Biased Information at Google ((Hygienists))

Discussion in 'Dental Archive' started by Joel M. Eichen, Sep 3, 2005.


    Sometimes Google answers are somewhat biased!

    Joel M. Eichen DDS


    Subject: .Which states collude with dentists and force hygienist to
    work under dentists?
    Category: Health
    Asked by: ed777-ga
    List Price: $75.00 Posted: 26 Aug 2005 02:59 PDT
    Expires: 25 Sep 2005 02:59 PDT
    Question ID: 560742

    Which states collude with dentists and force hygienist to work under
    dentists thus creating the high U. S. dental prices indicated in Dental Hygienist believes they can clean your
    teeth in their own office at a lower total cost. Now, the Hygienist
    will take up to an hour to clean your teeth for $50.00+ (much of this
    money goes to the dentist) and then the dentists comes in, after
    cleaning, and claims they must inspect your teeth, and charges you
    $25.00 for 2 of three minutes of looking. That’s an hourly rate of up
    to $750.00 for the dentist and $20+ hourly for the Hygienist. Many
    people let their teeth rot in their mouth because they cannot afford
    the dentist’s high prices. Car manufactures say that $1,500.00 of the
    cost of a car is medical costs and this is one thing that prevents
    U.S. car and other companies from being able to compete with many
    country’s manufactures. Blocking of competition is democracy only for
    those who pay off the legislature and this hurts the citizens and
    leads to the destruction of nations by professions who misuse their
    government to gain their own personal welfare at the expense of all of
    us. A Root Canal, in India, costs $48.00 and in the U. S. the same
    quality root canal costs from $500.00 to $2000.00+. Something must be
    done!!! Hygienist must stand up for their rights!!!!!!!!


    Subject: Re: .Which states collude with dentists and force hygienist
    to work under dentists?
    Answered By: politicalguru-ga on 26 Aug 2005 05:25 PDT
    Dear ed777,

    " Most dentists oppose independent practice for hygienists because
    they feel hygienists are not trained to diagnose and treat oral
    diseases, and they fear that independent practice will erode their
    patient base but will not adequately treat patients. Although
    hygienists are trained to clean teeth and can apply sealants and
    fluoride, they can do little more than refer to a dentist those
    patients who need further help.

    On the other hand, the American Dental Hygienist Association (ADHA)
    strongly supports expanding the use of dental hygienists. The most
    commonly cited benefit of expanding hygienists' role is that they can
    provide high-quality preventive services to underserved patients.(19)
    Although it is not ideal to provide dental hygiene without the
    services of a dentist on site, the ADHA feels it is better for
    low-income patients to receive patient education, cleaning, fluoride
    and sealants than nothing at all. Under recent state practice site
    expansions, hygienists are able to go to schools, nursing homes, and
    other public health facilities to provide preventive services to the
    most vulnerable and underserved populations. Another argument states
    use to support expanded use of hygienists is that if they provide more
    preventive services, they can free time for restorative procedures by
    dentists who see publicly funded patients. The shortage of dentists
    who care for low-income patients makes this an attractive prospect for
    (SOURCE: Shelly Gehshan, Paetra Hauck, and Julie Scales, "Increasing
    Dentists' Participation in Medicaid and SCHIP",

    I'm afraid, Ed, that your question should have been "what states do
    allow hygienists to work independently".

    State Requirements from Hygienists

    "Presently, Colorado is the only state that has independent practice.
    There are no restrictive guidlines or other qualifications for
    independent practice in the state of Colorado. The only requirement is
    state licensure for dental hygiene. However, there are states that
    permit hygienists to perform without supervision in institution such
    as, nursing homes, community centers and other undeserved institutions
    where there is a need for oral health care [...]: Connecticut,
    Washington, California, Oregon and Nevada" (SOURCE: Research On Issue
    of Preceptorship (1999), <>).
    States the *allow* hygienists to work independently in some settings
    are marked here by **, the rest do not.

    Now for the states and their regulations:

    Alabama - Direct supervision in all settings.

    Alaksa - General supervision in all settings.
    In addition, "The State of Alaska is asking for federal funding and
    legislation that will send Native Alaskans to New Zealand for such
    training [of a "dental assistant, performing independent procedures].
    They will then be placed in remote Alaskan villages where they will be
    permitted to perform simple extractions and restorations with only a
    yearly supervisory visit from a dentist. The ADA strongly opposes the
    part of the program that permits the irreversible procedures."
    (SOURCE: Mel B. DeSoto, "AAO President-Elect's Report",

    Arizona - General supervision in all settings.

    Arkansas - Indirect supervision. However, " In some States, such as
    Arkansas, restrictions are so explicit that hygienists are confined
    for most services to direct supervision in a dental office" (SOURCE:
    "The Professional Practice Environment of Dental Hygienists in the
    Fifty States and the District of Columbia, 2001",

    *California - Indirect supervision. There is a special status, though,
    of a RDHAP. RDHAP (Registered Dental Hygienist in Alternative
    Practice) may have an independent practice: "Prior to the
    establishment of an independent practice, an RDHAP shall provide to
    the board documentation of an existing relationship with at least one
    dentist for referral, consultation, and emergency services" (SOURCE:
    Dental Board fo California,
    <>). Read
    more at:
    Kate Zimmermann, "Working", ADHA,

    **Colorado - no supervision, except in state institutions. Read also:
    ADHA’s Response to ADA Study: The Economic Impact of Unsupervised
    Dental Hygiene Practice and its Impact on Access to Care in the State
    of Colorado

    *Connecticut - general supervision, except in schools, where no
    supervision is required.
    "Connecticut has introduced House Bill 6819, which would allow
    registered dental hygienists to administer local anesthesia.
    Unfortunately, the lawyer who drafted the bill did not understand
    dental terminology; as it is worded, the bill would allow a dental
    hygienist to perform only infiltration. The Connecticut Dental
    Hygienists' Association, along with the Connecticut Dental
    Association, will propose a change to the language at the next public
    hearing. Since both associations want the change, it will probably be
    made." (SOURCE: ADHA Stateline News,

    Delaware - General supervision in all settings.

    District of Columbia - General supervision in all settings.

    Florida - Direct/General supervision, depends on the setting.

    Georgia - Direct supervision only

    Hawaii - Mostly general supervision, in clinics, direct supervision.

    Idaho - general supervision in all settings
    Read more here : Senate Health & Welfare Committee
    (search for hygienist)

    Illinois - Direct Supervision in most settings

    Indiana - Direct supervision except in schools (no supervision).
    "A licensed dental hygienist may provide dental hygiene instruction
    and in-service training without restriction on location. Dental
    hygienist may also provide dental prophylaxis for children up to and
    including grade 12 without supervision if the hygienist is employed by
    the state department of health, the state department of education or
    an elementary or secondary school. In any public health setting, may
    also do screenings and referrals." HealthINchools,

    Iowa - General supervision in all settings

    Kansas - Direct supervision in all settings.

    Kentucky - Direct supervision in all settings.

    Louisiana - Direct supervision in all settings

    Maine - General supervision in all settings.
    "A dental hygienist may practice in a public or private school,
    hospital or other non- traditional practice under "public health
    supervision status" granted by the dental board on a case-by-case
    basis. The hygienist may perform the duties they can do under general
    supervision. The dentist should have specific orders and procedures to
    be carried out, although the dentist need not be present when the
    procedures are being performed. A written plan for referral or an
    agreement for follow-up shall be provided by the public health
    hygienists, recording all conditions that should be called to the
    attention of the dentist. The supervising dentist shall review a
    summary report at the completion of the program or once a year. A
    dentist hygienist must apply to the board to practice under general
    supervision providing such information the board deems necessary. The
    board must take into consideration whether the program will fulfill an
    unmet need, whether a supervising dentist is available and that the
    appropriate public health guidelines and standards of care can be met
    and followed." (SOURCE: HealthINchools,
    Maine Dental Hygienists' Association
    In addition: "House Bill 1023 (Legislative Document 1461) has been
    introduced in Maine, which would create the position of an Expanded
    Function Dental Assistant (EFDA), which would require dental assisting
    certification. Under direct supervision of a dentist, the EFDA could
    perform reversible intraoral procedures including, but not limited to,
    placing and removing rubber dams and matrices; placing and contouring
    amalgam, composite, and other restorative materials; applying
    sealants; supragingival polishing; and other reversible procedures
    that are not designated to be performed only by a dentist or dental
    hygienist." (SOURCE: Linda Belaus, "Legislative Update from Around the
    Country", <>).

    Maryland - General supervision, direct in clinics and insitutional

    Massachusetts - Direct supervision in all settings. "Massachusetts
    finalized regulations to obtain a certificate to perform local
    anesthesia. To obtain a certificate, a dental hygienist must meet the
    following requirements.
    1. The applicant must be licensed as a dental hygienist in
    Massachusetts and provide the board with documentation demonstrating
    current certification in Basic Life Support and/or CPR.
    2. The applicant must successfully complete a training program or
    course of study in a formal program in the administration of local
    anesthesia, which shall be a minimum of 35 hours of instruction,
    including no less than 12 hours of clinical training, conducted by an
    educational institution accredited by the Commission on Dental
    Accreditation of the American Dental Association (ADA CDA).
    3. The applicant must successfully complete a written examination in
    the administration of local anesthesia administered by the Northeast
    Regional Board of Dental Examiners (NERB) or any successor agency
    approved by the board.
    4. Instructors must be licensed in Massachusetts." (SOURCE: ADHA
    Sateline, <>).

    Michigan - General supervision in all settings.

    Minnesota - Dierct supervision in most settings. "In Minnesota, the
    governor has signed Senate Bill 1498, which allows dental hygienists
    to administer injections of local anesthetic agents or nitrous oxide
    inhalation analgesia as specifically delegated in a collaborative
    agreement with a licensed dentist. The dentist need not first examine
    the patient nor be present. If the patient is considered medically
    compromised, the collaborative dentist shall review the patient
    record, including the medical history, prior to the provision of these
    services. These changes are allowed only under a collaborative
    agreement in health care settings and are not allowed in private
    practice at this time." *(SOURCE: ADHA Sateline,

    Mississipi - Direct supervision in all settings.

    Missouri - General supervision in all settings.

    Montana - General supervision in all settings.

    Nebraska - General supervision in all settings. "A late February
    committee hearing was set for Nebraska Legislative Bill 182, which
    would permit dental hygienists who have accumulated 3,000 clinical
    practice hours in the last five years to practice without supervision
    in a number of non-office settings. These settings would include
    hospitals, nursing homes, assisted living facilities, tribal clinics,
    and public or private schools or preschools. The measure also permits
    some additional services within the dental hygiene scope. Among these
    is the authority to prescribe, as well as apply or dispense,
    antimicrobial rinses, fluorides, and other anticariogenic agents."
    (SOURCE: ADHA Sateline,

    *Nevada - "A dental hygienist who has special board authority may
    perform services in a health facility, school, or place designated by
    the board without supervision." (SOURCE: HealthINchools,

    New Hampshire - General and Direct supervision.
    "Under "public health supervision" dental hygienists may provide
    procedures authorized by a dentist in a public or private school,
    hospital or institution, provided the dentist reviews patient records
    once in a 12 month period." (SOURCE: HealthINchools,

    New Jersey - "At present, NJ has Direct Supervision in private dental
    offices. The dentist MUST be on the premises at all times that the
    hygienist is working. General Supervision means that the dentist is
    aware of and authorizes the treatment to be performed but does NOT
    have to be on the premises at all times. This allows greater
    flexibility accommodating patients. Independent Practice by dental
    hygienists is not permitted in NJ. (NJSA 45:6-64)" (SOURCE: New Jersey
    DHA, Legislation <>).

    New Mexico - General supervision in all settings.

    New York - "Recently confusion has arisen regarding the appropriate
    level of dental supervision for the practice of dental hygiene in New
    York State. In an effort to provide some clarity, this article
    examines the supervision requirements and discusses what those
    requirements mean for every day practice. As a general statement, the
    confusion arises, in part, due to the flexible nature of the
    supervision standards set by regulation. Ultimately, the appropriate
    level of supervision is up to the individual dentist and depends on
    the circumstances of a given situation. Despite the recent
    controversy, the existing supervision requirements have been in place
    since at least 1971 and nothing has changed the supervision
    requirements established under N.Y.S. law and regulations since then."
    (SOURCE: DHASNY, <>).

    North Carolina - Indirect Supervision in most settings.
    NC Dental Hygiene Association - Policy Statement

    North Dakota - Usually, general supervision. See:
    State Statute - North Dakota Century Code 43-20-01-43-20-12 -
    Hygienist (PDF)

    Ohio - Indirect supervision in most settings.

    Oklahoma - General supervision.

    **Oregon - "Employees in this class are authorized by the Oregon Board
    of Dentistry to practice dental hygiene on a patient under the
    authorization of a supervising dentist. Employees in this class
    receive general supervision from a licensed dentist who daily reviews
    the hygienist's work through patient review, charts, and informal or
    formal meetings with the employee. Work is evaluated for
    professionalism, thoroughness, compliance with professional standards
    such as those of the American Dental Association, and effectiveness of
    treatment as reflected in patient's well-being." (SOURCE: University
    fo Oregon System,
    "Independent Practice
    A Dental Hygienist who holds a Limited Access Permit (LAP) may provide
    most dental hygiene services without the supervision of a dentist. The
    provision of services under a Limited Access Permit is limited to
    patients or residents of the following facilities or programs who, due
    to age, infirmity or disability, are unable to receive regular dental
    hygiene care"
    (SOURCE: Board of Dentistry, State of Oregon,

    Pennsylvania - " A dental hygienist is prohibited from establishing or
    maintaining an office or other workplace for the provision of dental
    hygiene services separate or independent from the office or other
    workplace in which the supervision of a dentist is provided." (SOURCE:
    § 33.205. Practice as a dental hygienist.

    Rhode Island - General supervision in all settings.

    South carolina - General supervision in most settings.

    South Dakota - General supervision in all settings.

    Tennessee - Indierct supervision in most settings.

    Texas - General supervision in all settings.

    Utah - General supervision in all settings.

    Vermont - General supervision in all settings.

    Virginia - Dierct supervision in all settings.

    *Washington - No supervision in clinic and other settings. Read:
    Sunrise Review: Oral Health Professionals Omnibus Proposal

    West Virginia - Dierct supervision in all settings.

    Wisconsin - General supervision in all settings.

    Wyoming - Dierct supervision in all settings.

    Further Reading
    The Professional Practice Environment of Dental Hygienists in the
    Fifty States and the District of Columbia, 2001

    American Dental Hygienists’ Association

    I hope this answers your question. Please contact me if you need any
    clarification on this answer before you rate it. Search strategy:
    [hygienist dental supervision],
    [hygienist "Independent Practice" dentists] + [name of each state/DC].

    ed777-ga rated this answer: and gave an additional tip of: $50.00
    Good research by you researcher!!!!!!!
    Google’s research shows Dentist have colluded with all states, except
    Colorado, and prevented hygienist from working alone, and experience
    in 19 states, (which allow hygienist independent practice in schools
    and public treatment centers) has empirically proved that the
    hygienist perform well, working independently. If the legislators
    don’t understand this and keep our medical costs high by eliminating
    competition, the people will create law, in their referendums, that
    allows hygienist independent practice. Or, other countries and U.S.
    business people, a mentioned in, will be
    motivated to have hospital ships, off our borders, that escape our
    despotic legislators and treat our citizens at reasonable costs.

    In the 1980s states moved to reduce capacity at dental schools and
    some schools closed. Thus the competition that keeps prices low was
    eliminated. As a result, the ratio of dentists to population has
    dropped. In the following 20 years, given the age of dentists then in
    practice and estimates on when they would retire, more dentists would
    leave the profession (85,000) than would enter it (81,000). High
    demand for care and decreasing numbers of dentists relative to the
    population have meant that dentists' practices are full without their
    participation in public programs and as the dentists have
    legislatively eliminated their competition, they are free to charge
    over $1000.00 per hour, in some case, for their work. My root canal by
    the pleasant, efficient, U.S. dentist took 25 minutes at a charge of
    $670.00. His hourly wage rate calculates to be $1620.00. This means
    that the minimum wage worker must work 259 hours for one hour of work
    by this dentist and the college professor must work 46 hours for one
    of the dentists, even though the professor has had more education than
    the dentist. This same root canal costs $48.00 India. Would a
    compassionate person not think about the effect of their behavior,
    their greed?

    American Dental Hygienist Association (ADHA) strongly supports
    expanding the use of independent dental hygienists. The
    benefit of expanding hygienists' role is that they can provide
    high-quality preventive services at lower cost. Poor children are
    more than twice as likely as their more affluent peers to have
    dental caries, and their disease is more likely to go untreated
    "Presently, Colorado is the only state that has independent
    practice. There are no restrictive guidelines or other qualifications
    for independent practice in the state of Colorado. The only
    requirement is state licensure for dental hygiene. However, there are
    States that permit hygienists to perform without supervision, in
    institution such as, nursing homes, community centers, and
    other undeserved institutions where there is a need for oral
    health care.

    Gail Gilman, RDH, a California Health Manpower Pilot Project
    (Independent Practice participant for 9 years), says: “ It angers
    me to see these ads (by the dental profession) that insinuate
    hygienist aren’t qualified to treat the public unsupervised. It is
    already legal to work unsupervised in nursing homes, schools,
    hospital, home health agencies and public health clinics. It
    makes no sense that hygienists can work on sick people, old
    people, migrant workers, school children and American Indians,
    but not on the general public. Where’s the logic here?”

    The goal of ADHA and its state constituents is to increase the
    public’s access to the preventive and therapeutic services provided by
    dental hygienists. Colorado Department of Regulatory Affairs in July
    1985 stated that not only is the unsupervised practice of dental
    hygienists safe for consumers, but it also provides the public with
    the option to visit with a dental hygienist exclusively for
    preventive oral care and recognizes that dental hygienists are
    educated to refer patients to a qualified dentist, as needed.
    Additionally, the report reinforces that unsupervised practice should
    be all-inclusive in all settings, (not just in nursing homes, schools,
    hospital, home health agencies and public health clinics and school).
    As otherwise this would violate the equal protection clause in both
    the U.S. and Colorado constitutions stating that similarly situated
    people must be treated equally. But when are the hygienist, and the
    public going to get a backbone and stand up to the legislators and
    dentists in a referendum and correct this injustice?

    Comments Log in to add a comment

    Subject: Re: .Which states collude with dentists and force hygienist
    to work under dentists?
    From: politicalguru-ga on 01 Sep 2005 00:30 PDT
    Thank you for the rating and the tip, I wish you success in your
    Joel M. Eichen, Sep 3, 2005
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  2. Joel M. Eichen

    Joel344 Guest

    Joel344, Sep 4, 2005
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  3. Joel M. Eichen

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