Currently in 2018, dental hygienists are still not allowed to administer local anesthesia in Texas and the other 3 states, even though the most states in united states do. This article is discussing both the advantages and disadvantages of allowing dental hygienists to administer local anesthesia. A review of the literature from Pima libraries and websites was completed and three articles were selected for incorporation into the project. After discussing of the benefits of allowing dental hygienist give local anesthesia it was concluded that more efficient work in the dental office, potentially lower price benefit more underserviced population, the disadvantages (which include little chance to initiate infection, hematoma, nerve damage or blocking of facial nerve of patients) seems not the main part to be concern.
Keywords: dental hygiene education, dental hygienists, local anesthesia, practice scope of the dental hygienist, local anesthesia in the dental field
Since 1971, the first state permitted dental hygienists to administer local anesthesia, more and more states have allowed dental hygienists to do so. After more than 3 decades, the dental hygienists in most of states in United States have been approved to give local anesthesia except Texas, Mississippi, Alabama and Georgia.
This article is talking about the risk and the benefit for allow the dental hygienists to administer local anesthesia. And especially focus on the Texas states, also trying to explore the deep reason underling these four south American states which does not allow the dental hygienists to give local anesthesia. Which will lead to find out the essential question underlining the argument is about the dental hygienists’ role and furthermore the different perspectives on the importance of dental care.
Review of Literature
Local anesthesia is one of the most important ways for pain control in the dental field. The temporary loss of sensation in one part of the body produced by either topically applied or injected agent without depressing the level of consciousness. Compare with topical, injected agent have stronger the effect and last longer which could help dental hygienists go deeper clean without making patients painful. But allowing dental hygienists give injected agent local anesthesia is still a controversial topic today. According to some survey, most dental hygienists and dentists are supported that allows dental hygienists to administer injected local anesthesia in the United States, which believed could benefit both of dentists and hygienists. In that case, hygienists get more scheduled hours due to the independent work and it saves dentists’ time. Dentists will work more efficiently without the interrupts by hygienists who have to ask them to give their patients local anesthesia. Patients might also benefit from the potential decreasing oral health care price. Till now, the dental hygienists in most of the states in the United States have been allowed to give local anesthesia once they gain the specific license or permit in that state, except Texas, Mississippi, Alabama and Georgia.
In the past ten years, the trend in the dental field is to expend the dental hygienists’ scope of dental practice in the United States. Dental hygienists in 39 states can legally provide direct access care. In Georgia, HB 154 Passed legistlation in January 2018, making it the 40th direct-access state. This law will allow dental hygienist to practice with dental hygienists permitted to practice expanded roles in a number of settings under the general supervision of a dentist. In Minnesota since 2017 dental hygienists could be employed by health care facilities or programs, or nonprofits to perform preventive oral health care without an examination by a dentist. Arizona as a direct-access state that enables dental hygienists to practice as affiliated practice dental hygienists in public health settings, under a written agreement with a dentist. In Colorado, another direct-access state, there is no authorization or supervision requirement for dental hygienists to render most dental hygiene services. In fact, they may also own their own practices. Likewise, California’s RDHAPs may practice as independent contractors or own their own practices, with services rendered under general supervision, but without the need for dentists to examine patients prior to initial treatment.
In the view of April Velyn Catlett from the University of Tennessee Health Science Center?she find out in all 8 states, the registered dental hygienists have a high level of autonomy could feel competent to work independently. Her findings support Abbott’s theory of expert labor, which is built on the premise that all professions compete for jurisdictional boundaries in a conflict over rights to similar work. And then she gives a solution that if policymakers allowed registered dental hygienists to expand their scope of preventive dental practice, dentists would have more time to address the restorative dental needs of underserved populations in the United States resulting in improved access to dental care. (Catlett, A. V. 2014).
However, have the options to gain the permission to give local anesthesia does not necessary means that all dental hygienists will likely to do that. During an evaluation of permit local anesthesia within dental hygiene in Massachusetts, Katherine Soal and her collages from Massachusetts gives an extensive overview about that state, and then find out less than 10% of dental hygienists chose to obtain the permit for local anesthesia. In their research, they offered the new insights into why most Massachusetts dental hygienists choose not to pursue certifications, which are the Permit L holders was not needed in the type of practice and employer resistance. (Soal, Katherine., Boyd, Linda., Jenkins, Susan., November-Rider, D., ; Rothman, Andrew, 2016)
Even more, according to the research of Sherry Jennifer, who is the dental hygienist from Illinois, the state that does allow dental hygienists to obtain Local Anesthesia Certification. There is some serious consequence could lead from local anesthesia given by no eligible medical provider for children. Which is an overdose of local anesthetic can occur if blood pressure elevates and affects the central nervous system especially for children. The patients could slip into unconsciousness or go into complete respiratory failure. Even less than 1% of adverse reactions caused by local anesthetics are attributed to true allergy, a complication of local anesthetic administration include both local effects and systemic effects. Local effects may include the spread of infection, hematoma, nerve damage or blocking of the facial nerve, systemic effects can be infections, the risk of heart bacterial infection, cardiovascular problems, liver disease, and other complications. (Sherry, Jennifer. 2009)
In March 2017 Texas, many dental hygienists championed for the bill that suggests giving dental hygienist the Opportunity to give local anesthesia under the condition that they gained enough education and under the supervision of the dentists in Texas. However, Texas Dental Association states that they opposed to this bill due to patient safety because they feel that it lowers the education standard and it’s only about expanding dental hygienist’s scope of practice, possibly to open the door to independent practice by hygienists. It is not clear that allows dental hygienists give local anesthesia will lower the oral health care standard, but According to 2018’s States with the Best & Worst Dental Health survey, the States (include TX MS AL and GA) which are conservative about giving dental hygienists more work doesn’t seem like to have better oral health than other states. It is also suggested that Arkansas, Mississippi, Louisiana, West Virginia, and Texas are the top 5 highest percentage of Adults with low life satisfaction due to the oral condition. According to the dental care map in Taxes from the texastribune.org, there is at least one-third of the area in the state does not have enough dental care.
Methods and Procedures
Topic Selection: Texas has been one of the highest gaps between preventative dental care, and its population. The lack of Dentists is only going to increase in Texas over the next ten years due to the aging dentist population. Other states have already drafted legislation, educated health care providers, and provide dental hygienist direct access care for over a decade already and have shown reduced emergency health visits resulting from oral infections, and treatable oral health conditions. It is important to expend the scope of practice for mid-provider like dental hygienists to serve the people.
Resource search and Selection: A careful review of the significant literature related to the benefit and negative effect of allow dental hygienist to administer local anesthesia was conducted. The search was narrowed to local anesthesia administered by dental hygienists in last 10 years are 114 articles. Review of the abstracts was accomplished and 10 articles were selected for incorporation into the project.
Libraries/search engines and databases use: Several databases were used to search for the sources for this project. Research engines and libraries are used includes (1)search.proquest.com,(2) http://web.a.ebscohost.com/,(3) https://ebookcentral.proquest.com/(4)Wikipedia.com (5)googlescholar.com
Search terms: Several search terms were used to identify sources for this project. The search terms included (a) local anesthesia in dental field, (b) dental hygiene, (c) local anesthesia, (d) dental hygienist education, and (e) practice scope of dental hygienist. This search resulted in 18975 articles. Filters were used to narrow down the search, which like peer review, Article, last 10 years reach and English language. The result narrowed down to 114.
Boolean strings: No Boolean strings were used.
Age of the sources: The Age of the sources are under 10 years
Local anesthesia administration by dental hygienists is validated by the literature. Previous studies suggest that employers are allocating this pain control modality to dental hygienists and these providers are administering effectual injections that have presented positive practice outcomes. Given that the overall distribution of this study’s demographics presented an even distribution across all regions within the U.S., the results of this current assessment offer new data while paralleling the findings of previous studies relating to this topic.
Obviously, letting dental hygienists expanded duties like giving local anesthesia will benefit dental hygienists and dentists by allowing the hygienists to get more schedule hours and letting the dentists get more patients. Dentists will work more efficiently without the interruption by hygienists who have to ask them to give their patients local anesthesia. Patients might also benefit from the potentially decreasing oral health care cost. Also, some evidence shows those dental hygienists who have been properly educated could administer local anesthetics to patients without harm (Scofield, J.C., and Gutmann, M.E., 2005).
Opponents argue that topical anesthetic application with injection was not the most common form of local anesthesia in a clinic. Higher frequency of employment of this modality is expected, as it is likely to be considered the easiest to use and is likely to provide adequate anesthesia for the types of procedures dental hygienists perform, this may only require soft tissue anesthesia for patient comfort. Another consideration for this observed frequency would be patient preference. Studies have shown that patients rank needles as one of the most fear producing elements of their dental care. Additional studies may be warranted to explore patient satisfaction rates between these 2 modalities and their integrated use. “Some dentists believe the quality of care would be compromised and patient safety jeopardized because dental hygienists do not have the adequate background knowledge to prevent complications and recognize emergencies caused by anesthetics” (Scofield, J.C., and Gutmann, M.E., 2005)
Also, it is believed that there are some serious consequences couses from local anesthesia given by no eligible medical provider for patients. meaning overdose of local anesthetic can occur if blood pressure elevates and affects the central nervous system especially for children. The patients could slip into unconsciousness or go into complete respiratory failure. Less than 1% of adverse reactions caused by local anesthetics are attributed to true allergy. The complication of local anesthetic administration includes both local effects and systemic effects. Local effects may include the spread of infection, hematoma, nerve damage or blocking of the facial nerve, systemic effects can be infections, the risk of heart bacterial infection, cardiovascular problems, liver disease, and other complications?Sherry J, S.,2009?.
In some states like Texas because Dental Hygiene Practitioners would still be under the general “supervision of a dentist, and subject to a written collaborative practice agreement” (Davidson,2016) Quality of care would not suffer for those individuals needing quality care most. “The results of a variety of studies indicate that appropriately trained mid-level providers are capable of providing high-quality services, including irreversible procedures such as restorative care and dental extractions” (Wright.2013). There is a void in the State of Texas of qualified Dental Health Care Professionals available to treat the underserved population. Creation of Legislation adding a new mid-level provider of care would remove this void, and safely fill it with practitioners that can efficiently provide preventative services and treatments to families and individuals that otherwise would not receive treatment. The legislation is not only cost-effective, but it also unburdens the taxpayers by removing the excess uninsured patient load in Emergency Rooms due to dental health concerns and the related medical conditions that are caused by an untreated dental disease.
Dental hygienists play a significant role in the public oral health. Providing a high standard oral health care includes fixing the current oral health problems but also preventing the future oral disease. Allowing dental hygienists administer local anesthesia will increase the efficiency of the most dental hygiene work, benefits the public oral health care even though there is a low risk to initiate infection, hematoma, nerve damage or blocking of facial nerve of young patients. But this could be solved in proper additional medical education for the dental hygienist who chose to approach the local anesthesia licence. The importance of enlarge the practice scope of dental hygienists will improve the public oral health, allowing dental hygienists to give the local anesthesia could be the first step.