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Issues About Dental Hygienist in North Carolina

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Many of North Carolina’s school children in rural and low-wage areas who have never seen a dentist could have greater access to oral health care soon. On Jan. 16, the legislative rules review commission adopted a long-telegraphed change to scope of practice rules for North Carolina dental hygienists, an amendment that goes into effect on Feb. 1

The commission’s approval came after the North Carolina State Board of Dental Examiners unanimously approved the suggested amendment, which was several years in the making.

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But that’s not what oral health care’s newest profession is, as several dozen people discovered recently during a three-hour discussion organized by the John Locke Foundation, a conservative-leaning think tank that advocates for free-market policies. Inside Marbles Kids Museum about a half mile from the General Assembly chambers where state lawmakers define the limits of practice for North Carolina dentists and hygienists, a dental therapist from Minnesota chronicled her path for the dentists, hygienists, oral health policy advocates and lawmakers in attendance. Dental therapists are all about settling more people into dentist chairs, and they do it by providing some of the same care as dentists, especially in rural areas with oral health care provider shortages

Christy Jo Fogarty, the country’s first advanced dental therapist, pursued the master’s degree and state license in Minnesota, a state which expanded the scope of practice allowing her to do some of what a dentist does — extracting loose and diseased teeth, drilling cavities and placing temporary crowns on teeth. “Our scope of practice is about 12 percent of what a dentist can do,” Fogarty said. “But in that scope of practice, we are trained to the level of a dentist.” Fogarty became the first to receive the advanced therapist license in Minnesota’s two-tier system. That gives her the authority to provide care to patients even without a dentist present, while the therapists without that designation must have a dentist on site with them.

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They found that 99% of licensed hygienists reported having experienced pain or discomfort while treating patients! The hygienists reported pain in the neck and shoulder region, hands, fingers, and lower back. Nelson & Jevack (2001) concluded, "Due to the number of students and licensed dental hygienists who experience pain...proper ergonomics should be enforced in dental hygiene education for future physical wellness and career longevity among dental hygienists" (p. 119). The researchers (Nelson & Jevack, 2001) suggest -- as others have -- that instruments be redesigned, but also, the working environment needs to be improved for "better adjustments on patient chairs such as adequate height and tilt adjustments, operator stools with support for arms, adequate work breaks, proper lighting angles, space for legs under the patient chair, early medical intervention for symptoms, and angled instruments to reduce wrist flexion" (p. 119).

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Thus, the practice of dentistry in the State of North Carolina is hereby declared to affect the public health, safety and welfare and to be subject to regulation and control in the public interest

It is further declared to be a matter of public interest and concern that the dental profession merit and receive the confidence of the public and that only qualified persons be permitted to practice dentistry in the State of North Carolina.

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Michalak-Turcotte, C. (2000). Controlling dental hygiene work-related musculoskeletal disorders: The ergonomic process. Journal of Dental Hygiene, 74 (1), 41-58.

Nelson, J.O. And Jevack, J.E. (2001). Experiencing pain due to incorrect body positioning. Journal of Dental Hygiene, 75 (1), 90-129. Retrieved 15 February 2007 from Expanded Academic ASAP database.

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