OPINION: Research supports dental mid-level practitioners
Post Date: Feb 15 2015

By Tom Dennis − Editor, Grand Forks Herald
February 15, 2015
Opponents of licensing mid-level dental practitioners have a problem, and the problem is research.
Specifically, the problem is the absence of any research finding that fears of mid-level practitioners are warranted, as well as the presence of many conclusions that the reform works fine.
Here's hoping the North Dakota Legislature passes Senate Bill 2354, licensing advanced practice dental hygienists and letting science carry the day.
Since 2009, Minnesota has licensed dental therapists, mid-levels who can do not only dental hygienists' work but also a few tasks — filling cavities, routine extractions — that had been done only by dentists.
Maine and Alaska have similar programs, as do — notably — some 40 or 50 other countries, including Canada. Senate Bill 2354 would bring the reform to North Dakota.
Dentists' associations tend to oppose the change. Only dentists should perform those invasive and permanent procedures, they say.
But if safety is in fact an issue, then those states and countries that have made the change should be seeing the ill-effects.
So, what has been the experience elsewhere?
  •  "Although limited domestic research exists on the safety and efficacy of an expanded scope of practice for dental hygienists, studies of pilot programs have shown safe and effective outcomes," the National Governors Association concluded last year.
"International research provides stronger evidence that advanced-practice dental hygienists deliver safe, high-quality care."
  •  "Studies from Australia, Canada and the U.K., as well as Alaska, many employing blind evaluations, find that mid-level dental providers provide high quality care, including both diagnosis and treatment equal to that provided by dentists," a review in the Michigan Journal of Public Health declared in 2011.
"Moreover, MDPs provide this care in a cost-effective manner and enjoy a wide degree of social acceptance and patient satisfaction."
  •  "Federal Trade Commission staff support the Commission on Dental Accreditation's efforts to facilitate the creation of new dental therapy education programs and to expand the supply of dental therapists because these initiatives are likely to increase the output of basic dental services, enhance competition, reduce costs and expand access to dental care," the director of the FTC's Office of Policy Planning wrote in a November letter.
"(W)e write to urge CODA to finalize and adopt proposed standards without unnecessary delay, so that the development of this emerging service model can proceed, and consumers may reap the likely benefits of increased competition."
  •  For its part, the Commission on Dental Accreditation on Feb. 6 adopted initial accreditation standards for dental therapy education programs.
If this reform were a bad thing, then red flags would be waving over Minnesota, Alaska, Canada and elsewhere. Instead, the flags flying over those landscapes are green — or maybe white, signifying healthy teeth.
North Dakota should adopt this safe, high-quality and cost-effective change.

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