ADHA Supports House Committee Examination of Medicaid

Chicago—February 14, 2008—The American Dental Hygienists’ Association (ADHA) applauds the House Oversight and Government Reform Subcommittee on Domestic Policy for holding a hearing to address Medicaid’s response to systemic problems highlighted by the death of Deamonte Driver last February. Deamonte’s death from complications relating to an abscessed tooth provided all of us a tragic reminder that lack of access to oral health services can have serious—even fatal—consequences. Even more heartbreaking is that this tragedy could have been avoided as virtually all dental disease is preventable. Regrettably, despite this proven prevention capacity, dental caries (tooth decay) remains the single most common chronic disease of childhood, five times more common than asthma. The Centers for Disease Control recently reported that dental caries—which is an infectious transmissible disease—is on the rise among preschool children. Until the oral health care delivery system is restructured to improve access to dental care, children and other underserved populations, will continue to suffer needlessly from preventable dental disease.

As the largest national organization representing the interests of the more than 156,000 licensed dental hygienists and the patients they serve, ADHA is committed to working with this Subcommittee and all members of Congress, the entire dental community, and all who care about the nation’s oral health, in order to improve access to oral health services. As part of the oral health care team, dental hygienists play a key role in administering preventive care and treating oral disease while in its early stages. As research that speaks to the direct correlation between oral health and total health continues to emerge, the importance of individuals having access to preventive oral health care will increase and the need for services provided by dental hygienists and other members of the oral health care team will grow. It is imperative to the health of our nation that all Americans, particularly children covered by Medicaid and the State Children’s Health Insurance Program, have access to oral health services.

One way in which access to oral health services for underserved populations can be improved is through better utilization of the dental hygiene workforce. Dental hygienists are licensed health care professionals educated and trained to administer a range of preventive and educational services. The dental hygiene profession has been identified by the U.S. Bureau of Labor Statistics (BLS) as one of the fastest growing professions in the country. The population of dental hygienists is projected to increase by 30 percent by 2016.

In contrast to the booming professional population of dental hygienists, the most recent BLS data notes that the number of dentists is not anticipated to keep pace with the increased demand for dental services. An average of 6,000 dentists retire annually while little more than 4,000 new dentists graduate from dental schools each year. As the 2004 Report of the National Advisory Committee on Rural Health and Human Services noted, “the acute shortage of dentists is expected to worsen in the coming years.” The declining ratio of dentists to that of the population is a further concern as the U.S. population ages and the need for oral health care services increases.

In recognition of these workforce realities, a growing number of states—currently 22—allow dental hygienists to plan and initiate dental hygiene treatment without the specific permission of, or pre-examination by, a dentist. Additionally, 12 states recognize dental hygienists as Medicaid providers of oral health services and provide direct reimbursement for their services. These states are: California, Colorado, Connecticut, Maine, Minnesota, Missouri, Montana, Nevada, New Mexico, Oregon, Washington, and Wisconsin. The Center for Medicare and Medicaid Services should make other states aware of this approach, which makes it possible for dental hygienists to reach out directly to underserved populations.

In the wake of Deamonte’s death, a number of states, most notably Maryland, have expressed a renewed interest in examining what measures can be taken to improve the delivery of oral health care services to Medicaid patients and other underserved populations. Maryland convened a Dental Action Committee in 2007 to make recommendations on how access to oral health care can be improved for underserved children in the state. The Dental Access Committee’s final report, issued in September, included a recommendation “for immediate action” to establish a public health dental hygienist to serve patients in public health settings.

The Maryland Dental Hygienists’ Association is committed to working with other stakeholders in the state to bring about the systemic changes recommended by the Dental Access Committee to improve the delivery of care to children. At the national level, ADHA is developing an Advanced Dental Hygiene Practitioner (ADHP) provider model. ADHPs will be licensed dental hygienists who are Master’s level educated and trained to provide an increased scope of oral health services to patients in underserved areas. ADHPs will perform the traditional range of services currently administered by dental hygienists as well as additional prescriptive and minimally invasive restorative services. The ADHP will serve as a mid-level provider in oral health, functioning as a new member of the dental team. ADHPs will refer to dentists and other providers for needed services that lie outside of their scope of practice.

The concept of a mid-level provider in oral health is not a new one. More than 40 countries currently have established mid-level providers in oral health, including Canada, the United Kingdom, Australia, and New Zealand. In the United States, mid-level providers in medicine, such as nurse practitioners and physician assistants, help streamline the delivery of medical services.

The need for a mid-level oral health provider in the United States is reinforced by the growing body of data that illustrates the significant access to care problems which millions of Americans face on a day-to-day basis. A number of disturbing statistics highlight the access to care crisis in oral health in America. Tooth decay, while preventable, remains the nation’s most common chronic disease of childhood, five times more common than asthma. The National Association of Community Health Centers found that “restorative and preventive oral health services” were the top two most needed services in health centers across the country.

ADHA believes the Advanced Dental Hygiene Practitioner represents a timely, effective mechanism to help increase access to oral health care services for those who are currently disenfranchised from the oral health care system. As a Master’s level educated, licensed professional able to provide care directly to patients in a variety of public health settings, ADHPs would serve as a new entry point into the oral health care system. ADHA looks forward to finalizing the educational competencies for this new oral health care professional and seeks support for pilot testing the Advanced Dental Hygiene Practitioner concept.

ADHA applauds the House Oversight and Government Reform Subcommittee on Domestic Policy for highlighting the significant systemic problems that accompany the delivery of oral health care services to underserved populations. Oral health services must increasingly be provided directly to underserved populations in public health settings such as schools, community health centers, and nursing homes. Systemic changes that facilitate better utilization of the dental hygiene workforce, such as allowing dental hygienists to be directly reimbursed by Medicaid, allowing for greater latitude in dental hygiene practice, and establishing the ADHP provider are all changes that can help the nation improve access to oral health care.

For more information about ADHA, the Advanced Dental Hygiene Practitioner, dental hygiene, or the link between oral health and general health, visit ADHA at http://www.adha.org.

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