Legislative root canal Dentists, alas, still fight hygienist bill

The Sacramento Bee

July 5, 2006

A bill that would allow dental hygienists to clean teeth without a prescription barely won approval in the Senate Business and Professions Committee last week -- no thanks to the California Dental Association or the Senate's only dentist, Sen. Sam Aanestad, R-Grass Valley, who voted "no."

Shame on them.

The state's dentists have doggedly fought this sensible measure for months now. The bill, AB 1334 by Sen. Simon Salinas, D-Salinas, would allow specially trained dental hygienists to clean people's teeth and perform other oral health services without those patients first having to get a prescription from a dentist.

The prescription requirement, in law since 1998, has proved to be a significant barrier to dental care, particularly for the poor, the disabled and the elderly confined to nursing homes. Because many such people have no insurance and thus no access to dentists, they have no way to get prescriptions that would allow hygienists to perform their services.

Dentists claim they are opposed because patients would be placed at risk if seen by hygienists not working in a dentist's office. The terms of the bill and the available evidence make that hard to believe.

The hygienists allowed to practice independently under the Salinas bill must possess a B.A. degree or the equivalent. In addition, they must have a minimum of 2,000 hours of clinical training, complete 150 hours of an approved educational program and pass a written examination. Finally, they must have a contractual relationship with a dentist. In many cases, the hygienists will be assessing patients and referring them to dentists.

In three other states where hygienists can clean teeth and perform other dental health procedures without direct supervision from dentists and without prescription, there is no evidence of increased risk to patients. And under two health pilot programs in California, dental hygienists saw more than 20,000 patients without supervision by a dentist and without prescriptions with no adverse results.

So why is the dental association working so hard to defeat this bill? Could it be that dentists are opposed to it because hygienists represent a huge profit center in their practices and they don't want to lose control over them?

A report released this year by the nonprofit Dental Health Foundation concluded that the teeth of California's children are decaying at epidemic levels. The report found that 6 percent of the state's poorest children are in so much pain or have such bad infections that they are in urgent need of care.

There is an oral health care crisis in this state. Hygienists can help relieve the pain and suffering for millions -- if legislators stand up to the state's dentists.

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