Research & Commentary: Dental Therapy Can Relieve Wisconsin’s Dental Health Shortage

Published April 1, 2019

Like most states, Wisconsin faces a growing dentist shortage. According to the Health Resources and Services Administration, more than 1.2 million Wisconsinites, or nearly 20 percent of the state’s population, reside in counties with a severe dental shortage. Rural counties in Wisconsin are particularly hard hit by the dental health shortage; many would require multiple providers to even make a dent in the problem.

At the state level, one of the primary contributing factors that reduce dental access and increases costs is strict licensing requirements. Supporters of strict state licensing standards argue they assure quality care, but critics cite the arduous and often expensive licensing process. Onerous licensing criteria are a barrier to entry that harms the dental market by hindering new providers, thereby impeding the market competition needed to lower costs and improve access for patients.

Fortunately for states with a dearth of dental services, there is a simple solution that would expand dental care access and lower costs: dental therapists (DT).

Across the country, states are increasing the number of licensed dental therapists as a significant step to resolve their dental care shortages. In Wisconsin, two companion bills, Senate Bill 89 and Assembly Bill 81, were introduced in the General Assembly that would provide for the licensure of dental therapists and would require that the Dentistry Examining Board grant a dental therapist license to an individual satisfying certain criteria, which include completion of a dental therapy program and the completion of required examinations.

As is the case with all bills, scope and details matter. In general, DT laws should require general supervision only, which means DTs would not need direct supervision from a dentist when providing dental services. This is important because limiting DTs to direct supervision would not substantially increase dental access. The Wisconsin bills call for general supervision, which “does not require the presence of the dentist at the time a task or procedure is being performed or prior examination or diagnosis of a patient by a dentist prior to the provision of dental therapy services by a dental therapist.”

Dental therapists in Wisconsin would face all the same laws and restrictions as dentists and dental hygienists. DTs would also be required to complete 12 hours of continuing education each biennium. It is important to note these arrangements are not mandatory; a dentist must choose to work with a dental therapist and would frame a collaborative management agreement to determine how the DT will operate and when services are provided. The bill also gives DTs a voice on the examining board, requiring that two DTs be added once the first individual becomes licensed as a dental therapist in the state.

In 2009, Minnesota became the first state to authorize increased licenses for dental therapists. Based on the available evidence, Minnesota’s reforms have been positive. After just one year of expanding licenses for dental therapists, patient visits increased by 27 percent.

Moreover, children and adults served by DTs receive more frequent preventive care, which leads to a reduced need for invasive procedures over the long term, according to a report in the Journal of Public Health Dentistry. As the Pew Charitable Trusts notes, mid-level providers like dental therapists are already authorized to provide routine preventive and restorative care in more than 50 nations.

In short, states ought to ease licensing standards on DTs and allow them to practice without a dentist physically present. S.B. 89 and A.B. 81 would provide needed reforms that would help patients receive preventive and restorative treatment in a timely and affordable manner.

The following articles examine dental health care and dental therapist licensing in greater detail.

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.

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.                                         

States Consider Authorizing Dental Therapy to Expand Access
Mary Tillotson writes in Health Care News about the movement by several states to consider allowing dental therapists additional power to treat patients. “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,” wrote Tillotson.

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.

How Reforming Licensing Laws Can Help Fix America’s Dentist Shortage
Eric Boehm, a reporter at, examines the dentist shortage and argues in favor of reforming state dental licensing laws for dental therapists as a potential solution. “Children’s Dental Services … treats about 30,000 patients each year, mostly from the Twin Cities’ Hispanic, Hmong and Somali immigrant communities. The dental therapy model was first adopted by nonprofits and community clinics to lower costs, says Karl Self, the director of the University of Minnesota’s therapy program. But now, Dr. Self adds, private practices are hiring dental therapists, too. ‘We’re seeing that dental therapists can add value to the overall oral health team,’ he says.”

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

Pew Charitable Trust: Dental Campaign
Pew Charitable Trust has been providing research and analysis to encourage state lawmakers to allow dental therapists in their states to ensure patients have greater access to preventive and restorative treatment services. “Pew’s dental campaign works to close gaps in dental-care access by increasing the number of available providers and expanding the reach of preventive services through the use of dental sealant programs in high-need schools. Research shows that such programs are a valuable, cost-effective way to treat the children most at risk of tooth decay.”

5 Dental Therapy FAQs  
While states continue to grapple with what dental therapists are, how much education dental therapists receive, and where therapy is practiced, Pew Charitable Trusts has put together a helpful FAQ page to answer the most important and difficult questions related to dental therapy.


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.

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