Tuesday, October 19, 2021

The Dilemma of Dental Health Disparities; is there a Solution?

As dental health disparities continue to plague an increasing number of people in this country, licensed dental hygienists, and other professionals are trying to make a difference. Too often, there is pushback against using the excellent resources that could be utilized for those who need it the most.


Why is there such a resistance to allowing competent professionals to provide needed health care services in underserved populations? When healthcare professionals are available to serve vulnerable populations, it makes sense to utilize them.


Consider the Dental Hygienist. After two years of required pre-requisites, completing an accredited education program that includes 2000 hours of supervised clinical patient care, an associate or bachelor’s degree in Dental Hygiene will be attained. They must successfully pass an 8-hour national board and separate regional board examination before applying for licensure. Dental Hygienists' knowledge and skills are further enhanced through working within public health and/or private practice settings.


Too often, in settings outside of the dental office unnecessarily restrictive state board rules or laws do not allow, for example, licensed dental care providers from working to their scope of practice. In other words, professionals are often restricted from providing more than a simple teeth cleaning, fluoride treatment, or tooth sealants in states, such as Georgia. There are many other oral care services within the practice scope of a dental hygienist provided every day in private practices for those that have dental insurance or the wherewithal to afford it.


However, people in Title I schools, senior care settings, domestic violence shelters, and Federally Qualified Health Centers or clinics (FQHC's) to name a few are not so fortunate. The disparity in access to services, Teledentistry, and the use of proven products and technologies available to prevent cavities and treat gum disease that would reduce discomfort, tooth loss, and unnecessary costs are still prohibited in many states.


The result is that the most vulnerable populations are left to experience increased pain, decreased ability to chew which makes eating more difficult and compromises nutritional intake, negative health consequences, learning challenges, employment issues, and needless emergency room visits.


It is past time to let go of antiquated laws and rules, fear tactics, and turf battles. Solutions already exist to reduce health disparities and are being used successfully in other states. Let us work together to remove the barriers and improve the quality of life and welfare of the people in Georgia and across our country.

Pam Cushenan, RDH, MS, FSCDH
Contact me at: softsmilesinfo@gmail.com; www.softsmiles.com; “Oral Health for Life”

Monday, April 13, 2020

When will the Access to Oral Health in Georgia Law Make a Difference to the Underserved???


After years of challenging advocacy and coalition-building across the state, a law (HB 154) was passed in 2017 to increase access to oral care in Georgia; it was enacted on January 1, 2018. This law allows Georgia licensed dentists to authorize dental hygienists that have been licensed for at least two years to provide these preventive dental services when the dentist is not present: oral assessments, prophylaxis (cleaning), sealants, and fluoride. This type of supervision by the dentist is referred to as General Supervision.

Although general supervision is also permitted in private practice settings, this law is intended to benefit low-income children, special patients, and older adults, as well as anyone who is unable to access services in traditional settings. The safety-net setting sites indicated for general supervision services are Title I schools, long-term-care settings, domestic violence shelters, Federally Qualified Health Centers (FQHC's), and hospitals. These are considered to be areas where our most vulnerable populations are found.

In order to assist the dental profession in transitioning safely and effectively into providing services within the community, Dr. David Reznik and Dr. Eunice Chay created a Toolkit that is available to all practitioners. Not surprisingly, change is painfully slow.

The first adaptors have been private practice dentists who are able to have their dental hygienists provide these preventive services in addition to x-rays for their patients of record; patients who are already established and have had an initial exam by the dentist in that practice. This has been an easy transition, as not much has changed for the patient, other than receiving an exam by the dentist before or after dental hygiene services were rendered.

What has been more challenging is the care being offered and provided in safety-net settings. This often involves the purchase of special equipment, such as mobile dental units and/or teledentistry. Plus, reimbursement is lower in these settings, whether Medicaid, Medicare, or sliding fee. Many dentists are reluctant to make the investment on a slower, lower return. Hurry up and wait...

In my next blog, we will be discussing some of the pockets of change in our state...

Next blog: The Access to Oral Care Crawl vs. Sprawl

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