FUTURE OFDENTISTRY
service regulations, competency examinations and
workplace regulation may be that the nature of the
requirements will undergo review and revision regu-
larly, so as to recognize and encompass the many
positive developments that will emerge over time.
FUTURE CHANGES IN MOBILITY, COMPETENCY
AND SCOPE OF PRACTICE
The desire for greater professional mobility will
promote more consistent examiner calibration,
more uniform exam content, and more state recog-
nition of multiple regional boards. There will be
increased demand for continued development of
computer-based simulation as a valid method for
testing clinical skills. Current competency assess-
ment will be an integral factor in decreasing barriers
to mobility for dental professionals. Alternatives to
traditional licensure and state-specific licensure will
be implemented in an effort to reduce geographic
shortages by allowing dental professionals easier
interstate mobility.
There will be increased efforts to assure initial and
continued competency. Greater demand will exist
for documented and formalized continuing compe-
tency assessment. Greater emphasis will be placed
on in-depth clinical competency for the initial com-
petency examination.
Changing workforce requirements, advances in
technology and recognition of the complexities and
relationships between oral and systemic disease will
require redefinition of the scope of practice for den-
tists and allied dental professionals.
Telehealth will require cooperation among state
and national jurisdictions, and possibly the restruc-
turing of dental governance. Telehealth may stimu-
late more uniform scopes of practice among the
state statutes and regulations. Further restrictions
on dental assistants could result in a reduction of
available employees for dental offices and would
therefore alter the delivery of dental care to the pub-
lic. A critical under-supply of laboratory techni-
cians will occur in the future unless the number of
students in this field is increased. The exponential-
ly expanding aspects of technology will provide new
materials and procedures that will initiate expanded
functions for allied personnel.
The complexities and interrelations of oral and
systemic diseases will continue to evolve and require
more extensive examination and diagnosis by a
licensed dentist for every dental patient.
FUTURE CHANGES IN REGULATION OF DENTAL
PROFESSIONALSFederal and state activities are likely to increase
in the near future in the area of access to care for
Medicare beneficiaries, and for Medicaid and
SCHIP beneficiaries.
Federal activity is also likely to occur in addressing
issues of the workplace environment and likely will
include new proposals that will increase the cost of
delivering care, thereby increasing consumer costs
and, ultimately, decreasing access to oral health care.
Two examples that pose this possibility in the
near term are a promulgated but not yet enforced
rule on medical information privacy and a guidance
document issued by the U.S. Department of Health
and Human Services (USDHHS) stating that health
professionals must provide translation services to
non-English speaking patients.
The privacy regulation, intended to guard the con-
fidentiality of individually identifiable health informa-
tion, includes oral communication in addition to
paper and electronic records. This could possibly
mean that health professionals would not be able to
discuss patients' care in physical settings where the
conversation might be overheard. The recent trend in
dental office design has been toward exactly this type
of open space, and a strict interpretation of this rule
could have staggering compliance costs, much of
which would be passed on to patients.
Similarly, a strict interpretation of the USDHHS
guidance on providing translators for non-English
speakers, with no counterbalancing funding, could
create a situation in which dentists could no longer
afford to provide routine preventive care to such
patients. These are but two examples of why the regu-
latory pendulum will likely continue to swing between
extremes of cost control and consumer protection.Licensure and Regulation of Dental Professionals