East Central Component Legislative Forum July 21, :00 -10:00 am Ivy Tech Anderson Indiana Dental Hygienists’ Association

Welcome to the East Central Dental Hygienists’ Association Legislative Forum  The purpose of this forum is to share with you ways in which dental hygienists could better be utilized in regards to access to oral health care. Increasing our accessibility to patients would require legislative change.

What is a Dental Hygienist? Preventive oral health professionals who are licensed in Dental Hygiene to assess and provide educational, clinical, and therapeutic services that support total health. Provide preventive services that limit extent of cavities and periodontal disease. Indiana has approximately 3,800 Dental Hygienists.

Services Provided  Removes (scales) calculus and plaque, bacterial hard and soft deposit from above and below the gum line  Helps prevent and recognize dental disease  Polishes and removes extrinsic stain  Educates patients about the importance and techniques of good oral hygiene habits  Analyzes dietary needs and habits and provides nutritional counseling  Evaluates the need for preventive agents such as fluoride and sealants and applies them to the teeth for added resistance to decay  Screens for head, neck and oral cancer and high blood pressure  Exposes, processes and interprets dental x-rays  Designs and implements community dental health and dental educational programs  Designs and conducts research to further knowledge about dental health  Active member of dental team  *****Administer Local Anesthetic*****

Dental Hygiene Education In the State of Indiana, Dental Hygienists complete a minimum of three years of collegiate requirements in an accredited Dental Hygiene program. Dental Hygienists receive 3 times more clinical instruction in periodontal and preventive procedures than dentists. We do so much more than “just clean teeth”! We are very educated, just as an RN in a doctors office! Just because I can be trained on the job to take BP, weigh someone and draw blood, does not make me a nurse.

A few of the most notable courses taken in the dental hygiene program are: Anatomy and Physiology, Head and Neck Anatomy, Local Anesthesia, Radiology, Periodontics I and II, Pharmacology, Microbiology, Oral Anatomy, Oral and General Pathology, Medical Emergencies, and Clinical Dental Hygiene.

Importance of Oral Health to Overall Health  Dental hygienists save lives. The signs and symptoms of many life-threatening diseases are first apparent in the mouth.  Oral health is increasingly linked to systemic health.  Unlike most medical maladies, the principal dental diseases are fully preventable. Prevention is cost-effective.  The cost of providing restorative treatment is more expensive than providing preventive services.  Carious lesions are preventable through the use of fluoride and sealants.

The Nations Tremendous Unmet Dental Needs and Silent Epidemic  Dental disease (tooth decay) is the single most common chronic childhood disease, five times more common than asthma and seven times more common than hay fever  Dental caries- which is an infectious transmissible disease- affects more than half of all children by second grade  Disparities in oral health are common; there are higher levels of oral diseases among vulnerable populations, such as poor children, elderly persons and members of many racial and ethnic minority groups.  Oral health has been described as one of the single greatest unmet health care needs in the U.S. The current oral health workforce simply is not meeting the nation’s oral health needs.  While 45 million Americans lack medical insurance, more than 108 million lack dental insurance coverage.  There is an acute shortage of dentists that is expected to worsen in the coming years. Each year, approximately 6,000 dentists retire while only about 4,300 dentists graduate from dental school.  By contrast, there is a steadily rising number of dental hygiene education programs and dental hygienists. Presently, there are over 290 accredited dental hygiene education programs; at least one in every state. There was an 89% increase in the supply of dental hygienists from 1980 to 2000 and dental hygiene is expected to be one of the fastest growing professions between now and 2013.

Indiana’s Legislative Goals  Improve access to oral health care by permitting dental hygienists in the state of Indiana to practice under prescription supervision and to allow us to administer local anesthetic and nitrous oxide.  Prescription supervision, (HB 1172/2008) which means specific written or oral authorization by a licensed dentist or physician for a licensed dental hygienist to perform procedures according to a clearly defined treatment plan for all practice settings not just hospitals and clinics.  43 States allow some form of general supervision in public and private settings. Indiana NOT being one of them

Indiana’s Laws  Limit the type of practice settings by imposing restrictive supervision requirements  Dentist must be on premises during treatment and must inspect after completion (awaiting HB 1172 rule and regulation completion by Indiana Board of Dentistry)  Licensed dental hygienist employed by public health department or school may deliver patient education, perform routine prophylaxis without dentist being present. Hygienists are not allowed to take radiographs, deliver fluoride or sealant applications without the dentist’ supervision.

PEW Children’s Dental Campaign What We Do The Pew Children's Dental Campaign works on four efficient, cost-effective solutions: ensure that Medicaid and the Children’s 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 expand sealant programs for kids who need them most help expand access to optimally fluoridated water expand the number of professionals who can provide dental care to low-income children

PEW Report !!!!! YIKES!!! Indiana scored an “F” on the PEW Report Card! We are failing the children in Indiana. (and adults) Indiana has more than enough dentist in the state and Hygienist looking for jobs and we still received an “F” when it comes to access to care. Pew grades are based off of states meeting 8 benchmarks. Indiana meet 2 or less.

8 Benchmarks 1.Having sealant programs in at least 25 percent of high-risk schools. 2.Allowing a hygienist to place sealants in a school-based program without requiring a dentist’s exam. 3.Providing optimally fluoridated water to at least 75 percent of residents who are served by community water systems. 4.Meeting or exceeding the 2007 national average (38.1 percent) of Medicaid-enrolled children ages one to 18 receiving dental services.

5.Paying dentists who serve Medicaid enrolled children at least the 2008 national average (60.5 percent) of dentists’ median retail fees. 6.Reimbursing medical care providers through its state Medicaid program for preventive dental services. 7.Authorizing a new type of primary-care dental provider. 8.Submitting basic screening data to the national database that tracks oral health status.

IDHA Workforce Survey Statewide Eighty-seven percent of the responding dental hygienists indicated that there are too many dental hygienists in their community. For the Northeast region, 95 percent indicated there are too many dental hygienists in their community. Forty-five percent of the responding dental hygienists are working in dental hygiene or a related field full-time, while 42 percent are working part-time (less than 32 hours per week).

Eighty percent of the respondents Strongly Agree/Agree that the law in Indiana should be expanded so a licensed dental hygienist could practice in certain settings under general supervision. The settings most frequently mentioned by respondents as those they would like to see dental hygienists be able to practice under general supervision are public health facilities (93 percent), nursing homes (92 percent), long term care facilities (89 percent) and charitable clinics (87 percent).

What is your opinion about the number of dental hygienists in your community? East Central----87% say TOO Many! Statewide % say TOO many! New Dental Hygiene Schools are trying to open in Indiana. And in East Central!!! Graduates will have school loans to pay back but there are not enough jobs for these new graduates!! We need to create jobs!!

We can help each other!!! Remember There is NOT a dentist shortage in Indiana, yet we still received an “F” in the PEW report due to lack of access to care. We can improve this grade! There are a lot of unemployed or underemployed dental hygienists who are educated and capable to deliver care. We can place sealants, provide cleanings and access without a dentist. Studies show we do not need to take x rays prior to placing sealants. We can help so many people in a wide range of settings with a small change in legislation.!!!!!!!!!!

Thank you for coming !!!!