Expanded use of dental therapists on tribal lands gains editorial backing

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.

Photo: Dana via FlickrThe Swinomish Indian Tribal Community defends its recent hiring of a dental therapist as an act of tribal sovereignty, despite continued resistance from the dental community.

Photo: Dana via FlickrThe Swinomish Indian Tribal Community defends its recent hiring of a dental therapist as an act of tribal sovereignty, despite continued resistance from the dental community.

A recent news package in the Seattle Times detailed the challenges faced by poor Medicaid patients in seeking dental care.

Now members of the newspaper’s editorial board are calling for reforms they say would improve access to dental services in the state.

“Too many of Washington’s residents insured by Medicaid are not able to get the dental care they need, which endangers their general health as well,” they wrote in the editorial.

“Two simple things should be considered to improve the situation. The state could explore licensing dental therapists, who can provide limited basic services at a much lower cost than dentists,” the editors noted. “The other is to begin increasing Medicaid reimbursement rates, at least for certain patients, especially those at risk for costly health complications.”

“More providers and improvements in Medicaid funding for necessary dental care could improve the quality of life for thousands of people and could save taxpayers money,” they wrote.

While increased reimbursement rates have long been supported by organized dentistry, technically-trained midlevel dental providers have been fiercely opposed by many dental groups including the Washington State Dental Association.

In spite of such resistance, though, a dental therapist started work this month in Washington State.

He is part of a dental team serving the Swinomish Indian Tribal Community, a Puget Sound-based tribe. The Swinomish have defended the hiring of the therapist as an act of tribal sovereignty. But they expect legal challenges to their decision, the Times reported.

Therapists have been working in the tribal lands of Alaska for more than a decade. Variations of the model have also been in use in Minnesota and approved in Maine.

The providers, who often are compared to nurse practitioners, are trained to deliver a range of services including screenings, cleanings, preventive care, fillings and extractions. But while dental therapists work under the supervision of dentists, dental groups frequently contend that only dentists have the training to perform what they term irreversible surgical procedures such as drilling and extracting teeth.

Members of the profession should reconsider their opposition, the Seattle Times editors wrote.

“Dentists should view dental therapists and complementary, not competitors,” they said, citing Louis Fiset, the curriculum coordinator of the University of Washington program that has helped to train the Alaskan dental therapists.

“The use of dental therapists can make basic dental care more accessible to Medicaid patients and more affordable for people who are uninsured,” the editors said.

Meanwhile, in neighboring Oregon, state Sen. Laurie Monnes Anderson, a retired public health nurse, also has been speaking up for dental therapists.

“She said it makes sense to look outside the traditional dental care delivery box, especially considering the state of oral health among Oregon’s poorest residents,” wrote Sheila Hagar, who found a local angle on the Seattle story for the Walla Walla Union-Bulletin.

The therapist model has faced less resistance from organized dentistry in Oregon than in many other places, Hagar reported.

The Oregon Dental Association (ODA) supported 2011 legislation authorizing oral health pilot programs designed to explore the effectiveness of innovative delivery models — including dental therapists, Hagar wrote.

“We supported pilot projects so we can test out new ideas to see if they work specifically in Oregon,” ODA spokeswoman Christina Swartz Bodamer told Hagar. Two Native American tribes in the Coos Bay area of the state have sought state permission to approve a dental therapist pilot project for their communities, Hagar reported, citing the Lund Report, a nonprofit Oregon health newsletter.

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