Ga. dental board to reconsider hygienist proposal

The Georgia Board of Dentistry has rejected as written a proposed rule change that would have required a dentist's exam and written authorization before public health hygienists could provide basic preventive services in schools, community health centers, and prisons.

The board voted unanimously during its September 9 meeting to reconsider the proposed change again in 90 days.

Dental board President Isaac Hadley, DMD, declined to comment on the vote except to say that it was the third or fourth time the proposed rule change had come up.

Currently, Georgia law allows hygienists to work at dental facilities regulated by the state and county agencies without direct supervision of a dentist. But the Department of Community Health's Dental Provider Manual currently requires direct supervision for Medicaid reimbursement in Georgia, making it inconsistent with state regulations that exempt public health hygienists from the requirement of direct supervision, according to Elizabeth Appley, attorney for the Georgia Dental Hygienists' Association (GDHA). While dentists often go with hygienists to school-based settings so that the public health department can recover Medicaid reimbursement, they do not go in every instance, she said.

The proposed rule change would require that a dentist first examine a patient and issue written authorization for the hygienist's treatment, but would not require that the dentist be present at the facility.

The GDHA and the Federal Trade Commission (FTC) oppose the change, saying it would limit access to care, especially for children in rural and low-income communities.

"The proposed change will create an unnecessary obstacle for children receiving treatment at Head Start centers and in school settings for kids who are already in dire need of dental care," Janeime Asbury, RDH, president of the GDHA, told DrBicuspid.com.

The proposal was originally introduced in January but was tabled after the board heard extensive testimony opposing the change from the FTC, the Georgia Department of Community Health, district health directors, the American Academy of Pediatrics' Georgia chapter, and other community groups.

The proposed changes do allow hygienists to apply fluoride varnishes or rinses without a prior examination by a dentist.

The GDHA asserts that the restrictions would be a barrier to dental care, especially for schoolchildren.

"We don’t understand what the possible motive for this could be because it would have the effect of reducing access to care for poor and underserved communities," Appley told DrBicuspid.com. "There has been no evidence submitted that it would serve any public health interest, and there have been no reports of any problems under the existing rule that’s been in place for more than 20 years."

Access to critical preventive services provided by hygienists in school-based programs and community health centers helps prevent decay and other oral health problems in thousands of children and adults every year, and saves taxpayers millions of dollars annually in dental emergency room visits and extractions, Asbury said.

The Georgia Dental Association had expressed concern over the proposed change in a January 5 letter to the dental board. The group urged the board to allow hygienists to be supervised by a dentist who has given either written or oral instructions for patient treatment, but the dentist need not be present at the facility.

The FTC also opposes the change, saying it would likely would raise the cost of dental services and reduce the number of people receiving dental care, according to a recommendation sent January 5 to the Georgia dental board.