Minnesota lawmakers debate new dental care provider bills

St. Paul, Minn.鈥擜 new dental care provider may be inevitable in Minnesota, but the state dental association is working hard to ensure the best possible outcome for patients.

At press time, the state legislature was holding hearings on two bills regarding what has come to be termed a “midlevel” dental provider by various groups. The Minnesota Dental Association opposes one of the bills, which proposes an “oral health practitioner” with the authority to perform surgical and restorative procedures without a dentist being on-site to provide supervision.

A separate proposal, which MDA supports, would provide funding for a program at the University of Minnesota School of Dentistry to educate dental therapist providers who will be trained to practice under dentists’ supervision.

While the ADA supports policies that promote the dentist as leader of the dental team, the Association is providing legislative assistance to the Minnesota Dental Association through the State Public Affairs Program.

The MDA went into the legislative hearings prepared to advocate for patient safety.

“We’ve had a fairly dramatic change in our approach to this situation by moving from strict opposition to endorsing a new member of the dental team,” said Dr. Jamie Sledd, immediate past president of the MDA and a member of the ADA Council on Dental Practice.

That new team member is the dental therapy provider. After a 2008 fact-finding mission to learn about dental therapists with long histories in Canada, England and New Zealand, the U of M School of Dentistry announced its intention to create an educational program to train dental therapists in bachelor’s and master’s degree programs.

“This is a member of the dental team who would help increase the capacity of a dental practice to provide care for a greater number of underserved patients,” said Dr. Patrick M. Lloyd, dean of the U of M School of Dentistry.

“Dental therapists would prepare teeth and place restorations in primary and permanent teeth, and be educated to remove primary teeth,” said Dr. Lloyd. “However, they would be educated to provide these services in an institution accredited to teach these procedures and only under indirect supervision of a dentist. The dentist must be within an immediate locale to make intra-operative diagnoses and assist the dental therapist if clinical complications arise.”

“The MDA supports a limited number of surgical procedures to be provided by the dental therapist only if a Minnesota licensed dentist has first made a diagnosis and treatment plan, and if the dentist is on-site,” said Dr. Sledd. “Our desire is to create a new position that is integrated into the dental team and increases the reach and efficiency of dentists.”

In 2008, the legislature directed the Board of Dentistry to authorize a person to practice as an oral health practitioner, no sooner than 2011, as a way to extend dental care to the state’s rural and low-income patients. The OHP is a revised term for the advanced dental hygiene practitioner, a workforce model backed by the Minnesota Dental Hygienists’ Association, Hennepin County Safety Net Coalition and the Minnesota State Colleges and Universities system (the community colleges and public universities not affiliated with the University of Minnesota) and vigorously opposed in the legislative arena by the MDA.

The legislature also established a workgroup that included MDA representatives to determine the oral health practitioner’s scope of practice, level of supervision, education and regulation. The workgroup finalized its report to the state in December 2008. In the end, there was little consensus among its participants鈥擬DA endorsed the U of M dental therapist program while MNSCU, MDHA and the Safety Net Coalition moved in a separate direction by supporting their own model.

“The MNSCU model would expand the scope of practice for a dental hygienist after further education in a community college or state university鈥攏ot the U of M School of Dentistry,” Dr. Sledd said. “No institution in the MNSCU system has ever been accredited for teaching surgical and restorative procedures, and the OHP would be able to diagnose and treatment plan and provide these procedures without a dentist even being on-site.”

A separate bill advanced by the U of M School of Dentistry requests funding to create the dental therapy education program at the dental school.

Budget shortfalls will affect the proposals before the legislature during this session, said Dr. Scott Lingle, chair of the MDA Legislative Affairs Committee and a member of the ADA Council on Access, Prevention and Interprofessional Relations. Gov. Tim Pawlenty has proposed to cut spending in order to erase the state’s projected $4.8 billion deficit. Health care, colleges and universities, and aid to cities and counties are all on the chopping block, as are critical dental programs that provide preventive, restorative and palliative care to low-income patients.

There is also a chance both bills will be adopted, said Drs. Sledd and Lingle. The finance and health committees are expected to study the proposals in the upcoming weeks. The ADA News will provide updates on ADA.org as well as in forthcoming issues.

Minnesota will be the second state to authorize midlevel dental providers to perform irreversible procedures like restorations and extractions. Dental health aide therapists provide care to Alaska Natives living in remote villages of Alaska, an action opposed by the ADA and the Alaska Dental Society through a legal challenge that was settled in 2007. Maine is weighing the concept of a pediatric dental therapist workforce model, and Connecticut, New Hampshire and New Mexico are studying advanced dental hygiene practitioner proposals.