D2940 or Innovative Workforce Response

Dr. Blake McKinleyIan Murray

Overview

Mid-Level Provider (MLP) – a non-dentist performing dental procedures

– What are Mid-Level Providers?

○ DHAT: Dental Health Aid Therapist○ Independent Practice of Hygiene○ DT: Dental Therapist○ CDHC: Community Dental Health Coordinator (ADA

proposal)

OverviewWhy are MLP being established or

promoted?

Who determines whether or not MLPs are established and how?

Will the MLP have any less overhead than your will?

Then how will this decrease the cost of care?

No!

○ Increase access to care

WSDA Core Principles Without these principles there is no

support from the dentists.The dentist is the sole oral health professional

authorized to diagnose and prescribe treatment for patients.

Close on-site supervision may be allowed for procedures that are authorized by statutes when approved by the dentist based on the dentist’s determination of competency.

Regulation of the dental workforce will be the responsibility of the Dental Quality Assurance Commission.

ConceptsDentistry is a surgical art

When is an extraction simple?

Where does a pulpotomy stop?

When does something “simple” become complicated?

○ Surgery is the cutting of tissue, teeth are tissue.

○ Only in retrospect, regardless of the definition!

○ When the bleeding stops (regardless of definition)!

○ If after the pulpotomy, the pulp continues to bleed and your authority does not let you go down the canal, then what? Extraction?

Training and its Significance

Dentist○ High school education or equivalent○ 4 years college○ 4 years dental school

MLPDental Therapist

○ High school education or equivalent○ 2 years didactic○ Some clinical experience

Independent Practice of Hygienist ○ Junior College Training○ 4 Year College Training

Training and its Significance

MLP in medicine○ Physician Assistant

Education/Certification/Privileges:

Prerequisites to PA Education

Accredited PA Programs

National Certification

Maintaining Certification

State Licensure

Surgery?

ConclusionsWhat is the ADA policy?

The ADA does not believe a non-dentist should perform

surgical/irreversible procedures.

The ADA supports innovations in the dental team that would

improve oral health among people who lack adequate access

to care, provided that those innovations do not compromise

the very system they seek to extend. Our own Community

Dental Health Coordinator pilot project seeks to do that by

training community health workers who specialize in oral

health education and disease prevention, factors that

ultimately are the nation's best hope of ending what we all

agree are unacceptable levels of oral disease.

How does the CDHC fit?○ http://www.ada.org/cdhc.aspx

What is ASDA doing?○ C-1 Expanded Functions of Dental Assistants

and Dental Hygienists (1973, revised 1991, 1994, 2000, and 2005)

○ 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.