Editor's Note

WITH EVERY PASSING year, dentistry edges away from any Norman Rockwell portrait of a Caucasian dental hygienist showing a Caucasian child how to brush, demonstrating with an oversized brush and typodont. Access to dental care is a legitimate political issue, although still a relatively small one, and the boundaries of dentistry incorporate all low-income citizens.

WITH EVERY PASSING year, dentistry edges away from any Norman Rockwell portrait of a Caucasian dental hygienist showing a Caucasian child how to brush, demonstrating with an oversized brush and typodont. Access to dental care is a legitimate political issue, although still a relatively small one, and the boundaries of dentistry incorporate all low-income citizens.

California is such an interesting state to study from afar, isn't it? For example, in late 2014, the state auditor released a critical report about the efforts to adequately care for children in dental welfare programs. The agency overseeing children's dental care seemingly agreed with the criticism. The Sacramento Bee reported, "Health Care Services officials told auditors they agreed with the vast majority of the findings ..."

Basically, the agency was grilled for:

• Being unable to set up an adequate number of dental providers for low-income children who qualified for dental care.

• Not vigorously monitoring the insurer's (Delta Dental) role in the oral health-care process in the state's programs.

• Failing to increase the incentive of reimbursement to dentists over a long period of time, which prompts dentists not to accept new patients.

The California Dental Association didn't miss a beat in confirming its support of dental welfare in the state. The association said it was "disappointed" with the state's proposed budget, saying the governor ignored his own auditor. The current CDA president wrote, "We are disappointed that today's budget proposal does not make any attempt to address the access crisis that has resulted from Denti-Cal's failures. The findings of the state audit make it very clear that the Denti-Cal program needs substantial improvements in order to provide timely access to care for patients. This includes ensuring an adequate provider network and requires reasonable reimbursement rates."

By the way, the audtior's report clearly states in a repetitive manner that dental disease is largely preventable. In case someone needs to know, the phone number for the California Dental Hygienists' Association is (916) 993-9102. The prevention of dental disease is what all of those dental hygienists scattered from Redding to San Diego are there for. Give them a call, would you? Let's see if we can prevent some of this disease requiring the attention of underpaid dentists.

California, of course, is also a pioneer in the access to care arena, having brought RDH in alternative practice to fruition over the last 30 years or so. The number of RDH APs are in the hundreds now, rather than the dozens for many years. (See Christine Nathe's articles on RDHAPs on pages 66 and 68 in this issue.)

The attitude that often sticks with me regarding the dental hygiene approach to access to care is the simplicity of it. A dental hygienist wishes to break from traditional occupational niches and starts an independent practice targeting potential patients with all sorts of financial and physical impediments in her community. Often, it seems to be an option for the future when the hygienist tires of her current niche in dental hygiene - something to fall back on, if need be.

Regardless of personal satisfaction derived from serving a need, many dental hygienists - especially if alternative paths continue to be developed in various states - need to pay bills and earn revenue. So California's struggles to finish the job of providing access to care remind us that it's a tough task to develop public policies for millions of residents. Just hiring bureaucrats to oversee equitable reimbursement to dentists and dental hygienists is an exercise in futility.

So as we edge away from any warm and fuzzy depictions of dental care in Rockwell paintings, it becomes mandatory for dental hygienists to support their advocates. You've heard every possible argument on why it's important to be a member of the American Dental Hygienists' Association. This is perhaps the most important one. The future of dental hygiene is dependent on a strong organization that needs the support of all its members while sorting through the complex array of nuts and bolts to deliver (primarily preventive) dental care to a large population that desperately needs it. We're talking about millions of dollars and hundreds of clinics treating underserved patients in every corner of a political jurisdiction's boundaries. The ADHA needs your support in defining the best solutions for those residents. It won't work otherwise.

Mark Hartley

markh@pennwell.com

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