A controversial move to allow dental therapists to treat patients is raising concerns in many corners of the industry. In Minnesota, however, experts point to positive results.
In 2009, Minnesota became the first state to establish licensure of dental therapists. The primary purpose was to improve access to care for underserved populations.
Since then, only two other states—Maine in 2014 and Vermont this year—have passed similar legislation. Why only two? Aren’t there underserved populations in every state?
“I’m going to take the high road and say it’s a lack of understanding of what dental therapy is about, and the value it can bring to the delivery of oral healthcare to citizens in various areas,” says Karl Self, DDS, MBA, FACD, director, division of dental therapy at the University of Minnesota School of Dentistry. “And I say that because when I go around and share what we are doing, there is often a lot of concern expressed about dental therapy. And the biggest concern that is often cited to me is that these are unqualified people.”
Is that fear warranted?
Self explains that he is often asked, “How can you have lesser qualified people providing care to our most vulnerable populations?” But the reality is, at least in Minnesota and at the University of Minnesota, dental therapy students are educated directly alongside dental students and dental hygiene students. In other words, dental therapists take the same courses, pass the same competencies, and take their licensing exam side-by-side with dental candidates.
“And the examiners are blinded as to who is a dental candidate and who is a dental therapy candidate,” Self says. “So we truly believe that we are educating high quality individuals to provide that care.”
As further evidence, Self says the marketplace is a reflection of the confidence dentists have in dental therapists because many practices have brought on multiple individuals.
“More and more dentists are contacting us, because they talk with their peers, and they are impressed with the high quality of care [dental therapists] deliver,” he says. “These are individuals who come to our program not because they’re dentist wannabes or mini-dentists. They come because they have a passion for improving access to care for populations and communities.”
Still, according to the American Dental Association, access to care is already improving through other means. In an August statement, the ADA noted that the supply of dentists is growing and is expected to continue to grow. They also noted a Health Policy Institute study that showed rates of children visiting the dentist had increased in 47 of 50 states from 2000 to 2010.
The ADA said dentists are the best option for patients.
“The ADA believes it is in the best interests of the public that only dentists diagnose dental disease and perform surgical and irreversible procedures,” the ADA statement said.
The Minnesota legislation passed in 2009 created two types of positions: dental therapist, and advanced dental therapist. In both programs candidates graduate as licensed dental therapists. Then, following 2,000 hours of practicing their craft they are eligible to pursue the process of becoming certified as an advanced dental therapist.
Self explains that the distinction between the licensed dental therapist and the certified advanced dental therapist is that the advanced dental therapist can do the full scope of practice under general supervision with the dentist not in the office. The value of that to practitioners in Minnesota is two fold.
“The dentists who are really excited about it are those who are involved in school-based care, those looking to do work in senior care facilities—places where if you have to send a dentist with another provider there’s no cost benefit to that,” Self says. “Being able to utilize a dental therapist in a school-based setting to do both the preventive aspects, the oral hygiene, education in classrooms, but then to also do some basic restorations, that’s a huge bonus to be able to have.”
In fact, Self explains that the intent of the legislation was to allow a dental practice to provide care in a cost effective way, because no practice is going to provide care to medical assistance patients if the it’s consistently losing money. But that’s not what’s happening in Minnesota.
“We don’t have peer reviewed documented studies on this, but the providers who have experience doing this are telling us that financially [dental therapists] can provide care and add to their bottom line,” Self says. “It may not be by millions of dollars, but there is a cost benefit to utilizing a dental therapist.”
Filling a Need
Self believes that dental therapists play a valuable role in Minnesota, and says that his state’s problems are not unlike many other parts of the country where access to care and reimbursement are concerned.
“We’re last in the country in reimbursement rates,” he explains. “So finding providers who are able to provide care for patients at those rates is difficult.”
In addition, the state has workforce issues to consider. Self points to a survey by the department of health indicating that approximately 45% of dentists plan to retire within the next 10 years. That means access to care, particularly for underserved populations, could only get worse.
“Licensing dental therapists is one strategy,” he says. “It’s not a silver bullet. But it’s our hope and desire that dentists continue to provide mentorship for [dental therapists] as well as help them work as part of the team.”