California Assembly favors better dental care for poor children — and something else

The California Assembly last month voted overwhelmingly to support the Virtual Dental Home. The bill is now in Senate committee.

What kind of program gets such strong support from both sides of the aisle?

First, AB1174 is about early identification and treatment of tooth decay and other dental issues in poor children. That’s not a partisan issue. Does anyone believe it’s the kids’ fault if their teeth are bad?

Second, it’s a pilot project. If in two years the program can’t demonstrate to the satisfaction of legislators that it can do what it promises, the program disappears.

Curiously, and despite the 76-0 Assembly vote in its favor, this proposed bill does dance with some controversy. It plunges right into the scope-of-practice debate.

There’s little question that these children need help. In a 2012 report published in the Sacramento Bee, the Center found that many suffered from broken or rotting teeth due to lax state oversight of dental plans contracted to serve hundreds of thousands of poor children in Sacramento and Los Angeles.  State legislators led by Sen. Darrell Steinberg (D-Sacramento) acted immediately to remedy the situation.

Almost two years later, too many poor California kids continue to suffer from bad teeth and little or no care. Hence, AB1174.

But there’s another aspect to this pilot that is, in some ways, even more interesting than the obvious good it might do for dental health. The bill represents another round in the “scope of practice” tug-of-war — evaluating what role various health professionals should play in serving patients.

AB1174 would place dental hygienists and dental assistants in schools and other child-centered settings with state-of-the-art diagnostic equipment. Under the remote supervision of a dentist, these dental professionals would take X-rays and provide interim fixes to dental issues until the dentist, with their input, develops a treatment plan.

Arrangements concerning the role of dental hygienists vary widely among states. According to the American Dental Hygienists Association, in some (Alabama and Georgia, for example), a dentist must be present for virtually any procedure a hygienist conducts. In others (Delaware, Idaho, Maryland, Oklahoma), a dentist must authorize work, but a hygienist may perform it without a dentist being present. Some states go further (Colorado, Oregon, Texas and Vermont, among others), allowing hygienists to conduct procedures without the presence and, in many cases, without the approval of a supervising dentist.

Under AB1174, California hygienists would be able to perform various dental tasks remotely under the general supervision of a dentist.

This arrangement falls in line with what the California Medical Association envisions as “team-based” care, allowing health professionals like physician assistants and nurse practitioners plenty of responsibility, but always under the eye of a team leader physician.

Whether the AB 1174 approach is the only – or best – arrangement only time (two years of it, at least, if it becomes law) and politics will tell. In California and across the nation, we’ve seen angry debate in recent years between physicians’ groups and other health professionals over their relative roles in the health care matrix (see the latest battleground, in Kansas).

But, if passed, this legislation should increase the possibility that California’s poor children will have their dental issues identified and dealt with, at the same time that it increases the role for non-dentist health professionals.  And it might serve as a petri dish for doctors, physician assistants and nurse practitioners to observe how workable that relationship can be.

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