CDA opposes hygiene legislation

New legislation sponsored by the California Dental Hygienists’ Association (CDHA) would make a number of changes pertaining to registered dental hygienists in alternative practice (RDHAPs).

Among the proposed changes in AB 502, authored by Assemblyman Ed Chau (D-Monterey Park), is eliminating the current requirement for RDHAPs to obtain a dentist’s prescription in order to continue providing services to patients after 18 months. The RDHAP license was created through legislation in 1998 and allows RDHAPs to deliver hygiene services in alternative settings, such as schools, skilled nursing facilities and other institutions for patients who face difficulties in accessing care in a traditional dental office.

The prescription requirement that AB 502 seeks to eliminate supports patients in seeking critical services from a dentist that a hygienist cannot provide. The goal of this requirement is for RDHAPs to provide hygiene services prior to a full examination and treatment plan by a dentist. Removing the prescription requirement could mean hygiene services continue without ever putting such a treatment plan in place.  Furthermore, without treatment from  a dentist, RDHAPs can find themselves being party to supervised neglect – a situation where additional care is needed, yet the hygienist can only provide a portion of that care, leading to deterioration of a patient’s oral health.

CDHA proposed this change last year as well, during the legislative sunset review process for the Dental Hygiene Committee of California. CDA strongly opposed the proposal and it ultimately did not move forward.

“CDA’s concern with this legislation is that the current prescription requirement helps patients get the full range of dental care they need and it also protects RDHAPs from a supervised neglect situation,” said CDA President Walt Weber, DDS. “We should not be weakening the connections between dental team members, particularly as the Virtual Dental Home program model was just made permanent last year and provides a significant opportunity to involve a dentist in these situations.”

The Virtual Dental Home model was enacted as a permanent program through AB 1174 last year, a bill CDA supported, and allows hygienists in certain community settings to provide basic care for patients under the diagnosis and direction of a dentist using telehealth technology, expanding access to care for underserved populations.

RDHAPs are also currently allowed to establish practices in communities that have been designated as dental health professional shortage areas (DHPSA). AB 502 also proposes allowing RDHAPs to continue practicing in a DHPSA even if the area’s designation changes.         

Given that the primary reason for the development of the RDHAP classification is to bring dental hygiene services to underserved communities, CDA will be working closely with the Legislature and stakeholders on ways to maintain access for patients in these areas while urging very careful consideration of how RDHAPs continue independent practices.

CDHA had previously announced that it would sponsor additional legislation this year to make a number of other changes such as reducing the supervision requirements for certain hygiene duties and removing the DHCC from the Dental Board’s jurisdiction. However, no bill with these provisions has been introduced.