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Research & Commentary: Dental Therapists Can Heal Michigan’s Dental Shortage

October 11, 2018

In this Research & Commentary, Charles Katebi examines a proposal in Michigan that would expand access to dental care for patients in rural communities and inner cities.

Michigan faces a growing dentist shortage. According to the U.S. Department of Health and Human Services, over 2.4 million Michiganders, one quarter of the state’s population, reside in counties that face a severe dentist shortage Fortunately, lawmakers are now considering a proposal that promises to expand access to affordable dental care for struggling communities.

On October 3, the House Committee on Health Policy hosted a hearing to consider Senate Bill 541 which would to permit dental therapists to perform a variety of dental services, including cavity preparations, primary teeth extractions, cavity fillings, and many other services.

Communities across the Great Lake State are in dire need of these qualified dental providers. Due to Michigan's dental shortage, nearly one in four third graders in Michigan suffer from untreated tooth decay. And without reliable access to dentists, these patients often visit the emergency room as their dentist of last resort. Research conducted by the Anderson Economic Group found that patients made over 8,000 visits to Michigan hospitals for preventable dental conditions in 2011, which costed patients and taxpayers $58 million.

Sadly, this dental access crisis is only getting worse.  A 2011 survey conducted by the Michigan Department of Community Health found that half of all Michigan dentists plan to retire by 2021 and 70 percent intend to retire by 2027. In other words, families across the state will have to wait even longer, travel farther, and pay more for dental care in the near future.

Fortunately, the recent proposal will allow dental therapists to provide for Michigan’s oral health care needs. These trained professionals already deliver a variety of routine treatments under the supervision of dentists in private practices, as well as community settings including schools and nursing homes. And unlike dentists, who must train for four years and pay more than $270,000 for schooling, therapists and hygienists can get certified within two years and pay as little as $36,000 for their education. This allows dental therapists to more easily enter the marketplace and provide less expensive treatments to patients.

Rural communities would especially benefit from improved access to basic dental services. After Minnesota became the first state to license dental therapists in 2009, the state’s Office of Rural and Primary Care found one-third of all Minnesotans experienced a reduction in wait times to receive dental care. The Office of Rural and Primary Care concluded, “Patients visiting rural clinics were nearly two times more likely to experience a reduction in wait time compared to their urban counterparts” after they introduced dental therapists.

Expanding access to dental therapists would also improve oral health. According to a report in the Journal of Public Health Dentistr, children and adults served by dental therapists receive more preventive care and need fewer invasive teeth extractions than patients who lack reliable access to dental providers.

Dental therapists have proven to be safe, effective, and affordable providers of dental care in America and abroad. Lawmakers should free these qualified professionals to treat all Michiganders, especially those who are most vulnerable.


The following documents provide additional information about dental therapy.

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.

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.

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.

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-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 The Heartland Institute’s website, Health Care News and PolicyBot, Heartland’s free online research database.

If you have any questions about this issue or The Heartland Institute’s website, contact Charlie Katebi, The Heartland Institute’s state government relations manager, at ckatebi@heartland.org or 978-855-2992.

Author
Charles Katebi is state government relations manager with the Heartland Institute
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