America Doesn't Have Enough Dentists
And dentists are partially to blame.
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.