Pacific Coast Society of Orthodontists Bulletin Winter 2021 - 14

PCSO News and Events

Advocacy and Legislative Update

Washington State Advocacy

Dr. Michelle Fogg Neal
Kirkland, WA

Over the past several years, the Washington
State Society of Orthodontists (WSSO) has been
extremely active at both the legislative and the
regulatory body levels. As legislative chair, I have
had the pleasure of working with several amazing
members of the WSSO board to be responsive
to regulatory issues that would negatively affect
both the orthodontic practice and our patients.
We spoke on behalf of the WSSO at several
Washington Dental Quality Assurance Commission meetings on critical topics such as specialty
advertising, scope of practice, and infection
control in the dental setting. The Commission
is active and has been considering dramatically
changing the language of our state administrative code that regulates the practice of dentistry.
Close attention to meetings, lobbying, engaging
our state dental association partners, and the national support from the American Association of
Orthodontists (AAO) has enabled our team to be
strong advocates and positively shift regulations
for our members and patients.
One of the biggest and most pressing issues in
our state has been the scope of practice permitted
for dental hygienists. When our legislative team
took over, proposals were under consideration to
allow dental hygienists to perform a number of
orthodontic procedures under " general " supervision with no licensed dentist or orthodontist on
the premises. The proposal was quite permissive
and would, in essence, have allowed them to
perform every orthodontic procedure, except bond
appliances and place brackets, without the presence of a licensed dentist. Supporting positions
for this dramatic change were offered from the
Washington Dental Hygienists' Association and
direct-to-consumer orthodontics (DTC) companies,
even though the WSSO is not aware of current curriculum on orthodontic techniques and procedures
in Washington State dental hygiene programs.
DTCs were seemingly interested in this change
because it would have permitted hygienists to
place clear aligner attachments and perform appliance adjustments without a licensed orthodontist
present. Teledentistry services are also permitted

under the Washington State code, including tasks
by auxiliaries that may be delegated under general
supervision; we did not feel that, given the lack of
orthodontic training, hygienists had the necessary
expertise to safely provide teledentistry orthodontic services. Approximately 60 WSSO member
orthodontists appeared at the hygiene scope-ofpractice hearings to testify that the original language allowing a broad range of orthodontic procedures without a licensed dentist present would
be detrimental to the people of Washington State.
As a result of our advocacy, the language of the
proposal was modified, and the rule that passed
now allows hygienists to place separators, take
impressions or scans, and fit bands under general
supervision. Hygienists are not allowed to bond
or remove orthodontic appliances or attachments
without the close supervision of a dentist licensed
in the state. This was a very favorable ruling for
the WSSO and will help maintain oversight for our
patients and ensure quality and safety.
Specialty representation has been another hot
topic in the state of Washington. The WSSO has
worked diligently at getting our other specialty organizations involved in this discussion to
protect the distinction of recognized advanced
training in an accredited dental specialty. The
Washington State Dental Association (WSDA)
and the AAO legal counsel all worked together to
protect the right to be called a dental specialist.
The language that ultimately passed has been
supported by the American Dental Association,
AAO, and other professional specialty societies.
Before the COVID pandemic, the WSSO legislative team was actively involved in crafting the
language written for state infection control policies. We want rules to ensure protection for our
patients but also to provide for appropriate and
effective infection control that will not be overly
burdensome or costly to implement. Significant
changes to existing infection control regulations
have been proposed for consideration by the
Commission. These changes will affect every
orthodontist and dentist in Washington State.

PCSO Bulletin Winter 2021

Pacific Coast Society of Orthodontists Bulletin Winter 2021

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2021