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Article: Minnesota Hygienists May Soon Pull Teeth DR. JERRY GORDON
Minnesota may be the first state to allow dental hygienists to pull teeth, begin the process of root canal, and drill and fill teeth.

Minnesota may be the first state to allow dental hygienists to pull teeth, begin the process of root canal, and drill and fill teeth. The bill, SF 2895, is now in the Minnesota state legislature. This legislation creates a new type of practitioner called an advanced dental hygiene practitioner or (ADHP). Under the noble guise of helping the underserved, this bill will allow undertrained and inexperienced individuals to diagnose and treat patients without the supervision of a dentist in most cases. The concept of the ADHP considered in SF 2895 is dangerously wrongheaded, and shows why it is unwise to have lawmakers with no understanding of dentistry and medicine make fundamental changes in the delivery of care to dental patients.

Most dentists are required to attend four years of college with a heavy concentration of science, and four years of dental school before practicing dentistry. Recently, New York has included an extra year, a mandatory residency prior to receiving a dental license, and other states are moving in that direction. Why is the trend more education, and not less? The answer is simple. Dentistry is a complex discipline that requires years of training and experience to become competent. I could fill every page of this newspaper with the potential problems and complications that will arise if SF 2895 becomes law. In fact, SF 2895 is the most shortsighted concept in recent memory. Let me take just one example of what can happen if the ADHP is allowed to extract a tooth. The first question is if the tooth actually needs to be removed. Can it be saved with root canal? Having never done a root canal or restored the tooth afterward with a crown or cap, there will be no real judgment brought to bear on the issue. What if there is swelling around the tooth? Is it better to drain the infection first (which they are not allowed to do), then remove the tooth, or do both at the same time? Will the ADHP know that if the infection is not drained that the person can die from this complication, even if the tooth has been pulled?What happens when the simple tooth extraction becomes difficult, and the roots break off in the jaw? Not trained or permitted to do what is necessary to remove the root fragments surgically, will there be a dentist or oral surgeon available to complete the procedure in a safe and timely manner? What will the ADHP do if they cannot stop the patient from bleeding, or the sinus is damaged during the procedure? These are just a few of the things a dentist must consider each time a tooth is extracted. In fact, some dentists don't even do extractions, opting to send these patients to an oral surgeon, who has three to four more years of training than the general dentist.

Bill SF 2895 will result in both harm and supervised neglect of the people unfortunate enough to be treated by the ADHP. This agenda driven legislation will not lower the cost of health care, or improve access, and should not be enacted into law.

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Dr. Gordon is the dental columnist for the Bucks County Courier Times. He has published more than 300 articles since 1998. Dr. Gordon was recently asked to provide commentary about mid-level providers for the influential dental journal Dental Abstracts.

Dr. Gordon responds to an article in Dental Abstracts challenging his views.

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