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Research & Commentary: Dental Therapists and Hygienists Should Play a Role in Ending Georgia’s Dental Health Shortage

February 14, 2017

In this Research & Commentary, Matthew Glans examines dental scope of practice laws and how Georgia could improve dental-care access by expanding scope of practice to dental therapists and hygienists.

Strict licensing standards have become a significant barrier to entry in many fields, including the dental industry. Supporters of strict state licensing standards argue they assure quality, but critics say the arduous and often expensive licensing process harms the dental market by hindering entry for new providers, thereby impeding the market competition needed to lower costs and improve access for patients. 

States across the country have begun to look toward non-dentist employees such as dental therapists and hygienists to cover their dental health shortages. Minnesota became the first state to authorize the expanded licensing of dental therapists in 2009. Based on the available evidence, the results of Minnesota’s reforms have been positive. After just one year of licensing dental therapists, patient visits increased by 27 percent. Last year, legislation expanding the scope of practice for dental therapists was filed in 12 states.

Georgia’s state legislature is considering a new proposal that would “authorize licensed dental hygienists to perform certain functions under general supervision in certain settings.” The proposal defines “general supervision” as a requirement for a licensed dental hygienist to be authorized by a licensed dentist. It does not require that a licensed dentist be present when these duties are performed.

Georgia faces a serious shortage of dental services, especially for Medicaid recipients. According to the Kaiser Family Foundation, there are just 4,803 active dentists in Georgia. Nicoleta Serban of the Georgia Public Policy Foundation (GPPF) notes roughly “865,000 Medicaid or PeachCare-eligible children in Georgia” need to travel to reach a dental provider for preventive care services. This shortfall is further complicated by the fact dentists often refuse to accept Medicaid patients, due to low reimbursement rates.

Some opponents of expanding the scope of practice in dentistry argue it will result in worsening quality of care. In testimony before the North Dakota House Human Services Committee, Michael Hamilton, research fellow for The Heartland Institute, argued these concerns are unfounded. “If therapists obtain licensure in North Dakota, dentists would remain responsible for the quality of treatment patients receive in their offices from any and all employees, whether dental hygienists, dental assistants, associate licensed dentists, or dental therapists. Therefore, to block dental therapy based on concern for quality of treatment is to doubt the quality, competence, and judgment of licensed dentists.”

Dental pain has even begun to place a burden on the nation’s emergency rooms. According to Pew Charitable Trusts, over two million people in 2012 reported to local emergency rooms for dental pain, costing taxpayers $1.6 billion, with Medicaid’s share totaling $520 million. Dental health is both important and overlooked, 101 people died in hospital emergency departments from 2008 to 2011 due to preventable dental disease.

Georgia lawmakers should work to close gaps in dental-care access by reforming dental licensing laws to allow for dental therapists and hygienists to provide expanded services. This will help ensure patients get preventive and restorative treatment when and where they need it. Benita Dodd of GPPF urges Georgia to follow the example set in Maine, Minnesota, and Vermont, which have proven that licensing dental therapists is a win-win for residents and dentistry professionals. “By lowering the barriers to entry, mid-level providers – dental therapists who train for two to four years – can provide routine care under the supervision of a dentist. They do so already in Maine, Minnesota and Alaska, providing preventive and routine restorative care such as filling cavities.”

The following articles examine dental health care and the licensing of dental therapists in greater detail.

Georgia Must Correct Dental Care Disparities
http://www.georgiapolicy.org/2016/07/georgia-must-correct-dental-care-disparities/
Nicoleta Serban of the Georgia Public Policy Foundation examines the severe lack of dental services available to lower-income Georgians, especially younger children. Serban argues expanding the role of dental hygienists could help to address the shortage.

Beyond Medicaid: Health Care for Low-Income Georgians
http://www.georgiapolicy.org/2016/01/beyond-medicaid-health-care-for-low-income-georgians/
Benita Dodd of the Georgia Public Policy Foundation outlines three market-friendly approaches Georgia lawmakers could use to expand access to care and improve the health of low-income Georgians. Each provides a solution that embraces limited government by reducing government regulations.

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.

Healthcare Openness and Access Project: Mapping the Frontier for the Next Generation of American Health Care
https://www.heartland.org/publications-resources/publications/healthcare-openness-and-access-project-mapping-the-frontier-for-the-next-generation-of-american-health-care
The Healthcare Openness and Access Project (HOAP) is a collection of state-by-state comparative data on the flexibility and discretion US patients and providers have in managing health care. HOAP combines these data to produce 38 indicators of openness and accessibility. The project provides state-by-state rankings over a number of variables, including occupational licensing.

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/fa
ct-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, The Heartland Institute’s website, and PolicyBot, Heartland’s free online research database. 

If you have any questions about this issue or The Heartland Institute’s website, contact John Nothdurft, The Heartland Institute’s government relations director, at john@heartland.org or 312/377-4000.

Author
Matthew Glans joined the staff of The Heartland Institute in November 2007 as legislative specialist for insurance and finance.