Stateline.

Direct access initiatives have taken center stage in the 2008 state legislatures. In Alaska, a bill for collaborative practice was sent to the governor. In Maine, the governor has signed a new law permitting dental hygienists to practice independently. And in Minnesota, steps are being taken to launch advanced dental hygiene practice.

Alaska dentists and dental hygienists agreed to the merger into one bill of a dental association initiated bill (allowing dental assistants to polish and provide restorative services) with a dental hygienists' association proposal (for collaborative practice and general supervision for local anesthesia). Dental hygienists would also be able to qualify to perform restorative services.

Now on the governor's desk, House Bill 319 would allow dental hygienists with at least 4,000 hours of experience in the last five years to practice according to a written collaborative agreement with a dentist. The board would need to approve the collaborative agreement, which could allow the dental hygienist to initiate services without the dentist's individual diagnosis and treatment plan at settings other than the dentist's usual place of practice. The collaborative hygienist could perform virtually any traditional dental hygiene service, including local anesthesia, pursuant to the terms of the agreement, whether or not the dentist was present.

The Minnesota State Senate overwhelming passed an amended Omnibus Higher Education Bill that contained a provision to put language in statute that creates the Oral Health Practitioner (OHP) and convenes a workgroup to make recommendations and propose legislation to define the scope, supervision and education of the provider. The amendment codifies that the OHP will be a licensed, educated provider who works under the supervision of a dentist via a collaborative management agreement. The amendment stipulates that OHPs must practice in underserved areas and cannot begin lawful practice prior to 2011.

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The scope of practice the workgroup is directed to design for the provider includes primary diagnostic, educational, palliative, therapeutic and restorative (cavity preps, restoration of permanent teeth, temporary crowns, placement of preformed crowns, pulpotomies on primary teeth, pulp capping) services, as well as extractions of primary and permanent teeth, placing and removing sutures and prescriptive authority (anti-infective, non-narcotic pain management and prevention).

The various stakeholders including representatives from Metropolitan State University, the University of Minnesota, the Minnesota Dental Hygienists' Association, the Minnesota Dental Association, the state board of dentistry, Safety Net Coalition and several other dentists representing various public health and special interest groups, as well as two state agency representatives, will populate the workgroup. The majority of dentists on the workgroup will have to have specific public health experience. The workgroup is charged with completing its work by December 15, 2008, and draft legislation to enact specific recommendations will be required by January 15, 2009.

Dental hygienists in Maine can practice independently in all settings, thanks to a proposal submitted by a denturist. Independent practice for dental hygienists was among the four proposals under consideration by the state's Department of Professional and Financial Regulation during their sunrise review. The other three were licensure of graduates of foreign dental schools, creation of a separate licensing board for denturists and hygienists, creation of an advanced practice dental hygiene practitioner, and independent practice. The Joint Committee in Business, Regulation and Economic Development released its recommendation from the sunrise review in late February. Their recommendation:independent practice. Facing no opposition by organized dentistry, the bill sailed through the Maine legislature and was signed into law by the governor in mid-April.

Independent practice dental hygienists are required to possess a bachelor's degree from a dental hygiene program accredited by the Commission on Dental Accreditation (CODA) and 2,000 work hours of clinical practice in a private dental practice; or possess an associate degree from a CODA-accredited dental hygiene program and 6,000 work hours of clinical practice in a private dental practice. They are also required to provide a referral plan to patients in need of additional care by a dentist.

Indiana became the 41st state, including Washington, D.C., to allow dental hygienists to administer local anesthesia. Under the new law, dental hygienists who have completed a board-approved course and received a board-issued dental hygiene anesthetic permit may administer local anesthesia under direct supervision. The bill also contained a provision to expand the current law to allow prescriptive supervision in hospitals, clinics, fixed charitable institutions, public health settings and correctional institutions. Under prescriptive supervision, a licensed dentist is not required to be physically present but needs to have examined the patient and prescribed the patient care within the previous 45 days. As a tradeoff with the Indiana Dental Association, dental assistants who have completed a board-approved curriculum are allowed to polish coronally and apply fluoride under the direct supervision of the dentist. The Indiana State Board of Dentistry must finalize the rules and regulations for the law to take effect.

The Virginia Board of Dentistry established guidelines, criteria and regulations to enable licensed hygienists to practice local anesthesia and administer nitrous oxide. A dental hygienist who completed a 36-hour course and successfully passed a CODA-accredited exam is certified to administer nitrous oxide and local anesthesia to patients 18 years of age or older under the direction of a dentist.

Stateline is prepared by the ADHA Division of Governmental Affairs.