Teledental hygiene

California just enacted a law that will require Medicaid in California (Medi-Cal) to reimburse services delivered by dentists and dental hygienists collaborating via telehealth.1 This law will become effective this month and is a telehealth method that focuses on teledentistry. Basically, telehealth is as simple as providers collaborating on patient assessment and treatment by using electronic health records.

BYCHRISTINE NATHE, RDH, MS

California just enacted a law that will require Medicaid in California (Medi-Cal) to reimburse services delivered by dentists and dental hygienists collaborating via telehealth.1 This law will become effective this month and is a telehealth method that focuses on teledentistry. Basically, telehealth is as simple as providers collaborating on patient assessment and treatment by using electronic health records.

The bill expands the types of procedures dental hygienists and dental assistants can perform without onsite supervision by a dentist. This includes deciding which type of radiographs and when to take them, and temporarily restoring dental decay with specific dental materials.

The concept for the new law was derived years ago as a pilot project at the University of the Pacific in San Francisco called the Virtual Dental Home Demonstration Project. The goal of this project was to improve access to dental services at low costs. By creating a Virtual Dental Home in sites throughout California, the Pacific hopes to deliver oral health services in locations where people live, work, play, go to school, and receive social services.2

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This law should afford dental hygienists the opportunity to provide care as outreach workers in schools, nursing homes, and other settings outside of the typical dental practice. Also important is that this concept has an interesting historical perspective. It mirrors Fones' original initiative of creating dental hygiene positions within the Bridgeport Public School system.

Additionally, this law describes the need for appropriate training programs for this new technology and scope of practice. This is great news for dental hygiene and the populations served. As a profession, we should be educating our students to provide care as part of a teledentistry team. This could result in real transformation.RDH

References

1. http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1174

2.http://dental.pacific.edu/Community_Involvement/Pacific_Center_for_Special_Care_(PCSC)/Innovations_Center/Virtual_Dental_Home_Demonstration_Project.html


Excerpts from California
AB-1174 Dental Professionals SECTION 1.

(1) Determine which radiographs to perform on a patient who has not received an initial examination by the supervising dentist for the specific purpose of the dentist making a diagnosis and treatment plan for the patient. In these circumstances, the dental hygienist shall follow protocols established by the supervising dentist. This paragraph shall only apply in the following settings:

(A) In a dental office setting.

(B) In a public health setting, using telehealth, as defined by Section 2290.5, for the purpose of communication with the supervising dentist, including, but not limited to, schools, head start and preschool programs, and community clinics.

(2) Place protective restorations, which for this purpose are identified as interim therapeutic restorations, and defined as a direct provisional restoration placed to stabilize the tooth until a licensed dentist diagnoses the need for further definitive treatment. An interim therapeutic restoration consists of the removal of soft material from the tooth using only hand instrumentation, without the use of rotary instrumentation, and subsequent placement of an adhesive restorative material. Local anesthesia shall not be necessary for interim therapeutic restoration placement. Interim therapeutic restorations shall be placed only in accordance with both of the following:

(A) In either of the following settings:

(i) In a dental office setting.

(ii) In a public health setting, using telehealth, as defined by Section 2290.5, for the purpose of communication with the supervising dentist, including, but not limited to, schools, head start and preschool programs, and community clinics.

(B) After the diagnosis, treatment plan, and instruction to perform the procedure provided by a dentist.

(b) The functions described in subdivision (a) may be performed by a registered dental hygienist only after completion of a program that includes training in performing those functions, or after providing evidence, satisfactory to the committee, of having completed a committee-approved course in those functions.


CHRISTINE NATHE, RDH, MS, is director at the University of New Mexico, Division of Dental Hygiene, in Albuquerque, N.M. She is also the author of "Dental Public Health Research" (www.pearsonhighered.com/educator), which is in its third edition with Pearson. She can be reached at cnathe@salud.unm.edu or (505) 272-8147.

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