A proposal to reduce the number of dentists on the state dental board and replace them with hygienists has set off alarms among dentists who fear it will weaken oversight of the profession when more scrutiny is needed.

"Public safety requires more expert input from our board, not less," said Dr. Glenn Okihiro, a former president of the Hawaii Dental Association. "The board’s responsibility is licensure, competency, investigating complaints and public safety. It’s not representing dental hygienists. That’s like telling attorneys that the bar association should have equal representation for paralegals."

The Board of Dental Examiners is made up of eight dentists, two hygienists and two members of the public, all of whom volunteer their time. House Bill 2458, introduced by Rep. Della Au Belatti and 12 colleagues, would create an 11-member board with five dentists, four hygienists and two public members. It would also require one of the dentists to have a public health background.

"Dental hygienists play a huge role in the dental care and dental industry," Belatti said. "We wanted to provide a little bit more of a voice to these folks to kind of equalize the board, and also include a community health dentist, as access to care is expanding with the Affordable Care Act."

Testimony was sharply divided, with dentists lining up in opposition and hygienists arguing in favor at a Health Committee hearing. But the bill passed unanimously and will be heard Monday by the Consumer Protection and Commerce Committee.

A companion bill in the Senate, introduced by Consumer Protection Chairwoman Rosalyn Baker, was deferred indefinitely by her committee and the Health Committee on Feb. 7, but has reappeared on the agenda for their joint meeting Wednesday.

Hawaii would be forging new ground if the proposal makes it into law. A review of the makeup of 50 state dental boards across the country by the Honolulu Star-Advertiser found they had on average seven dentists and 1.7 hygienists. Only seven states had three or more hygienists, and all of those had at least twice as many dentists on their boards.

Dental hygienists work under the supervision of dentists, who are ultimately responsible for their work. There are 1,520 licensed dentists and 1,030 dental hygienists in Hawaii, according to Brent Suyama, communications officer for the Department of Commerce and Consumer Affairs.

Suyama noted that the dental board’s mission is to represent the public interest, rather than the profession or the industry.

"That is the focus of all our boards and commissions," Suyama said. "They aren’t there for the industry. They are actually there for the consumer."

In testimony to the committee, dental hygienists argued that their two colleagues now on the board have a heavy workload and hygienists deserve more support.

"The Hawaii Dental Hygienists’ Association feels that the over-representation of dentists and under-representation of dental hygienists creates an environment where the majority group can easily steamroll or negate the opinions of the minority members," said Ellie Kelly-Miyashiro, president of the association.

"We understand that the role of the board is to ultimately serve the interests of the public, but the unique and valuable perspective of the dental hygienists is not adequately represented at the current ratio."

Jill Rethman, a past president of the hygienists’ group, said her profession focuses on the prevention of oral disease so "having both licensed members of the oral health care team equally represented on the board might give more prominence to issues regarding prevention and access."

The bill would also change the name of the board to the Board of Dentistry and Dental Hygiene.

Board chairman Dr. Mark Baird testified that the board’s current makeup is not problematic and said it would be hard to find dentists with a background in public health since they represent less than 2 percent of licensees.

The Hawaii Dental Association strongly opposed the legislation, saying that hygienists cannot separately oversee disciplinary action against dentists or even hygienists, since they practice under the direction of dentists.

"Reducing the number of dentists on the board will only serve to limit the professional resources and expertise of the board at a time when even more resources are needed," said Russel Yamashita, HDA representative.

The question of safety in dental offices shot into the public conscience after 3-year-old Finley Boyle of Kailua lapsed into a coma during a dental procedure performed by Dr. Lilly Geyer on Dec. 3. The child died a month later.

A lawsuit against Geyer and Island Dentistry for Children alleges that a staff member overdosed the child with powerful sedatives and then failed to monitor her vital signs or rescue her when she suffered cardiac arrest. Autopsy results are still pending.

On Jan. 27, new state rules took effect to tighten oversight of sedation in dental offices, requiring dentists to complete comprehensive training and obtain permits before giving patients moderate sedation, such as the oral drugs administered to Finley. The rules had been developed by the Board of Dental Examiners and approved in July.

Another bill introduced by Belatti, House Bill 2460, would prohibit dentists from presenting themselves to the public as specialists unless they are actually licensed as such. Hawaii dental rules already forbid false or misleading advertising and say dentists may not practice as specialists, such as pediatric dentists or orthodontists, unless they have completed the advanced training specified by the American Dental Association.

Hawaii issues licenses only for general dentists. The legislation would have the board issue specialty licenses.

Geyer, the dentist who treated Finley, was licensed as a general dentist, could treat patients of all ages and even limit her practice to children. But she could not call herself a "pediatric dentist" unless she had at least two more years of specialty training.

Geyer closed her practice after the tragedy. The state is investigating the case.

Formerly known as Lilly Tsou, Geyer was licensed in Hawaii in 2005, based on her credentials as a dentist in Pennsylvania and passage of the New England Regional Board exam. She was one of 87 dentists licensed during a transition period after the state stopped administering its own exam and before it began using a national exam, Suyama said.

All 87 had passed regional exams, he added.