1. D2940 or Innovative Workforce Response Dr. Blake McKinley Ian Murray

2. Overview Mid-Level Provider (MLP) – a non-dentist performing dental procedures – What are Mid-Level Providers? ○ DHAT: Dental Health Aid Therapist ○ Independent Practice of Hygiene ○ DT: Dental Therapist ○ CDHC: Community Dental Health Coordinator (ADA proposal)

3. Overview Why are MLP being established or promoted? Who determines whether or not MLPs are established and how? Will the MLP have any less overhead than your will? Then how will this decrease the cost of care? No! ○ Increase access to care

4. WSDA Core Principles  Without these principles there is no support from the dentists. The dentist is the sole oral health professional authorized to diagnose and prescribe treatment for patients. Close on-site supervision may be allowed for procedures that are authorized by statutes when approved by the dentist based on the dentist’s determination of competency. Regulation of the dental workforce will be the responsibility of the Dental Quality Assurance Commission.

5. Concepts Dentistry is a surgical art When is an extraction simple? Where does a pulpotomy stop? When does something “simple” become complicated? ○ Surgery is the cutting of tissue, teeth are tissue. ○ Only in retrospect, regardless of the definition! ○ When the bleeding stops (regardless of definition)! ○ If after the pulpotomy, the pulp continues to bleed and your authority does not let you go down the canal, then what? Extraction?

6. Training and its Significance Dentist ○ High school education or equivalent ○ 4 years college ○ 4 years dental school MLP Dental Therapist ○ High school education or equivalent ○ 2 years didactic ○ Some clinical experience Independent Practice of Hygienist ○ Junior College Training ○ 4 Year College Training

7. Training and its Significance MLP in medicine ○ Physician Assistant  Education/Certification/Privileges:  Prerequisites to PA Education  Accredited PA Programs  National Certification  Maintaining Certification  State Licensure  Surgery?

8. Conclusions What is the ADA policy? The ADA does not believe a non-dentist should perform surgical/irreversible procedures. The ADA supports innovations in the dental team that would improve oral health among people who lack adequate access to care, provided that those innovations do not compromise the very system they seek to extend. Our own Community Dental Health Coordinator pilot project seeks to do that by training community health workers who specialize in oral health education and disease prevention, factors that ultimately are the nation's best hope of ending what we all agree are unacceptable levels of oral disease. How does the CDHC fit? ○ http://www.ada.org/cdhc.aspx http://www.ada.org/cdhc.aspx

9. What is ASDA doing? ○ C-1 Expanded Functions of Dental Assistants and Dental Hygienists (1973, revised 1991, 1994, 2000, and 2005) ○ 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.