(The following article by David Wenner appeared in the Pennsylvania Patriot-News on Aug. 3.)
"There have been times when the dentist wasn't in the house and the hygienist couldn't work." Jeannine Peterson, CEO of Hamilton Health Center
Low-income people who can't get in to see a dentist will soon be able to get at least some dental care, thanks to a bill signed recently by Penn. Gov. Ed Rendell. Dental hygienists will be able to clean teeth and apply sealant and fluoride at schools, nursing homes, prisons and other public health settings.
In the past, they couldn't do that work without permission and supervision from a dentist. Now they will be able to contract on their own to provide the services. They also can be paid directly by Medicaid, the government health insurance program for the poor.
Pennsylvania dentists have fought the change for years, saying their involvement was needed to make sure patients with dental or medical problems get safe and appropriate care.
But state Sen. Pat Vance, R-Cumberland County, who wrote the bill and pushed for the expansion for years, has stressed the shortage of dentists who accept Medicaid patients. "There are almost none in Cumberland County, and I think there are very few, period," she said.
Regulations must still be written, a process that could take months, and people will not be able to get the new care until that step is completed, a spokeswoman for Rendell said. But Vance expects the bill to expand access to preventive care that can make a big difference in dental health, especially among children.
"We see this as a major step forward. It will be a great advantage to us," said Jeannine Peterson, CEO of Hamilton Health Center, a Harrisburg-based federal health clinic.
Hamilton, which has two dentists and is looking for a third, continually struggles to meet the demand for dental care. It uses dental hygienists to handle much of the teeth cleaning, Peterson said.
"There have been times when the dentist wasn't in the house and the hygienist couldn't work," she said.
Pennsylvania dentists are highly critical of Medicaid, complaining of low reimbursements and excessive administrative demands. They also say Medicaid patients can be unreliable, failing to show up for appointments.
Rendell originally wanted to allow qualified dental hygienists to be able to fill teeth, although this would have involved close involvement with a dentist.
Vance said she didn't support that idea because it wouldn't have overcome opposition by dentists, and she's unsure if it's appropriate for dental hygienists to handle fillings.
Advocates say lack of dental care is a widespread health problem among the poor, interfering with the education and overall health of children and leading to medical problems for older people.
At Sadler Health Clinic in Carlisle, the dentists often have to bring infections under control before they can begin dental work, said Bets Clever, executive director of the Carlisle Area Health & Wellness Foundation and a member of the Sadler board.
"It's certainly a move in the right direction," she said. "A good bit of what [dental hygienists] do is preventive, which is absolutely critical in oral health."
