Report of State Board of Dentistry April 27, 2012
Two hygienists were disciplined for being short of CE hours, one having taken credits from an unapproved provider. There was no request to make up the missed hours and the Board’s concern was that it was a green light to miss them if not required to catch up on lost hours. NOTE- Check to see that your CE provider is accredited so you don’t fall short in the number of total hours needed.
AEDs in Dental Office
The issue is whether an AED ( automatic external defibrillator) is needed in an office if it is in the same building
BOTOX and dermal fillers-
Can an esthetician work in a dental office? No because the scope of practice requires them to work with a physician and this is not possible in a ‘dental spa‘..
Hygienists and Local Anesthesia
1) Hygienist giving local anesthesia. It is being taught in the hygiene schools in the Commonwealth and as part of their training at HAC ( Harrisburg Area Community College) they are giving 10 mandibular blocks, 10 buccal and lingual infiltrates as well as 5 palatals and a Gow-Gates injection.
At Harcum, they have trained 150 hygienists in giving injections and they need 27 injections. One issue is that NJ requires training in Oraverse ( anesthesia reversal agent)) and hygienists in PA are not being trained in its use so licensure by reciprocity is not possible at this time. The use of Oraverse is taught didactically but not clinically.
Harcum is approved in PA but not in NJ since they don’t teach ( clinically) the use of Oraverse. The Board’s conclusion is that they don’t over-regulate and that a procedure can be taught in a school even if not allowed in the state. This is because Continuing education and in a school, 1) it advances the profession and 2) a dental student or hygiene student is under the direct supervision in a licensed program.
Dentists Over-prescribing pain meds?
Dr. Siegel reported on a meeting of the Association of Dental Boards and how 478 million prescriptions were written for pain medications and how dentists were alleged to be the highest volume writer of pain meds for adolescents and therefore this justified in the clamping down of dentists writing pain medication prescription medications. However, as Dr. Siegel pointed out dentists often write a single pain medication for adolescents and this id often as a result of extractions such as third molars so the results and conclusions need to be adjusted for these facts.
In some states pharmacies have software that allows pharmacists to ascertain the total number of pain medications written for an individual but this is not yet available in Pennsylvania.
Chairman Siegel reported on a three prong approach to get therapists into Pennsylvania and a newspaper push touting the advantages of therapists.
1) Kellogg Foundation $16 million grants pushing it in different states using the Alaska DHAT model.
2) Pew Foundation- “good cop” perspective trying to change the workforce.
3) CDHC- using a Bachelors and Master’s degree. Minnesota graduated some therapists but th eissue is whether they can go outide Federal Centers to practice?
In different states-
California- Dental Director model but no funding for a pilot program
N. Dakota- PEW model but Legislature has take no action.
Colorado- Dental legislation to be enacted in 2013
Alaska- DHAT model is under control of sovereign tribes not the State Board
Licensure by Portfolio exam
ADA RFP-Portfolio style exam. Iowa’s State Board unanimously opposed it on the grounds that the State Board has the obligation and privilege to regulate and a clinical exam should be regulated by the State Board.. There are many questions in this and Minnesota uses a mannequin only exam while New York uses the PGY-1 model .
Part 1 and Part 2 may consolidate to change from Pass Fail to a grading system again.
Access to care
The Board’s concern is how will the SBOD, PDA, PAGD and EFDA work to expand access to care and not allow outside corporations to come in. Chairman Siegel, “ It would be a shame to not work together to expand our mission in a proper manner.”
SBOD will have a recommendation about mobile dental vans at the June meeting.
The SBOD is required by law to have a balanced budget and the Chair’s goal is to be financially stable for many years (4-5 yrs) and not stop gap measure that will require action in a year or two. . Mr Romanecki , accountant detailed the fact that hygiene licensure fees have not increased in 10 years and dentist licensure has not increased in 5 years. The licensure is paid every two years so budgets are revenue heavy one year and light the next. Compared to our neighboring states, Pennsylvania is by far the lowest in application fee to get a dental license of well under $100 when other states (Delaware $225 dentist application-$56 hygiene application) and Massachusetts ( $660 dentist application- $126 hygiene app) and New Jersey ( $250 for a dentist to apply and $125 for a hygienist) and NY ( $377/$128) and Ohio ($334/$147) and Virginia ($400/75). The Board is investigating ways to balance the budget without raising taxes or fees if possible. The recommendation to the SBOD was to use the application fee to raise revenue since Pennsylvania is so far off from other states and it is not likely to be a disincentive to practice here.
Chairman Siegel- Consensus is we have to do something and we can sell a fee increase of modest proportions to keep the state friendly and develop a hybrid increase of both application fee and increased renewal fee. The SBOD asked opinion of both PAGD and PDA which was to strike a balance to keep members and not discourage our members from practicing here.
The Board is trying to find an acceptable mix possibly raising the renewal fee for dentists from $250 every two years to $300 every two years for dentists and raising hygienist licensure from $40 to $48 every two years. Something that is not too onerous but commensurate with other states. Any fee increase has to be approved by Gov. Corbett and he has stated his goal of minimizing any increases in fees or taxes.
Michael Kaner DMD JD FAGD