According to a Pew Center on the States study, untreated dental conditions led to 830,590 visits to nationwide emergency rooms in 2009. That number is up 16% from three years earlier and indicates that regular oral health care is now among the most neglected forms of health care for many Americans. Most experts cite cost as the largest factor contributing to poor dental care. Many Americans simply can’t afford to see a dentist. And as general health care costs continue to rise, this problem will undoubtedly become more widespread.
In an effort to fight this trend, a number of state lawmakers have proposed the creation of a new type of oral health practitioner called a dental therapist. Dental therapists would have two more years of training than a dental hygienist but two less than a full-fledged dentist. They would be able to provide routine dental care such as drilling, filling and removing teeth. They could read X-rays and prescribe some medications. All their work, according to the different plans, would be overseen by a regular dentist, the same way that a doctor oversees a nurse practitioner.
Since dental therapists are not paid as much as regular dentists, dental offices would be able to operate at lower costs, making dental care more affordable for the consumer. Moreover, with the dental therapists taking care of the routine dental care currently performed by dentists, dental office would be able to see hundreds if not thousands more patients per year. From the outside it seems like a win-win situation: consumers receive care at less cost and dentists get more customers.
However, many dentists actually oppose the idea of new practitioners. In Kansas, where the debate over dental therapists is in full swing, the Kansas Dental Association (KDA) has consistently held that the new practitioner would result in second-tier service. The dental therapist, they claim, doesn’t have the adequate training to deal with even “routine” dental care. What happens if there’s a complication during a tooth filling procedure? Or if something unexpected occurs while the therapist is replacing a crown? Does the dental therapist have the know-how to handle those types of situations?
Currently, dental therapists are practicing in only two states: Alaska and Minnesota. The Minnesota version of the dental therapist was hotly contested by the Minnesota Dental Society and is still a controversial position. Under the Minnesota plan, however, dental therapists can only work in clinics where at least 50% of the patients are low-income. In Alaska, the dental therapist is primarily a tool for providing basic dental care to extremely remote communities. While a dentist might not be able to operate cost-effectively in rural, less affluent areas, a dental therapist could serve those communities and still make a decent wage.
The dental therapist issue isn’t likely to disappear anytime soon. Lawmakers from New Hampshire, Massachusetts, Ohio, New Mexico, Vermont and Washington have all introduced legislation calling for the creation of dental therapist degrees. Meanwhile, lowering the cost of health care is a hot-button political issue for both sides of the political fence. The best outcome that any of us can hope for is the solution which affords the finest dental care for the most people. Whether that solution is the dental therapist or something else, only time will tell.
About Dr. Walters-Badillo:
Brian writes on behalf of Dr. Tracy Walters-Badillo. Dr. Walters-Badillo is a dentist in San Antonio Texas at Wurzbach Parkway Family Dental. She received her Doctor of Dental Medicine Degree at the University of Kentucky and then attended the University of Texas Health Science Center at San Antonio to complete a General Practice Residency. She is an active member of the American Dental Association, the Texas Dental Association, the American Academy of Implant Dentistry and the American Academy of Periodontology.