States across the country are moving ahead with laws aimed at putting dental therapists to work.

Legislators and health advocates hope the mid-level provider model will serve as a cost-effective way of getting dental care to historically underserved communities across the U.S.

Often compared to physicians’ assistants or nurse practitioners in the medical world, dental therapists receive technical training in a range of routine preventive and restorative procedures and work as part of dentist-headed teams.

But the model continues to face opposition from state and national dental societies, who have long contended that only dentists are qualified to drill and extract teeth. Such resistance, combined with the complexities and costs of setting up educational programs for the workers have complicated efforts to deploy dental therapists, as Barbara Mantel reported in a recent story for Rural Health Quarterly.

“Almost anywhere where dental therapy is getting passed, it has been a tough battle,” Cheyanne Warren, a dentist who supports the dental therapy model explained in Mantel’s story.

Dental therapists have been employed in other countries for decades.

Fifteen years ago, Alaskan Dental Health Aide Therapists, the first dental therapists to work in the US, had to overcome legal challenges from national and state dental associations to provide care in remote tribal communities that had long lacked dentists. Since then, tribes in Washington, Oregon and Idaho have embraced the model.

In 2009, Minnesota became the first state government to authorize the use of dental therapists; Vermont, Maine, Michigan, Connecticut, New Mexico and Nevada have since followed suit and other states are considering legislation.

Still, at this point Minnesota is the only state where a dental therapist program is up and running. In Vermont, where a dental therapist law was enacted in 2016, Warren and other supporters have been pushing to set up a program to begin training the providers but they have encountered challenges along the way, Mantel reported.

“’We thought this process would be easier than it has been,’ Warren explained in the story. A major hurdle has been funding, Warren acknowledged.

“We had to search for money.”

With help from federal and philanthropic grants the effort has gained traction. Warren has created the curriculum and is moving forward with plans for a dental therapy training program at Vermont Technical College, a public college with a dental hygiene program, Mantel wrote. The next steps will be obtaining accreditation from the national Commission on Dental Accreditation (CODA) and from the New England Commission of Higher Education.

“’I think it is safe to say that we will have a class that starts in the fall of 2021,” Warren told Mantel. The program is expected to accept 12 students including dental hygienists who will study for four terms, and high school graduates, who will study for nine terms, Mantel reported.

“Warren hopes her program will become a regional provider of trained dental therapists, and it may have to if Maine continues down its current path,” Mantel wroter. “Despite enacting a dental therapy law five years ago, the state is no closer now than it was then to creating its own training program,” she noted. Restrictions written into Maine’s dental hygiene therapy bill have proven a significant barrier to putting dental therapists to work in the state, Mantel learned in her reporting.

“Unlike the laws in other states, Maine’s law does not allow dental therapists with sufficient experience to work without a dentist present. They must always be directly supervised,” Mantel observed.

“’Until and unless Maine law allows for a dental therapist to practice under general supervision … there is limited interest for standing up a program given the associated costs,’ Domma Giatas, the executive director of planning and communications at the University of Maine at Augusta, told Rural Health Quarterly

‘The need for direct dental supervision is a barrier to employment opportunities for those who might receive training, especially in rural areas,’” Giatas added.

The American Dental Association (ADA) declined an interview request for the story, but issued a statement to Rural Health Quarterly.

“There is a critical need to connect underserved people seeking care with dentists ready to treat them,” the organization stated. “This can be accomplished through community health worker outreach and improved funding for dental services in Medicaid.”

But the group’s proposed fix did not include dental therapists, Mantel wrote.

Reporters: Has your state enacted a dental therapist law? If so, are efforts moving forward to train mid-level providers and to put them to work?