Dentists Lose Court Bid to Halt Project by Hygienists

A Sacramento judge Friday denied a bid by an association of 14,000 California dentists to halt a pilot project run by California State University, Northridge in which dental hygienists provide checkups and cleanings without supervision of a dentist.

The California Dental Assn. had filed a suit to stop the project, which is the first effort in the United States to assess the performance and economic viability of independent practices by dental hygienists, according to the Chicago-based American Dental Hygienists Assn. The suit alleged that the project poses a threat to public health.

Saying the dental association failed to offer sufficient evidence that the project would irreparably harm the public, Superior Court Judge Eugene T. Gualco refused to grant a restraining order.

But Gualco approved a second request from the dental association that the state Office of Statewide Health Planning and Development be required to show in a hearing that it followed proper rules and regulations in approving the project. The hearing is scheduled May 29 in Sacramento Superior Court.

Defendants Named

The dental association had alleged that state health officials had not adequately reviewed the program and had not held public hearings before approving it. The suit named as defendants the Trustees of California State University, the state health planning office and 15 dental hygienists who have already completed the training portion of the CSUN program.

Dental hygienists can practice without the supervision of a dentist in Colorado, but the California program is the first attempt to test hygienists’ independent performance under closely monitored conditions, said Connie Tussing, president of the 30,000-member American Dental Hygienists Assn.

The California Dental Hygienists Assn., which first conceived of the program, preferred to run a test of the idea before seeking legislation that would legalize the practice here, said Tobelle Segal, a dental hygienist who helped create the program. “Once you get the data, then when you go for the legislation, you have a stronger case,” Segal said.

In California, licensed dental hygienists can only practice under the supervision of a dentist. The project is allowed to circumvent that regulation because it was approved by the state health planning office under the Health Manpower Pilot Projects Act of 1972, which allows otherwise illegal experiments in alternative health care to proceed under carefully monitored conditions.

The project was first proposed in 1981 by the California Dental Hygienists Assn., which sought CSUN as a university partner as stipulated in the Health Manpower Pilot Act. It was approved by the state health planning office but lay dormant because of lack of funds, said Jerome Seliger, a CSUN professor of public health and director of the dental hygiene project.

Revived Last Year

The project was revived last year and reapproved by the state, Seliger said. In December, the first five hygienists who had completed the program began private practices, he said. Their work, including office care and visiting service for institutions such as nursing homes, is being monitored by dentists, public health specialists and state officials, Seliger said.

On top of the dental training they already received in pursuit of their licenses, the hygienists in the program have received several hundred hours of training in office management, he said.

The only services the hygienists offer are those they normally provided under a dentist’s supervision: cleaning, fluoridation, dental X-rays, general examinations and the like, said Segal. Problems requiring more attention are referred to a dentist, she said.

Of the five hygienists already practicing, three are running a group practice in Los Banos; one is providing dental hygiene at several nursing homes in Sacramento and another has a small private practice in San Francisco and also works in nursing homes, Segal said.

All five were named in the suit, along with Segal and nine other hygienists who completed their training but have not yet started practicing on their own.

The planned cornerstone of the project is a clinic, Dental Hygiene Associates Inc., which is scheduled to open in Reseda, said Segal, the clinic’s business manager.

She said the opening of the clinic, which will have up to eight hygienists, was delayed by the litigation. Saying that she was encouraged by the judges’ decision, Segal said the clinic should start seeing patients within two weeks.

The hygienists plan to charge rates that are competitive with those charged for the same services by dentists, she said. The program cannot undercut standard rates, she said, during its experimental phase. “We’re trying to prove that hygiene practice is feasible in the real world. “ But the clinic plans to accept Denti-Cal patients and offer free services to those who could not otherwise afford care.

New clients will be sought by canvassing churches, schools and other community organizations, she said, adding that the hygienists also hope to treat immigrants who have avoided dental care. For example, Segal said, “We’re going to reach into the Korean community here.”

Segal said the suit was filed because dentists fear losing business to clinics offering basic services such as cleaning. But, she said, the clinics may very well attract new patients to dentistry who had never seen a dentist before.

“By the California Dental Assn.’s own figures, 50% of the population never sees a dentist,” Segal said. The independent hygienists may be able to attract some of these patients, who in many cases would be referred on to dentists. “We feel we’ll be generating new business . . . among people who never saw dentists before,” Segal said.