State news

Access, Sept-Oct, 2008

On July 8, Louisiana Governor Bobby Jindal signed into law a water fluoridation bill supported by the LDHA and the Louisiana Dental Association. Senate Bill 312 mandates that public water systems statewide with at least 5,000 connections provide cost estimates to the state for implementing fluoridation by March 2009. The state will then work with each system to find grants and state budget funds to implement fluoridation community by community. Communities can vote to opt out if 15 percent of registered voters sign a petition.

On August 6, the New Jersey State Board of Dentistry approved rules permitting licensed dental hygienists who meet certain educational and training requirements to administer local anesthesia under direct supervision. The rules stipulate that the supervising dentist must assess the patient and determine which anesthetic agent (infiltration or block) the hygienist may administer.

In order to qualify for the permit, dental hygienists must have passed the NERB written local anesthesia exam and have completed a board-approved course in local anesthesia administration. The required course must consist of 20 hours of didactic and 12 hours of clinical instruction, including a minimum of 20 hours of monitored administrations of local. Additionally, licensed dental hygienists who hold a local permit must complete four hours of continuing education in the administration of local anesthesia every other biennial renewal period. This does not increase the total CE requirement, which is currently 20 hours.

Once the approved regulations are published, New Jersey will be the 42nd state, including the District of Columbia, to allow dental hygienists to administer local anesthesia.

New Jersey Dental Hygienists' Association (NJDHA) President Winnie Furnari RDH, MS, FAADH, noted, "The longstanding work by the leaders and members of the NJDHA is highly commendable. We thank ADHA, all the dental hygienists, dentists and members of the public who gave their support. As a result, the vote was a unanimous one. We wish the remaining states all success in this endeavor by working with the boards of dentistry in achieving this benefit for our patients."

A bill to establish the Community Dental Health Coordinator (CDHC) provider was introduced in the Michigan state legislature. Senate Bill 1400 would establish a CDHC pilot program to allow CDHCs to practice in areas designated as "dentally underserved" by the state board of dentistry. The pilot program would be four years in length but it could be extended.

The proposed bill would enable CDHCs to take radiographs, apply fluorides, polish coronally, place temporary restorative materials and scale Type I gingivitis patients, among other services. The bill directs the CDHC to work under the supervision of a dentist, although the level of supervision is not articulated. The provider would not be licensed by the state and would be required to complete a training program accredited by the "American Dental Association's Workforce Models National Coordinating and Development Committee" and the ADA's "Curriculum Committee."

The legislation is pending in the Senate Committee on Families and Human Services. To date, no hearing date has been set. Neither the Michigan Dental Hygienists' Association (MDHA) nor the Michigan Board of Dentistry endorses or approves of this CDHC concept as written. MDHA is opposed to any scope of practice being included in this workforce model.

The California Dental Hygienists' Association (CDHA) looks forward to January 1, 2009, as the beginning of a new era for dental hygienists. On that landmark date, dental hygienists will take on the authority to create and implement regulations related to licensure and education, evaluate dental hygiene education programs, and oversee disciplinary actions for the dental hygiene profession through the new Dental Hygiene Committee of California (DHCC). The committee will consist of four consumers, one general practice or public health dentist, and four dental hygienists (one dental hygienist who is an educator and one registered dental hygienist in alternative practice). The DHCC will fall under the umbrella of the Department of Consumer Affairs.

"This is true regulatory autonomy. Regulatory autonomy is an important hallmark of a profession," says CDHA President Noel Kelsch, RDHAP. She continues, "The DHCC and the regulatory autonomy it creates are very important because these put the profession of dental hygiene in a position to prioritize the dental hygiene legislative agenda in California, as well as allow the profession to determine how to maximize consumer utilization of dental hygiene services."

Kelsch notes that "autonomy means self-government, not freedom from all supervision." Creation of the DHCC does not change dental hygiene settings or supervision levels, which are in the state statute. The DHCC can pursue changes in the dental hygiene scope of practice.

Kelsch describes the effort to create the Committee as a sixyear, sometimes challenging, "legislative journey." Between 2002 and 2006, CDHA introduced two self-regulation bills that passed through the California Legislature, only to see them vetoed by the Governor. However, Kelsch concluded, "So many dental hygienists continued to contribute their time, expertise and efforts to this cause that it ultimately led to a third bill's success. Passage of this bill will give us a stronger voice in the future of access to care, allowing hygienists to meet the needs of the citizens of California."