MinnesotaMinnesota DentalDental TherapistTherapist JimJim NickmanNickman DDSDDS MinnesotaMinnesota’’ss RecentRecent ContributionsContributions MinnesotaMinnesota DentalDental TherapistTherapist .. HistoryHistory ofof MNMN DentalDental TherapyTherapy LegislationLegislation .. FinalFinal LegislationLegislation .. CurrentCurrent ProgramsPrograms .. FutureFuture ImplementationImplementation IssuesIssues MinnesotaMinnesota DentalDental TherapistTherapist BackgroundBackground andand LegislativeLegislative HistoryHistory Sen Shelia Kiscaden Safety Net Coalition OHCPOHCP There was successful passage of significant new funding for the (Maryland) Department of Health… after the death of Deamonte Driver in 2007, triggered a focused review of dental health services. $400,000 in operating revenue and $500,000 in capital revenue was appropriated …. Further, the legislation that expands the scope of practice for dental hygienists in certain settings was also enacted….Finally, $7 million was appropriated to increase dental reimbursement rates… MinnesotaMinnesota DentalDental TherapistTherapist .. SpringSpring 20072007 .. SensingSensing thethe comingcoming storm,storm, thethe MDAMDA appliesapplies forfor andand receivesreceives helphelp fromfrom thethe ADAADA PublicPublic AffairsAffairs programprogram .. NewsNews lettersletters toto membersmembers detailingdetailing ADHPADHP proposalproposal .. MDAMDA coco--sponsorssponsors MinnesotaMinnesota AssociationAssociation ofof CommunityCommunity DentistryDentistry’’ss springspring meetingmeeting promotingpromoting ADAADA’’ss CDHCCDHC proposalproposal MinnesotaMinnesota DentalDental TherapistTherapist .. SummerSummer 20072007 .. ADAADA PublicPublic AffairsAffairs programprogram conductsconducts focusfocus groupsgroups regardingregarding thethe ADHPADHP .. AlsoAlso examinedexamined whichwhich messagesmessages andand DentalDental AccessAccess proposalsproposals resonatedresonated withwith thethe publicpublic .. PresentedPresented toto thethe MDAMDA HouseHouse ofof DelegatesDelegates inin SeptemberSeptember 20072007 MinnesotaMinnesota DentalDental TherapistTherapist Sen Berglin Sen Marty Rep Thissen Sen Lynch Recommendation 7.3: Develop a midlevel dental practitioner to work within a collaborative agreement with a licensed dentist. A midlevel dental practitioner would be educated at the master’s degree‐level (over a two year course of study) to treat patients by providing diagnostic, preventive, therapeutic, and restorative dental services with a primary focus on the underserved. The midlevel dental practitioner would work under general supervision and under a collaborative agreement with a licensed dentist, similar to the arrangements that physicians assistants and advanced nurse practitioners have with physicians. SenSen AnnAnn LynchLynch ADHPADHP RepRep CyCy ThaoThao MinnesotaMinnesota DentalDental TherapistTherapist .. MinnesotaMinnesota DentalDental AssociationAssociation (MDA)(MDA) formsforms ““DentalDental AccessAccess CoalitionCoalition”” .. MembersMembers includeinclude ADA,ADA, AAPD,AAPD, MAPD,MAPD, AAEAAE amongamong othersothers .. EngagedEngaged aa locallocal PRPR firmfirm withwith connectionsconnections toto thethe DFLDFL majoritiesmajorities inin thethe LegislatureLegislature .. AdvisedAdvised onon ““grassgrass--rootsroots campaignscampaigns”” andand messagingmessaging .. FormsForms internalinternal ““OHPOHP tasktask forceforce”” DentalDental TherapistTherapist DTDT MinnesotaMinnesota DentalDental TherapistTherapist .. ADHPADHP proponentsproponents hadhad aa greatgreat gamegame planplan andand executedexecuted wellwell .. RelentlessRelentless LobbyingLobbying .. HearingsHearings withwith minimalminimal advanceadvance noticenotice .. LimitedLimited testimonytestimony .. ResponseResponse toto DDSDDS oppositionopposition ““turfturf battlebattle”” .. PressurePressure fromfrom dentaldental communitycommunity stallsstalls ADHPADHP progressprogress SenSen AnnAnn LynchLynch OHP SenSen YvonneYvonne OHP PrettnerPrettner SolonSolon DentalDental TherapistTherapist DTDT Countries educating dental therapists Select countries utilizing dental therapists Australia Jordan Canada* Netherlands Great Britain* New Zealand* Hong Kong Singapore Ireland Switzerland * Sites visited State of Minnesota Delegation University of Minnesota (6) Minnesota State College and Universities (3) Central Administration Metropolitan State University Mankato State University Minnesota Dental Association (2) Minnesota Board of Dentistry (1) Goals of site visits Get “firsthand” knowledge of situation historical context is important published information often biased, inaccurate or dated programs rapidly changing Query people at sites program directors and faculty dental professionals – community and academic students Goals of site visits Inspect education facilities size, quality, use of advanced technology teaching and learning styles employed outreach programs – number, location, duration of experience Judge impact of health care systems on programming student expenses – tuition, fees, books, etc. job opportunities Site visits to recognized dental therapist programs First Nations University Prince Albert, Saskatchewan, Canada 32 years in operation University of Otago, School of Dentistry Dunedin, New Zealand 70+ years in operation University of Sheffield, Faculty of Dentistry Sheffield, England 25+ years in operation Lesson learned from Canada visit Without a dental school-based program the profession did not embrace dental therapists. Lesson learned from visit to New Zealand Educating dental therapy students with dental students creates a professional partnership. Lesson learned from visit to Great Britain Having the dentist “on site” builds patient confidence and trust in dental therapists. Brickle Loen Scandrett Amundson Tarren Reisdorf O H P W Rau Shragg Benavides Schoenbaum Gjerde G Sheppard Flynn Perpich Blue Lloyd Carroll 1)1)EducationalEducational requirementsrequirements andand competenciescompetencies 2)2)TrainingTraining programprogram accreditationaccreditation 3) Scope of Practice 4) Level of Supervision 5)5) MedicationsMedications thatthat maymay bebe prescribed,prescribed, administered,administered, andand dispenseddispensed 6)6) ExtractionsExtractions thatthat maymay bebe performedperformed 8)8) AnAn assessmentassessment ofof thethe economiceconomic impactimpact 7)7) CriteriaCriteria forfor determiningdetermining practicepractice settingssettings 10)10) LicensingLicensing andand regulatoryregulatory requirementsrequirements 9)9) AnAn evaluationevaluation processprocess thatthat includesincludes clearlyclearly defineddefined outcomesoutcomes MDAMDA CoreCore PrinciplesPrinciples .. TrainingTraining mustmust occuroccur inin aa facilityfacility withwith thethe experienceexperience andand curriculumcurriculum toto traintrain safelysafely .. TheThe OHPOHP belongsbelongs inin aa dentaldental homehome asas aa membermember ofof thethe existingexisting dentaldental teamteam .. Examination,Examination, diagnosis,diagnosis, andand treatmenttreatment planningplanning remainremain withinwithin thethe solesole possessionpossession ofof aa licensedlicensed dentistdentist MDAMDA CoreCore PrinciplesPrinciples .. IrreversibleIrreversible proceduresprocedures shouldshould bebe performedperformed underunder thethe indirectindirect (on(on--site)site) supervisionsupervision ofof aa MinnesotaMinnesota LicensedLicensed DDSDDS .. CollaborativeCollaborative agreementsagreements shouldshould bebe reservedreserved toto provideprovide basicbasic preventativepreventative servicesservices inin thethe absenceabsence ofof anan onsiteonsite dentistdentist MDAMDA CoreCore PrinciplesPrinciples .. ToTo meetmeet thethe legislativelegislative intentintent ofof increasedincreased access,access, .. thethe DTDT oror OHPOHP mustmust notnot bebe limitedlimited byby practicepractice settingsetting .. MoreMore thanthan 50%50% ofof thethe DTDT’’ss oror OHPOHP’’ss patientpatient populationpopulation mustmust bebe fromfrom underservedunderserved populationspopulations Shoenbaum Shragg Berglin Marty Thissen Lynch DaysDays atat thethe CapitolCapitol Feb.Feb. 2525thth Feb.Feb. 1111thth SenSen AnnAnn LynchLynch OHPOHP RepRep CyCy ThaoThao Sen Yvonne Prettner Solon DTDT RepRep KimKim NortonNorton SenateSenate HealthHealth HousingHousing andand FamilyFamily SecuritySecurity SenSen JohnJohn MartyMarty SenSen DavidDavid HannHann HouseHouse HealthHealth CareCare && HumanHuman ServicesServices PolicyPolicy && OversightOversight LicensingLicensing DivisionDivision (( OHPOHP 4/3)4/3) (DT(DT 5/2)5/2) RepRep CyCy ThaoThao RepRep KimKim NortonNorton ConferenceConference CommitteeCommittee SenatorSenator MargaretMargaret RepRep TomTom AndersonAnderson KelliherKelliher RukavinaRukavina MinnesotaMinnesota DentalDental TherapistTherapist FinalFinal LegislationLegislation MinnesotaMinnesota DentalDental TherapistTherapist LawLaw ..EstablishesEstablishes aa newnew typetype ofof licensed,licensed, midlevelmidlevel dentaldental provider,provider, calledcalled aa dentaldental therapist,therapist, whowho willwill provideprovide basicbasic oraloral healthhealth andand dentaldental servicesservices toto underservedunderserved patientspatients andand communities.communities. DTDT Scope/Scope/ SupervisionSupervision .. UnderUnder IndirectIndirect (On(On Site)Site) SupervisionSupervision . Emergency palliative treatment of dental pain. The placement and removal of space maintainers. Cavity preparation . Restoration of primary and permanent teeth. Placement