Dental hygienists' hands are tied

W. Va. law requires dentist presence for work

By Eric Eyre
Published in The Charleston Gazette December 17, 2007

In West Virginia, dental hygienists polish teeth, scrape gums, take X-rays, give fluoride treatments and detect signs of diseases such as oral cancer.

They can do all that — just not without a dentist present.

West Virginia has one of the most restrictive dental-practice acts in the nation. Dental offices essentially must shut down when a dentist isn’t in the building.

Hygienists say it’s about time that those “antiquated” restrictions are eliminated.

They want the freedom to go to schools, nursing homes and community health clinics on their own to do the work they’ve been trained to do, helping in the battle to prevent tooth decay and gum disease.

“There’s such a need in those places,” said Jennifer Blaskovich, a hygienist who serves as legislative chairwoman for the West Virginia Dental Hygienists’ Association. “But right now, our hands are tied.”

Dentists also support a change — with stipulations.

“This has the ability to allow more patients to receive treatment in a dental office, and improving access is [our] goal,” said Richard Stevens, executive director of the West Virginia Dental Association.

Last January, hygienists and dentists submitted competing legislative proposals that would ease hygienist practice restrictions. Neither bill was passed.

Lawmakers have asked hygienists and dentists to work together and develop a compromise proposal for the upcoming session. The West Virginia Board of Dental Examiners, which regulates both professions, was assisting with negotiations this fall, but has since withdrawn from the talks.

A final meeting between dentists and hygienists is set for Wednesday in Wheeling.

“I’m really hopeful we’ll be able to come up with some kind of agreement,” Blaskovich said. “This would be a way to address the preventive portion of oral health. It would be a step in the right direction.”

The biggest sticking point right now? Tooth sealants.

Hygienists want the right to apply cavity-preventing sealants to children’s teeth in schools and health clinics. Dentists say the procedure should only be done in a dental office.

The thin plastic-like sealants are applied to the chewing surfaces of children’s teeth.

“You can’t use a flashlight, have a child sitting in a desk chair in a classroom and apply a sealant. You need a sterile environment,” Stevens said. “Sealants have to be applied where there’s proper equipment and supplies available, which is in a dentist’s office.”

Hygienists say they have no intention of applying sealants on children in classrooms. They plan to work in school-based health clinics.

Seventeen states allow dental hygienists to place sealants on children without them having a dental exam by dentists. Hygienists believe they could drastically reduce the number of West Virginia children who have decayed permanent teeth.

“We want to be able to do sealants in areas where children might not have access to a dentist,” Blaskovich said. “A sealant can be removed. A hygienist is not going to do a sealant with a tooth that has decay in it.”

Hygienists also want to practice at nursing homes. West Virginia has the nation’s highest percentage of older adults with total tooth loss. The number of seniors in the state is growing.

“Currently, a dental hygienist is not permitted to even brush someone’s teeth in one of these facilities,” Blaskovich said.

About 770 hygienists practice in West Virginia, one of only six states that have a law on the books that says a dentist must be present when a hygienist works. In a 2003 report, an advocacy group called Oral Health America gave West Virginia an F for its restrictive dental-hygiene provisions.

Under state law, West Virginia hygienists can’t even counsel patients about proper brushing and flossing without a dentist present.

Last year, Pennsylvania passed a law that allows experienced hygienists to work in schools, nursing homes and health clinics without a dentist’s authorization. The law requires that hygienists refer patients who need additional care to dentists. Those patients don’t face sanctions if they fail to keep their appointments.

It’s time that West Virginia lifts its restrictions and adopts a similar law, hygienists say.

“Basically, we want to be able to access the public with the things we’ve been trained to do,” Blaskovich said. “The Legislature could move West Virginia from a state of oral-health crisis to a state that is moving forward toward improving the oral and overall health of its citizens. Early detection and treatment of oral disease is critical to saving lives.”