Like many states, Florida is suffering from a growing dentist shortage. There are currently 52.3 dentists per 100,000 Florida residents, compared to a national average of 60.8 according to the James Madison Institute. In fact, the U.S. Department of Health and Human Services (HHS) designated 240 Florida regions as Health Professional Shortage Areas (HPSAs) and more than 5.5 million Floridians live in these areas, according to the Kaiser Family Foundation.
At the state level, strict licensing requirements reduce dental access and increase costs. Supporters of strict licensing standards argue they assure quality care. However, critics claim the arduous and expensive licensing process is a barrier to entry that hinders new providers from entering the market; thereby impeding market competition that would reduce costs and increase patient access.
Fortunately, for states with a lack of dental services, there is a simple solution that would expand dental care access and lower costs: dental therapists (DT). Indeed, states across the country are increasing the 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. DTs are allowed to provide a limited range of services. Therefore, they can typically complete their education requirements for about $36,000.
In an effort to relieve the dental service shortage in the Sunshine State, two bills have been filed that would allow dental therapists to practice as mid-level providers.
Senate Bill 684 and House Bill 649 require DTs receive training in line with national standards of safety and quality developed by the Commission on Dental Accreditation (CODA), the American Dental Association’s accrediting body. The bills would also require DTs to graduate with a degree from a CODA accredited program. Across the Sunshine State, several colleges are equipped to offer dental therapy training programs, according to the News-Press.
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. The Florida bills call for general supervision and allow supervising dentists to determine which procedures DTs could provide under their supervision. The Florida bills also allow DTs to provide remote care, which would help fill shortages in rural areas.
In 2009, Minnesota became the first state to authorize increased licenses for DTs. Based on the available evidence, Minnesota’s reforms have been positive. After just one year of expanding licenses for DTs, patient visits increased by 27 percent.
Moreover, children and adults served by DTs receive more frequent preventive care, which leads to a reduced need for invasive procedures over the long term, according to a report in the Journal of Public Health Dentistry.
In short, states ought to ease licensing standards on DTs and allow them to practice without a dentist physically present. These much-needed 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: Sinking Our Teeth into Innovative Workforce Reform
https://www.jamesmadison.org/wp-content/uploads/2018/05/PolicyBrief-DentalTherapy-v07-web.pdf
In this Policy Brief from the James Madison Institute, Jennifer Minjarez and Sal Nuzzo examine the positive role that dental therapists can have on access to care and dental utilization rates. “Florida policymakers should reform licensure regulations to grant dental providers the freedom to innovate. Florida’s population is rapidly growing and Floridians’ demand for dental care will continue to evolve. The best way to ensure Floridians have access to dental care is to let the market determine the number and types of Florida’s dental care providers. Allowing dental therapists the ability to practice would be a significant step in this direction,” wrote Minjarez and Nuzzo.
Dental Utilization for Communities Served by Dental Therapists in Alaska’s Yukon Kuskokwim Delta: Findings from an Observational Quantitative Study
https://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://heartland.org/wp-content/uploads/documents/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.
Early Impacts of Dental Therapists in Minnesota
https://mn.gov/boards/assets/2014DentalTherapistReport_tcm21-45970.pdf
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://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 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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Matthew Glans joined the staff of The Heartland Institute in November 2007 as legislative specialist for insurance and finance.
