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.