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Research & Commentary: Dental Therapists are a Crucial Tool for Ending Washington’s Dental Health Shortage

April 9, 2019

In this Research & Commentary, Matthew Glans discusses two proposed bills in Washington that would allow dental therapists to practice as mid-level providers.

Like many states, Washington State is facing a growing dental shortage. The U.S. Department of Health and Human Services (HHS) designated 124 Washington regions as “Health Professional Shortage Areas” (HPSAs). More than 1.9 million Washingtonians live in these regions, according to the Kaiser Family Foundation. The Kaiser study also found that Washington would need an additional 355 dental practitioners to remove its HPSA designation.

Fortunately for states with a lack of dental services, there is a simple solution to these problems that would expand dental care access and lower costs: dental therapists (DT). States across the country are increasing their number of licensed DTs to help relieve dental shortages. The path to becoming a DT requires significant training. However, it is far less costly and time consuming than what is necessary to become a dentist. Because DTs can only provide a limited range of services, they can typically complete their education requirements for about $36,000, much less than the cost of obtaining the education and certifications required to be a dentist.

In Washington, two companion bills were introduced in the state’s House and Senate that would permit dental therapists in Washington while setting new rules and requirements for licensure, the scope of practice for DTs, and the settings in which they will be allowed to practice.

The House bill, HB 1317, has advanced out of the committee stage, which is further than the Senate version. HB 1317 would require the state’s Department of Health to license to practice as a dental therapist any applicant who pays the required fees and completes a dental therapist program accredited or receives initial accreditation by the Commission on Dental Accreditation, passes necessary examinations, and completes a 400-hour preceptorship under the supervision of a dentist.

The House proposal outlines the scope of practice for the newly established DTs, as well as how to create a contracted arrangement between a DT and supervising dentist. As is the case with all bills, scope and details matter. In general, DT laws should require general supervision only, which means DTs would not need direct supervision from a dentist when providing dental services. This is important because limiting DTs to direct supervision would not substantially increase dental access.

Under HB 1317, a dental therapist would only be permitted to practice under the supervision of a licensed dentist. The specific guidelines would be outlined in a written practice plan contract made with the supervising dentist.

The bill would also restrict where DTs can practice, limiting them to federally qualified health centers; a clinic operated by an accredited school of dentistry or school of dental hygiene; Indian an Health Service facility; or in any clinic or practice setting, including mobile or temporary dental clinics, in which at least 35 percent of the dental therapists’ practice consists of patients who are enrolled in Medicaid. These restrictions would limit the ability of DTs to provide care to certain areas, but even with these limits in place, access to care would increase.

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. In one case study, Main Street Dental Care, which is located in Montevideo, Minnesota found that after just one year of expanding licenses for dental therapists, patient visits increased by 27 percent.

States ought to ease DT licensing standards and allow dental therapists to practice without a dentist physically present. HB 1317 and SB 5392 would be a good step in the right direction, providing needed reforms that 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 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