Research & Commentary: Special Interests Block Dental Therapists from Providing Needed Care

Published July 12, 2017

Like many states, Maine faces a serious shortage of dental providers. According to the Kaiser Family Foundation (KFF), one in four Mainers live in an area designated as having a dentist shortage. These shortages are even more pronounced in the poorest and most rural parts of the state.

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. 

In 2014, Maine legislators passed legislation to create the midlevel dental therapist, a new type of dental care provider, to help address the state’s dental health crisis. While this reform was a step in the right direction, the law only allows dental therapists to work in the presence of a dentist, unlike in Minnesota and Alaska, where dental therapists can operate semi-independently. Dental therapists can perform up to 95 services and procedures, compared to about 40 performed by hygienists and 30 performed by dental assistants.

Minnesota became the first state to authorize the expanded licensing of dental therapists in 2009. 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. Last year, legislation expanding the scope of practice for dental therapists was filed in 12 states.

According to the Portland Press Herald, the original version of the 2014 reforms was modeled based on Alaska’s program, where “dental therapists get two years of training to provide both preventive and basic care (like cleanings, fillings and tooth extractions) in areas where few or no dentists have set up practice.”

The Press Herald also notes despite several studies finding the Alaska model provides high-quality, effective care to those who had not received it before, the Maine law doesn’t allow dental therapists to travel to schools or nursing homes alone.

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.”

A recent Washington Post article reported the American Dental Association (ADA) has spent millions of dollars lobbying lawmakers across the country to reject dental therapy while filing several lawsuits to block legislation in states where bills passed.

ADA claims its fight against dental therapy is meant to prevent lesser-trained professionals from providing care, but dental therapists receive years of training, and similar professionals, such as physician’s assistants, exist in other fields of medicine. Eric Boehm of Reason Magazine uses the University of Minnesota’s dental therapy program to illustrate the qualifications dental therapists attain. Earning a bachelor’s degree in dental hygiene and master’s degree in dental therapy requires “32 months of dedicated course work, taking the same classes as dental students who stay for the full 48-month program.”

Allowing dental therapists in Maine to practice outside the immediate presence of a dentist would allow therapists to help close gaps in dental-care access and ensure patients receive preventive and restorative treatment when and where they need it.

The following articles examine dental health care and the licensing of dental therapists in greater detail.

Industry Foes Limit Mainers’ Dental Options
This editorial from the Portland Press Herald examines the debate over Maine’s flawed dental therapist reforms and how the dental lobby has made true reform difficult.

The Unexpected Political Power of Dentists
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
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-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. 

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.