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Entries in Dental Therapist (27)


All Mid-Level Practitioner Bills are Dead for 2012 


SB 6126 and HB 2226, the dental practitioner bills supported by the Kellogg Foundation and the Children’s Alliance, are now dead. HB 2226 died in the House Health Committee two weeks ago and SB 6126 will not pass out of the Senate Rules Committee. The WSDA appreciates our members' strong efforts and we're especially thankful for the leadership from the Board, committees, grassroots advocates and lobbyists. If you have received positive responses from your local legislators on WSDA’s position, please send them a thank you for supporting our concerns about patient safety and our continuing efforts to reduce barriers to oral health care. 

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Dental Practitioner Proposals Pose Considerable Health, Financial Risks

Pierce County Dental Society President Dr. Sammy Pak penned an editorial last week in the Tacoma News Tribune. The piece was in response to an editorial written in support of SB 6126 which would allow midlevel providers to perform surgical procedures without the on-site supervision of a dentist. Here's the piece:

Re: “Our state’s dental system is letting too many patients down” (Viewpoint, 1-29).

Anita Rodriguez recently argued on this page for a new category of mid-level dental provider authorized to practice independently from a dentist.

Rodriguez explained that many dentists oppose this proposal because of concerns for safety and quality of care. She also argued that such practitioners are much the same as the nurse-practitioners of 50 years ago – a profession once opposed by the establishment and now embraced by it.

I wanted to provide some clarity on many dentists’ views on this matter.

Rodriguez is writing in particular about two bills that are currently being considered by our Legislature. Both would create practitioners who, with an unspecified amount of training after high school, could perform irreversible procedures that include drilling and extractions without the on-site supervision of a dentist.

We have three concerns with these bills.

 • We are concerned about the seriousness of the procedures these mid-level practitioners could perform. The measures would allow dental therapists to do surgical procedures including pulpotomies (root canals on primary teeth), drilling for cavity preparation and extractions.

These procedures are irreversible and could be performed by an individual with a GED, an unspecific amount of training and no competency testing. There is no precedent for this mid-level practitioner anywhere else.

To Rodriguez’s point about nurse practitioners: Nurse practitioners cannot perform surgical procedures, and in our state they are required to receive a master’s or doctoral degree.

 • We are concerned about fracturing the dental home for patients. Under the structure of these bills, a patient with complications from a practitioner’s procedure would need to rush to a dentist to address the issue or wait for the dentist to come to him or her. Nearly every dentist can tell a recent story of a procedure that was more complicated than he or she expected.

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Dental Practitioner Bill Passes Senate Health Committee

This afternoon, the Senate Health Committee voted SSB 6126 out of committee with amendments. This means that the Senate version of the “dental practitioner” legislation moves out of committee and can potentially be considered by the full Senate. The following amendments were added to the bill:

  • Language requiring that a dentist be available for “instant communication via video conferencing during treatment if needed.”
  • Requires that practice plan contracts be “made available to the public upon request” and available “at the practice of the dental practitioner or the dental hygiene practitioner and provided to patients of the practitioner's practice upon request.”
  • The following section was added to the bill: “The American Dental Association and the Washington State Dental Association are encouraged to consult with stakeholders, including dentists, dental hygienists, and patient advocates, to study programs in the state that use volunteer dentists and oral surgeons to provide specialty care dental services, including tooth extractions and root canals, to low-income adults and children. This study should include an investigation into expansion of volunteer specialty care dental services into underserved areas in the state and methods to finance these programs. In order to provide the legislature time to review the work of the American Dental Association and the Washington State Dental Association, the results of this study should be reported to the legislature by January 1, 2013.”

Before passing the bill, members of the committee expressed a desire to continue to refine the scope of practice of the practitioners and other aspects of the legislation. A complete copy of the amended bill can be found here.

HB 2226, the House companion bill of SB 6126, died in the House Health Committee earlier this week.
The WSDA continues to oppose SSB 6126 because it fractures the dental home, increases patient risk, and is not an economically viable model. More information about our opposition can be found here. With the help of our grassroots dentists, we will continue to fight against this legislation. Grassroots dentists will receive more information early next week about how they can help.

Please contact with any questions.


Concerns about HB 2226/SB 6126 Raised in Recent KUOW Story

Last Thursday, KUOW in Seattle ran a story about the prospects of a new mid-level dental practitioner in Washington State. You can find it here. We appreciate KUOW giving WSDA the opportunity to explain our position, but there were two inaccurate statements that we need to clarify.

1.    New bills’ scope of practice – The story includes this information about the proposed practitioner’s scope of practice:

The proposed legislation would add a mid–level provider to today's dental team. The new therapist would be like a nurse practitioner is to a doctor.

Dr. Ray Dailey: "They're called DHAT. Dental Health Aid Therapist. And what they are trained to do is they spend two years of intensive training to do nothing more but minor dental work. They will do fillings, simple extractions.”

Nurse practitioners do not do surgical procedures. HB 2226 and SB 6126 would allow dental therapists to do more than minor dental work – it would allow them to do surgical procedures including pulpotomies (root canals on primary teeth), drilling for cavity preparation, and extractions . These procedures are irreversible and could be performed by an individual with a GED, an unspecific amount of training, and no competency testing. There is no precedent for this midlevel practitioner anywhere else.

2. New bills’ amount of supervision – The story also suggests the proposal would create mid-level practitioners who are supervised by dentists. Dr. Dailey explains how he saw the DHAT function in Alaska -- working under the on-site supervision of a dentist:

"Up in Bethel, Alaska, I had a chance to go up there to see DHATs in action working in a dental clinic and it was great. You had your hygienist providing cleanings and taking care of the gums. You had DHATs doing lots of these fillings. Just one after another. Then you had the dentist doing root canals or doing complex restorations, or providing that upper–tier stuff which is what a dentist gets training for."

But HB 2226 and SB 6126 would allow the mid-level dental practitioner to perform procedures without the on-site supervision of a dentist. Under the bill’s structure, a clinic could be staffed entirely by mid-level dental practitioners, without a dentist on site to help handle complications that might arise during surgical procedures. This fractured model of providing care is one of the main reasons that WSDA opposes the bill.

For a complete explanation of why WSDA opposes the bill, click here.

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