NMDA Journal Summer 2019

Dental Therapy The Next Step Barbara Posler RDH, NewMexico Dental Hygienists’ Association Chair, Council on Regulation & Practice On March 28, 2019, Governor Michelle Lujan Grisham signed into law HB308, establishing dental therapy. Several pro- visions in the bill are designed to increase access to oral health services. How soon will dental therapists be practic- ing in New Mexico? First and foremost, the Board of Dental Health Care will need to promulgate rules to support the statute. The Board will be seeking input as the rules are drafted. A public hearing will then be held at which time additional comments can be submitted prior to the board making its final decision. It is expected that the rules will be promulgated in a timely manner in order that the statute can be implemented as intended by the legislature. The statute requires dental therapy educational programs in New Mexico to be accredited by the Commission on Dental Accreditation. Any institution of higher education can apply for the CODA accreditation. According to CODA, the curricu- lum must include at least three academic years of full-time instruction or its equivalent with consideration given to dental hygienists for advanced standing; thus, the length of a dental therapy program could vary depending on how the institution structures its educational program. Dental thera- pists in New Mexico are required to be dental hygienists. In order for a dental therapist to perform restorations under general supervision, he or she must complete additional education of 2,000 hours or 1,500 hours for a dental hygien- ist who has five years of experience. New Mexico joins Minnesota, Maine, Vermont, Michigan, Arizona and Idaho in authorizing dental therapy. Editor’s Note: • The Rules will take about a year to go through hearings and writing • Accreditation will take at least a year • Education will be one to two years • The extra hours for additional education will be another year • We may see our first dental therapist in four to five years insurances will say five years. The device may need to be remade if significant crown work is done or if the patient loses any teeth dur- ing treatment. Anterior teeth can experience some soreness during treatment with an oral appliance. Periodontal health and sound occlusion must be present to consider an oral appliance. Treatment with MAD will have effects on the patients TMJ. Photos of occlusion and a full TMJ exam are highly recommended. Morning exercises and an AM aligner should be used daily. Morning repositioners are used to ensure no changes are happening to the occlusion and muscula- ture from MAD wear. Follow-up’s with the dentist are recommended at one month, two months, six months, then yearly. Additionally, with any type of treatment the patient should have follow up sleep studies to verify efficacy of PAP, orthodontics, or MAD. When it comes to treatment, there is no silver bullet. All have their limitations and side effects. It is our job, as keepers of our patient’s health, to present more importantly identify if and when there is a problem. Costs When it comes to lab costs for MAD, they can range from $200–650. Dental insurance will not pay for any sleep apnea treatment. The dentist can bill through medical insurance if the sleep physician recommends an appliance in the sleep study report and the patient is intolerant to PAP therapy. The patient will still have to pay their de- ductible and x any other possible co-pays if going through medical insurance. Saying when and how much medical insurance will pay is tough to predict. It depends. Medical insurance will pay for OSA ap- pliances in mild-moderate cases of OSA determined by the AHI. The MD can choose to refer to a specific in-network DDS/DMD. Dentists can apply to be in network with medical insurances and Medicaid. The dentist applies as a DME provider. Dentists can also bill as an out-of-network provider, but this may come with its own difficulties and caveats as well. Fully investigating how and what to bill when of- fering treatment for OSA should be done on an office-by-office basis. Overall, this is a very prevalent and serious condition that many of your patients in your practice have. And you will encounter it if you ask questions and look for it. When it comes to treatment, there is no silver bullet. All have their limitations and side effects. It is our job, as keepers of our patient’s health, to present more importantly identify if and when there is a problem. We can then, without personal bias or preference, present all of the information and treatment options to them. Together, then we can choose a direction to go in order to best treat their needs. If you can explain all of this and get your patient to accept any treatment, while fully aware of the pros and cons, to reduce or eliminate their sleep apnea then they will live a healthier, happier life and love you for it. 21