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Many Poor Communities Lack Adequate Dental Care; Here's an Easy Way to Fix That

Alaska allowed dental therapists to practice within Native American communities. Ten years later the evidence is pretty clear.

Paul Kitagaki Jr./MCT/NewscomPaul Kitagaki Jr./MCT/NewscomIt's a conclusion that almost seems too obvious. Communities with greater access to dental care have fewer children and adults with serious dental problems.

That's the main take-away from a newly released University of Washington study comparing Native American communities in Alaska. Researchers from the Pew Charitable Trusts, the Rasmussen Foundation and the W.K. Kellogg Foundation collaborated on the project, which tracked the number of preventative services and invasive procedures performed on members of 58 tribes of Alaska Natives between 2006 and 2015.

In native communities where dental therapists are working, children and adults had more access to preventative care (things like dental exams, fluoride treatments, and cleanings) and a lower incidence of serious dental issues requiring invasive procedures like tooth extractions.

"These proven, tangible and dramatic shifts in improved access and care for children of color is a game changer as we seek to advance racial equity and tackle health disparities for children of color," said La June Montgomery Tabron, president and CEO of the W.K. Kellogg Foundation, in a statement announcing the study's release.

Alaska is one of only a handful of states to have legalized the practice of dental therapy—a mid-level health profession, similar to nurse practitioners and physician assistants. The study suggests other states should consider doing the same.

Oregon and Washington have passed similar laws allowing dental therapists to treat members of Native American tribes. Only Maine, Minnesota and Vermont have legalized dental therapy in a broader way, but the effects there have been similar to what happened in Alaska. A 2012 study by the W.K. Kellogg Foundation found that dental therapists in Minnesota increased access to care while providing "competent, safe and effective" treatment.

As I wrote in The Wall Street Journal last year, dental therapists in Minnesota are serving the northern and western reaches of the state—where patients used to drive more than an hour to the nearest dentist— and also provide additional access to care for the poorer, minority neighborhoods in the Twin Cities.

These are the places most likely to be without adequate dental care. Dentists tend to cluster in suburbs because that's where the highest concentrations of people who can afford regular care live.

The U.S. Department of Health and Human Services considers a dental shortage any more than 5,000 people per dental provider. As of December 2016, 5,400 places with a combined population of more than 51 million people in the U.S. fit the bill.

Dental therapists are perfect for these under-served populations, but the dentists' lobby sees dental therapy as a threat to its control of the market.

That's why the Michigan Dental Association is fighting a dental therapy bill, despite the fact that more than 200 communities in Michigan lack access to basic dental care. In Texas, a trade group of dentists helped defeat a similar bill in 2015. The American Dental Association has spent millions of dollars trying to block those bills and others in Ohio, Massachusetts, and Kansas; it also filed multiple lawsuits trying to stop the Alaska program.

Against therapy we now know with this study is an unqualified success.

The Federal Trade Commission has urged dental school accreditors to make 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."

Maureen Ohlhausen, acting chairman of the FTC, spoke earlier this week at the Federalist Society about some of benefits of expanding access to care in health professions, noting that states should view mid-level licensees like dental therapists and nurse practitioners as part of the overall effort to reform licensing laws.

Legalizing mid-level dental professionals is a practical, commonsense way for state governments to deal with a tangible health care problem. Self-interested special interests should not be allowed to block ideas that are proven to improve outcomes for children and adults.

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  • Citizen X - #6||

    Whaddaya mean, placing limits on the supply of a needed service results in that service's supply being limited?!

  • SQRLSY One||

    Dentists = = greedy bastards, for far too many of them at least...

    HOW LONG until we have to see a dentist to get a prescription for a tooth brush!?!??

  • Jerryskids||

    The Federal Trade Commission has urged dental school accreditors to make 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."

    Meanwhile, the FCC has urged CBS to advertise NBC programs, arguing that they can "increase the output of basic entertainment services, enhance competition, reduce costs, and expand access." As if "serving the public" is a real thing. With the possible exception of volunteers at a soup kitchen, nobody's serving the public. They're earning a paycheck and everybody's a size queen when it comes to paychecks.

  • Michael Hihn||

    With the possible exception of volunteers at a soup kitchen, nobody's serving the public. They're earning a paycheck and everybody's a size queen when it comes to paychecks.

    Say "hi" to Bernie for me, the next time you see him.

  • Longtobefree||

    Not going to happen until the therapists can make enough money to match the political contributions of the 'real' dentists.

  • frankania||

    Just come here to MEXICO for dental care--private enterprise competition at its best. I just had a crown replacement for 10 bucks! While my sister in New Orleans paid $800 for one.....the difference in price will pay for your free vacation! Seriously, I have been doing this for decades (until I moved to Mexico permanently).

  • jerbigge||

    The professional classes will protect their "turf" any way they can.

  • Agammamon||

    more than 200 communities in Michigan lack access to basic dental care.

    I'm going to call you out on this. What do you mean by 'lack access'? What's your criteria for that?

    Is it because they don't have a dentist within their particular municipality? How many of those 200 are small cities that form part of a larger metropolitan area?

    Is there a time limit you've established as 'reasonable' for how long or how far they should have to travel before getting to a dentist? If so, how long/far is it?

    As an example - I live in a community of 15,000 people and we have no dentist here. But I have 'access' to dentists in Yuma AZ, San Luis MX, Algodones MX, etc. All within less than an hour drive. In fact, it takes longer to cross the border back into the US from my dentist in Mexico than it does to get to him *and* get an annual checkup.

    Algodones does a massive amount of cross-border work (actually crossing *two* borders as Canadians vacationing down here go to Algodones for dental work) and is the largest concentration of dentists in Mexico.

    Not that I'm not onboard with increasing the scope of service providers, I'm just not willing to take these sorts of bald-faced assertions as meaningful anymore. Seen too many people twisting definitions to suit their activism to trust it anymore.

  • Michael Hihn||

    "more than 200 communities in Michigan lack access to basic dental care."
    I'm going to call you out on this. What do you mean by 'lack access'? What's your criteria for that?

    I'm going to call you out on this. What you quoted, if quoted properly, applies to a specific example in Michigan. The criteria was cited as

    Dentists tend to cluster in suburbs because that's where the highest concentrations of people who can afford regular care live. The U.S. Department of Health and Human Services considers a dental shortage any more than 5,000 people per dental provider. As of December 2016, 5,400 places with a combined population of more than 51 million people in the U.S. fit the bill.

    This is similar to the lack of Medicaid providers in many inner cities, no profits for providers, just a different cause.

    As an example - I live in a community of 15,000 people and we have no dentist here

    You should have three. And you admit the coverage is shitty:

    All within less than an hour drive

    You think it's fine that a low-income person should have to drive AN HOUR for a teeth cleaning ,.. from a dentist she can't afford.

    Oh.

  • BambiB||

    One major reason that medical costs are increasing is government involvement.

    Government rules and regulations not only cost hundreds of billions of dollars a year, but they cost thousands of lives as well.

  • Michael Hihn||

    Typical libertarian establishment ..... analysis and slogans, with no knowledge of the actual issue or market. Dental Therapists have been doing lower-cost procedures for over 50 years, as employees of dentists. So the licensing impact is mostly on provider profitability, not consumer prices.

    In the mid-60s, my own dentist had been practicing for less than 10 years, in a small rural suburb. But he already employed a "dental assistant" for lower-skill procedures, which allowed him to spend more of his time on the highest billable hours. The assistant could ONLY work for a licensed dentist – just as now, and like current Physician Assistants.

    My dentist's billing clerk was a relative. I saw just enough billings to see the pricing and profit impact for even a small solo practice.

    It's THOSE profits (on employees) that licensing protects …. but only for solo practice. In group practice, market competition is more likely to align prices with costs, especially in dentistry with more cash patients. (Group practitioners can't control hourly fees, but will likely perform more high-billing hours. Division of labor.)

    So … licensing reforms would mostly affect only the low-incomes noted here. In paid markets, more practitioners would be driven into group practice. No, "assistants" won't practice on their own. Competition would increase THEIR market power within group practices, with little (if any) additional impact on those consumer prices.

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