1. Dissecting the Workforce Debate Tim Calnon District 2 Trustee 2011 Eastern Regional Meeting

2. 2 Overview What is a MLP? Navigating Acronyms Rationale of Alternative Workforce History American Programs ASDA Stance ADA Stance Protecting our Profession

3. 3 Objectives Educate, Educate, Educate Pay it forward 3

4. 44 Dental Workforce

5. 55 MID-LEVEL PROVIDERS

6. 66 = BAD

7. 77 Thanks for coming! Any Questions??

8. 88

9. 99 MID-LEVEL PROVIDERS

10. 10 Alternative Workforce Models

11. 11 NTAOAWM EFDA DT ADT ADHP CHDC OPA PDT DHAT

12. 12 Rationale of Alternative Workforce Underserved Populations Too Few Dentists Geographic Dispersion First Line of Care Liaison to Dentist Analogous Programs Abroad

13. 13 Deamonte Driver 12 year old Maryland Boy Evidence of Medicaid Red Tape Emotional, but evidence? 13

14. 14 Historical Perspective of the Dental Team

15. 15 History of Dental Assistants 1985, First Female Dental Assistant Dr. C. Edmond Kells of New Orleans hired Malvina Cueria, who is generally regarded as the first dental assistant 1900- Dentists start advertising assistants

16. 16 Dr. C. Edmund Kells 16 “The assistant is one of the dental institutions of the day and is due to survive as long as dentistry lives. The assistant is absolutely essential to the modern dental office.”

17. 17 1985, Courtesy of ADHA

18. 18 History of Dental Hygiene Dr. Alfred Fones is generally regarded as the Father of Dental Hygiene 1913, first hygiene school in Bridgeport, CT 1947, the ADA endorses a two year training program with requirements for accreditation

19. 19 History of Dental Hygiene 1972, the Forsyth Experiment begins Hygienists were trained in restorative procedures Results indicated that a dentist in solo practice using hygienist-assistant teams to provide restorative care could increase their productivity

20. 20 New Zealand Dental Nurses Present for Decades 18-24 month Education Many work in schools Independent Able to perform restorative procedures Deciduous Extractions 20

21. 21 Dental Team Observations Evolving Dental Team Large initial investment Necessary Dentist buy-in Not always successful

22. 22 Specific Workforce Models Expanded Function Dental Assistants Dental Health Aide Therapists Dental Therapist Advanced Dental Therapist Advanced Dental Hygiene Practitioner Pediatric Dental Therapist Community Dental Health Coordinator 22

23. 23 Specific Workforce Model Location: State (Enacted, proposed, pilot) Population: Public, private Settings: Office, clinic, schools, unspecified Education: Post secondary Supervision: From direct to collaborative Surgical: Yes, no Diagnosis: Yes, no Comment: Additional pertinent fact 23

24. 24 Expanded Function Dental Assistants (EFDA) Location: 27 states have some form of EFDAs Population: Public and private Settings: Clinic and Office Education and/or OJT: Two years (Varies by state) Supervision: Direct and/or indirect Surgical: No Diagnosis: No Comment: Different states use different acronyms* 24

25. 25 Dental Health Aide Therapist (DHAT) Location: AK (Not licensed by state)* Population: 85,000 native people of all ages Settings: Clinics in remote tribal villages Education: Two years (DENTEX in Anchorage) Supervision: Public health Surgical: Yes Diagnosis: Yes Comment: DHAT scope is competency based 25

26. 26 Dental Therapist (DT) Location: MN (Enacted 2009) Population: Patients with access barriers Settings: Clinic and office Education: Four to six years (28 month program) Supervision: Indirect and collaborative Surgical: Yes Diagnosis: No Comment: Scope differs with level of supervision 26

27. 27 Advanced Dental Therapist (ADT) Location: MN (Enacted 2009; no ADTs yet) Population: Patients with access barriers Settings: Clinic and office Education: Two add. years? (Master’s program) Supervision: Collaborative Surgical: Yes Diagnosis: No (May assess, authorized by DDS) Comment: Must be DT with 2000 hours to apply 27

28. 28 Advanced Dental Hygiene Practitioner (ADHP) Location: Proposed in several states Population: Unspecified Settings: Unspecified Education: Six years (Two year MS degree) Supervision: Collaborative Surgical: Yes Diagnosis: Yes Comment: ADHA model, certified as ADHP 28

29. 29 Pediatric Dental Therapist Location: ME (State bill introduced in 2009) Population: Limited to children age 0-12 Settings: Fed-designated dental shortage areas Education: Two years Supervision: Indirect Surgical: Yes Diagnosis: No Comment: Licensed by dental board 29

30. 30 Community Dental Health Coordinator Location: OK, CA, PA (University pilot programs)* Population: Underserved Settings: Public Health Education: 18 months (12 mo. didactic) Supervision: Direct and/or indirect Surgical: No Diagnosis: No Comment: Community health with dental skills, ADA supported 30

31. 31 REVERSIBLE

32. 32 REVERSIBLEIR

33. 33 What do WE think?

34. 34

35. 35 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

36. 36 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. 36

37. 37

38. 38 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 (Trans.2004:291), no. 13 (stating that, “The ADA is opposed to non-dentists making diagnoses, developing treatment plans or performing irreversible procedures.”) 38

39. 39 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. 39

40. 40

41. 41

42. 42 What is the root of the debate over Alternative Workforce models?

43. 43

44. 44...”must guard against focusing on any one barrier to the exclusion of others that are equally critical.”

45. 45 “Everyone deserves a Dentist.” - Dr. Ray Gist, ADA President

46. 46 What about our future...?

47. 47 Legislative Updates 2011 CT- ADHP bill : DEAD NM- CHDC, DT, EFDA : DEAD OR- DT : Held by Sponsor WA - DT, ADT : DEAD KS - RDP : DEAD ME - OHP : DEAD VT - DT : DEAD

48. 48 JOIN TODAY! 48 $5 = Your Future In Washington, if you’re not at the table, you’re on the menu.

49. 49 ADVOCACYADVOCACY

50. 50 Don’t let the tail wag the dog! Moral of the story:

51. 51 Acknowledgements Mr. Jon Holtzee, Director, Governmental Affairs ADA Adam Shisler, ASDA President

52. 52 Thank you! Tim Calnon t.calnon@gmail.com 585-613-5252