A spirit of collaboration ... and, yes, Independence

July 1, 1999
New Mexico determines that the best way to ensure adequate dental care for its underserved populations is to get dental hygienists more involved.

New Mexico determines that the best way to ensure adequate dental care for its underserved populations is to get dental hygienists more involved.

Christine Nathe, RDH, MS, and

Barbara Posler, RDH

In New Mexico, dental hygienists now can practice in a truly collaborative manner with dentists. A recent change to the state`s dental practice act defines this new practice as collaborative practice.

On April 8, New Mexico Governor Gary Johnson signed HB 265, after it unanimously passed in the Senate (38-0) and in the House by a 48-11 vote. Dental hygienists now may choose to work without the supervision of a dentist. The bill specifically states:

"A dental hygienist may be certified for collaborative dental hygiene practice in accordance with the educational and experience criteria established collaboratively by the committee and board."

In addition, the definition reads:

"Collaborative practice of dental hygiene means the science of the prevention and treatment of oral disease through the provision of education, assessment, preventive, clinical, and other therapeutic services as specified in (the act)...without general supervision..."

In essence, dental hygienists may work in a variety of settings including, but not limited to, a school, nursing home, Head Start program, or private dental hygiene practice while referring dental needs to dentists and/or specialists. Hopefully, more dental hygiene needs will be met by this new practice option. In fact, comprehensive dental needs should be met by using dental hygienists as collaborative practitioners. Collaborative practitioners can provide an effective method of integrating the population that does not seek regular dental care into the dental care delivery system in New Mexico. Fragmentation of dental care, which is now evident in emergency rooms across the state, should be alleviated by this integration and collaboration.

Targeting the underserved

In autumn 1996, the New Mexico Dental Hygienists` Association became aware of an initiative to open five additional dental hygiene programs, supplementing the program at the University of New Mexico (UNM), Division of Dental Hygiene. A needs assessment survey projected that dentists had difficulty retaining dental hygienists, but specific information regarding the actual manpower of dental personnel was not available.

Consequently, the UNM Dental Hygiene program conducted a manpower study and found no apparent shortage of dental hygienists. A bill (SB661) was introduced into the state senate during the 1997 legislative session, requesting funding for the five new programs. After testimony from dentists, dental hygienists, and representatives from community colleges, the legislators tabled the request and asked the interested parties to work together on a solution.

As a result, the Commission on Higher Education then formed a task force on the issue. Interested dental hygienists, dentists, and other professionals collaborated on this task force. After additional research on the dental hygiene manpower issue, state officials increasingly became involved, eventually speculating that there may be a manpower shortage of dentists. The shortage of dentists was linked to tremendous problems with the delivery of dental care in New Mexico. In particular, the population utilizing Medicaid insurance was not receiving adequate dental care.

Two memorial bills were passed in the 1998 legislative session. One memorial focused on studying recruitment and retention of health professionals (SJM17). The other memorial was aimed at studying oral health care access issues in New Mexico (SJM21). Dental hygienists, dentists, and other health care professionals in the state became active participants, and the memorials were coordinated by the New Mexico Health Policy Commission (NMHPC).

Legislation was drafted based on the recommendations from the NMHPC. Specifically, the NMHPC recommended that dental hygienists be able to provide care without a dentist`s oral exam. The off-site, unsupervised provision of otherwise authorized standard dental hygiene services specified in the Dental Health Care Act should be allowed, the NMHPC stated. It was theorized that, by allowing dental hygienists to work in any setting without dental supervision, more of the underserved population would be receiving dental hygiene care and be referred for restorative dental care.

In conjunction with these meetings, the Dental Subcommittee of the Children`s Health Insurance Plan (SCHIPS) was actively working on children`s dental issues. This group was composed of several dental hygienists, dentists, and Indian Health Service health care workers. Most of the recommendations focused on preventive dental services for patients in the age range of prenatal to 19 years, and the services were to be administered by unsupervised dental hygienists.

A high profile in the health community

The grassroots approach was evident following the NMHPC legislative initiatives. It cannot be emphasized enough that this success story took a great deal of time by the state`s dental hygienists and other health care providers and many trips to the legislative sessions. Historically, dental hygienists have kept in contact with their legislators for the past few decades, which has ensured a good relationship between dental hygiene and the political environment. This legislative focus is seen in the political savvy of the dental hygiene association members. Because of the commitment of a core group of dental hygienists, the profession benefited by political validation of the dental hygiene profession?s ability to provide quality oral health care without the supervision of dentists. It is also vitally important to observe the fact that, during all meetings concerning dental hygiene and access to care, dental hygiene was always represented.

Another important link was the contact dental hygiene had with an interdisciplinary cadre of professionals. Nurses, physicians, health care workers, teachers, administrators, early Head Start directors, women?s organizations, various health care organizations, and dentists were instrumental in supporting the collaborative practice bill. Many dental hygienists had worked with these individuals on dental issues prior to the introduction of the bill, so they were familiar with the capabilities of a dental hygienist. This initiative from nondental hygiene professionals proved invaluable in promoting the important issue.

Lastly, dental hygienists worked together. All active hygienists were aware of the issues and were kept abreast of the meetings. Working collectively, while keeping communication lines open was important.

Support from health care entities outside of dental hygiene and dentistry is vital to the success of dental initiatives. Moreover, diligent work from the dental hygiene community is necessary to carry the message that dental hygienists are in a position to make an impact on dental care dilemmas facing society. A collaborative effort between dental hygienists, dentists, and other health care workers is a step in the right direction toward improving the oral health of society.

Christine Nathe, RDH, MS, is an assistant professor at The University of New Mexico, Division of Dental Hygiene. She can be reached at (505) 272-8147 or [email protected]. Barbara Posler, RDH, is the Chair, Regulation and Practice Council, for the New Mexico Dental Hygienists? Association in Albuquerque.

What New Mexico considered

- Changing the Dental Health Care Act to make the credentialing process easier for dentist to obtain a dental license.

- Allowing the unsupervised practice of dental hygienists.

- Increasing the salaries of dental health professionals in community health centers.

- Exploring ways of procuring additional slots for New Mexicans in dental schools including expansion of the WICHE program.

- Establishing rural clinical/practical rotations for dental students.

- Establishing a New Mexico general dentistry residency program.

- Implement an oral health professional career ladder enabling students to easily transition from a dental auxiliary to a master`s degree level dental hygienist.