May 2, 2011 By Karen Fox, ADA News staff
Santa Fe, N.M.—A coalition of dentists and dental hygienists helped pave the way for New Mexico to become the first state to formally authorize the Community Dental Health Coordinator through its dental practice act.
It was the second legislative victory for the dental groups, which also defeated a measure that would have authorized practice by dental therapists in New Mexico, one of the five states eyed by the W.K. Kellogg Foundation for dental workforce changes based on the Alaska Dental Health Aide Therapist program.
The New Mexico Dental Association receives advocacy support from the ADA through the State-Based Public Affairs Program.
The revision of the dental practice act authorizes the state dental board to allow CDHCs to provide educational, preventive and limited palliative care and assessment services. Based on the ADA model, CDHCs will work with the general supervision of a licensed dentist in settings outside of traditional dental offices and dental clinics.
NMDA officials see the CDHC as a good fit for the state’s access needs.
“The Community Dental Health Coordinator allows for bridging the gap between the patient and the provider,” said Dr. Julius Manz of the New Mexico Dental Association. “The concept is to have an individual in the community who is knowledgeable about that community and its needs and limitations, as well as having knowledge of and relationships with the dental or medical community.”
Access to care issues are often unique to individuals, added Dr. Manz, naming language barriers, fear, financial problems and transportation—or various combinations of those factors—as contributing to access problems.
“The CDHC allows for individually working with that patient and overcoming access issues for that patient, then getting that patient into the health care system.
“That’s what we really like about the CDHC,” said Dr. Manz, who next month becomes the NMDA vice president. “The model addresses access to care on a very individualized level but looks at many different issues that prevent access to care. Some models only look at creating more providers. That’s part of it but only a part. There are so many more issues to consider.”
There are no CDHC training programs in New Mexico yet, but discussions are under way. Dr. Manz has an interest in starting one at San Juan College in Farmington, N.M., where he is the director of the dental hygiene program.
Negotiating the terms of the revised dental practice act (House Bill 187) was the top priority for a new collaboration between the New Mexico Dental Association and New Mexico Dental Hygienists’ Association. The Dentist-Dental Hygienist Liaison Committee began meeting two years ago to discuss legislative issues in the state. Once the committee came to consensus on the provisions of the revised dental practice act, the NMDA and NMDHA endorsed HB 187 and worked together to get it passed.
Dr. Manz, a member of liaison committee, said, “This was truly a collaboration between dentists and hygienists. I can’t emphasize enough how great it has been for these groups to work together. We may not always agree, but we can come together and talk about these issues and work toward what is best for the state and our patients. This is one area where things have changed and become very positive for us.”
Gov. Susana Martinez signed HB 187 April 7.
“The new law addresses a number of issues that will have a positive impact on dental care in New Mexico,” said Mark Moores, NMDA executive director. “We think it will really help improve oral health care and address some barriers that exist here.”
Besides codifying CDHCs, the dental practice act provides for expanded function dental auxiliaries; allows people licensed to practice dentistry or dental hygiene in another state or students enrolled as dental residents at the University of New Mexico to obtain temporary public-service licenses; and authorizes the dental board to accept the results for clinical examinations from all current regional testing agencies for initial dental licensure.
“We have to figure out ways to affect changes that are beneficial to patients,” Dr. Manz said of the legislative negotiations between the NMDA and NMDHA. “There has been a great deal of give and take, a lot of cooperation, and I think we’ve made significant gains that will improve access to care for all of our citizens.”
The law is effective for the new fiscal year beginning July 1. Mr. Moores said the liaison committee is now working with the state dental board to implement the new rules.
The ADA launched the CDHC pilot program in March 2009 to develop a new member of the dentist-led oral health team who functions as a community health worker with dental skills focusing on education and prevention. CDHCs who have completed the program are working in underserved communities where residents have no or limited access to dental care, providing limited clinical services and connecting patients to dentists for treatment.
Because CDHC candidates are drawn from the communities in which they serve, they are aware of social barriers that prevent access and can more effectively help their neighbors overcome these barriers. They may be employed by federally qualified health clinics, the Indian Health Service and tribal clinics, state or county public health clinics, or by other practitioners in underserved areas.
Pilot program participants are affiliated with three sites. Temple University’s Kornberg School of Dentistry trains participants to work in inner cities; the University of Oklahoma trains participants to serve in remote rural areas; and A.T. Still University Arizona School of Dentistry and Oral Health prepares participants to work in American Indian communities.