A neglected health care need

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Oral health is one of the greatest unmet health care needs in the US. Millions of Americans have no dental insurance and even those who do often cannot afford the cost of dental care. This crisis is particularly felt in vulnerable communities – low-income working families, minorities, rural populations, the elderly, and those with special needs.

Opinion: A neglected health care need


Tooth decay is the nation’s most common chronic disease – five times more common than asthma (Surgeon General, 2000). And it is expensive. A study of 2005 visits to 7 Twin Cities’ emergency rooms found over 10,000 related to oral health problems at a cost of nearly $5 million. Yet most ER treatment only consists of drugs for infection or pain and 40% of the patients returned at least once. Much of this is preventable if people receive proper treatment – every $1 spent on preventive care saves about $4 in dental costs (National Institute of Dental Research).

Oral health needs are usually ignored in debates on the health care cost crisis facing the state and nation as the huge baby boom generation nears retirement, but they are real: Medicare does not include dental benefits nor do most retirement plans, leaving seniors very vulnerable since those over 55 have much higher rates of periodontal diseases and decay. And only 42% of those on Minnesota’s public health programs receive dental care, leaving low-income adults and children equally vulnerable (DHS, March 2006).

Minnesota is typical of states in its oral health problems, but it is different in creatively pursuing solutions. We know that the current oral health care workforce simply cannot meet the needs of Minnesotans, so we must find a new approach to provide additional, affordable, sustained access to the oral health care system. This is where the Advanced Practice Dental Hygienist (ADHP) comes in.

An ADHP will be a licensed dental hygienist educated at the Master’s degree level. ADHPs will play an expanded role in treating patients by providing basic services including preventive care, diagnosis, treatment of pain and infection, and simple fillings and extractions, with a primary focus on providing access to oral health care for the underserved. Patients with greater needs will be referred to supervising dentists.

The role of ADHPs will be analogous to Nurse Practitioners in the medical arena, using advanced education to work at the top of their license while freeing dentists to work at the top of their own license. As Nurse Practitioners have increased access to medical care for the uninsured and underinsured, so will the ADHP in the oral health care field.

Metropolitan State University and Normandale Community College are partnering to increase oral health care access by pioneering this new rigorous master’s degree to prepare safe, well-trained and well-tested, cost-effective ADHPs. The program is being designed and will be taught by dentists and dental hygiene faculty, requiring approximately two years’ study, with significant clinical practice as part of this education experience.

ADHP’s can be employed in nursing home facilities, schools, community clinics, hospitals, or dental offices to provide the first line of prevention and care for these populations. The ADHP program will prepare community-minded health care practitioners, emphasizing geriatrics, pediatrics, and populations with special health care needs.

Research has shown that the cost of educating these providers is less than the cost of dental education and that gains in clinical productivity outweigh costs. Based on estimated hourly pay for current chair time for dentists and dental hygienists, the cost for one dentist to provide services to 1500 patients would allow for nearly four ADHPs to serve 6000 patients.

Long-standing similar programs in more than 20 countries across the world, including Canada, Great Britain, and New Zealand, have shown that formally educated non-dentist providers can deliver high quality, completely safe oral health care to underserved populations. The first cohort at Metropolitan State will enroll next year and start their practice internships in 2010.

About 1/3 of the state’s 3,000 practicing dentists are 55 years or older (MDH, 2005). There are 7 Minnesota dentists retiring for every 5 entering the profession, even with dental schools nationwide recently increasing the number of dental graduates. We cannot wait until this access crisis intensifies further help before we create solutions.

Statutory and regulatory changes are needed to expand the scope of practice of these highly trained dental hygienists. Legislation to make these changes is pending in the Minnesota House and Senate. The passage of this legislation will open new doors and opportunities for those wanting to serve Minnesotans with oral health care needs. Minnesota has long been a national leader in health care and can continue this leadership in the oral health care field. The need is critical and dental hygienists in the Master’s Degree program stand ready to meet that need.

Marilyn Loen, PhD, RN, is Dean of the College of Nursing and Health Sciences at Metropolitan State University.

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