Research & Commentary: Mississippi Should Allow Dental Therapy

Published May 31, 2018

According to U.S. Department of Health and Human Services data, more than 48 million people in the United States live in areas with dentist shortages, and this is likely to worsen in the coming years. The Health Resources and Services Administration projects by 2025, the number of dental shortage regions will more than double from 7000 to 15,600. Access to care is also limited for the 72 million children and adults  on Medicaid and the Children’s Health Insurance Program. Only about one-third of U.S. dentists accept patients on Medicaid.

One of the worst cases is Mississippi’s dental care market, which ranks at the very bottom of most studies, both in access to care and overall dental wellness. According to the 2017 America’s Health Rankings report, Mississippi ranks 49th for its number of dentists: 42.2 versus the national average of 60.8 per 100,000 people. Another report by WalletHub examined the 50 states and the District of Columbia across 25 key indicators of dental wellness and ranked Mississippi dead last.

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. 

Thankfully, for states like Mississippi that have a dearth of dental services, there is a simple solution that would expand dental care access and lower costs: dental therapists. States across the country are increasing the number of licensed dental therapists as a significant step to resolve their dental care shortages. 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.

According to the Pew Charitable Trusts, midlevel providers are authorized to provide routine preventive and restorative care in more than 50 nations. “Research has confirmed that they provide high-quality, cost-effective routine care and improve access to treatment in parts of the country where dentists are scarce.”

For most patients, dental therapists provide a cost-effective alternative to dentists. According to a new case study conducted by Apple Tree Dental and sponsored by The Pew Charitable Trusts, dental therapists are a vital and affordable member, especially for rural dental teams. The study found the therapist’s average daily billing was “94 percent of the average for the clinic’s dentists ($2,792 compared to $2,951).” The study concluded that since the difference in pay was significantly larger, the dental therapist’s role was very cost-effective.

Lack of available and affordable dental care is also placing a burden on the nation’s emergency rooms. Over two million people in 2012 reported to local emergency rooms for dental pain, costing taxpayers $1.6 billion, with Medicaid’s share totaling $520 million according to Pew Charitable Trusts. Unfortunately, lack of dental access can have dire consequences—101 people died in hospital emergency departments from 2008 to 2011 due to preventable dental disease.

A Policy Brief published by The Heartland Institute and Texas Public Policy Foundation points out, “Blocking dental therapy undermines licensed dentists’ liberty to treat patients to the best of their abilities as determined by the dentists’ consciences and professional judgment. Ironically, opponents of dental therapist licensing would also diminish licensed dentists’ ability to grow their practices.”

States ought to permit dental therapists to practice without a dentist physically present, thus expanding dental care access. Easing the regulatory burden on dental therapists will help ensure patients receive preventive and restorative treatment in a timely and affordable manner. Mississippi, like all states, should consider opening up its dental market by allowing more dental therapists to practice. In short, more dental care options at lower costs will benefit all Mississippians.

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 Health Care News, The Heartland Institute’s website, and PolicyBot, Heartland’s free online research database. 

The Heartland Institute can send an expert to your state to testify or brief your caucus; host an event in your state, or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact John Nothdurft, Heartland’s director of government relations, at [email protected] or 312/377-4000.