Community Dental Health Coordinators

1. Community Dental Health Coordinators Trent Lally District 6 Trustee

2. “Community Dental Health Coordinator” or “CDHC” • Part of an ADA comprehensive effort to improve access to oral health care for underserved Americans. • Promises to help Americans become better stewards of their oral health. What is a CDHC?

3. No. Mid-level providers are being promoted to drill, fill, and extract. CDHC focuses on the root causes of disease – the lack of adequate prevention and oral health literacy among populations. Is the CDHC a “mid-level provider?”

4. To help expand access to the same high quality dental care available to all Americans, the ADA is helping to develop a new member of the oral health team. National Coordinating and Developing Committee (NCDC) was established to create a CDHC training program. Background

5. Assist the dentist in the triage of patients • Address social, environment, and health literacy • Educate community members • Part of a comprehensive approach that also includes: • Improving Medicaid reimbursement rates • Placing new focus on oral health education • Prevention • Increasing government investments in the public health infrastructure How will the CDHC improve Access?

6. Students in the CDHC pilot program are recruited from the communities in which they serve. Comparable to Community Healthcare Workers (CHWs) but with clinical dental skills. Not a one-size-fits-all solution CDHC and the underserved

7. Pilot Programs 18-month training program (12 months didactic + 6 months internship) University of Oklahoma Temple University A.T. Still University Arizona School of Dentistry How are CDHC’s trained?

8. CODA Accreditation is the Goal Accreditation

9. Collect information (photographs, radiographs) Screenings Fluoride treatments Sealants Temporary filings Simple teeth cleanings (gingivitis) until a patient can have a comprehensive cleaning What is the CDHC scope?

10. Clinics Schools Churches Senior Citizen Centers Other public settings Where do CDHC’s work?

11. New Mexico first state to authorize CDHC model Update

12. Trent Lally Email: TLally01@gmail.com Phone: (248) 866-0760 Questions?

13. Dental Health Aid Therapist Dusty Pfundheller District 5 Trustee

14. “Dental Health Aid Therapist” • dependent practitioner working in a satellite clinic under the general supervision by an off-site licensed dentist located at a distant regional clinic What is a DHAT?

15. Alaska • Alaska Native Tribal Health Consortium (ANTHC) • 85,000 Alaska Native people live in rural Alaska with no road access. • 5 times caries risk in children • Alaska allowed high school graduates go to New Zealand for a two year program • Now ANTHC partnered up w/ Kellogg Foundation to study at University of Washington’s Medical School - 1 year is pre-clinical, 1 year clinical. • Now students are able to be trained in Washington University. How Were DHAT’s Created?

16. 2 yr program • Must have high school diploma or equivalent & 6wk online anatomy & physiology course • 1st year = pre-clinical work & classroom setting • 2nd year = clinical experience, village practice rotations • 400 clinic hours (six-month) residency program • Every two years DHATs must be recertified. • 24 CE credits • Demonstration of ongoing clinical competency Training for DHAT

17. Determined by the supervising dentist during the residency based on DHAT’s demonstrated clinical skills and tribal location needs • Determines of clinical procedures and scope of practice • Scope of practice is dynamic, may change periodically depending upon the maturing skills-set of the therapist. • Typical DHAT may provide oral exams, preventive dental services, simple restorations, stainless steel crowns, extractions and take x-rays. Scope of practice

18. Dependent practitioner working in a satellite clinic under the general supervision by an off-site licensed dentist located at a distant regional clinic. Supervision

19. Dustin Pfundheller Email: dpfundheller@dental.ufl.edu Phone: (715) 894-0083 Questions?

20. The Dental Therapy Model Ben Youel, District 7 trustee Aruna Rao, vice chair, Legislative Grassroots Network

21. December 2006 – ADHP program approved by Board of Directors of MN State Colleges & Universities System Spring 2007 – Safety Net Coalition (SNC) convinces MN Legislative Committee on Health Care Access to recommend the creation of a dental MLP February 2008 – SNC introduces bill to create ADHP in MN Dental Practice Act A Little History

22. April 2008 – Bill passes to begin creation of an “Oral Health Practitioner” April 2008 – U of MN unveiled proposed Dental Therapy program May, July & September 2008 – U of MN delegation visits Saskatchewan, New Zealand & England Early 2009 – “Dueling Bills” from U of MN/MDA & from the SNC A Little More History

24. May 2009 – A compromise reached: Dental Therapy (DT) & Advanced Dental Therapy (ADT) created Fall 2009 – DT program begins at U of MN & Oral Health Care Practitioner (OHCP) program at Metropolitan State University June 2011 – Seven students graduated with MS: OHCP from Metropolitan State And Finally… • December 2011 – Nine students will graduate with either Bachelors or Masters Degrees in Dental Therapy from U of MN

25. Dental Therapist • Graduate w/Baccalaureate or Master’s in accredited dental therapy education program • Pass independent clinical competency exam • Jurisprudence Exam Licensure • Advanced Dental Therapist • All requirements of Dental Therapist • 2,000 hours of practice as DT • Graduate w/Master’s in ADT • Pass board-approved competency exam • Apply for certification

26. Dental Therapist • Radiographs • Preventative Procedures & OHI • Sealants • Temporary Restorations • Space Maintainers* • Direct Restorations* • Pre-fab Crowns* • Pulpotomies (Primary teeth)* • Extractions (Erupted primary teeth)* • Tooth Reimplantation/Stabilization* • Local Anesthesia & Nitrous Oxide • Mouthguards • Provide, Dispense & Administer Analgesics, Anti-Inflammatories & Antibiotics *Require Indirect Supervision All duties subject to Collaborative Management Agreement (CMA) Scope of Practice & Supervision • Advanced Dental Therapist** • All duties of Dental Therapist • Oral Evaluations & Assessments • Extraction (Periodontally involved permanent teeth) **All Require Only General Supervision

27. The Insider Perspective

28. Ben Youel – bcyouel@gmail.com Aruna Rao - raox0062@umn.edu Questions?

29. Advanced Dental Hygiene Practitioner (ADHP) Burton Coleman ASDA District 4 Trustee

30. Advanced Dental Hygiene Practitioner • American Dental Hygiene Association (ADHA) proposed position in 2004 A dental hygienist who has graduated from an accredited dental hygiene program and has completed an advanced educational curriculum approved by the ADHA, which prepares the dental hygienist to provide diagnostic, preventive, restorative and therapeutic services directly to the public. • Response to 2000 US Surgeon General’s call to increase access to care & tx underserved. • M.D./Nurse Practitioner Analogy What is it?

31. Currently a proposed model public health settings schools federally qualified health centers (FQHCs) long-term care facilities hospitals nursing homes • State by state, currently none in full form Where is it?

32. Training requirements & curriculum not fully established • Bachelor’s degree + 2 years = Registered Dental Hygienist • RDH + 2 year Master’s level program Training & Curriculum

33. The proposed ADHP educational framework is organized by general domains (themes) and more specific competencies within each domain. I. Provision of Primary Oral Healthcare II. Healthcare Policy and Advocacy III. Management of Oral Care Delivery IV. Translational Research V. Professionalism Training & Curriculum Proposal

34. Hygiene • Dx + Perioeval, SRP, Prophy, Fluoride Tx, OHI • Restorative • Dx+ Direct Restorations (composites, amalgams, sealants) • Palliative Care • Temp restorations, pre-formed crowns, pulp caps, place & remove sutures • Prosthodontics • Adjust & repair removable, re-cement fixed • Surgery – dx, uncomplicated extractions • Path – dx & refer • Ortho – dx & refer • Anesthesia – local & N2O *generally, dentist supervision not required Scope of Practice

35. Many states unsupervised perio, fluoride, sealants • Trend to administer supervised local anesthesia & N2O monitoring • ADHP varieties appearing commonly in state legislation • Connecticut • New Hampshire • Idaho (ISU M.S. in DH but restorative, surgery, pulp exceptions) • Washington (Native American reservation) • Michigan • Licensing process not yet determined State by State Basis

36. ASDAnet.org/midlevel-providers (page) • ADA Workforce Statement (pdf) • ADHA Resource Center (page) • ADHA.org/governmental_affairs(page) • State Dental Boards • Google Burton Coleman burtoncoleman@gmail.com 615.477.2781 Resources

37. Summary of Mid-Level Providers

38. DHAT = Alaska (trained in University of Washington) Dental Therapist = Minnesota CDHC = University of Oklahoma, Temple University, & A.T. Still University Arizona School of Dentistry ADHP = currently none in full form Location?

39. Community Dental Health Coordinator or CDHC Which program is approved by ADA?

40. All can do: Collect information (photographs, radiographs) Screenings Fluoride treatments Sealants Temporary filings Simple teeth cleanings (gingivitis) until a patient can have a comprehensive cleaning What can each program do?

41. DHAT • What dentist determines they can do in 400 hr residency Dental Therapists • Temporary Restorations • Space Maintainers • Direct Restorations • Pre-fab Crowns • Pulpotomies (Primary teeth) • Extractions (Erupted primary teeth) • Tooth Reimplantation/Stabilization ADHP • Hygiene : SRP, Prophy, • Restorative: Direct Restorations (composites, amalgams, sealants) • Palliative Care: Temp restorations, pre-formed crowns, pulp caps • Prosthodontics: Adjust & repair removable, re-cement fixed • Surgery uncomplicated extractions What can each program do?

42. Current Statements of Position or Policy Voted on at House of delegates Feb 29th-March 3rd Speaker – Stephanie explains more on this ASDA Policies

43. Endorses expanded functions for dental auxiliaries only when each has received the appropriate education and training to guarantee competence, and when such functions fall within the laws established by their respective state of employment. Expanded functions for dental auxiliaries will not adversely affect the health and well-being of the public. C-1 Expanded Functions of Dental Assistants and Dental Hygienists

44. The practice of dentistry entails more than the simple performance of routine technical procedures. A dentist must possess a wide range of knowledge of the biological, anatomical, and physiological sciences in order to successfully and safely perform such procedures. A dentist must also be able to process and apply both the knowledge and the skills acquired in dental school in order to successfully and safely perform these tasks.

45. Examination, diagnosis and treatment planning • Prescribing work authorizations • Performing irreversible dental procedures • Prescribing drugs and/or other medications Only the Dentist Should Perform