Utah law currently requires dental hygienists to work under the supervision of dentists (see Utah Code Ann. ? 58-69-801(3)). There are some public policy arguments to support this model. However, it is a model that many states are moving away from for equally, if not more, compelling reasons.
Tooth decay and gum infection are the two most common human ailments. With just a little preventive care, children can avoid these ailments throughout their lives. Dental hygienists are in an excellent position to teach preventive care. In fact, hygienists specialize in prevention while dentists specialize in treating the diseases that result from poor oral care.
Unfortunately, some dentists see teaching and training as being unprofitable — after all, it is not covered by dental insurance plans ?— so hygienists are relegated to cleaning teeth as quickly as possible. They might be able to talk about the importance of personal home care while they are cleaning, but no time is provided for education and hands-on training.
At about 6 months of age, the first baby teeth usually begin to show themselves. It is important for parents to gently brush those teeth. As more teeth come in, if food gets caught between the teeth, parents should remove it with dental floss. But it is critical that parents use proper equipment and techniques, or they are very likely to damage their child’s gums. Hygienists are the professionals who are best suited to offer guidance and advice.
Similarly, hygienists can help teach children to brush and floss their own teeth. Most children have the coordination to learn these skills by age 6. However, proper brushing and flossing are not simple matters. A good technique increases effectiveness, while a bad technique can damage gums and do more harm than good.
Hygienists can also apply sealant to a child’s permanent teeth. Dental sealant is the best preventive product to come on the market since brushes and floss. It is simple to apply and does not require the involvement or supervision of a dentist.
It is very important that children learn — at an early age — the healthy behaviors that will prevent dental ailments. After all, an ounce of prevention is worth a pound of cure. Our children deserve the opportunity to be taught preventive skills by trained professionals, to receive preventive treatment and to enjoy the many wonderful benefits of oral health. To put it simply, a clean and sealed tooth will not decay and gum infection will not begin around clean teeth. The result, as Dr. Louis H. Mayo, M.D., has said, is that “daily plaque control can add 10 years to your life.”
But children cannot control plaque without training. It is time to give hygienists the opportunity to provide this service without restraint. It is time for our Legislature to allow dental hygienists to practice independently of dentists. This model is called independent practice, and it allows hygienists to take time for training without sacrificing profitability because they are able to retain the full fee for their services rather than remitting it to their supervising dentists and working for an hourly salary.
Independent practice is already happening in some states. Implementing it in Utah would not cost the state or the taxpayers anything, but it would provide immeasurable benefits to our citizens, particularly our children and their parents.
*Boyd K. Tobler is a retired dentist and a resident of Lehi.
To “Boyd K. Tobler” my dentist and his hygenist already do what you recommend.
It sounds like you hang out with dentists that have bad practice, and bad hygenists that don’t care about preventing problems.
The problem that you describe can be taken care of directly by the hygenist in the dentist office. That has many advantages because you are already in the office and have the x-rays available for the dentist to see. Unless the dentist is only after money, and does not care about the health of their patients, the charges for dental hygenists are usually part of the checkup bill and would not change.
Under your scenario, I would have to pay overhead charges 2 times when getting a problem looked at, once by the hygenist and a second time by the dentist. Your proposal would make things more expensive.
Posted by: Redshirt1701 | 8:45 a.m. Dec. 8, 2011
Deep Space 9, Ut
It would have been nice to have my teeth sealed when I was young, but it could just as easily occur in the Dentist’s office as anywhere else.
How, oh how did we ever get by for so many millenia without a hygenist to tell us how to do it right?
I’m actually with Redshirt on this one (another Miracle, Red. That’s 2 in one week).
Posted by: RanchHand | 8:58 a.m. Dec. 8, 2011
Huntsville, UT
I believe the two previous commentors have missed the point. Millions upon millions of Americans DO have tooth decay and periodontal disease, so yes, clearly, there are a lot of people whose oral hygiene is inadequate or incorrect. Instruction from a dentist or hygienist is needful and currently lacking.
Secondly, and most importantly, allowing hygienists to practice independently would not require patients to visit both a hygienist and a dentist and add to the costs. Patients could choose one or the other, based on their preferences and needs, and this would actually save costs.
It is likely many hygienists would continue to practice in Dental offices anyway, and you wouldn’t have trouble combining the functions if you like.
The point is that consumers should have the choice, and Hygienists are qualified professionals whose practice need not be restricted by the government.
Posted by:CitizenX | 12:23 p.m. Dec. 8, 2011
SALT LAKE CITY, UT
I believe the two previous commentors have missed the point. Millions upon millions of Americans DO have tooth decay and periodontal disease, so yes, clearly, there are a lot of people whose oral hygiene is inadequate or incorrect. Instruction from a dentist or hygienist is needful and currently lacking.
Secondly, and most importantly, allowing hygienists to practice independently would not require patients to visit both a hygienist and a dentist and add to the costs. Patients could choose one or the other, based on their preferences and needs, and this would actually save costs.
It is likely many hygienists would continue to practice in Dental offices anyway, and you wouldn’t have trouble combining the functions if you like.
The point is that consumers should have the choice, and Hygienists are qualified professionals whose practice need not be restricted by the government. ,
Posted by: CitizenX | 12:23 p.m. Dec. 8, 2011
SALT LAKE CITY, UT
To “CitizenX | 12:23 p.m.” so now when they visit their hygenist and find out that they have a cavity or some other issue that requires a Dentist, they can set up a second appointment, get a new set of x-rays, and pay for the overhead of another dental office.
I don’t think that you have ever looked at your dental bills to see what your dentist is charging you. Most reputable offices charge you less for the time that you are with the hygenist than when you are having work done by the dentist.
Would you go to a medical office that was staffed only with nurses (not nurse practicioners)?
Posted by: Redshirt1701 | 4:42 p.m. Dec. 8, 2011
Deep Space 9, Ut
You may be right on that scenario, a hygienist might spot a problem that would have to be referred to a dentist, yes. I have two thoughts on that.
First, it would still be allowed for hygienists to work in Dental offices, and I suspect most will, as there’s not likely much market for standalone hygienists. So you could as a consumer, avoid that possibility by visiting a combined office.
Second, part of the logic for allowing independent hygienists is to improve overall oral health, so someone visiting one regularly and conscientious about brushing and flossing etc. is unlikely to have this problem.
To pursue your analogy of hygienists to nurses, I believe that nurses are not required by law to work under the supervision of a doctor, the way hygienists are required to be supervised by dentists. Note that you don’t see standalone nurses offices.
I have to mention my observation that most hygienists are female, and most dentists are male. The requirement that the women be supervised by a man, unlike many other professions, is striking. This is of course an anecdotal observation, but I think it bears thinking about.
Posted by: CitizenX | 5:54 p.m. Dec. 8, 2011
SALT LAKE CITY, UT
Most dentists currently require patients to see a hygienist for a cleaning before scheduling an exam. If problems are found, whether during the cleaning or during the exam, a patient is almost always required to make one or more subsequent appointment(s) for treatment. The fees for all dental services are limited by what insurance plans will pay. So allowing dental hygienists to practice independently from dentists would have no effect on consumers, either in terms of out-of-pocket costs or in terms of potential scheduling inconveniences. It would, however, allow dental hygienists to control their general profession as well as their individual practices. They are qualified to do so, and there is no rational basis for prohibiting them from doing it. Governor Herbert used his 2011 state of the state address to encourage state agencies to reduce or eliminate regulation that unnecessarily restricts commerce and free trade. This is a prime example of where it would be appropriate to do so, and I believe the Division of Occupational and Professional Licensing should consider sponsoring legislation in this area.
Posted by: Dentist’s Daughter | 6:48 a.m. Dec. 10, 2011
SALT LAKE CITY, UT
Independent dental hygiene is an opportunity for a dentist to create a partnership/collaboration with a hygienist that operates as a satellite office that offers a non-committal relationship with a regular dentist. The hygienist could, examine, scale, polish, whiten and educate and if restorative work is to be done, then a referral can be made.
These satellite offices could be in high traffic areas; malls, downtown, entertainment zones and even business parks where a dental office is unlikely to be established. Once a dentist has established their office in one place they are unlikely to move to a new location unless where they are is a real dog.
I have a business plan in the works, but no amount of plan will overcome the short sightedness of a dental profession too entrenched in keeping dental hygienists from serving the public differently than what is being done today.