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. Additionally, access to care is also limited for the 72 million children and adults who rely on Medicaid and the Children’s Health Insurance Program. Only about one-third of U.S. dentists accept patients on Medicaid.
Strict licensing standards have become a significant barrier to entry in the dental industry. Supporters of strict state licensing standards argue they assure quality, but critics say the arduous and often expensive licensing process harms the dental market by hindering entry for new providers, thereby impeding the market competition needed to lower costs and improve access for patients.
A new study issued by the University of Washington examines one of the most promising solutions to the dental health shortage: the expansion of dental scope of practice to allow dental therapists to provide much-needed services. In the study, patient records and Medicaid claims data of patients treated in the period 2006 to 2015 in the Yukon-Kuskokwim Health Corporation (YKHC) were analyzed. YKHC serves 25,000 Alaska Native Americans, representing 58 federally recognized tribes.
Using this data, Dr. Donald L. Chi of the University of Washington’s School of Dentistry counted the total number of dental therapist treatment days provided in each community and compared the number of visits and treatments between communities without dental therapist treatment days to those with the highest number of treatment days. The study found increased exposure to dental therapists was associated with fewer extractions, fewer instances in which general anesthesia was used, and more preventive visits for adults and children.
States across the country have started to look toward dental therapists as one important way to solve their dental health shortages. In 2009, Minnesota became the first state to authorize the expanded licensing of dental therapists. Based on the available evidence, the results of Minnesota’s reforms have been positive. After just one year of licensing dental therapists, patient visits increased by 27 percent. In 2016, legislation expanding the scope of practice for dental therapists was filed in 12 states.
Some opponents of expanding the scope of practice in dentistry argue it will result in worsening quality of care. In testimony before the North Dakota House Human Services Committee, Michael Hamilton, research fellow for The Heartland Institute, argued these concerns are unfounded. “If therapists obtain licensure in North Dakota, dentists would remain responsible for the quality of treatment patients receive in their offices from any and all employees, whether dental hygienists, dental assistants, associate licensed dentists, or dental therapists. Therefore, to block dental therapy based on concern for quality of treatment is to doubt the quality, competence, and judgment of licensed dentists.”
According to the Pew Charitable Trusts, midlevel providers are authorized to provide routine preventive and restorative care in more than 50 nations. “Compared to dentists, dental therapists perform fewer procedures, require less training, and command lower salaries. 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.”
Dental pain has even begun to place a burden on the nation’s emergency rooms. According to Pew Charitable Trusts, 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. Dental health is both important and overlooked, 101 people died in hospital emergency departments from 2008 to 2011 due to preventable dental disease.
Allowing dental therapists in more states would help to close gaps in dental care access and ensure patients receive preventive and restorative treatments when and where they need it.
The following articles examine dental health care and the licensing of dental therapists in greater detail.
Dental Utilization for Communities Served by Dental Therapists in Alaska’s Yukon Kuskokwim Delta: Findings from an Observational Quantitative Study
https://heartland.org/publications-resources/publications/dental-utilization-for-communities-served-by-dental-therapists-in-alaskas-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 Unexpected Political Power of Dentists
https://www.washingtonpost.com/politics/the-unexpected-political-power-of-dentists/2017/07/01/ee946d56-54f3-11e7-a204-ad706461fa4f_story.html?utm_term=.f34db03019b9
Mary Jordan writes in the Washington Post about the power of the dental lobby and its efforts to block dental scope of practice reforms. Jordan also address the dental shortage crisis facing many parts of the country.
The Case for Licensing Dental Therapists in North Dakota
https://heartland.org/wp-content/uploads/documents/Policy%20Brief%20Dental%20Therapy%20North%20Dakota.pdf
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
https://heartland.org/news-opinion/news/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
https://heartland.org/publications-resources/publications/a-review-of-the-global-literature-on-dental-therapists
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
https://heartland.org/publications-resources/publications/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
http://reason.com/blog/2016/08/22/how-reforming-licensing-laws-can-help-fi
Eric Boehm, a reporter at Reason.com, 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)
http://kff.org/other/state-indicator/dental-care-health-professional-shortage-areas-hpsas/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%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.
Pew Charitable Trust: Dental Campaign
http://www.pewtrusts.org/en/projects/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
http://www.pewtrusts.org/en/research-and-analysis/q-and-a/2016/04/5-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, 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.
Matthew Glans joined the staff of The Heartland Institute in November 2007 as legislative specialist for insurance and finance.
