Hygienists Want Voters To Pick I-678 Initiative Would Change Law On Teeth Cleaning

The dental hygienist initiative may draw yawns from voters compared with drug and gun measures on the same statewide ballot.

But Initiative 678 is drilling holes in the relationship between hygienists and dentists. After 18 years of unsuccessfully pushing their cause in the state Legislature, hygienists are taking it to the voters.

They want to be able to do their jobs - cleaning teeth - without a supervising dentist.

“It’s a fairness issue,” said Peggy Ellingson, a Spokane hygienist and a faculty member in the hygiene program at Eastern Washington University. “It’s reasonable. It’s about allowing people to be entrepreneurs, to have their day.

“It’s a care issue. We want to be able to see the people who aren’t being cared for.”

Opponents of the initiative, including the brawny dental lobby, say hygienists do fine work under dentists’ supervision. But they worry that the initiative could hurt dental patients and raise costs.

Sue Weishaar is a dental hygienist. She also returned to school to become a dentist, and she says hygienists should not be allowed to clean teeth without a dentist’s supervision.

“I’ve experienced it both ways,” said Weishaar, now a Valley dentist. As a hygienist, “I really felt I was prepared to take on the world. But I really was not.”

Dental hygienists are required to have three years of college education, compared with the six to eight years of education required for a dentist. Hygienists clean and scrape teeth. Dentists are responsible for diagnosing problems, treating them and restoring teeth.

Hygienists say the proposal will increase dental choice. They say they can provide good dental care to more people, potentially at a lower cost than dentists.

Initiative supporters say hygienists can reach the half of Washington state residents who don’t receive dental care, such as people without insurance and the elderly. People who fear the dentist’s office will be more likely to turn to a hygienist for cleaning than to a dentist with drills and needles, hygienists say.

Opponents complain that the initiative would allow hygienists to inject local anesthesia, surgically remove infected gum tissue and administer drugs - all without a dentist’s supervision.

Opponents also worry that dental hygienists would be expected to recognize serious medical problems normally identified by a dentist.

“They want the whole ball of wax,” said Mary Krempasky Smith, a Spokane dentist. “I just don’t think that’s in the best interest of the public. I just think that’s a risk the public shouldn’t be asked to take on right now.”

About 3,100 dental hygienists practice in the state.

Washington hygienists have been allowed to clean teeth without supervision in nursing homes, hospitals, home health agencies, group homes, schools and government institutions and public health facilities since 1984.

“I have not a clue as to why it’s OK for us to see patients who are critically ill, but not patients who are well,” said Ellingson, also secretary for the Washington State Dental Hygienists Association. “I can only speculate that it’s an economic issue.”

Opponents say it’s still a safety issue. With critically ill patients, such as those in nursing homes, the hygienists are supervised by doctors and nurses, dentists say.

Critics also say the cost and hassle of dental care could increase if people make a visit first to a hygienist for cleaning and then to a dentist for diagnosis and treatment.

But in California and Colorado, where hygienists have been able to practice without a dentist’s supervision for years, few hygienists have struck out on their own.

Judy Boothby, a dental hygienist in California, has practiced solo since a pilot project launched in 1987. She said hygienists with ambition should be allowed to branch off from dentists.

She’s cleaned the teeth of a 100-year-old man who hadn’t seen a dentist in 65 years. She’s cared for a roomful of infants with shaken-baby syndrome, for people with Alzheimer’s. She’s spotted precancerous lesions and referred patients to dentists and doctors.

“I had no idea this population existed,” Boothby said. “They’re just not in the dental loop. They’re hard to work on. You can’t be driven by time or money or insurance.”

A University of Washington economist asked to study the initiative’s effects said quality of care is the strongest argument favoring solo dental hygienists.

Glenn Pascall said the dental hygienist proposal makes sense for consumers.

“There are no real arguments against this,” Pascall said. Opponents’ “real issue is focused on quality of care. If I had found major concerns about hygienists, that they were not adequately trained, that would have raised a huge concern. But their record is amazingly impeccable.”

Dentists say hygienists do great work, but only if supervised. They say hygienists’ malpractice insurance is so low because dentists absorb the insurance brunt.

“Right now the person who ends up with the lawsuit is the dentist, not the dental hygienist,” Krempasky Smith said.

The money line on this issue is drawn between employees and employers.

Hygienists, including at least 19 from Spokane, gave about 43 percent of the $368,797 fueling the initiative. These donations averaged $250 apiece.

The American Dental Hygienists Association tossed in $35,489. The Washington State Dental Hygienists Association donated $25,000. One Washington dental hygienist loaned the campaign $25,000 and donated another $25,000.

As of Friday, dentists who opposed the initiative had raised almost half as much as hygienists.

Dentists, including at least 23 from Spokane, gave about 72 percent of the $172,216 collected so far to fight the initiative. Each dentist donated an average of $310.

Dental associations from California and Oregon kicked in $10,000 apiece. The Tennessee and Colorado dental associations each donated $5,000. Florida’s dental association put in $6,301, Washington’s donated $4,695.78, and New Jersey’s dental association donated $2,500.

Some people crossed the typical boundaries. Several dentists have openly supported the initiatives.

And two dental hygienists donated money to the anti-initiative campaign. Julie Zanner, a Puyallup dental hygienist who gave $1,000, worried that independent hygienists would open up a Pandora’s box to managed care.

She said hygienists who want more responsibility should go back to school.

“Bottom line, this initiative is about power and control,” said Zanner, who is married to a retired dentist. “It’s about hygienists who want to be gatekeepers to the dental industry without paying their dues.”

, DataTimes MEMO: For a summary and the full text of Initiative 678, log on to The Spokesman-Review’s Web site, Virtually Northwest, at www.virtuallynw.com, and click on “Election Central.”

This sidebar appeared with the story: INITIATIVE 678 WOULD: Allow dental hygienists with five years experience under a dentist’s supervision to clean and scrape teeth and administer some anesthetics without supervision. Create a new regulatory board that would track the performance of hygienists.