Policy Brief: The State Lawmaker’s Case for Legalizing Dental Therapy

Published January 3, 2019

At its most fundamental level, the debate over whether to allow mid­level oral health care providers known as dental therapists to practice is not about teeth, dental hygiene, cost, access, years of schooling, or quality of care. These are undoubtedly crucial facets of the dental ther­apy issue, but just as facets of a diamond determine the shine of the stone, the key facets of dental therapy determine how effectively these midlevel providers help dentists deliver safe, high-quality care to unde­served patients. But the facets are not the diamond.

The diamond at stake is the liberty of two discrete groups, neither of which includes dental therapists. The first is ordinary patients of every strata across the United States. The second group is licensed dentists who have dared to dream beyond the establishment groupthink.

The liberty of patients and dentists is at risk of being lost or stolen by people who imagine giving dental therapists the freedom to practice will threaten oral health care as we know it. Opponents of dental thera­py would use their freedom to obstruct the freedom of others—and all in the name of the common good.

Ultimately, state lawmakers face one question looming above all other questions, claims, and statistics generated by the dental therapy debate: Is the freedom of patients to choose their oral health care providers and the freedom of licensed dentists to choose their employees so danger­ous that the state should deprive patients and dentists of their liberty?

We submit that liberating patients and dentists is a more rational, beneficial course of action than criminalizing dental therapy.

This Policy Brief keeps the liberty question front-and-center in the dental therapy debate. In Section One, the authors unpack the as­sumptions and logical fallacies that frequently obscure the liberty question.

In Section Two, the authors provide a narra­tive history of dental therapy in the United States and throughout the world. We show dental therapy to be a long-established, fully functional occupation with all the maturity and checks and balances that opponents fear dental therapy lacks. We also track the movement of dental therapy in the United States, from Alas­ka to Minnesota, then to tribal territories, and finally to states that have recently passed den­tal therapy laws and programs but do not yet have practicing therapists.

In Section Three, we explicate the natural rela­tionship between supervising dentists and their hired dental therapists, in addition to the rig­orous education and training requirements for dental therapists in the United States.

Section Four dives deeper into the applica­tion of dental therapists’ training to perform services and procedures within their scope of practice. This section explores options avail­able to lawmakers who want to learn more about treatment, best practices, and safeguards in order to draft dental therapy laws tailored to their state’s interests.

Section Five distinguishes appropriate metrics for evaluating dental therapy from the inap­propriate metrics oppo­nents often use. Dental therapy emerges as a successful, innovative model that achieves re­sults favorable to pa­tients, dentists, and state lawmakers.

Section Six quotes dentists in their own words expressing unbridled support for dental therapy.