Occupational Licensing

How Reforming Licensing Laws Can Help Fix America's Dentist Shortage

More states should follow Minnesota's lead by legalizing mid-level dental professionals.


Jo Kirchherr/Westend61 GmbH/Newscom

Few people look forward to a trip to the dentist, but regular access to basic check-ups can prevent the vast majority of painful—and expensive—dental issues.

It's a shame, then, that there are thousands of communities across the United States experiencing a shortage of dental care. It's a problem that cuts across cultural and political boundaries, with shortages found in rural farming towns and densely populated inner cities. Oftentimes, shortages pop up in poor communities because only about one-third of dentists in America accept patients on Medicaid.

As I wrote in this weekend's edition of the Wall Street Journal, some states are taking steps to address this shortage in basic dental care by reforming licensing laws to create a new classification of dental professional.

Dental therapists are not massaging patients' teeth and gums; they are specialists with years of training. At the University of Minnesota, getting a dual bachelor's in dental hygiene and master's in dental therapy requires 32 months of dedicated course work, taking the same classes as dental students who stay for the full program. After passing a state exam, dental therapists are authorized to clean teeth and fill cavities, though they cannot do orthodontic or reconstructive work.

Once in the field, therapists must work under the supervision of a licensed dentist, either in private practices or a public health clinic. Seven years after the first dental therapists were licensed (in Minnesota), there are now more than 60 across the state.

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.

Alaska, Maine and Vermont have also legalized dental therapists. Native American tribes in Washington State and Oregon have them too.

Too often, entrenched political interests prevent this sort of innovation from taking place. Michigan Dental Association is fighting a dental therapy bill in that state, despite the fact that there are more than 200 communities in Michigan lacking access to basic dental care that could benefit from having more people authorized to fill cavities. In Texas, a trade group of dentists helped defeat a similar bill in 2015.

In Minnesota, the initial opposition to dental therapist among the state's dentists has passed. Now, private practice dentists are hiring dental therapists so they can treat more patients and make more money. It's an arrangement that's good for the public's heath and good for the bottom line too.

Read the whole thing here.

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  1. As the husband of a dentist I can without a doubt say they need more regulation and protections. This new Ferrari won’t pay for itself.

  2. Nurse Practioners for dentistry.

    I’m sure you hear the same arguments against allowing somebody who’s perfectly capable of handling 99% of the situations they’re seeing to not be allowed to do so because “what about that 1% of the time when somebody has some rare disease and the NP doesn’t catch it?” The vast majority of medical practice involves treating stuff like sinus infections, not Mongolian Rhinoceros Foot Blagophomia that you can only get by eating raw chicken while sky-diving during a snowstorm in October.

    1. you can only get by eating raw chicken while sky-diving during a snowstorm in October.

      Dammit, now I have to reschedule my trip.

    2. Don’t nurse practitioners work under the supervision of a doctor?

  3. This is the sort of issue where reason and statistics do not matter to people.

    This is one of the outcomes from a high percentage of Americans (vast majority of Ds) believe that government is ‘good’ and government is the ‘solution’ to anything potentially negative.

    1. But it is the sort of issue that saves people money. And everyone cares about that.

      And it’s not as if the Dental Therapists aren’t licensed and regulated. So people can rest assured that daddy government is keeping them safe.

      1. Basically it’s allowing inferior products to be provided at cheaper prices. Just as in healthcare, I’d be pessimistic that the public will prefer it over, say, the alternative option of trying to get govt to force cheaper prices for higher quality.

        1. Basically it’s allowing inferior products to be provided at cheaper prices.

          And you know the product is inferior how? Seriously, you don’t need a medical degree to clean teeth. I’ve never had an actual dentist clean my teeth – it’s always an assistant of some sort. Filling cavities fits right in there too. Removing the up front cost to be licensed allows these DTs to perform the exact same service at lower price points.

          1. It’d be a dental hygienist who cleans your teeth.

            Dental assistants assist dentists with procedures ? if you’ve ever had a cavity filled, the dental assistant is the second person.

            Dental hygienists are educated more and paid more and can do more things that a dental assistant.

        2. Dental therapists work under the supervision of a dentist just like dental hygienists.

  4. It’s not just about costs. It’s about THIS option. The program in Minnesota ran into the same problem access to care typically runs into….once people are educated in more urban areas, they tend to want to stay there. Getting people to go to rural, more desolate areas after they meet their professional spouses and dine and shop in a plethora of restaurants and malls is more difficult. The rural space looks less appealing. Jobs for their partners are less available. That’s why the dental therapists in Minnesota have mostly stayed in urban areas, too. We have a distribution problem….not a lack of professionals to help people. Incentivizing loan paybacks or start ups would be a better way to solve the access to care issue, in my opinion. People in rural areas often understand their trade off….they might have to drive to get the access to things they want.

    And, not every dentist drives a Ferrari. Maybe those who serve the wealthy population and charge for it do, but many don’t–but this is the case in almost every business. Most rural dentists in Medicaid type clinics make $100-$150K, then they pay off their loans for 7-10 years. After 8 years of school and 8 years of loan repayment, and 16 years of serving the healthcare profession, if someone wants to save up for a Ferrari–so be it. Don’t be fooled, some of those dentists driving Ferraris are only leasing Ferraris. The pressure to look successful is often the achilles heal for many professionals–not just dentists.

  5. But it is the sort of issue that saves people money. And everyone cares about that.
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  6. Basically it’s allowing inferior products to be provided at cheaper prices. Just as in healthcare.
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