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Oral Health Practitioner Work Group Public Input

Your name: Linda Jorgenson
Your e-mail: linda.jorgenson@century.edu
County of residence: Washington
Profession: Dental hygienist
Work group topic: Scope of practice / Level of supervision
Your comments: It is generally agreed that there are growing gaps in the dental workforce throughout the country and in Minnesota. Those gaps result in fewer and fewer dentists available to treat more and more patients, as well as fewer dentists to hire, supervise and/or collaborate with dental hygienists who would provide preventive care. Those with no insurance are the last to receive care; those eligible for public program assistance are not far behind. Growing needs - less access to care. One of the most important objectives in the creation of a mid-level practitioner is to create a clinician who has the education/competencies/license/authority to assess patient characteristics, diagnose problems, plan care and then implement a plan of care to meet the patients' needs. Please consider this as you deliberate about the level of supervision the mid-level clinician should require. If supervision requirements are overly restrictive, it will constitute another barrier to access. On the other end of this issue is the education / competencies required to ensure safe practice by the mid-level clinician. If the education and competencies are adequate, supervision should not be an issue. Thank you for receiving this feedback. Linda Jorgenson
This e-mail was sent on: Oct-03-2008 at 02:14 pm

Your name: Paul Bischel 10/4/08
Your comments: The hourly wage for the dentist, is that a self employed person, before SS is taken out, etc.,? Or is that the wage as an employee, after SS, etc. is taken out? For the OHPs, is that the self employed wage, or employee wage? If that is an employee wage for the OHPs, would not another, at least 40% of that number, be added to cover total expense, thus the $42.50 would be almost $60.00 per hour? If that is the wage per hour for the self employed dentist, the per hour salary would go from $150.00 to $60.00 if overhead is 60%. What is gained? If after a short education these OHPs can do as much care as qualified educated dentist after 4 years of dental school, and 4 years of pre-dental, we should then do the same for say teachers. After high school, a short education these people could teach, and their salary will be less. Thus from 4000% increase in education cost the last 30 years, it could be reduced. I am sent law cases against companies, and the judge allows the attorneys from $3000.00 to over $30,000.00 per hour. This then explains why in a state, there were around 40 some that applied for a dental license, 50 some for a medical license and over 2000 for an attorney license. There is more. Thank you. Why have two levels of care? If the patient was informed and they only want a dentist who is qualified to treat, do they have to be treated by a person who is not a dentist?   Paul

Your name: Laura Eng, DDS
Your e-mail: lauraengdds@yahoo.com
County of residence: Dakota
Profession: Dentist
Work group topic: Scope of practice / Level of supervision
Your comments: I am a general dentist in St. Paul, where I've practiced since graduating from the University of Minnesota School of Dentistry in 1980. In the early 1970s, however, I was a dental hygiene student at the University of Iowa where I participated in an experimental program developed to address fears of a shortage of dentists and access to care issues. In an intensive twelve-month program, twelve dental hygiene students were trained to give local anesthesia, cut cavity preparations and place restorations for children and adults. The quality of the work was judged to be excellent. Along with others in the program, I was hired by the University of Minnesota School of Dentistry to treat patients in the TEAM clinic, a simulated practice setting where dental students learned to manage and supervise expanded function practitioners. All of our work was checked by the students or instructors and the intent was that if expanded function hygienists were needed for the public, they would always be under direct supervision of the dentist. Nationally, however, the predicted shortage of dentists was solved by opening new dental schools and increasing the number of graduating dentists. I have been following with interest the meetings of the OHP Work Group and the decisions being made. After having experience for more than four years as an expanded function dental hygienist and then 27 years as a dentist, I believe that if irreversible procedures are approved for the OHP, they must be done under indirect supervision, at a minimum. This means that the dentist has made the diagnosis and treatment plan and is on the premises. This is vital for the health and safety of the patient. It is during the more advanced procedures, and with the use of injected local anesthetic, that medical emergencies are most likely to occur. In addition, it is not at all uncommon for the tooth being treated to have more decay than anticipated, to have an exposure of the pulp or to have a large portion of the tooth break during the procedure. At this time, a change in the treatment to be done is needed, which would include immediate and clinical, not virtual, assessment by the dentist. If the revised treatment is beyond the scope of what the OHP can do, the patient can be treated by the dentist and unnecessary delay of the patient's dental care is avoided. I believe that without this safeguard, the safety and well-being of patients will be compromised. Thank you for the opportunity to communicate my concerns to the Work Group. I know they are all working hard and want to do the best for the patients of Minnesota. Laura Eng, DDS
This e-mail was sent on: Oct-28-2008 at 05:36 pm

Your name: Paul Bischel 11/12/08
Your comments: Thank you for the (interested parties) e-mail. If you can not get a dentist to treat people for free, how will you get other people to? Maybe some govt. employees would come in after hours & work for free??? This is not what some people may like to come up. Many times I would like to go to a govt. office on Sat. or Sunday, but they are always closed. Since dentist fees are reduced when they treat welfare patients, why not do the same for all govt. employees, including teachers, when they have to work with these people. Take the money, put in a pool & pay each person a % of the pool??? Thus the dentist will receive more for the treatment. In England, why are so many dentists going into a cash practice, thus reducing the chance to see a doctor? Many people in that country need dental treatment.  Paul Bischel

Updated Tuesday, November 30, 2010 at 04:21PM