National Dental Student Lobby Day: my first national meeting and what I would consider the beginning of my involvement with ASDA. Attending what is considered the most influential annual meeting that ASDA holds every year was an honor, and I’m glad to be able to attend again this year. This is an event where over 400 students from schools nationwide come together to lobby about important issues in organized dentistry as a unified voice, seeing that changes occurring in the profession are brought about by the ones who know it best: dentists and dental students.

As the newly appointed vice president of Colorado ASDA and first legislative liaison, it is my responsibility to relay information and updates about any current issues in dentistry. This entails being up-to-date on current legislation that could pass, or has passed, in either the House of Representatives or the Senate. Although these are my duties as the first legislative liaison, it is in everyone’s interest to remain engaged during the legislative process involving these issues because decisions made in the coming years will affect all of us within the profession. While I’m not expecting everyone who reads this to try and set up meetings with legislators (frankly I’m happy you’re still reading), I would like people to be informed with what is going on in the world of organized dentistry, and what issues we are lobbying for in DC this Tuesday. Mid-level providers, access to care, licensure, and student debt are a few considerable issues that are of concern. Student debt and access to care specifically are the two that ASDA has decided to focus on at National Lobby Day this year. Two bills aimed at helping lower student debt are H.R. 649 (Student Loan Refinancing Act) and H.R. 4223 (Post Grad Act). The Student Loan Refinancing Act would allow graduates to refinance their student loans if a lower interest rate becomes available down the road. The Post Grad Act would make it much easier to get subsidized student loans while in school, meaning that students would not accrue interest while in school as well as for six months post-graduation. If both of these bills were to pass, students would have the potential to save tens of thousands of dollars! The third bill that will be lobbied for on Tuesday is H.R. 539 (Action for Dental Health Act of 2015) and addresses the access to care issue. The Action for Dental Health Act of 2015 would allow programs such as Mission of Mercy (MOM) and Give Kids a Smile to apply for readily available funds (around $15 million) that the CDC has set aside for public health projects. This bill is an amendment to the Public Health Service Act due to its current exclusion criteria regarding what sort of organizations can apply for these funds.

Albeit somewhat brief, this is what is going on in the world of organized dentistry at the current time! It would not surprise me if most of this information is foreign to you, but I hope that this new knowledge you now possess will motivate you to stay informed on the current issues in our profession.

Like many other dental students, I’m from a state that doesn’t have its own dental school. Unfortunately, this leads to a very high lack of access to care for the residents of my home state, New Mexico. When speaking to several members of the NMDA about issues that are impacting our state, the words “mid level care providers” and “dental therapists” inevitably pop up. My basic assumption of these words (which are one in the same) at the time was “a non-dentist” that can perform “dentist” duties. Those are scary words to hear as a dental student, investing hundreds of thousands of dollars and four years of my life, only to have the same job done by somebody who has only received a bachelor’s degree. I decided to dive a little further into the subject about the pros, cons, regulations, and education requirements surrounding the dental therapist…so here we go!

The Basics….  

• Dental therapists operate under a dentist’s license in an office or satellite clinics. Their basic duties vary depending on each state’s rules.
  • Scope of practice includes fillings, seating crowns, performing extractions, adjusting dentures, diagnosing radiographs, making treatment plans
• Dental therapists are currently practicing in Minnesota, Maine, and Alaska. There are different names for the profession popping up in legislature all over the country (including Colorado)
• Two types:
  • Dental therapist-
    • Requires a bachelors’ degree in Dental Therapy with several licensure and competency exams in order to practice. May perform some services under “indirect supervision,” which means a dentist must be on-site to authorizes procedures, or under “general supervision,” which means the dentist is off-site and must still authorize procedures.
  • Advanced dental therapist-
    • Dental therapy degree along with a masters’ degree in Advanced Dental Therapy which requires 2,000 hours of clinical practice and a certification exam. They may do all that a dental therapist can do, and also perform oral evaluations, treatment plans, and non-surgical extractions of teeth.
    • Practices under the supervision of a dentist, but all procedures can be completed under “general supervision.”

The Case FOR Dental Therapists…

• Contrary to what many believe, there isn’t a lack of dentists in certain “at need” states, rather a lack of distribution. This can be alleviated by dental therapists working at satellite clinics in rural areas addressing basic needs of the community without patients being forced to travel to far-away dental offices.
• They only perform routine care, so it opens up the dentist’s schedule to perform more complex care like endodontics, prosthodontics, and implantology, while still addressing basic needs of the office’s patient pool. This is viewed as a way to expand a dentist’s practice and maximize profit.

The Case AGAINST Dental Therapists…  

• It is a common opinion within the dental community that if Medicaid and insurance reimbursements didn’t drive practitioners to lose money on certain procedures, many more would practice in areas where fee-for-service dentistry isn’t the norm. Many dentists believe that more changes to Medicaid and insurance reimbursements need to be made in order to drive practitioners to “low income” areas.
• States should address access to care issues by reimbursing dentists who work in rural areas. Dental therapists have the ability to work on simple cases, but comprehensive care is the only way to effectively provide dentistry that is at the standard of care.
• The ADA believes that the “one-size-fits-all” model provided by dental therapists is not the best way to reach populations that live in rural communities.
• Dentists do not want their profession’s quality to be in jeopardy with the addition of therapists who are less educated in dentistry.

In the end, it is up to YOU as a dental professional to decide what is best for you, and most importantly, the patients in your home state. Being involved in your local ASDA and ADA chapter will make a difference whether dental therapists become a reality where you live.

This past October, I attended the ASDA National Leadership Conference.  Having recently been elected the ASDA Alternate Delegate for my class, I was sincerely excited and curious about this conference.  I knew I would be surrounded by others who shared my same enthusiasm about ASDA and my commitment to enhancing our dental school experience and future profession. Given my legal background, I am particularly interested in ASDA’s and the ADA’s role in legislative and legal issues regarding dental school education and the dental profession.  While I thought I had a good grasp of the issues regarding the profession, at the conference, I learned so much more about the various nuances within the law that affect dentists. I was thoroughly impressed by the commitment of ASDA and ADA to advocate on our behalf. For this blog post, I wanted to highlight three areas regarding the law and dentistry that were large topics of discussion at the conference.

1)  Pending U.S. Supreme Court Case about Dental Boards and Anti-Trust

Recently, the United States heard oral arguments for North Carolina Board of Dental Examiners v. Federal Trade Commission.  This case hinges upon whether the NC Board of Dental Examiners has the authority to send warning letters to non-dentists who offer dental services, such as teeth whitening.  For this case, the FTC is concerned that the Board is engaging in antitrust behavior.  The pivotal issue in this case is whether the Board of Dental Examiners is considered “private", as anti-trust laws only apply to private entities. While the NC Board of Dental Examiners is considered a public entity, the FTC argues that it is comprised of dentists who primarily make their living as private dentists, and thus, they are also affected by the market that they are attempting to regulate. The ADA submitted an Amicus Curiae brief to the Supreme Court for this case.  An Amicus Curiae brief is essentially an opinion of a third party that is not directly involved in the case but has a substantial interest in the outcome.  The final decision should be issued sometime in 2015. You can view the ADA’s brief here.

2)  Student Loans

The accumulation of significant student loans is a large source of stress for dental students.  While the rising costs of tuition are often unavoidable, ASDA and the ADA are advocating for students and recent graduates from a tax standpoint.  Currently, most dentists’ incomes are too high to have a student loan interest deduction on their taxes.  The ADA is actively lobbying the federal legislature to completely eliminate this income cap.  This way, interest on federal student loans can be considered a tax deduction, which can potentially save dentists up to thousands of dollars each year. To take action on Student Loans through ASDA's Action Site, Engage, CLICK HERE.

3)  Dental Mid-Level Providers

Unlike Colorado, other states in the country are allowing “mid-level” providers to provide some basic, yet irreversible dental procedures in order to increase access to dental care.  ASDA and the ADA are very concerned about this, as it allows individuals with less than four years of dental training to perform procedures that can permanently affect a patient’s tooth.  Additionally, the addition of mid-level providers dilutes the dental profession in these states, which can have a substantial impact on the quality of dental services and the salaries for dentists. ASDA seeks to ensure that only dentists provide irreversible dental procedures to patients.

These three issues are just some highlights of the myriad of issues and work that ASDA and the ADA do on our behalf.  In addition to attending the legislative sessions, I attended marketing, financial, and other sessions which my colleagues have already highlighted. This conference confirmed to me that ASDA is really looking out for us. I certainly caught the “ASDA fever”!