‘GAME CHANGER’
New law opens doors for dental care across state with easier access to hygienists
Ascension Columbia St. Mary’s provides preventive dental care at its Family Health Center for patients who have diabetes or who are pregnant. Dental care is particularly important for those patients because inflammation and infection from poor oral health can affect the health of pregnant women and periodontal disease can complicate managing diabetes.
However, before a dental hygienist at the clinic could do cleanings or provide other preventive care, patients first had to been seen by a dentist.
Ascension Columbia St. Mary’s would schedule 20 or so patients at a time to be seen by a dentist from its St. Elizabeth Ann Seton Dental Clinic, which the health system sponsors. The dentist would do a quick assessment. The patients then could schedule an appointment with a dental hygienist.
That system changed this summer when Gov. Scott Walker signed a bill that allows dental hygienists to work without the supervision of a dentist.
Dental hygienists previously could work on their own only in schools, public health departments, and dental and dental hygienist schools.
The seemingly minor change in state regulations could significantly improve access to preventive dental care in Wisconsin.
“We’ve been waiting for this for many years,” said Emilia Arana, a pediatrician with Sixteenth Street Community Health Centers. “This is huge for us. It is going benefit many patients.”
The new law enables clinics — particularly those such as community health centers that provide care primarily to people with low incomes — to hire dental hygienists to provide basic preventive care, such as cleanings, fluoride varnishes, sealants and education on oral health.
“Now that barrier is gone,” said Arana, the state chapter advocate for oral health care for the American Academy of Pediatrics.
Sixteenth Street plans to hire dental hygienists as quickly as possible, initially providing preventive oral care to children and then expanding to adults.
Access to dental care for adults and children covered by Medicaid programs, such as BadgerCare Plus, is a longstanding problem throughout Wisconsin.
Only one in four people covered by Medicaid programs had dental care in the previous year, according to a January 2014 report by the Wisconsin Department of Health Services.
Wisconsin allocates about 1% of its
We’ve been waiting for this for many years. This is huge for us. It is going benefit many patients.” EMILIA ARANA SIXTEENTH STREET COMMUNITY HEALTH CENTERS PEDIATRICIAN
Medicaid budget to dental care. And many dentists don’t accept or limit the number of patients covered by Medicaid programs because the state’s reimbursement rates typically don’t cover their costs.
Allowing dental hygienists to work in medical clinics will make it easier for low-income patients to get access to basic dental care throughout the state, said Matt Crespin, associate director of Children’s Health Alliance of Wisconsin.
“It made sense from a prevention viewpoint,” he said.
Dental hygienists also will be able to teach parents about oral health as part of wellness exams.
That’s important because one in three 3-yearolds has tooth decay when entering the Head Start program, Crespin said.
The new law also is expected to increase access to basic dental care in rural areas. The same holds for people in nursing homes.
“A lot of them can’t even get to the dentist,” said Jennifer Martinson, president of the Wisconsin Dental Hygienists’
Association.
Martinson, who lives in Amery in northwestern Wisconsin, said she has trained pediatricians on how to apply fluoride varnishes — yet couldn’t do it herself in a medical clinic.
Dental hygienists are licensed to provide teeth cleaning, fluoride treatments, dental sealants, non-surgical periodontal treatments, oral cancer screenings and preliminary oral evaluations.
They typically make $60,000 to $70,000 a year. Equipping an exam room costs $15,000 to $20,000. Portable equipment costs about the same.
A clinic can bill Medicaid for services provided by dental hygienists.
The new law was backed by organizations such as the Wisconsin Hospital Association, Children’s Health Alliance of Wisconsin, Children’s Hospital of Wisconsin, Wisconsin Dental Association, Wisconsin Public Health Association, Wisconsin Oral Health Coalition and American Academy of Pediatrics-Wisconsin Chapter.
The co-authors of the bill were Rep. Kathleen Bernier (R-Lake Hallie) and Sen. Sheila Harsdorf (R-River Falls), Crespin said. Sen. Leah Vukmir (R-Brookfield), the chairwoman of the Senate
Committee on Health and Human Services, and Rep. Joe Sanfelippo (RWest Allis), chairman of the Assembly Committee on Health, also were strong supporters of the bill.
“We got broad support across the aisle,” Crespin said. “You don’t see that much anymore.”
Crespin also said allowing dental hygienists to work in schools but not in medical clinics was difficult to justify.
It will take time for medical clinics to begin hiring dental hygienists and incorporate them into their practices.
Ascension Columbia St. Mary’s, for instance, initially will have parttime dental hygienists at its clinics, starting with its Family Health Center at 1121 E. North Ave.
Providing basic dental care in medical clinics will be more convenient for low-income patients, who often can’t simply duck out of work for a dental appointment and who often have to rely on public transportation, said Bill Solberg, director of community services for Ascension Columbia St. Mary’s.
And Solberg also is optimistic about the new law’s potential to improve oral health in the state.
“This could be a game changer,” Solberg said.