Georgia

1. Georgia

2. Dental hygienists are licensed, preventive oral health care professionals who provide educational, clinical, research, administrative, and therapeutic services that support total health by promoting optimal oral health

3. Education • Dental hygienists are required to graduate from an accredited dental hygiene program that is at least two years in length. (plus prerequisite core classes) • Graduation is followed by successful completion of the National Board Dental Hygiene Examination. This qualifies graduates to take a state or regional licensing examination that includes both a written and clinical component. • Dental hygienists must be licensed in the state in which they work and must practice in accordance with regulatory laws and dental hygiene practice acts.

4. Currently there are 313 entry-level dental hygiene educational programs and 75 baccalaureate degree-completion and master’s programs. • There are 16 programs located around the state of Georgia. • A dental hygiene educationrequires an average of 86 credit hours for an Associate degree, or 122 credit hours for a Baccalaureate degree. http://www.adha.org/downloads/AD-exec_report-2008.pdf.

5. General education courses: English, speech, psychology and sociology • Basic science courses: chemistry, anatomy, physiology, biochemistry, microbiology, pathology, nutrition, and pharmacology • Dental science courses: dental anatomy, head and neck anatomy, oral embryology and histology, oral pathology, radiography, periodontology, pain control and dental materials • Dental hygiene science courses: oral health education/preventive counseling, patient management, clinical dental hygiene, community dental health, medical and dental emergencies, and supervised instruction in pre-clinical and clinical practice.

6. Accredited dental hygiene programs require an average of 2,794 clock hours of curriculum. • This includes 654 clock hours of supervised clinical dental hygiene instruction http://www.adha.org/downloads/AD-exec_report-2008.pdf.

7. During the clinical component of the curriculum, dental hygiene students provide care and debridement for patients of increasing difficulty. • They provide treatment for patients with varying degrees of oral disease from the “healthy” patient’s preventive visit, to the periodontally involved. • Consequently, the dental hygienist is the most highly qualified person in the dental office to provide this type of care.

8. Before and after dental hygiene treatment http://www.greenpointdentalcenter.com/periodontal_treatment.html

9. The need for professional dental hygiene care

10. gingivitis Moderate Periodontitis Early periodontitis Advanced periodontitis Stages of periodontal disease

12. Adjunctive services provided by hygienists: • Sealants • Nutritional counseling • Amalgam polishing • Fluoride therapies • Subgingival Oral irrigation/antimicrobial treatment • Medicament placement

13. According to the accreditation standards for dental hygiene education programs, these subjects prepare dental hygiene students to communicate effectively, assume responsibility for individual oral health counseling, and participate in community health programs. • The accreditation standards require that dental hygiene students be prepared to assume responsibility for the assessment, planning and implementation of preventive and therapeutic services. They must also be taught how to assimilate knowledge requiring judgment, decision-making skills, and critical analysis

14. The Federal 2009 census reports that there are 173,900 licensed dental hygienists and 86,270 dentists in the United States. Since 1990, the number of dentists per 100,000 U.S. population has continued to decline. This decline is predicted to continue so that by the year 2020 the number of dentists per 100,000 U.S. population will fall to 52.7. • However, since 1990, the number of dental hygiene programs has increased by 27%. In addition, from 1985–86 to 1995–96, the number of dental hygiene graduates has increased by 20%, while the number of dentist graduates has declined by 23%. http://www.bls.gov/oes/current/oes291021.htm http://www.bls.gov/oes/current/oes292021.htm

15. Source: ADA Survey of Allied Dental Education, 1986-2008;Commission of Dental Accreditation Accredited (CODA) Allied Programs List, 2008,2009, 2010

16. The United States Health Resources and Services Administration’s Bureau of Health Professions National Center for Health Workforce Information and Analysis has studied dental and dental hygiene workforce issues. • Two of the regional centers for health workforce studies have cited and made policy recommendations to consider expanding the role of dental hygienists to include the delivery of oral health care services in shortage areas and to children on Medicaid.

17. The Association of State & Territorial Dental Directors (ASTDD) has developed an Oral Health Improvement Plan to serve the needs of their state. • Their vision is that there would be a strong and effective governmental oral health presence in states and territories to assure optimal oral health.

18. Since the 1980s ASTDD has used the Guidelines for State and Territorial Oral Health Programs to assist health agency officials and public health administrators to develop and operate strong oral health programs. (revised June 2010) • Access Georgia’s plan at: http://www.astdd.org/state-programs/Georgia/ • Dental hygienists are trained and ready to assist with the goals established by this plan in Georgia.

19. It is clear that the numbers of dental hygiene programs and graduates are increasing and that licensed dental hygienists are well educated to provide preventive and therapeutic services to the public. • The American Dental Hygienists’ Association believes that dental hygienists who are graduates of accredited dental hygiene programs are competent to provide services without supervision. www.adha.org

20. Oral health is a critical component of total health

21. Current research has linked periodontal disease to heart and lung disease, diabetes; and a number of other systemic diseases. • Numerous recent studies have also demonstrated the association between periodontal disease and a variety of respiratory diseases, including COPD and pneumonia. • It is well documented that diabetic patients with periodontal disease have difficulty with glycemic control. • Because of the overwhelming science supporting the “oral-systemic connection”, patients with these systemic conditions should have access to dental hygiene services on a very routine basis.

22. The first-ever Surgeon General’s Report on Oral Health has called attention to this important connection and states, that if left untreated, poor oral health is a “silent X-factor promoting the onset of life-threatening diseases which are responsible for the deaths of millions of Americans each year.”

23. Early detection of disease • The early detection and treatment of oral disease is critical to saving lives. During oral health examinations, dental hygienists can detect signs of many diseases and conditions like HIV, oral cancer, eating disorders, substance abuse, osteoporosis, and diabetes. • In addition, dental hygienists can work with patients to develop oral health care treatment plans that manage oral infection so it does not exacerbate serious diseases.

24. The Surgeon General’s Report on Oral Health reports serious disparities exist in access to oral health care, especially among low-income populations. • One in four American children is born into poverty (annual income of $17,000 or less for a family of four). Children and adolescents living in poverty suffer twice as much tooth decay as their more affluent peers while their disease is more likely to go untreated.

25. Dental Decay (caries) • Dental caries (decay) is the most common chronic disease nationally affecting 53% of 6-8 years olds and 84% of 17 year olds. • A devastating effect of dental decay can be death from the bacteria that enters the bloodstream as in the 2007 case of Demonte Driver. He had no access to dental care. The cost of providing restorative treatment is more expensive than providing preventive services.

26. It is not only socially responsible, but fiscally prudent, to increase access to preventive services. Each year millions of productive hours are lost due to dental diseases. • An estimated 51 million school hours per year are lost because of dental-related illness. • Students ages 5 to 17 years missed 1,611,000 school days in 1996 due to acute dental problems—an average 3.1 days per 100 students. Community Voices: HealthCare for the Underserved.2001. Poor Oral Health Is No Laughing Matter. Washington, DC: Community Voices: Health Care for the Underserved. National Center for Health Statistics. 1996. Current estimates from the National Health Interview Survey,1996

27. “Early tooth loss caused by dental decay can result in failure to thrive, impaired speech development, absence from and inability to concentrate in school, and reduced self-esteem.” Office of Disease Prevention and Health Promotion. 2000. Healthy People 2010. In Office of Disease Prevention and Health Promotion

28. Other Oral Health Problems • Serious oral health problems also occur among adults. Each year about 30,000 Americans are diagnosed with oral and pharyngeal (throat) cancers, and more than 8,000 people die of these diseases. • In addition, almost 30% of elderly adults no longer have their natural teeth due to tooth decay and gum disease.

29. Unlike most medical conditions, the three most common oral diseases -- dental caries (tooth decay), gingivitis (gum disease) and periodontitis (advanced gum and bone disease) -- are proven to be preventable with the provision of regular oral health care. • Despite this prevention capability, tooth decay -- which is an infectious transmissible disease -- still affects more than half of all children by second grade. Clearly, more must be done to increase children’s access to oral health care services.

30. The Issue of Access to Care

31. In most states dental hygienists practice under what is known as general supervision. This means that a dentist has authorized a dental hygienist to perform procedures but need not be present in the treatment facility during the delivery of care. • In Georgia, dental hygienists are required to practice under direct supervision. This means the dentist must be present in the office while the care is being provided.

32. The Surgeon General’s Report on Oral Health identified barriers which keep people from needed care—inability to pay for care and inability to travel or physically access the places where care is delivered, or a lack of dentists practicing in the area. • Dental hygienists can play a role in resolving these problems.

33. Regrettably, the experience, education and expertise of dental hygienists are now dramatically underutilized. • ADHA wants to be part of the solution to the current problems of oral health disparities and inadequate access to oral health services and ADHA believes that increased utilization of dental hygienists is an important part of that solution.

34. Due to the proliferation of dental hygiene programs in Georgia and the restrictive rules governing our practice, there is a ready workforce of dental hygienists who are ready to meet this health care need.

35. ADHA advocates that the services of dental hygienists who are graduates from an accredited dental hygiene program can be fully utilized in all public and private practice settings to deliver preventive and therapeutic oral health care safely and effectively.

36. “Licensed dental hygienists, by virtue of their education and clinical preparation, are well prepared to deliver preventive oral health care services to the public, safely and effectively, independent of direct supervision.” ADHA

37. If improvement in the nation’s health care system is to occur, more equitable access to basic quality oral health care at affordable costs is necessary. • Licensed dental hygienists are educated and qualified to perform oral health care services, furthermore, dental hygienists serve as an efficient pipeline for identifying and sending on those who need the care of a dentist.

38. Dental hygienists are competent to provide services in a variety of settings more accessible to patients—residences of the homebound, public health and school based programs, community clinics, and more.

39. To increase access to oral health care, the American Dental Hygienists’ Association recommends the following: • That oral health care providers continue to educate the public about the need to maintain their oral health and the importance of preventive care. • That dental hygiene education programs provide dental hygiene students with the knowledge and skills necessary to deliver oral health care services in a variety of practice settings and encourage the utilization of externships in underserved areas. • That federal government funding/grant programs (Title VII and VIII of the Public Health Service) include dental hygiene provisions. • That partnerships be developed among health care organizations, state and federal government, and other interested groups to educate the public on the importance of oral health and the integral role of oral health in total health. • That licensed dental hygienists be recognized by the state and federal government as Medicaid providers. • That state governing bodies eliminate statutory/regulatory language that restricts the public’s access to oral health care services provided by licensed dental hygienists.

40. Georgia