Trisha E. O`Hehir, RDH, BS
A 1996 policy statement from the American Dental Asso-ciation proclaimed that dentists should be able to delegate scaling procedures to assistants. On several occasions, dentists have introduced legislation allowing dental assistants to perform tasks which are included in the defined duties of a licensed dental hygienist . The most recent case is in Kansas, where the state`s dental association introduced a legislative bill allowing dental assistants with "board-approved training" to polish and perform supragingival scaling.
We can take one of three approaches to these actions by organized dentistry to usurp the duties of our profession:
- We can ignore them and hope they go away.
- We can staunchly defend our profession and the duties we are licensed to perform.
- We can turn such adversity into opportunity.
At different times in our lives, we may respond from any one of these positions. The ostrich approach is the easiest to understand. Although the profession may be threatened elsewhere, if I don`t feel the pinch personally, it is hard to get excited. It is easier to look at my individual situation and see stability, respect, and a secure future. Giving up dental hygiene duties in another state doesn`t appear to threaten my current position.
In such a case, I don`t see why I should get excited. Chances are, I don`t even know what`s going on in other states. Even if I were aware, it`s hard to see how my involvement would do any good. I`m perfectly happy in my own world, in my own job, paying little or no attention to what happens several states away. Ignoring attacks against our profession is generally based on lack of information.
The second approach is a strong defense. When attacked, this is our first response. Those in a position to defend the profession gather together supporters to fight the battle. They collect evidence to negate the stand taken by the opposition.
In this case, the evidence included all of the reasons a dental assistant should not be allowed to perform dental hygiene duties. Treating patients requires more than a quick course in the use of power scalers and polishing cups. What about the detection and removal of subgingival calculus? What about assessing the periodontal health of the patient? What about the medical history of the patient?
It appears that the delegation of dental hygiene duties to dental assistants is motivated not by a sincere interest in patient health, but rather by greed. A dental assistant scales and polishes, and the patient is charged the same as if a dental hygienist had performed the procedures. The dentists involved clearly plan to increase their profits by paying less in salary.
Defense against licensure attacks takes money, time, and people. These are not our areas of surplus. Dental hygiene will never be in a position to outspend dentistry. Despite that fact, these battles can and have been won by dental hygienists getting together and working hard to preserve the profession as we know it. Defending our position is often a win-lose situation. It`s them or us. We both can`t win.
The third option appeals to me, turning adversity into opportunity. Instead of turning first to defense, maybe we should pause to look at the situation more closely. What opportunities can we see for our profession in such situations? We must look at these attacks as opportunities to negotiate. Dentistry proposes we agree to give up something of value. Our question should be: What can we reasonably expect the other side to give up? What would an equitable trade-off be in this situation?
How about an equitable trade-off
The proposed legislation in Kansas appears to be one-sided. The dental association proposal asks dental hygienists to give up supragingival scaling and polishing to dental assistants. What do the dentists propose giving up in exchange? Nothing. If they can introduce a bill detailing what we should give up, we should introduce amendments to such a bill detailing the equitable trade-offs they must give up as well.
It only seems fair that simple procedures should be taken from both sides. If scaling and polishing are so easy that dental assistants can learn these skills on the job, drilling and filling should be even easier. After all, research has shown dental hygiene students mastered restorative procedures faster and better than dental students. After all, these are really just simple technical procedures which can be delegated. This type of delegation of duties would please legislators, since cost savings for patients should be part of the solution.
Delegating simple amalgam and composite restorations to a lesser-trained individual is a good business decision. This is an opportunity for dental hygiene to get on the bandwagon of saving money for the public and freeing the dentist`s time for more costly and more involved procedures. This would actually be of benefit to dentists. Eliminating simple restorations from their schedule would allow them to focus their energies on more lucrative procedures.
I can`t see why dentists wouldn`t be happy to give up simple restorations, as happy as they must think dental hygienists are to give up scaling and polishing. However, they may cling to simple restorations as an integral part of their profession, saying it takes much more training to learn than could be provided in a short course for dental assistants.
Solve the shortage of dentists too
If the dental profession is unwilling to give up simple restorations to dental assistants, another solution to the shortage of dentists should be considered. According to recent statistics, 50 percent of the population is not now receiving dental care. There is definitely a shortage of qualified dentists. A quick solution to this problem would be to grant state licensure reciprocity for both Mexican and Canadian dentists. Allowing Mexican and Canadian dentists to start work tomorrow would provide a needed solution to this obvious and serious shortage of dentists! Was not the "shortage of dental hygienists" cited as justification for this bill?
Another focus of opportunity is the scope of practice for dental hygiene. Giving up scaling and polishing comes with a price. What would you like? What is it worth to you? What would it take for you to give up these duties? Several things come to mind, depending on the state: local anesthesia, self-regulation, the right to own a dental practice, or independent practice. Don`t let this list restrict your thinking. What changes would you like to see for dental hygiene? Negotiations can provide an opportunity to redefine the profession in a positive way.
What is your response to the latest assault on the dental hygiene profession? Do you ignore, defend, or see an opportunity? What will your response be next time?
Trisha E. O`Hehir, RDH, BS, is a senior consulting editor of RDH. She also is editor of Perio Reports, a newsletter for dental professionals that addresses periodontics.The Web site for Perio Reports is www.perioreports.com. Her e-mail address is trisha @perioreports.com.