MY VIEW A


s a member of the current Workforce Committee formed by ODH and as the MDA Legislative and Regulatory Committee chair,


I often ponder, “what do we do with all the issues we see with workforce shortages and how can we guide our profession?”


As profession, we must work on this because there is no denying it’s a problem not subsid- ing. I would venture to say at some point over the past couple of years, every provider has experienced staffing shortages. I feel until we address workforce changes needed at the core of our profession, we won’t have adequate providers to serve the populations in our state: dentists, hygienists or assistants. I believe it is time for MDA to start finding solutions, or they will be found for us. People in the state are asking and will make plans without us; however, if we work together with other oral health stakeholders, we can come out as leaders instead of adversaries to change.


This rings true now more than ever, es- pecially when you look at actions in other states and precedence being set. For ex- ample, Colorado had such an issue this year. HealthierColorado, a consumer help group, had sponsored language for a dental thera- pist. This group had success the previous ses- sion and, for lack of better terms, steamrolled the Colorado Medical Society with legislation. With this they pushed forward with dental therapist legislation.¹ The bill sponsor became the president of the Senate, which poised the bill to be a train headed down the tracks. The Colorado Dental Association (CDA) had no chance of defeating it and opposition would have led to a furious fight in the Senate and House committees, as well as a battle on both houses floor. This forced a shift in the CDA’s effort, from one of fighting the bill to that of shaping it as much as they could.


I believe strongly in this association and will fight for it for many years to come if member- ship will have me as a leader. And I believe the time is now to think more broadly of the dental health of our state. More and more groups interested in addressing overall


20 focus | JUL/AUG 2022 | ISSUE 4


healthcare and social issues are taking notice that do not have the same pulse on dentistry. This easily can lead to change beyond our control and liking. We must be mindful and aware of how the pressure of other groups and agencies, offering their solutions, can rapidly occur.


I am grounded in certain philosophies for my practice, as I’m sure each of you are grounded in your own philosophy of care, or delivery model, or practicing in a certain geographic area, etc. This is what makes Missouri den- tistry diverse. Yet, I think one thing in our profession we can agree unites us is patient care. I would venture to say for the diversity of our membership, we certainly are not di- verse in our thoughts on ways to expand care through proven models. It is this diversity that has the power to make us stronger if we unite and support each other. Without unity and support we will eventually fall.


In November 2020 we asked members about these issues (IRT, anesthesia, scaling, expand- ed functions) and presented these results² at the 2021 House of Delegates. In summary, these findings indicated:


• Majority support for a trained assistant to work under the supervision of a hy- gienist. This includes chairside suction- ing, intraoral pictures, radiographs and coronal polishing.


• Majority disagreement of allowing hygienists to place interim therapeutic restorations under the general supervi- sion of the dentist.


• Regarding local anesthesia under general supervision for hygienists: Majority sup- port for topical and infiltration anesthe- sia under general supervision; 48 percent of respondents support block anesthesia under general supervision.


• Majority support for the expanded func- tion dental assistant program to include a scaling component curriculum.


If you’re not familiar with the levels of supervision in Dental Practice Act,³ I ask you to review them with the above information as they pertain to each survey answer. You can access those definitions at modental.org/


practiceact (under Dentists, Supervision rules) or use the link in the References.


These surveys, as well as calls and emails to the MDA office and more, indicate members want to consider what can be done to assist with patient care, yet archaic policies and resolutions tie our hands. Not only do I see MDA losing membership to this issue if we do not start to make significant change, but we will lose our voice as being a major stakehold- er in the dental healthcare delivery system within our state if we do not offer solutions to put our own “house in order.” Membership decline and apathy means loss of voice and power at the Capitol.


Challenges can bring opportunities—oppor- tunities that can truly make a difference for oral healthcare needs, and at the same time, continue to be grounded in important policy to protect the profession and the public. I firmly believe the delivery of that care by a team needs to be enhanced and reconsidered. MDA will not give up diagnosis or treatment planning, yet MDA should support trained and educated dental professionals working at the top of their scope.


Let us look at EFDA dental assistants for example. If a provider does not believe in the program, or want to delegate these proce- dures, they do not have to allow it in their office. By having a rule that allows more to be delegated, it does not force a provider if they are not comfortable. But it does allow the ability for dentists, who are comfortable del- egating procedures under direct supervision to trained and permitted assistants, to add this scope to their practice to better manage patients, increase efficiencies and see more people in shortage areas.


I personally can speak to the value of the EFDA program being available in my rural private practice, which also is one of the few Medicaid provides in the area. I am inundated with patients, and to continue to serve my county and surrounding counties, I must be vigilant and utilize efficiencies in which I have trust and faith. I do not allow everything “legal” in the Practice Act to be done in my


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