Editorial: Dental common sense

Let hygienists work without prescription

Editorial, Sacramento Bee January 19, 2006

Eight years ago, after years of debate and in the face of fierce opposition from dentists, the state approved legislation that permits specially trained dental hygienists to work on their own without the supervision of a dentist under certain circumstances. Specifically, the law allows hygienists in California to clean the teeth of the home-bound elderly, people with disabilities and the uninsured - in short people who don't have the means or the ability to see dentists on a regular basis.

But there is one catch: Before hygienists can legally clean the teeth of patients on their own, they must first make sure that the patients get a prescription from a dentist. That requirement has proved to be an effective barrier to needed care, for obvious reasons.

The populations in need of the service are, by definition, underserved. They need the very care the hygienists provide because they have no access to dentists.

AB 1334 by Assemblyman Simon Salinas, D-Salinas, would solve the problem. It would permit specially trained dental hygienists to treat the homebound, schoolchildren, nursing home residents and patients who reside in areas where the state has certified a dentist shortage exists.

Not surprisingly, the California Dental Association is opposed. They claim that hygienists are not adequately trained to work without supervision. To allow them to do so, the dental group suggests in its letter of opposition, may pose a risk to patient safety.

That is self-serving nonsense. Experience shows that expanding the reach of hygienists benefits patients. Under two Health Manpower pilot projects conducted in California, hygienists treated 20,000 patients over a 16-year period without benefit of prescriptions and with zero adverse impacts.

Dental problems among the poor are epidemic in California. More than half of the state's schoolchildren have untreated tooth decay, which care by hygienists could help prevent. One survey found that 26 percent of preschoolers, 28 percent of the kids in kindergarten through third grade and 44 percent of high school students had no dental insurance coverage. AB 1334 would improve oral health for millions of poor people in this state who never see a dentist. It deserves to become law.