Dentists Fail to Halt Plan for Hygienists to Practice on Own

California’s dental hygienists have won an important legal skirmish in their effort to practice without supervision by dentists.

A Sacramento Superior Court judge has rejected a petition by the 14,000-member California Dental Assn. to halt a pilot project--the first of its kind in the nation--in which 15 hygienists are practicing on their own, eight in the San Fernando Valley.

A leader of California’s hygienists said Monday that the ruling paves the way for “legislation in two or three years that will allow for widespread unsupervised practice by hygienists, which is the way of the future.”

Kathleen Alvarez, president of the 5,000-member California Dental Hygienists Assn., also predicted that independent practice would lower the cost of dental care and would bring into the field hygienists willing to make house calls and to visit patients in nursing homes and other facilities where patients get inadequate dental care.

But California Dental Assn. spokesman Bob Ingle said that, despite the ruling late Friday by Judge Rothwell B. Mason, the association will “continue to oppose a situation that we see as possibly leading to patient abuse.”

Dentists receive “about four times as much education as hygienists do, and are much better equipped to handle a patient’s important problems,” he said. “For instance, a lot of oral cancer is diagnosed by dentists.”

Ingle said that no decision has been made whether to appeal the judge’s ruling. The dental group was seeking an injunction against the pilot program sponsored by California State University, Northridge and sanctioned by the state’s Office of Statewide Health Planning and Development.

Hygienists are trained to clean teeth, take X-rays and administer fluoride treatments. Under state law, however, they cannot fill cavities, administer anesthetics or diagnose dental problems.

Except for the 15 hygienists working in the Cal State project, all California hygienists are required to work under the supervision of a dentist.

Colorado is the only state in which hygienists are permitted to practice on their own, but it has no program to evaluate their work. Since unsupervised practice was legalized there in 1986, the state’s dentists have launched a legal effort to thwart the handful of hygienists who have set out on their own.

Alvarez said that legal challenges by the dental associations in California and Colorado to independent practice are “largely sexist and economic in origin.”

Dentists, who are usually male, “have always been in control of their hygienists, who are usually female,” she said, “and they don’t like to lose that control.”

The hygienists participating in the California pilot project are working in a variety of settings around the state.

Seven are in a group practice in Reseda, and three others operate a group practice in Los Banos, about 35 miles from Merced. Two in La Canada Flintridge and one each in Sacramento and San Francisco provide care at nursing homes, in office buildings or to home-bound patients. And one rents a room in a Van Nuys dental clinic.

In an effort to test whether they can generate business and perform quality work, the American Assn. of Dental Hygienists is subsidizing the practices.

Peggy Labrenz, one of the Reseda group practitioners, said Monday that it “remains to be seen if a group practice can make a go of it.”

Her group, which began in March, has grown from three patients a week to 15 to 20 weekly, she said, with most of them seeking $30 cleanings. The hygienists, most of whom work part time at the clinic, share equipment and office costs.

Most patients hear about the service from talks the hygienists give at nursing homes and senior citizen centers, Labrenz said.

Many of the hygienists’ patients are referred to dentists for additional care, she said.

“I think we generate a lot of business for dentists, maybe more than enough to cover what they lose by not having us as part of their practice,” Labrenz said.

Participating hygienist Nancy Chesler said after six months of solo practice in Van Nuys, she is “convinced more than ever there are many, many people out there, especially in nursing homes, who need dental care but don’t get it.”