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Research & Commentary: Addressing Idaho’s Dental Health Shortage with Dental Therapy

February 26, 2019

In this Research & Commentary, Matthew Glans examines a new proposed law in Idaho that would allow the Idaho Board of Dentistry to license dental therapists, a reform that could help address the state's dental health shortage.

According to U.S. Department of Health and Human Services data, nearly 58 million people in the United States live in areas with dental shortages, and this is likely to worsen in the coming years. The Health Resources and Services Administration projects by 2025 the number of dental shortage regions will more than double from, 7,000 to 15,600. Additionally, access to care continues to be limited for the 72 million children and adults who rely on Medicaid and the Children’s Health Insurance Program. Only about one-third of U.S. dentists accept patients on Medicaid.

Like most states, Idaho faces a growing dentist shortage. According to the Idaho Department of Health and Welfare, there are 42 dental health professional shortage area designations for geographic areas and populations across the State of Idaho. These designations cover a total of 97 percent of the state’s land area.

At the state level, one of the primary contributing factors that reduce dental access and increases costs is strict licensing requirements. Supporters of strict state licensing standards argue they assure quality care, but critics cite the arduous and often expensive licensing process. Onerous licensing criteria are a barrier to entry that harms the dental market by hindering new providers, thereby impeding the market competition needed to lower costs and improve access for patients.

Thankfully, for states like Idaho that have a dearth of dental services, there is a simple solution that would expand dental care access and lower costs: dental therapists. States across the country are increasing the number of licensed dental therapists operating within their borders to help resolve their dental care shortages.

In 2009, Minnesota became the first state to authorize increased licenses for dental therapists. Based on the available evidence, Minnesota’s reforms have been positive. After just one year of expanding licenses for dental therapists, patient visits increased by 27 percent.

A new bill has been introduced in Idaho that would authorize the Idaho Board of Dentistry to “license mid-level dental providers who would be called dental therapists, who have completed education and training requirements prescribed by the Board, to perform a scope of procedures as set forth by the Board, only under the supervision of licensed dentists in Idaho.” The bill would require therapists to complete a course of study in dental therapy, graduate from a dental therapy school accredited by the Commission on Dental Accreditation of the American Dental Association, and complete 500 hours of supervised clinical practice under the direct supervision of a dentist.

How these laws are fashioned is important. Any new law authorizing dental therapists must ensure regulations only mandate general supervision, not direct supervision. If direct supervision is required, then a dental therapist would need to be in the direct company of a dentist to provide dental services, significantly reducing the benefits of expanding dental therapy.

The Idaho bill would have the state’s dental board determine the appropriate levels of supervision for each authorized service or procedure; Idaho legislators should ensure the level of supervision for services is not so high as to undermine the capabilities of the new dental therapists.

The path to becoming a dental therapist requires significant training, but it is far less costly and time consuming than becoming a dentist. Since therapists are permitted to provide a smaller range of services compared to those offered by dentists, they can complete their education for around $36,000 and more easily enter the marketplace, where they provide less-expensive treatments to patients—without sacrificing quality of care.

According to a report in the Journal of Public Health Dentistry, children and adults served by dental therapists receive more frequent preventive care, which leads to a reduced need for invasive teeth extractions compared to those who don’t have access to basic care.

For most patients, dental therapists provide a cost-effective alternative to dentists. According to a case study conducted by Apple Tree Dental, sponsored by The Pew Charitable Trusts, dental therapists are a vital and affordable part of many rural dental teams. The study found the therapists’ average daily billing was “94 percent of the average for the clinic’s dentists ($2,792 compared to $2,951).”

As the Pew Charitable Trusts notes, midlevel providers like dental therapists are already authorized to provide routine preventive and restorative care in more than 50 nations. “Research has confirmed that they provide high-quality, cost-effective routine care and improve access to treatment in parts of the country where dentists are scarce.”

A Policy Brief published by The Heartland Institute and Texas Public Policy Foundation points out, “Blocking dental therapy undermines licensed dentists’ liberty to treat patients to the best of their abilities as determined by the dentists’ consciences and professional judgment. Ironically, opponents of dental therapist licensing would also diminish licensed dentists’ ability to grow their practices.”

States ought to permit dental therapists to practice without a dentist physically present and ease the regulatory burden on dental therapists. These reforms would help patients receive preventive and restorative treatment in a timely and affordable manner.

The following articles examine dental health care and dental therapist licensing in greater detail.
 

Dental Therapists Could Solve Dental Care Crisis
https://www.postregister.com/opinion/guest_column/dental-therapists-could-solve-dental-care-crisis/article_0ba35c6b-24fc-566d-9a7b-51bcbfdbc465.html
Phil Haunschild of the Idaho Freedom Foundation discusses the growing dental health care shortage in Idaho and how the creation of dental therapy licenses would help address the problem.

Dental Utilization for Communities Served by Dental Therapists in Alaska’s Yukon Kuskokwim Delta: Findings from an Observational Quantitative Study
https://www.heartland.org/publications-resources/publications/dental-utilization-for-communities-served-by-dental-therapists-in-alaskas-yukon-kuskokwim-delta-findings-from-an-observational-quantitative-study
This study from the University of Washington examines whether dental utilization rates in Alaska Native communities were associated with the number of dental therapist treatment days and quantifies differences in dental utilization rates between communities without dental therapist treatment days and those communities with the highest number of dental therapist treatment days.

The Case for Licensing Dental Therapists in North Dakota
https://www.heartland.org/_template-assets/documents/publications/Policy%20Brief%20Dental%20Therapy%20North%20Dakota.pdf
In this Policy Brief, Michael Hamilton, Bette Grande, and John Davidson ask North Dakota lawmakers: “Does licensing dental therapists in North Dakota pose a risk to public health great enough to justify depriving (1) dentists of their right to employ and supervise dental therapists and (2) patients of their right to access providers of their choice?” They argue the answer is clearly “no.” Far from jeopardizing the public health, licensing dental therapists would likely expand patient access to high-quality oral care services and reduce oral care costs in North Dakota.                                         

States Consider Authorizing Dental Therapy to Expand Access
https://www.heartland.org/news-opinion/news/states-consider-authorizing-dental-therapy-to-expand-access
Mary Tillotson writes in Health Care News about the movement by several states to consider allowing dental therapists additional power to treat patients. “Millions of rural Americans lack access to proper dental care, a shortage 12 states are considering filling by authorizing dental therapy, an oral-care-industry profession roughly equivalent to a physician assistant or nurse practitioner,” wrote Tillotson.

Early Impacts of Dental Therapists in Minnesota
https://www.heartland.org/publications-resources/publications/a-review-of-the-global-literature-on-dental-therapists
The Minnesota Department of Health and Minnesota Board of Dentistry examine in this report how authorizing dental therapy in Minnesota resulted in increased access for previously uncared-for patients.

A Review of the Global Literature on Dental Therapists
https://www.heartland.org/publications-resources/publications/a-review-of-the-global-literature-on-dental-therapists
This report from the W.K. Kellogg Foundation provides a 460-page review of the benefits of dental therapy as demonstrated in more than 50 countries.

How Reforming Licensing Laws Can Help Fix America’s Dentist Shortage
http://reason.com/blog/2016/08/22/how-reforming-licensing-laws-can-help-fi
Eric Boehm, a reporter at Reason.com, examines the dentist shortage and argues in favor of reforming state dental licensing laws for dental therapists as a potential solution. “Children’s Dental Services … treats about 30,000 patients each year, mostly from the Twin Cities’ Hispanic, Hmong and Somali immigrant communities. The dental therapy model was first adopted by nonprofits and community clinics to lower costs, says Karl Self, the director of the University of Minnesota’s therapy program. But now, Dr. Self adds, private practices are hiring dental therapists, too. ‘We’re seeing that dental therapists can add value to the overall oral health team,’ he says.”

Dental Care Health Professional Shortage Areas (HPSAs)
http://kff.org/other/state-indicator/dental-care-health-professional-shortage-areas-hpsas/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D  
The Kaiser Family Foundation analyzes the dental care health professional shortage areas in each state in order to show which states have the largest discrepancies in dental-care access.

Pew Charitable Trust: Dental Campaign
http://www.pewtrusts.org/en/projects/dental-campaign
Pew Charitable Trust has been providing research and analysis to encourage state lawmakers to allow dental therapists in their states to ensure patients have greater access to preventive and restorative treatment services. “Pew’s dental campaign works to close gaps in dental-care access by increasing the number of available providers and expanding the reach of preventive services through the use of dental sealant programs in high-need schools. Research shows that such programs are a valuable, cost-effective way to treat the children most at risk of tooth decay.”

5 Dental Therapy FAQs
http://www.pewtrusts.org/en/research-and-analysis/q-and-a/2016/04/5-dental-therapy-faqs  
While states continue to grapple with what dental therapists are, how much education dental therapists receive, and where therapy is practiced, Pew Charitable Trusts has put together a helpful FAQ page to answer the most important and difficult questions related to dental therapy.

 

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit The Heartland Institute’s website and PolicyBot, Heartland’s free online research database.

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Author
Matthew Glans joined the staff of The Heartland Institute in November 2007 as legislative specialist for insurance and finance. In 2012, Glans was named senior policy analyst.
mglans@heartland.org @HeartlandGR