WORKFORCE


Putting Politics Aside for Success A strong dental profession needs a strong dental team


by VICKI WILBERS, MDA EXECUTIVE DIRECTOR F


or any provider in healthcare, appro- priate levels of education equate to a level of care that can be provided effectively and efficiently. This in turn equates to a successful pathway for more health services to be provided by that person and delivered to patients. Examples abound in the medical field, such as CRNA, nurse practitioners, physician assistants, LPNs, RNs, etc.


Oral healthcare is no different. Although dentistry is more specialized than medicine and does not have as many levels and types of providers, there are certainly specific permits, certifications and licensure that allow for one person to do more than another in a dental practice.


Ultimately, as noted in the articles through- out this publication, upskilling dental team members is a proven way to delegate proce- dures, and thus increase practice efficiency and patient care. Most of the information provided relates to dental assistants within expanded function duties, but it also applies to dental hygienists — and both are ex- tremely important team members within the dental care delivery system.


What can get in the way of being progressive — upskilling — to make things more effective in a delivery system is the politics of it all. So what if we take incremental, progressive steps forward by addressing what kinds of upskilling might be “appropriate” for a dental assistant or a dental hygienist, with such upskilling done in controlled environments with appropriate education, to assure patient safety and prove efficacy?


This is exactly what is being done within our state’s oral healthcare delivery system currently through various pilot projects.


22 focus | FALL 2023 | ISSUE 3


Although we have reported on this in past Focus workforce articles and updates, let me again outline how we got here for both the dental hygienist and the dental assistant team members.


Committees, surveys, grants, outreach, meetings, meetings (and more meetings) … so what is the most recent happenings on workforce? In the last two years, there has been a significant amount of work, equaling action, equaling progress.


In summary, it began with post-pandemic discussions and surveys, then the creation of an exploratory committee on workforce that brought forth considerations for MDA dental hygiene policy changes. In the meantime, legislative action to enable pilot projects was passed and the concept of a new type of expanded function dental assistant (the OPA) emerged as idea to test. Subsequently, a workgroup formed to develop curriculum and the OPA pilot concept advanced with support by the State Office of Dental Health (ODH) and the Missouri Dental Board (MDB), as well as the Governor’s Office.


The flowchart on the next page gives a quick visual summary, but now let me more specifi- cally walk you through some of those parts and tell you more about where we are today, and you can read the following articles, too.


In 2022, a statute passed to allow the MDB and ODH to consider innovative ways to extend the oral healthcare workforce to populations that may others have difficulties utilizing existing oral healthcare facilities — to note, both the MDB and ODH must ap- prove and ensure these types of pilot projects are conducted within the measurements set forth in statute. The statute was supported by MDA, and at the time, by the Missouri Dental Hygienists’ Association (MDHA).


The first pilot idea, which we will call the Nursing Home Project, was up and running within that same year, and you can find an update about it on page 24. That project allows a hygienist and an EFDA (which could be a dental assistant or hygienist) to provide care to nursing home patients without a den- tist present. The pilot allows for services such as scaling and root planing, local anesthesia under general supervision, temporization of fillings — all in a controlled setting, with a supervising dentist’s order, conducted with a specific timeframe of the pilot. Provision of this care is through a supervising den- tist’s diagnosis, conducted typically through teledentistry.


The Nursing Home Project is being done within a specific timeframe and the MDB has already agreed to move forward with a full rule promulgation to permanently allow hy- gienists to administer local anesthesia under general supervision. This proposed change to the administration of local anesthesia has been met with mixed emotions: The rule change still is being vetted by the MDB, even while MDHA is touting it as a huge victory for the dental hygiene profession. But ultimately, it was the consideration of and advocacy by the MDA, whose members discussed and took action to change its posi- tion on this that eventually moved it forward so that, at the very least, we could support


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