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Dental Hygienists Want Pair of Bills to Clarify Their Enhanced Practices

Two bills introduced by Sen. Fred Girod, a dentist, would give clearer authority for dental hygienists to practice in Oregon as they have already been doing. One restores their right to prescribe fluoride and antimicrobials; the other refines the state law governing their practices, but faces opposition from Capitol Dental.
February 5, 2015

The Oregon Dental Hygienists Association is pushing two bills intended to clean up bureaucratic snafus and ensure that the liberal scope-of-practice given to hygienists under Oregon law in 2011 can work effectively in dental practices.

The simplest bill, Senate Bill 302, would restore the authority of dental hygienists to prescribe, dispense and administer fluorides and anti-microbial solutions.

The dental hygienists’ lobbyist, Alec Shebiel, told the Senate Health Committee on Monday that they had long had the authority through the Board of Dentistry to use such medications, but ironically lost it when they asked to be allowed to administer epinephrine shots -- or epipens -- an authority recently granted school teachers.

A state assistant attorney general, in reviewing the state’s statutes, found that dental hygienists not only don’t have authority to administer epipens for cases of anaphylactic shock, there was no statute that said they could use prescription fluorides and antimicrobials, either.

SB 302 provides a clear statute giving them the right to prescribe these products necessary to their job, and also edits state law to make clear that the use of such products is a basic part of a dentist’s work.

“This bill needs to move quickly to solve this problem,” Shebiel said. It could hardly breeze through the Capitol more quickly -- it passed the Senate Health Committee unanimously on the first day of the session and could pass the full Senate by the end of the week before it get goes to the House.

A second measure, Senate Bill 301, would remove language from state law that independent dental hygienists are required to follow, but which Shebiel said the Dental Hygienists’ Association finds confusing.

One of the requirements of the Oregon Dental Practice Act for dental hygienists who wish to have enhanced practices is that they conduct an “overall risk assessment and referral parameters” with a dentist. But since all dental hygienists do this regardless if they want to operate more independently, Shebiel said the language was redundant.

The bill keeps intact requirements that dental hygienists reach an agreement with a licensed dentist about the administration of anesthesia; prescribing prophylactic antibiotics and nonsteroidal anti-inflammatory medications; and temporarily restoring teeth without drilling.

But SB 301 may likely take more negotiation -- Capitol Dental Care, one of the state’s leading dental care organizations, which provide dental services to Oregon Health Plan members -- objected to the removal of the risk assessment language. Capitol’s Deborah Loy said that it would interfere with the team-based collaborations Capitol has had approved with the Board of Dentistry.

Whatever the disagreement, SB 301, like SB 302, still stands a high chance of passage. Sen. Laurie Monnes Anderson, D-Gresham, who sponsored the bill along with the Senate’s dentist, Sen. Fred Girod, R-Stayton, said that increasing access to oral care is a top career priority for her, and that dental hygienists should be allowed to work to the top of their ability, particularly when dentists are in short supply to serve people who are economically disadvantaged, a group that disproportionately includes racial and ethnic minorities.

The expansion of Medicaid -- and Oregon’s decision to expand comprehensive dental coverage to adults -- has given coverage to hundreds of thousands of people who could not afford to see a dentist before. Access hasn’t always caught up, but the utilization of dental hygienists has helped fill the gap.

“Oregon has been on the forefront,” of giving more authority to dental hygienists, Monnes Anderson said. “I have talked with some dental hygienists that have expanded their practice and access is increasing and more people are being served that did not receive dental services in the past.”

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