Research & Commentary: Dental Therapists Can Soothe Florida’s Dental Shortage Pains

Published January 3, 2018

Florida faces an oral care crisis. According to the U.S. Department of Health and Human Services, more than 5.5 million Floridians reside in communities designated as “Dental Care Health Professional Shortage Areas” (HPSAs). Fortunately, a Florida lawmaker wants to expand access to dental care by allowing dental therapists, hygienists, and assistants to offer oral care treatments.

Florida state Rep. Daniel Perez (R-Miami) recently introduced a proposal to permit midlevel providers to perform a variety of dental services. These include extracting primary teeth, managing dental trauma, applying desensitizing medications, and many other services. State Sen. Jeff Brandes (R-St. Petersburg) says this legislation offers families who lack reliable access to dentists the opportunity to receive affordable oral care.   

“This bill would allow Florida the opportunity to be a leader in reducing regulatory barriers by developing a more efficient and effective dental care delivery model,” says Brandes. “It would break down barriers to entry for care and, based on research, would provide better outcomes for Floridians.”

The case for expanding the scope of practice for these midlevel providers is stronger now than it has ever been. In the coming years, a growing number of Floridians will be reaching retirement age and demanding an increasing amount of dental treatments. At the same time, a growing number of dentists will also be reaching retirement age and hanging up their lab coats. A 2016 Survey by the Florida Department of Health discovered 9 percent of practicing dentists plan to close their practices within the next five years, listing retirement as their primary reason.

Midlevel providers can help satisfy Florida’s oral health care needs. Dental hygienists, therapists, and assistants already provide a variety of routine treatments under the supervision of dentists in private practices, as well as community settings likes schools and nursing homes. And unlike dentists who must train for four years and pay more than $270,000 for schooling, therapists and hygienists can get certified within two years and pay as little as $36,000. This allows midlevel providers to more easily enter the marketplace and provide less expensive treatments to patients.

Rural communities in particular stand to benefit from improved access to basic dental services. After Minnesota became the first state to license midlevel professionals in 2009, the state’s Office of Rural and Primary Care found one-third of all Minnesotans experienced a reduction in wait times to receive dental care. Minnesota concluded, “[P]atients visiting rural clinics were nearly two times more likely to experience a reduction in wait time compared to their urban counterparts” after they introduced dental hygienists and therapists.

Yet, despite this success, dental associations continue to vehemently oppose allowing midlevel professionals to assist dentists in their work. In the fall issue of the South Florida District Dental Association’s newsletter, the interest group warned a “hurricane” of “second-tier” providers threaten to expose patients to substandard care.

Nothing could be further from the truth. More than 1,100 studies across 26 countries have found dental hygienists and assistants provide patients safe and effective care. Even the American Dental Association’s Council on Scientific Affairs concluded that “the results of a variety of studies indicate that appropriately trained midlevel providers are capable of providing high-quality services, including irreversible procedures such as restorative care and dental extractions.”

Dental hygienists and therapists have proven to be safe and affordable providers of oral health care treatments in America and abroad. Lawmakers in the Sunshine State should free these qualified professionals to treat all Floridians, especially the most vulnerable.

The following documents provide additional information about dental therapy.

Research and Commentary: Florida Should Allow for Dental Therapists–commentary-florida-should-allow-for-dental-therapists
In this Research & Commentary, Senior Policy Analyst Matthew Glans examines Florida’s increasing dentist shortage and how dental therapists can fill the Sunshine State’s pressing need for effective oral care. “Florida lawmakers should work to close gaps in dental-care access by reforming dental licensing laws to allow for dental therapists and ensure patients get preventive and restorative treatment when and where they need it,” wrote Glans.

America Doesn’t Have Enough Dentists
Eric Boehm, a reporter at, examines America’s dentist shortage and argues in favor of reforming state dental licensing laws for dental therapists as a potential solution. “More than 5,000 localities lack adequate access to dental care, which the department defines as having fewer than one dentist for every 5,000 residents. About 55 million Americans live in those areas … To address the shortage, you need to get more dental professionals into the field,” Boehm wrote.

The Reform that Can Increase Dental Access and Affordability in Arizona
Naomi Lopez Bauman, director of healthcare policy at the Goldwater Institute, and John Davidson, senior fellow at the Texas Public Policy Foundation, examine the dental access shortage in Arizona and how dental therapists could help fill this gap. “Limiting the supply of providers not only increases the cost of care services; it forces consumers and government payers to pay prices higher than they might otherwise. To increase dental access and affordability for Arizonans, lawmakers should allow for dental therapists,” wrote Lopez Bauman and Davidson.

The Case for Licensing Dental Therapists in North Dakota
In this Policy Brief, Michael Hamilton, Bette Grande, and John Davidson ask North Dakota lawmakers: “Does licensing dental therapists in North Dakota pose a risk to public health great enough to justify depriving (1) dentists of their right to employ and supervise dental therapists and (2) patients of their right to access providers of their choice?” They argue the answer is clearly “no.” Far from jeopardizing the public health, licensing dental therapists would likely expand patient access to high-quality oral care services and reduce oral care costs in North Dakota.

Dental Utilization for Communities Served by Dental Therapists in Alaska’s Yukon Kuskokwim Delta: Findings from an Observational Quantitative Study
This study from the University of Washington examines whether dental utilization rates in Alaska Native communities were associated with the number of dental therapist treatment days and quantifies differences in dental utilization rates between communities without dental therapist treatment days and those communities with the highest number of dental therapist treatment days.

Early Impacts of Dental Therapists in Minnesota
The Minnesota Department of Health and Minnesota Board of Dentistry examine in this report how authorizing dental therapy in Minnesota resulted in increased access for previously uncared-for patients.

A Review of the Global Literature on Dental Therapists
This report from the W.K. Kellogg Foundation provides a 460-page review of the benefits of dental therapy as demonstrated in more than 50 countries.

Dental Care Health Professional Shortage Areas (HPSAs),%22sort%22:%22asc%22%7D
The Kaiser Family Foundation analyzes the dental-health professional shortage areas in each state in order to show which states have the largest discrepancies in dental-care access.


Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit The Heartland Institute’s website, and PolicyBot, Heartland’s free online research database. 

If you have any questions about this issue or The Heartland Institute’s website, contact John Nothdurft, The Heartland Institute’s government relations director, at [email protected] or 312/377-4000.