The Heartland Institute Releases Policy Brief on Dental Therapy

Published January 28, 2019

The brief, published January 3, was written by Michael Hamilton, a writer and editor for Good Comma Editing LLC and a policy advisor for The Heartland Institute, and Charlie Katebi, a state government relations manager for Heartland.

The authors examine the debate over dental therapy, or the provision of dental care by health care professionals who are not licensed dentists but have schooling comparable to dentists and who can help fill the gap in underserved populations. The writers cite several reasons why “mid-level” oral health care providers should be allowed to practice and how more dental therapy options increases freedom for patients and providers.

“The liberty of patients and dentists is at risk of being lost or stolen by people who imagine giving dental therapists the freedom to practice will threaten oral health care as we know it,” Hamilton and Katebi write. “Opponents of dental therapy would use their freedom to obstruct the freedom of others—and all in the name of the common good. Ultimately, state lawmakers face one question looming above all other questions, claims, and statistics generated by the dental therapy debate,” the authors continued. “Is the freedom of patients to choose their oral health care providers and the freedom of licensed dentists to choose their employees so dangerous that the state should deprive patients and dentists of their liberty?”

More Liberty, Less Criminalization

Hamilton says that liberating patients and providers through dental therapy is a rational and mutually beneficial course of action, and will produce positive outcomes that criminalizing dental therapy can never achieve.

“People forget that the most fundamental determinant of a positive patient experience is the freedom to choose which providers they wish to obtain care from,” Hamilton says. “To deprive them of this freedom on the pretense of protecting their best interest is irrational. “Similarly, dentists should be free to vet, hire, and supervise dental therapists that they wish to be responsible for,” Hamilton adds.

“It makes no sense to rob a minority of enterprising dentists of this ability when those dentists have the same letters after their names as the dental lobby opposing dental therapist licensure.”

No Fear

Katebi says that one reason for some states’ reluctance to embrace dental therapy is a misapplied fear that dental therapists are a second-tier level of care compared to dentists.

“People want quality health care, and state legislators naturally want to make sure they’re not doing anything to provide services that aren’t up to par,” Katebi said. “This is a reasonable expectation. The reality with dental therapy, however, is that dental therapists work directly with supervising dentists and have a very specific and rigorous educational requirements. They are comparable to physician assistants and, in the same way, provide quality care to patients that frees up the dentist to focus on the more severe care cases. In addition to helping fill out dental needs in underserved areas, a dental therapist’s presence can decrease wait times and loosen the burden on scarce resources.”

Provider Trust

Hamilton says that once people understand the relationship between dentists and their dental therapists, many of the fears about quality of care should dissipate.

“No dentist will be forced to hire a dental therapist,” Hamilton says. “Dentists who do hire therapists willingly claim responsibility for the quality of care they provide under the dentist’s supervision. No patient will be forced to receive treatment from a dental therapist. Nevertheless, patients can rest assured that therapists emerge from their training programs with equal or more training in their narrow scope of practice than do dentists, who have a much wider scope of practice.”

Patient Trust

Hamilton and Katebi say that one of the most important aspects of the dental therapy debate, and the one they try to cover extensively in their paper, is that patients should be allowed to make their own decisions about their dental care.

“The freedom to choose a provider is a concept we have moved away from in this country with the adoption of a health care system that was moving toward centralization and control by the federal government,” Katebi said. “That kind of system is detrimental to both providers and patients because it puts a burden on doctors to comply with bureaucratic requirements and destroys the individual doctor-patient relationship. Dental therapy brings some of that choice back to health care because people will have the choice of going to a regular dentist or utilizing a dental therapist for maintenance such as cleanings. Letting people choose in health care is direction we should be determined to move toward.”

Hamilton agrees with his colleague and says choosing a health care provider is no different than the responsibility voters have of choosing legislators.

“Average people are qualified to choose which dental care providers they trust, whether they are dentists, dental therapists, or dental hygienists,” Hamilton says. “If the federal and state constitutions deem the common man qualified to choose the most qualified lawmakers, surely he can recognize good care from bad.”