health care

Dental Association Pushes Nonsensical Argument Against Dental Therapists

Mid-level dental providers can fill cavities and provide other basic dental services, allowing full-fledged dentists to focus on patients with serious problems.

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Zeljko Dangubic/Westend61 GmbH/Newscom

More states are considering legalizing mid-level dental professionals, known as "dental therapists," who have more training than hygienists but not as much as dentists.

Only four states (Alaska, Maine, Minnesota, and Vermont) have legalized the practice so far, but bills to allow dental therapists to work alongside traditional dentists have been introduced in a handful of other states this year, NBC News reported this week.

Increasing the supply of trained dental professionals would help expand access to dental care, something that many Americans unfortunately can't take for granted. According to guidelines from the U.S. Department of Health and Human Services, there are thousands of areas in the country experiencing a shortage of basic dental services (defined by the department as an area with more than 5,000 residents per dental provider), mostly in inner cities and sparsely populated rural areas.

In Minnesota, dental therapists have helped to address that shortage. As I wrote last year in the Wall Street Journal, dental therapists in Minnesota are helping to address that shortage by expanding existing dental practices and helping more people have access to care. Many of the children who see dental therapist Christy Jo Fogarty at the Minneapolis-based Children's Dental Services have never been to a dentist before because few dentists choose to set up practices in poor areas and only 40 percent of dentists nationally accept patients on Medicaid.

This sounds like a win-win, but the American Dental Association, which represents licensed dentists, is worried about the growth of dental therapy, as NBC News highlighted in its piece.

"They are licensed, and have taken boards," says Dr. Jane Grover, director of the ADA's Council on Access, Prevention and Interprofessional Relations. "Why wouldn't you want to have dentists treating patients that have high levels of disease?"

Grover is right about that last part. Dentists have a higher level of training than dental therapists and are able to treat a wider range of dental issues. Someone with "high levels of disease" absolutely should be treated by a dentist, if not a specialist.

That doesn't mean dental therapists are untrained. At the University of Minnesota, getting a master's degree in dental therapy requires 32 months of dedicated course work, taking the same classes as dental students who stay for the full 48-month program. After passing a state exam, dental therapists are authorized to clean teeth, take X-rays, and fill cavities, but they cannot do orthodontic or reconstructive work.

Grover is trying to confuse two related, but separate issues. Increasing access for mid-level dental providers actually fixes both.

Dental therapists are filling a much-needed gap in the supply of dental professionals who can perform basic treatments, giving more patients access to essential dental care. In turn, that allows dentists to focus on the more serious cases—the people with "high levels of disease" or problems that go beyond cavities.

This is really about the ADA trying to block what it sees as unwanted competition from new providers. State-level dental associations have fought dental therapy bills for the same reason.

Yet, in reality, this supposed threat of increased competition has resulted in cooperation that's good for both dentists and patients. One dentist in rural Minnesota who I spoke with for the Wall Street Journal piece, John Powers, told me that he was initially skeptical of dental therapists but now employs four of them because being able to treat more patients helps his bottom line.

The Federal Trade Commission has urged dental-school accreditors to clear the way for mid-level professionals like therapists, arguing that they can "increase the output of basic dental services, enhance competition, reduce costs, and expand access."

States should clear the way for more mid-level dental professionals—even restricting them to practicing only in areas with dental care shortages or under licensed dentists, as has been proposed in some places. Restricting the supply of dental care does nothing to help patients and probably doesn't help dentists either, regardless of what the ADA says.

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  1. Good article, but restricting the supply of those who provide dental care doesn’t help those who are currently providing that dental care? We need more “proof” than one dentist who likes the arrangement before we throw out the laws of supply and demand.

  2. I am too lazy to find the link(s) if there are any, but years and years ago the US Air Force studied the dental health of incoming recruits, and those who came from states where dentistry was LESS regulated, came in with better dental health!

    1. Why aren’t you too lazy to post some bogus recollection from “years and years ago”?
      This is fake info if I ever saw it…

  3. As the husband of a dentist I can say without waiver that these so-called dental therapists are a scourge on my ability to buy everything I want.

    My wife started in Maine after dental school working at a corporate dental office. Lack of care is a real problem in the state. They have legalized numerous non-dentist dentist for many years. They had denturists to make people dentures without a dentist present and hygiene patients had to only be checked by a dentist one time a year (as opposed to at every visit in Indiana). Maine’s other issue is until maybe 5 years ago Maine didn’t have a dental school and the new graduates are probably 1 or 2 years out at this point.

    Also, who wants to live in Aroostook County and provide services to people up there? I think it would be great and I would happily move up there but I am an odd bird.

  4. Nah. This won’t solve the problem. What you need is education. How about a government grant, to make educational commercial segments? And then you could play them during morning cartoons, when the children are watching. And you could come up with a catchy song that still goes ’round and ’round in the watcher’s head, 45 year later, like a satanic cursed earworm, after teeth have become a thing of the past for the poor demented victims.

  5. Access to care issues are primarily geographic and financial. Geographic access problems result from maldistribution where there are people living in an area with zero or too few dentists. Financial access problems result from people seeking but not finding nearby providers who accept Medicaid (or CHIP for children) to pay their bill or uninsured people need a sliding scale to reduce the bill to what they can afford. Lack of Medicaid dentists results from ever declining reimbursements and severely reduced services covered and ever increasing complexity to participate.
    The author simply parrots others who promote the myth that dental therapists will solve the problems of Access to Care. There are no real connections between graduates of dental therapy training programs and Access to Care in the US…it totally depends on the job ad the dental therapist answers.
    The countries that successfully addessed Access to Care had well-funded public health systems committed to making it happen. The hero was never the therapist, it was the system. The US does not have that. No country on this planet ever solved access issues by simply expanding the workforce.

  6. Eric Boehm, you are nonsensical to take a couple of sentences from someone’s interview and call that the official “push” from the dental association.
    It is very nonsensical of you to confuse the public health concern for the unmet needs of the underserved and the ability of dental therapists to add to the bottom line of existing dental offices.
    It is a myth that dental therapists are the hero that will magically conquer the existing problems for the Medicaid population or the working poor. Publish the evidence that dental therapists “enhance competition, reduce costs, and expand access.” They are employees…and the degree to which they help the underserved is totally dependent on the mission of the place where they work. Only in FQHCs and non-profit settings do they make a substantial difference. Half of Minnesota’s dental therapists work in those settings…and half don’t.

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