Senate bill imperils dental care
Albert J. Marro / Staff FILE Photo
Dr. Judith Fisch performs triage on a patient during a past Free Dental Clinic Day in Rutland.
Dr. David McLean got it right when he wrote a recent oped that “Healthy teeth and gums aren’t a luxury.” Too often it seems as if dentistry is an afterthought when it comes to discussions about health care reform. Yet healthy teeth and gums are essential to our personal health and to reducing expenses to our pocketbooks, as well as to our health care system overall. There is a strong correlation between poor oral health and conditions such as diabetes and heart disease, and conversely a strong correlation between good oral health and overall health.
Through the Vermont State Dental Society, my colleagues and I are working hard to expand access to high-quality and affordable dental health care in our communities and through Vermont’s health care reform initiatives. We are also working to ensure that dental health, and its relationship to overall individual health and total health care costs, is a significant part of Montpelier’s health care reform discussion.
This is important because every Vermonter deserves access to good oral health care. It is very important that the Legislature understands the practice of dentistry in order to get dental health policy right.
Through our Vermont Action for Dental Health plan, Vermont’s dentists are working to expand access to dental care in schools, nursing homes and community health centers. We are also working to ensure that adequate and affordable pediatric dental health care is included in insurance plans offered in Vermont’s new health insurance exchange.
There is, however, a proposal in the state Senate (S.35) that would be a step in the wrong direction and could undermine access and quality of care and increase costs.
S.35 was motivated by out-of-state interests with limited knowledge of Vermont’s specific oral health needs and thus does not address our Vermont-specific dental health challenges. The bill creates far too many questions, and its supporters provide too few answers.
For example, under S.35, a new type of practitioner would be created called a licensed dental practitioner, or LDP. An LDP would have a scope of practice, under S.35, that includes medically necessary oral surgery and a range of irreversible procedures. Yet the educational requirements for an LDP, as of this writing, would be only a three-year degree in dental hygiene, plus one year additional training and 400 hours of clinical training in procedures that a licensed dentist performs.
Oral surgery is very significant medical care. That’s why patients — and the profession’s best practice standards — require a fully licensed Doctor of Dental Science to perform this treatment. Creating a new profession with this scope of practice and minimum level of education is not the right choice for Vermont.
In addition, there is no definition or guidance in the proposed law on what, or where, those 400 clinical hours would need to be focused to ensure patient health. And since Vermont does not have a dental school, there is no accredited educational institution prepared to deliver this training.
These are just a few of the shortcomings of S.35 — there are many more. S.35 is not a solution to Vermont’s dental health challenges. A lesser-trained provider is not the answer. We’d prefer the Senate work with us to advance the Vermont Action for Dental Health. Our plan contains better solutions that will get real results.
Dr. Judith Fisch practices general dentistry in Rutland and was one of the authors of the Vermont Action for Dental Health plan.