Alternative Workforce Models Ben Youel, Illinois 13, Vice President Tim Calnon, Buffalo 13, Leadership Development Work Group, Chair

@ASDAnet #ASDAnet there are profound and consequential disparities in the oral health of our citizens silent epidemic

@ASDAnet #ASDAnet Programming has taken a multi-pronged approach including: Funding mobile dental vans to reach rural populations, Improving public health dental education, Increasing the number of underrepresented minorities enrolled in dental school, and Supporting community-led projects for new workforce models.

@ASDAnet #ASDAnet The Pew children's dental campaign works on four efficient, cost-effective solutions: 1. Ensure that Medicaid and the Childrens Health Insurance Program – the programs that serve low- income children – work better for kids and for providers so that insurance coverage translates into real access to needed care 2. Expand sealant programs for kids who need them most 3. Help expand access to optimally fluoridated water 4. Expand the number of professionals who can provide dental care to low- income children

@ASDAnet #ASDAnet Dental Health Aide Therapist (DHAT)

@ASDAnet #ASDAnet Advanced Dental Hygiene Practitioner (ADHP) In response to the access crisis, state policymakers, consumer advocates and oral health coalitions are pioneering innovations to extend the reach of the oral health care delivery system and improve oral health infrastructure. Among these innovations is the creation of a mid-level oral health provider to provide much needed restorative dental care to underserved populations.

@ASDAnet #ASDAnet Unsupervised private dental hygiene practice has not had a notable effect on access to care in Colorado.

@ASDAnet #ASDAnet New Zealands program in the schools has been in place a long time, and thus it may be surprising to learn that Baltimore adolescents had … the lowest number of DMF teeth and the second- or third- lowest number of decayed teeth.

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@ASDAnet #ASDAnet Community Dental Health Coordinator (CDHC) cdhc.aspx

@ASDAnet #ASDAnet Dental Therapists / Advanced Dental Therapists (DT/ADT) First State to License a Dental Midlevel Provider

@ASDAnet #ASDAnet Nearly 9,500 new dental providers are needed to meet the countrys current oral health needs. However, there are more dentists retiring each year than there are dental school graduates to replace them.

@ASDAnet #ASDAnet Four MLP Programs DHAT ADHP CDHC DT/ADT

@ASDAnet #ASDAnet DHAT = Alaska (trained in University of Washington) CDHC = University of Oklahoma, Temple University, & A.T. Still University Arizona School of Dentistry; New Mexico ADHP = Nowhere Dental Therapist / Advanced Dental Therapist = Minnesota Locations

@ASDAnet #ASDAnet All can do: Collect information (photographs, radiographs) Screenings Fluoride treatments Sealants Temporary fillings (IRM) What can each program do?

@ASDAnet #ASDAnet What can each program do? CDHCDTDHATADHP Triage Develop and implement community education programs Direct Restorations Pre-formed crowns Primary teeth extraction Perio-involved perm teeth extraction (ADT) Pulp capping Pulpotomies Local/Nitrous Provide & administer analgesics, anti- inflammatories and antibiotics (ADT) Dx & Tx Planning (ADT) Repair removable pros Re-cement fixed pros Space maintainers Splinting Full hygiene scope Direct Restorations Pre-formed crowns Primary tooth extraction Non-surgical perm teeth extraction Pulpotomies Local Full hygiene scope Direct Restorations Pre-formed crowns Uncomplicated extractions Repair removable pros Re-cement fixed pros

@ASDAnet #ASDAnet REVERSIBLE

@ASDAnet #ASDAnet REVERSIBLE IR

@ASDAnet #ASDAnet What do WE think?

@ASDAnet #ASDAnet

@ASDAnet #ASDAnet C1 Expanded Functions of Dental Assistants and Dental Hygienists The American Student Dental Association endorses expanded functions for dental auxiliaries only when each has received the appropriate education and training to guarantee competence, and when such functions fall within the laws established by their respective state of employment. It is incumbent on the profession to assure that expanded functions for dental auxiliaries will not adversely affect the health and well-being of the public. The practice of dentistry entails more than the simple performance of routine technical procedures. A dentist must possess a wide range of knowledge of the biological, anatomical, and physiological sciences in order to successfully and safely perform such procedures. A dentist must also be able to process and apply both the knowledge and the skills acquired in dental school in order to successfully and safely perform these tasks. Thus, only the dentist should perform the following functions. These functions include but are not limited to: a. Examination, diagnosis and treatment planning b. Prescribing work authorizations c. Performing irreversible dental procedures d. Prescribing drugs and/or other medications

@ASDAnet #ASDAnet C2 Independent Practice The American Student Dental Association is strongly opposed to independent dental hygiene practice, and favors the team approach for providing comprehensive dental care.

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@ASDAnet #ASDAnet Opposition to Pilot Programs Which Allow Nondentists to Diagnose Dental Needs or Perform Irreversible Procedures Resolved, that the American Dental Association opposes pilot programs that are in violation of the ADA policy stated in Resolution 24H-2004 (stating that, The ADA is opposed to non- dentists making diagnoses, developing treatment plans or performing irreversible procedures.)

@ASDAnet #ASDAnet Diagnosis or Performance of Irreversible Dental Procedures by Nondentists Resolved, that the American Dental Association by all appropriate federal legislative and judicial means resist any effort compromising the quality of dental health care services by allowing any nondentist to diagnose or perform irreversible dental procedures except as otherwise authorized by state law with reference to physicians.

@ASDAnet #ASDAnet What is the root of the debate over Alternative Workforce models?

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@ASDAnet #ASDAnet Breaking down Barriers to Oral Health for All Americans

@ASDAnet #ASDAnet …must guard against focusing on any one barrier to the exclusion of others that are equally critical.

@ASDAnet #ASDAnet Everyone deserves a Dentist. - Dr. Ray Gist, ADA President

@ASDAnet #ASDAnet -82 million underserved -27.8% visit dentist -System with 7-8 Million capacity Coordination is critical

@ASDAnet #ASDAnet Underserved populations = Unserved individuals 1 million/ 1% $2.16 Billion Charity

@ASDAnet #ASDAnet -Internal understanding -34 Graduates practicing -7 Core Competencies -Sunset evaluation

@ASDAnet #ASDAnet SYSTEMATIC REVIEW In populations where nondentists conduct diagnostic, treatment planning, and/or irreversible/surgical dental procedures, is there a change in disease increment, untreated dental disease, and/or cost- effectiveness of dental care?

@ASDAnet #ASDAnet The Journal of the American Dental Association January 1, 2013 vol. 144 no

@ASDAnet #ASDAnet 18 Observational studies from 7,701 citations Conclusion: Poor quality evidence –Decease in caries with MLP, but same as with dentist treated pop. –Select pop. Treated by MLP show greater decrease –*Results should be applied with caution*

@ASDAnet #ASDAnet What about our future...?

@ASDAnet #ASDAnet JOIN TODAY! $5 = Your Future In Washington, if youre not at the table, youre on the menu.

@ASDAnet #ASDAnet ADVOCACYADVOCACY

@ASDAnet #ASDAnet Dont let the tail wag the dog!

@ASDAnet #ASDAnet Thank you! Ben Youel Tim Calnon PACE Verification Code: AS1304