A pair of bills would ease restrictions on dental care by allowing training hygienists to do routine procedures without the presence of a dentist, particularly at schools.
Hygienists could, for example, administer local anesthetics, under supervision, and perform dental hygiene at schools, without a dentist.
Lawmakers will now likely decide which bill to use for the final version that will head ultimately to the governor.
The bills are similar, and each includes a provision for teledentistry: in other words, meeting with a patient online to cull data, record symptoms, and make assessments, for example.
During the pandemic, writes N.C. Health News, dentists turned to teledentistry to connect with patients through video chat, coaching them to use their phones to photograph their mouths and offering consultations through screens.
“The practice, born of necessity in the midst of a global health crisis, offered a path to help address a long-standing and widespread need in North Carolina’s health system: access to oral health care,” the health website says.
It’s an important measure, says Jordan Roberts, government affairs associate and health care analyst at the John Locke Foundation.
“Teledentistry may confuse some people when they hear the term, but this bill does several things that will expand dental care services in our state,” Roberts said.
“The bill rolls back some restrictions on how dentists and dental hygienists can collaborate with each other and sets standards for how that collaboration can be done using new technological means. By allowing dentists to use teledentistry and allowing dental hygienists to do more without the supervision of a dentist, we can increase access to dental care and stretch the dental resources we have in this state to be able to serve more patients.”
As of September 2019, an estimated 2.4 million North Carolinians struggled to get adequate dental care, N.C. Health News says, citing the Health Resources & Services Administration of the U.S. Department of Health and Human Services.
“Residents in 98 of the state’s 100 counties live in a region designated by the federal government as a Dental Health Professional Shortage Area, or HPSA.”
Nearly three-quarters of the state’s counties have been designated “Dental Health Provider Shortage Areas,” according to the N.C. Oral Health Collaborative. The problem is only getting worse: Dentists are retiring faster than new practitioners are taking their place.
Teledentristry is seen as a way to bridge the gap and allow dentists at a central location to at least examine or consult with a patient who does currently see a dentist regularly. Most dental issues are preventable, the collaborative says, and even an online dental visit can help people stave off problems. It’s is a relatively new concept in North Carolina. There is nothing in current state law that prohibits it, but there is little infrastructure to support it.
Bobby White, CEO of the N.C. Board of Dental Examiners, has told industry groups that his organization has wanted to move forward with teledentistry, but “out-of-date language” in the Dental Practice Act would need updating first — which these two bills accomplish.
As such, few practices offer teledentristry currently. But it builds on the growing trend of telemedicine, in which doctors meet with patients virtually for routine visits. This, too, is viewed as a critical way to extend health care access, particularly in rural parts of the state with few practicing physicians. Many hospital systems are able to offer telemedicine visits for common conditions 24/7, and for a low cost.
The N.C. Medical Board cautions that it’s vital for patients to receive the same level of care via the internet as he or she would in person. Doctors also shouldn’t prescribe things like pain medicine with only a virtual visit, the board recommends. Similar concerns have been raised in teledentistry.
Sen. Jim Perry, R-Lenoir, is the primary sponsor of the bill in the Senate, while Rep. Donny Lambeth, R-Forsyth, is leading the effort in the House.