RALEIGH — Dental hygienists could gain more freedom to treat patients in rural areas and nursing homes.
The N.C. Board of Dental Examiners has a chance to change regulations on hygienists Thursday, Jan. 16, when the state Rules Review Commission will consider freeing hygienists to perform reversible procedures without direct dental supervision in shortage areas.
North Carolina is short on dental care, particularly in rural areas. The state ranks 37th in the nation for its access to dentists. The N.C. Department of Health and Human Services flagged 59 counties for shortages of dental care in 2018. Camden, Hyde, and Tyrrell counties haven’t had a single dentist between them for the past decade.
Matters are especially bad for low-income families, seniors, and American Indian children. The supply of dentists shrinks still further for those covered by Medicaid, as only 29.7% of dentists participated in North Carolina’s Medicaid in 2016.
“One thing I’m not sure people realize is that while oral health has greatly improved, poor people still lose their teeth at the same rate they did 30 years ago,” Sen. Jim Perry, R-Lenoir, said. “And the state of your oral care is linked to so many other issues, such as heart disease.”
The proposed reform aims to break open the supply of dental care by loosening regulatory restrictions, allowing dentists to supervise more than two working hygienists in shortage areas.
The rule change also bucks the long-standing tradition that patients must see a dentist before being treated by a hygienist. The regulation made it difficult to bring care to rural areas, as dentists couldn’t send hygienists to patients without accompanying the mobile clinic.
“In the past, that left the patient with no place to go for a dental home,” said Bobby White, N.C. Board of Dental Examiners chief executive officer. “This provides a dental home. … For one thing, the patient doesn’t come to the dentist. The hygienist and the spearheading team can go out to the facility. We hope that this will make a lot of difference.”
If approved, the change will allow hygienists to perform reversible treatments without a dentist present in high-need areas. This would free hygienists to travel to shortage areas — namely public schools, nursing homes, and rural clinics — and provide basic preventative care.
“Not having our hands tied will help a lot,” said Crystal Adams, Catawba Valley Community College departmental head of dental hygiene. “There’s a lot of people who fall in the cracks, and of course there are barriers to care. … This allows us to serve. … people who are not always able to access the dental care they need. It is definitely a move in the right direction.”
The reform is months in the making. It has already gone through the pre-approval process, and if all goes smoothly in the Rules Review Commission, the change will kick in this February.
“Limiting dental hygienist reach through rules and regulations only serves to restrict access patients otherwise would have,” said Jordan Roberts, health policy analyst for the John Locke Foundation. “Dental care reform needs to focus on creating an environment where dental providers have as many opportunities as possible to treat patients safely.”
But if 10 or more people object during the meeting, the rule change will have to go before the General Assembly. White doesn’t expect to see any objections.
“Starting that conversation is important,” Perry said. “Dentists are pretty conservative by nature, so a lot of change isn’t something I’ve seen embraced in the dental community over the years. The fact that they’re having them having these conversations is a big deal, a positive step forward. You want them to lead the evolution in their rules and laws.”