September/October 2009

 Oral Healthcare Can’t WaitNot all of your patients speak up about their dental and oral health issues. You can. Continue reminding them that their oral healthcare can’t wait and keepthem coming to your practice. Download FREE marketing materials to raiseawareness and keep business going strong.Take action. Visit OralHealthcareCantWait.comto learn more.© 2009 Dental Trade Alliance

Legislative Updatecompiled by Rosana Rodriguez2008–2009 Emergency LAP Funds the word out that NDAA is not happy with what was taking place.Nebraska Dental Assistant Association received $3,000Submitted by: Roberta Worm CDA, FADAA After hours of discussion on the first debate and a filibuster of the second debate, LB 542 will not pass this year. During the first roundBill on Dental Assistant Duties in Nebraska Successfully of debate on LB 542, over four hours of discussion ensued regardingFilibustered this measure. The next day the Lincoln Journal Star called LB 542 theAs reported to the NDAA by the NDAA Lobbyist, July 2009: most intensely lobbied bill of the session. Given the fact that abortion rights and the decision for lethal injection for the death penalty were The NDAA has been working towards amending LB 542, a bill two big issues in the legislature this session, it is quite amazing that leg-introduced by the Nebraska Dental Association (NDA) on behalf islation for dental assisting duties garnered the heaviest lobbying!of the Nebraska Board of Dentistry (BOD). The bill gives the au-thority for the BOD to place educational requirements on the du- The day before second debate, the NDAA sent a communiquéties of dental assistants in the state of Nebraska. Currently, the only to the entire Legislature indicating our support for Senator Karp-duties for dental assistants in Nebraska that require education and isek’s motion to bracket LB 542, which would have delayed furthertesting are for Radiology and Coronal Polish. Any other duty, unless consideration of the bill until next year.specifically listed in the prohibited functions, is allowed under sometype of supervision of a licensed dentist. The NDAA has been trying to negotiate changes in the bill since its introduction in January. The NDAA met and submitted amend- The proposed bill states: ments to the sponsor of the bill and although some changes were Section 1. Section 38-1136, Reissue Revised Statutes of Nebras- made from the original bill, it was the feeling of the NDAA that notka, is amended to read: enough changes were made to satisfy the goals of the NDAA. The • 38-1136 (1) The department, with the recommendation of NDAA felt that the ensuing summer and fall would hold the pos- sibility of some changes in the board positions of the NDA and the the board, shall adopt and promulgate rules and regulations BOD that would be more beneficial than the current composition governing the performance of duties by licensed dental hy- of these two boards. gienists and dental assistants. Second round debate began on LB 542 and a motion by Sena-• (2) The department, with the recommendation of the board, tor Karpisek to delay this bill to next year was defeated on a vote ofshall adopt and promulgate rules and regulations relating to 12 Senators in favor, 27 in opposition and seven not voting. Senatorthe performance of duties by dental assistants, which may Karpisek then decided to initiate a filibuster on the advancement ofinclude basic qualifications, education, training, and compe- the bill. Given that we were in the final days of the Legislative Ses-tency assessment of dental assistants. sion and that the Legislature was to adjourn for a four–day Memo- NDAA is opposed to the word “may” in (2). This allows the BOD rial Day Weekend, and given that 14 Legislators had been excused,to pick and choose which duties need education and which do not. Senator Karpisek decided to “talk” the bill to a halt.Historically, the BOD has wanted the dentist to be the one to pro- After three hours of debate and filibuster, the sponsor of the bill,vide education for their assistants and the NDAA has been opposed Senator Campbell, filed a motion to kill her own bill, which is a par-to allowing every dentist to make these choices rather than having a liamentary procedure that is used when you have decided that youuniform regulation or law for dental assisting duties. The NDAA has have run out of time. In parliamentary parlance, the sponsor of thelobbied for the word “may” to be changed to“shall,”which would pro- bill that has a motion filed to kill can “lay the bill over” for futurevide basic education, training and testing for dental assistants. debate, which is what Senator Campbell did. The net effect of thisAccording to the Senators of the Nebraska Legislature, LB 542 has action is essentially the same as if the Legislature had adopted thebeen the heaviest lobbied bill in the Legislature this year. NDAA mem- bracket motion, which would have delayed the bill.ber letters to senators and discussions have done a good job in getting The current status of LB 542 is that it will stay on Select File50 The Dental Assistant September/October 2009

for debate next year. During this six–month reasonableness is an essential component of 2009 LAP Fund Applicationsperiod, the NDAA will need to keep trying the negotiations ahead. California: requested $3,000 the BOTto find some common ground between all approved $3,000the parties in the dental professions to come The goal of the NDAA is to utilize this Submitted by: Kristy Borquez, CDA,up with agreed upon statutory and rule and legislation to further the NDAA’s efforts to RDAEF, FADAAregulation changes. Since the bill is on Se- improve the public health and safety deliv- Lap Funds Will Continue To Be Usedlect File, it is expected that the bill will be ered through the dental professions in the For the Consultant They Pay On adebated early in the session. State of Nebraska. Although no final action Monthly Basis. has been taken on LB 542, it is hoped the The most important lesson of this year’s Legislature’s reluctance to act on this bill Now that AB2637 and SB853 haveefforts is that people have a real impact on this year will encourage the Nebraska Den- gone into effect, efforts are being devotedwhat the Legislature does. Notwithstand- tal Association and the Board of Dentistry to identifying areas that need clarificationing the political dominance that the NDA to work in good faith with the NDAA to and assuring a smooth implementation andenjoys, the other dental professions had benefit all Nebraskans. transition. It is unknown at this time wheth-significant sway in the outcome. Persistence er there will be any additional legislation inby the NDAA’s leaders—Roberta Worm, Negotiation between the NDAA, NDA 2009 that will require monitoring or action.Cindy Cronick and Crystal Stuhr—to press and the NDHA is expected to take placetheir concerns had an impact. An alliance during the interim months until the Leg- Several areas surrounding educationalwith the hygienists on the bracket motion islature reconvenes in January. During this programs are being addressed, but it doesshould give a new resolve towards both or- time, it is hoped that all parties can come to- not appear that there will need to be any sig-ganizations defining what they want, so they gether and amend the bill so that the health nificant changes that will need to be madecan work in a unified manner with the Leg- and safety of Nebraska citizens is ensured by to the new laws governing RDA applicantsislature and the BOD during the months having dental assistants receive a baseline of and licensees.ahead. The NDAA’s ongoing posture of education before they are allowed to prac- tice direct patient care. One recent clarification of interest to ➤ 512009 September/October The Dental Assistant

RDAs is that existing RDAs do not have to January 2007 or 2008 due to the loss of the Hygienists’ Association proposes an “oralbe certified in pit and fissure sealants, unless key author and new legislators not willing health practitioner” with the authority tothey wish to perform that duty. Only RDAs to discuss anything controversial. Our origi- perform surgical and restorative procedureswho first become licensed on and after Jan- nal author was unable to author this year without a dentist being on–site to provideuary 1, 2010, must provide proof of having because of committee chairing duties—we supervision. While the MDA is pleased thatcompleted a board–approved course in this still have his support. We reintroduced our the MDA and School of Dentistry proposalduty in order to be licensed. However, RDA Bill in March 2009 with the Board of Den- was met with little resistance and was en-educational program faculty must be certi- tistry’s backing. There are five authors to thusiastically supported, they are also frus-fied in this duty no later than July 1, 2009. this Bill, SF 1911—now SF12 17. There trated that the legislature appears to be will- is no author in the House, but one lined up ing to pass both bills and is not inclined to With regard to the RDA practical exam, if needed; House Bill is HF 2377. Go to pick one over the other.the Dental Assisting Alliance has advocated https://www.revisor.leg.state.mn.us/revi-to COMDA that the two currently tested sor/pages/search_status/status_detail.ph The MDA experienced one setback afterprocedures be retained after 2009, with p?b=Senate&f=SF1217&ssn=0&y=2009 the Minnesota House Licensing Subcom-changes to the material used for the direct for more information. mittee rolled the OHP and dental therapistprovisional restoration (currently referred bills into an omnibus licensing bill knownto as a temporary sedative dressing). It is an- Testimony was heard on March 27, as HF 535 for consideration before the fullticipated that COMDA and the Board will 2009, in the Senate Health, Housing and House Health and Human Services Policymake a decision later this year. Family Security Committee. Bill passed and and Oversight Committee. On March 25 forwarded to the Senate Finance committee an amendment to strip the scope of practice COMDA and the Board may need RDAs because of the $15 increase in fee for initial and supervision of the OHP and replace ittoprovideinputforthevariouswrittenteststhat licensure. In a nutshell, DANB certifica- with the dental therapist language failed tomust be developed, including the Orthodontic tion would be required for initial licensure; gain a majority of the full committee. TheAssistant and Dental Sedation Assistant. If you grandfathering of the 7000–plus current next step is for HF 535 to be heard by themight be interested, email me at kdancer@ RDAs would occur. Currently one–third of full chamber at a date yet to be determined.earthlink.net and I will contact you when the RDAs in Minnesota hold certification.more information becomes available. On March 26 the Senate Finance Com- OHP/Dental Therapist: MDAA was mittee passed SF 1106, the bill that includes As a reminder, COMDA ceased to exist on present at all meetings although not invited both the OHP and dental therapist lan-July 1 of this year, and its functions were inte- to participate in the task force by legislator guage. The dental therapist bill is attachedgrated into the Dental Board. At the same time, in charge. MDAA is on record for support- to language that the MDA does not support,a new Dental Hygiene Committee was created. ing the Dental Therapist Bill which is what however, they were able to preserve the lan- the University of Minnesota Dental School guage that they support and move it forward. The Dental Assisting Alliance will be and MDA proposed. Debate over language Instead of going to the Senate floor directly,making recommendations to the Dental defining what has come to be known as a SF 1106 has been referred back to the rulesBoard concerning the most appropriate way “midlevel” dental provider in Minnesota committee until Senate leaders determinefor dental assisting issues to be appropriate- has continued in separate committees of the the bill's next action. MDA officials knew thely addressed, and will also be asking that the state’s Senate and House of Representatives. deck was stacked against them when theyBoard develop some mechanism by which The Minnesota Dental Association and Uni- went into legislative hearings in early March.to assure the dental assisting community versity of Minnesota School of Dentistry are Supporters of the OHP bill brought spokes-that fees paid by dental assistants are spent supporting a bill that would provide funding persons from Alaska and Canada and con-solely on dental assisting activities. for a program at the School of Dentistry to tended that [the OHP proposal] would not educate a new member of the dental team, cost MNSCU any money and that it was not Formoreinformation,seetheDentalBoard the dental therapist, at the dental school, necessary for a dentist to be supervising withof California’swebsite:www.dbc.ca.gov. with the dental therapist’s position being an anything more than a written agreement. integrated member of the dental team whoMinnesota: requested $3,000 the BOT would practice with a dentist’s supervision. The written agreement is referenced inapproved $3,000 the OHP legislation as the “collaborativeSubmitted by:Natalie Kaweckyj,CDA,RD- However, a competing bill advanced by management agreement.” An OHP couldARF, CDPMA, COA, COMSA, MADAA the Minnesota State Colleges and Universi- not work without one in place with a collabo-MDAA has many things going on in- ties system (community colleges and public rating dentist. The dentist would have the au-volving legislation universities not affiliated with the Univer- thority to authorize a scope of practice for the sity of Minnesota), the Hennepin County OHP (within the stated scope of the law), Licensure: MN has been pursuing licen- Safety Net Coalition and Minnesota Dental determine when consultation is required andsure for the past decade. The Bill was resub-mitted in January 2006 but never heard incommittee. The Bill was not resubmitted in52 The Dental Assistant September/October 2009

other parameters. However, it does not re- of the BOD has changed significantly since • Minor education:quire any specific periodicity of case reviews, 2003, and support for MDAA has weakened MEDA, MDHA, MDAA, PCreferrals or related activities, so its application and it’s endeavors. MDAA is represented atin day–to–day practice is an open question. every BOD committee meeting and full • Undecided: Board meeting. Some months, those meet- MDHEA The dental association finds fault with ings exceed 10 meetings.the OHP in two areas: First, the educational 5. Preliminary pulp vitality testing (re-element—the University of Minnesota Currently, the MDAA legislative com- cord findings for dentist to evaluateSchool of Dentistry is the only institution in mittee and the MDAA expanded functions and diagnose with all modalities)—the entire state accredited to teach surgical committee have merged and have been pur- Indirect supervision.dental procedures, as allowing this position suing in earnest to get additional expanded • Minor education:to be trained at any other school in Minne- functions approved for RDAs in MN. The MEDA,MDHA,MDA,MDAA,sota does a disservice to the worker's educa- following are the scaled down functions MDHEA, PCtion and to the rural and low–income popu- (from the list of 25) that were brought for-lations they will eventually serve; second, ward for further consideration at the BOD 6. Move coronal polishing from Indirectthe OHP plan is unrealistic in its require- Allied Education committee meeting, No- to General supervision.ments for supervision, specifically, it allows vember 1, 2006: (minor education = can • No additional education:the mid–level dental worker to perform be trained in office, added to curriculum; MEDA, MDHA, MDA,irreversible, surgical procedures without a major education = additional coursework). MDAA, PCdentist anywhere in the building. These will be brought forth again, regardless of licensure bill outcome in the next year. 7. Move application of topical agents This plan simply does not recognize the from Indirect to General supervision.realities and uncertainties in dental care 1. Placement of bases (glass ionomer) • No additional education:delivery. For example, a tooth extraction for RDA’s not pursuing the Restor- MEDA, MDHA, MDA, MDAA,may look straightforward at first glance but ative Functions course—Direct Su- MDHEA, PCcould become much more critical once the pervision. (MDA survey said 67%surgery begins and complications are dis- would not delegate this.) 8. Move placement of sealant from Indi-covered beneath the gum’s surface. This new • Major education: rect to General supervision.worker will only have a few years of training MDHA, MDA, PC • N o additional education:and is not equipped to handle the multitude • Minor education: MEDA, MDHA, MDA, MDAA,of problems that could arise. When a mid- MEDA, MDAA MDHEA, PClevel worker performs any surgical proce- • Undecided:dures, a dentist must be on-site to help out MDHEA 9. Administration of local anesthesia-or take over the procedure if the patient's Direct supervision.circumstances warrant it. Should both pro- 2. Placement of gingival retraction • No support:posals pass, the registered dental assistant’s cord— Direct supervision. MDA, MDHEA, PCfuture delegated duties could be impacted. • N o support: • Major education: MDHA, MDA, MDHEA, PC MEDA, MDAA Oral Surgery Assistants: There is pro- • Major education: • Abstain:posed expansion of surgery assistant du- MDAA MDHAties by the Minnesota Society of Oral • Undecided: (There has been open discussion with theMaxillofacial Surgeons (MSOMS). Many MEDA dental association on this one recently).of their assistants are not DANB–certified.Increased duties would include adminis- 3. Taking final bite registration for par- The MDAA previously proposed thetration of IVs, administering medications, tials, full dentures, crowns, bridges, in- administration of nitrous oxide analgesiaand removal of IV apparatus, to name a lays, and onlays—Direct supervision. in 1998 and it became a delegated duty infew. This has temporarily been put on the • No support: 2003. The Minnesota State Legislature alsoback burner at the BOD because of the MDA, MDHEA, PC mandated restorative functions as a way toOHP/Dental Therapist issue. • Major education: alleviate access to care issues in 2003 and in MEDA, MDHA, MDAA 2005, the first restorative assistants and hy- MDAA submitted a list of proposed gienists began to utilize the function. MDAAexpanded functions that was originally 4. Fit trial endodontic filling points— has since had to defend restorative func-drafted in 2003 for a licensure summit and Direct supervision. tions as an expanded duty, with the threat ofonly heard in the policy committee this year • N o support: a moratorium being placed on any addition-at the Board of Dentistry. The composition MDA al certificants of the restorative functions (Continued on page 55) 532009 September/October The Dental Assistant

Hearing Impairment tive Communication. Cultural DifferencesContinued from page 45 11. Availableat: http://adaptiveenvironments. Continued from page 39 org/neada/pubdocs/pub_352_t3fact2.pdf.patient should leave the visit with written in- Accessed: May 2009. Recommended Readingstructions to reinforce the information you 12. U.S. Department of Justice. Americans withhave provided.2,5 Disabilities Act. Good Neighbors—Communicating With the Mexicans, 13. Available at: http://www.ada.gov/t3hilght. by John C. Condon, 1985. Published by Intercul-Conclusion htm. Accessed: May 2009. tural Press, Inc. The patient with a hearing impair- Janet Jaccarino, CDA, RDH, MA, is an Kiss, Bow, or Shake Hands, by Terri Morrison, Waynement may offer even greater challenges for Assistant Professor in the Department of Al- A. Conaway, and George A. Borden, PhD., 1995.care than the patient who is blind. With lied Dental Education in the School of Healthknowledge, patience, understanding and a Related Professions at the University of Medi- Management in Two Cultures—Bridging the gap be-little imagination, your office can provide cine and Dentistry of New Jersey. She has been tween US and Mexico, Eva Kras, 1996–2006 Inter-a stress–free, pleasant dental experience teaching dental hygiene and dental assisting cultural Press, Incfor everyone involved. The next article will students since 2000 and can be reached at jac-help your office treat the patient with a de- [email protected]. Cultural Diversity: Eating in America—Mexican–American,velopmental disability. Ohioline.osu.edu/hyg-Fact/5000/5255.html. ❖ www.mexconnect.com/mex_/culxcomp.html . The Office—Procedures and Technology, Mary EllenReferences Oliverio, William R. Pasewark, Bonnie R. White, 5th ed, Thomson, 2006.1. Dougal, A., Fiske, J. Access to special care Networking Betty Ladley Finkbeiner, CDA-Emeritus,dentistry, part 2. Communication. Br Dent J. Continued from page 15 BS, MS, began her career as an on–the–job2008; 205: 11-21. trained dental assistant for the late Joseph S.2. Wentworth, L.E., Rowe, D., Persons with working is the prime source of career infor- Ellis, DDS in Grand Rapids, Mich., and laterNeurologic and Sensory Disabilities. In: Darby mation and job leads, and your professional became a CDA. She served on the original Tri-and Walsh. Dental Hygiene Theory and Practice. association provides a tremendous oppor- partite Committee to change the legislation to2nd ed. St. Louis, Mo: Saunders; 2003: 800-4. tunity for networking. include the dental assistant in the state law and3. DECOD Program (Dental Education in As the saying goes, “membership has its later was appointed to a four year term on theCare of the Disabled). Module IX. Dental Man- privileges.” Board of Dentistry from 2000–2004. She wasagement of patients with CNS and neurologic ❖ President of the Grand Rapids Dental Assistantimpairment. (a series of 12 booklets). 2nd ed. Se- Society, served on the MDAA Board, served onattle: DECOD, School of Dentistry, University of Natalie Kaweckyj, CDA, RDARF, two MDA Task Forces, was a consultant toWashington; 1998. CDPMA, COA, COMSA, MADAA, cur- the Dental Assistant National Board Practice4. U.S. Department of Justice. Americans with rently serves as Vice President of ADAA and Management Test Construction Committee,Disabilities Act. has served as Secretary of ADAA in 2002, and was a consultant to the ADA Commission5. Availableat:http://www.ada.gov/t3hilght.htm. Seventh District Trustee in 2003 and 2006, on Dental Accreditation for ten years. She re-Accessed: May 2009. and is a past director of the ADAA Foundation. ceived Bachelors and Masters degrees from the6. Wilkins, E.M. The patient with a sensory She is the author of several ADAA continuing School of Education at the University of Michi-disability. In: Clinical Practice of the Dental Hy- education courses. Ms. Kaweckyj holda a B.A. gan. Betty has authored numerous articles ingienist. 10th ed. Philadelphia, Pa: Lippincott in biology from Metro State University and is state and national dental journals and over tenWilliams & Wilkins; 2009: 870-98. president of the Minnesota Educators of Dental dental assistant textbooks, and created the first7. Hear–It.org. MP3 users risk hearing dam- Assistants. She is currently pursuing her mas- online program for on–the–job trained dentalage. Available at: http://www.hear-it.org/page. ter’s degree in public health and is active in local, assistants in the State of Michigan. A Profes-dsp?page=3680. Accessed July 1, 2009. state and national dental assisting associations. sor Emeritus from Washtenaw Community8. Wallhagen, M.I., Strawbridge, W.J., Shema, College, Betty now resides in Fort Myers, Fla.,S.J., Kurata, J., Kaplan, G.A. Comparative impact with her husband and two senior cats. Bettyof hearing and vision impairment on subsequent continues to write for professional journals,functioning. JAGS. 2001; 49: 1086-92. provide consulting to dental offices, and write9. Chavez, E.M., Ship, J.A. Sensory and Motor textbooks. She is now completing her dream ofDeficits in the Elderly: impact on oral health. J writing children’s books about cats who takePublic Health Dent. 2000; 60 (4): 297-303. adventurous journeys.10. U.S. Department of Justice. Americans withDisabilities Act. Fact Sheet 2. Providing Effec-54 The Dental Assistant September/October 2009

Legislative Update to the 14,000–plus dental professionals in Currently there is an amendment toContinued from page 55 Minnesota requesting feedback on access the Iowa Code Section 147.14(4) which eliminates certain restrictions on personscourse or any additional expanded duties. to care issues and what duties they would who would be eligible to serve on the IowaThe composition of the board of dentistry like to see each auxiliary be able to perform. Dental Board, namely adjunct faculty mem-has changed greatly over the last four years Postage alone will be over $5,000. MDAA bers. With the advice and help of the lob-and the older dentists are opposed to the is planning on polling the dental assisting byist, Immediate Past president Jeannene‘girls’ doing any direct patient care. MDAA profession only, which would cut costs in Veenstra has approached the IDB to form ahas supplied supporting documentation on half. MDAA is looking at various avenues committee with at least one dental assistanthow competent and qualified dental assis- to do this. So far lobbying cost have been on it to research representation of dental as-tants can aid the dental profession. absorbed by various associations we have sistants on the IDB. The board has allowed worked with. Mileage alone eats most of the a committee to be formed and two dental New on the horizon is the collaborative funding received. assistants will serve on this committee.practice agreement for hygienists and nowthere is discussion on incorporating assist- The IDB has chosen Veenstra and Janeing duties for qualified assistants. This topic Iowa: Requested $3,000 the BOT ap- Slach, CDA, RDA, BA, EFDA. The use ofis agreeable with all organizations. proved $1,200 LAP Funds will help IDAA with the lobby- Submitted by: Jeannene Veenstra ist should they need to go to the legislature MDAA recently had to defend the concerning the addition of dental assistantstopic of exposing radiographs and dental Iowa has retained a lobbyist since 2007 to the Iowa Dental Board.assistants—language was submitted that and has had their budget reduced by a sig-omitted the RDA by a non–dental organi- nificant amount of income due to the Iowa ❖zation and a lot of last minute educating and Dental Association (IDA) taking away anlobbying was needed. The dental associa- estimated Continuing Education incometion keeps requesting that a survey be sent from annual conference of $39,000.ADC_ADAA_2009:Layout 1 8/7/09 12:19 PM Page 1 Vinyl Polysiloxane (VPS) Lead Free X-Ray Apron Super Hydrophilic formulation offers excellent Environmentally friendly lead-free dimensional stability and tear strength for crisply aprons, lighter weight and more flexible detailed impressions every time. No odor and than conventional aprons, with the same no irritation provide greater patient comfort. protective qualities. Aprons are backed with a tear resistant cling back, with NEW! 0.25mm lead equivalency protection.Rigid Bite Registration #10 Universal Ultrasonic #100 ThinStyle Scaling InsertsMousse-like vinyl polysiloxane derivative #1000 3-Bendmaterial in a high performance cartridge Quality resin handle inserts,dispensing system. Firmer setting material with finely crafted in Israel.excellent tear strength. A Shore-A hardness of Internal water channel.90+ ensures precise, stable bite registrations. Compatible with all stack-type (magnetostrictive) units. Quala Dental Products are sold exclusively through members of the American Dental Cooperative.To place an order, contact your local Quala Distributor, or call 1-800-929-4ADC for an authorized dealer near you. 552009 September/October The Dental Assistant

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