1. Community Dental Health Coordinators Trent Lally District 6 Trustee

2. What is a CDHC? “Community Dental Health Coordinator” or “CDHC” Part of an ADA comprehensive effort to improve access to oral health care for underserved Americans. Promises to help Americans become better stewards of their oral health.

3. Is the CDHC a “mid-level provider?” No. Mid-level providers are being promoted to drill, fill, and extract. CDHC focuses on the root causes of disease – the lack of adequate prevention and oral health literacy among populations.

4. Background To help expand access to the same high quality dental care available to all Americans, the ADA is helping to develop a new member of the oral health team. National Coordinating and Developing Committee (NCDC) was established to create a CDHC training program.

5. How will the CDHC improve Access? Assist the dentist in the triage of patients Address social, environment, and health literacy Educate community members Part of a comprehensive approach that also includes: Improving Medicaid reimbursement rates Placing new focus on oral health education Prevention Increasing government investments in the public health infrastructure

6. CDHC and the underserved Students in the CDHC pilot program are recruited from the communities in which they serve. Comparable to Community Healthcare Workers (CHWs) but with clinical dental skills. Not a one-size-fits-all solution

7. How are CDHC’s trained? Pilot Programs 18-month training program (12 months didactic + 6 months internship) University of Oklahoma Temple University A.T. Still University Arizona School of Dentistry

8. Accreditation CODA Accreditation is the Goal

9. What is the CDHC scope? Collect information (photographs, radiographs) Screenings Fluoride treatments Sealants Temporary filings Simple teeth cleanings (gingivitis) until a patient can have a comprehensive cleaning

10. Where do CDHC’s work? Clinics Schools Churches Senior Citizen Centers Other public settings

11. Update New Mexico first state to authorize CDHC model

12. Questions? Trent Lally Email: TLally01@gmail.comTLally01@gmail.com Phone: (248) 866-0760

13. Dental Health Aid Therapist Dusty Pfundheller District 5 Trustee

14. What is a DHAT? “Dental Health Aid Therapist” dependent practitioner working in a satellite clinic under the general supervision by an off-site licensed dentist located at a distant regional clinic

15. How Were DHAT’s Created? Alaska Alaska Native Tribal Health Consortium (ANTHC) 85,000 Alaska Native people live in rural Alaska with no road access. 5 times caries risk in children Alaska allowed high school graduates go to New Zealand for a two year program Now ANTHC partnered up w/ Kellogg Foundation to study at University of Washington’s Medical School - 1 year is pre-clinical, 1 year clinical. Now students are able to be trained in Washington University.

16. Training for DHAT 2 yr program Must have high school diploma or equivalent & 6wk online anatomy & physiology course 1 st year = pre-clinical work & classroom setting 2 nd year = clinical experience, village practice rotations 400 clinic hours (six-month) residency program Every two years DHATs must be recertified. 24 CE credits Demonstration of ongoing clinical competency

17. Scope of practice Determined by the supervising dentist during the residency based on DHAT’s demonstrated clinical skills and tribal location needs Determines of clinical procedures and scope of practice Scope of practice is dynamic, may change periodically depending upon the maturing skills-set of the therapist. Typical DHAT may provide oral exams, preventive dental services, simple restorations, stainless steel crowns, extractions and take x-rays.

18. Supervision Dependent practitioner working in a satellite clinic under the general supervision by an off-site licensed dentist located at a distant regional clinic.

19. Questions? Dustin Pfundheller Email: dpfundheller@dental.ufl.edu Phone: (715) 894-0083

20. The Dental Therapy Model Ben Youel, District 7 trustee Aruna Rao, vice chair, Legislative Grassroots Network

21. A Little History December 2006 – ADHP program approved by Board of Directors of MN State Colleges & Universities System Spring 2007 – Safety Net Coalition (SNC) convinces MN Legislative Committee on Health Care Access to recommend the creation of a dental MLP February 2008 – SNC introduces bill to create ADHP in MN Dental Practice Act

22. A Little More History April 2008 – Bill passes to begin creation of an “Oral Health Practitioner” April 2008 – U of MN unveiled proposed Dental Therapy program May, July & September 2008 – U of MN delegation visits Saskatchewan, New Zealand & England Early 2009 – “Dueling Bills” from U of MN/MDA & from the SNC

24. May 2009 – A compromise reached: Dental Therapy (DT) & Advanced Dental Therapy (ADT) created Fall 2009 – DT program begins at U of MN & Oral Health Care Practitioner (OHCP) program at Metropolitan State University June 2011 – Seven students graduated with MS: OHCP from Metropolitan State And Finally… December 2011 – Nine students will graduate with either Bachelors or Masters Degrees in Dental Therapy from U of MN

25. Licensure Dental Therapist Graduate w/Baccalaureate or Master’s in accredited dental therapy education program Pass independent clinical competency exam Jurisprudence Exam Advanced Dental Therapist All requirements of Dental Therapist 2,000 hours of practice as DT Graduate w/Master’s in ADT Pass board-approved competency exam Apply for certification

26. Scope of Practice & Supervision Dental Therapist Radiographs Preventative Procedures & OHI Sealants Temporary Restorations Space Maintainers* Direct Restorations* Pre-fab Crowns* Pulpotomies (Primary teeth)* Extractions (Erupted primary teeth)* Tooth Reimplantation/Stabilization* Local Anesthesia & Nitrous Oxide Mouthguards Provide, Dispense & Administer Analgesics, Anti-Inflammatories & Antibiotics *Require Indirect Supervision All duties subject to Collaborative Management Agreement (CMA) Advanced Dental Therapist** All duties of Dental Therapist Oral Evaluations & Assessments Extraction (Periodontally involved permanent teeth) **All Require Only General Supervision

27. The Insider Perspective

28. Questions? Ben Youel – bcyouel@gmail.combcyouel@gmail.com Aruna Rao - raox0062@umn.eduraox0062@umn.edu

29. Advanced Dental Hygiene Practitioner (ADHP) Burton Coleman ASDA District 4 Trustee

30. What is it? Advanced Dental Hygiene Practitioner American Dental Hygiene Association (ADHA) proposed position in 2004 A dental hygienist who has graduated from an accredited dental hygiene program and has completed an advanced educational curriculum approved by the ADHA, which prepares the dental hygienist to provide diagnostic, preventive, restorative and therapeutic services directly to the public. Response to 2000 US Surgeon General’s call to increase access to care & tx underserved. M.D./Nurse Practitioner Analogy

31. Where is it? Currently a proposed model public health settings schools federally qualified health centers (FQHCs) long-term care facilities hospitals nursing homes State by state, currently none in full form

32. Training & Curriculum Training requirements & curriculum not fully established Bachelor’s degree + 2 years = Registered Dental Hygienist RDH + 2 year Master’s level program

33. Training & Curriculum Proposal The proposed ADHP educational framework is organized by general domains (themes) and more specific competencies within each domain. I. Provision of Primary Oral Healthcare II. Healthcare Policy and Advocacy III. Management of Oral Care Delivery IV. Translational Research V. Professionalism

34. Scope of Practice Hygiene Dx + Perio eval, SRP, Prophy, Fluoride Tx, OHI Restorative Dx + Direct Restorations (composites, amalgams, sealants) Palliative Care Temp restorations, pre-formed crowns, pulp caps, place & remove sutures Prosthodontics Adjust & repair removable, re-cement fixed Surgery – dx, uncomplicated extractions Path – dx & refer Ortho – dx & refer Anesthesia – local & N 2 O * generally, dentist supervision not required

35. State by State Basis Many states unsupervised perio, fluoride, sealants Trend to administer supervised local anesthesia & N 2 O monitoring ADHP varieties appearing commonly in state legislation Connecticut New Hampshire Idaho (ISU M.S. in DH but restorative, surgery, pulp exceptions) Washington (Native American reservation) Michigan Licensing process not yet determined

36. Resources ASDAnet.org/midlevel-providers (page) ADA Workforce Statement (pdf) ADHA Resource Center (page) ADHA.org/governmental_affairs (page) State Dental Boards Google Burton Coleman burtoncoleman@gmail.com 615.477.2781

37. Summary of Mid-Level Providers

38. DHAT = Alaska (trained in University of Washington) Dental Therapist = Minnesota CDHC = University of Oklahoma, Temple University, & A.T. Still University Arizona School of Dentistry ADHP = currently none in full form Location?

39. Community Dental Health Coordinator or CDHC Which program is approved by ADA?

40. All can do: Collect information (photographs, radiographs) Screenings Fluoride treatments Sealants Temporary filings Simple teeth cleanings (gingivitis) until a patient can have a comprehensive cleaning What can each program do?

41. DHAT What dentist determines they can do in 400 hr residency Dental Therapists Temporary Restorations Space Maintainers Direct Restorations Pre-fab Crowns Pulpotomies (Primary teeth) Extractions (Erupted primary teeth) Tooth Reimplantation/Stabilization ADHP Hygiene : SRP, Prophy, Restorative: Direct Restorations (composites, amalgams, sealants) Palliative Care: Temp restorations, pre-formed crowns, pulp caps Prosthodontics: Adjust & repair removable, re-cement fixed Surgery uncomplicated extractions What can each program do?

42. ASDA Policies Current Statements of Position or Policy Voted on at House of delegates Feb 29 th -March 3 rd Speaker – Stephanie explains more on this

43. C-1 Expanded Functions of Dental Assistants and Dental Hygienists Endorses expanded functions for dental auxiliaries only when each has received the appropriate education and training to guarantee competence, and when such functions fall within the laws established by their respective state of employment. Expanded functions for dental auxiliaries will not adversely affect the health and well-being of the public.

44. 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.

45. Only the Dentist Should Perform Examination, diagnosis and treatment planning Prescribing work authorizations Performing irreversible dental procedures Prescribing drugs and/or other medications