What are you recommending to patients who want whitening done but seem to have major sensitivity on their teeth?

Let me know your thoughts,

Warmest regards,

Dentist in Rancho Cucamonga

1. Your strengths: Creating programs and curriculum for the hygiene department. Prevention for patients and how to get patients to say “YES” to your care.

1. Your weaknesses: Marketing my business and selling myself.

1. An ideal Sunday: Sundays are church and rest

1. Your favourite sports: Currently I do a lot of exercise which includes lifting weights. I love tennis.

1. Yours favourite dish: Sushi

1. An ideal working day: My ideal work day is having breakfast and coffee with my husband in the mornings. He oversees the financial aspects of Dental Practice Solutions and works with some of the dentists on their financials. We have a morning team meeting to discuss what we need to accomplish for the day and upcoming tasks, events. We suggest our clients have a morning team meeting so we do the same for our business.

      I have about two or more phone meetings each day with dentists.

1. Your hobbies: Fitness, reading various books, travels, quilting,

1. Your favourite TV shows: Many of the reality shows. I can just get lost in these. No thinking is required.

1. Interesting experiences and anecdotes from your practice:

      Lived in Spain at age 18 for a summer. My mother died of endocarditis. Last time she had hygiene appointment with me I found an abscess on lower left molar. She had the tooth extracted, a bridge placed and two months later died of endocarditis. This has made me passionate about spreading the word that Oral Health Contributes to our Overall Health!

1. The book you are currently reading:  I am reading many books. Once is called “Crucial Conversations.” Another one is The Big Leap.

1. Your favourite procedure: Scaling and Root Planning. I am a hygienist so go figure!!  J

1. A few time management tips: Begin with the end in mind.

 For example meet with your team each morning. This is NOT to discuss patients and flip thru charts but to discover what you don’t know.

Each team member has already audited their charts before the morning to discover things like:

Does the patient have outstanding treatment that needs to be scheduled?

Does the patient have a family member that needs to see the hygienist?

Even down to “Does the patient have a birthday this week?”

Even the personal things count!

1. Your message to young dentist and students?

      “Status-quo” is not a word. Nix that word and replace it with “Mastery.”

I think it is sad that dentists spend a lot of money and time in dental school and then building a practice (their business); then many of these dentists, I see them basically run their practice into the ground 20, 30, or 40 years later.Now their dental business is not worth any money. Some just give their business away or sell for very little money when this could be a big part of your income for retirement.

Think of this as an investment and you can consistently build your dental practice to be sustainable and something you will sell and add to part of the money for your retirement.Be open to having a mentor—a dental expert to keep you constantly, always moving forward to be your very best you can be.

1. Your husband’s contribution in your career:

      My husband is my biggest supporter. He is the one who told me I could build an empire. He saw me making big bucks for my dental hygiene society as the president and told me I had the ability to make money for myself by sharing my knowledge. I used to make a lot of money annually for the dental hygienists in my community and never would have thought that I could do this and make money for my own business IF I had a business. The rest is history.

1. How much time and money do you spend on CE:I spend maybe $5,000 annually as I travel to a lot of dental meetings. I spent thousands of hours educating myself and maybe 50 hours annually attending continuing education.

1. Are you looking backward or forward?

      Always looking forward

1. Your favourite vacation spot: Somewhere warm with a beach. Most recently was Hawaii but give me sun, warm temperatures, a beach, and I am happy!

1. You are passionate about: Prevention of oral disease, eating healthy and exercise.

1. Your favourite book: The Bible

1. Your favourite music: Soft rock and Top 40

1. Philosophy of life: I want to make life easy and enjoyable for others.

1. Your comments on http://www.dentistrytoday.info:

      It feels easy to search and manoeuvre around. What you are doing is amazing! You are creating a space for colleagues to learn from the best experts.

I want to compliment Dr. Veerendra Darakh for all of his efforts and hard work. This site is the very best place and resource for Asian dentists to gather information to help support their dental career.

http://www.dentistrytoday.infois a great support for women and student dentists. I also see this as a place to learn about dental products, technology and education so it allows a strong force for dental corporations to be seen globally.

If a company is looking to increase their revenue by promoting their products, this is a great place for them to be.

      Allow patients to request an appointment via your website.

1. Where have you lectured till now?

      All over the USA– about all 50 states even Hawaii as of August 2015! All over Canada except Toronto

1. Do you are rotary stones to sharpen scalers? 

​      Not usually​

1. After how many patients you sharpen your scalers?

​Most hygienist will work with freshly sharpened instruments.​

1. Do you feel that patients who have undergone dental bleaching are less prone to plaque accumulation? 

​      No​

1. How do you motivate patients for dental bleaching? 

​The way that works best to motivate patients to bleach their teeth is to ask them at the beginning of their hygiene appointment, "If there is one thing we can change about your smile, what would that be?" Most patients will answer "I want whiter teeth." Now, you have patient who "may" need old composites replaced return for new composites and they may accept a treatment plan for veneers. This one question will open the door to more high-end treatment.

1. What should be the constituents of a welcome kit for a patient?

​In today's world there is not a need to mail a welcome kit but when a new patient registers online they should be provided with your office mission statement, a letter from doctor – or the dentist they will be seeing.

Patients should receive information about the appointment they scheduled, a confirmation of the date and time of appointment, include a list of your office services, a map to get to your office, medical history, and cancellation policy, HIPAA form (any other office policies should and can be signed electronically once they arrive at your office). When possible have a way to electronically send all signed documents to your office electronically.​

1. Do you feel that a welcome kit should be sent by post to the patient or should be given to the patient in the clinic? 

​Prefer the office electronically send new patients documents to the patient. Its best if the patient can be sent a link to the office website and they complete necessary information before they arrive to the office. This is automatically sent to your office and it can merge with the patients chart.

1. Do you recommend discount coupons to grow the practice?

​Yes, Discount coupons can work. If you do decide to use coupons I suggest you offer Free Whitening to all New Patients. We have a system that is turn-key for dental practices to do this! The bleach syringes can be customized with your office information. Why promote another company’s name when your patients can take home a bleach syringe with your office name and information? Check it out how you can easily implement this system to get more new patients: http://bit.ly/WhiteningOrderform

I love Dentrix but Open Dental can work in various countries globally, so dentists outside the US should look at Open Dental in fact they are located here in Oregon!

1. How should the front office be trained so that they are able to disseminate information regarding oral hygiene effectively to patients?

      There are courses that teach communication and I teach DISC personality types which helps to effectively communicate with the 4 various personality types. (Not to promote myself but the DISC Profile helps understand various types of people and how they will accept communication messages, how you can get them to accept your care, etc.)

1. Your favourite dentist:

      My favourite is typically the one dentist I am currently working with and in fact I went "Undercover" to a corporate dental office here in Oregon and the dentist I had was fantastic! He did not know I was a dental professional but provided the very highest level of care!

      I actually love my clients who are dentists. I think they are wonderful people and the dentists I worked for while a clinical hygienist are also the most amazing clinicians!

1. Interesting anecdotes from your career has a hygienist:

      Not many hygienists can say they actually started a hygiene school from the ground up! I got to pick out all the equipment, hire the faculty, the office admin team and develop curriculum besides writing the accreditation papers for ADA approval.

1. How do you manage patients with implants?

      Some of my clients (dentists) are placing ceramic implants so they require special instruments for the hygienists to use. I suggest special ultrasonics and thatpatients return to see the hygienist every 3 months when there are implants present. Good home care is a must and no tobacco use!

1. Please describe the current medico legal scene in USA as pertaining to dentistry & dental hygienists:

      We have to be licensed by each region in the US or at least the state where a hygienist works. We must be CPR certified every 2 yrs. Some states require that you take blood pressure.

1. How many dental hygienists have been sued by patients?

      None that I know of It’s the dentist they will sue: The dentist is the owner and the one with the money.​

1. What precautions should a dentist & a dental hygienist take to prevent himself from being sued? 

Follow the standard of care and your legal and ethical responsibilities for your state, country, province, etc. Carry Malpractice Insurance "Just in case."​

1. You prefer hand scaling or scaling by an ultrasonic scalar:

      Personally, I don't get a lot of calculus so I prefer hand scaling but I think most patients can benefit from a combination of both and especially perio patients benefit from both!

1. Do you feel that an illuminated ultrasonic scalar has any advantages?

      If the clinician does wear a light on their head now, the illuminated ultrasonic is amazing!

1. You favourite client in your consulting business:

      The ones I am currently working with. Seriously?! I really enjoy working with the dentists who have been in practice less than 5 yrs. They are so eager to learn. Dentists with an attitude of "I don't need help!" are not able to grow. Leaders, people who will grow,are the ones who are open to always learning.

      Dentistry changes quickly and an open mind to constant and never ending learning is what it takes to be successful throughout your career and as a business owner it is imperative.

1. From which regions do you have clients from?

      I have the ability to work with dentists throughout the world: India, Brazil, Cyprus, Philippines, Australia and the US Virgin Islands.And of course the US.

* Please describe your career till date:

After high school I worked as a dental assistant and then graduated from University of Southern California in Los Angeles with a Bachelor’s degree in Dental Hygiene.

After graduation at USC I started working in clinical hygiene as well as teaching the dental hygiene students (senior students) clinical skills at USC and prepared them topass their state boards.

In 2000 started my business Dental Practice Solutions and also began teaching the dental students (senior dental students) “Practice Management” Course.

The school later went to PBL (Problem based learning) and no longer included this practice management course in the curriculum.

After we moved to Oregon a few years, in 2007, I was asked to help write the accreditation for a new hygiene school in Portland Oregon.

I am currently full-time with my business Dental Practice Solutions.Currently our focus is on the hygiene department and most recently launched Dental Hygiene Solutions which includes a (hybrid) online 6 month hygiene empowerment curriculum.This course encourages leadership in the hygiene team where they are empowered to lead the practice to provide premium services and helpenroll patients into treatment plans. I facilitate the course via SKYPE while the team views bi-monthly video modules with transcripts and implementation guides to put what they learn into action.

*Please describe your transition from a hygienist to a consultant:

I have worked really hard to transition from a clinician and academia into consulting. It has been a lot of learning and especially learning about marketing my business.

Being a consultant and business ownermore work than being a clinical dental hygienist. It is very rewarding to see the hygienists enjoy their careers more because they don’t have to work as hard when proper systems are in place. I get a big KICK—- A lot of energy –seeing my clients grow their business.Their dental practice grows quickly when we begin to work on their hygiene department which is very exciting.

*How should a dentist increase awareness regarding oral hygiene in his practice?

All dental professionals need to talk oral health and its relationship to total health. This needs to always be on the website, in brochures patients can take home, it should be on posters, etc. throughout the office. Oral health and how important it is to living a longer and healthier life needs to be a regular discussion –a conversation with our patients.

*Please describe how to set up an effective recall system:

First of all each new patient needs to hear the importance of their oral health and regular preventive care. We need to use words such as “Preventive Care” “Hygiene Appointment”, etc., vs. “Cleaning” Or “Deep Cleaning”.

At the end of each hygiene appointment a particular conversation takes place which tells the patient when they need to return and why they need to return. It’s the hygienist’s role to explain the value and benefits for returning.

Understanding this concept is how you will keep a large majority of your patients returning. It is never a question to the patient asking “When do you want to return???” I hear this all the time and in this situation patients will tell you, “Let me think about it and I’ll call you back.”

Give your patients reason, an urgency to return routinely and never allow patients to leave with at least telling them “Mrs. Patient, I am going to call you on _______ day to be sure we get that appointment scheduled.”

This is about 98% of your patients that need to leave with a next appointment. Strive for 98%.

Each month run a report of patients who do need a hygiene appointment. From the 1st time a patient comes to your office you should know how they want to be contacted and if they want a text message then 1st send patients a text message to re-connect with them to get them back for their necessary hygiene preventive  care appointment, exam with doctor and if necessary complete unscheduled treatment with doctor.

*Do you feel that patient education by a dentist could lead to patient resistance & suspicion?

Anything is possible but how doctor speaks to their patient makes all the difference. Patients don’t care how much you know but they care how much you appear and show that you care about them! This is what makes all the difference.

*What are qualities of a good dental receptionist?

Some qualities of a good dental receptionist are someone who speaks clearly and is upbeat, and very pleasant on the phone when they answer. This person needs to say the name of the office and their name then ask, “How may I help you?” OR “How can I make you smile today?” That always gets a big smile on the other end of the phone!

After the receptionist answers saying this they need to listen and be able to answer the patient’s questions. The receptionist is the 1st voice (first point of contact, most times) when a new patient calls the office so they need to sound professional, friendly and like they really care about the person on the phone. They should be able to tell each patient how great the doctor is!

*What are the qualities of a good dental hygienist?         

Qualities of a good dental hygienist are: friendly, patient-centred, a person who shows they care about people and who is able to communicate with patients so they are a “Partner” with the patient. They are like an advocate and they are working with the patient to discover and show the patient what is going on in their mouth-good and bad.

*Do you feel women dentists are better communicators?

Some are but I have worked with some who are not.

We are all unique in our own way.

Treatment Planning is the process of using critical thinking skills from the information taken in during the data collection phase of the hygiene appointment. You will then organize the pertinent patient data into a concise list of clinical situations.

These are discussed with the patient in a manner that will bring the patient into the treatment planning process. "Co-Diagnosis" = Patient and Clinician Decide. Inspire interest from your patient about their total health.

These suggestions will suppoort Five Star Dental Hygiene Care During the Treatment Planning Process.

Five Star Tips

1. Sit the patient up-right in the chair. Knee-to-knee and eye-to-eye
2. Nix the word "find" Saying something to the patient like this: "Mr. Jones remember when we were taking the pictures inside your mouth and we saw those areas that are bleeding? (Continue conversation about what you "See" or "Saw")
3. Use pictures to explain the treatment and areas of the patients mouth to be treated (Use brochures, tooth models, typodont, posters, print their perio chart and highlight, etc.)
4. Understand the various personality styles of people so you know how to speak at their level
5. Recognize when you need to provide help to your patient so you can support them to ask the right questions
6. Ask open-ended questions
7. Be proactive and know ahead of time what type of objections your patient may have (most objections have to do with: time, money or fear)
8. To overcome an objection talk about the benefits and value of completing treatment and this will be the opposite of their objection
9. Be open to scheduling a consultation appointment to further discuss more complex treatment plans
10. Role-play and practice treatment planning skills as a team

VIDEO/BLOG: Click the link to watch this 5 min training: https://youtu.be/sfIguRCZFt0

Are you doing all of these at this time?

What can you do to improve your treatment planning skills?

Grab the Free Resource Below to develop elegant communication with your patients. 

GET YOUR FREE RESOURCE HERE: http://bit.ly/ValueBenefitseBook

  ABOUT DEBBIE SEIDEL-BITTKE, RDH, BS

In 2000, Debbie founded Dental Practice Solutions, a dental practice management business focused on creating profitable dental hygiene departments, as well as improving the total bottom line of the dental practice. She has been named as one of Dentistry Today's Top Consultants for 10 years in  row!

Debbie is a former clinical assistant professor from the University of Southern California where she taught the senior dental hygiene students skills to treat periodontal patients. She also co-taught the practice management course  at USC from 200o-2002. (Until the school start PBL – Problem Based Learning) Debbie also wrote the accreditation for a new dental hygiene program in Portland, Oregon and is a former dental hygiene program director.

Debbie has a team of experts to guide teams throughout the world to provide quality, patient centered practices that sustain profits for the life of their dental practice.

It is very important that as a dental professional, you understand what a valuable role you play because we are helping our patients to live a longer healthier and happier life. Isn’t that right?

I sure hope you agree because my experience as a dental practice management consultant has proven to me that dental practices who embrace this philosophy are the happiest dental teams and the most profitable!

Do you currently enjoy what you do at your dental office? If you can share that enthusiasm with your patients it will spread great news throughout your community which is certain to bring more raving fans into your office! When you are happy and really value what you do for your patients, then you will experience not only personal joy but your patients are most likely to tell everyone about how much they love coming to your office! (Please view the 2 minute video: http://youtu.be/roSoFHCb3Vg)

This is one of the easiest ways to have new patients coming into your dental office each and every day your office is open! The key is to share your enthusiasm. It spreads like a wild fire!

Tip number 1 is: Value

Value what you do professionally and then add value to your patients.

What I mean by adding value to your patients is about using words that add value. When you speak to a hygiene patient for example; if that patient has 4 and mm pockets and BOP what do you say when scheduling the patient’s next visit?

What many STILL, in today’s world say (you know all the research we do have about the mouth/body connection- right?!)is this. I hear the entire team say the word “Cleaning”. It’s a word I consistently have to work with clients to not use with their patients! We are no longer in the business of cleaning teeth. In today’s world we are all about creating healthier and longer lives for our patients. Let’s get that clear and speak about this value we add to our patients.

Have you ever met a patient who didn’t want to live a longer and healthier life?

Well neither have I!

When a patient is making their next appointment, create value around why they need to return. It may sound something like this:

“Mrs. Johnson, today we talked about and you remember that I showed you (imagine the hygienist showed the patient those areas by using her/his intraoral camera) those areas where you have 4 and 5mm pockets and we saw the bleeding when I was probing. It is very important that you maintain these areas at home with your power tooth brush and floss plus, I need to get in there and remove the bacteria at least every 90 days to keep those areas healthy. And this is what will also keep your body healthy. To maintain the health of these areas and your body I want to see you every three months (or state what the correct interval is for each individual patient), so I can see you on Wednesday May 13th at 10 am. I know you like the morning appointments and I have the same time and day in three months available to see you then. Will that work for your schedule?”

Do you think Ms. Johnson is more likely to say “YES” to accept the dental hygiene appointment when you state it like this?

Many times I hear the scheduling coordinator ask something like this: “Mrs. Johnson, when would you like to come back for your cleaning?”

Which question do you believe has a higher level of confidence on behalf of the dental professional and adds value and benefits for the patient to return for routine care?

This is your schedule so take charge of it. You must feel proud of your office and the quality of care you provide your patients so OWN IT! Take control of getting patients back to the office and on time!

Tip Number 2: The dental hygienist is themost important person to schedule all hygiene patien’s next visit. The hygienist is the one team member who was just with the patient and discovered what the patients’ needs were. The hygienist knows exactly why the patient needs to return for their next dental hygiene appointment.

Imagine a patient hygiene preventive care appointment. Does your hygiene patient have disease in their mouth? Did the hygienist and patient discover areas of 4 and mm pockets with bleeding on probing? Most hygienists want to see this patient back in maybe six weeks or at the very most three months.

It’s in the hygiene treatment room that the hygienist is in the best position to explain to their patient WHY their patient needs to come back for their next hygiene appointment.

Many offices are sending a hygiene patient to the front desk to make their next appointment and by the time the patient arrives at the front desk, it is very possible, that the patient has already forgotten why they needed to come back see the hygienist AND many times the scheduling coordinator gets so busy that they forget to schedule the patients next hygiene appointment. Yes, I do see this happen ALL too often! At Dental Practice Solutions we review our client data weekly and it happens! No one really intends to let patients leave without a next appointment scheduled but for numerous reasons this happens. It is something to look at each week to be sure these patients are not lost and without a next appointment.

Team members, all the dental auxiliaries, have so much to do in so little amount of time, that making the patients next appointment can be easily forgotten. This is when time and money are spent chasing patients down to get them back to your office. The end result is the patient spends more time and money in the dental office because their oral disease has become a larger problem by the time they get back to their dental office. Now, the patient is spends more money to care for an oral condition that could have been easily treated or better yet – prevented.

I hope these tips will be helpful to you in keeping your schedule full and experiencing your perfect day’s schedule at the office.

Enjoy your day at the office and next week I will provide more tips to schedule your perfect day!

Please be sure to click on the 2 minute video at the top of this blog.

Please feel free to comment below.

Doctor, do you know what is happening with your patient’s next appointment?
Does your hygienist have time to schedule patient’s next appointment?
Check out last week’s blog which shows a pie chart and some information to help keep hygienists running on time.

Download your No Charge 7 Day Dental Hygiene Profit Program Here: http://bit.ly/7DayDentalHygieneProgram

ABOUT DEBBIE SEIDEL-BITTKE, RDH, BS

Debbie Seidel-Bittke, is Founder of Dental Practice Solutions, one of the largest dental consulting businesses focused on increasing profits through proven systems and services in the dental hygiene department.

Last year the clients of Dental Practice Solutions had no less than a 34% increase in their production and the collections followed alongside of the production numbers.

This alone, is only one of the reasons that Debbie is known for the 10th year in a row, as one of Dentistry Today’s Top Consultants!
Visit: http://www.dentalpracticesolutions.com for more information.

Dental hygienists who receive additional training in HIV prevention counseling and diagnostic testing may be appropriate professionals to conduct rapid HIV testing, according to a new study in the International Journal of Dental Hygiene (April 10, 2013).

Expanded rapid HIV testing initiatives are needed outside the routine medical setting to normalize HIV testing in the U.S., and the dental setting is a logical choice as almost two-thirds of Americans visit their dentists on a regular basis, the study authors noted.

Lead author Anthony Santella, PhD, from the Sydney Medical School at the University of Sydney, told that, to the best of his knowledge, the only other study that examined this topic among dental hygienists was in Italy.

And although the role of dentists and dental hygienists in chronic disease screening has been debated over the past few years, a study with a national representative sample of dental hygienists has not been conducted and published in the U.S., he noted.

“The overarching goal of this study was to determine knowledge and attitudes to HIV and willingness to conduct rapid HIV testing among dental hygienists in the U.S.,” explained Santella. “We hope by exploring these factors we can provide public health policy insight and evidence on the possible expansion of rapid HIV testing into the dental setting.”

Some stigma remains

The study authors conducted a cross-sectional survey of 634 practicing dental hygienists and senior dental hygiene students who were recruited by phone using a purchased list of dentists practicing in New York City, through in-person recruitment efforts at local continuing education symposia, and through New York City area dental hygiene schools.

After a thorough literature review, Santella and his colleagues chose two survey instruments to measure knowledge of HIV and attitudes toward people with HIV. The knowledge survey was adapted from the HIV Knowledge Questionnaire initially designed for populations with low literacy levels. The final survey used included 13 questions assessing knowledge. The HIV attitudes questions were derived from a scale originally developed for psychiatry residents.

Inclusion criteria for the study included being a U.S. resident and a practicing dental hygienist. The survey was conducted between September 2011 and January 2012.

Here are some of the key results:

Given a test of 13 questions on HIV knowledge, the mean test score in the group was 10.5.

Out of a total of 634 respondents, 475 (74.9%) achieved a score of 75% or higher on the knowledge test, and these individuals were divided into a group titled high scorers; the remaining 25.1% of individuals with scores under 75% were placed into the low-scorers group.

Those with high test scores were more likely than those with low test scores to feel comfortable about counseling about sexual HIV prevention methods.

Those with high test scores were also less likely than those with low test scores to feel that patients with HIV should be quarantined to prevent the spread of infection and to feel that dental hygiene students should be allowed to opt out of being able to treat patients with HIV.

A majority (58.53%) of the high-scoring group did indicate that they would be willing to conduct HIV rapid testing.

Santella told that he and his colleagues were surprised to find that even with a well-educated sample of 634 dental hygienists, many carried some level of stigma or negative attitude toward people with HIV.

“For example, even among dental hygienists with high knowledge of HIV, they felt people living with HIV should be quarantined to stop the spread of infection and that dental hygiene students should be able to opt out of treating patients with HIV,” he noted.

Dental offices located in areas where HIV surveillance reports suggest there are significant cases of undiagnosed HIV infection and/or late diagnosis should consider partnering with their local or state health department and sexual health clinics to offer rapid HIV testing, Santella added.

Many dental offices already offer chronic disease screening tests, and HIV testing can potentially be added to the mix of test offerings, he said.

On a completely different note, I have just posted on the continuing education forum about O’hehir University. A new on-line virtual university specifically for dental hygienists wishing to upgrade from a diploma/associates degree to a bachelors or masters degree in oral health promotion. Further details are at http://www.ohehiruniversity.com

In a public hearing March 21 at the Connecticut State Capitol, for example, members of the Public Health Committee heard testimony from some 80 people regarding HB 5541, which would recognize the practice of expanded function dental auxiliaries (EFDAs) and establish a new certification program for advanced dental hygiene practitioners (ADHPs).

Under the proposed legislation, Connecticut ADHPs — through a collaborative agreement with a licensed dentist — would be allowed to:

Formulate an individualized care plan
Administer local anesthesia
Diagnose and treat certain oral diseases and conditions
Provide diagnostic, educational, palliative, therapeutic, prescriptive and minimally invasive restorative oral health services, including preparing and restoring primary and permanent teeth using direct placement of appropriate dental materials; temporary placement of crowns and restorations; placement of preformed crowns; pulpotomies on primary teeth; direct and indirect pulp capping in primary and permanent teeth; and placement of atraumatic temporary restorations
Prescribe, dispense, and administer certain drugs
Remove mobile or exfoliating primary teeth and mobile permanent teeth
Place and remove sutures
Prevent or intercept potential orthodontic problems
Provide temporary reparative services to patients with defective prosthetic appliances
Use electronic technology to transfer digital radiography, photography, clinical assessment data, and fiber optic imaging in collaboration with other healthcare professionals when warranted
"The ADHP will add a new member to the dental team to deliver care to the underserved in Connecticut," the Connecticut Dental Hygienists’ Association (CDHA) website states. "This proposal will make it possible for thousands of underserved patients who cannot obtain care to receive needed dental care."

Testimony heats up

In written testimony submitted to the committee on March 20 and 21, supporters of the bill agreed with the ADHP.

"Millions of adults and children in the United States have inadequate access to dental care, which results in serious oral health problems," noted Jay Friedman, DDS, MPH.

"Expanding the oral healthcare workforce to include ADHPs, as proposed in HB 5541, will allow access to basic dental care for this underserved population, which has long been neglected by traditional dental providers."

“The creation of an ADHP makes little sense for this state.”
— Jack Mooney, DMD, Connecticut State Dental Association
Vicki Veltri of the Office Health Advocate — an independent state agency — testified that "this bill represents an important step in the development and maintenance of a robust and sustainable dental healthcare system while controlling costs. ADHPs will have an even greater impact [than EFDAs] on access to and the efficiency of Connecticut’s dental network, much in the same way that Advanced Practice Registered Nurses and Physician Assistants have increased access to medical care and reduced the overall cost of care."

In addition, Veltri stated, "the requirements that HB 5541 imposes for certification for either of these disciplines ensure that these providers have an appropriate level of education and training."

Even the state Department of Public Health (DPH) chimed in, noting that the DPH scope of practice review committee "did not identify any public health and safety risks associated with allowing appropriately educated and trained dental assistants and dental hygienists to engage in expanded functions or with allowing appropriately educated and trained dental hygienists to practice as midlevel providers."

Opposing views

But opponents of the Connecticut bill — which include the ADA — contend that public safety is an issue and question whether adequate education and testing requirements are being addressed.

"Appropriately educated and trained dental assistants and dental hygienists are proven assets to the dental team and help dentists deliver care more efficiently, permitting more people to receive the comprehensive oral healthcare they deserve," the ADA wrote in its testimony. "However, the ADA cannot support any call for the development of an ‘advanced’ dental hygiene position that would work ostensibly without the involvement of a dentist. Ultimately, HB 5541 would only serve to fragment care and splinter the effectiveness of the full dental team."

And Jack Mooney, DMD, chair of the Connecticut State Dental Association’s Access to Care Committee, noted that there is currently no CODA-approved program for ADHPs, no national or regional governing board, no independent assessment of the candidate’s dental surgical skills, and no definition on the administrative burden and costs of regulation that this new type of practitioner might place on the DPH.

"The creation of an ADHP makes little sense for this state," he testified. "ADHP educational requirements fall short for the amount of increased scope asked for … [and] there is no evidence that costs to the patient would be reduced, so its supposed effect on access will be negligible."

On March 21 the Connecticut Public Health Committee heard almost two hours of discussion on HB 5541 legislation, according to Celeste Baranowski, RDH, CDHA Legislative Chair.

"Connecticut dental hygienists made an excellent case and had wonderful witnesses who attested to the need for the ADHP," she told DrBicuspid.com. "We’ll be working with the committee members to see that the bill is advanced to the floor of the House and Senate, and a vote is expected in the next few weeks."

NJ bill moves forward

Meanwhile, the N.J. state senate last week passed SB 298, which would allow certified hygienists in New Jersey to expand their practices under the supervision of a dentist to schools, clinics, nursing homes, hospitals, prisons, and facilities that treat persons with developmental disabilities.

SB 298 would also:

Permit dentists to use discretion regarding when hygienists must practice under direct supervision, or under the physical management of a dentist, and restricts dentists to supervising no more than three licensed hygienists at a time
Mandate that dental hygienists can only administer local anesthesia, nitrous oxide and other anesthetic procedures designated by the State Board of Dentistry under the direct supervision of a dentist
Prohibit a dental hygienist from performing intraoral services aside from administering preventative measures, such as applying fluorides, sealants, and other recognized topical agents designed to prevent oral disease or discomfort
Establish that only those licensed to practice dentistry in New Jersey may diagnose, treat, or operate on another person and bill or receive payment for dental services
But the proposed bill, which now goes to the state assembly for consideration, would also prohibit hygienists from performing invasive procedures.

"This bill would allow hygienists to better serve and accommodate their patients in the most responsible and safe manner," noted Sen. Joe Pennacchio, DDS (R-Essex/Morris/Passaic), who co-sponsored SB 298 with Sen. Jeff Van Drew (D-Atlantic/Cape May/Cumberland).

Dental hygienists in New Jersey welcome the changes proposed by this bill, Rebecca Welch Pugh, RDH, executive director of the New Jersey Dental Hygienists Association, told DrBicuspid.com.

"As you know, the need for dental care is great. Dental caries is the single most common chronic disease of childhood, and yet, is largely preventable," she stated in an email. "The treatment provided by dental hygienists, such as fluorides and sealants, can do much to alleviate this situation. This bill will allow dental hygienists in New Jersey a new opportunity to deliver care they are educated, tested, and licensed to deliver."

Discussions with the New Jersey Dental Association brought their support to the issue, Pugh added.

"Currently the bill has received a positive vote in the NJ Senate and is on the agenda for an Assembly committee hearing," she stated. "No opposition has been identified."