A few states are trying to alleviate their oral health care shortages by allowing the licensing of dental therapists — a fairly new class of dental care providers, essentially dentistry’s version of physicians’ assistants. They face strong resistance from dentists.
In the handful of states where they are legally approved, dental therapists — who generally get two years of intensive training before going out into the field — can provide services ranging from cleanings to extractions to pediatric stainless steel crowns, says Mary Williard, director of the Alaska Native Tribal Consortium, a program that trains dental therapists.
Minnesota was the first to allow licensing of dental therapists in 2009. Alaska followed, and together these states have 59 active practitioners. Maine Gov. Paul LePage, a Republican, signed that state’s bill into law last month, and efforts are underway in other states, including Vermont, New Mexico and Kansas. A bill that would allow dental therapists to practice in Washington state stalled in committee in February.
“Maine is having an oral health crisis,” says Mark Eves, Maine’s speaker of the House. “The rural part of the state is at a critical point where we need to do something.”
Heather Luebben, an advanced dental therapist practicing in Coon Rapids, Minn., began her stint in oral health as a hygienist before training to become a dental therapist.
“You can’t deny that there are more people having trouble receiving dental care,” Luebben says. “We have rural areas that just don’t have enough dentists.”
This is true for many states. Three times as many people nationwide are without dental insurance as are without health insurance, according to Delta Dental insurance company data. Medicare does not pay for dental services except in rare cases, and Medicaid leaves dental insurance up to the states.
As a result, oral health care is a challenge, especially in rural areas where access to dentists is low and many people do not address dental health issues until it is too late. These people often end up in emergency rooms instead of at a dental office, says author and health care activist Wendell Potter. The Pew Center on the States estimated that in 2009, more than 830,000 visits to emergency rooms were for preventable dental conditions. This was a 16% increase from 2006.
“As we look at public funds spent on people who go to the ER for dental pain, it’s one of the highest expenditures we have as a state,” Eves says. “We’re managing pain without getting to the source of the problem.”
Despite its recognition of oral health disparities, the American Dental Association is firmly against states approving dental therapists. The association lobbied hard against the dental therapy bill in Maine, Eves says.
“The ADA does not consider the one-size-fits-all mid-level dental provider model to be a viable solution to the diverse set of barriers that impede millions from getting dental care,” the group said in a statement.
ADA spokesman Robert Raible declined USA TODAY’s request for further comment.
Those in favor of licensing dental therapists say the opposition is from both an economic and a quality-of-care standpoint.
“They’re doing this from the perspective of what is best for their members,” Potter says.
But when dental therapists work in dentists’ private practices, they have been shown to increase income, Williard says: “This would be an economic advantage, just like having a hygienist is.”
Luebben says dental therapists and dentists aren’t in competition with each other.
“I see us as another provider who is able to work along with dentists,” she says. “The more people we have trained, the more people who can care for others.”