In 2009, 830,000 visits to emergency rooms around the country could have been prevented if the patients had seen a dentist earlier. In 2011, more than half of children on Medicaid went without dental care. These facts lie behind the story of Deamonte Driver, a Prince George’s County, Md., seventh-grader who died of a preventable infection that spread from his mouth to his brain in 2007. Maryland pushed through some reforms following Deamonte’s death, but the situation across the country has not dramatically improved.
Everyone seems to agree that there is a dental care crisis in the United States, particularly among people in poor or rural areas. People who have dental insurance or the means to pay out of pocket can get a high level of care. Those without struggle. Medicaid must cover dental services, but try finding a dentist who participates in the program, which offers small reimbursements: Only perhaps a third of dentists accept Medicaid. Deamonte’s mother faced this problem. In less-developed areas, sometimes regardless of their ability to pay, patients may have to travel hours to get care.
One potential solution is to license less-qualified “dental therapists” to carry out some basic services, such as filling cavities, that currently only dentists perform. Behind this effort is the experience of more than 50 countries and a few states that allow these mid-level providers to practice in public and private settings. Most recently, the Pew Charitable Trusts released its second report on how dental therapists are working in a few places around the United States and Canada. The results are encouraging.
In the two private dental practices and the three public-health dental operations the Pew researchers examined, dental therapists counseled patients, extracted teeth, filled cavities and performed other relatively simple procedures. The number of patients serviced jumped. With more of the basic work taken care of, dentists could focus on complicated procedures, which also allowed them to bill more. Overall, the private practices brought in more than enough revenue to cover the dental therapists’ salaries.
Several states are considering bills to license dental therapists, but many dentists have been skeptical. The American Dental Association recently released a plan to improve access to dental care, and it left out dental therapists. Instead, the dentists’ group favors more community coordinators who can counsel patients on oral health and help them find a dentist. Instead of a focus on dental therapists, said ADA President Charles Norman, his group favors a broader package that will address many problems at once. Besides, he said, many dentists might find that dental therapists don’t make the financial sense that the Pew study suggests.
Even if that’s so, it’s not a reason to continue artificially constraining the supply of qualified practitioners. With the right training and supervision, dental therapists can do a lot of work that doesn’t require an advanced degree. If the finances don’t pan out in some places, fine. But state policy should not close off the option.