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Tue May 27, 2008
Dental Hygienists in Kansas Take Services to Seniors
By Elana Gordon
Kansas City, MO – Dental hygienists typically work inside an office alongside a dentist. In many places it's illegal for hygienists to practice anywhere else. But in Kansas, some hygienists are now stepping out of the office and providing teeth cleanings in places where people need it most. KCUR's Health Reporter, Elana Gordon, reports.
Inside Villa St. Francis Nursing home in Olathe, a resident is sitting by himself on the couch. I ask him about his teeth and he points his front bottom ones.
Resident: These ones down here are kind of bad. They kind of got cavities in them.
Like many seniors, he has more problems with his teeth now than he did when he was younger. Yet seniors often have more trouble getting themselves to the dental office for regular cleanings. Dental hygienist Susan Hemberger says a lot of older adults take medications, which can cause dry mouth.
Hemberger: It can cause a lot more plaque buildup and tarter buildup and more infection in the mouth.
Hemberger says the buildup can be associated with more serious health conditions like heart attacks, strokes, and lung infections. She says as people age, they're less likely to feel pain in their mouth and alert someone that something's wrong. And she says those who look after seniors, whether its family members or nurses, are oftentimes overbooked with caring for seniors' other medical needs and may overlook their oral health issues.
Hemberger: It's a losing situation.
But there's another big issue when it comes to dental care for seniors. Again, nursing home resident:
Resident: If you don't have money in your bill to pay for something, people like me, the old timers, we used to have insurance and we'd pay the bill right when we go it, but it don't come easy anymore.
He says he hasn't done anything about his cavities because he can't afford to. It's a common problem. Eldonna Chestnut is director of adult and childcare facilities in Johnson County. She says only 1% of seniors living in nursing homes in the county carry dental insurance.
Chestnut: There really just isn't a whole lot out there for the elderly other than out of pocket. And even a screening, it'd be between 60 and 100 dollars, and on a fixed income a lot of them just don't have that.
That's why Chestnut is spearheading a new program called Elder Smiles. Through the program, hygienists will give seniors regular cleanings, at home, in their care facilities. She says taking the teeth cleaning services to people who wouldn't normally have access to them will prevent more serious dental problems. But, until recently that kind of outreach was illegal in Kansas. Hygienists could only work under the direct supervision of a dentist - or indirectly, only if they were seeing patients of their supervising dentist.
Over the last five years the state has loosened up, allowing hygienists to work independently in places like nursing homes, schools, boys and girls clubs, and senior centers. Maggie Smet says she was the first hygienist in Kansas to obtain a permit to work at remote locations without a dentists' direct oversight.
Smet: That allows a dental hygienist who has certain criteria, they have to have a certain amount of experience and malpractice insurance and a sponsoring dentist, to work in several different places where you have populations that may be somewhat handicapped in getting to a dental office.
About half of U.S. states now allow hygienists to work outside dental offices to some degree. Michael McCunniff with UMKC's School of Dentistry and says the movement to give hygienists more mobility, and responsibility has sparked a national debate about the way dental services should work and the role of dental hygienists.
McCunniff: It's been a touchy situation, conversation. Sometimes we forget that we all work as a team and we can become territorial. And because of that it does create conflicts.
McCunniff says a big part of the debate centers around how much leeway hygienists should have from dental offices and what types of services they should be able to provide. In Colorado, a hygienist can operate a practice completely unsupervised and separate from a dentist. In areas of Alaska, where dentists are extremely scarce, the state created a dental position that's equivalent to a nurse practitioner, where a person with a modified dental training, can provide more restorative dental services in places where it otherwise wouldn't be available. McCunniff says it's a matter of each state finding the right balance.
McCunniff: It takes a dental team to make this all work, and we all have our different parts we play in it. It's just figuring out what are the right combinations and what works.
He says the recent changes in Kansas, which are much less extreme, came about because the state's Dental Association and the Dental Hygienist association developed the special permit program together and then brought it to the state legislature. Kevin Robertson is executive director of the Kansas Dental Association and says it's a good system, but that there're still some issues that haven't been resolved.
Robertson: For example, if a hygienist goes out to a nursing home or any center, whether it's head start or a school or whatever, if they find anything that's more severe than just a cleaning, then there's not an automatic mechanism by which the dentist provides that care.
The idea of community-based hygienists is still relatively new. Less than 100 of them are registered in Kansas, and none of them work with seniors in north east Kansas long term care facilities, like Villa St. Francis in Olathe. Back on his couch, the resident there says he can't remember the last time he had a teeth cleaning, but that it would really help him.
Resident: Well if it didn't cost too much, it would benefit me a whole lot. Keep me from getting cavities, I suppose.
Fortunately for him, the new Elder Smiles Program will soon begin sending dental hygienists to his place. Plans are to expand the program to a variety of adult care facilities, senior service centers, subsidized senior housing and meal programs, as part of a larger push to take good dental hygiene to people, and places, lacking it now.
Funding for health care coverage on KCUR has been provided by the Health Care Foundation of Greater Kansas City.
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