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Hygienists prepare for open battles with dentists in dispute over practice laws

That year, Illinois lawmakers considered measures to expand oral health care in a state that is home to millions of people Dental care deserts.

But when the Illinois State Dental Society virtually met with key lawmakers for its annual spring lobbying day, proposals to have dental hygienists clean the teeth of certain disadvantaged patients without a dentist seemed doomed.

State food. Dave Syverson, a Republican legislative leader, warned about the bills, even if they sounded minor. “It’s all about getting the camel’s nose under the tent,” he said in an audio recording of the meeting that KHN received. “We will shortly have hygienists doing the work that they should have attended dental school for if they wanted.”

The senator added that he missed “the reception and dinners you host” and the “nice softball questions I usually get” from the former president of the dental association who happens to be his first cousin.

The bills never made it off the committee.

The Illinois situation is indicative of the types of legislative dynamics that play out when subordinate health care providers such as dental hygienists, Nurse practitioner and optician try to gain more autonomy and access to patients. And the fate of these Illinois bills illustrates the power that lobbying groups like the Illinois Dental Society have in developing guidelines on where health professionals can practice and who keeps the profits.

“There’s always a fight,” said Margaret Langelier, a researcher at the Center for Health Workforce Studies at the University of Albany in New York. “We have orthopedic surgeons who argue with podiatrists about who can take care of the ankle. We have psychiatrists arguing with clinical psychologists about who can prescribe and what they can prescribe. We have nurses fighting pharmacists for injections and vaccinations. It’s the turf wars. “

In 2015 the Illinois Dental Offices Act Revised to allow hygienists to treat low-income patients with Medicaid or uninsured in “public health facilities” – such as schools, safety net clinics, and programs for mothers and children – without a dentist examining them or being on site. In addition to cleaning, the hygienists can x-ray, place seals, and apply fluoride.

This year legislators proposed bills that would have expanded these attitudes Nursing homes, Prisons and mobile dental trolleys.

The state dental association in a Memo to members, wrote that the fact that hygienists took years to develop their public health training program shows that “they have no real interest in providing access to health care for patients in need.”

As it is, Illinois haunts many other states Allow dental hygienists unattended contact with patients. In Colorado, at the far end, hygienists can own offices.

“It’s just the nature of the beast, politically in Illinois. In these other states, the dental lobby isn’t that strong, ”noted Margaret Vaughn, executive director of the Illinois Rural Health Association. “The Illinois State Dental Society is much more powerful and much better organized than the hygienists politically.”

From 2015 to 2019, the dental society spent more than $ 55,000 lobbying for its annual lawmaker meeting and meals, usually held in a swanky Italian location near the State Capitol in Springfield public publications. During the same period, the Illinois Dental Hygienists Association reported not spending anything in its lobbying reports. (No group has listed issues since early 2020.)

The dental society has two exclusive lobbyists and four lobbying firms under contract, state records show. The hygienists group meanwhile does not employ lobbyists and contracts with only one company.

The Dental Society makes generous donations to Republicans and Democrats. It is Political Action Committee had nearly $ 742,000 in cash as of June 30, according to Reform for Illinois’ Sunshine Database. While the PAC has been serving $ 4,050 in support of the state Sen. Melinda Busch, a Democrat who sponsored the Nursing Homes Act, the database shows that it did a lot more to help elect Syverson, the senator who spoke at the conference. There has been more than $ 123,000 to his campaigns since 1999, with bigger annual gifts than Bush.

“I am receiving input from many groups on both sides of the topic,” Syverson emailed KHN. “You are not helping to influence my vote on any particular bill. If a PAC sends a check while we are negotiating or voting on an issue, I would not accept it. “

The Hygienists PAC donated $ 1,100 to the Bush campaign committee. according to the databasebut not for Syverson. Bush did not respond to requests for comment.

“The bottom line is, if you don’t have a healthy mouth, you don’t have a healthy body,” says Ann Lynch, advocacy and education director American Dental Hygienists Association. “It only makes sense that we should remove any barriers that prevent a licensed healthcare provider from fully practicing.”

But Dave Marsh, a lobbyist for that Illinois Dental Society, said it would be dangerous for hygienists to treat nursing home residents, who are often older and sick.

“I just don’t think anyone with a two-year associate’s degree is medically qualified to correct your health,” added Marsh. “You are trained to brush your teeth. You take a sharp little instrument and scratch your teeth. They do. That’s all they do. “

He said the problem is not a lack of dentists, but a lack of dentists who can afford to take Medicaid patients – and “nobody wants to raise taxes to actually reimburse dentists at higher rates”.

He also pointed to the lack of research on the benefits of dental hygienists having more professional freedom.

Langelier acknowledged that little scientific literature exists on the subject, in part due to inadequate data collection on oral health. But in 2016, a Study she co-authored in Health Affairs found that the greater the autonomy of dental hygienists, fewer people had to have teeth removed due to tooth decay or disease. And she said Medicaid data shows more children had dental visits as hygienists expanded their practice.

“I don’t want this to be bitter,” said Laura Scully, chair of the Access to Care Committee State Hygienist Association. “I want it to be more of a collaboration, because that’s what it’s really about: coming together so we can help more people.”

Karen Webster works as a dental hygienist for the Health partnership in three cities, a free clinic in St. Charles, Illinois, about 40 miles west of Chicago. In the past, she could only briefly examine patients before arranging them with one of the centre’s volunteer dentists, often for months.

“Imagine you had a toothache and the doctor couldn’t see you that day,” she said, noting that her patients had low incomes. “You cannot afford the services. They wait until something hurts. “

But since she was a public health dental hygienist, Webster has now been doing instant cleanings, taking x-rays to send to teledentists for checkups, and applying a solution called silver diamine fluoride that can stop tooth decay.

“It’s a lot more efficient from start to finish,” she said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health topics. Along with Policy Analysis and Polling, KHN is one of the three main operational programs at KFF (Kaiser Family Foundation). KFF is a non-profit foundation that provides the country with information on health issues.


This story can be republished for free (details).

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Reference: khn.org


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