visit to a dentist for an annual exam, referred when necessary to a dentist for immediate treatment, and referred to specialists as needed.
• That all patients treated by the hygienist must sign a waiver acknowledging they have been referred to a dentist and the dental hygienist has informed them in detail of the status of their oral health.
• That dental hygienists may perform periodontal debridement, scaling, and root planing when indicated
• That the dental hygienist would have the ability to prescribe fluoride supplements, topical fluoride, and chemotherapeutic agents when indicated.
• That pit and fissure sealants would be placed by the dental hygienist after she/he diagnoses a need. This diagnosis would include a clinical exam and radiographs if possible which would be performed by the dental hygienist.

VDHA acknowledges that this proposal does not fully address or solve the problem of access to oral health care in the state of Vermont. However, we do feel that this proposal is a part of the solution to these problems. We believe the adoption of this proposal will increase access to care for many underserved people in our state in a safe, effective, and socially responsible manner.