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Public Comments HOUSE COMMITTEE ON PUBLIC HEALTH Hearing Date: March 31, 2021 8:00 AM Printed on: April 5, 2021 12:51 PM COMMENTS FOR: HB 2348 Amita Prakash, Dr Private practice Cedar park, TX Would like RDH to administer local anesthetic for hygiene treatment to help the patient. Sarai Leiva, RDA Self/Dental Hygiene student Cibolo, TX I believe this will change dentistry for the better. Emily Conley, DR Mosaic Dentistry cedar Park, TX I support the extension of duties to allow registered dental hygienists to administer local anesthesia under the direct supervision of the dentist after sufficient training has been completed. There is benefit to allow more autonomy to the hygienist as it builds their value in the practice, with the patient and allows more efficiency in the day-to-day flow. Many states allow this delegation and there has been no adverse impact to the profession of dentistry nor has it taken away the dentists ability to run a successful practice. On the contrary, I believe it has helped many practices increase production and patient satisfaction due to patient's not having to wait for the dentist to administer local. I believe the dental hygienist should be under the same regulation and oversight that the dentist is in regards to knowing safe anesthesia practices, appropriate anatomy so that they minimize adverse effects and documentations in the chart notes. Stephen Robirds, DDS ( Orthodontist) self and member of the Texas Association of Orthodontists AUSTIN, TX Teledentistry is all about better access to maintain good dental health. It provides a way to monitor potential problems without going to the dentist's office. Whenever appliances ( such as aligners or braces) are placed in a patient's mouth to actively move teeth without first conducting an proper in- person examination with diagnostic records, the chances of oral health problems increases greatly. The dental condition and well being of patients must be determined before these appliances are placed. An addition to the wording of the bill to require in-person examinations and diagnostic records before placing active appliances in a patient's mouth would prevent harm to the consumer. That is better access to dental health for everyone. Kristin Byam Self Dental Hygienist Page 1 of 26 COMMENTS FOR: HB 2348 Fort Worth, TX I am a practicing dental hygienist since 2008. I am current with all my state regulated CE’s and my license is in good standing. As a hygienist, we are adequately educated to perform local anesthetic under the supervision of a dentist and in fact many hygienists from 46 states around the country have done so safely for the past 40 years. It is a standard of care in many states to be able to offer this comfort to our patients. Please consider our bill. Chaney Foote, Dental Hygienist self San Antonio, TX Good Afternoon, I have been a dental hygienist for 8 years. I graduated from Louisiana State University with a BS in Dental Hygiene. I am a military spouse and have lived in multiple states of which I could administer local anesthesia, to include ASA, MSA, PSA, and IA nerve blocks. The six years of my career, prior to living in Texas, I successfully administered local anesthesia daily with zero adverse events. There is absolutely no reason a dental hygienist that is trained in the process should not be able to provide this service for their patients. This fact is evident in the all but 3 states that allow properly trained dental hygienist to administer local anesthesia. Please consider the data as is related to this subject. Thank you. Amy Teague, RDH, MS self/dental hygiene Celina, TX Good afternoon, I am a Texas-licensed practicing hygienist and have now practiced for 30 years in Texas and teaching about 18 of those 30 years. As I study the research across our nation, I notice the disadvantage that our patients in Texas have over other states. And you ask why a disadvantage to patients? Because our patient's time is precious and research shows that a hygienist is preferred to give injections over dentists. Journal of Dental Hygiene. Oct 2019, Vol. 93 Issue 5, p40-47. 8p., Author(s): Moody Smith, Annette; Gurenlian, JoAnn R.; Freudenthal, Jacqueline; Appleby, Karen M. This article also points to the patients supported legislation that allows hygienists to administer local anesthesia. My mentor, from Washington State, practiced in Texas for years and felt it was a disservice to our community when she learned of Texas Hygienists not providing local. In Washington, she was asked to provide the local for the dentist, as his patients preferred her giving the anesthesia over the dentist. This dissertation by Attanasi at the University of Maryland @ Baltimore refers to reasons New York hygienists should expand their scope, as they are allowed to provide anesthesia but some had not yet become certified in the state when published in 2011. It points to benefits like: "better pain management, continuity of care, increased production, and a higher quality of dental hygiene services". (http://hdl.handle.net/10713/777). I teach my students the importance of practicing "evidence-based-dentistry" but I feel that the governing board in Texas does not believe in this as they do not allow hygienists to administer local anesthesia. The evidence is clear, the majority of states in the US allow hygienists to provide local safely and effectively, Washington state since 1971, New Mexico/1972, and Missouri/ 1973. How long is long enough to prove that with proper education, this is a "doable" procedure for licensed hygienists to provide in Texas? Longevity of safe and effective practices of 46 states allowing the practice of dental hygiene should point to the safety and effectiveness of hygienists giving local anesthesia. "Show me the evidence that this is not safe practice"-- I don't think you can! Sarah White, RDH ADHA/ Self RDH Mesquite, TX Page 2 of 26 COMMENTS FOR: HB 2348 Local Anesthesia Derek Winegar, Dr self, dentist georgetown, TX it makes sense to allow administration of local anesthetic by trained dental hygienists under the direct supervision of a dentist. Heidi Weber, RDH TDHA Fort Worth, TX I am in support of this bill. It saddens me to know that our state is so far behind in access to care. 46 other states allow RDH'S to safely practice. How are we not one of them? Lynda Bean, RDH, BADH Self Salado, TX As a licensed Texas dental hygienist and educator I am in support of HB 2348. Texas dental hygienists are currently prevented from practicing to the full capacity of their education and licensure. As an educator, I observed many issues for my students if they were moving out of state following graduation. They are also placed in a difficult position when taking regional licensing clinical exams in other states. Many of my students at Temple College were military spouses and the current regulations preventing dental hygienists from administering local anesthesia makes it difficult when they transfer to a new duty station outside Texas. Tiffany Dickson, RDH Self Austin, TX I have been a registered dental hygienist for 8 years. 5 of those years I practiced In Illinois. I was able to perform and give local anesthetic under supervision. This helped my patients feel comfortable and helped the dentist when he was running behind with patients. I never had any complications. I am eager to be able to perform this in Texas. Chantel Keller, Dr. Self, dentist BELTON, TX To Whom It May Concern, My name is Dr. Chantel Keller, and I am a dentist in the Temple area. Since my graduation from Texas A&M University College of Dentistry in Dallas, I have practiced in the state of Nebraska, and just recently moved back to Texas. Nebraska is a state in which dentists are able to delegate the administration of local anesthesia to properly trained hygienists. Upon my return to Texas, Page 3 of 26 COMMENTS FOR: HB 2348 I have found my hands tied in regards to this outdated rule/law, preventing hygienists from delivering local anesthesia to our patients. I have found that dental hygienists are highly trained in facial anatomy and pharmacology, making ideal clinicians for anesthesia administration. Having practiced outside of the state, I feel Texas is a large step behind many other states permitting hygienists to deliver local anesthesia to our patients. Although topical anesthesia has come a long way, it is only effective on soft tissues, and is often inadequate for the level of anesthesia needed in order to make patients comfortable during root planing procedures, by anesthetizing the tooth itself, which is the source of their discomfort. Additionally, I have found that in my time working with hygienists well-trained in local anesthesia administration, I encountered no adverse or harmful outcomes from their administration of this. In comparison to other types of anesthesia delivered by anesthesiologists, local anesthesia in a dental setting is completely different, with minimal epinephrine, usually in a concentration of 1:100k, or even no vasoconstrictor with the use of plain anesthetic without epinephrine. There is very little risk of any adverse effects with anesthesia administration, and with proper education, dental hygienists will be fully capable of this task. Just as a nurse can be delegated the task of administering epinephrine or other medications, dentists should be able to delegate the task of local anesthesia to our hygienist. If this passes, I would advise my hygienist what and how much to deliver. For those dentists opposed to hygienists delivering local, the answer is simple: they can continue to run their practice in the same manner as always, administering their own local to their patients.
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