With nearly a fourth of Kentucky's 1 million children living in poverty and suffering some of the worst oral health in America, the state Board of Dentistry voted recently to develop regulations to permit hygienists to treat children in a public-health setting, perhaps stemming a near-epidemic of tooth decay in the very young.
Hygienists will still be responsible to dentists when working in public-health settings, such as schools, where they can apply preventive treatments on their own, if the new regulation wins legislative committee approval.
It isn't as far as we want to go in confronting our horrific problems, but it may remove stones in our path that have kept a tight control on the use of hygienists.
In the past, organized dentistry in Kentucky, fearing competition from hygienists, has opposed expanding their scope of practice, but as Kentucky remains stalled near the bottom of state rankings of oral health, younger dentists are accepting the need for change, says Dr. James Cecil, a retired dentistry professor at the University of Kentucky. The recent action may have been "from desperation, over recent bad publicity as the popular press portrays the profession as unresponsive to the needs of our poor citizens," Cecil said in an interview.
"While dentistry still remains where medicine was 20 years ago when many doctors opposed licensing physician assistants and nurse practitioners," Cecil said, dentists "will learn they can make more money when their services become more available through greater use of auxiliaries such as the hygienists."
Cecil, former chief dental officer for the U.S. Navy and distinguished as a national leader in public health, this month participated with Kentucky Youth Advocates in the organization of a new Kentucky Oral Health Coalition, whose startup is funded by a foundation grant.
This coalition of various organizations — including public health departments, nurses, physicians, insurers and some dentists — will be independent of dental associations or the state's two dental colleges, and it will campaign for better programs for general as well as oral health.
In the early months of a year when the Kentucky General Assembly, like the U.S. Congress, has reached little agreement on public issues, the Kentucky Department of Public Health, actively supported by Gov. Steve Beshear, seems to be gaining traction on oral health needs.
Grant awards from the Appalachian Regional Commission are expected to go to two of 13 new local health coalitions in Eastern Kentucky.
The grants will pay for one mobile dental van and equipment to reach out to an area with children whose teeth are so decayed they were one focus of an ABC 20/20 documentary viewed by 11 million people in 2009.
Through funding by the federal government, the oral health program will begin training general dentists in more pediatric care. And with additional funding from ARC, this project focuses on dentists in the ARC counties for participation.
Meanwhile, Cecil and KYA hope to organize more local dental coalitions in rural Western Kentucky. Coalitions may decide to include days to help older citizens with appalling dental health needs.
There are now 25 such coalitions in the state. As more are established, the challenge is to expand the reach of the state's 3,000 hygienists, to assist and encourage the state's 2,400 active dentists to become more proactive about solving problems that drag down oral health, and to educate parents to care for their children's teeth, beginning in their first year of life.
Historically, in a culture with so much poverty, Kentuckians have stoically accepted being toothless in old age as part of the price. First, there are awful workforce problems.
What starts with neglect in childhood evolves into a workforce of adults with severe tooth loss and poor self image, plus illnesses associated with dental disease (obesity, diabetes, strokes and heart disease and Alzheimer's) and last, a distressing cohort of toothless elderly poor, sadly, among the highest in the country.
It's a grim story, but Cecil sees determination in the dental profession to address the problems. With a new added role for hygienists, he said, "the dam may be broken."