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Enhanced Dental Teams

About Enhanced Dental Teams (EDTs)

dental team

An Enhanced Dental Team (EDT) goes beyond the traditional dental office or public health models by using strategies such as teledentistry or affiliated practice to provide dental care access for underserved communities. An Enhanced Dental Team will be better able to:

  1. Bring dental prevention services to underserved children, families and communities
  2. Help children and families find and have a "dental home" for professional care
  3. Serve larger areas by bridging distance between families and a dental office or clinic
  4. Coordinate dental and oral health care for children and families with local providers

Strategies to Build Enhanced Dental Teams

Workforce solutions to Arizona's burden of oral disease are complex and require a multi-level approach for improving access to care. Recent initiatives to improve the oral health workforce have lead many partners to a readiness to promote strategies to enhance dental teams. These strategies include teledentistry practice and affiliated practice. With early seeding of teledentistry and affiliated practice dental hygienists in Arizona, there is a powerful opportunity to improve their outreach and service to underserved populations and in underserved areas.

Teledentistry

Teledentistry practice utilizes offsite collaborating dentists to diagnose and plan/coordinate treatment using electronic and communication technologies. Teledentistry permits underserved patients in remote areas to enter the dental care delivery system without having to travel to the dental office. This strategy uses technology for storing and forwarding patient information. Dental data collected by a front line oral health provider in a community setting is sent to a dentist located at another site. The dentist can evaluate the patient data in real time or at a later time and develop a diagnosis and treatment plan for the patient. Teledentistry capabilities can also provide training opportunities for offsite staff, oral health providers and other medical/childcare providers living and working in distant areas. The technology encourages interactive consultations among professionals, facilitates interaction between patients and their providers, provides specialty consultations, and allows real-time diagnostic examinations.

Affiliated Practice

Affiliated practice (AP) utilizes qualified dental hygienists permitted by Arizona State law and regulations (A.A.C. R4-11-609) to provide dental hygiene and preventive oral health services, in limited settings to qualifying patients, subject to the practice parameters established by an agreement with an affiliated dentist.

Mid-level providers like nurse practitioners or physician assistants can increase the productivity, enhance the delivery of appropriate primary health care, and maximize staffing cost benefit. Mid-level providers can be used to extend care to the underserved and to extend primary care to those already in the delivery system. A mid-level provider's scope of service varies depending on the provider designation, state credentialing/licensing, and the state practice laws. Arizona's response to the oral health mid-level provider is the Affiliated Practice Dental Hygienist. Typically, practice laws require the dentist to provide direct or general supervision of the dental hygienist as well as requiring an examination before a dental hygienist can deliver any treatment services. However, Affiliated Practice utilizes qualified dental hygienists permitted by Arizona State law and regulations to provide dental hygiene and preventive oral health services to children who are eligible (according to family household income and/or participation in the national school meal program) to receive services within a public health agency, institutional setting, public/private school or government sponsored program.

This provides the opportunity for Affiliated Practice Dental Hygienists to deliver services in community settings outside the confines of the traditional dental office. The Affiliated Practice Dental Hygienists add to the mix of strategies and team members that advance the idea of a flexible, responsive dental team to the varying needs of the patient populations and communities. Affiliated Practice can also provide a new point of entry into the oral health care delivery system for underserved populations or in underserved areas.

Affiliated Practice Dental Hygienist (ADHP)

There are differences of duties performed by an Affiliated Practice Dental Hygienist (APDH)PDF and a Registered Dental Hygienist (RDH) in a Public Health setting.

Affiliated Practice Dental Hygienist (APDH) Duties

  • Assessment (any or all of the following may be provided)
    • Medical and dental history review
    • Blood pressure screening if indicated by medical condition
    • Screen the oral cavity and surrounding structures to include any or all of the following assessments, as appropriate:
      • extraoral head and neck areas
      • intraoral hard and soft tissues
      • perform periodontal assessment
    • Perform dental restorative charting and recording of clinical findings
    • Perform a caries risk assessment
    • Expose and process dental radiographs according to ADA guidelines Dental Hygiene/Preventive Services (any or all of the following may be provided)
      • Perform all procedures necessary for a complete prophylaxis, except root planning, the administration of local anesthetic, administration of nitrous oxide analgesia and placement of sutures.
      • Apply dental sealants to teeth according to ADA and Centers for Disease Control and Prevention guidelines.
      • Administer topical fluoride gels and varnishes as indicated according to ADA and Centers for Disease Control and Prevention guidelines.
    • Education
      • Discuss patient's homecare procedures and provide instruction when appropriate.
      • Provide tobacco cessation intervention and referral when appropriate.

Registered Dental Hygienist (RDH) in a Public Health Setting

  • Assessment (any or all of the following may be provided)
    • Medical and dental history review
    • Blood pressure screening if indicated by medical condition
    • Screen the oral cavity and surrounding structures to include any or all of the following assessments, as appropriate:
      • extraoral head and neck areas
      • intraoral hard and soft tissues
    • Perform dental restorative charting and recording of clinical findings
    • Perform a caries risk assessment
  • Dental Hygiene/Preventive Services (any or all of the following may be provided)
    • Administer topical fluoride gels and varnishes as indicated according to ADA and Centers for Disease Control and Prevention guidelines.
  • Education
    • Discuss patient's homecare procedures and provide instruction when appropriate.
    • Provide tobacco cessation intervention and referral when appropriate.

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