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Dental Hygiene Practitioner Debate Heats Up - Take Action Now

Dental Hygiene Practitioner Debate Heats Up - Take Action Now

June 5, 2016

The debate over authorizing “dental hygiene practitioners,” to improve access to good oral health, just heated up a lot more this week.

Background: Dental Hygiene Practitioners (DHPs) are dental hygienists who – after completing additional training – are able to deliver basic but critically necessary care to underserved populations in the state. DHPs work under the supervision of a dentist, and can bring care directly to people in schools, nursing homes, and other community settings. Access to oral health care is a particularly difficult for older adults, for people with disabilities, for children with MassHealth coverage, and for rural communities. Licensing this new oral health care clinician, as is done successfully in several other states, would expand access to essential health care for these underserved people.

With our strong support, the state Senate unanimously voted to include a provision creating DHPs in its version of the budget. But there’s no corresponding provision in the House budget, so the issue is up to the joint House-Senate budget conference committee which begins meeting this week.

However, the Mass Dental Society has come out strongly against the proposal, spending many tens of thousands of dollars to convince the public to oppose the provision. 

Meanwhile, objective experts are weighing in strongly in favor of the proposal.

Two weeks ago, Dr. Don Berwick, former president of the Institute for Health Care Improvement, an evidence-based center devoted to quality care, and a former national administrator of Medicare and Medicaid, wrote a detailed review in the Globe of studies supporting DHPs. He cited over 1,100 studies which found that DHP care is certainly comparable, and often superior, to care from a dentist. Berwick, who also sits on the state's Health Policy Commission, concluded,

“Proper dental care is as much a human right and as smart an investment as is proper medical care. By passing the Dental Health Practitioner legislation, Massachusetts now has a chance to add access to dental health to its list of proud commitments.”

This was amplified at a meeting of the state’s Health Policy Commission on Wednesday. The HPC revisited key findings on emergency department visits for preventable oral health conditions, noting that almost half of all preventable ED visits for oral health were paid for by MassHealth, while just 35% of all licensed dentists in Massachusetts accept MassHealth. In light of these glaring numbers, the HPC pointed to licensing DHPs as proven solution:

Health Policy Commission Support for Dental Hygiene Practitioners


Commissioners enthusiastically supported the proposal. Commissioner David Cutler stated that he was “convinced” of the model and Commissioner Berwick reiterated that establishing mid-level dental providers is a “slam dunk” policy that expands access, potentially decreases costs, and also serves as an opportunity for economic growth by providing a new health care career path. Although Commissioner Carole Allen admitted she was initially cautious as some providers have indicated concerns about establishing a “2-tiered system of care,” after further studying the significant amount of evidence affirming the quality of care delivered by mid-levels and their potential for expanding dental access, she is now a firm supporter of the model, she said.

Health Care For All rejects the calls for more study and delay.  The evidence is overwhelming that DHPs would provide high-quality dental care to people who need it the most. We urge people to contact their state representative and ask them to contact the House members of the budget conference in support of this “slam-dunk” policy.

                                                                      -- Kelly Vitzthum