More States Adopt Laws to Boost Oral Health Care Workforces
PEW ARTICLE | August 9, 2019 | By: John Grant
Six states have passed laws in the past 12 months authorizing dental therapists to practice in a role similar to physician assistants in medicine. The addition of Connecticut, Idaho, Nevada, and New Mexico in 2019—along with Arizona and Michigan in 2018—brings to 12 the number of states that allow dental therapy in some capacity.
Nearly as many are considering dental therapy laws or regulations intended to increase access to oral health care, particularly in underserved communities. Just five years ago, only three states had put any similar measures in place.
Dental therapists work under the supervision of a dentist, providing preventive and routine restorative care, such as filling cavities or placing temporary crowns. Although they first entered the U.S. workforce in 2005, these midlevel providers have been practicing elsewhere for nearly 100 years. More than 50 countries allow this approach to expand the reach of dental practices.
Most recently, Nevada and Connecticut joined the list of states that have passed laws authorizing dental therapy. In Nevada, dental therapists support safety net providers, such as federally qualified health centers, rural health clinics, tribal health clinics, and other entities that serve Medicaid patients or those who are low-income and uninsured.
Legislation authorizing dental therapy received broad support in New Mexico and was signed into law this past spring. Just weeks before the law passed, Ben Larzelere, a retired Lutheran pastor in Santa Fe, made the case for the change in the Sante Fe New Mexican as lawmakers were considering what to do. “We can no longer ignore a health crisis that plagues our state and so many of our most vulnerable. We know how to remedy this health crisis,” Larzelere wrote. “All it takes is a concerned community, an enlightened and caring government, and the laws needed to turn hope into reality.”
Allowing dental therapists to practice represents a proven path to broadening access to care. Research from Alaska demonstrates that oral health outcomes improve in places where these providers work. A 2018 study published in the Journal of Public Health Dentistryfound that children and adults in Alaska Native communities served by dental therapists had lower rates of tooth extractions and more preventive care than those in similar communities that did not have these services.
In Minnesota, which authorized dental therapists to practice in 2009, case studies show that patients and other dental team members report high satisfaction with dental therapists. Similarly, staff reported good collaboration and positive relationships with the dental therapists.
Some state dental associations that may not have supported the idea of dental therapists early on now acknowledge the profession and its role.
For example, this year’s legislative material from the Alaska Dental Society highlights the importance of dental therapists. “Together with dental hygienists, dental therapists, and other dental team members, the dentists of Alaska, whether in private practice, tribal entities, or federal clinics, work hard daily to improve the oral health of Alaskans,’’ the appeal to lawmakers says. “Oral health in Alaska, as reported by Alaskan residents, ranks noticeably higher than the overall U.S. population.”
And patients appear enthusiastic as well in states that have allowed dental therapists to practice.
“It’s been a fantastic response from our patients,” Minnesota dentist David Gesko said in a recent interview. “The patients have accepted dental therapists from day one. Patients love that these new providers are willing to see them, help them, and deal with their dental problems.”
More states could soon join Minnesota. In Wisconsin, legislative proposals this year have come from both the governor and a bipartisan group of lawmakers. A hearing for legislation sponsored by Assistant House Majority Leader Mary Felzkowski is expected in the days ahead. Fifty organizations across the political spectrum back dental therapy in the state. And one recent study hints at the potential economic benefit: The data show more than 41,000 emergency room visits a year in the state for preventable dental conditions—at a cost of nearly $25 million annually.
Additional research helps build the case. For example, a recent report by the Association of State and Territorial Dental Directors (ASTDD) says that state policymakers should consider dental therapy a best practice when assessing how to boost access to oral health care for underserved populations. And newly released polling data show that 71 percent of Americans said they would be willing to receive dental care from these lower-cost providers.
So far, Alaska, Arizona, Connecticut, Idaho, Maine, Michigan, Minnesota, Nevada, New Mexico, Oregon, Vermont, and Washington have authorized the practice of dental therapy, and more are likely to follow.
Although no single approach can fix every dental care need, these practitioners continue to prove their value and help practitioners meet the continuing demand. The 72 million children and adults relying on Medicaid and the Children’s Health Insurance Program face a scarcity of care. Meanwhile, 56 million Americans live in areas with dentist shortages. These populations and others benefit from increasing the ranks of dental therapists bringing care to their communities.
John Grant directs The Pew Charitable Trusts’ dental campaign.