Minnesota OKs mid-level dental care provider Oral Health Practitioner

St. Paul, Minn.鈥擳he debate over whether dental hygienists should be given the authority to perform irreversible procedures like extractions and restorations on patients in Minnesota has been resolved, at least for now.

The state Senate passed the omnibus higher education bill (SF 2942) April 21, which authorizes a new mid-level dental provider known as the Oral Health Practitioner to be established no earlier than Jan. 1, 2011.

Instead of establishing the Advanced Dental Hygiene Practitioner with no restrictions, the state’s commissioner of health was directed to form a workgroup to develop the parameters of the Oral Health Practitioner鈥攁 revised term for the undefined mid-level provider position鈥攖hat includes dentists from the practicing and educational communities. The workgroup will bring its recommendations for the scope of practice, supervision and education requirements to the legislature in 2009.

“The workgroup gives all the key stakeholders seats at the table,” said MDA President Jamie Sledd. “This means that the Minnesota Dental Association, the University of Minnesota School of Dentistry, the Safety Net Coalition, state dental board, Minnesota State Colleges and Universities, and the Minnesota Dental Hygienists’ Association will work together to determine what the Oral Health Practitioner will be.

“The Minnesota Dental Association now has the opportunity to help develop the scope of practice, training and supervision of the Oral Health Practitioner,” said Dr. Sledd. “We will also have a voice when it comes to ensuring that this new practitioner promotes access to oral health care in a way that is safe for the public and maintains Minnesota’s high standard of care.”

Included among the issues the workgroup will study, said Dr. Sledd, are the OHP’s education and competencies; accreditation of programs; scope of practice (preventive, diagnostic, palliative, therapeutic and restorative services that might be included); level of supervision required; appropriate practice settings; the economic impact on dental care and access; and licensure and regulatory requirements.

The approval of SF 2942 was a better outcome than MDA anticipated when the ADHP bill was introduced two months ago.

“We worked hard to convince the legislature that there were better ways to improve oral health access,” said Dr. Sledd. In March, MDA introduced a comprehensive access initiative of its own which included loan forgiveness provisions, enhanced scholarship programs, a study of the ADA’s Community Dental Health Coordinator workforce model and a revision of dental care administration in the state’s public health programs.

“The legislature was determined to get something passed in this session,” said Dr. Sledd. “All the key legislators who supported the MDA told us, ‘You have to come to the table with a solution and have to be able to work collaboratively with stakeholders.’ “

The ADA supported the MDA in its opposition to the ADHP, which was modeled after an American Dental Hygienists’ Association workforce proposal. “While far from ideal, this study provision will allow the ADA to assist MDA in collecting data to make our best case for the correct scope, education and training of this position,” said Dr. Mark J. Feldman, ADA president.

Many states are looking for ways to extend access to oral health care, especially for patients living in underserved areas, and see mid-level providers like dental hygienists as one solution.

Last year, South Carolina’s state dental board fought a legislative ruling that eliminated a requirement that dentists examine children before dental hygienists could perform care through the school system. The Federal Trade Commission later supported the hygienists’ right to see the children first.

On the other hand, the Maryland State Dental Association supported expanded duties for hygienists in public health settings as a sensible division of labor. As of Oct. 1, dental hygienists in Maryland will be able to provide limited services under general supervision in public health settings without direct dental supervision.

Currently, 18 states allow dental hygienists to practice with limited supervision, though state laws restrict the setting, the services or the duration of time over which hygiene care may be provided. Colorado is the only state with unlimited unsupervised dental hygiene practice, but Maine is about to become the second.

Minnesota SF 2942 calls for the commissioner of health to convene the study group by Aug. 1. “A key role for the MDA in this workgroup is determining the level of supervision associated with the Oral Health Practitioner,” said Dr. Sledd. “The study will explore under what conditions a mid-level provider would be appropriate, including when surgical procedures may be allowed. If some surgical procedures are allowed, will there be a dentist present?”

MDA’s advocacy efforts were consistently bolstered by grassroots members and students throughout the prolonged debate over bills in the Senate and House, said Dr. Sledd.

“I’m very proud of how hard the members and students from the University of Minnesota School of Dentistry worked and all the time they took to contact legislators and meet with them to discuss the ramifications of this legislation.”