Making headway in providing access to care

Sept. 9, 2013
The "head in the sand" attitude and prevailing resistance to change may be catching up with organized dentistry.

The "head in the sand" attitude and prevailing resistance to change may be catching up with organized dentistry.

by JoAnn R. Gurenlian, RDH, PHd

Over the past month, I have been reading excerpts of articles in local newspapers addressing the issue of expanding access to oral health care by utilizing dental therapists and independent dental hygiene practitioners. Legislation in Maine and Massachusetts is prompting a discussion about the need for midlevel providers and alternatives to traditional dental practice settings for meeting the oral health needs of the public.

Although the discussion of midlevel dental hygiene providers has been in existence since the 1980s, the difference noted in these two states is that for the first time, the public is acknowledging a need and recognizing the wily ways of dental associations to block necessary change. In Maine, L.D. 1230 An Act to Improve Dental Health is being met with opposition from the American Dental Association. Their arguments against this bill are that there is no access to care problem nor is there a dentist shortage, and that dental hygienists have limited training. However, the facts speak otherwise.

  • There were 11,960 emergency room visits for dental problems by MaineCare patients in 2009, representing a $6.6 million expenditure that could have been avoided if these individuals were receiving regular preventive oral health care.
  • Fifteen of the state's 16 counties have federally designated dental health professional shortage areas.
  • Sixty-five percent of children on MaineCare cannot get dental care, making Maine the sixth worst in the nation.
  • Forty percent of Maine dentists are planning to retire or substantially reduce their hours in the next five years.
  • Dental hygienists who would serve as midlevel providers would have four to six years of education as opposed to the "semester's worth of school" misrepresentation promoted by the dental association.

Similar findings are apparent in Massachusetts with respect to need.

  • More than 600,000 residents live in areas designated as having a shortage of dentists.
  • Elderly in nursing home settings often go without oral health care.
  • Over 31,000 hospital emergency room visits in 2011 were the result of preventable dental problems.
  • Fifty-three percent of children in families eligible for MassHealth did not see a dentist in 2011.
  • Dentists do not accept MassHealth, the state's Medicaid program, in more than half of the state's 351 cities and towns.

The main concern expressed in Massachusetts by the dental association is the need to guarantee safety of the patients. Like the Maine Dental Association, the Massachusetts Dental Society misrepresents the level of education dental hygienists would earn to serve as midlevel providers.


Other articles by JoAnn Gurenlian


There appears to be a growing trend to call out dental associations for their astonishing denial of the facts and the unwillingness to address the oral health crisis that is occurring across cities, towns, and states in our country. The "head in the sand" attitude and prevailing resistance to change may be catching up with organized dentistry. Admittedly, this behavior has worked for 30 years, so why change now? During this time when preventive actions could have been taken but were stymied, the oral health of the public became worse. Access to dental homes has decreased, while oral diseases have increased. We have reached that critical juncture wherein even the public and legislators can clearly see that the current oral health care system has failed and other models of oral health care are needed. It is long past the time for dentistry to take Paine's advice and "Lead, follow, or get out of the way."

When all is said and done, the public looks to leaders who will create solutions to the problems at hand. The momentum to introduce alternate workforce legislation is not limited to Maine (LD 1230) and Massachusetts (HB 274). Kansas (SB 197/HB 2157), New Hampshire (SB 193), Vermont (HP 273/SB 35), New Mexico (HB 17/SB 567), Washington State (HB 1516/SB 5385), and North Dakota (HB 1454) are also pursuing alternative pathways to address these issues.

What can we do to contribute to initiatives to change the oral health care crisis in our country? First, support the current legislative initiatives. Write letters to legislators, newspaper editors, and the local community; offer to volunteer if you are in a nearby state to provide education; and champion those dental hygienists who have the courage to pursue change. Second, examine the oral health needs within the state where you reside and determine what health care models might be effective to prevent oral disease and improve oral health. Midlevel providers are not a panacea; they represent one approach to addressing a very complicated health care situation. Third, stay informed and active in your local, state, and national professional associations. Your voice needs to be heard on many levels.

In closing, be inspired by others who see a future for our profession and are not afraid of change. Phebe A. Blitz, RDH, MS, dean, Office of VP Academic Affairs at Mesa Community College and mentor to many of us says it best. "I believe laws will be changed soon to allow hygienists to provide care without supervision. Then we will be more effective and able to provide better quality care. By working supervised, we're cheating people out of what we could do if we weren't shackled to an old way of providing care."1 RDH


Majeski J. Dental Hygiene 2013-2113 and Beyond. Access. May-June 2013; 27(5):14. Retrieved from:

JOANN R. GURENLIAN, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing-education programs to health-care providers. She is a professor and interim dental hygiene graduate program director at Idaho State University, and president-elect of the International Federation of Dental Hygienists.

More RDH Articles
Past RDH Issues