The Mississippi Dental Hygienists’ Association works to promote access to oral health across Mississippi in the best way to meet the needs of patients and providers. To this extent, the following represents the policy and government work sought by the association.
Mississippi is the only* state in the nation with graduates from accredited dental hygiene programs who work under direct supervision of dentists after graduation.
The MDHA endorses the position that general supervision of RDHs should be the rule of law rather than direct supervision. As the Mississippi statute 73-9-5 currently states, a dental hygienist must work under direct supervision of a dentist, which means that the dentist must be physically present in the facility in order for a dental hygienist to provide preventive care. Board Regulation 13 further defining direct supervision written by the Mississippi Board of Dental Examiners (MSBDE) states that a dentist must:
- Be physically present in the dental office or treatment facility,
- Personally diagnose the condition to be treated,
- Authorize the procedures to be performed,
- Remain in the dental office or treatment facility while the procedures are being performed by the auxiliary, and
- Evaluate the performance of the dental auxiliary.
General supervision of RDHs specifies that a supervising dentist authorizes his or her licensed dental hygienist to perform preventive procedures, but is not required to be physically present. But general supervision requirements wouldn’t stop there. Additional stipulations must be met in order for RDHs to work without the physical presence of a dentist, including requiring:
- That the RDH has a year (or 1,600 hours) of patient treatment experience
- Current CPR Certification
- Adhering to medical emergency written protocols established by the dentist
- That the dentist has diagnosed and examined the patient within 11 months prior to the appointment
- That patients are notified in advance that the dentist will not be on site, and the dental hygienist cannot diagnose any dental conditions,
- That the RDH cannot practice dental hygiene for more than a set number of consecutive days; and
- That RDHs provide proof of liability insurance to the MSBDE.
There are many reasons the MDHA supports a change from direct to general supervision, including:
1. Dental hygienists earn college degrees (Associate’s or Bachelor’s) from an institute of higher learning accredited by the American Dental Association’s Council on Dental Accreditation. In fact, each Mississippi RDH graduating from an accredited institution must be successful in the exact same educational standards as the RDHs licensed in states practicing general supervision.2. Competency standards are rigorous for dental hygienists. For initial licensure in Mississippi, an RDH must successfully pass:
a. The National Dental Hygiene Board Exam
b. A regional clinical board exam,
c. A computerized case-based regional exam,
d. A jurisprudence exam, and
e. Apply for licensure regulated and overseen by the MSBDE.
3. Procedures that MDHA advocates for implementation under general supervision are proven to be safe and effective by the RDHs practicing in states that have utilized general supervision for decades;
4. A total of 96% of the United States (48 out of 50 states) allow dental hygienists to work under general supervision;
5. Surveys administered across a 3 year span revealed an average of 90% of responding RDHs in Mississippi are in support of general supervision;
6. Internal polls show that RDHs working in border towns of Mississippi seek employment across state lines to work in less restrictive states such as Tennessee and Louisiana; and
7. Anonymous surveys revealed that RDHs have worked under general supervision principles in Mississippi.
General supervision of RDHs is a proven long-standing practice in virtually every state. Educational requirements for Mississippi RDHs are identical for RDHs in states practicing under general supervision. It’s also of note that dentists opposed to allowing an RDH to provide preventive care under general supervision would never be forced to do so.
Finally, to alleviate thoughts that general supervision is synonymous with independent practice, the Mississippi Dental Hygienists’ Association asserts:
• Independent practice is not the same as general supervision,
• Independent practice requires no supervision and direction from others (Mosby’s Medical Dictionary) while general supervision requires multiple levels of supervision
• MDHA is not advocating for ANY type of independent practice, and
• MDHA is not advocating for ANY type of mid-level provider.
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*although Alabama has 2 accredited dental hygiene programs, dental hygienists are not statutorily required to graduate in order to practice dental hygiene.