Prevention is key, and hygienists are key to prevention

Liz Nies, immediate past president of the Idaho Dental Hygienists' Association

Dental hygienists’ roles must be expanded in Idaho.

Idahoans lack access to oral health care now.  The Surgeon General’s report, Oral Health in America, identifies vulnerable populations including children, women, elderly, racial and ethnic groups, low income groups, special needs groups and residents of rural areas. Idahoans are certainly represented in these vulnerable populations.

The Idaho Oral Health Action Plan states, “Oral health in Idaho is a serious public health issue.”

But there are practical solutions. There are 1,505 dental hygienists and 1,257 dentists with active licenses in Idaho. Dental hygienists are health care professionals who have the knowledge, skills and responsibility to provide oral health promotion and health protection strategies for individuals and groups.

A dental hygiene license allows the provision of oral prophylaxis (teeth cleaning), fluoride, sealants and injections among other advanced procedures. The number of dentists is predicted to grow at 4 percent compared to 43 percent for dental hygienists. Also, 97 percent of Idaho is designated as a dental health professional shortage area based on the number of dentists available to serve the population.

Fifteen states, including eight western states, allow direct reimbursement to dental hygienists for preventive services from Medicaid. Not Idaho.

The Idaho Dental Hygienists’ Association, or IDHA, has requested the approval of dental hygienists for direct reimbursement for services in hopes of increasing the number of providers and having a positive impact on access to care. This request has been denied.

The Idaho Oral Health Action Plan identifies that this reimbursement would be a measure to improve the health of Idahoans. Early oral health care in a child’s life reduces costs to Medicaid by 48 percent. When children lack access to care, emergency rooms are used for unbearable pain from tooth decay; therefore, as many as 52 percent of children under 3.5 years old experience the hospital as their first dental visit. This travesty results in high costs to Medicaid and others.

The average cost for care for these operating room visits per child is $1,508; non-hospitalized children cost $104. Direct reimbursement would permit dental hygienists to provide more preventive care to children, improve oral health knowledge and enhance overall quality of life and well-being. Dental hygienists are already providing these services in other states at reduced costs with no evidence of detriment to patient safety.

Direct access refers to a dental hygienist initiating treatment based on assessment and needs without the dentist’s authorization, treating the patient without the dentist present and maintaining a provider-patient relationship. Forty states permit direct access. Not Idaho. Idaho is a general supervision state, meaning a dentist needs to authorize services prior to delivery by a dental hygienist, but need not be present at the time of patient care. IDHA advocates for direct access because of its ability to reach out to patients and families for oral health education and treatment within the dental hygienists’ scope of practice, without sacrificing patient safety.

The IDHA supports the Advanced Dental Hygiene Practitioner, a mid-level provider with a master’s degree who would work collaboratively with other health care providers. This position, supported by the Institute of Medicine, the Pew Center, in the Surgeon General’s report and the National Call to Action to Promote Oral Health, would be educated at the same level as nurse practitioners, physician assistants and other mid-level providers. These highly educated and skilled licensed practitioners would help fill the gap in health care shortage areas in Idaho.

Oral health care is no longer considered a separate health or disease issue from the rest of the body. Research reveals links between periodontal disease (gum and bone disease) and cardiovascular (heart) disease, diabetes, obesity, osteoporosis, pulmonary (lung) diseases and others. It is evident that medical professionals will be providing more oral health care in the future; therefore, there is a need for dental hygienists to deliver care in medical settings.

Prevention is key, and dental hygienists are key to prevention.  The public deserves direct access to dental hygiene services to prevent problems and instill the values of good oral health for everyone.

(The byline on this column was changed 12/26/11 to reflect that the column was the statement of the hygienists’ association as a whole).

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