The Minnesota Model: Advanced Dental Hygiene Practice Timeline

The timeline that follows marks both legislative and relational milestones reached, demonstrating Minnesota's commitment to advancing oral health professional practice, development of collaborative partnerships, and increasing access points for oral health care delivery.  

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How the "Minnesota Model" began...

Beginning in the late 1990s, committed oral health stakeholders began the journey to create innovative models for delivery of oral health care to underserved and underinsured Minnesotans.  Limited Authorization for Dental Hygienists (2001) was created and allowed dental hygienists to practice in alternative settings under a collaborative agreement with a dentist who is not on site.

More than just Cleaning Ladies

Innovative thinkers moved discussion from licensed dental hygienists working in non-traditional dental settings (2001) to the vision of an Advanced Dental Hygiene Practitioner (American Dental Hygienists Association), who could provide some restorative and surgical services in addition to the dental hygiene scope of practice. The path to create this practitioner through the legislative process in Minnesota took twists and turns. In 2009 proponents of this oral health provider achieved a compromise resulting in both the dental therapist and the country's first dental hygiene-based mid-level practitioner known as an advanced dental therapist (ADT).

Years later (2017) the "Limited Authorization" statute for dental hygienists was re-named Collaborative Practice Authorization for Dental Hygienists in Community Settings. Changes to the statute were made to more clearly describe advanced practice for dental hygienists and the opportunity for expansion of oral health care services to traditionally underserved populations by dental hygienists. Additionally, the Minnesota legislature authorized licensed dental assistants to provide part of their scope of practice alongside a collaborative practice dental hygienist in community settings.  Minnesota is also recognizing the benefit of non-dental providers such as Community Health Workers/Navigators as an asset to oral health care delivery and as emerging, integral members of the "21st Century Dental Team."

 


1999 - 2000

Dental hygienist demonstration projects
[Laws of Minnesota, 1999, Chapter 245, Article 4, Section 118]. Effective July 1, 1999, the Legislature authorized the Department of Human Services (DHS) to allow projects that extend access to the services of dental hygienists by providing services outside traditional dental offices, without the patient first having to be seen by a dentist. The services still must be authorized by a licensed dentist. These projects are permitted to serve patients who have "limited access" to dental care. Limited access is defined as unable to receive regular dental services in a dental office due to age, disability or geographic location.

This legislation allowed for the funding of several demonstration projects utilizing dental hygienists in creative ways and laid the groundwork for today's collaborative practice authorization in community settings. Historical version 1999, Chapter 245, Article 4, Section 118.  The results of this directive were to be reported back to the legislature in 2001.

MN Department of Human Services (DHS) convened a Dental Access Advisory Committee (DAAC) to discuss MN Medicaid dental innovations and infrastructure developments.


2001      

To respond to the charge of the 1999 statute, the DAAC workgroup discussed MN Medicaid dental innovations and infrastructure developments.  Among the strategies identified by this group were expanding the dental workforce by increasing the number of providers who treat Minnesota Health Care Program (MHCP) beneficiaries and deploying allied providers in nontraditional ways.

Click here for the full DHS report of 1/15/01-  Dental Access for Minnesota Health Care Programs Beneficiaries: Report to the 2001 Minnesota Legislature.   

This DHS Report to the Legislature brought about Minnesota Statute 150A.10 Subd. 1a, Limited Authorization for Dental Hygienists, i.e. collaborative dental hygiene practice (CDHP).  Original historical 2001 version of the limited authorization/collaborative practice law. 


2002 - 2003

In February 2003 the Department of Human Services released this report as required by Minnesota Statute 2002, Section 256B.55.  At that time the Dental Access Advisory Committee (DAAC) recognized the underutilization of collaborative agreements since the enabling legislation in 2001 and attributed it to the limitation of services allowed.  The DAAC recommended that sealants be allowed to be placed without the dentist seeing the patient first and for services to be expanded to school-based sites.

Executive Summary Update: Dental Access for Minnesota Health Care Programs Beneficiaries, February 2003.  

Prior to the release of this document, the Minnesota Dental Association hosted a seminar on January 31, 2003 to discuss whether access to care would increase if dental sealants were placed by dental hygienists without the examination by a dentist. With the expertise of Dr. Robert Feigal, the outcome of that meeting supported this change. 

Subsequently, legislation in 2003 included the provision of sealants, a key preventive measure for children, by dental hygienists under the Limited Authorization/Collaborative practice law.  Historical version of 2003 Minnesota Chapter 150A.10.

Minnesota school-based oral health programs provided by collaborative practice dental hygienists: Dental sealant program (below)

Normandale Community College collaborated with Apple Tree Dental on delivering care to children at Ridgeview Elementary in Bloomington, Minnesota using portable equipment and telehealth (below).


2004 - 2006

Normandale Community College hosted numerous continuing education events: Basic Screening Survey Calibration session, information forums, and Q & A sessions. NCC Collaborative Dental Hygiene Practice web site was developed; on-going communication opportunities offered.


2005 -2007 

In 2005 additional procedures were authorized for dental hygienists utilizing the limited authorization collaborative practice model: administration of local anethesia and nitrous oxide oxygen inhalation analgesia- Historical version of the 2005 law.

Rules to allow dental hygienists and dental assistants under indirect supervision (dentist is present) to provide restorative procedures were added to Minnesota Chapter 150A.10, Subd. 4. This does not include collaborative practice authorization for dental hygienists who practice without the presence of a dentist.  Click HERE to access the current statute including restorative procedures.

Minnesota's first "Restorative Functions- Educate the Educator" class, (pictured below) for dental hygiene and dental assisting educators (Normandale Community College).

  

Clinical portion of the course:


2007-2008

The Oral Health Committee, led by Michael Scandrett, JD, (pictured below) of the Minnesota Health Care Safety Net Coalition, supported the Advanced Dental Hygiene Practitioner (ADHP) and advocated for legislation in 2008, (funded by the United Way of Minnesota). 


Amos Deinard, MD, pediatrician, University of Minnesota, #1 supporter of a new intra-professional dental team member, with Colleen Brickle, RDH EdD, Normandale Community College.


Suzanne M. Beatty, DDS and Jayne E. Cernohous, DDS, were the first dentists in the nation to educate dental therapists/advanced dental therapists.  Both are strong supporters of Minnesota's dental hygiene-based dental therapy program. 



First class of Metropolitan State University, in partnership with Normandale Community College, Bachelor of Science in Dental Hygiene (BSDH) and post-Baccalaureate students.


2008

Statutory language introduced for a new intra-professional dental team member. Provider title changed from Advanced Dental Hygiene Practitioner (ADHP) to Oral Health Practitioner (OHP). A legislative workgroup (shown below) was mandated by the Minnesota legislature.


2009

Legislation introduced by Senator Ann Lynch and Representative Cy Thao. Titles changed from Oral Health Practitioner (OHP) to Dental Therapist (DT) and Advanced Dental Therapist (ADT).

The History of Introducing a New Provider in Minnesota: A Chronicle of Legislative Efforts 2008-2009 (ADHA)

May 16, 2009: Governor Tim Pawlenty signed Senate File 2083 into law, creating the DT/ADT.


The first cohort of Metropolitan State University/Normandale Community College ADT students along with Senator Ann Lynch, Representative Cy Thao and Presidents Joe Opatz (Normandale) and Sue Hammersmith (Metropolitan State University).


Deans Marilyn Loen (Metropolitan State University) and Colleen M. Brickle (Normandale Community College) along with Presidents Opatz and Hammersmith as well as Senator Lynch and Representative Thao.


2011

PEW Charitable Trust was a supporter of Minnesota's new intra-professional dental team members. 

The Minnesota Story:  Pew Children's Dental Campaign features Normandale Community College


Spring 2011

Advanced Dental Therapy Community Forum at Normandale Community College;  over 150 people attended this celebration.


Senator Al Franken was the keynote speaker at the ADT Forum.


Senator Al Franken and Marshall Shragg, Executive Director of the MN Board of Dentistry.


The first cohort of Metropolitan State University/Normandale Community College ADT students graduated June 23, 2011 and entered the workforce immediately.


Fall 2011

Metropolitan State University Advanced Dental Therapy Clinic opens in Maplewood MN.


Spring 2012

Ann Battrell, E.D., American Dental Hygienists Association, spoke to the Minnesota Dental Hygiene Educators Association members on dental hygiene and changes in the profession.


Fall 2013

In the fall of 2013, Normandale Community College and Metropolitan State University admitted its first cohort of dually admitted and enrolled dental hygiene students.  This was the first program in the United States between a community college and university to begin this innovative journey of combining associate and baccalaureate courses simultaneously. This streamlined approach enables a student to obtain the competencies to practice as a dental hygienist in alternative practice settings, or to move more quickly into a dental therapist education track.


2014

Minnesota Statute (2009), mandated that the Minnesota Department of Health and the Minnesota Board of Dentistry provide a report to the Legislature on the status of dental therapy and advanced dental therapy.  Click HERE to access the report below.


2015

A historic vote by the Commission on Dental Accreditation (CODA) took place on August 7, 2015 presenting a catalyst for the advancement in dental hygiene scope of practice. This seismic event creates a major paradigm shift in dentistry by giving recognition and validation to the existence of the new intraprofessional workforce member whose contributions as an integral member of the oral health team will advance a solution to the longstanding oral healthcare access issue.

Access magazine (May-June 2014) features an article describing the American Dental Hygienists' Association's policies that supported establishment of a mid-level oral health care practitioner who must be a licensed dental hygienist and who provides primary oral health care directly to patients.  Click HERE for 'The Develpment of Dental Therapy Education Programs, (page 20), where you will find a helpful narrative on the Dental Therapy Accreditation Standards.


Spring 2016

The American Dental Education Association (ADEA) Gies award presented to the University of Minnesota School of Dentistry, Metropolitan State University/Normandale Community College and the Minnesota Board of Dentistry: For Development of Dental Therapy Education in the United States.

Category: Vision, Innovation and Achievement Classification: Public or Private Partner.


2016-2017

Normandale Community College's "21st Century Dental Team" vision is a collaboration of dental and other health professionals.  To ensure its success, the current models of practice should continue to be enhanced through policies that promote further access to care.

MN Statutes 150A. 10, subd. 1a (2001) Limited Authorization for Dental Hygienists was amended and signed into law by Governor Mark Dayton on May 11, 2017. "Collaborative practice authorization for dental hygienists in community settings" expands the locations at which a dental hygienist may provide oral health services, eliminates clinical requirements, includes the provision of all services by dental hygienists under general supervision, and expands the utilization of licensed dental assistants to provide direct services to clients (education, preventive agents, radiographs, etc.).  Click HERE for the current statute (2017). 

As of early 2018 the Minnesota Board of Dentistry will be promulgating rules to reorganize the language for the scope of practice for dental hygienists and include more duties under general supervision.  All duties will also apply to dental hygienists with collaborative practice authorization.  For example, the dental hygienist with collaborative practice authorization may place temporary fillings after the new rules are passed.  This will significantly increase the kinds of services provided in alternative settings.

It is anticipated to to take 1-2 years for these new rules to complete the process.  For an update on progress of these proposed rule changes for dental hygienists see the Minnesota Board of Dentistry website.

Click HERE for the current rules, chapter 3100.8700

Jeanne Anderson, LDH, MPA, Minnesota Dental Hygienists' Association, with Representative Nels Pierson (chief House bill author) testifying in support of HF 1712.  This amendment to dental hygiene collaborative practice passed unanimously and moved to the Senate for hearings.


Some key supporters of HF 1712 from Normandale Community College, the Minnesota Dental Hygienists' Association, the Minnesota Oral Health Coalition, the Minnesota Safety Net Coalition and the Minnesota Department of Health.


May 8, 2017
HF 1712 presented to the Senate by Senator Michelle Benson
Final passage: Yea = 63  Nay = 0            

May 11, 2017
HF 1712 presented to Governor Mark Dayton and signed into law.

 Senate vote


2017

Debut of the Minnesota 21st Century Dental Team and launching of the revised Normandale Community College collaborative dental hygiene practice website.  Click here for video of the Oral Health Summit II