135438491 © GDArts | Dreamstime.com

The Montana experience: Fighting House Bill 411 to protect children

March 24, 2023
Your state association has your back, but they need your help. Montana hygienists and the public came together to protect the children and defeat HB411.

I’m an ordinary hygienist. I work clinically in a general practice, and I pay my dues every year to the American Dental Hygienists’ Association and my state and local components. My involvement with my professional associations consists of going to some continuing education courses that they sponsor, occasionally considering (and so far rejecting) taking on a leadership role in my local component, and—on very rare occasions—writing to my representatives when urged to do so by those in the association who follow the political goings-on that affect our profession. Generally, I just expect my association’s professional lobbyist to fight for the good of our profession. To be honest, I find that aspect of the profession confusing and, well, kind of boring. 

So when Jackie Sanders, chief editor of RDH magazine, asked me if I would write an article on a bill that Montana dental hygienists recently fought that would allow dental assistants to provide oral prophylaxis to children, my first thought was, “You’re asking the wrong person.” 

You might also enjoy: Advocacy and lobbying as a dental professional: Finding your voice

But before I could reply to that effect, I thought about it. My conscience has always been a little uneasy with my lack of real involvement in the things that matter to the future of our profession, always allowing others to do the dirty work while I reap the rewards. And Jackie’s description of what these Montana hygienists went through was intriguing: “The work and the knowledge of this group of RDHs were exquisite and relentless on some levels. Mostly very stressful.” I enjoy writing, and I enjoy a challenge, so I put aside my misgivings and said, yes, I will do this. 

The official name of the bill is a mouthful: “An Act allowing a dental auxiliary to perform oral prophylaxis under certain circumstances; providing for education and exam requirements; allowing for relevant training and experience; extending rulemaking authority; and amending section 37-4-408, MCA.” For short, it is simply called HB411. 

Montana HB411 proposed unlicensed dental assistants provide “oral prophylaxis” to children ages 12 and under. The bill’s sponsor, a House representative and dentist from the Bozeman area, introduced the bill under the premise of “workforce shortage of dental hygienists.” 

The Montana Dental Hygienists’ Association (MDHA) and hygienists throughout the state spearheaded and mobilized the effort focused on protecting these young children who were the subjects of the bill. 

There were three “A” pillars to the lobbying efforts: advocacy, accuracy, and all together. This interview captures those three pillars from the perspective of three Montana dental hygiene leaders: Clancy Casey, past president and legislative cochair of the MDHA; Diedri Durocher, executive administrator of the MDHA, cochair of the Legislation Committee, and CDCA-WREB-CITA examiner; and Tonette Hollingsworth, president of the MDHA and past ADHA District X trustee. 

A peek at the interview

I’ve featured one answer from each dental hygienist here, and I invite you to read their entire interviews here. 

What was the original language in HB411? 

Clancy Casey: The original bill was for “oral prophylaxis by dental assistants.” There were amendments throughout the process. The first amendment read “supragingival scaling,” but the bill still had language about “oral prophylaxis.” The second amendment allowed for offices with 50% population of Healthy Kids Program (Medicaid) to participate with having scaling assistants. It was proposed the dentist would provide a donation toward hygiene scholarships due to the dentist making a larger profit. It is important to note that prior to the legislation, a “scaling assistant” was proposed to the Dental Board in March 2022. It was rejected with four of the five dentists on the Board voting against it. 

What was the main concern from dental hygienists? 

Diedri Durocher: We were most concerned with the protection of the children 12 and under who were the subject of this bill. It was tantamount to experimentation on a vulnerable population. The lesser amount of education (11 months compared to dental hygiene being at least three years of college) and no clinical boards similar to CDCA-WREB-CITA for dental assistants were problematic in the proposed bill. To be able to offer even supragingival scaling, a licensed dental hygienist needs to graduate from an ADA accredited dental hygiene program, take national boards, a regional clinical board, jurisprudence examination, pass a national background check, and hold an active state license. Yet a dental assistant would not have the same requirements. Dental assistants are valuable and essential members of the oral health-care team, providing support for the dentist and hygienist, and helping the office run smoothly, but they are not educated to perform any type of prophylaxis. 

Did you find legislators needed to be informed about our prerequisites, education, and services we provide compared to other personnel in the dental office? 

Tonette Hollingsworth: Yes. Unfortunately, most people outside of dentistry really have no idea what the difference is between a dental hygienist and a dental assistant. A lot of people assume that because the assistant works directly with the dentist, they have equal training as hygienists. The frustrating part of this was the misinformation given during the hearing about our education. This is where it is crucial to have testimony that explains the intensive study of dental hygiene, include prerequisites and number of lab and patient clinical hours. 

We can all do our part

I was very impressed by the determination of Montana dental hygienists to protect the safety of children and to spread the word about the problems with this bill. By banding together and raising the public’s awareness and getting them involved as well, the bill was tabled in the House Human Services Committee 17-4 and ended its trek through the legislative session on February 16, 2023. 

The lesson I learned in writing this article is that legislators listen to professionals and the public. We may not all be directly involved in the politics of our profession, but we can all do our part in protecting the public and defending the licenses we worked so hard to attain. 

Keep abreast of the legislative issues in your state through your state hygiene association. When issues come up, speak out. Remember, there is strength in numbers! Your voice counts! You can find your legislators here.

Author’s note: A big thank-you to Montana hygienists Clancy Casey, Diedri Durocher, and Tonette Hollingsworth for their valuable input for this article.