health care

America Doesn't Have Enough Dentists

And dentists are partially to blame.

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Ingram Publishing/Newscom

When state Rep. Jason Sheppard (R-Lambertville) was a county commissioner in Monroe County, Michigan, the local community health clinic decided to start offering dental services. In one way, the effort was a success: "There was an immediate influx of patients," Sheppard recalls. The only problem? Finding dentists to treat them.

That sort of supply-side problem in health care is not unique to Michigan. According to the U.S. Department of Health and Human Services, more than 5,000 localities lack adequate access to dental care, which the department defines as having fewer than one dentist for every 5,000 residents. About 55 million Americans live in those areas. In Michigan alone, there are 270 such zones, mostly in inner cities and rural areas.

That's why Sheppard and other state lawmakers want to authorize dental therapists—mid-level health care professionals akin to physician assistants or nurse practitioners—to fill cavities and treat other basic dental problems. The goal is to get more trained dental professionals into the field. The idea is being opposed by much of the established dental industry: The American Dental Association (ADA) and state-level trade organizations of dentists have opposed such bills, citing concerns about therapists' level of training. In Florida, the state trade association has likened dental therapy to a hurricane.

That's bunk. Dental therapists take take the same classes and exams as their colleagues who go on to become full-fledged dentists. They merely skip more advanced classes in reconstructive work and oral surgery—and the bills being considered don't authorize them to do that work. If dental therapists can assume a greater role in providing basic care, full-fledged dentists can spend more of their time focused on the more difficult and sophisticated cases.

That seems to be working in Minnesota, which became the first state to legalize dental therapists in 2009. There are now more than 70 licensed to practice, working under the supervision of dentists. The Federal Trade Commission has urged dental school accreditors to clear the way for mid-level professionals like these, arguing that they can "increase the output of basic dental services, enhance competition, reduce costs, and expand access."

As The Washington Post pointed out earlier this year, the ADA's opposition is a serious stumbling block in most states.

"Dentists do everything they can to protect their interests—and they have money," Maine state Rep. Richard Malaby (R-Hancock) told the Post.

The dental shortage is likely to get worse in the next few decades. According to the ADA's own numbers, about a third of American dentists are over the age of 55 and thus nearing retirement. The lack of dentists is a problem felt most acutely by low-income individuals and families. According to the Pew Charitable Trusts, federal Medicaid data show that about 14 million children from low-income families did not receive any professional dental care in 2011.

Subsidizing care through federal, state, or local government programs can't solve this problem. To address the shortage, you need to get more dental professionals into the field.

A bill to legalize dental therapists in Michigan cleared the state Senate earlier this year—despite objections by the Michigan Dental Association—and could be taken up by the state House when it returns to legislative session in January.

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14 responses to “America Doesn't Have Enough Dentists

  1. The dangers of unlicensed dentistry were explored thoroughly in McTeague…

    1. Indeed, the unintended consequences of getting, ‘ze authorities’ involved.

  2. It used to be that dental school was for those who couldn’t make it to med school-so the field still suffers from a lack of prestige. I remember hearing a while back that starting about 1990, dental schools relaxed their GPA requirements so there wouldn’t be a shortage. Sounds like its not working.

  3. Loyola, Northwestern ………… have closed their dental schools while keeping their law schools open. There are way too many lawyers. There is way too much poor planning on campuses.

  4. But whether the Constitution capitalism really be one thing, or another, this much is certain – that it has either authorized such a government economy as we have had, or has been powerless to prevent it.

    Updated Spooner.

    Now, it’ll be tempting to hear the slander against a favorite buzzword, and get all het up. Keep in mind that it could be noisy, and maybe even fun, but we’d still be living under an economy with every appearance of guild control and a severe allergy to free markets.

  5. Even worse, idiots around the country are voting to remove fluoride from their water supply so now more poor people will start having tooth decay.

    1. That poison in your tap water is useful up to the age of 7. If no one in your house is under 7, get the filter. Source: dentist.

      1. If no one in your house is under 7, get the filter. Source: dentist.

        Brushing needs to be done anyway and putting highly concentrated fluoride on your teeth for 2×2.5 min. twice a day is as effective as swilling tap water all day long (otherwise, the dentist doing it once every 6 mos. would be worthless). Since you have to brush why have it in the water?

    2. Fluoride doesn’t prevent tooth decay nearly as well as good dental hygiene does.

      Also, from a libertarian standpoint, the issue isn’t exactly fluoride itself as much as it is paying extra for fluoride and getting extra lead when most people drink bottled water or other beverages anyway. You wouldn’t believe the number of people who regard me as some sort of pond scum swilling crack head for ordering/drinking tap water.

      1. Ew, you drink tap water? You pond scum swilling crack head!

    3. Fluoride give me really bad acid reflux, which not only destroys my teeth but also my esophagus.

      1. Same here.

  6. Dental therapists take take the same classes and exams as their colleagues who go on to become full-fledged dentists.

    Sometimes it seems that all they ever do is take… take… take.

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