February 25, 2014: AB 1174 (bringing the Virtual Dental Home concept into the needs of poor children) was approved unanimously by the state Assembly in January and is now in Senate committee. The bill extends the use of tele-medical collaboration to reach Medi-Cal patients with health professionals consulting on-line with physicians -- already okayed by the Legislature -- to the field of dentistry. As noted today by Richard Kipling on California HealthCare Foundation's Center for Health Reporting:
In a 2012 report published in the Sacramento Bee, the Center found that many suffered from broken or rotting teeth due to lax state oversight of dental plans contracted to serve hundreds of thousands of poor children in Sacramento and Los Angeles. AB1174 would place dental hygienists and dental assistants in schools and other child-centered settings with state-of-the-art diagnostic equipment. Under the remote supervision of a dentist, these dental professionals would take X-rays and provide interim fixes to dental issues until the dentist, with their input, develops a treatment plan.
And therein lies the potential for controversy -- what the medical industry refers to as "scope of practice": in this care, how much responsibility may a dental hygienist be given?
Under AB1174, California hygienists would be able to perform various dental tasks remotely under the general supervision of a dentist.
This arrangement falls in line with what the California Medical Association envisions as “team-based” care, allowing health professionals like physician assistants and nurse practitioners plenty of responsibility, but always under the eye of a team leader physician.
California’s poor children will have their dental issues identified and dealt with, at the same time that it increases the role for non-dentist health professionals....
The first efforts to bring the Virtual Dental Home concept to poor children was developed by the Pacific Center for Special Care at University of the Pacific, Arthur A. Dugoni School of Dentistry...specially trained dental hygienists in advanced practice, dental hygienists in public health settings and dental assistants provide dental care to underserved populations in a community setting, such as a school.. The hygienists and assistants virtually collaborate with a dentist using telehealth technology such as hand-held x-ray devices to provide critical dental services, assessment and care. The early stages of the program have been tested in 10 counties, including San Mateo (photo above, at an Early Head Start location in East Palo Alto). Funding for the pilots has come from First 5 California. (In Los Angeles County, e.g., the efforts were funded by a $1 million grant from First 5 LA.)