Lawmakers hear dentistry proposal for rural areas
Post Date: Feb 10 2015

By Amy R. Sisk - The Bismarck Tribune
February 10, 2015
A proposal to get more dental services to rural North Dakota would make the state one of the first in the nation to allow dental hygienists to perform some of the same procedures as dentists.
Lawmakers heard from the dental and health communities Tuesday on Senate Bill 2354, which would authorize advanced practice dental hygienists to work in North Dakota. Those hygienists, who already practice in Minnesota and Maine, would be able to do basic procedures such as fillings and tooth extractions.
Rep. Marvin Nelson, D-Rolla, told the Senate Human Services Committee about the need in his district, which includes Rolette County with a high percentage of Native Americans.
The Ronald McDonald Care Mobile recently visited the county but accidentally parked six blocks away from the school it was scheduled to serve. The mistake meant that one-quarter of the kids slated to receive care on the mobile dental clinic did not make their appointments. Many of their parents worked a half hour away and did not want their children walking to the vehicle alone, Nelson said.
“As you move the dental care away from the patient, it gets worse,” said Nelson, who spoke in favor of SB2354, sponsored by Sen. Dick Dever, R-Bismarck.
Dever said 40 percent of the state’s counties have one dentist or none at all.
Supporters say advanced practice dental hygienists would not only help rural populations and Native Americans, but also the elderly and Medicaid and Medicare patients, who are less likely to receive adequate dental care.
The bill faces opposition from dentists, who say it’s too soon for North Dakota to allow advanced practice dental hygienists. They say there’s not enough evidence showing hygienists are an effective way to meet the state’s needs.
Sen. Brad Bekkedahl, R-Williston, who works as a dentist, said North Dakota needs to spend time monitoring the effectiveness of the hygienists in other states.
“I would much rather be the 10th or 12th or 15th state leading this charge instead of the second or third,” he said.
Paul Tronsgard, president of the North Dakota Dental Association, said lawmakers need to consider whether the bill might lead to large corporate dental operators that offer fewer services. He questioned whether there would be enough of a demand in rural areas to keep hygienists in business without subsidizing their work.
His organization is backing alternatives, including bills to simplify the school loan repayment program for dentists working in rural communities and serving Medicaid patients, as well as a measure to direct more money to a program that offers sealant to low-income kids.
Tronsgard also expressed concern over how much say North Dakota would have in the advanced practice hygienists’ training.
North Dakota State College of Science in Wahpeton has a two-year program to train dental hygienists and assistants, but the state but does not have a dental school.
Under the bill, the North Dakota Board of Dental Examiners would set education requirements for the advanced practice hygienists.
Rachelle Gustafson, executive director of the North Dakota Dental Hygienists' Association, said she hopes the board sets the bar high by requiring a master’s degree.
Schools in Minnesota offer master’s degrees in dental therapy, in which students take the same classes and tests as dentists, said Leon Assael, dean of the School of Dentistry at the University of Minnesota. Those students, however, only train for a limited number of procedures related to untreated tooth decay.
Students studying to become dentists see their dental therapy peers as a way to expand their future practices, he said.
“Those students that are working with these mid-level providers are embracing their relationship with those mid-level providers and understanding that this increases their capacity to make their communities better,” he said.
The bill also has the support of the AARP, North Dakota Public Health Association and Americans for Prosperity.
“We believe it will take some time, but we do believe there will be some dentists that will be on board with this,” Gustafson said.

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