On November 23, the Mississippi Board of Dental Examiners voted to change a regulation that will lower the standard of care to Mississippi’s dental patients by: 1) Allowing dental hygienists to practice up to 10 days a year without direct supervision from a dentist; 2) Allowing dental patients to go up to seven months without actually being seen personally by a dentist for examination; 3) Allowing a dentist with two hygienists to go on a two-week vacation, keeping the clinic open with only dental hygienists seeing patients.
The pressure to do this seemed to come only from the dental hygiene lobby and a few outlying dentists. The Mississippi Dental Association, when queried, voted overwhelmingly against changing this regulation.
When queried in detail for the need for this change in the regulation, it appeared there were only two answers: “Convenience to the dentist” and GREED.
The members who voted “yea” on this extended independent practice by hygienists were: Roy L. Irons, DDS of Gulfport (228-863-6413), Steven Mark Porter, DDS (662-328-1600), Dr. Robert L. Smith, Jr., DDS (662-429-5055) and Laura Currie Richoux, R.D.H. (228-896-7022).
The dental care team, which consists of dentists, dental assistants and hygienists, is the best model for insuring the highest dental care to patients. Allowing hygienists, if even for a limited time, to independently see patients without consultation by a dentist will ensure that malignancies are missed, that serious dental disease is missed or treatment delayed, and that the dental care of patients is diminished.
Those who believe medical/dental care and “access” are enhanced by allowing mid-level providers (nurse practitioners, registered nurse anesthetists and dental hygienists) increased independent practice are deluded. Mid-level providers such as these, practicing under the direct supervision of dentists and physicians, enhance patient care and in the case of anesthesiology, as the anesthesia care team, function well and safely. But independent practice by mid-level providers should not be the standard of care.
Despite the decades of endless lobbying by mid-level providers, nurse anesthetists are not physician anesthesiologists, nurses are NOT physicians and hygienists are NOT dentists. However experienced, no amount of training by mid-level providers eclipses, in the case of medicine, four years of medical school, three years of residency training and two years of specialty fellowships, and in the case of dentists, four years of dental school and at least two (sometimes more) years of specialty training.
I believe that Mississippi’s dentists will rue the day that the board changed this regulation. Once the nose of the camel is under the tent, the game is over. It will lead, inevitably, to clamors by mid-level providers for more, more and more independence, and the sovereign expertise of dentists will be lost forever.
There will be little to stop dental hygienists from lobbying again for further independence, and the state will see dental hygienists opening independent, freestanding hygiene clinics, to the detriment of Mississippi’s dental patients. This scenario is not as far-fetched as it appears. Nurse practitioners in the state, for all intents and purposes, practice independently of their “supervising” physicians, who are often up to 50 miles away. This is not supervision.
I urge the citizens of Mississippi, and especially Mississippi’s dentists, to call the above-named dentists who voted in favor of this change and let them know of your displeasure and anger at this radical change. In addition, you may express your dissatisfaction to the Board of Dental Examiners at 601-944-9622. Ask the board to vote on this again when the governor has replaced the missing board member. The citizens of Mississippi deserve the best dental care possible, and allowing independent practice days by dental hygienists will not accomplish this.
Heddy-Dale Matthias, MD, is a Northsider.