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Research & Commentary: Dental Therapists

August 30, 2016

In this Research & Commentary, state government relations manager Logan Pike discusses why states should reform their licensing laws to allow for dental therapists to practice.

Research & Commentary: Dental Therapists

A growing number of states and tribal communities are allowing dentists to employ dental therapists to help meet the growing need for routine dental care.

The Pew Charitable Trust defines dental therapists as “midlevel providers, similar to physician assistants in medicine, whom dentists hire to extend quality care to more patients, expand their practices, and deliver treatment to underserved populations.” They can also bring care directly to schools or nursing homes under the supervision of a dentist. Dental therapists provide preventive and routine care, such as filling cavities, placing temporary crowns on teeth, and extracting severely diseased or loose teeth.

In 2009, Minnesota became the first state to authorize the licensing of dental therapists. After the first year of licensing, patient visits increased by 27 percent and an additional 214 Medicaid patients were served. In 2016, legislation was filed in 12 states to authorize dental therapists.  Dental therapists are currently practicing in Alaska and Minnesota, and they have been authorized to practice in Vermont and in tribal communities in Oregon and Washington State, which are in the process of implementing their laws. Dental therapists are also operating in at least 50 countries

Opponents of dental therapy claim therapists are insufficiently trained and would put patients at risk, but proponents argue therapists can increase the output of basic dental services, enhance competition, reduce costs, and expand access.

Dental therapists receive rigorous training in the most commonly needed routine procedures in dental care. Under the Commission on Dental Accreditation’s national dental therapy accreditation standards, students must receive at least three academic years of full-time instruction, including clinical experience. For certain areas of practice, dental therapists receive the same training as dentists. More than 1,000 studies from across the globe found no quality concerns for these mid-level providers.

According to U.S. Department of Health and Human Services data, more than 48 million people in the United States live in areas with dentist shortages, and this is likely to worsen in upcoming years. The federal government projects by 2025, the shortage of dentists will more than double. Access to care is also 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.

The problem is severe among children and senior citizens. Over 18 million low-income children went without dental care, including routine exams, in 2014. Three out of four children with Medicaid across four states did not receive the dental services for which federal law requires coverage, and one in four did not visit a dentist between 2011 and 2012.

In 2014, senior citizens made up 15 percent of the U.S. population, and their share of the population is expected to nearly double by 2060. As the number of senior citizens increases in the coming decades, the demand for care for this age group will increase, which will create significant problems since nearly 40 percent of seniors did not visit a dentist in 2014.

Dental health problems can impair children’s growth and development, hinder productivity and job opportunities, and complicate detection of oral cancers. According to Pew Charitable Trusts, more than two million people in 2012 resorted to emergency room visits for dental pain, costing taxpayers $1.6 billion, with Medicaid’s share totaling $520 million. Tragically, 101 people died in hospital emergency departments from 2008 to 2011 due to preventable dental disease.

The field of dentistry is changing, and states desperately need to reform the care delivery system to address oral-health needs. Regular access to basic check-ups can prevent the majority of painful and costly dental issues. Dental therapists can improve the productivity and efficiency of dental practices, help increase access to care, give dentists the option to serve more patients inside and outside the office, and free up dentists to focus on more complicated procedures.

Lawmakers should work to close gaps in dental-care access by reforming dental licensing laws to allow for dental therapists and ensure patients get preventive and restorative treatment when and where they need it.

The following documents provide additional information about dental therapists.

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.

Older Americans Need Better Access to Dental Care
http://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2016/07/older-americans-need-better-access-to-dental-care
Almost 40 percent of seniors did not visit a dentist in 2014. As the number of older Americans increases in the coming decades, the demand for care for this age group will intensify. In this fact sheet, Pew Charitable Trusts examines the health risks seniors currently face, from poor access to mental health services to dental-care barriers. “The use of dental services declines as people age due to a variety of factors. Perhaps the single greatest barrier is the inability to afford care. Seniors with dental insurance are 2.5 times more likely than those without coverage to visit a dentist, and about half of seniors lacked insurance in 2015.”

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 Health Care News at https://www.heartland.org/publications-resources/newsletters/health-care-news, The Heartland Institute’s website at http://heartland.org, and PolicyBot, Heartland’s free online research database at www.policybot.org.

The Heartland Institute can send an expert to your state to testify or brief your caucus; host an event in your state; or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact Logan Pike, state government relations manager, at lpike@heartland.org or 312-377-4000. 

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