Dental hygienists at center of public health furor

Anita LaTourette, a dental hygienist, travels to elementary schools and works on hundreds of Georgia children every year.

Through a public health program, LaTourette cleans teeth, removing bacteria, and applies sealants and fluoride treatments to students on the free-and-reduced-lunch program. “A lot of the children have not seen a dentist,’’ she says. “We’re their dental home.’’

But LaTourette fears a proposed change in Georgia Board of Dentistry rules may limit access to dental care that children currently have through public health.

Consumer advocacy organizations, public health officials and some legislators, as well as hygienists like LaTourette, are protesting the proposed Georgia rules change on supervision of dental care in public health settings. They say the revision would require a dentist to examine a patient prior to a public health hygienist’s treatment.

That change would increase costs and reduce access to dental care for poor children, these groups say.

The rule revision is scheduled to be discussed at a hearing before the state dentistry board Friday in Macon.

The proposal has created a sudden uproar within public health circles. The Federal Trade Commission staff has even weighed in, saying in a letter that the revision “would harm the state’s most vulnerable consumers. The lack of dental care is a particular problem for children in rural and low-income communities.’’

The board’s executive director could not be reached for comment. Meanwhile, though, the Georgia Dental Association, which represents dentists, says there has been ‘’a lot of misunderstanding’’ about the proposed change.

The Board of Dentistry is trying ‘’to codify what public health dental hygienists are doing now,’’ says Martha Phillips, GDA’s executive director. “I don’t think the board was trying to take away anything that public health hygienists are doing.’’

With many questions surrounding the issue, Phillips says, the dental board needs to clarify what’s currently allowed. Yet she acknowledges that the proposed wording is flawed.

Many children in need of dental care

The impact of dental disease in children, meanwhile, is substantial. An estimated one in five children go without dental care in a given year. More than 51 million school hours nationally may be lost each year to dental-related illness. The Georgia Dental Hygienists’ Association, citing a 2005 survey, says 27 percent of Georgia third-graders have untreated tooth decay.

The percentage of Georgians living in areas where dental health professionals are in short supply exceeds the national average, adds Dr. Harry Heiman, director of health policy at the Satcher Health Leadership Institute at Morehouse School of Medicine.

“There are significant disparities in oral health in low-income minority communities and rural communities,’’ Heiman says. “It costs pennies on the dollar to prevent dental disease versus treating it after the fact.’’

A 2010 Pew Center report gave Georgia a “C” grade on its dental access for disadvantaged children. That grade, though not exemplary, is better than or equal to other Southeastern states, except for South Carolina, which received a “B.’’

Terminology comes into play

Georgia’s public health director, Dr. Rony Francois, citing the Pew Center report mentioned above, said in a letter last month to the Board of Dentistry that Georgia’s current rules governing hygienists “are among the most stringent in the nation.’’ The Dental Association’s Phillips disputes that characterization.

At its core, the conflict over the hygienist practices centers on terminology. Currently, public health dental hygienists see children under what’s known as “appropriate supervision.” The meaning of that phrase has not been defined by regulation, but it has been interpreted by many as allowing a dental hygienist to work on child without a dentist seeing the child first.

The Board of Dentistry’s revision would change the term to “indirect supervision,” though it’s not exactly clear to a layperson what that phrase would mean.

The Dental Association’s Phillips says the current public health policy needs clarification. She says a state official reports that public health dentists already evaluate children before sealants are applied to their teeth.

Consumer groups and public health officials say the terminology switch would be a change in policy, not a clarification. They say it would require a dentist to assess the need for preventive treatments before a hygienist could work on the patient. That, according to Francois, would raise costs and thereby reduce access to dental care for low-income children.

“There is no evidence that the care provided by Division of Public Health dental hygienists under current regulations has had any detrimental effect on Georgia children,’’ said Francois. “Nor is there any evidence in the dental literature to suggest that dental hygienists are not capable of initiating and carrying out these services.’’

Joann Yoon of the consumer group Voices for Georgia’s Children says access to dental care for children is already limited in the state. “We don’t want it more limited in any way,’’ she says.