By Mary Otto
Public health leaders agree that school-based programs are a good way to get preventive dental care to at-risk kids. However, staffing and costs can be a barrier to keeping such programs running.
Dental hygienists are trained and licensed to provide preventive care and can offer an affordable way to expand dental services. But in some states, dental practice acts restrict the ability of dental hygienists to work outside of dental offices, bill Medicaid for their services or serve patients who have not first been examined by a dentist.
For a state by state look at what dental hygienists are allowed to do, see this report by the American Dental Hygienists Association
State legislatures and licensing boards should review state dental practice acts to ensure that licensed dental providers – including dental hygienists and an emerging category of mid-level providers called dental therapists – can serve patients in all appropriate settings, according to recommendations in a new Sealant Work Group report by the Children’s Dental Health Project.
Such workers should be able to enroll as Medicaid providers and allowed to submit claims and receive direct reimbursement for oral health services, the expert panel concluded.
The public health advantages of allowing dental hygienists and dental therapists to serve patients in school-based programs were also the topic of discussion at Health Journalism 2017.
In a panel at Health Journalism 2017, “Oral Health Stories to Watch in 2017,” Jane Koppelman, research director of the Pew Charitable Trusts Dental Campaign, said efforts are underway in some states to reexamine dental practice acts to allow dental hygienists more freedom to work in settings such as schools.
“What we are seeing now is a flurry of activity at the state level to ease these restrictions,” she said
Is your state considering such measures?
As for dental therapists, he technically trained mid-level providers so far are only working in a few places in the country, such as Minnesota and in tribal communities in Alaska and Washington state (with a tribal pilot program in Oregon getting underway). Vermont and Maine have approved the midlevel providers but have not started using them yet, Koppelman noted.
Dental therapists, who are licensed to provide a narrow range of routine preventive and restorative procedures, also hold promise for expanding access to affordable dental care, Koppelman said.
“Some clinics are employing dental therapists in schools and nursing homes and rural hospitals to deliver care in more convenient locations” she observed. “It costs between 40 [percent] and 60 percent of the cost of sending a dentist.”
Dental therapists continue to face opposition by organized dental groups. However, some states are examining the model as a way of getting more care into public health settings including schools. For background, check out Pew’s look at state efforts on this front.
To learn more about the effectiveness of dental sealants, and how school sealant programs work, there are these resources:
- The U.S. Centers for Disease Control and Prevention offers an updated look at research as well as user-friendly news graphics in this Vital Signs report.
- The National Maternal and Child Resource Center has issued a new version of its sealant manual: “Seal America: The Prevention Invention.”
- In the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, researchers have offered a detailed look at what federal data is telling us about the prevalence of sealant use and oral disease among American children over time.
- The Association of State and Territorial Dental Directors has assembled a helpful collection of resources on sealants, including key studies and reports.
Mary Otto is AHCJ’s oral health core topic leader. Otto got interested in covering oral health in 2007, writing for The Washington Post about the death of a child who had suffered complications from an untreated dental infection. Since 2008 she has continued to write about oral health, as a freelance writer for the Post, drbicuspid.com, and other publications. Her book, “Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America,” was released in March 2017.
