R. Bruce Templeton: Complex dentistry requires full training

As legislators struggle to develop a sustainable, quality health-care system available to all Minnesotans, we must remind them that safe dental care is an important part of that equation.

Access to dental care is a challenge for too many, especially those in rural and low-income areas. In its urgency to address access problems, the Legislature is considering some innovative solutions. Innovation can dramatically improve people's health. But as a doctor, I am acutely aware of the do-no-harm principle and caution our leaders against being seduced by a risky, experimental proposal marketed under the guise of innovation.

An experimental proposal being rushed through the Legislature and supported by the Star Tribune in an editorial on the opposite page has raised significant concerns from a wide variety of public-health and dental professionals. This proposal would allow dental hygienists to drill and extract teeth without a dentist present or even on the premises. Although the proposal calls for some sort of agreement between the new hygienist and a licensed dentist, the dentist may have virtually no oversight role. In fact, the dentist working with the hygienist would not even have to practice in the state of Minnesota.

In addition, the hygienist could prescribe drugs and independently make a final decision on the diagnosis of oral diseases, without a dentist ever examining the patient.

All of these procedures, which currently require the oversight of a licensed dentist, would be granted to a hygienist whose education would be half that required of a dentist. No other state legislature has ever approved a program that combines this level of complex surgery with such a minimal education.

Extracting a tooth and drilling in a patient's mouth are not simple procedures. A broken root tip, uncontrolled bleeding and numerous other contingencies can complicate these procedures, rapidly and dramatically. This is just one of the reasons why patients -- including people whose geographic or economic circumstances make it difficult to get dental care -- need and deserve treatment from fully qualified, trained and licensed dentists. Suggesting that they should be treated by practitioners with less-comprehensive training who might be "good enough" is not an acceptable or responsible solution.

This untested proposal died in the House a few weeks ago because of lack of support. But proponents continue to try to circumvent the process in order to push this legislation through the Senate, despite the risks. This is not how Minnesotans should make decisions about health care.

Our state has some of the best dental care in the country. One reason for this is the team model, in which fully trained dentists, hygienists and dental assistants work together to provide the highest-quality care. We must find ways to extend this care to people who don't have adequate access. But in striving to do so, we cannot compromise safety and quality. Lawmakers must work with the full spectrum of oral-health professionals to build a foundation for comprehensive, common-sense solutions to our oral health-care crisis that keep patients safe and healthy.

R. Bruce Templeton is the first vice president of the Minnesota Dental Association and the past president of the Minnesota Society of Oral and Maxillofacial Surgeons. In his practice he has treated underserved patients at the Veteran's Administration Hospital in Minneapolis and in areas of Canada's far north.