Kansas Health Institute | Information For Policy Makers. Health for Kansans.

TOPEKA — Three dentists told members of the Senate Public Health and Welfare Committee today that Kansas needs to move forward in creating a new class of dental worker so that access to care is improved for poor children and others who have trouble finding someone to treat them.

Senate Bill 192 would allow specially trained dental hygienists to be licensed as Registered Dental Practitioners and includes a list of 34 procedures the technicians would be allowed to perform under a dentist's supervision, though the dentist would not need to be physically present during the work.

A companion measure, House Bill 2280, has already met stiff opposition from the Kansas Dental Association and is stalled in the House Health and Human Services Committee.

The same opponents of that identical bill are expected to appear before the Senate committee on Wednesday after the proposal's supporters are given another 15 minutes to make their arguments.

"Extremely disappointed"

Two of the three dentists who appeared in support of SB 192 said that a large percentage of their patients are children on Medicaid. They chided fellow dentists for refusing to take Medicaid patients and then opposing a plan to deliver alternative care.

"I am extremely disappointed by the dental association's stand on this bill," said Dr. Daniel Minnis of Pittburg's Access Dental Clinic, "and by my profession's unwillingness to work on real and meaningful solutions to the access issues."

Dr. Melinda Miner, who practices in Hays with her husband, Dr. Daniel Miner, said when the couple first began practice in 2000, they were the only dentists in town accepting Medicaid patients. A decade later, she said, 50 percent of the patients she and her husband see are on Medicaid but they're still the only dentists in town who will take them. She said she was flabbergasted that other dentists would oppose licensing dental practitioners.

"If they won't help us see these children," she said, "why would they oppose us?"

Opposing dentists had earlier this legislative session told the House committee that they feared patients' safety would be imperiled if the new class of technicians were allowed to do procedures currently done only by dentists.

They testified that the "lives and safety" of Kansans would be jeopardized if lesser-trained persons were allowed to do things such as pull baby teeth and install temporary crowns without a dentist's direct supervision.

Procedures that sound simple can quickly turn dangerous, they said.

"If there is one consistency in the practice of dentistry," Dr. Glenn Hemberger, president of the Kansas Dental Board, told the House panel, "it is that procedures frequently do not go as planned."

Needless deaths

But Minnis told the Senate committee that two children on Medicaid had died needlessly in 2007 because they had infected teeth that went untended. The infections spread and the children succumbed for want of care.

"A simple $80 extraction would have saved either of these children's lives," he said.

Minnis said the dental association in 1906 opposed allowing dental hygienists to work at all. Now, he said, hygienists are viewed as indispensable by all in the profession. In the future, he said, registered dental practitioners also will be correctly seen as essential by those now opposed to them.

Committee members also heard from Dr. Ron Nagel, a dentist retired from the U.S. Public Health Service.

Nagel said he had been in charge of oral health care for Native American tribes in Alaska where he worked to integrate mid-level caregivers into the system because there weren't enough dentists to provide needed access.

He said the Alaska dental association sued to stop the program but failed. Now there are more than 30 of the caregivers at work in Alaska and the problems cited by their opponents have not materialized.

"They have been working under incredible scrutiny since 2004," Nagel said. "No other dentists in the country have undergone that level of scrutiny...There is simply no evidence to corroborate the statements I've heard about quality or safety issues."

The dentists' testimony in favor of the bill struck a chord with at least one committee member.

Sen. Roger Reitz, R-Manhattan, a physician, said their remarks had been, "spellbinding."

"This is good stuff," he said.