LADHS

Volunteers help thousands at Calif. free clinic
By Donna Domino
May 5, 2010

More than 6,000 patients, most of them seeking dental care, packed a free seven-day clinic held in Los Angeles last week, at times overwhelming the 250 dentists, oral surgeons, hygienists, and dental assistants who volunteered their services. Is this a sign of things to come for other states that have cut Medicaid benefits? "It's pretty chaotic, but it's controlled chaos," San Gabriel, CA, dentist Daniel Cheng, D.D.S., told DrBicuspid.com during a break on April 30 -- a day he treated 600 patients.Due to the sheer volume, patients were limited to one procedure. And the sponsoring organization -- Remote Area Medical -- fell short of its goal because of a shortage of volunteer medical professionals. "I promised everybody they could get one treatment. Some have 20 cavities, so I have to ask, 'What's your priority? Whatever bothers you, I'll take care of it,' " Dr. Cheng explained. "If we can save a tooth, we'll save it."

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California Dental Hygienists’ Association Conducts Statewide Outreach Efforts to Provide Low-Income Children Access to Dental Care

As National Children’s Dental Health Month draws to a close, California’s dental hygienists are reminding parents and guardians that protecting the smiles of California’s youngest children is a yearround
commitment.
“Taking a month to spotlight this issue is a wonderful opportunity to better educate parents and the public,” said Daphne Von Essen, president of the California Dental Hygienists’ Association (CDHA). “But this really needs to be something we as a society focus on 365 days a year because we have millions of
California children suffering from insufficient oral health care.”

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As a charitable all volunteer organization RAM’s focus has been outside the United States, but recognizing the growing number of people lacking access to quality medical attention it is now spending significant time and resources in the states. Receiving some well-needed press on the CBS program 60 minutes, RAM started this year in Knoxville Tennessee and then moved to Kentucky and Virginia before coming to California to its first and largest urban expedition.

The Los Angeles Dental Hygiene Society was one of the first to get the call for needed assistance. In a relatively short period of time, Laurel Bleak, president of the Los Angeles Dental Hygiene Society, and PJ Attebery, LADHS’ newsletter editor, attended RAM planning meetings with five other local Los Angeles area dental societies, along with the USC Mobile Dental Clinic and faculty from the Loma Linda Dental Hygiene program. Understanding the expansive scope and magnitude of the project, PJ and Laurel got to work immediately with logistical planning and communication, contacting the presidents of the local Southern California hygiene components for volunteers, instruments, ultrasonics, and much needed supplies. CDHA was one of many answering the call, donating fluoride varnish and plaque lights.

Dental and medical care providers came to The Forum in Inglewood in the wee hours of the morning on August 11^th and were met with hundreds of people waiting in lines overnight to seek medical attention. On August18^th, when RAM closed the Forum doors and moved on to Utah, over 6000 patients had been seen with over 14,000 patient procedures performed. Over half of the patients served sought dental care, culminating in approximately 2,200 extractions, 5,500 teeth saved, and 1,800 dental cleanings.

Laurel and PJ commented that the experience of planning and delivering dental care was rewarding and transforming.  “We saw the direct benefits of our intervention. The need was overwhelming and greater than we could have imagined. People came at midnight to camp out on the sidewalk to get a number for entry.  All priority numbers for patients were completely given out by the 4^th day of the 8-day event. While feeling a great sense of accomplishment and pride for what we collectively did, it was equally heartbreaking that so many in need were turned away.”

LADHS became involved in the planning in May2009. We came together as a community to do something quite miraculous in three months. This is what the California Dental Hygiene Association and all of its components are all about.

Imagine an autonomous dental hygiene profession without oversight by the Dental Board of California. SB853 makes the autonomous Dental Hygiene Committee of California a reality that becomes effective July 1, 2009.

This bill establishes criteria for licensure of a registered dental hygienist, a registered dental hygienist in alternative practice, or a registered dental hygienist in extended functions by the DHCC. This bill sets forth the committee’s functions and duties, including issuing, reviewing, and revoking licenses as well as developing and administering examinations. Additional committee functions include adopting regulations, determining fees and education programs and continuing education requirements for a registered dental hygienist, a registered dental hygienist in alternative practice, and a registered dental hygienist in extended functions. The bill requires the Dental Hygiene Committee of California to
establish a diversion program for licensees whose competency may be impaired due to drug or alcohol abuse, and to establish diversion evaluation committees, with specified duties in that regard.

SB853 establishes the Dental Hygiene Committee of California (DHCC) under the Department of Consumer Affairs. This bill abolishes the Committee on Dental Auxiliaries (COMDA) transferring its authority to regulate the practice of dental assisting to the Dental Board of California (DBC), and creates a standing advisory committee for dental assisting. The bill establishes within the DBC a full-time management-level staff position to manage matters related to dental assisting. The Dental Assistant Committee will be a three-member subcommittee of the Dental Board of California beginning July 1, 2009. Between January and June 2009 administrative authority for managing matters related to dental hygienists will seamlessly transition from COMDA to the new DHCC.

The Dental Board of California (DBC) sunsets and becomes the Dental Bureau of California on July 1, 2008. On January 1, 2009, the Dental Bureau of California will revert back to the Dental Board of California.

SB853 creates, within the jurisdiction of the board, the nine-member Dental Hygiene Committee of California, which will have specified memberships and duties. The semantics can be confusing, but the executive officer of the DHCC will actually report to the director of the Department of Consumer Affairs, not the executive officer of the dental board.

We owe a great deal of gratitude to the many years of efforts by so many who made this achievement possible, especially JoAnn Galliano, RDH, MEd and Terry McHale, our lobbyist at Aaron Read and Associates. Michael Miiller of Senator Don Perata’s office and representatives of the California Dental Association are to be commended for their assistance and collaboration. Now we begin a new era of implementing the charge of this legislation – to better serve the consumers of California

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There are times that I remember, and times that I forget. I'm known for forgetting my glasses and having to resort to holding papers at arm's length, unable to clearly see something right before my eyes. But there are other things I remember with precise clarity. One such moment was when I sat on the left-hand side, in the third row, second from the end at the 2003 American Dental Hygienists Association's House of Delegates. In her president's address, Tammi Byrd shared the goals of our organization: 1) achieve autonomy of dental hygiene education, licensure, and practice, 2) promote consumer advocacy in oral health as part of total health, and 3) raise awareness of ADHA as the recognized authority for the profession of dental hygiene. These goals are still etched in my mind, and I was thrilled that they were such high-reaching goals and plans for the future of our association. Flash forward, and I'm even more thrilled to declare these dreams a reality for the Golden State.

On a very lucky Friday the 13th, in June 2008, Governor Arnold Schwarzenegger signed Senate Bill 853. This single act of pigment to pulp finalized a new law that will change the future of dental hygiene in California. It unleashed the dreams of access to care and unveiled the profession of dental hygiene in California. The measure creates the Dental Hygiene Committee of California (DHCC), an agency dedicated solely to overseeing the state's dental hygiene progression." This new regulatory body will replace the Committee on Dental Auxiiliaries and will be housed under the Department of Consumer Affairs in July 2009. With the governor's signature, California becomes the first state in the nation to establish a self-regulating agency charged with licensure, education, and enforcement of dental hygiene. In six short years from first bill to signature, California dental hygienists reached ADHA's goal of obtaining professional autonomy in education, licensure, and practice!

That single signature was the result of a process that took almost six years to complete. Each step that we took was outlined in the strategic plan for the California Dental Hygienists' Association. A group of determined professionals utilized all available resources to make a change in the very practice of dental hygiene in California. Some people lobbied, some wrote letters, and others simply paid their membership dues to help supply funds for this endeavor. All of these acts combined changed the future of dental hygiene and access to care for all. It was a journey, and it was worth every single step.

What is autonomy?

Autonomy means self-government. It contrasts with the term hegemony, which means the domination of one state or group by another. An autonomous profession is one in which the practitioner has the qualifications, responsibility, and authority for the provision of services which fall within its scope of practice.

Autonomy does not mean complete freedom from all monitoring and regulation. Even the most entrenched professions are closely scrutinized and their practices repeatedly reviewed by bodies established by federal and state statutes, accrediting agencies, consumer groups, and peers.

Dental hygiene in California will not be free from external review and regulation. The profession is responsible for formulating standards for independent practice, for the definition of the appropriate scope of its professional practices, and for the development of individual and institutional standards for the delivery of services to the public.

Is dental hygiene a profession or a career?

Professions tend to be autonomous, which means they have a high degree of control over their affairs: "professionals are autonomous insofar as they can make independent judgments about their work"1 This usually means "the freedom to exercise their professional judgment."2 However, it has other meanings. "Professional autonomy is often described as a claim of professionals that has to serve primarily their own interests ... this professional autonomy can only be maintained if members of the profession subject their activities and decisions to a critical evaluation by other members of the profession."3 The concept of autonomy can therefore be seen to embrace not only judgment, but also self-interest and a continuous process of critical evaluation of ethics and procedures from within the profession itself.

In California, the bill has been signed that changes dental hygiene to a true profession by virtue of its ability to regulate itself. Dental hygienists in California can now be recognized and categorized as midlevel practitioners.

There are times that we remember, and times that we forget. The goals of ADHA that Tammi shared so many years ago can help us all remember just what our dreams are — they are too important to forget. Just as I need my glasses to see clearly, it is my hope that dental hygienists will use the goals of their organization to clearly see the future for the profession of dental hygiene. Autonomy is a goal worth working for. Thanks to many of you, it has not been a pipedream.

About the author

Noel Brandon Kelsch, RDH, is a freelance cartoonist, writer, and speaker. Noel's cartoons can be seen in RDH magazine and her articles have been published in both dental and nursing trade magazines, as well as books. She has received many national awards, including Colgate Bright Smiles Bright Futures, RDH/Sunstar Butler Award of Distinction, USA magazine Make a Difference Day award, President's Service award, Foster Parent of the Year, and is a five-time winner of the Castroville (Calif.) Artichoke Cook-off! Her family lives in Moorpark, Calif. She can be contacted at n.kelsch@sbcglobal.net.

References

1. Bayles MD, Professional Ethics, Belmont, Calif.: Wadsworth, 1981.
2. http://www.wma.net/e/policy/a21.htm The World Medical Association Declaration of Madrid on Professional Autonomy and Self-Regulation, 1987.
3. http://www.ingentaconnect.com/content/klu/meta/2000/00000021/00000005/00274496 Hoogland J & Jochemsen H, Professional Autonomy and the Normative Structure of Medical Practice, Theoretical Medicine, 21.5, Sept. 2000, pp. 457-475.