Proposed changes to a rule requiring more supervision for Georgia dental hygienists could limit access to basic preventive care for needy children, government and industry groups say.
The Federal Trade Commission recently raised concerns that the proposed amendments by the Georgia Board of Dentistry, which would require dentists to indirectly supervise dental hygienists at certain public health facilities, could increase the cost of dental services and reduce the number of consumers receiving care.
“We’re particularly concerned about the possible negative effects of the proposed changes to the rules on the poor, especially children and other vulnerable populations,” said Susan DeSanti, director of the FTC’s Office of Policy Planning.
The changes, which would apply to dental facilities overseen by the Georgia Department of Community Health, county boards of health and Department of Corrections, could be interpreted as requiring a dentist’s initial diagnosis for each patient before a dental hygienist can provide treatment, the FTC stated in a letter to the Georgia Board of Dentistry.
That could mean increased costs for transporting dentists to sites, making care unaffordable for some people in low-income communities. It could also prevent care in areas where a dentist is unavailable, the agency said. The FTC said the changes would likely stifle competition, from which consumers benefit, and encouraged any rule change to be narrowly crafted to lessen any anticompetitive impact.
The Georgia Board of Dentistry said the rule change is about safety, noting the board has a legal mandate to protect the state’s dental patients.
“A portion of the consideration of this proposed rule lies with the facilities mentioned above having the necessary dentist resources to provide the level of supervision required for these dental hygiene procedures,” said Dr. Clyde Andrews, chairman of the board’s Rules Committee.
Dental hygienists say the proposed restriction will especially hurt poor children.
"This is about access to care," said Elizabeth Appley, legislative counsel for the Georgia Dental Hygienists’ Association.
Public health dental hygienists go into public schools where 50 percent or more of the children are in free- or reduced-lunch programs, as well as provide services through mobile health vans and at health centers, she said. They provide cleanings, sealants, fluoride varnishes and other preventive services, Appley said.
“We’re talking about a time when public health is being cut,” she said. “People are losing health insurance when they lose their jobs.”
Preventive dental care has been proven to help significantly reduce cavities and other oral problems that take a toll on the overall well-being of individuals, she added.
The FTC said it has found no evidence of any of the current practices being harmful in any way.
“If there’s no health or safety reason for the indirect supervision of a dental hygienist, then why are we adding that cost?” the FTC’s DeSanti said.
Martha Phillips, executive director of the Georgia Dental Association, said the group has frequently received phone calls from public health dental hygienists asking what services they are allowed to provide, so there was a need to put rules in writing.
Phillips said the proposed rule changes as written are flawed but she thinks the board’s intent was not to prevent dental hygienists from providing children with the services they need.
“It’s really upsetting to us that we’ve gotten to the point where this has been blown out of proportion,” Phillips said. “I know our intention is to support public health.”
The application of fluoride varnishes and rinses doesn’t require a dentist’s examination, she added.
It’s hard enough for schools to get funding for supplies, much less dental care, said Nancy DeMott, president-elect of the Georgia Dental Hygienists’ Association. “You’re not going to get more funding the way the economy is.”
Preventive dental care is important to children’s overall health, DeMott said. If a child gets an abscess because of a cavity, he or she is going to be in pain and could miss school, she said.
“They don’t have dental insurance, so they don’t go to the dentist,” she said. “Prevention is much cheaper.”
The Georgia Board of Dentistry is slated to listen to public comments and possibly vote on the changes at its meeting Friday in Macon.
