LETTER: Dental midlevels can and do expand access to care
Post Date: Oct 20 2015

By Judy Bernat - Printed in the Grand Forks Herald
October 20, 2015
In his recent column, Dr. Brent Holman, executive director of the North Dakota Dental Association, misrepresented the facts surrounding advanced practice dental hygienists ("Dental therapist experiment isn't working," Page A4, Oct. 9).
He also failed to describe the benefits patients and dentists have experienced since Minnesota has allowed dentists to hire advanced hygienists. The evidence is clear: advanced hygienists play an important role in expanding access to routine dental care.
Advanced hygienists are similar to physician assistants on the medical team. They perform a smaller number of procedures than dentists, so they can complete their rigorous educations more quickly.
The University of Minnesota educates these providers side by side with dental students. All students − whether future advanced hygienists or dentists − must meet the same clinical competency on the routine dental procedures that both can perform.
The Commission on Dental Accreditation, which accredits all dental education programs, recently implemented training standards for advanced hygienists following years of study. This decision is an acknowledgment of the growing demand for advanced hygienists, and every U.S. institution that educates them has announced that they will be applying for accreditation.
Holman calls advanced hygienists a failed experiment and manipulates the American Dental Association's own research in an effort to dismiss the idea of advanced practice hygienists. The fact is that advanced hygienists currently practice in 50 other countries, and an increasing number of states are working to add these providers to the dental team.
There is nothing experimental about advanced hygienists, which is why more and more dentists are hiring them.
Since advanced hygienists began practicing in Minnesota in 2011, they have helped dentists improve access to care for rural, low-income, uninsured and Medicaid-insured patients while also reducing wait and travel times. As of July, 46 percent of the state's advanced hygienists were employed in nonprofit community clinics, federally qualified health centers or hospital-owned clinics. Forty-three percent worked in rural Minnesota, where the need for better access to care is great.
Holman also misrepresented the American Dental Association Health Policy Institute's recent report when he wrote that "Minnesota ranks at or near the bottom of states in the number of children who receive dental care under Medicaid." What he failed to mention is that North Dakota ranks even lower.
That means Minnesota is doing a better job serving children on Medicaid, even though North Dakota's Medicaid reimbursement rate is one of the highest in the country.
Clearly, there is a need to do more to help North Dakotans get dental care. I know Holman cares deeply about doing this, especially for children. His pediatric dental practice is among the few in our state that sees a significant number of kids on Medicaid.
Although he has concerns about advanced hygienists, I'd encourage him to visit with his colleagues in Minnesota who have hired them and now are able to care for more people.
Bernat is president of the North Dakota Dental Hygienists' Association.

You can read the original letter here

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