Within the last few years, a new class of dentists has emerged called dental therapists. The position has spawned in states facing oral health care shortages, but the new professionals, also known as midlevel dental providers, are being met with strong resistance from dentists.
In 2009, Minnesota became the first state to allow licensing of dental therapists. Since then, Alaska followed and Maine signed a state bill regarding the measure into law last month, becoming the third state to do so. Meanwhile, legislative efforts in other states like Vermont, Kansas and New Mexico are underway.
Essentially, dental therapists are dentistry’s version of physician’s assistants. After two years of intensive training prior to entering the field, they operate under the direct supervision of dentists and are able to perform hygiene maintenance (regular cleanings), fill cavities, give restorations, provide sealants, utilize extractions and administer local anesthesia. They can do as many as 53 procedures in some states. Conversely, licensed dentists, who receive eight years of training, can perform more than 500 procedures.
At the heart of the problem is the severe shortage of dentists, which is fairly surprising considering the profession ranked No. 3 in U.S. News & World Report’s 100 Best Jobs of 2014.
“Maine is having an oral health crisis,” Mark Eves, Maine’s speaker of the House, told USA Today. “The rural part of the state is at a critical point where we need to do something.”
In Maine, 15 out of its 16 counties do not have enough dentists, with more than 62 percent of low-income children in the state going without access to dental care in 2011, according to DentistryIQ. The 600 practicing dentists among a population of 1.3 million constitutes the fewest dentists per capita in New England. To complicate matters, 40 percent of Maine’s dentists are nearing retirement.
A similar dilemma is taking place in Coon Rapids, Minnesota. Heather Luebben, an advanced dental therapist, pointed out that Minnesotans lack access to proper dental care, as licensed dentists are too few and far between. Luebben began her career as a hygienist before training to become a dental therapist, and she is one of 32 dental therapists who are now practicing since the state’s law was passed.
ER room: A bad alternative for the dentist’s office
In these rural towns, people often wait until something is bothering them to visit the dentist. Toothaches, swollen gums and teeth falling out are among some of these issues, and chronic bad breath can be a red flag of underlying problems. As a consequence, these patients end up in emergency rooms instead of a dental office. The Pew Center on the States estimated that more than 830,000 emergency room visits stemmed from preventable dental conditions in 2009.
“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 told USA Today. “We’re managing pain without getting to the source of the problem.”
Resistance on the front lines
Palliating symptoms such as gum disease, chronic halitosis and tooth decay are short-sighted fixes. And even though the need for dentists is widespread, the American Dental Association is strongly against states approving dental therapists.
“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 association said in a statement.
The Maine Dental Association (MDA) lobbied heavily against the bill, arguing that the University of New England College of Dental Medicine, which opened last fall, will offset future shortages.
Dr. Jonathan Shenkin, who represented the MDA, said creating a new provider does not address the core issue – people aren’t accessing dental care because they cannot afford it.
Whether it’s the costly dental bills or lack of access – or both, as it likely is – a solution is in the works. In the meantime, people should pay close attention to their oral health by brushing twice a day, flossing once a day and making smart food choices. In the wider scope of things, 53 nations, including Canada, Australia and Great Britain allow dental therapists.