By Mary Otto
In some cases, struggles over restrictions in state dental practice acts have pitted dental hygiene and health advocacy groups against state dental boards and professional organizations representing dentists.
Dental organizations contend that “direct supervision” rules, which require a dentist to be on-site when a hygienist is providing services, or “prior exam” rules requiring a dentist to examine a patient before receiving treatment from a hygienist protect patients and ensure quality of care.
But hygienists have pushed back, arguing that such rules unnecessarily restrict their ability to provide services safely within their scope of practice.
For their part, health advocacy groups have asserted that “direct supervision” and “prior exam” rules drive up costs and represent significant barriers to patients’ access to needed services.
In a few significant cases, the Federal Trade Commission (FTC), under its charge to protect the health care marketplace from unfair competition and to ensure consumer access to care, has supported easing restrictions.
In a new Pew policy brief, Tara Koslov, acting director of the FTC’s Office of Policy Planning offered this observation.
“Oral health experts agree that these restrictions … are not always necessary to protect patient health and safety, and may be particularly harmful in public health settings and dental shortage areas where people lack adequate access to preventive services.”
The FTC has issued comments and taken legal action in response to state dental practice acts that it determines unfairly restrict the ability of dental hygienists to provide needed care to patients in public health settings.
As the Pew brief notes, the agency in 2003 filed charges in an ultimately successful suit against the South Carolina Board of Dentistry for reinstating a “prior exam” rule that required children to be examined by a dentist before receiving treatment from hygienists – after the state legislature had removed the requirement.
In the suit, the FTC argued that the dental board’s actions “hindered competition in the delivery of preventive dental services to school-aged children and deprived thousands of school children – particularly economically disadvantaged children – of the benefits of preventive oral health care.”
And in 2010, the FTC warned the Georgia Board of Dentistry about restrictions under discussion in that state. Still, the complicated battle over dental supervision in Georgia wore on for years, as James Salzer reported in a 2016 story for the Atlanta Journal-Constitution. Dentists fought to uphold a “direct supervision” requirement as hygienists sought the ability to serve patients without a dentist on-site.
“Dentists say they are concerned about the safety of patients; dental hygienists say they are trying to get basic care to more Georgians,” Salzer summarized in his story.
At a hearing on the issue, researchers told Georgia legislators that the state could save millions of dollars a year and serve thousands more poor children by increasing access to basic dental care, Salzer reported.
A Georgia bill signed into law in 2017, and taking effect Jan. 1, 2018, allowed dental hygienists to apply sealants and provide other preventive services in public health settings under “general supervision.” That means a dentist is no longer required to be present during the treatment.
The American Dental Hygienists’ Association (ADHA) offers a summary of 2017 legislative actions impacting dental hygienists, including the Georgia “general supervision” law.
The group also tracks laws and regulations related to the practice of dental hygiene throughout the United States.
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