Millions of rural Americans lack access to proper dental care, a shortage 12 states are considering filling by authorizing dental therapy, an oral-care-industry profession roughly equivalent to a physician assistant or nurse practitioner.
Although dental therapists are not licensed dentists, their training includes three academic years, clinical experience, and, for certain procedures, the same training as dentists.
Approximately 7,000 dentists would have to start practicing in more than 5,300 communities across the United States to end the current dentist shortage that affects more than 46 million people, according to data from the Health Resources and Services Administration (HRSA), part of the Department of Health and Human Services. The shortage will grow to 15,600 dentists by 2025, HRSA projects.
To fill the gap, a dozen states were “actively exploring” authorizing dental therapy to provide preventive and restorative care, traditionally to patients in underserved areas, when most state legislatures adjourned for the year, according to a map created by the W.K. Kellogg Foundation. The map was last updated in June 2016.
The profession is currently authorized in Alaska, Maine, Minnesota, and Vermont, and it’s also permitted for one native tribe in Washington State.
More than 50 countries and territories permit dental therapists to treat patients, states A Review of the Global Literature on Dental Therapists, a 2012 Kellogg report.
Most state legislatures are scheduled to reconvene in January 2017.
Pure Michigan Dentistry
Michigan Senate Bill 103, sponsored by state Sen. Mike Shirkey (R-Lansing), would permit dental therapists to apply for licenses and practice under the supervision of a licensed dentist.
Shirkey says letting dental therapists treat patients would help correct Michigan’s shortage.
“The data is pretty clear that we have pockets of areas across the state that don’t have proper dental care and access to service for what I would call intermediate restorative types of procedures,” Shirkey said. “This [bill], I believe, is part of an overall plan to enhance access across the state.”
Legalizing dental therapy as a profession would motivate dental hygienists to excel and dentists to grow their practices, Shirkey says.
“It’s an opportunity for hygienists who choose to increase their skillset to get additional education and an opportunity for dentists who have an entrepreneurial bent to expand their services,” Shirkey said.
Two Tiers, One Goal
John Grant, director of the dental campaign at Pew Charitable Trusts, says opponents of dental therapy unfairly criticize the profession as creating a two-tiered system of care, “one for patients who can afford to see a dentist, and another for poor patients and those on Medicaid, who will see a dental therapist.”
Opponents fail to acknowledge countless patients lack any access to oral care, regardless of quality, Grant says.
“In the larger picture, there are already two tiers of care: those who can afford to get care and the tens of millions who can’t,” Grant said.
Gritting Their Teeth
Opposition to dental therapy will eventually turn into enthusiasm for the profession, Grant says.
“When physician assistants were first introduced, they were similarly opposed by doctors’ trade organizations,” Grant said. “Now, most doctors can’t imagine working without them. Many dentists in Alaska and Minnesota who were originally opposed to hiring a dental therapist are now very happy to have them as part of their team. These dentists have grown their practices and are able to treat more patients.”
Shirkey says objections from dentists that therapists would provide poor care are self-indicting, because dentists would oversee dental therapists in his state.
“I put the concern over quality right back in the dentists’ laps,” Shirkey said.
No Tooth Fairy Tales
Dental care increased in Minnesota after lawmakers authorized dental therapy in 2009. As of February 2014, the state had licensed 32 dental therapists, according to “Early Impacts of Dental Therapists in Minnesota,” a report to the legislature by the state’s Department of Health and Board of Dentistry.
Dental therapists at 15 clinics participating in the study served 6,338 new patients, 84 percent of whom were enrolled in a government-sponsored health insurance program, the report states.
Shirkey says oral care providers should be free to improve and practice their skills, and patients should be free to benefit.
“I don’t understand why we would create unnecessary restrictions [on people] who, if they chose, can enhance their skillsets, earn more money, and increase their professional stature,” Shirkey said. “To me, this is about freedom and about removing obstacles to restorative-type [dental] services in underserved areas, and it doesn’t have to require taxpayer investment.”
Mary C. Tillotson ([email protected]) writes from Ann Arbor, Michigan. Michael Hamilton contributed to this report.
Logan Pike, “Dental Therapists,” Research & Commentary, The Heartland Institute, August 30, 2016.
Jane Koppelman, “Dental Therapists: A Free-Market Approach to Expanding Access to Care,” Children’s Dental Campaign, The Pew Charitable Trusts, August 2016.
“Early Impacts of Dental Therapists in Minnesota,” Minnesota Department of Health and Minnesota Board of Dentistry, February 2014.
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