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Dental Therapists Fill Medicaid Holes and Dentists’ Pockets

A new study suggests dental therapists would boost dentists’ profits and help more Medicaid patients get care. So why are dentists so opposed to states’ efforts to license them?

Like most dentists, Dr. John Powers of Main Street Dental Care in Montevideo, Minn., was skeptical about hiring a dental therapist -- a mid-level provider licensed to perform basic dental work, like filling cavities. But after hiring one in 2012, he is skeptical no more. Not only was he able to provide services to more people, his practice earned an extra $24,000 in profit that year.  

“I was apprehensive,” admits Powers, even though he knew that a dental therapist (DT) would help him provide care to Medicaid patients whose insurance doesn’t cover the full cost of most dental services. Minnesota is one of only three states -- the others are Alaska and Maine -- to license DTs, and Powers became the first private practice dentist in the United States to hire one. A recent study by the Pew Charitable Trusts took a first look at the pioneering practice to find out if dental therapists do, in fact, help private practices serve low-income patients and make money doing so. 

Finding ways to treat more Medicaid patients -- and more of the nearly 47 million Americans that live in dentist shortage areas -- is critical because poor dental health is linked to more serious and costly health problems, such as heart disease and diabetes. In addition, the Pew study estimates that more than 830,000 dental-related visits to emergency rooms across the United States in 2009 could have been avoided with preventive care.

After just 11 months with Powers’ dental therapist Brandi Tweeter working part time, new patients at his practice were up 38 percent, and the share of Medicaid patients was up from 26 percent to 39 percent. Not only do the Medicaid patients add to the bottom line (contributing to that $24,000 boost in profits), Powers says, but he is also freed up to perform more complicated and profitable procedures on privately insured and private-pay patients. “Having Brandi gives me the opportunity to do higher-level dentistry,” he says. “I can’t do those [procedures] if I have a backlog of fillings.”

Jane Koppelman, research director for the Pew Children’s Dental Campaign, says her study was intended to counter pushback from dentists around the country who don’t want DTs taking over some of their work. “One of their reasons is that dental therapists don’t make financial sense for the dentist,” she says. So Koppelman looked at Powers’ numbers and at a practice in Canada (dental coverage is not part of its national health care, making it similar to insurance here in the U.S.). The study found that a practice in Saskatchewan, which has been using DTs since 1974, generated CA$216,987 in profit in just one year. 

Between 15 to 20 states are currently considering licensing DTs to practice, Koppelman says. Proponents still face stiff opposition from dentists though, which Powers considers “somewhat ironic.” When he started practicing in the late 1960s as a dental assistant in the Army, dental hygienists were not allowed to do a procedure called deep scaling -- cleaning the teeth under the gum line. “There was pushback by dentists then, and now you can’t find a dentist in this state who isn’t saying, ‘Let the hygienist do deep scaling,’” he says. “Now we have another level of provider that can help them out, but there is resistance to that too. DTs are being trained in the same dental schools that dentists are. If you can’t trust a DT, how can you trust a dentist?”

David Levine is a GOVERNING contributor.
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