Dental hygienests want new rights
HARTS -- Barbara Hughes polishes teeth.
She also takes X-rays, scrapes under gums, applies sealants to children's molars to block decay and tells people about proper flossing and brushing.
She's done all those things and more as a dental hygienist in Southern West Virginia for the past seven years.
But Hughes isn't allowed to work here at the Robert C. Byrd Health Center dental clinic unless a dentist is present. She can't even look into a patient's mouth. State law doesn't allow it.
Hughes says that's unfair to hygienists, dentists and patients.
"People depend on somebody being at the office," said Hughes, who works for Valley Health at the dental clinic in Harts. "You have to cancel patients. People get lost in the cracks. They don't maintain their oral health."
Dental offices across the state must shut down when a dentist isn't in the building.
West Virginia is one of only six states that still have such a law on the books. In a 2003 report, an advocacy group called Oral Health America gave West Virginia a grade of F for its restrictive dental-hygiene practice act.
House of Delegates Health and Human Resources Chairman Don Perdue, D-Wayne, is expected to introduce a bill in the Legislature this week that will do away with the restriction.
Hygienists in nursing homes, schools, prisons, public-health facilities and community clinics would be permitted to perform most of their normal duties, except administer local anesthesia and apply cavity-preventing tooth sealants.
"To do hygiene, you don't need a dentist right there," Hughes said. "This should have been done years and years ago."
The West Virginia Dental Association, which represents dentists across the state, drew up the proposal. The state Board of Dental Examiners has promised to write new rules if the bill becomes law.
"It's a step in the right direction," said Dr. Dan Brody, a dentist who works with Hughes in Harts. "It brings us in line with other states, and it's going to improve access to care."
The proposed bill includes stipulations:
s Hygienists couldn't work more than three consecutive weeks without a dentist in the office.
s They must complete an emergency medical course.
s A dentist must have examined the patient not more than seven months before the hygienist provides services.
s Hygienists must receive a special permit from the state dental board to work alone. They must have at least two years experience.
Members of the West Virginia Dental Hygienists' Association say the stipulations make the proposal too restrictive.
Patients should be allowed to see a hygienist even if they haven't seen a dentist in the past seven months, the association asserts. Hygienists also don't think they should have to obtain an extra permit, because they're already licensed through the state. And they criticize the three-week limit on unsupervised work.
"We just think it's too restrictive," said Jennifer Blaskovich, legislative chairwoman for the state hygienist association. "But we're willing to work and come up with something both groups are happy with."
Hygienists also want the right to apply tooth sealants when dentists aren't present. It's something hygienists do dozens of times each year. "It's a standard of preventative care," Blaskovich said.
The hygienist association is supporting its own proposed legislation, which also is expected to be introduced this week. The bill would let hygienists work at health clinics, nursing homes and schools without a dentist on staff. Hygienists would have to be affiliated with a dentist to work at a dental practice without a dentist present.
Jason Webb, lobbyist for the hygienists, said his group has spent five years trying to get the law changed to give hygienists more freedom.
"The dentists' version of the bill helps dentists," Webb said. "Our version helps poor people and the needy in West Virginia. The dentists just don't want to lose their workforce, because it makes them so much money."
In 2003, the West Virginia Dental Association appointed a task force to examine ways to improve access to oral health care. The task force found that other states started to change dental-practice acts to let hygienists work without a dentist present about 10 years ago.
Forty-four states and the District of Columbia permit hygienists to work without direct supervision. All states that border West Virginia do so.
"We're not the last, but we're among the last," said Richard Stevens, executive director of the state dental association.
Last fall, the group's board voted 26-1 to support legislation to allow hygienists to practice without dentists standing over their shoulder.
The average dentist works 47 weeks a year, Stevens said. In West Virginia, dentists must shut down their offices when they take vacations and sick days, attend training seminars or see patients at hospitals.
"This isn't a cure-all, but it's an effort to expand the delivery of oral health care," Stevens said. "It will generate income for the office, generate income for the hygienist and generate the services that patients need."
The dental association's proposed legislation stops short of allowing hygienists to operate their own practices. They must be affiliated with a dentist no matter where they work.
Colorado is the only state that allows independent hygiene practices with no dentists on staff. Even so, only about 17 such practices exist in Colorado, mostly in middle-income and affluent parts of the state. Only 20 of the state's 2,700 dental hygienists work in such practices, according to a 2005 American Dental Association study.
"The biggest concern of dentists is we would want to operate a practice of our own," Hughes said. "It's like the old saying: Give them an inch and they'll take a mile."
About 1,100 hygienists are licensed in West Virginia. They normally graduate from two-year programs. Six colleges in the state offer dental hygiene degrees. West Virginia University has a four-year hygienist program.
Dentists spend at least four years in dental school after receiving an undergraduate degree.
Hughes said she hopes the debate over legislation and possible changes in the law don't spark a long-term rift between dentists and hygienists.
"Generally, dentists think of us as professionals," Hughes said. "The hygienist is basically the liaison between the patient and dentist. We're the ones that give them the experience so they don't feel like a herd of cattle rushed through here."
To contact staff writer Eric Eyre, use e-mail or call 348-4869. Eyre's coverage of oral health is being supported by a Kaiser Family Foundation journalism fellowship.