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Access to dental care is a challenge for many, especially those in rural and low-income areas. Many innovative solutions have been proposed to improve access to high-quality care. However, whenever we evaluate new proposals we must first ensure that we do no harm to those patients that need care the most.
One proposal currently before the Legislature has raised strong concern from a wide variety of public health officials and dental professionals.
The bill causing such widespread concern would allow dental hygienists to drill into teeth, cut gums and extract teeth without a dentist present or even on site. In addition to performing surgery, the hygienist would be allowed to prescribe drugs and independently make a final decision on the diagnosis of oral diseases without a dentist examining the patient.
All of these procedures, which currently require the oversight of a licensed dentist, would be granted to a hygienist with half the education without an objective, third-party examination as is required of all other dental professionals for obtaining a license. Nowhere in the U.S. has a program that combines this level of surgery with this level of minimal education been attempted — and for good reason.
Extracting a tooth or cutting into a patient’s gums are not simple procedures. The breakage of a root tip, uncontrolled bleeding and numerous other contingencies mean that the procedure should never be labeled “simple.”
To compound concerns, should the new practitioner actually treat those in underserved areas, they would likely face the most challenging and risky procedures that had been aggravated by lack of previous care and preventative measures.
Poor and rural patients in underserved areas deserve the same skilled professionals as everyone else. Suggesting that low-income individuals or those living in remote locations should be treated by practitioners who might be “good enough” is not an acceptable or responsible solution.
One would assume that with all the risks involved, the bill would truly guarantee at least some improvement in the number of oral care providers practicing in underserved areas. Yet, inexplicably, the new hygienist bill does not address that need at all. Rather than requiring, or even encouraging, these practitioners to set up shop in areas that are traditionally the most challenging areas to deliver care, it allows this new hygienist to practice anywhere in the state and does not require them to serve underinsured or underserved populations.
Minnesota has some of the best dental care in the country for a reason; fully trained dentists and hygienists work in concert to provide the highest quality of care.
We must preserve this high quality of care, continue to grow successful programs recently enacted by the
Legislature and develop innovate but safe programs that deliver care to all Minnesotans.
We look forward to working with lawmakers to build a foundation for comprehensive, common-sense solutions to our oral healthcare crisis that keep patients safe and healthy.
Malterud is president of the Minnesota Academy of General Dentistry, a member of the Minnesota Dental Access Coalition. Malterud practices in St. Paul.
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