Editorial: No reason to artificially constrain supply of dental practitioners

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

Blog photo credit: Photo by U.S. Pacific Fleet via Flickr

Photo by U.S. Pacific Fleet via Flickr

In a recent editorial, The Washington Post endorsed the licensing of dental therapists to expand care to millions of Americans who lack it.

“Everyone seems to agree that there is a dental crisis in the United States, particularly among people in poor and rural areas. People who have dental insurance or the means to pay out of pocket can get a high level of care. Those without struggle,” wrote members of the newspaper’s editorial board in the July 14 piece.

In building their case, the Post editors harked back to the 2007 death of Deamonte Driver, a child on Maryland’s Medicaid program who died after his abscessed tooth went untreated. (I covered his story when I worked at the Post).

While Maryland has made some progress in getting more dental care to underserved people, including Medicaid patients, the Post editors noted “the situation across the country has not dramatically improved.”

“One potential solution is to license less-qualified ‘dental therapists’ to carry out some basic services, such as filling cavities, that currently only dentists perform.”

They cited a February paper from the Pew Charitable Trusts to back up their position.

The study, “Expanding the Dental Team,” examined three nonprofit settings where midlevel dental providers have been employed as part of larger dental teams. The paper concluded that the auxiliaries – dental therapists working in a tribal clinic in Alaska and in a safety net clinic in Minnesota as well as hygienists taking part in a telehealth project in California – had successfully extended services; and that their employment had been a cost-efficient method of delivering care.

Maine legislators recently approved legislation clearing the way for dental therapists to go to work in that state.

Several other states are also weighing measures that would allow dental therapists.

Yet such efforts are opposed by the American Dental Association, as the Post acknowledged.

“Instead of a focus on dental therapists, said ADA President Charles Norman, his group favors a broader package that will address many problems at once. Besides, he said, many dentists might find that dental therapists don’t make the financial sense that the Pew study suggests,” wrote the Post editorial board.

“Even if that’s so, it’s not a reason to continue artificially constraining the supply of qualified practitioners,” the editors concluded. “With the right training and supervision, dental therapists can do a lot of work that doesn’t require an advanced degree. If the finances don’t pan out in some places, fine. But state policy should not close off the option.”

1 thought on “Editorial: No reason to artificially constrain supply of dental practitioners

  1. Robert Bowman

    The lesson of nurse practitioners and physician assistants is relevant. Initially contributing to health access as required by legislation, steady changes have been seen for decades. This has substantially reduced the proportions in primary care, family practice, and where needed.

    New PA studies indicate clustering of physician assistants, with only 15% in rural locations, mainly because less than 25% are found in family practice positions – the only positions filled that distribute.

    NP and PA concentrations are found in urban settings with top concentrations of clinicians (often counties with medical schools or major system hospitals) and rural settings most concentrated (Marshfield, Cooperstown NY, Dartmouth-Hitchcock, around Geisinger).

    For dental assistants or any new workforce creation to distribute, the distribution would need to be legislated as a part of the design – a permanent design for dental access. If NP and PA had been required to remain in family practice – the primary care and the distribution where needed would be more than doubled. Going backward is likely an impossibility – especially with ever greater movements to more independence. This design, if it is truly specific to dental access, must be set this way at the start with a clear understanding that dental access will retain the top priority for decades to come.

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